Mike Malloy

[Don Smith]

http://www.greanvillepost.com/

I’ll be honest. I haven’t read the decision on “Obamacare” by the Supremes. I left that to my lawyer acquaintances. I read the spin with disgust and dismay. I usually read pending legislation before opining, but c’mon, so much has been made of this thus far that it doesn’t really take a rocket scientist to figure out what would, hence did happen. The Supremes backed forced-purchase. The decision pivoted on the idea that the mandate “was justified as a tax. Because people who don’t obtain insurance pay a tax to the IRS, the mandate was within Congress’s power to raise taxes for the general welfare. As a result, the Affordable Care Act was upheld.“

Got that? Its ok because its ALWAYS ok to tax the poor more. If you can’t afford to directly pay the Insurance Companies, the Government will make you pay it as a tax and give it to the mother-fckers anyway, dig?

That is the real problem. But Duh-merica’s wee heads are exploding for all the wrong reasons. And Liberaloi-duhs are celebrating against their own interests too.

more..
_________________
" A bayonet is a tool with a worker at both ends."- Lenin
Patriotism is a manifestation of the Stockholm Syndrome.
"How does it become a man to behave toward this American government to-day? I answer that he cannot without disgrace be associated with it."
-Thoreau
"Information is the currency of Democracy." Jefferson

[Spitfire of ATJ]

Bernie Sanders is using today's decision to push forward Vermont's plan of Single Payer Universal Health Care.

State by State will follow until it's the law of the land.
_________________
He's baaaack.....

http://kucinich.us/

[Doc]

June 28, 1012
The Supreme Court Ruling on the Patent Protection and Affordable Care Act

Go ahead and wade through the cacophony of responses to the Supreme Court decision. It should be a fascinating excursion through society's exposed soul at its finest, and at its worst. Some of the responses you will hear will rely on refined cognitive processes and others on fundamental reflexive emotions.

You will not hear much new. The sounds will only be louder and more concentrated. Most of you will be able to sort the good policies from the bad policies and identify the special interest sources of the various proposals. Most of us know to keep foremost in our thoughts the only special interest that counts - the patient - with the full understanding that special interests which truly support patients are the ones that we want to pull out of the chaff, leaving behind those such as the private insurers who would serve others using the patient only as marketplace chattel.

We need to continue to guard against the "sound-good" proposals that would seem to move us incrementally toward a high performance system that serves all patients well. By incremental proposals we are not referring to important measures such as reinforcing the primary care infrastructure and expanding the presence of community health centers in underserved communities. Improving the effectiveness and quality of the health care delivery system is a continual process that must always be with us.

The sound-good incremental steps are those that would seem to move us in the right direction but are more like trying to walk up the steep side of a mountain in deep, loose sand. The steps seem to go forward, but the peak is never reached. Yet we will hear pleas to move up this slope. We have been climbing this slope for half of a century, and it's time to look for another route.

Many will plead to keep the glass half full now that the Act has been upheld, while others of us will complain about the glass being half empty. It is time to end this petty fray when we can have a full glass - affordable, high quality care for everyone - simply by enacting a single payer national health program. Call it an improved and expanded Medicare for all, if you will.

(Yes, the Supreme Court ruled that the individual mandate survives as a tax, and that Medicaid is limited but not invalidated. But these decisions have been only a diversion, and thus are included here only as a parenthetical remark. The decisions were limited to an Act that merely tweaks the status quo, when what we need is a new act that rejects the status quo. The Supreme Court does not have the authority to bring us that act. Above all, we must guard against celebrating the fact that the Affordable Care Act was upheld, if that should mean that we would walk away from the reform that we desperately need.)

[Doc]

The Kansas City Star
July 1, 2012
The remedy is universal Medicare
By Jack Bernard

We did end up with a health care reform law. But, strangely enough, it was stolen from Romneycare and the Republican side of the aisle simply because of the political cost to the Democrats of inaction. It is a horse put together by a committee — ineffective, complex and political. If Romneycare is any indication, it will clearly not control costs to the taxpayer, the top health care concern of most Americans.

The public does not understand the new health care reform law’s true benefits, which are substantial in regard to access. Short-term, Democrats will again lose independent voters in many swing states vital to their 2012 chances.

Plus, this administration squandered the chance for real reform, a simple expansion of Medicare. The “government takeover” catch phrase scared them off.

Universal Medicare is a concept that makes sense technically and fiscally. The U.S. currently has per capita health expenditure costs double that of other developed nations on single-payer systems.

Medicare For All can be paid for through payroll and employer taxes, just like Medicare and Social Security are now. It is affordable because private insurance marketing and administrative costs (30 percent of the premium) are eliminated for employees and the firms employing them. Costs can be controlled through the Independent Payment Advisory Board, an independent panel set up under Obamacare. And, just like those programs, it would find immediate acceptance by the American public after implementation.

For more information on costs and benefits, please go to the web site of Physicians for a National Health Program at www.pnhp.org/.

Taking the long view, universal Medicare will eventually be implemented in the U.S., because of increasing premium costs and cost shifting if nothing else. But in 15 or 20 years, our health care cost and quality problems will be even worse because of congressional inaction.

(Jack Bernard is a retired health care executive who formerly worked with Kansas hospitals on planning and cost containment issues. He is now a Republican county commissioner in Monticello, Ga., a suburb of Atlanta.)

http://www.kansascity.com/2012/07/01/3683661/as-i-see-it-the-remedy-is-medicare.html

Comment: This op-ed is of special significance for us for two reasons: 1) Medicare for All is not only a liberal/progressive issue as these are the words of a Republican health care executive, and 2) The efforts of PNHP to communicate the single payer message are gaining traction as he cites us as an authoritative source.

Jack Bernard is to be commended for his persistent efforts to inform the public on a better health care alternative. We need to renew and expand our important work on behalf of health care justice for all. It's working.

[Doc]

June 26, 2012
OECD Economic Surveys: United States 2012
The United States needs to foster education and innovation to keep its cutting edge

Particularly worrying is the performance in education, which is essential to provide workers with the skills necessary to become more productive and to adapt to technological change. Attainment in tertiary education stagnated over the past three decades while it grew significantly in almost every other OECD country. Today, 22 out of 30 OECD countries surveyed have more graduates in science and engineering among the 25 to 34 year old workers than the United States.

To prevent long-term unemployment from becoming chronic, the Survey suggests a greater focus on “active” labor market programs that help to facilitate job search and guide individuals towards training and education. These measures have proven to be effective even during periods of high unemployment and should complement existing “passive” benefit programs. The United States spends very little on activation policies relative to other OECD countries.

The Survey also highlights rising income inequality in the United States. The trend owes mainly to rising skill premiums and disproportionate income growth for top earners over the past two decades. High income inequality is also associated with low intergenerational social mobility. Children born to low-income parents in the U.S. find it more difficult to move up the social ladder than in most European OECD countries.

Providing equal access to high-quality elementary and secondary education is essential to addressing this challenge. The Survey also notes that the U.S. tax and benefits system is much less effective in reducing relative poverty than that of other OECD countries. This is largely the result of the limited and poorly targeted financial transfers to low-income households.

http://www.oecd.org/document/59/0,3746,en_21571361_44315115_50653435_1_1_1_1,00.html

OECD Economic Surveys: United States 2012 (122 pages)
http://www.keepeek.com/Digital-Asset-Management/oecd/economics/oecd-economic-surveys-united-states-2012_eco_surveys-usa-2012-en


Comment: So what does an economic survey of the United States have to do with health care? Simply that we cannot expect to have a superior health care system that serves everyone well if we don't fulfill our citizen obligation to demand greater government oversight and intervention in education, employment, and especially in the intolerable rise in income inequality. Current trends in the United States are not encouraging.

Trying to fix health care alone without addressing our other serious economic deficiencies offers little hope of bringing to all of us a truly high performance health care system. The Affordable Care Act, by establishing a standard of low actuarial value plans with excessive financial barriers to care will not enable the masses to have the same access to high quality care that the more affluent members of our society experience.

Why are we focusing on austerity when our potential is so great? We should reject political leaders who would foster yet more austerity. We need leaders who understand the importance of education, employment, and more equitable income distribution. That's not only good for our economy, it's good for our health as well.

[Doc]

The New York Times
July 3, 2012
In Rwanda, Health Care Coverage That Eludes the U.S.
By Tina Rosenberg

Last week’s Supreme Court decision upholding of the constitutionality of President Obama’s health care law moves the United States closer to the goal of health coverage for all. All other developed countries have it. But so do some developing nations — Brazil, Thailand, Chile. These countries are mostly middle income. But one country on the list is among the poorest of the poor: Rwanda.

The point is not that Americans should envy Rwanda’s health system — far from it. But Rwanda’s experience illustrates the value of universal health insurance. “Its health gains in the last decade are among the most dramatic the world has seen in the last 50 years,” said Peter Drobac, the director in Rwanda for the Boston-based Partners in Health, which works extensively with the Rwandan health system.

It couldn’t have happened without health insurance.

Rwanda is known, of course, for the 1994 genocide that killed 800,000 Tutsi and moderate Hutu. Since 1994, the country has been ruled by Paul Kagame, at first as de facto leader and, since 2000, as president. Kagame runs a repressive regime that equates criticism with treason; opposition journalists or politicians in Rwanda have disappeared or died mysteriously.

But Kagame is also widely admired as the most effective leader in Africa. A country in ashes 18 years ago is now safe and clean. It is one of the least corrupt countries in Africa. Per capita income has tripled — although the fact that it is now only $550 a year tells you how destitute Rwanda was.

Its most impressive gains, however, have been in health. AIDS has been cutting life expectancies in Africa and is widespread in Rwanda. Yet life expectancy at birth in Rwanda has increased from 48 to 58 — in the last 10 years. Deaths of children under 5 have dropped by half in five years; malaria deaths have dropped by roughly two-thirds. “Of all countries in Africa Rwanda is probably getting the closest to having health for all, health access for all,” said Josh Ruxin, a longtime resident of Rwanda who is the founder of the Access Project, a Rwandan-run health program.

One key reason that Rwandans are so much healthier today is the spread of health insurance. In 1999, Rwanda’s health facilities sat unused, as the vast majority of people couldn’t afford them. In response, the Health Ministry began a pilot project of health insurance in three districts. In 2004, the program began to spread across the nation. Now health insurance — called Mutuelle de Santé — is nearly universal. Andrew Makaka, who manages the health financing unit at the Ministry of Health, said that only 4 percent of Rwandans are uninsured.

In most poor countries — and in the United States — health disasters are a leading cause of a family’s decline into poverty, but not for Rwandans. “It gives relief to people knowing that if you get sick, you don’t need to have a lot of money,” said Dr. Agnes Binagwaho, Rwanda’s health minister. “It gives you psychological stability so you can concentrate on something else. The money can be used for other things — this is very important in trying to stimulate economic development.”

“You can bring on all the diagnostic services, new technologies and specialties,” said Drobac. “But if those things can’t reach people in need, what’s the point?”

We could ask the same thing in the United States. Rwanda, starting from nothing, decided to build a health system that includes everyone. And it found economic value, alongside human value, in doing so. Now we can get started.

http://opinionator.blogs.nytimes.com/2012/07/03/rwandas-health-care-miracle/?ref=opinion


Comment: Rawanda, one of the poorest nations in the world, has seen a dramatic improvement in the health of their people since the establishment of their near-universal health insurance program, Mutuelle de Santé, covering all but 4 percent of their population.

After the Affordable Care Act is fully implemented in the United States, over 8 percent of our population will still be uninsured - over twice the percentage of Rawanda's uninsured. Shouldn't we be ashamed? We know how to do better than that; we just have to do it.

[Doc]

Chicago Tribune
July 3, 2012
With health care law upheld, employers weigh shift to defined contribution insurance plan
By Peter Frost

Many Chicago-area employers have remained on the sidelines with their employee health plans, waiting for the U.S. Supreme Courtto determine whether the 2010 health care overhaul passed constitutional muster.

But with the court's decision last week to uphold most of the law, companies may pursue a historic change.

Many employers are quietly considering a move away from traditional defined benefit plans and toward defined contribution plans, which set aside a fixed amount of money each year for employees to use toward health care costs.

Under the structure of defined contribution plans, companies hand an employee a set amount — say $9,000 — and employees use that money to buy or help pay for a health insurance plan they choose themselves.

At the heart of the shift is a desire of companies to reduce their exposure to health care costs by shifting the risk of unpredictable expenses to their workers.

Few employers, particularly large companies, are eager to discuss their internal deliberations on the issue because they don't want to raise concerns among employees before final decisions are made, said Paul Keckley, executive director of the Deloitte Center for Health Solutions, the health care research arm of consulting firm Deloitte LLP.

"The only thing that's certain right now is (companies are) doing everything that's legal to shift cost to employees," Keckley said.

Employees of companies that pursue the defined contribution route may be funneled into so-called corporate health care exchanges, which function in much the same way as state-run exchanges.

The private exchange market "is really emerging and growing, largely because of all the interest in the state exchanges," said Michael Thompson, a principal in PricewaterhouseCoopers LLC's global human resources practice.

Inside the exchanges, employees will be offered more choices on what types of coverage they desire — and how much they're willing to pay.

"If you value broad access and you're willing to pay for it, that's fine," Thompson said. "If you're willing to live with a narrower network (of providers) and possibly a higher deductible, you would have the ability to save significant money on your premiums."

On private exchange GoHealth.com, consumers can shop and ask for advice. Michael Mahoney, GoHealth's vice president of marketing, said the company has explored a corporate health care exchange for its employees, but it will continue offering its "traditional and robust" health insurance plan for the time being.

His reason? "If you give control to the employees, they could choose to save money and possibly choose something where they're not completely covered, so they end up in a pinch. Right now, we're going to overspend on our employees and give them more than they want so they're always covered."

http://articles.chicagotribune.com/2012-07-03/business/ct-biz-0703-corp-exchanges--20120703_1_health-care-health-insurance-deloitte-center


Comment: Just as they did with employee pension plans, employers are now gearing up to convert employee health benefit programs from defined benefit to defined contribution. What does that mean?

Over the past few decades, employers passed on the risks of their pension plans to their employees by switching from a defined benefit (a guaranteed dollar amount that employees would receive monthly in retirement) to a defined contribution such as 401(k) plans (a set dollar amount contributed to the pension account, but with no guarantee of the amount received in retirement - the employee thus bearing the full risk of the uncertain investment returns on the pension funds).

Now many employers plan to do the same with their health benefit programs. They intend to pay a set dollar amount for the premiums, whereas the employees will have to bear the the costs of health care inflation plus the costs of any benefits in excess of the basic program to be offered by the employer.

This will be disastrous. Employees are already being stuck with higher deductibles in order to slow the rate of premium increases for the employer. With defined contribution, premiums can be contained further by limiting the benefits covered, by further increasing the out-of-pocket cost sharing of deductibles, copayments and coinsurance, by tiering cost sharing of different levels of products and services, and by further restricting the panels of approved health professionals and institutions.

When the employee uses the defined dollar amount to purchase plans from the choices offered, but must pay the full balance of the premium, most will choose lower cost plans that place them at very high risk for out-of-pocket expenses should they or their family members need health care. This is the disaster that is pending. Employees will not be able to afford the care that they or their families need, in spite of being nominally insured by their employers.

From a policy perspective, we can understand why employers would want to control their overhead expenses, in this case by protecting themselves from health care inflation, but we can't understand why policymakers would want to keep employers in charge of health care financing for the majority of Americans, and then add further insult by perpetuating regressive tax policies that favor wealthier employees over those with lower incomes.

With this defined contribution threat looming, we should once and for all remove the employer from the equation. Let's replace our health care financing system with a much more sensible and equitable single payer national health program, which would remove from employers the burden of having the responsibility of supervising

[Doc]

Despite the Supreme Court leaving most of President Obama's health care law intact, the prognosis is still grim for America's broken health care system.

Republican governors and conservative state legislators are already planning to reject the Medicaid expansion envisioned in the health care law.

This will leave millions of low-income Americans without any kind of health care coverage, in addition to the tens of millions we already knew the law wouldn't cover.

And Republicans in Congress are determined to repeal the law -- and they might gain the power to do so in the next election.

We need to solve America's health care crisis, and we know it may take awhile. So with health care reform back in the public debate, we need to start advocating now for the real solution: single-payer health care.

Tell Democrats: Support Medicare for All. Click below to sign the petition.

http://act.credoaction.com/campaign/medicare_for_all/?r_by=42925-3676060-wynJeIx&rc=paste1

[Doc]

American Medical News
July 9, 2012
How to split the health care dollar (America’s Health Insurance Plans meeting)
By Emily Berry

Payers are well aware that physicians and hospitals need the kind of business expertise that insurers have held almost exclusively until now: how to track claims, coordinate care, administer case management and deploy a new records system.

Health insurers are offering physicians and health systems access to that expertise — for a price. UnitedHealth Group’s enormously profitable Optum subsidiary is one example of that business angle. Indeed, Dr. Safavi said, some hospitals and doctors may be in a position of paying Optum for consulting and information technology expertise so they can be prepared for the demands that United and other insurers will make under new payment models. They will have to pay United before they can get paid by United.

http://www.ama-assn.org/amednews/2012/07/09/bisa0709.htm


Comment: What did you expect? As long as private insurers are left in charge, as they are under the Affordable Care Act, they will always figure out a way to work the system to benefit themselves. We really do need to replace them with a single payer system.

[Doc]

The Washington Post
July 9, 2012
Seasonal firefighters face many dangers without health insurance; union seeks federal coverage
By Associated Press

They work the front lines of the nation’s most explosive wildfires, navigating treacherous terrain, dense walls of smoke and tall curtains of flame. Yet thousands of the nation’s seasonal firefighters have no health insurance for themselves or their families.

The National Interagency Fire Center in Boise, Idaho, which coordinates firefighting efforts nationwide, says 15,000 wildland firefighters are on the federal payroll this year. Of that number, some 8,000 are classified as temporary seasonal employees, who work on a season-to-season basis with no guarantee of a job the following year and no access to federal benefits.

In two years, the Affordable Care Act, the new federal health care law, will allow seasonal firefighters the same opportunity to buy health insurance as other uninsured Americans.

http://www.washingtonpost.com/national/health-science/seasonal-firefighters-face-many-dangers-without-health-insurance-union-seeks-federal-coverage/2012/07/09/gJQAUMWHZW_story.html


Comment: Very few would disagree with the principle that firefighters and their families should be covered with health insurance, even if only seasonally employed. The question then is, should that coverage be provided by the government as the employer?

The issue of health insurance coverage faces all seasonal employees. If coverage is provided, would it be only during the period of employment? Would off-season employment in other occupations be the source of intermittent and therefore fragmented coverage? Would being unemployed off-season qualify the family for Medicaid, again with fragmentation of coverage?

Does the ability to purchase coverage through state exchanges, to be established under the Affordable Care Act, provide adequate opportunities for coverage in these populations with fluctuating incomes, with varying eligibilities for coverage or for subsidies? Are the rules that allow exemptions, based on income, from the mandate to purchase coverage an adequate solution, since it means that the family would remain uninsured?

With variations in the type of coverage and especially in the composition of provider networks between various employer-sponsored plans when there may be more than one employer during the year, or with intermittent coverage under Medicaid, or with individual plans purchased through the exchanges, or with dependency on charity or safety-net institutions during periods while uninsured, is this disruption and fragmentation an acceptable standard for coverage for these families? No.

It would be less expensive and more efficient to provide one single coverage throughout life - coverage that provides choice of health care professionals and institutions. Employment status should no longer be a factor in determining health benefits, choices in health care, and even whether or not one is covered at all. An improved Medicare that covered everyone would finally bring an end to our irrational current and ACA-pending methods of financing health care.

[Doc]

We Still Need Medicare for All!

The Supreme Court upheld the Affordable Care Act--including the individual mandate to purchase private health insurance.

Even with the mandate, the ACA leaves at least 26 million people uninsured, fails to reduce healthcare costs, and keeps multimillion dollar for-profit private insurance companies up and running (who will undoubtedly find ways to weasel out of any positive aspects of the ACA).

Since the ACA is clearly a flawed law, let's focus on expanding and improving what we already know works: Medicare.

Send an email to Congress and the President with the following message: We're not done yet! The Affordable Care Act leaves millions of people uninsured and does nothing to reduce costs. Medicare is loved, cost-effective and should be improved and expanded to cover everyone under a national, single-payer healthcare system.

To be more effective, call Congress after you send an email.

[Doc]

Letter
July 10, 2012
From: Kathleen Sebelius, Secretary of Health and Human Services
To: State Governors

Excerpt:

As you know, beginning in 2014, the Affordable Care Act provides for the expansion of Medicaid eligibility to those adults under age 65 with incomes up to 133 percent of the federal poverty level who were not previously eligible for Medicaid. The Supreme Court held that, if a state chooses not to participate in this expansion of Medicaid eligibility for low-income adults, the state may not, as a consequence, lose federal funding for its existing Medicaid program. The Court's decision did not affect other provisions of the law. For example, the decision did not change the fact that the federal government will completely pay for coverage under the eligibility expansion in 2014-2016, and for at least 90 percent of such costs thereafter, or that states have flexibility to design the benefit package for the individuals covered.

Ultimately, I am hopeful that state leaders will take advantage of the opportunity provided to insure their poorest working families with unusually generous federal resources while dramatically reducing the burden of uncompensated care on their hospitals and other health care providers. If any state were to choose not to do so, the Affordable Care Act exempts individuals who Congress determined cannot afford coverage from the individual responsibility provision. As to the very small number of affected individuals who would not quality for the statutory exemption, Congress provided additional authority, which we intend to exercise as appropriate, to establish any hardship exemption that may be needed.

http://capsules.kaiserhealthnews.org/wp-content/uploads/2012/07/Secretary-Sebelius-Letter-to-the-Governors-071012.pdf


Comment: It is outrageous that some governors are refusing to provide coverage to low-income adults, even though the Affordable Care Act authorizes the federal government to pay most of the costs of this expansion in the Medicaid program. So what is the Obama administration doing to be sure that these individuals become insured?

Many of these low-income adults who are not yet included in the state Medicaid programs are so poor that they will qualify, under ACA, for an exemption from the "individual responsibility provision" - the penalty or "tax" that must be paid for not being insured. Thus they have the explicit right to remain uninsured without being penalized for being so.

Others are still poor, but fall above the threshold for the exemption from the individual responsibility provision. It is for this sector that the administration is taking action. They are making the generous offer to exercise their authority to provide exemptions for these additional individuals from the penalty or tax that would otherwise be assessed for not being covered by an extension of a Medicaid program that the governors refuse to authorize, or for not purchasing a plan in an insurance exchange that they can't possibly pay for even with the subsides provided (not to mention that most of these very low-income adults were presumed under ACA to be covered by Medicaid, thus the law seems to lack provisions for them to be allowed to receive subsidies for purchase of plans in the exchanges).

Wow. The most needy population is being left out and all the administration can do is to relieve them of the financial penalties they would owe for being uninsured?

To be fair, this is not simply a response of an uncaring president and his administration. They have an irreparably flawed health care financing system with which to work. But the administration should be lambasted for not just cooperating with but also for leading with the planning and implementation of such an unmerciful system.

This system is beyond repair. We need to replace it with a humane, equitable and efficient single payer national health program that would take care of the health care needs of all of us.

[Doc]

Center for Studying Health System Change
July 2012
Dispelling Myths About Emergency Department Use: Majority of Medicaid Visits Are for Urgent or More Serious Symptoms
By Anna Sommers, Ellyn R. Boukus, Emily Carrier

Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments (EDs) for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a new national study by the Center for Studying Health System Change (HSC). About 10 percent of nonelderly Medicaid patient ED visits are for nonurgent symptoms, compared with about 7 percent for privately insured nonelderly people.

Misconceptions

Policy makers and providers frequently point to Medicaid patients’ heavy reliance on hospital emergency departments as a problem that contributes to crowded emergency departments, long wait times and high costs, as well as poor management of chronic conditions. Recent research has dispelled misconceptions linking ED use to crowding, finding that most crowding results from emergency patients admitted to the hospital but waiting for an inpatient bed—so-called ED boarding—not a high volume of nonurgent ED visits. Other research has dispelled the mistaken belief that most ED users have Medicaid coverage, are uninsured or do not have a usual source of care. In fact, people with private insurance account for most ED use, and people with higher incomes and a private physician as their usual source of care are driving ED visit increases over time.

Other misconceptions about Medicaid patients’ ED use continue to drive policy. In response to state budget crises, some Medicaid programs have sought to cut ED use by denying payment for emergency care viewed as unnecessary, increasing patient cost sharing to discourage visits and penalizing patients for too many ED visits—all based on the assumption that Medicaid patients commonly use EDs to evaluate symptoms that could wait for a primary care clinician to treat. Media coverage of so-called frequent flyers—a small number of people with hundreds of ED visits—may have contributed to commonly held views that Medicaid and uninsured patients often use emergency departments inappropriately.

http://www.hschange.com/CONTENT/1302/


Comment: In an effort to control health care spending we are seeing efforts to punish Medicaid patients for their excessive use of our Emergency Departments (EDs). This reports adds to the policy literature that confirms that this premise is flat out wrong. Just like privately insured patients, most Medicaid patients use EDs for urgent and emergency conditions.

Rather than penalizing patients for attempting to receive urgent care that they should have, we should direct our efforts to incorporating health system design changes that would improve access to urgent care services, both through EDs and through other community resources such as extended-hour practices and urgent care centers. As an example, EDs could use community physicians during peak hours to provide care for less intensive problems that have been sorted out by triage.

With a single payer system we could adjust incentives to encourage more effective and efficient use of our health care delivery system. Under our current fragmented financing system, dominated by private health plans and perpetuated by the Affordable Care Act, rational coordination of care for urgent conditions is not possible because of conflicting interests, financial and otherwise.

We can do a much better job of getting our priorities straight through a single payer national health program.

[Doc]

The Washington Post
July 9, 2012
Terror among the rich
By Richard Cohen

I wrote last year that Obama had lost the Hamptons. Nothing has changed. He is roundly denounced for not doing a Heimlich on the economy, for his allegedly socialist ways, for Obamacare, for low employment, for high unemployment, for not returning phone calls, for not asking advice — for being cold, distant and, increasingly, just for being president of the United States. The man, it seems, has to go.

I share some of these sentiments. The economy remains in the doldrums, the occasional good month followed by two or three bad ones. Obama is something of a cold fish, which may be something he cannot help, but he is also a lazy politician, unwilling — not unable — to do the telephoning and backslapping that his job requires.

As for Obamacare, it is both a legal and programmatic mess not because it is even modestly socialist but because it is not socialist enough. A government-run health-care system such as the ones used in virtually all the industrialized world — the so-called single-payer system — would have been the way to go. Instead, we have a system in which private insurance companies will abuse doctors and patients alike in the cause of profit. This, alas, truly is the American Way.

http://www.washingtonpost.com/opinions/richard-cohen-obama-the-ineffable/2012/07/09/gJQA3mcCZW_story.html


Comment: Obviously, this quote is being distributed because of the strong endorsement of single payer, a vastly superior model of financing health care when compared to the current "American Way" of using private insurance companies.

Although, in this opinion article, Richard Cohen blasts President Obama for his, shall we say, inaction, he doesn't include here the difficulties Obama faced from the obstructionism by the opposition party, nor from the inaction of the electorate which suffers from a combination of being uninformed and misinformed, thus unable to advocate effectively for policies that would benefit us all. Of course, the candidate of the opposition party spent the weekend in the Hamptons hauling in millions in campaign donations from the "terrified rich," thus offering little hope that the November elections would bring us any relief from our political quagmire.

Political leaders do not lead; they follow. We will have to lead by promoting education, coalitions, and grassroots efforts. It will be not be easy, but there is no substitute for massive citizen activism.

[Doc]

It would have been easier to go to a single-payer system ("Improved Medicare for All") if the Affordable Care Act was found to be unconstitutional, which I think it is.

After reading the Preamble to the Constitution and the Declaration of Independence, I can't help but think that forcing Americans to purchase private health insurance (defective at that) is criminal. Talk at present is mostly about politics and the coming elections rather than what is wrong with the ACA.

Gone for now, as we protect President Barack Obama, is that he took single-payer health care off the table, or that three-fourths of the American people want the government to undertake a new effort and start over on health care reform, or that 70 percent of the American people want a single-payer system. The talk, especially from the Democrats, will be that the ACA is a good start.

The American people will think that everybody will be covered with quality and affordable health care under the ACA, but this is something the ACA and private health insurance cannot do. So we ask ourselves, if these cannot work, then why are we waiting to implement a system that will work — an "Improved Medicare for All" system?

If the Supreme Court had found the ACA mandate unconstitutional, we could have said, "Mr. Obama, give us an 'Improved Medicare for All' system." Medicare for seniors was implemented in one year. We could have said, "Mr. Obama, forget about this bad health care plan that the insurance companies put together, and let's do what's right. Let's save that $1 trillion bailout we are giving the private insurance companies and let's do something about this rising cost of health care."

Well, that is out of the question for now. Hopefully, we will only have to wait until after the presidential election in four months. Until then, we can sit back and watch people suffer, hoping that it will not be us or our families. Candidates running for office can say that the ACA is a good start, but will they also say that private health insurance does not work and we must go to a single-payer system as soon as this election is over?

Don't kid yourself: We must go to a single-payer system as soon as possible. The ACA will have high deductibles, co-pays and out-of-pocket costs. The ACA could cause individuals to go bankrupt if they get a major illness either themselves or in their family. Under this law, we will have un-insurance, under-insurance, and unaffordability. We will have as high as 30 percent of premiums going to insurance companies for their administration and profits. And we will have private corporations buying and controlling our health care facilities. With a single-payer system, we will have global budgets for our hospitals and clinics, which will solve much of our broken fragmented system.

The longer we allow private, for-profit health care to dominate the system, the richer and more powerful they become. Let's send them packing.

[Doc]

The Commonwealth Fund
July 2012
Oceans Apart: The Higher Health Costs of Women in the U.S. Compared to Other Nations, and How Reform Is Helping
By Ruth Robertson, David Squires, Tracy Garber, Sara R. Collins, and Michelle M. Doty

Abstract

An estimated 18.7 million U.S. women ages 19 to 64 were uninsured in 2010, up from 12.8 million in 2000. An additional 16.7 million women had health insurance but had such high out-of-pocket costs relative to their income that they were effectively underinsured in 2010. This issue brief examines the implications of poor coverage for women in the United States by comparing their experiences to those of women in 10 other industrialized nations, all of which have universal health insurance systems. The analysis finds that women in the United States — both with and without health insurance — are more likely to go without needed health care because of cost and have greater difficulty paying their medical bills than women in the 10 other countries. In 2014, the Affordable Care Act will substantially reduce health care cost exposure for all U.S. women by significantly expanding and improving health insurance coverage.

From the Conclusion

When fully implemented, the Affordable Care Act will correct much of the inequity in the U.S. system. A substantial expansion of affordable health insurance options is expected to reduce the percentage of uninsured working-age women from 20 percent to 8 percent.

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Jul/1606_Robertson_oceans_apart_reform_brief.pdf


Comment: Over 35 million working-age women in the United States potentially face financial hardship should they need health care either because they are uninsured or because their insurance exposes them to excessive out-of-pocket expenses. That's not acceptable.

The authors of this Commonwealth Fund report note how the Affordable Care Act "will correct much of the inequity in the U.S. system." But not enough. Not only will underinsurance remain a problem, 8 percent of working-age women will have no insurance at all. That's not acceptable either, especially since we already know how to fix our system and can afford to do so. We simply have to do it.

[Doc]

DesMoinesRegister.com
July 16, 2012
Head-in-the-sand 'solution' is killing GOP
By Jack Bernard

We Republicans have ourselves to blame for the Affordable Care Act, or Obamacare.

Our reaction to the Clinton health reform proposals in the early 1990s was to have conservative think tanks come up with a free competition model based on expansion of private insurance and Medicaid. That idea became Romneycare, which evolved into Obamacare.

It is our baby, ugly or not.

It is the height of hypocrisy for us now to criticize our own idea unless we have something better to replace it. And, the replacement needs to be comprehensive, not just a series of unacceptable statements and proposals based on doing away with traditional Medicare by turning it into a voucher program and gutting Medicaid by making it into a block grant.

Using vouchers for Medicare just dumps the cost problem into the lap of the powerless patient, rather than the federal government that has clout, making the cost escalation problem worse. The block grants for Medicaid idea just shifts the cost issue onto the states rather than the federal government, which once again solves nothing and only makes things worse.

States will just cut services and people from their Medicaid roles, creating more uninsured. Don’t Iowa hospitals serve enough uninsured in their emergency rooms now?

This gets us to what we as Republicans should do: throw out our rule book and be innovative. People my age will remember how we Republicans were 100 percent against recognizing China before Richard Nixon, the anti-communist crusader, came out for it. We must do the same with health care.

There is only one way to control health care costs and insure universal access — and that is by first admitting that the U.S. system has failed and then adopting ideas that have been proven to work elsewhere. We should take a look at how health care is financed and delivered in other developed nations with lower cost and better morbidity and mortality rates.

A Commonwealth Fund study was issued in May 2012 which did just that for 13 countries. The bottom line is that we spend 17.4 percent of our gross national product on health care, far more than other developed nations, which averaged 9.5 percent. Our per-capita spending was $7,960 versus $3,182 for the group as a whole.

Why? One key factor is prices. For example, U.S. pricing on the 30 most commonly prescribed brand name drugs is one-third higher than Canada and double France, both of which have a form of Universal Medicare.

From looking at the international data, if we Republicans really want to dump the Affordable Care Act, the way to go is Medicare for all. Studies show that the nations with universal health care have better overall health care outcomes than we do, not worse.

And, according to the respected Physicians for a National Health Program, www.pnhp.org, yearly savings generated under Medicare for all would be $400 billion. That would go a long way towards paying for universal coverage, versus the Affordable Care Act, which will increase systemic costs because it relies on private insurance.

The canard about waiting times to see doctors is just a tactic to scare the public. If you need a knee replacement for a knee that has been going bad for years, waiting a little longer for an operation should not be a major issue for the patient. Despite the scare tactics, no one who needs immediate care in Canada is ever left to sit in a line. In any case, there should be no waiting lists at all here. Canada spends just $4,363 per capita on health care versus our $7,960.

If we Republicans took the Medicare-for-all approach, it would thrust us into the vanguard of reform. Instead of the Democrats stealing our ideas, we could steal theirs. When it was implemented and turned out to be widely accepted, as was Medicare in the 1960s, we would be the party the public would look to for the future.

Of course, there is an alternative. We can stick our heads in the sand and push for infeasible actions. That approach is killing us regarding immigration and will work just as well for health care.

(JACK BERNARD of Monticello, Ga., is a retired health care executive who worked extensively with Iowa health care providers, including Iowa Health System. He now is a member of the Jasper County (Ga.) Board of Commissioners and Jasper County Board of Health. Contact: bernard_jack@hotmail.com)

http://www.desmoinesregister.com/article/20120716/OPINION01/307160040/


Comment: This article should be distributed widely. Although it is written by a Republican, targeting his fellow Republicans, if his party can understand this message, then the Democrats and others who bailed on Medicare for all should be able to understand it as well.

[Doc]

Nurses Union Will Keep Fighting for Medicare for All
Rose Ann DeMoro | JuNurses ly 17, 2012

Now that the Supreme Court has upheld the Affordable Care Act, former insurance company executive Wendell Potter’s appeal to single payer advocates to “bury the hatchet,” recently published in The Nation [1], is both misdirected and shortsighted.

Potter argues that insurance industry pirates will exploit left critiques of the ACA to subvert implementation of the law. He calls on proponents of more comprehensive reform to forgive and forget, embracing the massive concessions made by the Obama administration and its liberal allies.

But there are some gaping holes in this thinking.

First, the insurers hardly need to rely on the single-payer movement to sabotage elements of the law they don’t like. They have office towers full of high-priced lawyers who are adept at identifying loopholes in the much-touted consumer protection provisions, like the bans on pre-existing condition exclusions or dropping coverage when patients get sick, or limiting how much money can be siphoned off for profits and paperwork.

Second, let’s not have illusions about the history of the ACA.

Before he was elected, President Obama, an advocate of single-payer when he was in the Senate, called on progressives to push him. Instead, most of the liberals reduced themselves to cheerleading while all the pressure came from the right.

So when the healthcare bill was introduced, the President, with the active encouragement of groups like Health Care for America Now, blocked single payer from consideration. Persuading people through consent, rather than coercion, to accept inadequate solutions for societal needs has long been a key feature of the neoliberal agenda. It's one reason so many people vote against their own interests.

To get any hearing from Sen. Max Baucus, who was running the Senate side of the debate, nurses, doctors, and single-payer healthcare activists had to get arrested in a Senate Finance Committee hearing. On the House side, Democrats who proposed single payer amendments endured heavy-handed threats from then-White House chief of staff Rahm Emanuel. Meanwhile, then-Press Secretary Robert Gibbs publicly attacked the “professional left” who will only “be satisfied when we have Canadian healthcare and we’ve eliminated the Pentagon.”

It should not come as a surprise that negotiating with your supporters before engaging political opposition, and lecturing, hectoring and seeking to silence healthcare activists who have worked for years for real reform, Obama and the Democrats ended up with a weaker bill. That bill lacked the public option HCAN and other liberals had claimed would be their bottom line, while HCAN and other liberals embraced the individual mandate – the brainchild of the rightwing Heritage Foundation – as high principle.

Even with its positive elements – yes, it does have some – the Affordable Care Act uses public money to pad insurance profits (the subsidies to buy private insurance), prevents the government from using its clout to limit price gouging by the pharmaceutical giants, does little to effectively control rising healthcare costs for individuals and families that have made medical bankruptcies and self-rationing of care a national disgrace, and falls far short of the goal of universal coverage.

We can, as Michael Moore has said [2], acknowledge that the Supreme Court decision was a defeat for the opponents of any reform of our healthcare system without pretending that our nation’s health care crisis is over.

For three weeks in June and July, the California Nurses Association/National Nurses United sponsored a tour that drew about 1,000 people to free basic health screenings and another 2,000 to town hall meetings in big cities and rural communities across California. We heard a lot of stories like this one, from Carolyn Travao of Fresno:

I worked for Aetna health insurance for 15 years. When I took early retirement, I thought my Cobra would be manageable. Then they sent me a bill in January for $1,300 a month and I couldn’t pay it.



Soon after,

I had a heart attack. I knew I didn’t have health insurance. I have a mortgage. I had a 401(k) that I knew would get wiped out, so I didn’t go to the hospital. I stayed at home for 16 hours, suffering chest pains, praying that I would die because my son would be left homeless and I do have insurance to pay off my mortgage so if I die he would at least have a home. I couldn’t take the pain any longer and I kept passing out, and he kept saying "Mom, you’re going to die."

“OK," I said, "take me to emergency." So we went to emergency. But when I got home, my bill was $135,000. I have $13,000 left in my 401k. I don’t think I can even start [paying]. I never thought I would lay there and want to die. But I would have rather died knowing that my son would be left homeless with no job.



Since the ACA’s cost control mechanisms for insurance companies are so weak – for example permitting insurers to charge far more based on age and where you live – and hospitals will still largely have free reign to impose un-payable bills, will Carolyn and millions like her really have guaranteed healthcare under the ACA?

Sadly, nurses who have seen far too many patients like Carolyn know the answer all too well. That is why nurses and our organization will never stop fighting for guaranteed healthcare based on a single standard of quality care for all that is not based on ability to pay and is not premised on protecting the profits of healthcare corporations that long ago wrote off patients like Carolyn Travao.

Unlike Wendell Potter and many of the liberals, nurses see the ACA as a floor, not a ceiling. It’s time now for those who say they recognize its limitations and believe in genuinely universal healthcare to join us in pushing for an improved and expanded Medicare for all.

Nurses respect the president. But they love their patients far too much not to go the distance for their patients’ health and survival.
Source URL: http://www.thenation.com/article/168928/nurses-union-will-keep-fighting-medicare-all

[Doc]

The Nation
July 11, 2012
The Battle for Healthcare Has Just Begun
By the Editors

If you thought the battle over healthcare reform came to an end when the Supreme Court declared the Affordable Care Act’s individual mandate constitutional, think again. The fight is just beginning. On one side the Republican Party and its big money allies aspire to defeat President Obama, take control of Congress and repeal the largest piece of domestic legislation in forty-five years. Mitt Romney’s plan is even more regressive. He’d not only eliminate insurance for the 30 million Americans covered by the ACA; he would change the way the industry is taxed and regulated, turn Medicare into a voucher program and transform Medicaid into a block grant, which together would strip access to healthcare from as many as 28 million Americans who are currently insured.

On the other side are people-powered progressives determined to implement the law and strengthen its less than ideal aspects to achieve universal coverage (see Wendell Potter, page 4). Under the ACA, for example, states will be empowered to create state-based single-payer systems. Vermont has already passed such legislation, and advocates in California are pushing a similar plan, passed by the legislature twice, only to be vetoed both times by then–Governor Schwarzenegger.

But if the fast and furious attack from the right is any indication, we have our work cut out for us. As many as eight Republican governors—led by Tea Party ideologues like Florida’s Rick Scott, Wisconsin’s Scott Walker, South Carolina’s Nikki Haley, Texas’ Rick Perry and Louisiana’s Bobby Jindal—have refused to implement the law’s expansion of Medicaid to cover some of America’s poorest. In Florida, that would affect some 1.3 million people who make less than 133 percent of the federal poverty level (about $31,000 a year for a family of four). In Texas, where 25 percent of residents are uninsured—the highest rate in the nation—Perry’s intransigence would leave 1.8 million out in the cold.

This cruel, cynical agenda has been enabled by a cabal of groups bankrolled by the 1 percent, such as the Chamber of Commerce and Karl Rove’s Crossroads GPS. Even before the Supreme Court decision came down, these organizations had spent some $235 million on attack ads vilifying “Obamacare,” and they are on track to spend much more by November. Already the Koch-backed Americans for Prosperity has launched a $9 million campaign against the ACA and the Democrats who voted for it. Concerned Women for America has pledged another $6 million.

These ads and the rhetoric emanating from the Tea Party guvs are nothing but open fearmongering and baldfaced lies. They insinuate that the ACA would ration healthcare (in fact, the ACA rations it no more or less than the current system). Governor Scott justified his refusal to expand Medicaid by claiming it would add $1.9 billion to Florida’s budget (though the federal government funds 100 percent of Medicaid expansion in the first three years, and Florida’s own healthcare agency estimates it would cost the state far less). Not to be outdone, Rush Limbaugh hysterically called the ACA the “biggest tax increase in the history of the world” (when, in fact, it contains tax breaks for middle-class Americans).

These lies have done a great deal of damage. Many people are confused about what the act does and does not do, creating a debate that seems to take place in an alternate reality. The stakes in this fight, then, are profound: the health of millions of Americans, of our shared social safety net and—not least—of our democracy itself.


Comment: It is disappointing to see that the editorial position of The Nation has framed the current status of the health care debate as, on the left, a determination to "implement" and "strengthen" the Affordable Care Act, and, on the right, an effort to "repeal" ACA.

The objection is not with the characterization of the right, but with the implication that the left has settled on a right-center approach designed by conservatives. Token mention is made of the Vermont and California efforts to enact single payer, but, in fact, states do not have the option of diverting federal funds from programs such as Medicare and Medicaid into a state-based single payer program, nor can they bypass federal requirements such as the ERISA restrictions, usurping funds from employer-sponsored self-insured plans.

All the tweaking in the world cannot repair the highly-flawed, fragmented, and egregiously administratively wasteful model of ACA. It needs to be replaced with a bona fide model of social insurance - the most appropriate for the United States being a single payer, improved and expanded Medicare that covers everyone.

Also, it is a mistake to be hung up on a left-right linear polarity when the issue of health care justice should be much more inclusive. In an article this week in the Des Moines Register, retired health executive Jack Bernard stated, "If we Republicans took the Medicare-for-all approach, it would thrust us into the vanguard of reform. Instead of the Democrats stealing our ideas, we could steal theirs."

The Democrats did steal the Heritage model which was originally introduced by Republicans as a conservative response to the Clinton proposal. Democrats have now succeeded in enacting it, but what a terrible model. It will leave tens of millions uninsured while creating a new standard of underinsurance, imposing financial hardship on those with health care needs.

Everyone should read Jack Bernard's article, and then we should see if we can get past the simplistic polarization to bring us together to improve our health as individuals and to improve the health of the nation.

Jack Bernard, "Head-in-the-sand 'solution' is killing GOP":
http://www.desmoinesregister.com/article/20120716/OPINION01/307160040/

[Doc]

Health Affairs
July 18, 2012
Medicare Beneficiaries Less Likely To Experience Cost- And Access-Related Problems Than Adults With Private Coverage
By Karen Davis, Kristof Stremikis, Michelle M. Doty and Mark A. Zezza

The 2010 survey results indicate that compared to people who are privately insured, Medicare beneficiaries are less likely to have cost-related access problems, high premium and out-of-pocket health care expenses as a share of income, and financial problems because of medical bills. And compared to nonelderly adults with employer-based coverage, Medicare beneficiaries are more likely to have access to a medical home—a primary care provider who knows their medical history well, is accessible, and helps coordinate their care. Studies show that patients with medical homes are less likely to report medical errors or gaps in the coordination of their care and are more likely to be up-to-date with their preventive care.

Given these findings, it is not surprising that Medicare beneficiaries are far less likely than privately insured adults to give their health insurance plan a fair or poor rating, while being far more likely to report excellent quality of care.

Among Medicare beneficiaries, those with Medicare Advantage are more likely than adults with traditional Medicare to give their insurance a fair or poor rating. Although Medicare Advantage enrollees are less likely to spend 10 percent or more of their income on premiums and out-of-pocket expenses, they are more likely to report cost-related access problems than adults with traditional Medicare. This may in part reflect beneficiaries’ experience with private health maintenance organization plans that offer lower premiums in return for limited access to a smaller network of providers.

The evidence reported here from surveys now spanning a decade shows that Medicare is doing a better job than employer-sponsored plans at fulfilling the two main purposes of health insurance: ensuring access to care and providing financial protection.

http://content.healthaffairs.org/content/early/2012/07/16/hlthaff.2011.1357.abstract

Summary by The Commonwealth Fund:
http://www.commonwealthfund.org/~/media/Files/Publications/In%20the%20Literature/2012/Jul/1613_Davis_Medicare_vs_employer_ins_HA_07_18_2012_ITL.pdf


Comment: One of the goals of the Affordable Care Act was to protect private, employer-sponsored health plans - a sector that was considered to be functioning well. In so doing, a less expensive Medicare for all model was rejected. So how do the private plans compare to Medicare?

According to this report, "Medicare beneficiaries are less likely to have cost-related access problems, high premium and out-of-pocket health care expenses as a share of income, and financial problems because of medical bills. And compared to nonelderly adults with employer-based coverage, Medicare beneficiaries are more likely to have access to a medical home - a primary care provider who knows their medical history well, is accessible, and helps coordinate their care," and are "far more likely to report excellent quality of care."

Medicare is not perfect and does need improvement, but it performs far better than the best of the private plans - the employer-sponsored health plans. Individual and small group plans have an even worse performance.

Above all, "Medicare is doing a better job than employer-sponsored plans at fulfilling the two main purposes of health insurance: ensuring access to care and providing financial protection."

Right now, efforts are being made to convert Medicare into a market of private plans. Why should we pay more for less health care choice, greater risk exposure, and poorer quality? Any sane individual who is paying attention should realize that we should be doing the opposite - improve Medicare and then provide it for everyone.