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Thursday, May 22, 2014

Health Care Reform Articles - May 22, 2014

Single-Payer Advocates Hit Capitol With New Sense Of Reality

By Julie Rovner
Kaiser Health News, Capsules blog, May 21, 2014
Advocates for a single-payer “Medicare for all” health system are fanning out across Capitol Hill this week, lobbying members of Congress.
But years of mostly fruitless struggles – and watching the intense opposition to the much less sweeping Affordable Care Act – appears to have left them with a much more clear-eyed view of what it will take for them to accomplish their goal.
“This is tough stuff,” Sen. Bernie Sanders, D-Vt., told a roundtable of advocates he convened in the Dirksen Senate Office Building. “Single-payer health care bills – it ain’t going to take place here in Washington. I suspect it’s going to take place, as it did in Canada, with a state [Saskatchewan] going forward. I hope it will be my state.”
Indeed, Vermont in 2011 passed legislation that would make it the first state to create its own single-payer system, called “Green Mountain Care.” The experiment is set to launch in 2017, the first year that’s allowed under the Affordable Care Act. But key decisions about exactly how the plan would work, in particular how it would be financed, have yet to be made.
Meanwhile, those who have been pushing for a system that would effectively end private insurance say there’s no question they have the facts on their side.
“What we know about single-payer has zero to do with the merits,” said Robert Weissman of Public Citizen, referring to widespread charges by opponents that single payer systems are inefficient and can deny care. “We have proven alternatives in every other industrialized country in the world – better outcomes at less cost.”
That’s challenged, of course, by single-payer opponents who maintain that other countries keep costs down less by being more efficient and more by rationing care.
The advocates even took on the ongoing scandal at the Department of Veterans Affairs, where former service members have reportedly been dying while waiting to get care – despite the fact that the VA system is fully government-run, and not the same as single-payer, where doctors and hospitals would remain private, with pyment from the government.
“If the VA had the resources it needed to work, it would be a model for government-provided health care,” said Michael Lighty of the National Nurses United union.
For the moment, however, the single-payer advocates recognize that their mission is to convince a public that is clearly unhappy with the status quo in health care that a single-payer system is a potential option.
“The most important thing is to show people that change is possible,” said Gerald Friedman, an economics professor from the University of Massachusetts-Amherst. “That’s the role that Vermont has had – showing that it’s possible to get something done.”
And the Affordable Care Act may in fact be nudging the effort along, panelists said. With predictions that many employers will eventually push their workers onto the new health exchanges, “we face a fundamental choice in the long term,” said Lighty of the nurse’s union. “We either are going to have single-payer or individual purchase.”
And single-payer advocates are increasingly confident that’s a fight they can win. Even if it may not be any time soon.

Single Payer Advocates: How Do We Defeat Healthcare for Profit?

By Anne Meador
DCMediaGroup, May 21, 2014
“We have a completely irrational system. Every other industrialized nation has proven outcomes at less cost,” said Robert Weissman of advocacy group Public Citizen.
The U.S. is one of few industrialized countries which don’t offer universal healthcare to its citizens. Weissman and other panelists cited high rates of infant mortality and shortened life expectancy for poor women, even as the U.S. far outspends other countries for healthcare.
In one respect, however, the American healthcare system is unbeatable.
“It’s not true to call healthcare in America a failure,” said Gerald Friedman, Professor of Economics at the University of Massachusetts at Amherst. “It’s very successful, just not at providing healthcare, but at making profits.”
The heart of the problem is the damaging trend of privatization which began in the 1980′s, pitting profit-making enterprises against the public good.
“Costs have been completely out of control, and the plan is to shift those costs onto individuals,” said Dr. Andrew Coates of Physicians for a National Health Program.
Friedman said access to healthcare in the U.S. is rationed by commodifying it. Thirty percent of Americans have difficulty accessing heathcare, even if they have health insurance. Only four percent of people have difficulty getting healthcare in countries with a single payer system, where government foots the bill for healthcare costs.
Access to healthcare can also be regarded as a moral issue, according to Michael Lighty, Director of Public Policy for National Nurses United. He said that nurses want to be caregivers and exercise their clinical judgment on behalf of patients “under a single standard of high quality.” Market-based healthcare makes that impossible, and the Affordable Care Act has not been a solution. Under the ACA, he said, we have a tiered system with services according to ability to pay.
Far from being a step toward a single payer system, as many supporters claim, the Affordable Care Act further entrenches private health insurance. “There is no affordable market solution to healthcare,” said Dr. Margaret Flowers, a physician and organizer of Popular Resistance.
Poor patients living in Dr Coates’ area near Vermont can’t afford premiums and co-pays. “What we’re finding is, visits to the ER are going down, while admissions to the hospital are going up. Patients are coming in much sicker.”  From his point of view, wealth inequality is leading to a breaking point. “There are hideous disparities. We concentrate on the top one percent or top one-thousandth of one percent, but the poor are getting poorer,” he said. “Income inequality creates its own crisis. At some point, something’s got to give.”
He thinks that establishing healthcare as a right for all would be a remedy. “It would be liberating,” he said. “We deserve basic human dignity. It would change our basic political culture.”
Panelists seemed to agree that a grassroots political movement was needed to achieve universal healthcare under a single payer system, which they also view as part of a broader struggle.
http://www.pnhp.org/print/news/2014/may/single-payer-advocates-how-do-we-defeat-healthcare-for-profit

Health insurers bring to mind 'greedy, money, expensive, profit'

The Morning Consult, May 20, 2014
As the health insurance industry increasingly looks to market directly to consumers for new revenue, legacy brand challenges remain.  The words “greedy”, “money”, “expensive”, and “profit” dominated voter responses when asked to identify what comes to mind when you think of health insurance companies.
This puts insurers in a precarious position with respect to the Affordable Care Act’s health insurance exchanges should health plans choose to raise premiums next year during open enrollment.  Brand connotations will also impact investment decisions as some insurers look to acquire hospitals and physician practices or diversify into consumer-facing health IT products. The following word clouds illustrate the 100 most frequently given responses.
In a word or two, could you please tell me what comes to mind when you think of health insurance companies?
http://www.pnhp.org/print/news/2014/may/health-insurers-bring-to-mind-greedy-money-expensive-profit

Solution to challenge of providing health care to all is a single-payer system, say experts, advocates

ACA doesn't fix U.S. health care system, must be replaced with Medicare-for-All

By Public Citizen Inc.
National Journal, Press Release, May 21, 2014
WASHINGTON -- There is a solution to the challenge of providing health care coverage to the 50 million Americans who are uninsured, and that solution is a Medicare-for-All, single-payer system, a panel of experts and advocates said today.
The panel kicks off two days of events highlighting the benefits of a single-payer system, which would curb out-of-control health care costs and provide a humane standard of care to all who enter the medical system. Participants of the events include All Unions Committee for Single Payer Health Care-HR 676, American Medical Student Association, Gray Panthers, Healthcare-NOW!, Labor Campaign for Single Payer Healthcare, National Nurses United, National Organization for Women, Physicians for a National Health Program, Progressive Democrats of America and Public Citizen.
"We need a system that provides coverage as a matter of right, and that eliminates the wasteful role of the health insurance industry," said Robert Weissman, Public Citizen president. "We know there's a better way, as every other industrialized country shows. It's past time for the United States to provide health care coverage to everyone as a matter of right, through a national single-payer, Medicare-for-All system."
The Affordable Care Act (ACA) does not solve the central problems with the American health care system. After the ACA is fully implemented, millions of vulnerable people still will go without coverage, and tens of millions will remain underinsured, facing substantial deductibles, co-pays and co-insurance. A single-payer system would achieve far greater savings than the ACA, which maintains the role of the costly and wasteful private insurance industry. It also would be less complicated to put into place because it is already in place for Americans over 65 in the form of Medicare.
"The Affordable Care Act is reducing the number of uninsured, yet at the end of the day, it is not a program of universal access to care," said Dr. Andrew Coates, Physicians for a National Health Program president. "Because the major failings of the U.S. system still persist -- avoidable death and bankruptcy, racial and socioeconomic disparities, the perverse incentives of profiteering, burgeoning costs -- the urgency for single-payer national health insurance has never been greater."
Added U.S. Rep. John Conyers, Jr. (D-Mich.), "In 2014, it is long past time to recognize affordable, quality health care as a basic human right. While the Affordable Care Act was a historic first step, the only way we can wholly reform the United States' broken health care model -- and provide truly universal coverage to all Americans -- is through a single-payer system. It is for these reasons that, since 2003, I have repeatedly introduced H.R. 676, 'The Expanded & Improved Medicare for All Act,' that would publicly finance and privately deliver health care to millions of Americans that were previously left behind. The fight for lasting, transformative health care reform that single-payer promises is far from over, and it is only through the efforts of dedicated activists that will keep us marching forward towards progress."
http://www.pnhp.org/print/news/2014/may/solution-to-challenge-of-providing-health-care-to-all-is-a-single-payer-system-say-exp

A Cancer Treatment in Your Medicine Cabinet?

Pfizer to Apply for Breast Cancer Drug Approval

Pfizer said on Friday that the Food and Drug Administration would let it apply for approval of its heavily promoted experimental breast cancer medicine based on midstage patient testing results. That means Pfizer will not have to do bigger, and very expensive, late-stage patient studies to apply for approval of the drug, palbociclib. Additional studies could have delayed Pfizer’s application by years. Pfizer said that by the third quarter of this year, it would apply for approval to use palbociclib with a drug called Femara, or letrozole, as an initial treatment for postmenopausal women with a certain type of advanced breast cancer. The F.D.A. last year named palbociclib a breakthrough therapy, a designation given to medicines for diseases with no or inadequate treatments that is meant to speed up the approval process. Midstage test results showed that by combining palbociclib with letrozole, patients on average survived 20.2 months before their tumors worsened. That was about twice as long as the benefit for women in a comparison group who received only letrozole.

http://www.nytimes.com/2014/05/17/business/pfizer-to-apply-for-breast-cancer-drug-approval.html?src=rechp 


Federal funds earmarked to offset Affordable Care Act insurer losses


NOAM N. LEVEY

The Obama administration has quietly adjusted key provisions of its signature healthcare law to potentially make billions of additional taxpayer dollars available to the insurance industry if companies providing coverage through the Affordable Care Act lose money.
The move was buried in hundreds of pages of new regulations issued late last week. It comes as part of an intensive administration effort to hold down premium increases for next year, a top priority for the White House as the rates will be announced ahead of this fall's congressional elections.
Administration officials for months have denied charges by opponents that they plan a "bailout" for insurance companies providing coverage under the healthcare law.
They continue to argue that most insurers shouldn't need to substantially increase premiums because safeguards in the healthcare law will protect them over the next several years.
But the change in regulations essentially provides insurers with another backup: If they keep rate increases modest over the next couple of years but lose money, the administration will tap federal funds as needed to cover shortfalls.
Although little noticed so far, the plan was already beginning to fuel a new round of attacks Tuesday from the healthcare law's critics.
"If conservatives want to stop the illegal Obamacare insurance bailout before it starts they must start planning now," wrote Conn Carroll, an editor of the right-leaning news site Townhall.com.
On Capitol Hill, Republicans on the Senate Budget Committee began circulating a memo on the issue and urging colleagues to fight what they are calling "another end-run around Congress."

Best ideas from LePage’s welfare consultant lifted word-for-word from someone else’s work

Maine’s unemployment rate has slid to its lowest level since September 2008, but that doesn’t mean it’s easy to find work if you’re looking. Maine has nearly 16,000 fewer jobs today than it did in December 2007 at the official start of the recession.
So if Gov. Paul LePage’s administration is intent on lining up recipients of Temporary Assistance for Needy Families with job opportunities, a subsidized employment program for the low-income adults receiving that assistance makes sense.
You can learn a lot about these subsidized job placement programs from a 2011 paper authored by policy experts from the Center on Budget and Policy Priorities and the Center for Law and Social Policy, both based in Washington, D.C. The 35-page paper is an informative read.
Apparently, Gary Alexander — the welfare consultant hired by Gov. Paul LePage’s administration through a $925,000 no-bid contract — agreed.
One of the few sensible recommendations from his group’s recently released 228-page report on Maine’s government assistance programs is for Maine to start a subsidized jobs program for its TANF recipients. According to the Center on Budget and Policy Priorities, or CBPP, Maine is one of 10 states without such a program.
But in keeping with the rest of his paper, Alexander’s recommendation on subsidized work programs is far from original. In fact, much of it is lifted directly from the CBPP report.
To its credit, the Alexander Group cites the report as a source. But following the citation, the Alexander Group uses much of the CBPP report, word for word, passing it off as Alexander Group work.
“We don’t think professional standards would include excerpting significant chunks of text without quotation marks,” said Liz Schott, a senior fellow with the Center on Budget and Policy Priorities’ welfare reform and income support division and one of the report’s three authors. “They listed text and made it appear like their own, and, yes, that appears to be plagiarism.”
It starts with a list about advantages to subsidized work programs. Then, the Alexander Group discusses the experience of other states that have started subsidized work programs. For about two full pages, pages 110 and 111, the Alexander Group uses the CBPP’s work, virtually word or word.
“Most recently (from 2009 to present), subsidized jobs programs have largely been associated with two groups: welfare recipients and ex-offenders,” reads the Alexander Group report on page 110. “As a part of efforts to shift the focus of their public-assistance programs to work, some state and county welfare agencies have used their regular TANF funds to create subsidized employment programs for individuals who have not been successful at finding unsubsidized employment.”
On page 5 of the CBPP report, you’d find the following: “Most recently, subsidized employment programs have largely been associated with two groups: welfare recipients and ex-offenders. As a part of efforts to shift the focus of their public assistance programs to work, some state and county welfare agencies have used their regular TANF funds to create subsidized employment programs for individuals who have not been successful at finding unsubsidized employment.”
And the Alexander Group section on subsidized employment isn’t the only part that relies heavily on the Center on Budget and Policy Priorities’ work. In discussing general assistance, the Alexander Group relies on a 2011 report, authored by Schott and Clare Cho, about general assistance programs throughout the country.
“In 2011, as states struggled to close large budget shortfalls, ten states considered proposals to further shrink or eliminate general assistance, and seven states adopted such measures,” reads the Alexander Group report on page 99. “Illinois and Kansas eliminated their programs, Minnesota restricted eligibility, Michigan reduced benefit levels for all recipients, Washington restricted eligibility and reduced benefit levels for all recipients who still qualify, and Rhode Island has cut benefits for some recipients.”
A look at page 2 of the CBPP report turns up this information: “Then in 2011, as states struggled to close large budget shortfalls, ten states considered proposals to further shrink or eliminate General Assistance, and seven states adopted such measures. Illinois and Kansas eliminated their programs, Minnesota restricted eligibility, Michigan reduced benefit levels for all recipients,Washington restricted eligibility and reduced benefit levels for all recipients who still qualify, and Rhode Island is cutting benefits for some recipients.”
And to think this work will cost taxpayers $925,000. How much of it should have been paid to the Center on Budget and Policy Priorities?

http://bangordailynews.com/2014/05/21/opinion/best-ideas-from-lepages-welfare-consultant-appears-to-be-plagiarism/print/

Author of report from which Alexander Group lifted text: ‘It’s literally two pages of text’

Posted May 21, 2014, at 1:02 p.m.
AUGUSTA, Maine — A portion of a report by the Alexander Group, which Gov. Paul LePage’s administration commissioned as part of its welfare reform efforts, was copied from work done by a liberal Washington, D.C., think tank.
That revelation caused the Department of Health and Human Services on Wednesday to request resubmission of portions of the report while claiming the media and Democrats were trying to politicize the issue, which was dubbed “LePlagiarism” on social media.
The Alexander Group and the Department of Health and Human Services told the Bangor Daily News in written statements Wednesday afternoon that attribution errors were made in the report.
The author of a report on the federal Temporary Assistance for Needy Families program, which the Bangor Daily News reported in an editorial Wednesday was plagiarized by the Alexander Group, said she has never seen the organization’s work copied so liberally.
LaDonna Pavetti, vice president for the family income support division of the Center on Budget and Policy Priorities, said Wednesday morning that in her experience, what the Alexander Group did went far beyond normal or acceptable. The BDN found that pages of the Alexander report appeared nearly verbatim from the Center on Budget and Policy Priorities’ earlier study.
“I have never seen this,” said Pavetti. “It’s literally two pages of text [that were copied]. It’s not a small piece of text.”
Officials from the Department of Health and Human Services and the Alexander Group acknowledged Wednesday that errors were made. DHHS Commissioner Mary Mayhew said in an email response to questions from the BDN that the department is asking the Alexander Group to resubmit portions of the report.
“We acknowledge that there were citation errors made by our vendor of the ‘Baseline Analysis of Maine’s Welfare Programs,’” said Mayhew. “The Alexander Group has acknowledged those errors. The department has directed the Alexander Group to make the necessary corrections and resubmit the report. We will evaluate them in the context of their overall performance, as we do with all department vendors.”
The written statement said the department is “concerned that the media and Democrats have chosen to politicize punctuation over policy, instead of evaluating these critical reform recommendations on their merits.”
DHHS provided a written statement from the Alexander Group in which the firm acknowledged that the report “clearly falls short of The Alexander Group’s standards — and past record — of excellent performance and value.”


Troubles With Veterans’ Health Care


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