Twin Cities Daily Planet
Musician and activist John Kolstad got involved in the health care debate back in the 1990s when he and a group of people informally studied it in a series of study circles where they’d discuss and study art, books and politics. Then the issue of health care came up. As the owner of Mill City Music, Kolstad is responsible for purchasing his and his wife’s health insurance. “I studied advanced physics and music, and I do some pretty good at those—but I could not understand my health policy,” Kolstad said. “It was maddening.” As he delved into the subject, first through his study circle and then as a concerned citizen, Kolstad became a proponent of universal, single-payer health insurance.
You're a musician. How does access to health care uniquely affect artists?
Originally I was thinking of this from the point of view of a small business owner. Then you realize that artists are small businesses too. Musicians and artists are people who have been revered by every single culture for years, but look at what we do to our musicians here. They have to fend for themselves because they are often self-employed. I’ve lost some friends because of that, and now I’ve been trying to get some of my artist friends to actually talk to the public about health care.
I was involved in an event with artists for health care in May, and a lot of artists got a concert type event together. I wasn’t sure how that would work, but we had speeches and then Pop Wagner came out and did these rope tricks and would talk about the health care system (his friends had gotten together for him to help raise his deductible, which was $10,000). Then Kevin Kling got up and told about his brush with the health care system. It was great. So this is something that affects a lot of people and there are more and more stories out there and they’ve got to be told.
Why are you advocating for the Minnesota Health Plan?
When we were reading about this back in the 1990s in our study circles, we were looking at all kinds of studies, including about of the experience of Europe. We realized that European countries are spending half as much money for the same results, depending on what outcomes you use. We were reading and picking apart all the bills being proposed, including one being proposed by Wellstone at the time, and it just became very obvious that of all these different approaches, single-payer was the best option.
What have you found to be the biggest challenge about pushing single-payer in Minnesota?
I tell you, my big shock was back when I was learning about this. I thought, “I just gotta go to the people in the DFL and let them know we gotta do this.” And I thought the DFL would fall over themselves. But the DFL wasn’t interested! At one time we had a convention and every single delegate supported single-payer, but the leadership of the party was not interested in solving this problem, or if they were they weren’t interested in going up against the insurance companies.
The insurance companies have lots and lots of money—and I’m not against corporations, my business is a corporation itself—but it’s hard to go up the insurance companies when they have so much money. So campaign finance reform is tied to health care in a major way.
So what do you see as the next step?
I think the media is losing its credibility and they’ve failed to tell the people of our state important information about health care. I tell you, now that I’ve heard so many presentations and sifted through all the bills and information on this—and I’ve sifted through a lot—I think that if the people of Minnesota knew what was going on, they would realize that this can’t be solved any other way. So the question is how do we get to the people of the state to recognize it?
I was involved in creating the Metro Independence Business Alliance, a coalition of independent businesses. One of the motivations for businesses to join is so they can pool together their collective clout. It took us a couple of years to get to where we could talk about health care. But then we invited our membership and we had three presenters on why small businesses should support single payer. The whole board has unanimously endorsed single payer and the John Marty bill. That’s the ticket though. It’s about, how do we keep the people of Minnesota informed and how do we go up against false information?
Why is it so hard for people to talk about single payer?
You know, the solutions are all around us and the only thing that’s blocking us is lobbyists and campaign money.
Wednesday, June 29, 2011
Tuesday, June 28, 2011
Declines in physician acceptance of Medicare less than private coverage
By Tara F. Bishop, MD, MPH; Alex D. Federman, MD, MPH; Salomeh Keyhani, MD, MPH Archives of Internal Medicine
A number of articles in the lay and medical press report a decline in the number of physicians who accept patients with Medicare; however, to our knowledge, recent trends in acceptance of different types of insurance have not been examined. Using data from a national survey of physicians, we examined trends in physician acceptance of different types of insurance and self-pay patients.
Results
The percentage of physicians accepting new patients did not vary significantly between 2005 and 2008, ranging from 94.2% to 95.3%. Physician acceptance of new Medicare patients dropped from 95.5% in 2005 to 92.9% in 2008 (P = .01). Physicians in private practice were largely responsible for the declining acceptance of Medicare patients as determined in stratified analyses (95.5% in 2005 vs 93.0% in 2008; P = .01) (eTable).
There was a more pronounced decline in physician acceptance of patients with private noncapitated insurance (93.3% in 2005 vs 87.8% in 2008; P < .001). A smaller percentage of adult primary care physicians accepted private noncapitated patients over the study period (97.3% in 2005 vs 89.9% in 2008; P < .001).
Rates of acceptance of new Medicaid and private capitated patients were lower than Medicare and private noncapitated insurance, but also showed a decline over the study period. Acceptance of self-paying patients was more than 96% in all years and did not change significantly over the study period.
While reports in the press highlight physicians' dissatisfaction with Medicare, we found only a small decline in physician acceptance of Medicare patients between 2005 and 2008. In contrast, the decline in physician acceptance of noncapitated privately insured patients was more pronounced. Physicians continued to accept patients who were self-paying.
Although physician reimbursement under Medicare is often cited as the reason why physicians turn away Medicare patients, our findings that more than 90% of physicians continue to accept Medicare patients despite marginal increases in reimbursement suggest that anecdotal reports may be overstating access problems.
The observed decline in acceptance of private noncapitated insurance was unexpected and could be related to reimbursement but also to administrative burden. Acceptance rates of capitated insurance was lower and may reflect lower reimbursement in this model. Finally, the low and declining acceptance of new Medicaid patients is not surprising given the program's historically poor reimbursement rate. Low rates of Medicaid acceptance may threaten access to care for the estimated 16 million Americans who will receive Medicaid coverage as a result of the Patient Protection and Affordable Care Act.
eTable. Percentage of physicians accepting new patients by insurance type, practice type, and specialty, 2005-2008:
Comment:
By Don McCanne, MD
The good news in this report is that the often stated claim that physicians are dumping Medicare patients in favor of privately insured patients is not really true, at least as of 2008. Although there has been a small decline in the numbers of physicians accepting Medicare, well over 90 percent still do. Contrary to claims otherwise, the decline in the acceptance of privately insured patients was even greater.
Examining the breakdown in the eTable (link above) reveals some other interesting though not unexpected findings. With the exception of community health centers, close to one-third of physicians do not accept new Medicaid patients. Even more do not accept privately insured capitated patients (paid a flat amount per month per patient rather than fee for service). Over half of HMOs do not accept self-pay patients, though acceptance rates for these patients is very high in private practices and community health centers.
Although cash paying patients had the best access, this report does not cover the potentially catastrophic consequences of being uninsured or inadequately insured (e.g, high deductibles). Having adequate insurance is essential. The new lower actuarial value standards of private insurance make them a less desirable model for expanding coverage. Also the chronic underfunding of Medicaid makes it a poor choice.
Although Medicare remains popular and is widely accepted, it does need to be improved. Once we do that then it would be the ideal program to cover everyone. Acceptance rates would be virtually 100 percent.
A number of articles in the lay and medical press report a decline in the number of physicians who accept patients with Medicare; however, to our knowledge, recent trends in acceptance of different types of insurance have not been examined. Using data from a national survey of physicians, we examined trends in physician acceptance of different types of insurance and self-pay patients.
Results
The percentage of physicians accepting new patients did not vary significantly between 2005 and 2008, ranging from 94.2% to 95.3%. Physician acceptance of new Medicare patients dropped from 95.5% in 2005 to 92.9% in 2008 (P = .01). Physicians in private practice were largely responsible for the declining acceptance of Medicare patients as determined in stratified analyses (95.5% in 2005 vs 93.0% in 2008; P = .01) (eTable).
There was a more pronounced decline in physician acceptance of patients with private noncapitated insurance (93.3% in 2005 vs 87.8% in 2008; P < .001). A smaller percentage of adult primary care physicians accepted private noncapitated patients over the study period (97.3% in 2005 vs 89.9% in 2008; P < .001).
Rates of acceptance of new Medicaid and private capitated patients were lower than Medicare and private noncapitated insurance, but also showed a decline over the study period. Acceptance of self-paying patients was more than 96% in all years and did not change significantly over the study period.
While reports in the press highlight physicians' dissatisfaction with Medicare, we found only a small decline in physician acceptance of Medicare patients between 2005 and 2008. In contrast, the decline in physician acceptance of noncapitated privately insured patients was more pronounced. Physicians continued to accept patients who were self-paying.
Although physician reimbursement under Medicare is often cited as the reason why physicians turn away Medicare patients, our findings that more than 90% of physicians continue to accept Medicare patients despite marginal increases in reimbursement suggest that anecdotal reports may be overstating access problems.
The observed decline in acceptance of private noncapitated insurance was unexpected and could be related to reimbursement but also to administrative burden. Acceptance rates of capitated insurance was lower and may reflect lower reimbursement in this model. Finally, the low and declining acceptance of new Medicaid patients is not surprising given the program's historically poor reimbursement rate. Low rates of Medicaid acceptance may threaten access to care for the estimated 16 million Americans who will receive Medicaid coverage as a result of the Patient Protection and Affordable Care Act.
eTable. Percentage of physicians accepting new patients by insurance type, practice type, and specialty, 2005-2008:
Comment:
By Don McCanne, MD
The good news in this report is that the often stated claim that physicians are dumping Medicare patients in favor of privately insured patients is not really true, at least as of 2008. Although there has been a small decline in the numbers of physicians accepting Medicare, well over 90 percent still do. Contrary to claims otherwise, the decline in the acceptance of privately insured patients was even greater.
Examining the breakdown in the eTable (link above) reveals some other interesting though not unexpected findings. With the exception of community health centers, close to one-third of physicians do not accept new Medicaid patients. Even more do not accept privately insured capitated patients (paid a flat amount per month per patient rather than fee for service). Over half of HMOs do not accept self-pay patients, though acceptance rates for these patients is very high in private practices and community health centers.
Although cash paying patients had the best access, this report does not cover the potentially catastrophic consequences of being uninsured or inadequately insured (e.g, high deductibles). Having adequate insurance is essential. The new lower actuarial value standards of private insurance make them a less desirable model for expanding coverage. Also the chronic underfunding of Medicaid makes it a poor choice.
Although Medicare remains popular and is widely accepted, it does need to be improved. Once we do that then it would be the ideal program to cover everyone. Acceptance rates would be virtually 100 percent.
Sunday, June 26, 2011
Federal spending: With regard to children's welfare, bucks stop here
The Oregonian
Think seniors are the victims in the current federal budget debate? Think again.
One of the hottest political issues in the coming election year will no doubt be how to shore up the Social Security program when the baby boomers start to retire en masse. This is an important issue that must be addressed, but it greatly overshadows a little-known fact: that it is children who get the short end of the stick when it comes to federal spending. The bulk of U.S. federal spending goes to defense, Social Security and Medicare. Children are not a budget priority despite decades of solid research showing the importance of investing in children ages 0-5, because these are critical years for brain development.
According to a 2010 report from the Urban Institute and the Brookings Institution, in 2009 less than 10 percent of federal budget outlays were devoted to children. To put this another way, in 2007 total public spending (federal/state/local) on children was $10,642 per child while public spending on older adults was $24,300 per adult. More shockingly, perhaps, is the finding that children's share of domestic federal spending shrank by 6 percentage points between 1960 and 2009 while spending on the nonchild portions of Social Security, Medicare and Medicaid doubled. Is this the result of societal attitudes that devalue children or the fact that senior citizens are a strong and mobilized voting bloc?
According to Lilian Katz, an expert in early childhood education, "Each of us must come to care about everyone else's children. ... The good life for our own children can be secured only if a good life is also secured for all other people's children." Other Western industrialized countries in Europe and Scandinavia have made this paradigm shift as demonstrated by public policies that invest in children, such as family allowances (a monthly stipend given to families regardless of income that helps to cover the cost of raising children), universal health care, government-subsidized child care for working parents and paid family leave, to name a few.
In contrast, U.S. rankings on international comparisons of child poverty, infant mortality and student performance in math and science are embarrassingly poor. Federal and state governments have often failed the young by allowing millions to forgo health care coverage; ignoring countless children who attend highly segregated, substandard schools; and looking the other way when children are failed by the state child welfare agencies designed to protect them.
A recent story of a 4-year-old child who was killed by her mother, after being abused and severely malnourished, made front-page news in The New York Times. The mother has been charged with murder, the grandmother with manslaughter. However, since this family was involved with child protection authorities, two city child-welfare workers are being prosecuted for criminally negligent homicide.
For decades, child-welfare advocates such as the Child Welfare League of America and the Children's Defense Fund have worked tirelessly to galvanize lawmakers to focus more on the welfare of children and the challenges facing child-welfare systems that are severely underresourced. However, there is one concrete step that could set us on the right path in seriously improving the lives of our nation's children.
President Obama should convene a White House Conference on Children, which would bring together child-welfare experts from across the country to review the current state of children in the U.S. and identify strategies for improvement. Starting in 1909, this conference was held every 10 years. However, the last one was held in 1970. Positive outcomes of previous conferences include the creation of the Child Welfare League of America; improvements in state regulation of child labor; the creation of the American Pediatric Society; and efforts to end the systematic institutionalization of children.
A White House Conference on Children would help to shine a spotlight on the needs of children. It could also help educate lawmakers on two important programs for children ages 0-5 that are supported by loads of research and offer a lot of bang for the buck: (1) early childhood education programs, and (2) home visiting programs, which provide support and parenting education to new parents. Even a divided Oregon Legislature sees the light. This session, it passed a joint memorial (HJM 12) urging Congress to convene a WHCC.
Our politicians often talk endlessly about "family values," echoing that "children are our future." In actuality, we are a nation that had a Society for the Prevention of Cruelty to Animals before a Society for the Prevention of Cruelty to Children. We are one of only two nations in the world that has failed to ratify the U.N. Convention on the Rights of the Child (the other is Somalia). And we are a nation that puts children at the bottom of the barrel when it comes to federal spending. A federal bill calling on the president to convene a WHCC failed in the 111th Congress.
Perhaps a new consciousness will emerge in the United States, expressed eloquently by author and activist Pearl S. Buck: "If our American way of life fails the child, it fails us all." Making sure that our parents and grandparents are taken care of in their golden years is priceless. Making sure that our children get a good start in life -- equally priceless.
Think seniors are the victims in the current federal budget debate? Think again.
One of the hottest political issues in the coming election year will no doubt be how to shore up the Social Security program when the baby boomers start to retire en masse. This is an important issue that must be addressed, but it greatly overshadows a little-known fact: that it is children who get the short end of the stick when it comes to federal spending. The bulk of U.S. federal spending goes to defense, Social Security and Medicare. Children are not a budget priority despite decades of solid research showing the importance of investing in children ages 0-5, because these are critical years for brain development.
According to a 2010 report from the Urban Institute and the Brookings Institution, in 2009 less than 10 percent of federal budget outlays were devoted to children. To put this another way, in 2007 total public spending (federal/state/local) on children was $10,642 per child while public spending on older adults was $24,300 per adult. More shockingly, perhaps, is the finding that children's share of domestic federal spending shrank by 6 percentage points between 1960 and 2009 while spending on the nonchild portions of Social Security, Medicare and Medicaid doubled. Is this the result of societal attitudes that devalue children or the fact that senior citizens are a strong and mobilized voting bloc?
According to Lilian Katz, an expert in early childhood education, "Each of us must come to care about everyone else's children. ... The good life for our own children can be secured only if a good life is also secured for all other people's children." Other Western industrialized countries in Europe and Scandinavia have made this paradigm shift as demonstrated by public policies that invest in children, such as family allowances (a monthly stipend given to families regardless of income that helps to cover the cost of raising children), universal health care, government-subsidized child care for working parents and paid family leave, to name a few.
In contrast, U.S. rankings on international comparisons of child poverty, infant mortality and student performance in math and science are embarrassingly poor. Federal and state governments have often failed the young by allowing millions to forgo health care coverage; ignoring countless children who attend highly segregated, substandard schools; and looking the other way when children are failed by the state child welfare agencies designed to protect them.
A recent story of a 4-year-old child who was killed by her mother, after being abused and severely malnourished, made front-page news in The New York Times. The mother has been charged with murder, the grandmother with manslaughter. However, since this family was involved with child protection authorities, two city child-welfare workers are being prosecuted for criminally negligent homicide.
For decades, child-welfare advocates such as the Child Welfare League of America and the Children's Defense Fund have worked tirelessly to galvanize lawmakers to focus more on the welfare of children and the challenges facing child-welfare systems that are severely underresourced. However, there is one concrete step that could set us on the right path in seriously improving the lives of our nation's children.
President Obama should convene a White House Conference on Children, which would bring together child-welfare experts from across the country to review the current state of children in the U.S. and identify strategies for improvement. Starting in 1909, this conference was held every 10 years. However, the last one was held in 1970. Positive outcomes of previous conferences include the creation of the Child Welfare League of America; improvements in state regulation of child labor; the creation of the American Pediatric Society; and efforts to end the systematic institutionalization of children.
A White House Conference on Children would help to shine a spotlight on the needs of children. It could also help educate lawmakers on two important programs for children ages 0-5 that are supported by loads of research and offer a lot of bang for the buck: (1) early childhood education programs, and (2) home visiting programs, which provide support and parenting education to new parents. Even a divided Oregon Legislature sees the light. This session, it passed a joint memorial (HJM 12) urging Congress to convene a WHCC.
Our politicians often talk endlessly about "family values," echoing that "children are our future." In actuality, we are a nation that had a Society for the Prevention of Cruelty to Animals before a Society for the Prevention of Cruelty to Children. We are one of only two nations in the world that has failed to ratify the U.N. Convention on the Rights of the Child (the other is Somalia). And we are a nation that puts children at the bottom of the barrel when it comes to federal spending. A federal bill calling on the president to convene a WHCC failed in the 111th Congress.
Perhaps a new consciousness will emerge in the United States, expressed eloquently by author and activist Pearl S. Buck: "If our American way of life fails the child, it fails us all." Making sure that our parents and grandparents are taken care of in their golden years is priceless. Making sure that our children get a good start in life -- equally priceless.
Them That’s Not Shall Lose
NY Times
“Anyone who has ever struggled with poverty knows how extremely expensive it is to be poor.”
James Baldwin penned that line more than 50 years ago, but it seems particularly prescient today, if in a different manner than its original intent.
Baldwin was referring to the poor being consistently overcharged for inferior goods. But I’ve always considered that sentence in the context of the extreme psychological toll of poverty, for it is in that way that I, too, know well how expensive it is to be poor.
I know the feel of thick calluses on the bottom of shoeless feet. I know the bite of the cold breeze that slithers through a drafty house. I know the weight of constant worry over not having enough to fill a belly or fight an illness.
It is in that context that I am forced to assume that if Washington politicians ever knew the sting of poverty then they have long since vanquished the memory. How else to qualify their positions? In fact, according to the Center for Responsive Politics, nearly half of all members of Congress are millionaires, and between 2008 and 2009, when most Americans were feeling the brunt of the recession, the personal wealth of members of Congress collectively increased by more than 16 percent. Must be nice.
Poverty is brutal, consuming and unforgiving. It strikes at the soul.
You defend yourself with hope, hard work and, for some, a helping hand. But these weapons grow dull in an economy on the verge of atrophy, in a job market tilting ever more toward the top and in a political environment that would sacrifice the weak to the wealthy.
On Thursday, the Pew Research Center released a poll that showed how disillusioned low-income people have become. Those making less than $30,000 were the most likely to expect to be laid off or be asked to take a pay cut. Furthermore, they were the most likely to say that they had trouble getting or paying for medical care and paying the rent or mortgage.
But at least those numbers include people with incomes. A vast subset is chronically unemployed and desperately searching for work. According to the Consumer Reports Employment Index, “In 23 of the past 24 months, lower-income Americans have lost more jobs than they have gained.” It continues, “Meanwhile, more affluent Americans seem to be gaining more jobs than they are losing.”
And the current election-cycle obsession to balance the books with a pound of flesh, which is being pushed by pitiless Republicans and accommodated by pitiful Democrats, will only multiply the pain.
Until more politicians understand — or remember — what it means to be poor in this country, we are destined to fail the least among us, and all of us will pay a heavy price for that failure.
“Anyone who has ever struggled with poverty knows how extremely expensive it is to be poor.”
James Baldwin penned that line more than 50 years ago, but it seems particularly prescient today, if in a different manner than its original intent.
Baldwin was referring to the poor being consistently overcharged for inferior goods. But I’ve always considered that sentence in the context of the extreme psychological toll of poverty, for it is in that way that I, too, know well how expensive it is to be poor.
I know the feel of thick calluses on the bottom of shoeless feet. I know the bite of the cold breeze that slithers through a drafty house. I know the weight of constant worry over not having enough to fill a belly or fight an illness.
It is in that context that I am forced to assume that if Washington politicians ever knew the sting of poverty then they have long since vanquished the memory. How else to qualify their positions? In fact, according to the Center for Responsive Politics, nearly half of all members of Congress are millionaires, and between 2008 and 2009, when most Americans were feeling the brunt of the recession, the personal wealth of members of Congress collectively increased by more than 16 percent. Must be nice.
Poverty is brutal, consuming and unforgiving. It strikes at the soul.
You defend yourself with hope, hard work and, for some, a helping hand. But these weapons grow dull in an economy on the verge of atrophy, in a job market tilting ever more toward the top and in a political environment that would sacrifice the weak to the wealthy.
On Thursday, the Pew Research Center released a poll that showed how disillusioned low-income people have become. Those making less than $30,000 were the most likely to expect to be laid off or be asked to take a pay cut. Furthermore, they were the most likely to say that they had trouble getting or paying for medical care and paying the rent or mortgage.
But at least those numbers include people with incomes. A vast subset is chronically unemployed and desperately searching for work. According to the Consumer Reports Employment Index, “In 23 of the past 24 months, lower-income Americans have lost more jobs than they have gained.” It continues, “Meanwhile, more affluent Americans seem to be gaining more jobs than they are losing.”
And the current election-cycle obsession to balance the books with a pound of flesh, which is being pushed by pitiless Republicans and accommodated by pitiful Democrats, will only multiply the pain.
Until more politicians understand — or remember — what it means to be poor in this country, we are destined to fail the least among us, and all of us will pay a heavy price for that failure.
Thursday, June 23, 2011
Obama administration revises insurance appeal rules - to benefit insurers
Kaiser Health News
The Obama administration announced Wednesday that it is scaling back some of its earlier rules under the 2010 health law that governed consumers' right to appeal denials by health plans, disappointing patient advocates and earning praise from industry groups.
The health overhaul gives members in group and individual health plans the right – many for the first time -- to appeal the denial of coverage to an independent review panel. But the administration's new rules provide beneficiaries less time to prepare their appeal, less information about why their claim was denied and limit what type of denials can be challenged.
A spokesman for America's Health Insurance Plans, which had pressed the administration for changes, said the trade group was still reviewing the 95-page document, but the group's overall impression was positive.
"The new regulations take important steps to simplify and streamline the appeals process so that patients can receive the most accurate and timely decision about their medical claims," said the spokesman, Robert Zirkelbach.
Stephen Finan, senior policy director at the American Cancer Society Cancer Action Network, said Wednesday's announcement would have the opposite effect. "Transparency and independence are critical to ensure that a fair and objective appeal is conducted," he said. "Unfortunately, there are numerous barriers and burdens placed on the consumer that could prevent a timely and objective resolution to a denial."
Comment:
By Don McCanne, MD
Was reform intended to benefit patients or insurers? As the reform process evolved, the insurers were dictating the policies. Understandably, they took care of their own interests first. Their lack of concern for patients is confirmed by the fact that their policies will leave 23 million people without any coverage and tens of millions more with inadequate coverage.
Officials of the Obama administration, along with leaders in Congress, were complicit with the insurers during the legislative process that led to the Affordable Care Act. You might think that they would show some remorse by tailoring the provisions of the act to better benefit patients. No.
The example of the rule change for determinations involving urgent care shows where their heart is. If a patient requires urgent care, the system should be designed to ensure that the necessary care is provided immediately. Yet the contorted explanation leading to the revised rule. It is being revised to ensure that the insurers are allowed three days instead of one to make a decision. That might even save them money should the patient die in the interim.
The administration's rule: first do no harm - to the insurance company. And the patients? Who's making these rules anyway? The patients need to butt out.
What would be the appeals process for a determination of urgent care under a single payer national health program? Appeals? What are you talking about? If the patient urgently needs care, the patient gets care - now! Period.
The Obama administration announced Wednesday that it is scaling back some of its earlier rules under the 2010 health law that governed consumers' right to appeal denials by health plans, disappointing patient advocates and earning praise from industry groups.
The health overhaul gives members in group and individual health plans the right – many for the first time -- to appeal the denial of coverage to an independent review panel. But the administration's new rules provide beneficiaries less time to prepare their appeal, less information about why their claim was denied and limit what type of denials can be challenged.
A spokesman for America's Health Insurance Plans, which had pressed the administration for changes, said the trade group was still reviewing the 95-page document, but the group's overall impression was positive.
"The new regulations take important steps to simplify and streamline the appeals process so that patients can receive the most accurate and timely decision about their medical claims," said the spokesman, Robert Zirkelbach.
Stephen Finan, senior policy director at the American Cancer Society Cancer Action Network, said Wednesday's announcement would have the opposite effect. "Transparency and independence are critical to ensure that a fair and objective appeal is conducted," he said. "Unfortunately, there are numerous barriers and burdens placed on the consumer that could prevent a timely and objective resolution to a denial."
Comment:
By Don McCanne, MD
Was reform intended to benefit patients or insurers? As the reform process evolved, the insurers were dictating the policies. Understandably, they took care of their own interests first. Their lack of concern for patients is confirmed by the fact that their policies will leave 23 million people without any coverage and tens of millions more with inadequate coverage.
Officials of the Obama administration, along with leaders in Congress, were complicit with the insurers during the legislative process that led to the Affordable Care Act. You might think that they would show some remorse by tailoring the provisions of the act to better benefit patients. No.
The example of the rule change for determinations involving urgent care shows where their heart is. If a patient requires urgent care, the system should be designed to ensure that the necessary care is provided immediately. Yet the contorted explanation leading to the revised rule. It is being revised to ensure that the insurers are allowed three days instead of one to make a decision. That might even save them money should the patient die in the interim.
The administration's rule: first do no harm - to the insurance company. And the patients? Who's making these rules anyway? The patients need to butt out.
What would be the appeals process for a determination of urgent care under a single payer national health program? Appeals? What are you talking about? If the patient urgently needs care, the patient gets care - now! Period.
Wednesday, June 22, 2011
Not Single Payer in Vermont
singlepayeraction.org
Look at the headlines that came out of Vermont last month.
CBS News: Vermont Governor Signs Single Payer Health Law.
Democracy Now: Vermont Governor Signs Single Payer Health Law.
Kaiser Health News: Shumlin Signs Vermont’s Single Payer Law.
Here’s the problem:
It’s not single payer.
Not even close.
Physicians for a National Health Program (PNHP) was onto the Vermont bill early.
On April 7, the group put out a press release titled:
Vermont Bill Mislabeled Single Payer.
But PNHP’s criticism of the bill was muted.
After all, one of PNHP’s own – Dr. Deb Richter – was taking the lead in Vermont to get the bill passed.
But single payer activists – not happy with the Vermont result – are now coming out of the closet.
“Single-payer activists need to be honest,” Chicago single payer activists Helen Redmond told Single Payer Action last week. “The law signed by Gov. Peter Shumlin is not single-payer.”
“Not even close.”
Redmond says that even the phrase “single payer” was “stripped out early on during ‘sausage making’ sessions.”
“Single payer means one payer, like Medicare and the VA,” Redmond said. “One source paying the bills, not several. The Vermont law continues to allow private insurers to operate in Vermont indefinitely. That’s why the insurance industry vampires didn’t declare total war on Shumlin and the Green Mountain Care ‘universal’ health care program because they’ve still got a ton of skin in the game.”
Redmond said that the bill only declares “an intention or aspiration: to provide health care for all Vermont residents – “six years down the road, when by the way, Shumlin will no longer be in office.”
“Aspirations and intentions are not good enough,” Redmond said. “We need health care as a human right now. 45,000 Americans die every year because they lack access to health care.”
And Redmond questioned whether moving for single payer at the state level is a realistic strategy.
“The deck is stacked against passing single-payer at the state level because of a complex series of federal programs, laws and regulations and the savvy, we-can-wait-‘em-out, insurers understand this,” she said. “Vermont and any other state that attempts to pass single-payer must obtain waiver after waiver allowing them exemption from federal constraints. The powers that be inside the beltway will not grant these waivers. Remember, they take a lot of cash from the insurance and pharmaceutical industries to ensure their financial health.”
“When it comes to state single-payer initiatives, activists have to think strategically and ask themselves, ‘Is this the fight that we need to have?’ Fights over waivers and ERISA, or a nationwide fight to win a single-payer system for the entire country?”
“In my opinion, it’s better to have a fight for national legislation like H.R. 676 as proposed by Rep. John Conyers that really does create a single-payer system and abolishes the private insurance industry than to have a fight over a piece of state legislation with no funding mechanisms, is riddled with numerous bureaucratic roadblocks and makes vague promises to enact what the majority of people want – health care as a human right for all.”
“There is no short-cut to a national single-payer health care system and politicians with the best of intentions will not gently enact it. There is no way to avoid a head on collision with the parasitic, for-profit insurance industry to put them out of business once and for all. Let’s stay on that road.”
Look at the headlines that came out of Vermont last month.
CBS News: Vermont Governor Signs Single Payer Health Law.
Democracy Now: Vermont Governor Signs Single Payer Health Law.
Kaiser Health News: Shumlin Signs Vermont’s Single Payer Law.
Here’s the problem:
It’s not single payer.
Not even close.
Physicians for a National Health Program (PNHP) was onto the Vermont bill early.
On April 7, the group put out a press release titled:
Vermont Bill Mislabeled Single Payer.
But PNHP’s criticism of the bill was muted.
After all, one of PNHP’s own – Dr. Deb Richter – was taking the lead in Vermont to get the bill passed.
But single payer activists – not happy with the Vermont result – are now coming out of the closet.
“Single-payer activists need to be honest,” Chicago single payer activists Helen Redmond told Single Payer Action last week. “The law signed by Gov. Peter Shumlin is not single-payer.”
“Not even close.”
Redmond says that even the phrase “single payer” was “stripped out early on during ‘sausage making’ sessions.”
“Single payer means one payer, like Medicare and the VA,” Redmond said. “One source paying the bills, not several. The Vermont law continues to allow private insurers to operate in Vermont indefinitely. That’s why the insurance industry vampires didn’t declare total war on Shumlin and the Green Mountain Care ‘universal’ health care program because they’ve still got a ton of skin in the game.”
Redmond said that the bill only declares “an intention or aspiration: to provide health care for all Vermont residents – “six years down the road, when by the way, Shumlin will no longer be in office.”
“Aspirations and intentions are not good enough,” Redmond said. “We need health care as a human right now. 45,000 Americans die every year because they lack access to health care.”
And Redmond questioned whether moving for single payer at the state level is a realistic strategy.
“The deck is stacked against passing single-payer at the state level because of a complex series of federal programs, laws and regulations and the savvy, we-can-wait-‘em-out, insurers understand this,” she said. “Vermont and any other state that attempts to pass single-payer must obtain waiver after waiver allowing them exemption from federal constraints. The powers that be inside the beltway will not grant these waivers. Remember, they take a lot of cash from the insurance and pharmaceutical industries to ensure their financial health.”
“When it comes to state single-payer initiatives, activists have to think strategically and ask themselves, ‘Is this the fight that we need to have?’ Fights over waivers and ERISA, or a nationwide fight to win a single-payer system for the entire country?”
“In my opinion, it’s better to have a fight for national legislation like H.R. 676 as proposed by Rep. John Conyers that really does create a single-payer system and abolishes the private insurance industry than to have a fight over a piece of state legislation with no funding mechanisms, is riddled with numerous bureaucratic roadblocks and makes vague promises to enact what the majority of people want – health care as a human right for all.”
“There is no short-cut to a national single-payer health care system and politicians with the best of intentions will not gently enact it. There is no way to avoid a head on collision with the parasitic, for-profit insurance industry to put them out of business once and for all. Let’s stay on that road.”
Tuesday, June 21, 2011
Protesters Rally Against Health Insurers
The Bay Citizen (San Francisco)
More than 100 protesters from community and labor groups rallied outside the Moscone Center in downtown San Francisco Thursday morning to call for the end of private health insurance and for "Medicare for all," while members of the America's Health Insurance Plans met at their national convention inside.
"There is no reason to have a health insurance industry. It only serves them. It doesn't serve the public," said Arthur Persyko, a volunteer with Single Payer Now, a San Francisco-based health care reform advocacy group. "They are there to make their bottom line happy. They deny care to people who need it. They are a useless, destructive part of our health care system. It's a crime, really."
State Sen. Mark Leno is sponsoring legislation, SB 810, that would establish a universal health care system in California. A similar bill passed the legislature in 2006 and again in 2008, but was vetoed both times by then-Gov. Arnold Schwarzenegger. Advocates say with a Democrat now in the governor's seat, this time could be different. But even if the bill does ultimately pass, it does not include funding for such a system.
"Separate legislation or a ballot measure would have to finance it," said Anthony Wright, executive director of Health Access, a consumer advocacy group.
More than 100 protesters from community and labor groups rallied outside the Moscone Center in downtown San Francisco Thursday morning to call for the end of private health insurance and for "Medicare for all," while members of the America's Health Insurance Plans met at their national convention inside.
"There is no reason to have a health insurance industry. It only serves them. It doesn't serve the public," said Arthur Persyko, a volunteer with Single Payer Now, a San Francisco-based health care reform advocacy group. "They are there to make their bottom line happy. They deny care to people who need it. They are a useless, destructive part of our health care system. It's a crime, really."
State Sen. Mark Leno is sponsoring legislation, SB 810, that would establish a universal health care system in California. A similar bill passed the legislature in 2006 and again in 2008, but was vetoed both times by then-Gov. Arnold Schwarzenegger. Advocates say with a Democrat now in the governor's seat, this time could be different. But even if the bill does ultimately pass, it does not include funding for such a system.
"Separate legislation or a ballot measure would have to finance it," said Anthony Wright, executive director of Health Access, a consumer advocacy group.
Man Turns to Crime for Prison Health Care
NY Times
As if conjured up by a presidential speechwriter to star in an anecdote about America’s dysfunctional health insurance system, James Verone, an unemployed 59-year-old with a bad back, a sore foot and an undiagnosed growth on his chest, limped into a bank in Gastonia, N.C., this month and handed the teller a note, explaining that this was an unarmed robbery, but she’d better turn over $1 and call the cops. That, he figured, would be enough to get himself arrested and sent to prison for a few years, where he could take advantage of the free medical care.
Just to make sure that no one was confused about his intentions, Mr. Verone made sure to let the teller know that he would be sitting on a couch in the bank, waiting for the police. Before he set out for the bank that morning, he also mailed a letter explaining his scheme to a local newspaper, The Gaston Gazette.
“When you receive this a bank robbery will have been committed by me. This robbery is being committed by me for one dollar,” the letter read. “I am of sound mind but not so much sound body.”
In a television interview last week with a local news station, WCNC, Mr. Verone explained that he was hoping for a three-year sentence, which would give him a place to live and free health care until he was old enough to collect a Social Security check and buy a condo on the beach. “I’m sort of a logical person and that was my logic, what I came up with,” he said.
According to Diane Turbyfill, a Gazette journalist who also interviewed Mr. Verone, there was one flaw in his cunning plan. “Because he only demanded $1, he was charged with larceny from a person,” not bank robbery, Ms. Turbyfill wrote. “Still a felony, the count doesn’t carry as much jail time as bank robbery.”
As if conjured up by a presidential speechwriter to star in an anecdote about America’s dysfunctional health insurance system, James Verone, an unemployed 59-year-old with a bad back, a sore foot and an undiagnosed growth on his chest, limped into a bank in Gastonia, N.C., this month and handed the teller a note, explaining that this was an unarmed robbery, but she’d better turn over $1 and call the cops. That, he figured, would be enough to get himself arrested and sent to prison for a few years, where he could take advantage of the free medical care.
Just to make sure that no one was confused about his intentions, Mr. Verone made sure to let the teller know that he would be sitting on a couch in the bank, waiting for the police. Before he set out for the bank that morning, he also mailed a letter explaining his scheme to a local newspaper, The Gaston Gazette.
“When you receive this a bank robbery will have been committed by me. This robbery is being committed by me for one dollar,” the letter read. “I am of sound mind but not so much sound body.”
In a television interview last week with a local news station, WCNC, Mr. Verone explained that he was hoping for a three-year sentence, which would give him a place to live and free health care until he was old enough to collect a Social Security check and buy a condo on the beach. “I’m sort of a logical person and that was my logic, what I came up with,” he said.
According to Diane Turbyfill, a Gazette journalist who also interviewed Mr. Verone, there was one flaw in his cunning plan. “Because he only demanded $1, he was charged with larceny from a person,” not bank robbery, Ms. Turbyfill wrote. “Still a felony, the count doesn’t carry as much jail time as bank robbery.”
Monday, June 20, 2011
Poor children denied specialty care
New England Journal of Medicine
Expansions of Medicaid and the Children’s Health Insurance Program (CHIP) are designed to extend access to high-quality medical care to all U.S. children. However, evidence suggests that the 37 million children covered by Medicaid–CHIP are less likely to receive specialty care than children covered by commercial insurance.
We designed an audit study in which research assistants posing as mothers made paired calls to the same clinic and attempted to schedule an appointment for a child needing specialty care. The calls were separated by 1 month and varied only by insurance status (private vs. Medicaid–CHIP insurance).
With the use of an experimental study design involving simulated requests for specialty care, we measured real-world scheduling behavior in an urban area with a high density of medical specialists. The results showed significant disparities in children’s access to needed outpatient specialty care, attributable to specialists’ reluctance to accept public health insurance. These results held across all audited specialties. (66% of the callers reporting Medicaid–CHIP coverage were denied an appointment for specialty care, as compared with 11% of the callers reporting Blue Cross Blue Shield insurance.) Moreover, even when children with Medicaid–CHIP were not denied appointments outright, the appointments were, on average, 22 days later than those obtained for privately insured children with identical health conditions (even though the clinical scenarios represented urgent situations).
Overall, we found considerable disparities in access to outpatient pediatric specialty care that were attributable to providers’ nonacceptance of public insurance.
Comment:
By Don McCanne, MD
A well functioning health care system removes barriers to the care that patients need. It is sad commentary that the United States has a program for the most needy that instead crates a barrier to care. As this study shows, merely being covered by Medicaid disqualifies many children from being able to access the specialized care that they need.
This doesn't happen in other nations. If a person needs care, access is automatically provided without any thought given to the mechanism of payment.
In the United States, even though we have more than enough money already in the system to pay for all essential care, we have erected a wasteful, fragmented, dysfunctional financing system that creates barriers that must be negotiated before appropriate care can be obtained. It's not the money; it's the flawed financing system.
We need to caste aside these barriers and create an equitable financing system that is automatic - a single payer national health program. We have the money. Now all we need is the political will.
Expansions of Medicaid and the Children’s Health Insurance Program (CHIP) are designed to extend access to high-quality medical care to all U.S. children. However, evidence suggests that the 37 million children covered by Medicaid–CHIP are less likely to receive specialty care than children covered by commercial insurance.
We designed an audit study in which research assistants posing as mothers made paired calls to the same clinic and attempted to schedule an appointment for a child needing specialty care. The calls were separated by 1 month and varied only by insurance status (private vs. Medicaid–CHIP insurance).
With the use of an experimental study design involving simulated requests for specialty care, we measured real-world scheduling behavior in an urban area with a high density of medical specialists. The results showed significant disparities in children’s access to needed outpatient specialty care, attributable to specialists’ reluctance to accept public health insurance. These results held across all audited specialties. (66% of the callers reporting Medicaid–CHIP coverage were denied an appointment for specialty care, as compared with 11% of the callers reporting Blue Cross Blue Shield insurance.) Moreover, even when children with Medicaid–CHIP were not denied appointments outright, the appointments were, on average, 22 days later than those obtained for privately insured children with identical health conditions (even though the clinical scenarios represented urgent situations).
Overall, we found considerable disparities in access to outpatient pediatric specialty care that were attributable to providers’ nonacceptance of public insurance.
Comment:
By Don McCanne, MD
A well functioning health care system removes barriers to the care that patients need. It is sad commentary that the United States has a program for the most needy that instead crates a barrier to care. As this study shows, merely being covered by Medicaid disqualifies many children from being able to access the specialized care that they need.
This doesn't happen in other nations. If a person needs care, access is automatically provided without any thought given to the mechanism of payment.
In the United States, even though we have more than enough money already in the system to pay for all essential care, we have erected a wasteful, fragmented, dysfunctional financing system that creates barriers that must be negotiated before appropriate care can be obtained. It's not the money; it's the flawed financing system.
We need to caste aside these barriers and create an equitable financing system that is automatic - a single payer national health program. We have the money. Now all we need is the political will.
Sunday, June 19, 2011
Single payer system a 'credible alternative' to Medicare's woes
Madison.com
I take exception to the May 23 editorial, "Don't let Medicare go bankrupt." After praising Rep. Paul Ryan for a Medicare plan which would dramatically shift the increasing costs of Medicare from the government onto the recipients of Medicare, you stated: "Those who disagree with Ryan's Medicare prescription haven't offered credible alternatives."
I disagree since the most credible solution to the rising costs of Medicare, and all health care, has been offered repeatedly for many years and certainly during the health care discussions leading up to the health care reform law.
It's a single payer system similar to those used by every other industrialized country where health care for all is provided for between 8.5 percent and 11 percent of gross domestic product.
That would improve on the 17 percent to 18 percent of GDP we in the United States now pay. With that huge decrease in the cost of health care, Medicare would not be in danger of bankruptcy and other U.S. citizens would have affordable health care.
Currently, 20 percent to 30 percent of every health care dollar spent is paying for administrative costs and profits, including huge CEO remuneration for the insurance companies.
Medicare's administrative costs are 4 percent. A single payer system would offer savings of administrative costs, provide health care for everyone and prevent Medicare from going bankrupt.
I take exception to the May 23 editorial, "Don't let Medicare go bankrupt." After praising Rep. Paul Ryan for a Medicare plan which would dramatically shift the increasing costs of Medicare from the government onto the recipients of Medicare, you stated: "Those who disagree with Ryan's Medicare prescription haven't offered credible alternatives."
I disagree since the most credible solution to the rising costs of Medicare, and all health care, has been offered repeatedly for many years and certainly during the health care discussions leading up to the health care reform law.
It's a single payer system similar to those used by every other industrialized country where health care for all is provided for between 8.5 percent and 11 percent of gross domestic product.
That would improve on the 17 percent to 18 percent of GDP we in the United States now pay. With that huge decrease in the cost of health care, Medicare would not be in danger of bankruptcy and other U.S. citizens would have affordable health care.
Currently, 20 percent to 30 percent of every health care dollar spent is paying for administrative costs and profits, including huge CEO remuneration for the insurance companies.
Medicare's administrative costs are 4 percent. A single payer system would offer savings of administrative costs, provide health care for everyone and prevent Medicare from going bankrupt.
'Life, Death And Politics' Treating Chicago's Uninsured
You can listen to the 19-minute broadcast here
The first time Dr. David Ansell went into the men's room at Cook County Hospital in Chicago, he immediately ran out. "It was so bad, I couldn't use it," he says. "I ran across the street and had to use the bathroom there. It was quite an introduction to my first day at County."
Ansell is now the vice president for clinical affairs and chief medical officer at Rush University Medical Center. But he began his medical career in 1978 at County, Chicago's public hospital, where he worked as an attending physician for almost two decades. His social history of the hospital, "County: Life, Death and Politics at Chicago's Public Hospital," details his own time on the wards — and examines health care in America from the perspective of the uninsured.
Working at County, Ansell says, made him realize just how much the current payment system drives health care inequalities. "There's a misunderstanding that if you just go to the [emergency room], that's health care," he says. "It's not. ... And I don't think the public or politicians really understand that. I think the last health reform attempt which is being bandied about — we don't know what's going to happen — is likely to fall short with regards to equity."
Doctors Within Borders
Cook County Hospital, where Ansell worked, was a public hospital, a place that treated people with nowhere else to go. Physicians and residents who worked at County, meanwhile, were entering an environment with underfunding, mismanagement, high patient demand, safety concerns and antiquated equipment.
"I went into medicine because I wanted to help people, and when I went to medical school, I found it very disillusioning," Ansell says. "County was a place that many of us went because we believed that disease had social etiologies — the idea that disease just emanated from the individual and wasn't somehow constrained or influenced by societal factors. Going to a place like Cook County Hospital was a place where we could live those beliefs out."
Health care at County was very different from care at private or university hospitals. When Ansell first started treating patients, County had no air conditioning, poor sanitation and limited patient privacy. "The beds were lined up one after another, separated by curtains, but there was really no privacy," he says. "Patients would roll in and they'd be lined up around the walls of this one room, and the middle was lined with stretchers and wheelchairs. You were forced to take histories and examine patients under these conditions."
In 2002, a new hospital called the John H. Stroger Jr. Hospital opened in Chicago, replacing Cook County. The facility provides more dignified conditions for patients. But the new facility, Ansell says, cannot compensate for social inequalities and limited access to preventive health care.
"Just yesterday I had a conversation with a physician [who] says there's a many-months wait to see the eye doctor," he says. "There are 4,000 patients waiting to get a colonoscopy. This is not a screening colonoscopy — they've got blood in their stool. ... The new hospital and the doctors and the nurses and the clinics are spectacular, [but] if you look at the whole system and you look at the outcomes we're getting ... people are going blind waiting to see the eye doctor, in a country where it doesn't have to be."
Health Inequalities
On the South Side of Chicago, the life expectancy of an African-American male is eight years lower than that of a Caucasian man, Ansell explains.
"When you look at the reasons for it, at least half of this is [because of] heart disease and cancer and things that could be treated," he says. "One of the problems with our current system is segregating people by insurance status, which ends up limiting the options of care — especially when you get down to the specialty care that people need."
During his 17 years at Cook County, few if any of Ansell's patients could get their hips replaced — or other medically necessary but not trauma-related treatments.
"The only fair way to do this is where people have a card that gets them in, where that card is accepted widely and broadly by everyone, and [giving people] choice," he says. "So you could go anywhere you want, you get the care you want, and choose your own doctors — and that would be some sort of universal plan — Medicare for all, single-payer. We need a system that really gives patients — poor or rich — adequate care."
The first time Dr. David Ansell went into the men's room at Cook County Hospital in Chicago, he immediately ran out. "It was so bad, I couldn't use it," he says. "I ran across the street and had to use the bathroom there. It was quite an introduction to my first day at County."
Ansell is now the vice president for clinical affairs and chief medical officer at Rush University Medical Center. But he began his medical career in 1978 at County, Chicago's public hospital, where he worked as an attending physician for almost two decades. His social history of the hospital, "County: Life, Death and Politics at Chicago's Public Hospital," details his own time on the wards — and examines health care in America from the perspective of the uninsured.
Working at County, Ansell says, made him realize just how much the current payment system drives health care inequalities. "There's a misunderstanding that if you just go to the [emergency room], that's health care," he says. "It's not. ... And I don't think the public or politicians really understand that. I think the last health reform attempt which is being bandied about — we don't know what's going to happen — is likely to fall short with regards to equity."
Doctors Within Borders
Cook County Hospital, where Ansell worked, was a public hospital, a place that treated people with nowhere else to go. Physicians and residents who worked at County, meanwhile, were entering an environment with underfunding, mismanagement, high patient demand, safety concerns and antiquated equipment.
"I went into medicine because I wanted to help people, and when I went to medical school, I found it very disillusioning," Ansell says. "County was a place that many of us went because we believed that disease had social etiologies — the idea that disease just emanated from the individual and wasn't somehow constrained or influenced by societal factors. Going to a place like Cook County Hospital was a place where we could live those beliefs out."
Health care at County was very different from care at private or university hospitals. When Ansell first started treating patients, County had no air conditioning, poor sanitation and limited patient privacy. "The beds were lined up one after another, separated by curtains, but there was really no privacy," he says. "Patients would roll in and they'd be lined up around the walls of this one room, and the middle was lined with stretchers and wheelchairs. You were forced to take histories and examine patients under these conditions."
In 2002, a new hospital called the John H. Stroger Jr. Hospital opened in Chicago, replacing Cook County. The facility provides more dignified conditions for patients. But the new facility, Ansell says, cannot compensate for social inequalities and limited access to preventive health care.
"Just yesterday I had a conversation with a physician [who] says there's a many-months wait to see the eye doctor," he says. "There are 4,000 patients waiting to get a colonoscopy. This is not a screening colonoscopy — they've got blood in their stool. ... The new hospital and the doctors and the nurses and the clinics are spectacular, [but] if you look at the whole system and you look at the outcomes we're getting ... people are going blind waiting to see the eye doctor, in a country where it doesn't have to be."
Health Inequalities
On the South Side of Chicago, the life expectancy of an African-American male is eight years lower than that of a Caucasian man, Ansell explains.
"When you look at the reasons for it, at least half of this is [because of] heart disease and cancer and things that could be treated," he says. "One of the problems with our current system is segregating people by insurance status, which ends up limiting the options of care — especially when you get down to the specialty care that people need."
During his 17 years at Cook County, few if any of Ansell's patients could get their hips replaced — or other medically necessary but not trauma-related treatments.
"The only fair way to do this is where people have a card that gets them in, where that card is accepted widely and broadly by everyone, and [giving people] choice," he says. "So you could go anywhere you want, you get the care you want, and choose your own doctors — and that would be some sort of universal plan — Medicare for all, single-payer. We need a system that really gives patients — poor or rich — adequate care."
How Libby, Montana, Got Medicare for All
Kay Tillow, FireDogLake
In 2009 when the Washington Beltway was tied up with the health care reform tussle, Montana Democratic Senator Max Baucus, chairman of the all powerful Senate Finance Committee, said everything was on the table -- except for single payer. When doctors, nurses and others rose in his hearing to insist that single payer be included in the debate, Baucus had them arrested. As more stood up, Baucus could be heard on his open microphone saying, “We need more police.”
Yet when Senator Baucus needed a solution to a catastrophic health disaster in Libby, Montana, and surrounding Lincoln County, he turned to the nation’s single-payer health care system, Medicare, to solve the problem.
Baucus’ problem was caused by a vermiculite mine that had spread deadly airborne asbestos, killing hundreds and sickening thousands in Libby and northwest Montana. The W.R. Grace Company that owned the mine denied its connection to the massive levels of mesothelioma and asbestosis and dodged responsibility for this environmental and health disaster. When all lawsuits and legal avenues failed, Baucus turned to our country’s single-payer plan, Medicare.
The single-payer plan that Baucus kept off the table is now very much on the table in Libby. Unknown to most of the public, Baucus inserted a section into the health reform bill that covers the suffering people of Libby, not just the former miners but the whole community – all covered by Medicare.
They don’t have to be 65 years old or more. They don’t have to wait until 2014 for the state exchanges. No 10-year rollout – it’s immediate. They don’t have to purchase a plan – this is not a buy-in to Medicare – it’s free. They don’t have to be disabled for two years before they apply. They don’t have to go without care for three years until Medicaid expands. They don’t have to meet income tests. They don’t have to apply for a subsidy. They don’t have to pay a fine for failure to buy insurance. They don’t have to hope that the market will make a plan affordable. They don’t have to hide their pre-existing conditions. They don’t have to find a job that provides coverage.
Baucus inserted a clause in the Affordable Care Act to make special arrangements for them in Medicare, and he didn’t wait for any Congressional Budget Office scoring to do it.
Less than two months after the passage of the health reform bill on March 23, 2010, Nancy Berryhill of the Social Security Administration in Denver joined personally in setting up an office in Libby to sign up these newly eligible people.
“This is a new thing,” Berryhill told the Missoulian. “No other group like this has ever been selected to receive Medicare.” Berryhill issued a nationwide alert to inform anyone who had lived or stayed in Lincoln County of their eligibility. She opened a storefront in Libby at the old downtown city hall where she signed up 60 people on the first day. She plastered the towns of Whitefish and Eureka with pamphlets explaining the program and added three new staffers to the office in Kalispell.
Berryhill said she did not know how much the care would cost. That kind of analysis was beyond her directive to sign the people up. There have been no reports of competition from the private for-profit Medicare Advantage plans. The sick are not profitable.
No one should begrudge the people of Lincoln County. The mine wastes were used as soil additives, home insulation, and even spread on the running tracks at local schools. Miners brought the carcinogens home on their clothes. The W.R. Grace Company dumped much of the cleanup costs onto the federal government. A June 17, 2009, order by the Environmental Protection Agency, the first of its kind, declared Lincoln County a public health disaster. The Libby Medicare provision in the health reform law is based on the area covered by that EPA order.
Baucus gave his reasons to The New York Times for its only story on this unique benefit: “The people of Libby have been poisoned and have been dying for a decade. New residents continue to get sick all the time. Public health tragedies like this could happen in any town in America. We need this type of mechanism to help people when they need it most.”
Health tragedies are happening in every town. Over 51 million have no insurance. Over 45,000 uninsured people die needlessly each year. Employers are cutting coverage and dropping plans. States in economic crisis are slashing both Medicaid and their employees’ plans. Nothing in last year’s reform law will mitigate the skyrocketing costs. Most insurance is threadbare and doesn’t cover. More than 50 percent of us now go without necessary care. As Baucus said of Medicare, “We need this mechanism to help people when they need it most.” We all need it now.
Bill Clinton recently stated that the U.S. could give coverage to all for $1 trillion a year less than we now pay if we adopted the system of any other advanced nation. (Unfortunately, he did not say this when it would have mattered most during the 1993 and 2009 health care reform debates.)
Other industrialized countries have found that to cover everyone for less they must remove the profit-making insurance companies. Congressman John Conyers has reintroduced H.R. 676, the Expanded and Improved Medicare for All Act, which does exactly that. There are 60 cosponsors. It would cover all medically necessary care for everyone including dental and drugs by cutting out the 30 percent waste and profits caused by the private insurers.
So as the Ryan Republicans try to destroy Medicare and far too many Democrats use the deficit excuse to suggest cuts in its benefits, let us counter with the Libby prescription to clean up the whole mess. Only a single payer, improved Medicare for All, can save and protect Medicare, rein in the costs, and give us universal coverage.
Medicare will celebrate its 46th birthday on July 30, 2011, and all are invited to join in the festivities. Medicare was passed in 1965 and implemented within less than a year. When we pass H.R. 676, this single-payer bill, we can all be enrolled in the twinkling of an eye.
Kay Tillow lives in Louisville, Ky., and is a leader of All Unions Committee for Single Payer Health Care – H.R. 676.
In 2009 when the Washington Beltway was tied up with the health care reform tussle, Montana Democratic Senator Max Baucus, chairman of the all powerful Senate Finance Committee, said everything was on the table -- except for single payer. When doctors, nurses and others rose in his hearing to insist that single payer be included in the debate, Baucus had them arrested. As more stood up, Baucus could be heard on his open microphone saying, “We need more police.”
Yet when Senator Baucus needed a solution to a catastrophic health disaster in Libby, Montana, and surrounding Lincoln County, he turned to the nation’s single-payer health care system, Medicare, to solve the problem.
Baucus’ problem was caused by a vermiculite mine that had spread deadly airborne asbestos, killing hundreds and sickening thousands in Libby and northwest Montana. The W.R. Grace Company that owned the mine denied its connection to the massive levels of mesothelioma and asbestosis and dodged responsibility for this environmental and health disaster. When all lawsuits and legal avenues failed, Baucus turned to our country’s single-payer plan, Medicare.
The single-payer plan that Baucus kept off the table is now very much on the table in Libby. Unknown to most of the public, Baucus inserted a section into the health reform bill that covers the suffering people of Libby, not just the former miners but the whole community – all covered by Medicare.
They don’t have to be 65 years old or more. They don’t have to wait until 2014 for the state exchanges. No 10-year rollout – it’s immediate. They don’t have to purchase a plan – this is not a buy-in to Medicare – it’s free. They don’t have to be disabled for two years before they apply. They don’t have to go without care for three years until Medicaid expands. They don’t have to meet income tests. They don’t have to apply for a subsidy. They don’t have to pay a fine for failure to buy insurance. They don’t have to hope that the market will make a plan affordable. They don’t have to hide their pre-existing conditions. They don’t have to find a job that provides coverage.
Baucus inserted a clause in the Affordable Care Act to make special arrangements for them in Medicare, and he didn’t wait for any Congressional Budget Office scoring to do it.
Less than two months after the passage of the health reform bill on March 23, 2010, Nancy Berryhill of the Social Security Administration in Denver joined personally in setting up an office in Libby to sign up these newly eligible people.
“This is a new thing,” Berryhill told the Missoulian. “No other group like this has ever been selected to receive Medicare.” Berryhill issued a nationwide alert to inform anyone who had lived or stayed in Lincoln County of their eligibility. She opened a storefront in Libby at the old downtown city hall where she signed up 60 people on the first day. She plastered the towns of Whitefish and Eureka with pamphlets explaining the program and added three new staffers to the office in Kalispell.
Berryhill said she did not know how much the care would cost. That kind of analysis was beyond her directive to sign the people up. There have been no reports of competition from the private for-profit Medicare Advantage plans. The sick are not profitable.
No one should begrudge the people of Lincoln County. The mine wastes were used as soil additives, home insulation, and even spread on the running tracks at local schools. Miners brought the carcinogens home on their clothes. The W.R. Grace Company dumped much of the cleanup costs onto the federal government. A June 17, 2009, order by the Environmental Protection Agency, the first of its kind, declared Lincoln County a public health disaster. The Libby Medicare provision in the health reform law is based on the area covered by that EPA order.
Baucus gave his reasons to The New York Times for its only story on this unique benefit: “The people of Libby have been poisoned and have been dying for a decade. New residents continue to get sick all the time. Public health tragedies like this could happen in any town in America. We need this type of mechanism to help people when they need it most.”
Health tragedies are happening in every town. Over 51 million have no insurance. Over 45,000 uninsured people die needlessly each year. Employers are cutting coverage and dropping plans. States in economic crisis are slashing both Medicaid and their employees’ plans. Nothing in last year’s reform law will mitigate the skyrocketing costs. Most insurance is threadbare and doesn’t cover. More than 50 percent of us now go without necessary care. As Baucus said of Medicare, “We need this mechanism to help people when they need it most.” We all need it now.
Bill Clinton recently stated that the U.S. could give coverage to all for $1 trillion a year less than we now pay if we adopted the system of any other advanced nation. (Unfortunately, he did not say this when it would have mattered most during the 1993 and 2009 health care reform debates.)
Other industrialized countries have found that to cover everyone for less they must remove the profit-making insurance companies. Congressman John Conyers has reintroduced H.R. 676, the Expanded and Improved Medicare for All Act, which does exactly that. There are 60 cosponsors. It would cover all medically necessary care for everyone including dental and drugs by cutting out the 30 percent waste and profits caused by the private insurers.
So as the Ryan Republicans try to destroy Medicare and far too many Democrats use the deficit excuse to suggest cuts in its benefits, let us counter with the Libby prescription to clean up the whole mess. Only a single payer, improved Medicare for All, can save and protect Medicare, rein in the costs, and give us universal coverage.
Medicare will celebrate its 46th birthday on July 30, 2011, and all are invited to join in the festivities. Medicare was passed in 1965 and implemented within less than a year. When we pass H.R. 676, this single-payer bill, we can all be enrolled in the twinkling of an eye.
Kay Tillow lives in Louisville, Ky., and is a leader of All Unions Committee for Single Payer Health Care – H.R. 676.
Thursday, June 9, 2011
Can We Hide From the Insane Master?
gerryspence.wordpress.com
It’s time we lay naked the myth, expose it like ripping the shirt off a fat man’s belly. We are not a democracy. Americans are not free. Our politicians do not represent us. We have not been taught or told the truth. None. We are the new slaves.
Slaves must have a master. Yes. The master is the corporate glob that controls us, speaks for us, that provides us with our only voice, the corporate media, that uses us up for its profit, that engorges itself while masses of our people remain jobless and hungry and that uses our resources and children to extend its aggression across the world for more profit.
The master is dead, of course. It does not breath or feel, and it is immortal. Such a frightening spectacle, for the master is not only dead, but insane! It is addicted to profit. Does it not terrorize us to see these organisms, these profit seeking corporations, still fighting for more, squeezing the life blood out of its workers for more, cheating its shareholders for more, twisting its barrowers for more, killing for more, blithely destroying the earth for more, bringing on wars where untold thousands of the innocent are wounded and killed – all for more? More!
In short, if I were to describe a monster so large it could not be seen, so ubiquitous that it covered every part of our being, so powerful that it controls our government and the governments of many nations, yet a monster without a heart or morals – and that has such power over the minds of the people that the people, the slaves, believe they are free and are willing to lay down their lives for the monster – if realizing this truth, might we all not run, hide, yes, scurry into small holes like frightened rabbits to seek refuge somewhere where the monster could not reach us? But what if I tell you that there is no place to hide? The master, the monster, the corporate glob occupies every nook and cranny where we once might have hidden. And it knows where we are. Even a cow can occasionally break through the fence and find momentary freedom in the neighbor’s pasture, but not the people. We cannot escape.
Is there hope? Stay tuned.
It’s time we lay naked the myth, expose it like ripping the shirt off a fat man’s belly. We are not a democracy. Americans are not free. Our politicians do not represent us. We have not been taught or told the truth. None. We are the new slaves.
Slaves must have a master. Yes. The master is the corporate glob that controls us, speaks for us, that provides us with our only voice, the corporate media, that uses us up for its profit, that engorges itself while masses of our people remain jobless and hungry and that uses our resources and children to extend its aggression across the world for more profit.
The master is dead, of course. It does not breath or feel, and it is immortal. Such a frightening spectacle, for the master is not only dead, but insane! It is addicted to profit. Does it not terrorize us to see these organisms, these profit seeking corporations, still fighting for more, squeezing the life blood out of its workers for more, cheating its shareholders for more, twisting its barrowers for more, killing for more, blithely destroying the earth for more, bringing on wars where untold thousands of the innocent are wounded and killed – all for more? More!
In short, if I were to describe a monster so large it could not be seen, so ubiquitous that it covered every part of our being, so powerful that it controls our government and the governments of many nations, yet a monster without a heart or morals – and that has such power over the minds of the people that the people, the slaves, believe they are free and are willing to lay down their lives for the monster – if realizing this truth, might we all not run, hide, yes, scurry into small holes like frightened rabbits to seek refuge somewhere where the monster could not reach us? But what if I tell you that there is no place to hide? The master, the monster, the corporate glob occupies every nook and cranny where we once might have hidden. And it knows where we are. Even a cow can occasionally break through the fence and find momentary freedom in the neighbor’s pasture, but not the people. We cannot escape.
Is there hope? Stay tuned.
US healthcare: Profits before patients
What is the point of having the world's best medical facilities if citizens don't have the money to access healthcare?
When Stan Brock started Remote Area Medical (RAM) in 1985, never in his wildest dreams did he think his services would be needed in the United States, the wealthiest country in the world.
RAM began as an all-volunteer mobile medical clinic that provided free and immediate health care to people living in remote areas of the Amazon rainforest. In 1992, he was asked to bring the clinic to Knoxville, Tennessee. He was shocked by what he saw.
"People were in desperate need of the most basic care," he said at RAM's most recent expedition in Oakland, California last month. "It didn't occur to me when I first came to this country, but it wasn't long before I could see there were similarities between people who don't have access to healthcare in a place like the Amazon and people who have access but can't afford it in America - and they're all in the same boat."
An estimated 50 million Americans are uninsured and another 25 million are underinsured, meaning they can't pay the difference between what their insurance will cover and the total cost of their medical bills. Someone files for bankruptcy every 30 seconds in the US because of a serious health problem, according to a Harvard University study.
Since 1992, RAM has conducted 640 expeditions in the US. When the travelling medical clinic comes to town, the lines begin forming at around midnight. An average of 3,000 people are treated at a typical four-day event. Over 90 per cent of the patients are in desperate need of basic dental and vision care. Each clinic costs roughly $100,000 to run, requires over 1,000 volunteers, and takes an entire year to organise.
When patients entered the clinic at the Oakland Coliseum, they were greeted by smiling volunteers, rows upon rows of dental chairs, optometric stations, and tables covered with medical tools, gloves, and equipment.
When Milka Guiterrez heard that free healthcare was being offered, she moved her schedule around to get a good place in line. On Sunday night, long after her three kids were sound asleep, she left her house at 1am. She was number 474 in line.
Shortly before patients began entering the makeshift clinic five hours later, Guiterrez ran home, grabbed her kids, and returned with her fingers crossed. She got lucky.
She and her kids had eye exams and dental work. Her eight-year-old daughter Paloma was in pain from the drilling, but managed to crack a smile. "When I used to smile, there was yellow stuff everywhere," she said wiping away tears. "I was so embarrassed. I stopped smiling when I was six. It hurts, but now I'm happy."
After 12 years with the US Postal Service, Anita Moore was hurt on the job and lost her health insurance. She got in line at 3:30am. By 6pm, she had her eyes checked, her teeth cleaned, two fillings, and four extractions.
Six months ago, she had an injury and hasn't been able to lift her arms above her shoulders. The pain went away after 15 minutes of acupuncture at the clinic. "I was so happy because I couldn't lift. I was just shocked. Now I can move them around," she said. "It's a blessing."
Les Kuller, an unemployed construction worker who got in line at 5:30am, lost his health insurance when his wife passed away two years ago. He got a molar fixed, had his blood pressure checked, was given a pair of eyeglasses, and had chiropractic and physical therapy work. He was so touched by the care he received and the volunteers he met, he came back the next day to join them.
"The least I could do is give back," he said. "On one hand, this is so incredibly amazing that all these volunteers can pull this together. On the other hand, it's a sad commentary about what the hell is going on in Washington and why the hell these knuckleheads can't walk across the aisle and shake hands and figure this thing out."
Kuller says he hopes people standing in overnight lines for basic medical care "embarrasses the hell" out of politicians. I heard similar sentiments from several people receiving care at the clinic.
When profit comes before care
Democratic politicians proudly point to the Patient Protection and Affordable Care Act, the bill that was signed by President Obama in March 2010, as real progress, but Physicians for a National Health Program (PNHP), an organisation of doctors who support healthcare for all, say the bill is nothing more than a false promise of reform.
Instead of eliminating the real problem, the new legislation will enrich and further entrench the profit-driven, private health insurance industry, and leave 23 million people still uninsured in 2019, according to PNHP.
If Republicans have their way, the 45 million seniors and people with disabilities who rely on Medicare will see their out-of-pocket costs double - or do without treatment altogether.
RAM founder Stan Brock doesn't like to talk about politics. He's too busy making sure people get treated. RAM's next stop is in Pikeville, Kentucky. From there, he and his team will head to Cocke County, Tennessee, Wise County, Virginia, and Chicago, Illinois. Because he's has had so many requests from all over the country, he sees no end in sight.
This is what happens when profit comes before care.
UnitedHealth's first quarter profits this year rose 13 per cent to $1.35 billion from $1.19 billion last year. UnitedHealth CEO Stephen Hemsley's total compensation of $101.96 million last year made him the highest paid executive in the country.
The US is the only major country in the industrialised world that doesn't guarantee healthcare to all of its citizens. It's unconscionable that 45,000 people in the US die every year because they can't afford care.
Senator Bernie Sanders, an independent from Vermont who believes that the US should put patients over profits, recently re-introduced the American Health Security Act, which would provide every citizen with healthcare coverage through a state-administered, single payer program.
Here's a fact from the PNHP that never made its way through the noise machine during the so-called healthcare debate - which was shaped by the insurance industry from the beginning. It should be repeated over and over again. the bureaucracy and paperwork of the profit-making health insurance industry consume one-third of every healthcare dollar.
Streamlining payment through a single-payer system would save more than $400 billion per year - which is enough to provide comprehensive, high-quality coverage for all.
RAM's Stan Brock says a single-payer system, as long as it covers dental and vision, would put him out of business in the US. "That would allow us to go back to the Amazon, Central America, Haiti - and other places where we belong."
Rose Aguilar is the host of Your Call, a daily call-in radio show on KALW in San Francisco. She's the author of "Red Highways: A Liberal's Journey into the Heartland."
The views expressed in this article are the author's own and do not necessarily represent Al Jazeera's editorial policy.
When Stan Brock started Remote Area Medical (RAM) in 1985, never in his wildest dreams did he think his services would be needed in the United States, the wealthiest country in the world.
RAM began as an all-volunteer mobile medical clinic that provided free and immediate health care to people living in remote areas of the Amazon rainforest. In 1992, he was asked to bring the clinic to Knoxville, Tennessee. He was shocked by what he saw.
"People were in desperate need of the most basic care," he said at RAM's most recent expedition in Oakland, California last month. "It didn't occur to me when I first came to this country, but it wasn't long before I could see there were similarities between people who don't have access to healthcare in a place like the Amazon and people who have access but can't afford it in America - and they're all in the same boat."
An estimated 50 million Americans are uninsured and another 25 million are underinsured, meaning they can't pay the difference between what their insurance will cover and the total cost of their medical bills. Someone files for bankruptcy every 30 seconds in the US because of a serious health problem, according to a Harvard University study.
Since 1992, RAM has conducted 640 expeditions in the US. When the travelling medical clinic comes to town, the lines begin forming at around midnight. An average of 3,000 people are treated at a typical four-day event. Over 90 per cent of the patients are in desperate need of basic dental and vision care. Each clinic costs roughly $100,000 to run, requires over 1,000 volunteers, and takes an entire year to organise.
When patients entered the clinic at the Oakland Coliseum, they were greeted by smiling volunteers, rows upon rows of dental chairs, optometric stations, and tables covered with medical tools, gloves, and equipment.
When Milka Guiterrez heard that free healthcare was being offered, she moved her schedule around to get a good place in line. On Sunday night, long after her three kids were sound asleep, she left her house at 1am. She was number 474 in line.
Shortly before patients began entering the makeshift clinic five hours later, Guiterrez ran home, grabbed her kids, and returned with her fingers crossed. She got lucky.
She and her kids had eye exams and dental work. Her eight-year-old daughter Paloma was in pain from the drilling, but managed to crack a smile. "When I used to smile, there was yellow stuff everywhere," she said wiping away tears. "I was so embarrassed. I stopped smiling when I was six. It hurts, but now I'm happy."
After 12 years with the US Postal Service, Anita Moore was hurt on the job and lost her health insurance. She got in line at 3:30am. By 6pm, she had her eyes checked, her teeth cleaned, two fillings, and four extractions.
Six months ago, she had an injury and hasn't been able to lift her arms above her shoulders. The pain went away after 15 minutes of acupuncture at the clinic. "I was so happy because I couldn't lift. I was just shocked. Now I can move them around," she said. "It's a blessing."
Les Kuller, an unemployed construction worker who got in line at 5:30am, lost his health insurance when his wife passed away two years ago. He got a molar fixed, had his blood pressure checked, was given a pair of eyeglasses, and had chiropractic and physical therapy work. He was so touched by the care he received and the volunteers he met, he came back the next day to join them.
"The least I could do is give back," he said. "On one hand, this is so incredibly amazing that all these volunteers can pull this together. On the other hand, it's a sad commentary about what the hell is going on in Washington and why the hell these knuckleheads can't walk across the aisle and shake hands and figure this thing out."
Kuller says he hopes people standing in overnight lines for basic medical care "embarrasses the hell" out of politicians. I heard similar sentiments from several people receiving care at the clinic.
When profit comes before care
Democratic politicians proudly point to the Patient Protection and Affordable Care Act, the bill that was signed by President Obama in March 2010, as real progress, but Physicians for a National Health Program (PNHP), an organisation of doctors who support healthcare for all, say the bill is nothing more than a false promise of reform.
Instead of eliminating the real problem, the new legislation will enrich and further entrench the profit-driven, private health insurance industry, and leave 23 million people still uninsured in 2019, according to PNHP.
If Republicans have their way, the 45 million seniors and people with disabilities who rely on Medicare will see their out-of-pocket costs double - or do without treatment altogether.
RAM founder Stan Brock doesn't like to talk about politics. He's too busy making sure people get treated. RAM's next stop is in Pikeville, Kentucky. From there, he and his team will head to Cocke County, Tennessee, Wise County, Virginia, and Chicago, Illinois. Because he's has had so many requests from all over the country, he sees no end in sight.
This is what happens when profit comes before care.
UnitedHealth's first quarter profits this year rose 13 per cent to $1.35 billion from $1.19 billion last year. UnitedHealth CEO Stephen Hemsley's total compensation of $101.96 million last year made him the highest paid executive in the country.
The US is the only major country in the industrialised world that doesn't guarantee healthcare to all of its citizens. It's unconscionable that 45,000 people in the US die every year because they can't afford care.
Senator Bernie Sanders, an independent from Vermont who believes that the US should put patients over profits, recently re-introduced the American Health Security Act, which would provide every citizen with healthcare coverage through a state-administered, single payer program.
Here's a fact from the PNHP that never made its way through the noise machine during the so-called healthcare debate - which was shaped by the insurance industry from the beginning. It should be repeated over and over again. the bureaucracy and paperwork of the profit-making health insurance industry consume one-third of every healthcare dollar.
Streamlining payment through a single-payer system would save more than $400 billion per year - which is enough to provide comprehensive, high-quality coverage for all.
RAM's Stan Brock says a single-payer system, as long as it covers dental and vision, would put him out of business in the US. "That would allow us to go back to the Amazon, Central America, Haiti - and other places where we belong."
Rose Aguilar is the host of Your Call, a daily call-in radio show on KALW in San Francisco. She's the author of "Red Highways: A Liberal's Journey into the Heartland."
The views expressed in this article are the author's own and do not necessarily represent Al Jazeera's editorial policy.
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