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Please enable Javascript to view the comments powered by Disqus.More From Shots - Health News
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Please enable Javascript to view the comments powered by Disqus.How a Single-Payer System Can Save US Health Care
As Minnesota�s physicians, health care leaders and legislators grapple with the complex changes brought by the Affordable Care Act (ACA), many are concerned that even after the law is fully implemented, hundreds of thousands of people will remain uninsured while health care costs continue to spiral.
What if there were a simple, streamlined solution that would guarantee health coverage for every Minnesotan while saving the state billions of dollars? A growing number of Minnesota physicians are endorsing what they consider to be such a solution: single-payer health care. Weary of having to comply with hundreds of different insurance plans� administrative requirements while their patients are denied needed tests and treatments, these physicians are drawn to the simplicity, cost-effectiveness and truly universal coverage offered by a single-payer system.
Their views were supported by an independent analysis last year demonstrating that with a state-based single-payer system, every Minnesotan could have comprehensive coverage while the state would save billions annually.
A deeply flawed system
The desire for meaningful reform comes in the face of the U.S. health care system�s long-recognized dysfunction. Despite health care accounting for 18 percent of the nation�s economy�twice that of other wealthy democracies�48 million Americans lack health coverage. Another 29 million are underinsured, having poor coverage that exposes them to unaffordable out-of-pocket expenses. Health insurance premiums have doubled over the past decade, with the average annual cost for family coverage now exceeding $15,700; and health care costs now account for two-thirds of personal bankruptcy filings in the United States.
At the root of these problems is the fact that we have a fragmented, highly inefficient system. Employed Americans younger than 65 years of age have job- based insurance, if their employer chose to provide it; the elderly and disabled are covered through Medicare; the poor by Medicaid; military veterans through the Veterans Administration; and American Indians through the Indian Health Service. Persons who do not fall into any of those categories must try to purchase individual coverage in the private market, where it is often prohibitively expensive or unobtainable if they have a pre-existing health condition.
Owing largely to this fragmentation and inefficiency, a staggering 31 percent of U.S. health care spending goes toward administrative costs, rather than care itself. Inefficiency exists at both the provider and payer level. To care for their patients and get paid for their work, physicians and hospitals must contend with the intricacies of numerous insurance plans�which tests and procedures they cover, which drugs are on their formularies, which providers are in their network. Meanwhile, private health insurance companies divert a considerable share of the premiums they collect toward advertising and marketing, sales teams, underwriters, lobbyists, executive salaries and shareholder profits. The top five private insurers in the United States paid out $12.2 billion in profits to investors in 2009, a year when nearly 3 million Americans lost their health coverage.
The ACA of 2010, known widely as Obamacare, is expected to extend coverage to 32 million more Americans But it accomplishes this goal primarily by expanding the current fragmented, inefficient system and maintaining the central role of the private insurance industry in providing coverage. As a result, the ACA is expected to do little to rein in health care spending. Furthermore, it will fall far short of achieving universal coverage, as tens of millions of Americans (including 262,000 Minnesotans) will remain uninsured after its full implementation.
The solution
The central feature of a single-payer health care system would be one health plan that covers all citizens, regardless of their employment status, age, income or health status. Having a public fund that pays for care would slash administrative inefficiencies and eliminate profit-taking by the private insurance industry.
Under a single-payer system, the way society pays for health care would change, but the market-based health care delivery system would remain. Physicians and hospitals would continue to compete with one another based on service, quality of care and reputation. The chief difference is that they would bill a single entity for their services, rather than numerous insurers.
Individuals would benefit immensely by having continuous coverage that is decoupled from their employment. This would alleviate �job lock,� in which people remain in undesirable employment situations in order to maintain coverage. In a single-payer system, individuals could choose to see any provider, in contrast to the current system in which choice is restricted to those who are in-network. Deductibles and copays would be minimal or eliminated, removing cost as a barrier to obtaining needed care.
A single-payer system would be funded through savings on administrative costs, along with modest taxes that would replace the premiums and out-of-pocket expenses currently paid by individuals and businesses. The cost savings to individuals, businesses and government would be considerable. The nonpartisan U.S. General Accounting Office concluded that single- payer health care would save the United States nearly $400 billion per year, enough to cover all of the uninsured.
Physician support for a simplified, universal health care system is robust and growing. A 2008 survey published in Annals of Internal Medicine found that 59 percent of physicians supported a national health insurance system�up from 49 percent in 2002. Physicians for a National Health Program, a national organization advocating for single-payer reform, reports a membership of 18,000. In Minnesota, single payer has been formally endorsed by nearly 800 physicians, other providers and medical students.
The Minnesota model
Recognizing the implausibility of achieving single-payer reform at the national level in the current political climate, many single-payer advocates have turned their attention to state-level reform. The ACA provides for �state innovation waivers� to be granted beginning in 2017, allowing states to implement creative plans they believe would work best for them. With this in mind, organized single-payer movements have taken root in states as varied as Colorado, Hawaii, Illinois, New York, California, Oregon and Vermont. Vermont�s governor and Legislature passed a law in 2011 setting the path for the state to move toward single payer.
In Minnesota, two advocacy organizations�Health Care for All Minnesota and the Minnesota chapter of Physicians for a National Health Program�are garnering public support for a single-payer system. Gov. Mark Dayton has expressed support for single payer, and Sen. John Marty (DFL-Roseville) has authored legislation to establish such a system in Minnesota. Known as the Minnesota Health Plan, it would replace the current inefficient patchwork of private and public health plans with a single statewide fund that would cover the health needs of all Minnesotans�inpatient and outpatient services, preventive care, prescription drugs, medical equipment and mental health and dental care. A 2012 study by the Lewin Group confirmed the feasibility of single payer in Minnesota. It concluded that adoption of a single-payer system would provide coverage to every Minnesotan, including the 262,000 left uncovered by the ACA, while saving the state $4 billion in the first year alone. The average Minnesota family would save $1,362 annually in health costs, while the average Minnesota employer that currently provides insurance would realize savings of $1,214 per employee per year. The analysis showed these savings came primarily from administrative simplification; provider compensation remained unchanged.
Conclusion
With nearly 50 million uninsured people in the United States and skyrocketing health costs, the need for profound reform of our health system could not be more clear. The ACA is a start, but it will fall far short of achieving universal coverage, and it allows unsustainable spending growth to continue. Single-payer health care would eliminate administrative waste and inefficiency, thereby creating an opportunity to achieve truly universal, cost-effective health care.
This article originally appeared in the April 2013 issue of Minnesota Medicine.
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Please enable Javascript to view the comments powered by Disqus.More From Shots - Health News
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Please enable Javascript to view the comments powered by Disqus.From USA Today –
The availability of employer-sponsored insurance has fallen by about 10% over the past decade, which has spurred an increase in the overall number of Americans without health insurance, according to a report released today.
“This documents that in virtually every state across the country, there has been a steady decline in employers that provide coverage over the past 10 years,” said Andrew Hyman, director of the Robert Wood Johnson Foundation’s health care coverage team. “It would be a real stretch to say this was caused by anticipation of the Affordable Care Act,” President Obama’s 2010 health care law.
The universal coverage requirement and the state health insurance exchanges needed to make it work will start Jan. 1. Some employers have said they may drop health insurance because it would be cheaper to pay a $2,000 fine and have employees buy insurance through the exchanges instead of paying an average of $15,000 to buy that employee health insurance.
Other employers have said they will drop employees’ hours below 30 a week to avoid the requirement to provide insurance or pay a fee.
If so, employers would be following a trend that started before the health care law passed in 2010. The new study found that employer-sponsored coverage dropped from 69% to 60% between 1999 and 2010. The amount each employee paid annually for insurance more than doubled in that period from $435 to $1,056 for an individual and from $1,526 to $3,842 for a family.
The Johnson foundation’s State Health Access Data Assistance Center conducted the research.
Coverage also varied from state to state, based on state law, regional employment rates and average employer size.
Hyman said the steady decline in coverage has come in spite of changes in the economy and employment rates throughout the decade.
“So now we’re all wondering how it will change with the implementation of the ACA,” he said. The “silver lining,” he said, is that with the new law, even those who don’t receive coverage through their employer will be able to get a plan through the health exchange system.
Predictions vary on the law’s effects. The Congressional Budget Office says between 3 million and 5 million fewer people will have employer-subsidized insurance. A Towers Watson survey of more than 500 companies with more than 1,000 employees found none of the companies plan to drop insurance because of the law. A House Ways and Means Committee study found that 71 Fortune 100 companies said they could save $28.6 billion by dropping health insurance and paying the $2,000-per-employee fine.
However, health insurance brokers say their business clients are “staying the course” on their current health plans, said John Torinus, co-founder of Successful Entrepreneur Investors and who has served on several health care reform task forces. As a former CEO, he said he considered health coverage a benefit not just to the employee, but also to the employer.
In a presentation to the World Health Care Congress Wednesday, Torinus said corporations have the power to turn the tide of rising health care costs. Consumer-driven plans, as well as employers who help employees make good decisions about spending and lifestyle, are a better answer than dropping employees’ insurance. Healthy employees are more productive, take less time off and are happier.
He said more employers are offering health care at the workplace so they can ensure employees receive preventive checks to keep them healthy, the employer isn’t saddled with unnecessary referrals and procedures and the employee goes to a less-expensive, better-quality specialist when there are several options from which to choose.
Kent Bradley, senior vice president and chief medical officer of grocery store giant Safeway, proposed that employers could address the rising costs of Medicare by pushing back the time in a person’s life that he or she starts being unhealthy.
Employers are better able to provide incentives � employees at Safeway pay premiums based on their behaviors, and they can save up to $760 per person � as well as a supportive workplace to help people make healthy lifestyle choices. So rather than having a population of seniors dealing with chronic disease from obesity, such programs could stave off illness until a population turns 75 or older, he said.
Hyman said he expects employers to continue to offer insurance.
“I think, frequently, employers are thinking and projecting based on one or two factors,” he said. “But it will be interesting to see what they do with a range of considerations.”
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Comments You must be signed in to leave a comment. Sign In / RegisterPlease keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.
Please enable Javascript to view the comments powered by Disqus.From USA Today –
The availability of employer-sponsored insurance has fallen by about 10% over the past decade, which has spurred an increase in the overall number of Americans without health insurance, according to a report released today.
“This documents that in virtually every state across the country, there has been a steady decline in employers that provide coverage over the past 10 years,” said Andrew Hyman, director of the Robert Wood Johnson Foundation’s health care coverage team. “It would be a real stretch to say this was caused by anticipation of the Affordable Care Act,” President Obama’s 2010 health care law.
The universal coverage requirement and the state health insurance exchanges needed to make it work will start Jan. 1. Some employers have said they may drop health insurance because it would be cheaper to pay a $2,000 fine and have employees buy insurance through the exchanges instead of paying an average of $15,000 to buy that employee health insurance.
Other employers have said they will drop employees’ hours below 30 a week to avoid the requirement to provide insurance or pay a fee.
If so, employers would be following a trend that started before the health care law passed in 2010. The new study found that employer-sponsored coverage dropped from 69% to 60% between 1999 and 2010. The amount each employee paid annually for insurance more than doubled in that period from $435 to $1,056 for an individual and from $1,526 to $3,842 for a family.
The Johnson foundation’s State Health Access Data Assistance Center conducted the research.
Coverage also varied from state to state, based on state law, regional employment rates and average employer size.
Hyman said the steady decline in coverage has come in spite of changes in the economy and employment rates throughout the decade.
“So now we’re all wondering how it will change with the implementation of the ACA,” he said. The “silver lining,” he said, is that with the new law, even those who don’t receive coverage through their employer will be able to get a plan through the health exchange system.
Predictions vary on the law’s effects. The Congressional Budget Office says between 3 million and 5 million fewer people will have employer-subsidized insurance. A Towers Watson survey of more than 500 companies with more than 1,000 employees found none of the companies plan to drop insurance because of the law. A House Ways and Means Committee study found that 71 Fortune 100 companies said they could save $28.6 billion by dropping health insurance and paying the $2,000-per-employee fine.
However, health insurance brokers say their business clients are “staying the course” on their current health plans, said John Torinus, co-founder of Successful Entrepreneur Investors and who has served on several health care reform task forces. As a former CEO, he said he considered health coverage a benefit not just to the employee, but also to the employer.
In a presentation to the World Health Care Congress Wednesday, Torinus said corporations have the power to turn the tide of rising health care costs. Consumer-driven plans, as well as employers who help employees make good decisions about spending and lifestyle, are a better answer than dropping employees’ insurance. Healthy employees are more productive, take less time off and are happier.
He said more employers are offering health care at the workplace so they can ensure employees receive preventive checks to keep them healthy, the employer isn’t saddled with unnecessary referrals and procedures and the employee goes to a less-expensive, better-quality specialist when there are several options from which to choose.
Kent Bradley, senior vice president and chief medical officer of grocery store giant Safeway, proposed that employers could address the rising costs of Medicare by pushing back the time in a person’s life that he or she starts being unhealthy.
Employers are better able to provide incentives � employees at Safeway pay premiums based on their behaviors, and they can save up to $760 per person � as well as a supportive workplace to help people make healthy lifestyle choices. So rather than having a population of seniors dealing with chronic disease from obesity, such programs could stave off illness until a population turns 75 or older, he said.
Hyman said he expects employers to continue to offer insurance.
“I think, frequently, employers are thinking and projecting based on one or two factors,” he said. “But it will be interesting to see what they do with a range of considerations.”
More From Shots - Health News
Comments You must be signed in to leave a comment. Sign In / RegisterPlease keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.
Please enable Javascript to view the comments powered by Disqus.U.S. to boost rather than cut payments to health insurers
By Sandhya Somashekhar
The Washington Post, April 1, 2013
The Obama administration reversed itself Monday, scrapping plans to cut by 2.2 percent the rates paid to health insurers that take part in the Medicare Advantage program.
The insurance industry and more than 100 members of Congress had objected to the cut in the per capita growth rate, which was proposed in February. The insurers mounted a vigorous campaign, using television ads and phone banks, to persuade lawmakers to oppose the reduction.
On Monday, the Centers for Medicare and Medicaid Services (CMS) announced that it was changing its method of calculating reimbursement rates. Instead of cutting payments for Medicare Advantage plans, it will increase them by 3.3 percent.
�The policies announced today further the agency�s goal of improving payment accuracy in all our programs, while at the same time ensuring program stability and preserving beneficiary choice,� Jonathan Blum, the CMS�s acting principal deputy administrator, said in a statement.
http://www.washingtonpost.com/national/health-science/us-to-boost-rather…
Comment:
By Don McCanne, M.D.
The private Medicare Advantage plans, offered as options to the traditional government-run Medicare program, were to have their egregious overpayments reduced by provisions of the Affordable Care Act. This year they were to have a 2.2 percent reduction in their rates, but instead received a 3.3 percent increase. That is a rate 5.5 percent higher than scheduled, which increases the payments to the Medicare Advantage plans by over $5 billion! What happened?
It is easier to understand why when you realize that the program was established as an effort to privatize Medicare. The previous effort – private Medicare + Choice plans – didn’t work since the insurers were unable to provide profitable plans at a cost comparable to the traditional Medicare program.
Recognizing that, Congress established the Medicare Advantage program, authorizing payments averaging 14 percent over the costs of traditional Medicare. This would allow the private plans to offer a more attractive option with greater benefits and lower our-of-pocket costs. Once enough people were enrolled in the private plans then they could start to make the traditional Medicare program even less attractive through greater cost sharing, through means testing that chases away the more affluent beneficiaries, and through reducing payment rates causing a further decline in the number of willing providers.
Originally, the private Medicare + Choice plans were successful in enrolling healthier, lower cost patients. With time, many of those patients required more care, and the insurers started dropping out of markets in which they experienced losses. So the next phase – Medicare Advantage.
With Medicare Advantage, risk adjustment was used to transfer funds from insurers that cornered healthier patients to insurers that enrolled more patients with greater needs. Soon it was evident that the insurers became masters at enrolling patients who were not very ill but who could be coded as having expensive problems. Although efforts have been made to further refine the risk adjustments, our government’s payment accuracy website reveals that the insurers are still able to game the system, such that 14 percent of payments remain improper – over $13 billion.
Another one of the methods used to improve payments – but not reduce payments since the proposal was to be revenue neutral – was to retain some of the funds for the Medicare Advantage plans and then use them to reward plans with higher quality ratings, 4 or 5 star. Well, when they were ready to start reducing the overpayments, as required by the Affordable Care Act, the insurers protested that they couldn’t afford the reductions. So the administration revised the quality awards to include 3 star plans, thus assuring that 80 percent of Medicare Advantage plans would have their required reductions largely offset with the quality awards. But this was not revenue neutral. No problem. The administration declared these expanded awards to be a “demonstration,” and thus drew funds from their demonstration project kitty (our tax funds). That diversion of funds will continue through 2014.
So now we’re down to this year, and, of course, the insurance industry said that they would not be able to tolerate the scheduled reductions of 2.2 percent. They called out the forces. They even had more than 160 Representatives and Senators of both parties lobbying the administration to reverse these cuts. Yesterday, it became evident that they were successful – increasing payments 5.5 percent over the scheduled 2.2 percent cut – a $5 billion bonanza. How did they do it?
The sustainable growth rate (SGR) was a formula designed to slow the growth of spending on physician care down to sustainable levels. In response, physicians adjusted the frequency and intensity of their services to make up for what they perceived to be a reduction in their reimbursement rates. The formula would require a reduction in rates that would especially impact primary care physicians. Congress has deferred the reductions for fear of losing too many physicians from the program, but that has resulted in a 25 percent deficit for which Congress needs to enact a “doc fix.” Here’s where the shell game comes in.
In violation of the standards of the Office of the Actuary, CMS decided that Congress inevitably would enact a doc fix, which then they could say represents an increase in the cost of providing care to all Medicare beneficiaries. Thus the phantom increase has been applied to the new Medicare Advantage rates. Little does it matter that there was no increase since Congress has continued to authorize the suspension of the SGR reductions. It is specious for CMS to claim that payments went up this year because of the not-yet-enacted doc fix when they have been up the whole time. Also it seems not to matter that the doc fix which they used in their calculations has not been fixed, and the money will have to come from somewhere… but certainly not from the $5 billion bonus they just gave the Medicare Advantage plans – money that never existed but will have to be drawn from Medicare payroll taxes, from general funds for Part B, and from increases in Part B Medicare premiums that will be paid by Medicare beneficiaries in the traditional plan who are not receiving any of the extra benefits that enrollees in the Medicare Advantage plans are receiving. Unfair.
But it’s worse than this. Not only is the administration bending over backwards to take good care of the private Medicare Advantage insurers, they are now engaged behind the scenes to further impair the traditional Medicare program – a strategy to further push privatization.
The Ryan/Wyden and Frist/Breaux/Thomas premium support voucherization of Medicare has proven to be too hot for the privatizers, considering the backlash that they have experienced. So premium support is off the table during the Obama administration’s negotiations with Congress over the next manufactured fiscal crisis. So what has replaced the vouchers?
It has been leaked, presumably deliberately, that Obama is proposing to combine the Part A (hospital) and Part B (physician) deductibles into one deductible for Parts A & B combined. The intent is twofold – to reduce the amount that the federal government is paying for Medicare, and to increase the sensitivity of Medicare beneficiaries to prices paid for Medicare benefits – making them empowered health care shoppers. This increase in out-of-pocket spending will especially impact the majority who do not require hospitalization and thus have lower total costs. This strategy will make those who have fewer health care needs wonder why they are paying so much more than they thought they would once they were on Medicare.
Bu that’s not all. About 90 percent of Medicare beneficiaries are protected from excessive cost sharing through Medigap plans or through employer-sponsored retirement health benefit programs. The consumer-directed camp has long wanted to bash the Medigap plans so patients would be exposed more directly to the costs. Obama’s team is proposing just that. They want to prohibit the Medigap plans from providing protection for the deductible – removing it, or at least reducing it, as a Medigap benefit. Another option that they are considering is to assess a 15 percent tax on Medigap premiums which would have a similar net financial impact as prohibiting coverage of the deductible.
So what is a person to do? You can accept the traditional Medicare program, but you will face higher deductibles, perhaps a Medigap tax, an even higher Part B Medicare premium, and perhaps means-tested premiums and benefits which will gradually shift down to middle-income individuals. This will not be pleasing to the majority who have only modest health care needs. The other option? You can enroll in a Medicare Advantage plan with greatly reduced cost sharing plus expanded benefits, and perhaps not even a plan premium, all thanks to Congress and the administration who are using our tax funds to provide very generous subsidies to the private Medicare Advantage plans.
A crummy traditional Medicare program with high out-of-pocket costs, or a slick private plan with most costs prepaid, by the government no less? It is presumed that the majority will rush over to the private plans, especially when they see what extra bennies they get.
What then? Congress can then continue to ratchet down government spending on the traditional program, causing an exodus of willing providers – stripping the program down to worse-than-Medicaid. After the private plans have become the standard and Medicare is in the tank, then what? Premium support vouchers! The government gradually pares down the support for the premium you select, so you are now really an empowered shopper – empowered to buy whatever meager benefits you can afford with your measly premium subsidy.
Excuse the length of today’s message, but I hope you understand why. It’s not that I’m a soothsayer… but maybe I am.
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Please enable Javascript to view the comments powered by Disqus.Three years ago, the Affordable Care Act ushered in a new day for health care.
Since then, more than 6.3 million seniors and people with disabilities with Medicare have saved more than $6.1 billion dollars on prescription drugs.� Nearly 71 million Americans got expanded access to preventive service at no charge through their private insurance plans, and 47 million women now have guaranteed access to additional preventive services without cost sharing. More than 3.1 million young adults who were uninsured were able to gain coverage by being able to stay on their parents� insurance policies until they turned 26. �And parents no longer have to worry about insurers denying coverage to their children because of a pre-existing condition.
Americans are getting more value for their health care dollars due to the health care law. Affordable Care Act initiatives are promoting coordinated care; paying for quality, not quantity; and dramatically reducing fraud and waste, contributing to the slowest growth in national health spending in 50 years.�
Consumers also saved $2 billion in 2012, because of programs to review premium rates and to require insurers to provide rebates if they do not spend at least 80% of premiums on care, rather than overhead, such as executive pay and marketing.� And the law�s initiatives have extended the life of the Medicare Trust Fund by eight years.
But that�s only the beginning. Thanks to the health care law, starting October 1, 2013, qualified individuals will have access to quality health insurance through the new Health Insurance Marketplace.
With the Marketplace, there�ll be a whole new way to find health insurance that fits consumers� needs and budgets, with less hassle. Individuals, families, and small business owners in every state and the District of Columbia will be able to shop in the Marketplace for private insurance coverage that begins in January 2014. �
For the first time, you�ll be able to go to one place to learn about health insurance; get accurate information on different plans; and make apples-to-apples comparisons of private insurance plans�including costs and benefits.� You�ll get a clear picture of what you�re paying and what you�re getting before you make a choice. You�ll also be able to learn, with a single application, if you qualify for a free or low-cost plan, or a new kind of tax credit that lowers your monthly premiums right away.
Because the Affordable Care Act outlaws discriminating against anyone with a pre-existing or chronic condition, as of January 1, 2014, no one can be turned away by plans in the Marketplace or charged more because they�re in poorer health�or just because they�re a woman. At last, being a woman will no longer be a pre-existing condition.
And every health insurance plan in the Marketplace will cover a standard set of essential health benefits that includes, among other benefits, hospital stays, prescription drug coverage, preventive services, oral and vision care for kids.
Open enrollment begins October 1, 2013. Get ready now for the Marketplace by signing up for e-mails and text messages for updates and information at https://signup.healthcare.gov/
In June, the site will be unveiling the new Marketplace. You�ll be able to learn everything you need to know about the Marketplace, including how it works, the benefits of health insurance, how to choose a plan based on your needs and lifestyle, and more. Then in the fall, you can use this site to enroll in a plan from home, or from any place you can access the Web.
Every American needs and deserves quality health insurance.� The Marketplace will help ensure that Americans will have access to quality, affordable health insurance.
Learn more about the Health Insurance Marketplace at www.healthcare.gov/marketplace.
Follow Secretary Sebelius on Twitter at @Sebelius.
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