SY Health, Health Care: March 2013

Saturday, March 30, 2013

Pennsylvania Tightens Abortion Rules Following Clinic Deaths

March 28, 2013

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A police car is posted outside the Women's Medical Society in Philadelphia, on Jan. 20, 2011. Dr. Kermit Gosnell, accused of murder, performed abortions in the clinic.

Matt Rourke/AP

A Philadelphia doctor who performed abortions is on trial for murder. Kermit Gosnell, 72, is accused in the deaths of a female patient and seven babies who the prosecutor says were born alive. District Attorney R. Seth Williams laid out the case in disturbing detail in a grand jury report last year.

When authorities raided Gosnell's clinic in 2010 they found squalid conditions: blood on the floor, the stench of urine and a flea-infested cat wandering through the facility.

In court, Gosnell's attorney said his client is unfairly being held to standards one might expect at the Mayo Clinic. A jury will decide Gosnell's fate, but what is clear now is that state regulators were not doing their job.

"Unfortunately and tragically in Pennsylvania, facilities were going uninspected for years," says Maria Gallagher, a lobbyist with the Pennsylvania Pro-Life Federation. Gosnell's clinic went 17 years without an inspection, according to prosecutors.

"As for Dr. Gosnell's case, there were admitted failures in oversight at the department," says Aimee Tysarczyk, press secretary for Pennsylvania's Department of Health. But now the agency is inspecting abortion clinics regularly and making sure they meet state standards.

In 2011, the Gosnell case was mentioned frequently as Pennsylvania's General Assembly passed a law that put stricter requirements on abortion clinics. Now most clinics in the state are held to the same standards as outpatient surgery centers. That means abortion clinics must have doors and elevators that can accommodate a stretcher in case something goes wrong.

For some clinics, such as Planned Parenthood of Southeastern Pennsylvania, that meant expensive remodeling.

"Overall the cost was about $450,000 to get two of our facilities into compliance," says CEO Dayle Steinberg. The nonprofit had to install hands-free sinks. Tile floors were torn out and replaced with seamless floors that are easier to clean. The clinic's heating and air-conditioning system was upgraded and a new room was built to house sterilization equipment.

Steinberg says her organization already had a low rate of complications � less than one-tenth of 1 percent. She contends Pennsylvania's new requirements did nothing to improve services for women at her clinics.

"They were thinly disguised as improving patient safety, when really it was about increasing the cost for abortion providers � hoping that some of them wouldn't be able to afford it," Steinberg says.

Enlarge image i

An undated photo of Gosnell released by the Philadelphia District Attorney's office. Gosnell, who catered to minorities, immigrants and poor women at the Women's Medical Society, was charged with murder in the deaths of a patient and seven babies.

The author of the legislation that put the tougher regulations in place disputes that.

"This is all about patient safety," says state Rep. Matt Baker. "We made it clear that we weren't going to arbitrarily and capriciously shut down abortion clinics."

Abortion opponents were not the only ones supporting Baker's legislation. State Rep. Margo Davidson says her 22-year-old cousin, Semika Shaw, died of sepsis and infection after an abortion at Gosnell's clinic. Davidson delivered an emotional speech on the Statehouse floor in 2011.

Dedicating her vote to Shaw, Davidson said she hopes the law will safeguard the health of women seeking abortions, "so that never again will a woman walk into a licensed health care facility in the state of Pennsylvania and be butchered, as she was."

Now that the law is in effect there are five fewer abortion clinics in Pennsylvania, though it's unclear whether the stricter regulations were the only reason they closed. That leaves 17 other providers in the state. Backers of the law say now if a woman enters a clinic in a poor neighborhood � or a rich one � she can be assured it is meeting a basic standard of care.

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Saturday, March 23, 2013

Health Insurers Warn on Premiums

From the Wall St. Journal –

Health insurers are privately warning brokers that premiums for many individuals and small businesses could increase sharply next year because of the health-care overhaul law, with the nation’s biggest firm projecting that rates could more than double for some consumers buying their own plans.

The projections, made in sessions with brokers and agents, provide some of the most concrete evidence yet of how much insurance companies might increase prices when major provisions of the law kick in next year�a subject of rigorous debate.

The projected increases are at odds with what the Obama Administration says consumers should be expecting overall in terms of cost. The Department of Health and Human Services says that the law will “make health-care coverage more affordable and accessible,” pointing to a 2009 analysis by the Congressional Budget Office that says average individual premiums, on an apples-to-apples basis, would be lower.

The gulf between the pricing talk from some insurers and the government projections suggests how complicated the law’s effects will be. Carriers will be filing proposed prices with regulators over the next few months.

Part of the murkiness stems from the role of government subsidies. Federal subsidies under the health law will help lower-income consumers defray costs, but they are generally not included in insurers’ premium projections. Many consumers will be getting more generous plans because of new requirements in the law. The effects of the law will vary widely, and insurers and other analysts agree that some consumers and small businesses will likely see premiums go down.

Starting next year, the law will block insurers from refusing to sell coverage or setting premiums based on people’s health histories, and will reduce their ability to set rates based on age. That can raise coverage prices for younger, healthier consumers, while reining them in for older, sicker ones. The rules can also affect small businesses, which sometimes pay premiums tied to employees’ health status and claims history.

Dr. Ben Carson: Health Care Is 'Upside-Down'

March 11, 2013

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Dr. Ben Carson is known for blazing trails in the neurological field � including breakthrough work separating conjoined twins. Now he's making waves for his political views. Host Michel Martin talks with Carson about the current state of health care in America and his upcoming speech at the Conservative Political Action Conference.

MICHEL MARTIN, HOST:

This is TELL ME MORE from NPR News. I'm Michel Martin. We're going to start off the week by meeting people who are involved with some of this country's more challenging debates around health care. In a few minutes, we'll meet the first person in this country to try out a new method for prostate cancer treatment. The treatment worked and now he's hoping his experience would persuade other skeptics, especially other African-Americans to participate in clinical trials.

But first we want to speak with a man of medicine who is now making a splash in the political arena. You might know Dr. Benjamin Carson as one of the preeminent neurosurgeons in the world. He was the first man to successfully separate twins who were born joined at the head. You might know him from his remarkable life story that inspired a movie starring Cuba Gooding, Jr. Or you might know him from his interview on this program after he was awarded the Presidential Medal of Freedom.

But lately, he's been getting a lot of attention for this speech that he gave at the National Prayer Breakfast last month.

(SOUNDBITE OF BREAKFAST SPEECH)

DR. BENJAMIN CARSON: It's very difficult to speak to a large group of people these days and not offend someone. I know people walk around with their feelings on their shoulders waiting for you to say something - ahh - did you hear that? And they can't hear anything else you say. The PC police are out in force at all times.

MARTIN: He went on to criticize President Obama's policies on everything from health care to taxes - all this while the president sat just a few steps away. After the speech, the Wall Street Journal ran an editorial titled "Ben Carson for President." The Atlantic called him a, quote, "new conservative folk hero." Now all eyes are on Dr. Carson for his next speech at the Conservative Political Action Conference, or CPAC, which is this week.

And Dr. Carson took time from his busy schedule to speak with us about it. Dr. Carson, welcome back to the program. Thanks for joining us.

CARSON: Thank you. Good to be back.

MARTIN: Now your concerns about health care in this country, the health care system overall, how it's practiced, are not new. For example, you talked about these issues when you were on this program. Are you talking more about these issues or are more people listening now?

CARSON: Well, you know, I've been talking about it for a long time. If you go back and read my 1999 book called "The Big Picture," a lot in there about health care. I've been very concerned about how we do it. And I wouldn't characterize myself as criticizing the president. I've been talking about these things long before he was on the scene. So it's not so much a criticism of him as it is placing out there some other ideals about how we get this thing under control.

And, you know, we spend twice as much per capita on health care in this country as the next closest nation and yet we have tremendous access problems. And I believe there are some ways that we can do it which would provide very excellent access to everybody at substantially less cost.

MARTIN: Why do you think your speech at the National Prayer Breakfast got so much attention?

CARSON: Well, I think it resonated with a huge number of people. You know, I've gotten literally thousands of contacts from people across the country - and the most poignant ones being elderly people - who said I had given up on America and I was just waiting to die. And now they felt revived. And I think what I really talked about, again, was not a criticism of anything but just some stuff that makes sense, logical things that make sense.

People are starving for that coming out of Washington. And it's not a Democrat thing or a Republican thing. I think it's a politician thing.

MARTIN: I do want to talk more about the substance of some of your ideas, particularly for people who haven't had a chance to read some of your books. In fact, you talk a lot about your ideas about health care in your latest book "America the Beautiful: Rediscovering What Made This Nation Great."

But I want to spend just a couple more minutes talking about where you decided to make these comments, about the conservative syndicated columnist Cal Thomas, who's one of the organizers of the prayer breakfast, said that he felt your remarks was inappropriate for the occasion, that you turned a non-political occasion into a political occasion. And he said it's not about politically correct; it's about being rude.

And I've personally heard you speak about the importance of being courteous. He says you owe the president an apology. Do you think you do?

CARSON: I don't think so at all. In fact, I don't believe that expressing your opinion, regardless of who is there, is being rude. And it's a shame that we've reached a level in our country where we think that you don't have the right to put your opinion out there. And the setting, I think, is extraordinarily appropriate because we're talking about the health of our nation, not only the physical health of our nation but also the spiritual health of our nation.

MARTIN: Do you think that your race plays some role in the attention that is being gotten here? I mean, the fact is that you and the president are both highly achieving African-American men from humble beginnings, if I can put it that way, and that there's something delicious in that confrontation.

CARSON: I suspect that in some people's minds that probably did create a little tasty tidbit, particularly those individuals who tend to think that if you're black you have to think a certain way and you have to act a certain way, which I find really quite offensive.

MARTIN: If you're just joining us, I'm speaking with Dr. Ben Carson. He's the director of pediatric neurosurgery at the Johns Hopkins Hospital. He's speaking at the Conservative Political Action Conference later this week and he's getting a lot of attention for comments he made at the National Prayer Breakfast which was last month. Talk a little bit more, if you would, about - I know your interest in some of these issues goes beyond health care, but health care is, I think, the area that you know best.

What is it that you think - the particular nugget that you would want people to come away with? What you think would be better?

CARSON: Well, first of all, in order to have good health care you need a patient and you need a health care provider. Along has come the middle man to sort of facilitate the relationship and now the middleman has become the primary component with the patient and the health care provider at its beck and call. This is totally upside down, and anything that we do that enhances that middleman and decreases the doctor-patient relationship actually exacerbates the situation rather than making it better.

So what - the reason that I proposed health savings accounts for everybody starting at birth, is because you very quickly accumulate an amount of money that you can use for your interactions with those health care providers. Also, you develop a very good doctor-patient relationship and also because you now have some responsibility for that account, you're going to be looking for good bargains. Other people are going to be making sure that they provide good bargains. You bring the whole health care system into the free market. And that's going to help to control cost as well.

MARTIN: You also talk, though, about the need for some sort of catastrophic insurance to address truly catastrophic situations.

CARSON: Yes.

MARTIN: Is that getting an equal amount of attention?

CARSON: Well, no one's really asking me about that. I appreciate you asking about it. Yes, that obviously does have to be a component of the plan. And that is the place where you can bring the government and where you can bring Medicare or Medicaid in. We can work out a system whereby that's done for considerably less money than we're spending now. Because you're taking the middleman out of the equation for 80 percent of the medical encounters.

MARTIN: I noted that you are talking with the Conservative Political Action Committee next week, CPAC which is, well, in Washington circles it's a big deal. It's considered a platform for people with political aspirations. Do you consider yourself a conservative?

CARSON: I consider myself a logical person and, you know, a lot of people try to categorize me in one way or another. You know, there are some of the things that I say that probably would be considered very much non-conservative. For instance, I think that the medical insurance industry needs to be reformed dramatically because we've put them in an untenable situation.

They make money by denying people care. That's an inherent conflict of interest. That situation needs to be addressed. Some people would say that's not a conservative way of thinking. But I don't think really conservative or liberal; I think what makes sense? What's going to help the American people? What's going to give them what they need? Not only in health care but in terms of jobs, in terms of education, in terms of a whole host of issues that, you know, I addressed in the most recent book, "America the Beautiful."

MARTIN: The Wall Street Journal editorial, as I mentioned, the title of it is "Ben Carson for President." We mentioned that CPAC has been a springboard for people who are aspiring to kind of a broader place in the public debate. Do you have aspirations for a career in public service? Do you have any intention of perhaps finding other platforms to discuss your ideas about policy?

CARSON: Certainly that has been pushed upon me many times in the past and there's no way I'm getting into the cesspool of special interest groups. Wouldn't do it anyway in the world. People say, well, why don't you run for Congress? You could get there very easily. Why would I want to run for Congress and continue to get tainted with all the things that people get tainted with as they come along the system.

I think perhaps a much better role would be to use my voice and to use my influence to help change the tone of this nation, to help us to realize that, you know, we're not enemies. A very wise man once said a house divided against itself cannot stand, and here we find ourselves in a situation where we're more divided than ever and we need to develop the kind of leadership that encourages people to work together, to join together, to utilize their strengths in order to improve our situation, not to continue to exacerbate it.

MARTIN: But on the question of the tone and the timing, could a reasonable person say, you know, the time for you to be heard on this issue was when healthcare reform was being debated, and that was not for a short amount of time. More broadly, one could argue, it's been debated for 40 years; narrowly, in this administration, one could argue, it was debated in the first two years of the administration.

I mean at this point could a reasonable not mean person say that this is a heckler's veto?

CARSON: Well, let me put it this way. During the healthcare debate, I was contacted by the administration to get my views and I was having quite a very decent conversation with the gentleman until he asked me what did I do for the president during the campaign, and I said that I'm an independent and that was the end of that conversation. Two months later I get another call. I guess they thought better of it and I was teaching a lesson.

I said I'm in the middle of teaching a lesson, can we talk in 40 minutes. The person was offended. I mean how could you possibly be doing anything more important than taking to the White House. That was the end of that conversation. You know, I talked to David Axelrod about that, and I tell him about those two conversations. He said, well, you know, we have some young people who perhaps don't exercise the best judgment and you shouldn't judge the whole administration on that basis.

I take him at his word that you shouldn't, but it's not that I haven't made an attempt to influence the direction of things.

MARTIN: That was Dr. Benjamin Carson. He's the director of Pediatric Neurosurgery at Johns Hopkins Hospital. His latest book - he's written many of them - is "America the Beautiful: Rediscovering What Made This Nation Great," and he was kind enough to take time out of his busy schedule to join us from member station WYPR in Baltimore. Dr. Carson, thanks for joining us.

CARSON: My pleasure.

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Friday, March 22, 2013

States Urged to Expand Medicaid With Private Insurance

From the New York Times –

The White House is encouraging skeptical state officials to expand Medicaid by subsidizing the purchase of private insurance for low-income people, even though that approach might be somewhat more expensive, federal and state officials say.

Ohio and Arkansas are negotiating with the Obama administration over plans to use federal Medicaid money to pay premiums for commercial insurance that will be sold to the public in regulated markets known as insurance exchanges.

Republicans in other states, including Florida, Louisiana, Pennsylvania and Texas, have expressed interest in the option since Gov. Mike Beebe of Arkansas, a Democrat, received a green light from Kathleen Sebelius, the federal secretary of health and human services.

Valerie Jarrett, a top White House aide, has been a catalyst in talks with Ohio and other states.

The idea of using �premium assistance� to buy private insurance for new Medicaid beneficiaries is a sharp departure from the 2010 health care law, in which Congress expanded Medicaid to cover the poorest Americans and assumed that people with higher incomes would obtain private coverage through the exchanges.

In many states, Republicans are trying to create a hybrid of the two alternatives, taking federal money for the expansion of Medicaid but using it to help people buy commercial insurance instead.

State Senator Jonathan Dismang, a Republican from central Arkansas, said the idea appealed to him because it would �use the markets to provide better health care and to increase competition in the health insurance industry,� which could drive down costs.

The Arkansas Medicaid director, R. Andrew Allison, said the state had obtained �conceptual approval� from Ms. Sebelius to use Medicaid money to help low-income adults enroll in private insurance through the exchange in 2014. This arrangement, he said, could double the number of people in the exchange, to perhaps 500,000, while shrinking enrollment in the traditional Medicaid program.

The idea appeals to many doctors and hospitals because they typically receive higher payments from commercial insurance than from Medicaid.

�We supported the expansion of Medicaid before this idea came up, and we are more excited now,� said David W. Wroten, the executive vice president of the Arkansas Medical Society. �Providers of all types would be paid at private insurance rates, and that will help recruit physicians for Medicaid, especially in rural areas.�

Advocates for beneficiaries are torn. On one hand, they want to provide coverage to as many people as possible, and the use of private insurance may be the only way to entice Republicans to support the expansion of Medicaid.

On the other hand, they say, private insurance will often be more costly than Medicaid, in part because it pays higher rates to health care providers. They said they feared that higher federal costs would fuel demands in Congress for cutbacks in Medicaid.

In addition, many advocates prefer Medicaid because it has strict limits on co-payments and deductibles and provides benefits that may not be available in commercial insurance. These include long-term care, dental services, medical equipment and even personal attendant services for some people with severe disabilities.

Federal officials said state Medicaid programs could provide these extra services as a supplement to private insurance.

In Ohio, Gov. John R. Kasich, a Republican, wants to expand Medicaid, citing the biblical injunction to help �the least among us.� He wants to provide coverage through private insurance for many of the new beneficiaries, including those with incomes from 100 percent to 138 percent of the poverty level ($11,490 to $15,856 a year for an individual).

Greg Moody, director of the governor�s Office of Health Transformation, said Ms. Jarrett called Mr. Kasich in late January and indicated that the Obama administration was receptive to his ideas. Federal and state officials are working out the details.

�Every day I am a little more encouraged that we can put together a package that is compelling to the State Legislature and can be approved by the federal government,� Mr. Moody said.

Erin Shields Britt, a spokeswoman for the federal Department of Health and Human Services, said, �Our goal in working with states has been to be as flexible as possible within the confines of the law.�

In Florida, state legislators rebuffed a proposal by Gov. Rick Scott, a Republican, to expand Medicaid, but are exploring alternatives that would use Medicaid money to help people buy private insurance.

The 2010 health care law generally required states to make Medicaid available to people under 65 with income less than or equal to 138 percent of the poverty level. The federal government will pay the cost for newly eligible beneficiaries from 2014 to 2016, with its share gradually decreasing to 90 percent in 2020. In upholding the law in June, the Supreme Court ruled that the expansion of Medicaid was an option for states, not a requirement. The ruling touched off ferocious debates in statehouses around the country.

Arkansas Republicans, who control both houses of the Legislature, opposed a straight expansion of Medicaid, but have warmed to the idea of subsidizing private insurance for the same people.

�The feds have agreed to do what my legislators in various conversations have asked me to go ask them to do,� Mr. Beebe said. �Basically they�ve agreed to give us about everything we�ve asked for. What that really amounts to is to take the Medicaid population and expand it all the way to 138 percent of the poverty level and use federal Medicaid dollars to purchase insurance through the exchange.�

�It will probably cost the feds a little more money to do this,� Mr. Beebe said. Arkansas officials said the increase would be less than 15 percent.

Alan R. Weil, the executive director of the National Academy for State Health Policy, an independent nonpartisan group, said he saw nothing inherently wrong in expanding Medicaid by paying the premiums of private health plans in a state insurance exchange.

With that approach, he said, low-income people can stay in one health plan even if their income fluctuates, so they lose Medicaid and become eligible for subsidies in the exchange, or vice versa. �How better to assure continuous coverage and continuous access to the same doctors?� Mr. Weil asked.

However, Leonardo D. Cuello, who represents poor people as a lawyer at the National Health Law Program, said the use of private plans could lessen protections for beneficiaries and increase costs to the government.

�Congress authorized premium assistance more than 20 years ago as a way to save money, by allowing Medicaid to pay premiums for people who had access to private coverage through an employer�s group health plan,� Mr. Cuello said. �It will now be used to provide individual coverage that is more expensive than Medicaid.�

Thursday, March 21, 2013

Affordable Care Act at 3: Paying for Quality Saves Health Care Dollars

This blog originally appeared on the Health Affairs Blog.

For decades before the passage of the Affordable Care Act, health care costs outstripped inflation, without corresponding improvements in health care quality.� Our system didn�t incentivize quality or efficiency.� We paid providers for the quantity of care, not the quality of care.� And we were not using technology to deliver smarter care.

The Affordable Care Act includes steps to improve the quality of health care and lower costs for you and for our nation as a whole.� This means avoiding costly mistakes and readmissions, keeping patients healthy, rewarding quality instead of quantity, and creating the health information technology infrastructure that enables new payment and delivery models to work.

Here are just a few ways that the health care law builds a smarter health care system and incentivizes quality of care � not quantity of care - to drive down costs and save you money.

We�re Shifting the Focus to Quality, Not Quantity

The health care law creates new Accountable Care Organizations (ACO) that incentivize doctors and other providers to work together to provide more coordinated care to their patients. �ACOs agree to take responsibility for the cost and quality of their patients� care, to improve care coordination and safety, and to promote appropriate use of preventive health services.� And when this new care model saves the Medicare program money, that savings is shared with the ACO. Over 250 organizations are participating in Medicare ACOs, giving more than 4 million Medicare beneficiaries access to high-quality coordinated care throughout the nation.� ACOs are estimated to save the Medicare program up to $940 million in the first four years.

The Affordable Care Act also ties Medicare Advantage bonus payments to the quality of coverage these private plans offer.� This gives seniors a broader range of higher-quality Medicare Advantage plans from which to choose.� As a result, in 2013, the 14 million Medicare beneficiaries currently enrolled in Medicare Advantage have access to 127 four- and five-star plans, which is 21 more high-quality plans than were available in the previous year.

Keeping You Out of The Hospital

Every year, about 2.6 million seniors � or nearly one in five hospitalized Medicare enrollees � are readmitted within 30 days of discharge, at a cost of more than $26 billion to the Medicare program.� Many of these readmissions stem from preventable problems. These rates can be drastically reduced if we do a better job coordinating care and support.� The health care law�s Hospital Readmissions Reduction Program reduces Medicare payments to hospitals with relatively high rates of potentially preventable readmissions to encourage them to focus on this key indicator of patient safety and care quality.

We�re starting to see results.� Medicare readmissions rates have remained stuck near 19 percent over the five years that the data has been collected (and likely for decades prior to that), but in 2012 the nationwide rate of hospital readmissions of Medicare patients declined to about 17.8 percent.� This translates to over 70,000 fewer preventable hospital readmissions.

Lowering Costs

Taken together, these improvements are providing more value for your health care dollar and helping to fuel historically low cost growth rates in Medicare and Medicaid.� Last year, per-beneficiary Medicare costs increased by only 0.4 percent, continuing the historically low Medicare growth we saw in 2011 and 2010. Per-beneficiary spending in Medicaid actually decreased 1.9 percent from 2011 to 2012.�

And a recent report found that health care price inflation in January dropped to 1.5 percent, one of the smallest increases on record.

As the nation�s largest insurer, Medicare can lead the way in effective practices like this that deliver better care and drive down costs.� Our goal is that these reforms and investments build a health care system that will ensure quality care for generations to come.

Learn more about the key features of the Affordable Care Act.

Follow Secretary Sebelius on Twitter at @Sebelius.

Wednesday, March 20, 2013

Affordable Care Act at 3: Abby’s Story

I remember the day the health care law passed three years ago. The law made history as one of the most significant pieces of health related legislation since the passage of Medicare and Medicaid. On a personal level, it fundamentally changed the course of my life. At the time, I was 20 years old, a college student, and facing the reality that I would be kicked off my parents� high-quality private insurance, on my twenty-first birthday. I would have limited, if any, options for health insurance and it put me face to face with my own mortality.

I was born with a serious, rare disease. Without high-quality health care, or health insurance, I would suffer potentially fatal consequences. Most children who are born with my disease, toxoplasmosis, have profound side-effects that can include organ failure, blindness, and intellectual disabilities. Throughout my childhood, I was fairly healthy. But during high school I began to face the realities of what it meant to have this disease. I had neurosurgery to replace the 16-year-old shunt that was installed to drain spinal fluid collecting on my brain, and I lost vision in my left eye when the parasite attacked my eyes. Since then, I have struggled to remain healthy and have had several shunt replacements and eye surgeries.

Knowing how stressful, painful, and scary these experiences were with health insurance, as I got older, my family and I went into a panic. We knew I would no longer be eligible for their insurance, and we knew beyond a shadow of a doubt that I would be denied coverage due to my multiple pre-existing conditions. This was where we were in March 2010.

But everything changed three years ago, when President Obama signed the Affordable Care Act.

Over the last three years, my fear has disappeared and has been replaced with a profound sense of hope and empowerment.� Now, I can stay on my parents� plan until I turn 26. As a 22-year-old college graduate with multiple pre-existing conditions, I could not be more grateful. Moreover, now there are no more lifetime limits on how much my insurance company will pay for my essential health benefits � and annual limits are ending, too. And in 2014, the health care law helps to ensure that I cannot be denied coverage due to my chronic illness.

However, there is greater hope beyond what I am experiencing personally. The governors of many states are getting behind expansion of Medicaid coverage for Americans who may find it difficult to afford private insurance. �The states and the federal government also are creating a Health Insurance Marketplace for each state, where people can compare health plans based on price and benefits and purchase the one that best fits their needs. Open enrollment starts Oct. 1, 2013, with coverage beginning as soon as January 2014.

I am eager to see what the coming years will bring. The Affordable Care Act is still a new law, and there is certainly more work to be done. It will not happen overnight, nor will it be easy. However, in just three years, we are already well on our way to building a more equitable, effective, and high-quality system of care. This is not the end; it is merely the beginning.

The U.S. Department of Health and Human Services supports the statements by the guest author of this article.

Friday, March 15, 2013

Why are you Thankful?

If you follow @HealthCareGov on twitter, you already know some of the many reasons why we are thankful for the health care law, the Affordable Care Act. From preventive benefits to strengthening Medicare, the Affordable Care Act is helping keep Americans healthy and protecting them from some of the worst abuses of the insurance industry.

This month, we�re highlighting the many reasons to be thankful for these new benefits. �So we put out the call asking you to give us a few examples about the new health care benefits you�re thankful for, and share stories about how you�ve been helped by the law. Already, on we�ve heard from hundreds of you.� Using the hashtag #ThanksHCR, here are just a few examples of what people across America have said on Twitter:

@MaineCAHC: #ThanksHCR for keeping Julie on her mom�s insurance so she can get the care she needs http://t.co/lGO4F5JN

@TxWellHealthy: In Texas, 149,000 young adults gained coverage due to ACA allowing kids under 26 to stay on parents� policies. #ThanksHCR

@AmerAcadPeds: Thanks to health reform, insures can�t deny coverage to kids due to pre-existing conditions. #ThanksHCR

@ABCardio1: Thanks to health reform, people with Medicare get a free annual wellness visit, AKA more time with their doc http://1.usa.gov/uRd3go #ThanksHCR

@NHCouncil: This thanksgiving season NHC gives thanks for ACA policies that help people with #chronic conditions. #ThanksHCR

@whereisthao: #ACA in effect - calling out unfair rate hikes by health ins industry! ow.ly/7BzWs #ThanksHCR

@HealthPolicyHub: #ThanksHCR for protecting #Medicare benefits for seniors and providing free preventive care with no co-pay.

@RWV4HealthCare: Love the fact that children can stay on their parents' insurance plans till age 26! #thanksHCR

@apiahf: Thanks 2 #HCR, people w #Medicare get discounts on prescription drugs and a free annual wellness visit. #ThanksHCR

@VA Organizing: #ACA is helping to protect patients from medical errors & making hospitals more reliable, less costly. 1.usa.gov/sQNMtK #ThanksHCR

So this Thanksgiving, as you gather around the table with family, friends, and great food, remember to share why you are thankful. Talk to your loved ones about the key features of the law that can help keep them healthy. And keep sharing your stories about why you are thankful for the many new benefits in the health care law by sending a tweet using the hashtag #ThanksHCR.

Thursday, March 14, 2013

Will Medicaid Bring The Uninsured Out Of The Woodwork?

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Wednesday, March 13, 2013

Missouri Single-Payer Bill Introduced

Ed Weisbart, MD, of PNHP-St. Louis, sends us this report about the introduction of Missouri’s state single-payer bill.

On May 4, 2012, the Missouri Health Care Policy committee gave a formal hearing to MO HB1405, a bill that would establish a MO state-wide single payer health plan. Two Physicians for a National Health Program physicians testified and one more wrote a strong letter in support. The bill has been consistently advanced thanks to the efforts of Missourians for Single Payer.

The first video below is the introduction of the bill from Rep. Mike Brown of the Kansas City area; the second is the testimonies, running a total of about 15 minutes. A big shout-out of thanks to Rep. Brown and all of our great co-sponsors.

We have to really thank Progress Missouri, a multi-issue progressive advocacy organization, for recording this and so generously sharing it with us all.

Ed Weisbart MD
PNHP-STL, Chair

Michael Brown Introduces HB1405

Members of the St. Louis chapter of Physicians for a National Health Program testify in support of single payer for Missouri

Monday, March 11, 2013

Healthcare for My Neighbors?

Our medical and medical insurance ethos sadly is that sick people are good for business. That health care should be a money making machine is the mentality of a nation tricked into believing for-profit health care and medical insurance are superior to national health care as practiced in every other industrialized nation. In contrast the ethos of national healthcare is to keep people healthy in order to save buckets of money. It works. Every nation with national health care delivers health care for all at a fraction of the cost Americans pay. The incentives of public health care are opposite to those of a for-profit system.

I am a WWII veteran. My response to conservatives who are certain government can�t do anything right is that I am grateful for VA health care and for Medicare, both run by �the government� and paid for in the same way we pay for public education and the fire department, i.e., through public taxation.

�In the box� thinking places profit over the health of the nation. It prevents Americans from having full medical insurance from day one. Unlike citizens of every other industrialized nation, Americans must wait until old age to get 80% rather than total coverage as in other nations.

We are the only industrialized nation in the world in which parents are forced to advertise in the local newspaper that an account has been set up at a local bank to accept donations to pay for treatment of a child with life threatening cancer. No Canadian, French, or English parent would need to �pass the hat� or to ask for charity in order to save the life of a child. In other nations it is never �charity�, but �healthcare with dignity.�

We are the only nation where private insurance companies can restrict services to a particular state forcing clients to travel thousands of miles for treatment, or dictate where a client can get a blood transfusion, or deny payment for a bone marrow donor search.

�Why should I pay for the health care of my neighbors?� is the outraged cry of conservatives. With national healthcare the answers are: (1) My neighbors pay for mine. (2) It is the ethical thing to do. (3) costs are half or less than half of what we pay now and would cover everyone.

Every other advanced nation pays a fraction of what the U.S. does. Canadians pay $3,000 per capita to cover everyone while the U.S. pays $7,000 per capita and leaves out 47 million plus an equal number of at risk underinsured souls. European nations pay a third of what we do with better outcomes.

A National health care system would make us feel good about ourselves. At last we could say with pride to the world, �We are willing to pay for the healthcare of our neighbors just like everyone else.�

Live in Oklahoma and want to get involved? Ron du Bois is one of the founders of Oklahomans for Universal Health Care and the convener of Stillwater Speaks Health Care Committee. Please contact Ron at (405) 377-2524 or duboisr@sbcglobal.net for more information.

Sunday, March 10, 2013

Healthcare for My Neighbors?

We’re Doing More to Protect Your Health

This week is National Consumer Protection Week, an excellent time for you to learn more about your new health insurance rights and the resources offered by the new health care law, the Affordable Care Act.

Thanks to the law, you have new options for health insurance coverage and are protected from some of the worst insurance company practices.� Now, children can no longer be excluded from coverage because of a pre-existing health problem, most young adults can stay on their parents� insurance policies until age 26, and people with pre-existing conditions can seek coverage from the new Pre-existing Condition Insurance Plan.� And in 2014, new Affordable Insurance Exchanges will provide all Americans with access to affordable, high-quality coverage.

The Affordable Care Act makes sure that your insurance works for you when you need it most: when you�re sick or injured. Insurance companies can no longer put a lifetime dollar cap on health benefits or revoke your coverage when you�re sick just because you made an honest mistake on your insurance application.�If your insurer denies your claim for benefits, there is a new right to appeal, and if a claim is denied again, the right to an outside, independent review.

The law also ensures that you get value for your dollar.�Now, insurance companies generally must spend at least 80 percent or more of your premium on health benefits and quality improvements, instead of for non-health expenses, such as overhead and advertising.� Starting this year, insurance companies that don�t meet the 80 percent standard will provide rebates to consumers.� And, insurers that propose to hike premiums by 10 percent or more may now be required to publicly justify these increases.

We�re working hard to fully implement all of the consumer protections and coverage options in the Affordable Care Act.� Search www.HealthCare.gov to learn more about your protections, investigate local health insurance options on the website�s Plan Finder, and explore a wealth of other consumer tools and resources.

A Cruel Blow to American Families

From the New York Times –

The Internal Revenue Service has issued a hugely disappointing ruling on how to calculate the affordability of health insurance offered by employers. Its needlessly strict interpretation of the Affordable Care Act could leave millions of Americans with modest incomes unable to afford family coverage under their employers� health insurance but ineligible for subsidies to buy coverage elsewhere.

The problem arises from murky language in the law. It says a worker cannot get taxpayer-subsidized coverage on the new health insurance exchanges, starting in 2014, unless the cost of employer-based health coverage for that worker exceeds 9.5 percent of the worker�s household income.

Both the I.R.S. and the Congressional Joint Committee on Taxation have interpreted the law to consider only the cost of covering the individual employee in calculating the 9.5 percent, not the much higher cost for a family plan.

Although some analysts had offered persuasive legal and social arguments for adopting a more expansive and generous interpretation of what the law requires, the strict interpretation prevailed in a final rule issued by the I.R.S. last week.

There is no doubt that this pinched approach will put a significant number of workers and their dependents in a bind. A Kaiser Family Foundation survey found that in 2012, employees� annual share of insurance premiums averaged $951 for individual coverage and $4,316 for family coverage. Under the I.R.S. rule, such costs would be considered affordable for an employee with a household income of $35,000 a year � making the employee�s spouse and children ineligible for a public subsidy on a health exchange, even though that family would have to spend 12 percent of its income for the employer�s family plan.

Estimates made in 2011 by respected research organizations suggested that some 2 million to 3.9 million non-working spouses and dependents would be harmed by the strict ruling. Looking only at children who were uninsured but supposed to gain coverage under health care reform, the Government Accountability Office estimated last June that 460,000 might remain uninsured because of the affordability definition, and that 1.9 million might stay uninsured if an existing children�s health insurance program is phased out as currently planned. This outcome is exactly the opposite of what health care reform is supposed to achieve.

It is hard to see what might be done to reverse this deplorable result. The ideal solution would be for Congress to clarify that the 9.5 percent calculation is based on a family plan, and that dependents can get subsidies on the exchanges if there is no affordable coverage at work. But House Republicans, who are bent on obstructing the health reform law, would never agree to helpful changes, especially one that would increase federal spending.

This problem increases the need to retain the children�s health insurance program, which is financed only through 2015. And it will be crucial to assess the impact that this misguided provision has on coverage, access to care, and the financial burdens on families of modest means.

Saturday, March 9, 2013

For One Senior, Medicaid Provides Model Care

Petersen says her mom couldn't afford the nursing home on her own. Her Social Security income is $600 a month and after selling her house she cleared only $3,500. A doctor suggested signing up for Medicaid to pay the $80,000 a year bill for her long-term care. Scarrow is left with about $50 of her Social Security check each month for spending money.

Petersen said, at first, her mother was embarrassed about accepting government help, because she's always been independent and supported herself. Much of her life was spent in facilities like this one, as a nurse's assistant.

"Mom worked in an era when health care was what it was called. It was called care. Kindness and care. In today's world, health care is money," said Petersen.

States Feel The Pinch

Colorado has nearly a half-million people on Medicaid and, like in a lot of other states, that number rose dramatically in the past year, increasing by more than 10 percent. The economy and unemployment are largely to blame.

Are You Covered?

A look at Americans and health insurance.

Interactive: Are You Covered?

Typically states and the federal government split the cost of Medicaid, though with the recent stimulus money the federal government is picking up a larger share now. Even with that help, Colorado has difficulty paying its share. Recently the governor trimmed payments to doctors and hospitals to help balance the state's budget.

Hoping For Overhaul

Politically, Petersen says she typically votes Republican. But last year she voted for Obama, and she's excited about efforts to overhaul health care in the United States. She's frustrated with the costs of her own coverage, but very happy with the Medicaid coverage her mother receives.

She doesn't have a specific solution for health care overhaul, but she does support things like tort reform and tighter regulations for insurance companies. In coming months, she'll watch closely to see what solutions policymakers in Washington come up with.

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Memphis AFL-CIO Labor Council Endorses HR 676

From UnionsForSinglePayer.org –

Irvin Calliste, President, Memphis AFL-CIO Labor Council, reports that the council has endorsed HR 676, national single payer health care legislation sponsored by Congressman John Conyers (D-MI).

Memphis Congressman Steve Cohen is one of the 76 co-sponsors of this legislation which is also called “Expanded and Improved Medicare for All.”

The Memphis council is the third one in Tennessee to endorse HR 676. The Knoxville-Oak Ridge Area and the Nashville and Middle Tennessee labor councils, as well as the Tennessee AFL-CIO, did so earlier.

HR 676 would institute a single payer health care system by expanding a greatly improved Medicare to everyone residing in the U.S.

In the current Congress, HR 676 has 76 co-sponsors in addition to Conyers.

HR 676 has been endorsed by 593 union organizations including 142 Central Labor Councils and Area Labor Federations and 40 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV
& MA).

For further information, a list of union endorsers, or a sample endorsement resolution, go to UnionsForSinglePayer.org.

Thursday, March 7, 2013

To Be A Young Scientist, 52 Will Do

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America Speaks Back: The Effort to Gut Social Security and Medicare Takes a Hit

The opponents of Social Security and Medicare are getting in high gear. After all, it makes perfect sense that after the collapse of a housing bubble has just destroyed the life savings of near retirees that we would cut their Social Security and Medicare. Okay, at least in Washington that makes perfect sense.

President Obama’s deficit commission is moving forward with Social Security and Medicare explicitly in their sights. They got a dry run for how this effort is likely to sell with the public on Saturday as the Peter Peterson funded group America Speaks sponsored a series of 19 “21st Century Town Meetings.” It seems that events didn’t quite go as planned.

The exercise was intended to show convince people that there were no options other than large cuts to Social Security and Medicare to hit their deficit targets. To ensure this result, the America Speaks crew put together a booklet that exaggerated future budget problems (the exercise was for the year 2025) by assuming a worse budget path than the country is currently facing.

America Speaks also excluded the possibility that the Fed would buy and hold more debt, in effect continuing its current course. This would substantially reduce the interest burden facing the country in 2025. While in normal times this could cause inflation, that is unlikely to be a problem in the foreseeable future. In comparable circumstances, Japan’s central bank has bought an amount of debt nearly equal to the country’s GDP (the equivalent of $14 trillion for the U.S.) and its economy is still facing deflation. There is no reason that the Fed could not follow the same path, unless the goal is to force cuts in Social Security and Medicare.

The America Speaks folks also denied participants the option of reducing public sector health care costs by reforming the U.S. health care system. As they say at America Speaks, everything is on the table, except reforms that would hurt powerful industry lobbies. The America Speaks crew also neglected to mention the Social Security trust fund and that it would have enough assets to pay all benefits through the year 2043, according to the Congressional Budget Office.

Given this stacked deck the participants rose up in revolt. They demanded the option to vote on a single-payer type health care system. The idea being to reduce costs by making health care more efficient rather than just cutting services in Medicare and other public sector programs. They also voted overwhelmingly for defense cuts and for every progressive tax option in the book, even though many had been seriously mischaracterized. For example, they listed the potential revenue from a financial speculation tax in 2025 as $30 billion a year even though there is good reason, based on the experience of other countries, to believe that we could raise close to ten times this amount.

Remarkably, even after spending more than 6 hours with the America Speakers, participants were still very poorly informed on several key budget issues. For example, more than 80 percent of the participants thought that the country had large budget deficits in the years immediately before the recession. (The budget deficits were less than 2.0 percent of GDP in the two years prior to the downturn.)

Less than a quarter of the participants realized that average wages are projected to increase substantially over the next three decades. The fact that real wages are projected to be more than 30 percent higher in 2040 would be an important consideration in an issue like increasing the payroll tax. And, less than a quarter of participants realized that the Social Security trust fund is projected to be fully solvent for more than 25 years into the future.

All in all, this was a good day for democracy. The America Speaks gang tried to shove their agenda down the public’s throat and the public pushed back. Let’s hope that the deficit commission gets the message.

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Tuesday, March 5, 2013

Cracking Down on Insurance Companies, Protecting Consumers

The health care law gives us new tools to protect consumers who are looking for health insurance.� One of those tools is �rate review�.� For the first time ever, in every State, insurance companies are required to publicly justify their actions if they want to raise rates by 10 percent or more. These increases are then reviewed by independent experts to decide whether they are reasonable � providing unprecedented transparency and easy-to-understand information about why insurers want to raise your rates. Thanks to health reform, if your insurance company wants to hit your wallet with a major increase, they have to tell you why. And if you don�t like what they have to say, you can take your business elsewhere.

Today, we�re using this tool to protect consumers and crack down on unreasonably high rate increases. We�re announcing that Trustmark Life Insurance Company has unreasonably raised health insurance premiums in: Alabama, Arizona, Pennsylvania, Virginia, and Wyoming � which would affect nearly 10,000 residents across these five States.

In each instance, Trustmark raised rates by 13 percent or more over the last year.� �For small businesses in Alabama and Arizona, when combined with other rate hikes made over the last 12 months, rates have increased by 27.2 percent and 18.1 percent, respectively. You can view more information about these rates here.

These increases are unreasonable and it�s time for Trustmark to immediately rescind the rates, issue refunds to consumers or publicly explain their refusal to do so.

The steps we�re taking today are just one way the Affordable Care Act is helping control health care costs and protect consumers. In addition to the review of rate increases, many States have the authority to reject unreasonable premium increases.� Since the passage of health reform, the number of States with this authority increased from 30 to 37, with several States extending existing �prior approval authority� to new markets.� And states are using this authority to save money for families and small businesses:

In New Mexico, the state insurance division denied a request from Presbyterian Healthcare for a 9.7 percent rate hike, lowering it to 4.7 percent;In Connecticut, the state stopped Anthem Blue Cross Blue Shield, the state�s largest insurer, from hiking rates by a proposed 12.9 percent, instead limiting it to a 3.9 percent increase;In Oregon, the state denied a proposed 22.1 percent rate hike by Regence, limiting it to 12.8 percent.In New York, the state denied rate increases from Emblem, Oxford, and Aetna that averaged 12.7 percent, instead holding them to an 8.2 percent increase.In Rhode Island, the state denied rate hikes from United Healthcare of New England ranging from 18 to 20.1 percent, instead seeing them cut to 9.6 to 10.6 percent.

The Affordable Care Act also includes new rules that help give you a better value for your health care dollar. The law�s 80-20 Rule requires insurers to spend at least 80 cents of each premium dollar on actual health care services and activities that improve health care quality, rather than administrative costs and CEO bonuses. �If insurers don�t abide by this rule, they will be required to give you a rebate.

By Trustmark�s own admission, they didn�t plan to abide by the 80-20 rule, leaving small businesses with an unreasonably high premium.� For this reason, we have found Trustmark�s rate increases to be unreasonable.�

The Affordable Care Act is making our health insurance marketplace more transparent and helping to fight high premium increases and we will continue to do all we can to shine a light on insurance companies who stick consumers with an unreasonable bill.

For more information about this rate review and to find rate increase information in your state, visit: http://companyprofiles.healthcare.gov/

For general information about rate review, visit:�http://www.healthcare.gov/law/features/costs/rate-review/

Sunday, March 3, 2013

Diabetes: Combating a Silent and Costly Killer

By 2050, as many as 1 in 3 adults in the United States could have diabetes if current trends continue, according to the Centers for Disease Control and Prevention (CDC). �Diabetes was the seventh leading cause of death in 2009, and people with diagnosed diabetes have medical costs that are more than twice as high as for people without the disease. The Affordable Care Act, the health care law passed in 2010, includes a number of provisions that directly address gaps in diabetes prevention, screening, care, and treatment.

Last week, CDC released its Diabetes Report Card 2012, which provides a snapshot of the impact of diabetes on our nation. Required by the Affordable Care Act, the Report Card profiles national and state data on diabetes and pre-diabetes, preventive care practices, risk factors, quality of care, and diabetes outcomes. ��It also documents the steps the Department of Health and Human Services (HHS) is taking to make a difference in the lives of millions of Americans living with diabetes and pre-diabetes today and to improve the lives of millions of Americans in the future through prevention.�

HHS is committed to fighting the diabetes epidemic across all of its relevant agencies and programs through a broad range of research, education, and programs that strengthen prevention, detection, and treatment of diabetes.� Thanks to the health care law, potentially life-saving preventive services are now offered in many health plans with no cost-sharing. These include:

Type 2 Diabetes Screenings for people with high blood pressure,Diet Counseling for people with known risk factors for cardiovascular and diet-related chronic disease, andBlood Pressure Screenings.

In addition, the Affordable Care Act expanded� CDC�s National Diabetes Prevention Program, a public-private partnership of community organizations, private insurers, employers, health care organizations, and government agencies working together to combat diabetes.�� The law also provides opportunities to improve treatment for people living with diabetes by supporting the creation of Medicaid health homes for enrollees with chronic conditions, and expands opportunities to address diabetes risk factors through community-based programs such as Community Transformation Grants.

We hope this Report Card will encourage individuals, communities, businesses, and other organizations to work with HHS to address the rising rates of diabetes and its consequences.� And we hope that more and more Americans will take advantage of the benefits of the Affordable Care Act, including the many free preventive services, so we can stop the current diabetes trends and be a healthier nation.

Read the full Diabetes Report Card 2012 (PDF - 1.36 MB).

Saturday, March 2, 2013

Frontline Responds on Sick Around America

By FAIR–

In the wake of a FAIR Action Alert (4/6/09), Frontline has responded to critics of its documentary Sick Around America, defending the film’s focus on mandatory private health insurance and its exclusion of the single-payer option. (Frontline’s full response follows.)

In an email response to FAIR (4/7/09), Frontline characterized FAIR’s charge that the documentary presented mandatory for-profit healthcare as the only alternative to the current U.S. healthcare system as “untrue” because the film’s narrator acknowledged that “other developed countries bar health insurance companies from making profits on basic care and cap their administrative costs.”

While it’s true that FAIR’s alert had not cited that statement, it did note that this point had been made in the film by a source. As FAIR’s Action Alert explained, though, “the only alternative to the current U.S. healthcare system that was examined in any depth in Sick Around America was Massachusetts’ system of mandating that people buy insurance from for-profit health insurance companies.”

FAIR’s alert also pointed out that Sick Around America misrepresented the findings of Frontline’s earlier documentary, Sick Around the World (4/15/08). In response to a statement by a spokesperson for health insurance trade group America’s Health Insurance Plans that her industry could offer universal coverage if the government mandated all citizens to have insurance, the film’s narrator stated, “That’s what other developed countries do.”

Frontline’s editors have denied that this was misleading, emphasizing in a letter responding to an article by Corporate Crime Reporter’s Russell Mokhiber (4/2/09) that “America’s Health Insurance Plans represents both for-profit and non-profit companies.” (The Frontline editors’ full response is at the bottom of this email.)

It’s true that this industry lobby group represents some non-profit companies, but the narrator’s claim is still misleading. Most of the health insurance companies represented by America’s Health Insurance Plans are for-profit–while, as FAIR’s alert pointed out, no developed country other than the United States relies primarily on a system of for-profit insurance. Frontline’s report conveyed the opposite impression.

Frontline’s editors have also been dismissing the fallout between Frontline and journalist T. R. Reid. Reid had worked on Sick Around the World and told Mokhiber that he left the production of Sick Around America because he felt that it contradicted the earlier film, which had emphasized that no other countries used for-profit health insurance and had examined the models of Taiwan’s and Britain’s publicly funded healthcare systems.

The editors stated, “Frontline believes the dispute centered on a conflict between Frontline’s journalistic commitment to fair and nuanced reporting and its aversion to policy advocacy and Mr. Reid’s commitment to advocacy for specific healthcare policy reforms, for positions he apparently advocates in his forthcoming book.”

Misleading the public about global healthcare systems and failing to explore any of the publicly funded alternatives to America’s private insurance system, is a strange way indeed of demonstrating commitment to “fair and nuanced reporting.”

Health Care Reform: We’re Not Done Yet

The Supreme Court has spoken. The Affordable Care Act, briefly on the ropes, has been blessed as the law of the land.

Too many feel that health reform is finally finished and we can move on to the big three issues: the economy, jobs and the deficit. However, because health care is the 800-pound gorilla of the economy, those issues cannot be solved without more far-reaching health reform.

Sorry, lawmakers, but you are going to need to get back in the ring to answer a fundamental question: what is the most cost-effective and constitutional way to finance health care so that we can have quality, affordable health care for everyone?

The answer � single-payer national health insurance, also known as an improved Medicare for all � would save America hundreds of billions of dollars annually. And as the Supreme Court reaffirmed, a program of this type, financed by taxes, is definitely constitutional.

Outrageously, this simple solution was never discussed in the two contentious years of debate surrounding the creation of the ACA because it was deemed �politically impossible.�

�Politically impossible� means that the mere utterance of �single payer� would be enough to prompt the medical-industrial complex, especially the pharmaceutical and insurance industries, to funnel millions of dollars in campaign contributions and lobbying money to opponents of real reform and to tea party groups in order to keep the status quo.

So America continues to promote the least cost-effective way of financing health care, which means that we spend twice per capita on health care than any other nation on earth.

When we were the global leader as we were back in the mid-20th century, we could afford to do this. However, we cannot afford our health care system anymore. It is hopelessly complex, bureaucratic, and outrageously expensive. Employers have shifted the cost to employees and it will only get worse as private insurers raise their premiums.

Beyond skyrocketing premiums, about 18 percent of our gross national product is consumed by health care. That figure will rise to 20 percent by the end of the decade. In order to fund this inefficient system, we have borrowed trillions of dollars over the past 50 years, transforming us into the world�s greatest debtor nation.

No matter who wins the November election, the next administration will be forced to confront the deficit. Unfortunately, it appears that our lawmakers� tunnel vision only offers slashing Social Security, Medicaid and Medicare for the poor and elderly as a way to reduce government spending. That course would be catastrophic.

No one seems to want to confront the fact that unless we are willing to embrace an improved Medicare for all, with its streamlined administration and bargaining clout, we have no hope of controlling health care costs, ensuring that our country will remain in debt. Had we adopted a single-payer system 20 years ago, we would have turned our national debt into a surplus today.

In a global economy, employers have to add the cost of health insurance to every product or service. When that cost is twice what the world spends, it eventually means that we are pricing our products too high. Manufacturers have moved their major factories overseas because of lower labor costs, of which health insurance is a key component.

Entrepreneurs are everywhere in America, but too many are locked into undesirable jobs because they need the health benefits. Those who want to put their toe into the self-employed world stop because of the risk of losing health benefits which is bad for an economy that needs creativity and risk.

State and local governments are being weighed down by pension obligations and retiree health benefits. Under a single-payer system, Philadelphia could be freed from the unpredictability of these costs and use those precious dollars for our schools, streets, or public safety.

An ABC/Washington Post poll shows that less than 40 percent of Americans view the ACA or the status quo favorably � remarkably low for a �uniquely American� solution.

Our politics have robbed us from even discussing a practical, commonsense solution � improved Medicare for all — that we desperately need in America. If the medical-industrial complex continues to win, health care costs will continue to rise, and the American people will be the losers.

Dr. Walter Tsou is former health commissioner of Philadelphia. He is a board adviser to Physicians for a National Health Program (www.pnhp.org) and resides in Philadelphia.

Friday, March 1, 2013

GOP To Make 31st Attempt To Repeal Obamacare Act

July 9, 2012

Listen to the Story

Morning Edition

4 min 27 sec Playlist Download Transcript

The House Rules Committee takes up a bill Monday called the "Repeal of Obamacare Act." And just like it says, the bill would wipe away the president's Affordable Care Act. A vote of the full House is planned for Wednesday.

It's the first legislative response from House Republicans after the Supreme Court upheld the law. But it is far from the first time the GOP has voted for repeal.

Over the past 18 months, the House has taken 30 floor votes to try to repeal, defund or dismantle the health care law. The first attempt came on Jan. 19, 2011 just two weeks after the GOP took control of the House.

On that day, Rep. Mike Pence,R-Ind., had this to say, "And today, House Republicans are going to stand with the American people and vote to repeal their government takeover of health care lock stock and barrel."

And that's exactly what House Republicans did, all 242 of them. They were joined by just three Democrats. But the measure languished in the Democratic-controlled Senate.

"Even in some bizarre universe where the Senate passed it, President Obama wouldn't sign it into law," says Sarah Binder, a senior fellow at the Brookings Institution and an expert in legislative gridlock.

But the House's efforts haven't been necessarily pointless. Binder says votes like the one planned for later this week are all about scoring political points.

"Much of what we see during split party control of Congress, is this message politics, which is the parties taking their chamber and using it to pursue a policy agenda that appeals to their party base," Binder says.

"I think we can agree that this is a vote that the American public has called for and a vote that we owe the American public," said Rep. Rodney Alexander, R-La., speaking in favor of his effort back in April of 2011 to pull funding from the health care law.

It passed the House on an almost purely partisan vote with criticism from Democrats like Connecticut Rep. Rosa DeLauro, "Mr. Speaker instead of working to create jobs, reduce the deficit and do the business of the American people, this majority has been consumed for months now with trying to repeal health care reform."

The measure failed in the Senate. Defunding and repeal efforts large and small have been tucked into everything from defense appropriations to student loans. A handful of smaller items have made it all the way through to a presidential signature. But most have failed or stalled in the Senate.

So, why try again? Why a 31st vote for repeal?

"We want to show people we are resolved to get rid of this," said House Speaker John Boehner, who appeared on CBS's Face the Nation on July 1.

Boehner said the law needs to be ripped out by its roots, and then replaced.

"And while the court upheld it as constitutional," Boehner added, "they certainly didn't say it was a good law."

The only real chance for Boehner and his Republican colleagues to get their way lies with the November election, and possibly an arcane budget procedure known as reconciliation.

For that to work, Mitt Romney would have to win the presidency, Republicans would have to maintain control of the House and win the Senate. When it comes to the Senate, it's virtually impossible for Republicans to get the 60 vote majority needed to overcome a filibuster. And that's where reconciliation comes in. Certain budget bills can go around the filibuster and only need 51 votes to pass.

But Sarah Binder at Brookings says the process would be procedurally challenging.

"It's complicated for Republicans to achieve this, but there is a vehicle if they can carefully calibrate their bill," she says.

That's a whole lot of ifs. And there are questions about if even that could repeal the whole law.

One thing that's not in question, though, is the outcome of Wednesday's expected vote on the Repeal Obamacare Act. Like so many similar efforts in the past, it will pass the House, with overwhelming Republican support.

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17,000-member organization of physicians says latest numbers show urgent need for single-payer health reform

Official estimates released this morning by the Census Bureau showing a marginal increase in the number of Americans without health insurance in 2008 – now estimated at 46.3 million, up from 45.7 million in 2007 – masks the true dimensions of the problem, a national doctors� group said.

Significantly, in Massachusetts, where an individual-mandate health reform law, much like what President Obama is proposing on a national scale, was passed in 2006, at least 352,000 people, or 5.5 percent of the population, remained uninsured in 2008. That number was actually (but non-significantly) higher than the number of uninsured in 2007, before strict enforcement of the individual and employer mandates went into effect.

�The legislation championed by the president and the congressional leadership is a virtual clone of the Massachusetts plan,� said Dr. Steffie Woolhandler, professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program (PNHP). �Today�s numbers show that plans that require people to buy private insurance don�t work. Obama�s plan to replicate Massachusetts� reform nationally risks failure on a massive scale.�

Woolhandler said last year�s job losses in the recession, and the corresponding loss of health coverage by many workers and their families, are inadequately reflected in the new data. An estimated 2.6 million people lost their jobs in 2008, most of them toward the end of the year. Those who lost insurance at the end of the year would probably be counted as insured in the Census data, she said.

Census officials cited a drop of 1.1 million in the number of persons who were covered by employer-based insurance, continuing an 8-year trend. Whereas 64 percent of Americans had employer-based coverage in 1999, only 58.5 percent had such coverage in 2008.

Dr. Quentin Young, national coordinator of PNHP, said had it not been for a leap of approximately 4.4 million people newly covered by government programs like Medicaid and Medicare, the overall uninsured rate would have set a new record.

Young said the �tragic and painful persistence� of tens of millions of uninsured persons in the country is �completely unacceptable� and underscores the urgency of enacting a Medicare-for-all program.

�The only way to solve this problem is to insure everyone,� he said. �And the only way to insure everyone is to enact single-payer national health insurance, an improved Medicare for all. Even President Obama has acknowledged this fact.�Young noted that Rep. Anthony Weiner, D-N.Y., is introducing an amendment to the House leadership�s health reform bill, H.R. 3200, which would essentially delete its present language and substitute the language of Rep. John Conyers� single-payer bill, H.R. 676. �It�s not too late for Congress to do the right thing,� Young said.

Dr. Don McCanne, senior policy fellow at PNHP, noted that the Census Bureau was once again silent on the pervasive problem of �underinsurance.� People are usually defined as underinsured if they spend 10 percent or more of their income (or 5 percent if they are low-income) on out-of-pocket medical expenses in the course of a year.

�Not having health insurance, or having poor quality insurance that doesn�t protect you from financial hardship in the face of medical need, is a source of mounting stress, anguish and poor medical outcomes for people across our country,� McCanne said. He noted that a recent study showed 62 percent of personal bankruptcies in the U.S. are now linked to medical bills or illness and three-quarters of those who went bankrupt had insurance when they got sick.

Winning Medicare for All? “I Like Our Chances”

Despite insights, Time magazine’s cover story falls short on remedy

In his recent Time magazine article, Steven Brill paints a vivid and rather depressing picture of the perverse malfunctioning of our health care system � overpriced and technology-addicted � and he acknowledges some of the advantages of Medicare.

Sadly, however, he shies away from an endorsement of the obvious solution: an improved Medicare for all, i.e. single-payer national health insurance.

I�ll come back to that a little later. However, let me first say that Brill masterfully illuminates much of what�s wrong with U.S. health care.

Take, for example, the �chargemaster� list: an archival, bizarrely hyper-inflated price list in each hospital based on some long-lost secret formulas and automatically inflated over time.

As a physician and health policy researcher, I�ve long known about the massive charges offered to non-contract payers (read: individuals not covered by a public or private insurer), charges that are completely meaningless for costing studies because they�re almost never paid in full and don�t represent the real resources used to provide care. However, what Brill lays out brilliantly (pun intended) is the following:

Some very poor (lower-middle income) people actually do pay the sky-high chargemaster rates. There is a cottage industry (growing, I�m sure, if nothing else due to this article) to help those hapless souls negotiate steep discounts on these ridiculous bills. Hospital administrators either refuse to discuss the chargemaster list or offer up the most heinous, transparently nonsensical justifications for using it. Perhaps worst of all, the CEOs of large not-for-profit providers are paid literally millions of dollars (OK, not tens of millions like big for-profit companies, but still �), thereby introducing into a supposedly public-good-oriented setting the compensation (and marketing) tone of for-profit industry. When these not-for-profits list their �charity� care they value it at the price levels in the chargemaster, even though the cost to produce those services is less than 10 percent of the chargemaster price.

In these and other instances, Brill performs an outstanding public service. However, he regrettably stops short (or his editors stopped him short) of explaining why a single-payer health care system is the only effective remedy for the mess we find ourselves in today. This despite the fact that much of what he says would lead you directly to that conclusion.

He goes so far as to quote others, including John Gunn, Sloan-Kettering�s chief operating officer, who says, �If you could figure out a way to pay doctors better and separately fund research � adequately, I could see where a single-payer approach would be the most logical solution. � It would certainly be a lot more efficient than hospitals like ours having hundreds of people sitting around filling out dozens of different kinds of bills for dozens of insurance companies.�

Yet Brill characterizes single payer, the most logical solution, as �unrealistic� and fraught with the danger of government overreach and intrusion, summarily dismissing it. Need we mention insurance-company overreach and intrusion in the doctor-patient relationship? Need we note the freedom of Medicare beneficiaries to choose their own doctor and hospital, something that would also characterize a single-payer system?

Incidentally, Brill sharply undervalues the government role in paying for health care. He says that the federal government pays $800 billion per year out of our $2.8 trillion health bill, with the remainder mainly picked up by private insurers and individuals.

The $800 billion federal spending on Medicare and the federal portion of Medicaid is right. However, when you add in other federal programs, the state portion of Medicaid, other state and local programs, health insurance for government employees, and tax subsidies, the total government contribution is over 60 percent of total health spending, and rising. Our government already spends enough to pay for universal single payer!

Single-payer health reform is clearly the answer. We need to create the meme and the momentum and the aura of inevitability to do the right thing � despite the opposition of individuals and organizations with massive vested financial interests in the private health industry. They can be overcome.

Think Lincoln and the 13th amendment. As he said (or at least Daniel Day-Lewis said in the movie), regarding prospects of passing the amendment out of Congress, despite doom-saying by his advisers � �I like our chances� (slight smile).

I like our chances on single payer because it�s now so obvious how irremediably broken our system is, and the house of cards will eventually fall. It�s all about perseverance and timing.

James G. Kahn, M.D., M.P.H., is a professor at the Philip R. Lee Institute for Health Policy Studies, Global Health Services, and the Department of Epidemiology and Biostatistics, all at the University of California, San Francisco. He is also past president of the California chapter of Physicians for a National Health Program.