Single Payer Rises Again
By Sarah Jaffe
In These Times, February 3, 2014
By Sarah Jaffe
In These Times, February 3, 2014
In These Times, February 3, 2014
As the ACA takes effect, an alternative gains ground at the state level
When Sergio Espana first began talking to people, just over a year ago, about the need for fundamental changes in the U.S. healthcare system, confusion often ensued. Some people didn’t understand why, if the Affordable Care Act (ACA) had passed, people still wanted to reform the system; others thought organizers were trying to sign them up for “Obamacare.”
Healthcare is a Human Right Maryland, the group to which Espana belongs, is in pursuit of something else: a truly universal healthcare system that would cover everyone and eliminate insurance companies once and for all. Espana and many others in the growing movement see opportunity in the renewed discussion around healthcare reform as the ACA’s insurance exchanges go into effect.
They believe that the ACA’s continued reliance on (and subsidies of) private insurance simply aren’t good enough. People are still falling through the cracks, employers are trying to dodge the requirement that they provide insurance for their workers, and many states refused federal subsidies to expand their Medicaid programs. What these activists want is a program that would replace existing insurance programs, cover everyone regardless of their employment status, and be funded by the government, with tax dollars. Such a plan had strong support when the national healthcare overhaul was being crafted in 2009—including initial backing by President Obama—but the president and Congress decided it wasn’t politically possible and passed the ACA as a compromise.
Now, the rocky launch of the healthcare exchanges that form the cornerstone of the Affordable Care Act has helped revive interest in single-payer, says Ida Hellander, director of policy and programs for the advocacy group Physicians for a National Health Program. New York State Assemblymember Richard Gottfried, the author of a 20-year-old single-payer bill that is receiving renewed support, points out that single-payer would avoid many of the issues of the ACA’s launch. “When you don’t have means testing and you don’t have to make guesses about who’s going to cover your doctor or your ailment, it’s very simple.”
While Republicans on the national stage have been grandstanding about “repealing and replacing” the ACA, grassroots activists are on the ground in many states organizing their neighbors around the idea of real universal healthcare. A national program remains the end goal, but Nijmie Dzurinko of Put People First! Pennsylvania believes that state efforts could have a domino effect. “Our job is to change what’s politically possible,” says Drew Christopher Joy of the Southern Maine Workers’ Center, which is leading the effort in that state.
According to Hellander, about 25 states already have solid organizing toward single-payer, often accompanied by pending legislation. Some of these efforts predate the ACA: The California Nurses Association led the charge for single-payer in the mid-2000s, twice getting a bill through the California legislature only to have it vetoed by Gov. Arnold Schwarzenegger. Hellander says that the ACA has slowed down some efforts at state reform, as officials turned to setting up exchanges, but the law spurred others in Minnesota, Washington, Hawaii and Oregon. In New York, Gottfried notes that his bill has support from physicians groups, the nurses union and a majority of the lower house of the legislature. And in Massachusetts, considered the laboratory for the ACA, single-payer is now on the table thanks to gubernatorial candidate Don Berwick, the former administrator of the Centers for Medicare and Medicaid Services under Obama.
The biggest legislative victory to date has come in Vermont. Act 48, signed into law by Gov. Peter Shumlin in May of 2011, would begin to create a “universal and unified” healthcare system for the state. The bill, pioneered by the Vermont Workers’ Center (VWC), is at the cutting edge of national healthcare policy. Its passage resulted from years of on-the-ground organizing around the principle that healthcare is a human right—that it must be universal, equitable, participatory, transparent and accountable.
However, Act 48 marks just the beginning of a lengthy process toward healthcare for all residents of the state, regardless of employment or citizenship. The next steps are to figure out how “Green Mountain Care” will fit into federal requirements set by the ACA and to pass a mechanism by which the program will be financed.
Weighing Testosterone’s Benefits and Risks
By RONI CARYN RABIN
Nearly a decade ago, researchers in Boston decided to see whether older men who were not in very good shape could benefit from daily doses of testosterone.
The scientists recruited several hundred volunteers and gave them the hormone or a placebo. Those taking testosterone got stronger, compared with those taking the placebo, and they could carry a load up stairs faster.
But they also had nearly five times the number of cardiovascular problems, including heart attacks and strokes, and safety monitors ended the trial early.
Since those findings were published in 2010, studies of testosterone treatment have produced mixed results. A 2012 study of veterans aged 40 and over with low testosterone found thatthose treated with the hormone were less likely to die, but more recent reports, including one published last week, have documented an increase in cardiovascular risk in men over age 65 taking testosterone, as well as in younger men with a history of heart disease.
Officials at the Food and Drug Administration said on Friday that they were reassessing the safety of testosterone products in light of the recent studies, and will investigate rates of stroke, heart attack and death in men using the drugs.
In recent years, testosterone has been heavily promoted as a cure-all for low energy, low libido, depression and other ills among middle-aged men. “Low T” is a ubiquitous diagnosis, heard in television commercials and locker rooms.
Don’t Ask Your Doctor About ‘Low T’
SANTA BARBARA, Calif. — A FUNNY thing has happened in the United States over the last few decades. Men’s average testosterone levels have been dropping by at least 1 percent a year, according to a 2006 study in The Journal of Clinical Endocrinology and Metabolism.
Testosterone appears to decline naturally with aging, but internal belly fat depresses the hormone further, especially in obese men. Drugs like steroids and opiates also lower testosterone, and it’s suspected that chemicals like bisphenol A (or BPA, commonly found in plastic food containers) and diseases like Type 2 diabetes play a role as well.
Men feel the loss. Clinical testosterone deficiency, which is variously defined as lower than 220 to 350 nanograms of testosterone per deciliter of blood serum, can cause men to lose sex drive and fertility. Their bone density often declines, and they may feel tired and experience hot flashes and sweats.
But “low T,” as the condition has been labeled, isn’t nearly as common as the drug ads for prescription testosterone would have you believe. Pharmaceutical companies have seized on the decline in testosterone levels as pathological and applicable to every man. They aim to convince men that common effects of aging like slowing down a bit and feeling less sexual actually constitute a new disease, and that they need a prescription to cure it. This is a seductive message for many men, who just want to feel better than they do, and want to give it a shot, literally.
The Insiders: Obamacare – The incompetence and denials keep coming
By Ed Rogers,
Two stories converge today to illuminate how the White House and the Democratic establishment are attempting to hide the next wave of Obamacare failures. Both Post stories reveal how the president and Democratic leaders at the state level are hiding problems with Obamacare instead of confronting and fixing problems.
First, Amy Goldstein of The Post reveals that the appeals process guaranteed in the Obamacare law does not actually exist. The story outlines an almost comical process that requires citizens who seek a fair hearing to have an innocent, HealthCare.gov-generated mistake corrected to fill out a seven-page paper form that is then inexplicably shipped to Kentucky, where it is entered into a government database that isn’t actually connected to anything. It’s a digital dead end for those who dare to complain. Typical. As a result, 22,000 Americans who have submitted an appeals request remain without proper coverage and they have no recourse. And, according to The Post, in the latest show of non-transparency from this administration, officials have “not made public the fact that the appeals system for the online marketplace is not working.” There is “no indication that infrastructure . . . necessary for conducting informal reviews and fair hearings had even been created, let alone become operational,” and administration officials are refusing to give any information as to when the appeals process might start moving. This is an administration that wants to hide things rather than fix things.
Next, The Post’s Jenna Johnson and Mary Pat Flaherty outline how Maryland state officials are trying to block an investigation into the debacle of the state health insurance exchange Web site, which has been plagued with operational problems since day one. Some Democratic officials — including Lt. Gov. Anthony G. Brown, who is running for governor — don’t want a full investigation because such an investigation could have a negative impact on the upcoming state elections for Democrats. Remarkably, and presumably with a straight face, Sen. Thomas Middleton (D-Charles), the chairman of the Finance Committee, reportedly argued that a full investigation would “distract health officials from signing Marylanders up for health insurance before the March 31 deadline.” Instead, some Maryland Democrats prefer to “defer to a previously scheduled state audit of the exchange that is expected to begin this summer and could take a year to complete.” This would conveniently push any revelations or accountability (the truth) until after the elections.
It is painfully obvious that many Democrats think the best political tactics for dealing with the numerous Obamacare problems are to ignore them, hide them or otherwise deny they exist. Democrats just keep insisting that folks are signing up and “glitches” are being fixed.
These two stories suggest that the Democrats hope Obamacare fatigue will set in and voters will begin to simply shrug as the problems become part of American life, that Obamacare will become another government-supplied annoyance for which no one is responsible and no one is to blame. The problem is that voters can’t just learn to ignore the calamity that is Obamacare because health care and health insurance are vital to the life of every American.
You can bet President Obama has completely checked out from any Obamacare management, and there is zero chance his staff and Cabinet want to bring problems to his attention or ask for his instructions.
Democrats may think they can stiff-arm all the inquiries into the problems with Obamacare, but they can’t. The Obamacare blight is here to stay and Democrats own it. The best politics for them would be to do everything they can to make sure the system works. But they can’t make sure Obamacare works if they continue to deny problems exist or hide these problems from the public. It is insulting to voters for the Democrats to shamelessly shift blame, plead ignorance and pretend things are fine. The sooner they realize this, the better off they will be in November. Engaging in denial and deceit isn’t a plan, and they won’t be able to maintain multiple cover-ups for the next nine months. The Democrats can run, but they can’t hide.
Follow Ed on Twitter: @EdRogersDC
‘Repeal and replace’ Obamacare now has some meaning, but why did GOP bother?
The constant refrain from the GOP in the last two election cycles was to “repeal and replace” Obamacare.
Nearly four years after the Affordable Care Act’s passage, three Republican senators — Utah’s Orrin Hatch, North Carolina’s Richard Burr and Oklahoma’s Tom Coburn — have done the most convincing job yet of filling in the “replace” part of the equation.
The Patient CARE Act — CARE is an acronym for Choice, Affordability, Responsibility and Empowerment — is similar to Obamacare in broad strokes (though not as similar as an earlier alternative). That points to the reality that Obamacare, while hailed as a monumental reform and derided as a massive government intrusion, only changed so much in the American health care system while keeping in place the fundamentals of the U.S.’s private health insurance market.
The Patient CARE Act’s primary mechanism for expanding insurance coverage? Tax credits for those with lower incomes — except that the credits would flow directly to the consumer rather than to the insurance company.
The act would also retain Obamacare’s provisions that allow young people to stay on their parents’ insurance until they’re 26 and bar insurance companies from placing lifetime limits on the amount they’ll pay out for consumers’ health care.
The proposal has some guarantees as well for patients with pre-existing health conditions: As long as they’ve remained insured, no insurer could deny them coverage for a pre-existing condition. The authors say the prospect someone could be denied coverage for a pre-existing condition if he or she didn’t remain insured acts as an incentive to have health insurance.
Gone would be the individual and the employer mandates. Gone would be healthcare.gov and the publicly funded, state-run, online health insurance exchanges. Gone would be the Medicaid expansion, replaced by tax credits for those making 300 percent of the federal poverty level ($34,470 for an individual) or less and a major Medicaid restructuring that caps funding to the states — potentially leaving state budgets entirely on the hook for major expenses.
Even a less ambitious law that expands coverage through a tax credit program needs a way to pay for itself.
To that end, the GOP alternative would keep in place changes to Medicare — including reduced payments to hospitals — projected to reduce future spending by more than $700 billion. Those changes attracted GOP ire during the campaign season as Romney and others accused Obamacare of cutting retiree benefits.
And the act would end a longstanding tax exemption on health benefits for employees who get insurance through their jobs. Thirty-five percent of an employee’s health plan costs would be taxable — meaning a noticeable hit to the paycheck.
Insurers need a way to make ends meet, too, without the customer base guaranteed by the individual mandate. For them, the Patient CARE Act would insert the pre-existing condition loophole and end the mandates on what private insurance plans need to cover; the Patient CARE Act would mean the end of preventive care provided without copays.
In a question-and-answer document Burr, Coburn and Hatch have distributed, they pledge to avoid a key Obamacare pitfall: “We want individuals who like their plan to be able to keep it.”
But by repealing Obamacare and its mandates that insurers cover basic services, Burr, Coburn and Hatch would risk falling into the exact same pitfall.
U.S. says HealthCare.gov enrollment appeal hearings to begin soon
Posted Feb. 03, 2014, at 9:16 p.m.
WASHINGTON — The Obama administration on Monday said it soon will begin hearings to resolve problems for people who enrolled in health insurance through the healthcare.gov only to encounter errors including unnecessarily high costs.
The U.S. Centers for Medicare and Medicaid Services, the lead agency responsible for implementing the health care reform law known as Obamacare, issued a statement saying it was reaching out to consumers with error-ridden enrollments to help them complete applications for coverage without a formal appeal.
The statement came in response to a Washington Post report that said about 22,000 Americans have appealed to CMS for help fixing enrollment mistakes that have led to excessive charges, enrolled them in the wrong health plan or denied them coverage altogether.
The appeals have hit a technological dead end, the newspaper reported, because the administration has yet to complete the technology infrastructure necessary to manage the appeals process.
Obamacare’s rocky implementation has already weathered paralyzing glitches and a public outcry over insurance policy cancellations for millions of people in the health plan market for individuals.
“CMS is working to fully implement an automated appeals system. Until we have that functionality, we are putting in place a manual review process wherever possible and expect hearings to begin soon,” said the agency.
“In the meantime, CMS is reaching out to these consumers to provide assistance so they can successfully complete their application without the need to complete the appeals process.”
CMS did not confirm the number of appeals reported by the Post but said those filed are “largely related to earlier technology problems that have since been fixed.”
A CMS spokesman declined to say how soon hearings might start. But analysts said a system would have to be in place before March 31, the end of the Obamacare open enrollment period for obtaining health coverage this year.
The Patient Protection and Affordable Care Act, President Barack Obama’s signature domestic policy achievement, is intended to extend private health coverage to the uninsured by selling private plans at subsidized rates through new marketplaces. The law also calls on states to expand Medicaid coverage for the poor.
Healthcare.gov, the Web portal for a federal marketplace that spans 36 states, crashed soon after its October launch, blocking access to some while saddling others with inaccurate enrollment files. Four months later, CMS is still scrambling to complete back-end systems that would allow the federal marketplace to pay government subsidies to insurers on behalf of low-income beneficiaries.
Republicans in Congress pounced on news of the appeals problem as fresh evidence that the healthcare law’s individual mandate should be delayed. The mandate requires most Americans to be enrolled in health coverage by March 31 or pay a penalty.
“Over four months after launch, the administration still does not have its act together. They appear to be incapable of addressing Obamacare’s failures, unfairly leaving Americans on the hook,” said Joe Pitts, chairman of the House Energy and Commerce health subcommittee.
Experts worry about effect of dropping hundreds of addicted Mainers from treatment
Posted Feb. 03, 2014, at 4:58 p.m.
BANGOR, Maine — On the first day of 2014, hundreds of Mainers were removed from their methadone and Suboxone treatment regimens after losing MaineCare coverage, prompting concern among addiction treatment experts and addicts that many former methadone patients will end up back on street drugs, in prison or dead.
MaineCare recipients known as “noncategoricals” — typically childless adults who don’t qualify for disability or other categories that would make them eligible — lost their coverage on Jan. 1. In that group are hundreds of addicts in recovery who use the program to pay for their chemical-assisted treatment.
Gov. Paul LePage began looking at ways to reduce the number of Mainers on MaineCare in recent years. He has said he wants more “able-bodied” Mainers to fend for themselves, work and pay for their own health care, and that the state’s welfare system isn’t financially sustainable.
Officials who deal with addiction worry the human costs will far outweigh the costs the state faces in paying for their treatments through MaineCare.
On the edge
Jacob Vanadestine, 33, of Palmyra had been on methadone for about six years. He began receiving treatment in Bangor five years ago at Discovery House, a national outpatient addiction treatment provider that also has offices in South Portland, Waterville and Calais.
“With all the drugs I did in my past, and how addicted I became, my brain has been altered by it for the rest of my life,” Vanadestine said during a recent interview. During that interview, he shook, struggled to sit still and was tense.
When Maine lawmakers passed a two-year lifetime limit on methadone treatment that took effect on the first day of 2013, Vanadestine figured he had two years to taper his doses and, hopefully, get clean. Then, in October, he received a letter notifying him that he would be losing MaineCare at the end of the year.
Instead of another year to taper off methadone, he had two months. As he weaned down his doses toward the end of the year, his withdrawal symptoms became so severe that he asked Discovery House to stop reducing his doses, he said. He had to come off methadone suddenly on Jan. 1.
On methadone, “I was able to at least keep myself out of trouble each day,” Vanadestine said. “Everybody that I know that’s using the program right, their lives have always gotten better.”
Vanadestine recently spent three nights in severe pain at the emergency department of a Pittsfield hospital waiting for a crisis bed to open up, according to his mother, Sheryl Vanadestine. He was eventually discharged and sent home without an answer, she said. Doctors think the pain is related to his withdrawal, but he isn’t so sure. He still has no health insurance, will have to swallow the costs and likely sit on the debt for a long time, his mother said. He recently sent out an application for disability, but isn’t sure if the severe knee and leg pains that put him in the hospital will be enough for him to qualify.
“It’s like all the old feelings, the old thoughts, the old cravings, all of it is starting to come back,” Jacob Vanadestine said during an interview a week before losing MaineCare benefits. He was worried he might relapse, get back onto street drugs and start shoplifting again to feed his addiction.
His concerns turned out to be right. According to his mother, he went to the streets in late January to acquire illicit drugs to stave off withdrawal pains.
“This is hard. This is scary. I mean, I don’t know, I might die,” he said in the weeks leading up to the end of his MaineCare.
Brandi Harriman, 28, of Glenburn and Lindey Saunders, 35, of Ellsworth also received letters in October saying they were losing MaineCare. Both also were receiving methadone treatments at Discovery House.
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Massachusetts Republicans see 2014 opportunity in Obamacare flaws
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| Massachusetts may have inspired Obamacare, but state Republicans see its flaws giving them an opening with voters in November. The state’s transition from its own health reform law to federal reform — from Romneycare to Obamacare — has been a mess. Massachusetts’s first-in-the-nation exchange had to be revamped to meet Obamacare requirements, but it melted down, threatening coverage for hundreds of thousands of people. Officials are relying on costly workarounds so people don’t lose insurance altogether, and there’s no timetable for a permanent fix. Although the state’s a Democratic stronghold and has only gotten more blue in recent years, Republicans have begun their 2014 campaigns by pointing to the Massachusetts experience with the federal law. (PHOTOS: Obamacare online glitches: 25 great quotes) The state’s diminished Republican Party hasn’t won a U.S. House race since 1994 or a governor’s race since 2002. Scott Brown’s brief claim on a Senate seat came and went. Democrats hold supermajorities in both branches of the state Legislature. The GOP is looking for a path back. “No other state has suffered more from Obamacare than Massachusetts,” said Republican Richard Tisei, who’s running a rematch this year against Democratic Rep. John Tierney in perhaps the state’s most competitive House race. He’s making the president’s health law the centerpiece of his campaign and says the first bill he would file in Congress would exempt the state from Obamacare. “Our website was fully functional and hadn’t really experienced any problems,” Tisei said, referring to the enrollment portal that worked under the state’s pioneering 2006 law. “Now we have the worst website in the country … the state’s going to have to spend millions and millions of dollars just to get back to where we were.” (PHOTOS: 25 unforgettable Obamacare quotes) Charlie Baker, the GOP front-runner in the race to succeed Gov. Deval Patrick, who chose not to seek another term, says he would also seek an exemption from Obamacare. “There are a lot of people in Massachusetts who are being negatively impacted by something that hasn’t really moved the ball here for people at all,” said Baker, a former health insurance executive who lost to Patrick in 2010. “Massachusetts led the country on health reform. I would like to see us get back into a leadership position.” Early polls show Baker trailing the Democratic front-runner for the nomination, Martha Coakley. And Democratic strategists say there’s time to fix the enrollment problems, which affect only a sliver of the population, well before the elections. Still, the GOP says the ongoing health law problems feed a narrative that seemed unthinkable just a few months ago. And Brown, after all, initially won over voters who backed the state’s health law but were dubious about its federal counterpart. After a bipartisan deal signed into Massachusetts law in 2006 by then-Gov. Mitt Romney, Massachusetts helped the state insure more people than any other — 97 percent, by some estimates. Its success became the model for the federal reform. After the Affordable Care Act passed in 2010, Massachusetts accepted tens of millions of dollars to rebuild its exchange. It chose a contractor to lead the redesign — CGI, the same firm that blazed the way for the federal website, HealthCare.gov, to catastrophic results. http://dyn.politico.com/printstory.cfm?uuid=1CD90A2F-4825-452C-9941-A4AF08BF605C |
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