Friday, July 16, 2021

Trojan horses and fatal flaws

1 comment:

Craig said...

4:01 PM (1 hour ago)
to GreatNorthernHealth, Barbara

Thanks Joel.

Meeting Steve after years of sounding the alarm about loopholes for HMOs, ACOs and "integrated delivery systems" in what would otherwise be single-payer bills or proposals was a real pleasure for me.

I first began sounding the alarm about these "Trojan horse loopholes" around 2005 or 2006. That year I attended PNHP's annual meeting in Santa Monica and joined a breakout session to hear CA PNHP and other groups discuss a bill that had been introduced in 2003 by Sen. Shiela Kuehl that she and everyone else was calling a "single payer" bill. In fact, the bill had an enormous loophole in it for HMOs.

I understood why Kuehl and other Californians felt they had to create a loophole for HMOs (Kaiser Permanente is headquartered in CA and is enormous). What I couldn't understand is why anyone would call such a bill a single-payer bill.

CA PNHP's chair invited me to discuss how to get rid of that loophole with the CA PNHP board. We had a half-dozen conversations over the phone (it included a few people from the national PNHP office), but little came of our conversations. Since then very few people within the movement have resisted the growing trend to insert loopholes for risk-bearing entities into single-payer bills. Bernie Sanders, and groups in four or five other states, have sponsored bills they call "single payer" bills with loopholes that would permit the insurance industry to slither through them.

When Steve and I met through One Payer States two years ago, we quickly realized we shared the same concern about Trojan Horse loopholes. We wrote the paper referred to above with the OPS Policy Work Group. Steve is a member of the national PNHP board. He made a presentation on this issue to the PNHP monthly meeting last night. I hope it induces PNHP to get serious about this issue.


On 2021-07-16 14:52, Barbara Barbara wrote:

Thank you Joel.
Excellent. His payment for physicians based on time was a new model for me. Very interesting!

Best wishes,
Barbara Qualley

On Jul 16, 2021, at 11:36 AM, Joel Clemmer wrote:

Our homegrown, nationally-recognized expert, Kip Sullivan, has spent years helping us understand the health insurance biz and the dangers of HMOs, ACOs, IDSs, whatevers. Further Kip has spotted weaknesses in legislative proposals that fail to embrace real single-payer.

Another player has recently been plowing similar ground and I've found it useful to listen to what he has to say. For one thing, hearing similar concepts expressed in different ways helps me to "get it."

The other player is Stephen Kemble M.D.of Hawaii. He has presented talks through the One Payer States organization and just did a very thorough yet compact one on the ACO Trojan Horse - his label. You can find it here on their You Tube channel. The URL is
The presentation is 30 minutes (amazing economy!) and the rest is Q/A.
Good stuff !