Saturday, January 31, 2015

Health Care Reform Articles - January 31, 2015

Barriers to More Healthcare Reform Are Numerous

Apathy and fear are among the biggest stumbling blocks, experts say.

WASHINGTON -- The lack of greater movement toward universal healthcare coverage -- especially a single-payer system -- in the U.S. can be boiled down to four letters: AFIG, according to Philip Caper, MD.
The "A" stands for Apathy, Caper said Wednesday during a briefing on barriers to healthcare reform sponsored by the National Academy of Social Insurance (NASI). Caper is with Maine AllCare, an organization devoted to getting universal healthcare in Maine.
The attitude of many people is "'I've got mine; why should I worry about anyone else?'" said Caper, a founding member of NASI, whose mission is to increase public understanding of how social insurance contributes to economic security.
"Or think of young invincibles, who think it's worth the risk to go uncovered," continued Caper, who was speaking by phone from Maine. "Perhaps apathy is the result of our emphasis on personal liberty and personal responsibility."
The "F" stands for fear, Caper continued -- "fear of change; the fear of losing coverage they already have; or the fear of loss of income or profitability" on the part of those working in the healthcare industry.
"I" is for ignorance, he said, making it clear that he was not equating ignorance with stupidity, rather a lack of information and understanding. "Most Americans don't understand the healthcare system and don't understand there are better ways of financing this," Caper said.
"I definitely include doctors in this group," he added. "I can tell you from personal experience that it's almost impossible to get health policy into the medical school curriculum, where the focus is rightly on clinical medicine."
And finally, there is the "G" -- for greed. "This may seem harsh [but] the widely accepted view of healthcare as just another business is uniquely American, at least in degree," he said. "I have heard some people say the healthcare system is becoming a wealth extraction machine. This view is reinforced by news stories of opportunistic pricing of drugs for chronic diseases such as hepatitis."
Satisfied With the Status Quo
Another barrier to changing the way health insurance is delivered comes from the fact that many people are satisfied with their employer-provided health insurance, said Laurence Seidman, PhD, professor of economics at the University of Delaware in Newark.
"But they don't seem to realize two things," he continued. "First, what would happen if they lose their job? And second, [they don't realize] that the rising premiums for medical care that their employers are paying is a key reason why their wage and salary growth has been so low."

Did Obamacare Just Have Its Best Week Ever?

But at America’s kitchen tables, or more likely, at family computers, a different story is unfolding – and enrollment success stories are popping up in the places you’d least expect.
According to new data released by HHS, more than 9.5 million people had signed up for a Marketplace plan by January 18th. That figure does not include millions more enrolled in Medicaid. Given that the Administration’s own goal was 9.1 million enrolled, this year’s Open Enrollment period is looking quite rosy. One more sign of growing interest in health care: 42% of this year’s enrollees have selected plans for the first time on the federal Marketplace.  
In states where elected officials tried to position themselves as skeptics of affordable health care during 2014 campaigns, their constituents have chosen to enroll regardless, indicating a shift in political tides.
In Florida, for example, Governor Rick Scott spent millions painting his opponent as an Obamacare supporter in his race for the Governor’s seat. Since then, Florida has led the nation in enrolling residents: 1.2 million Floridians have signed up for a plan. One zip code outside of Miami holds the record of the most enrollees in the country.
Other states where anti-Obamacare in past years ran deep, such as North Carolina, Georgia, Idaho and Virginia have also seen higher than average percentages of eligible residents sign up for coverage. In North Carolina, Senator Kay Hagan lost her seat after enduring millions of dollars worth of ads pillorying her support of the ACA. The state is now 6% above the national average in percentage of eligible residents enrolled. In Georgia and Kentucky, senatorial candidates Michelle Nunn and Alison Lundergan Grimes refused to even say whether they would’ve voted for the law for fear of being tied to it. Despite their reluctance, both still lost their elections. Now, both states have seen above average enrollment percentages.

Don't Trade Away Our Health

Tuesday, January 27, 2015

Health Care Reform Articles - January 27, 2015

To Collect Debts, Nursing Homes Are Seizing Control Over Patients

Single-Payer: It's What the People Want

New poll shows majority of Americans support such a system.

A majority of Americans support a single-payer, Medicare-for-all healthcare system, a new poll shows.
The results showed that just over 50 percent of the 1,500 likely voters surveyed indicated support for a single-payer system. Almost 80 percent of Democrats supported such a plan, while 25 of Republicans did.
The findings were first shared with The Hill by the Progressive Change Institute, an arm of the Progressive Change Campaign Committee.
The new poll comes on the heels of Vermont Governor Peter Shumlin's abandoning what was seen as a trailblazing plan to create a single-payer healthcare system in his state. The move was derided by Dr. Andrew D. Coates, president of Physicians for a National Health Program, who said, "Vermonters throughout the state understand that an equitable health care system must be truly universal and must remove all financial barriers to medically necessary care. They recognize that a public single payer is an essential incremental step toward these goals."
"The time for a single-payer system is now. Our patients in every state urgently need it," Coates added.
That sentiment is widely shared.

Costs derail Vermont’s dream of a single-payer health plan


For decades, liberal activists yearned for a European-style, single-payer health system that they argued would lead to more affordable, efficient, and comprehensive medical coverage for all citizens. When Vermont four years ago enacted a landmark bill to establish the nation’s first single-payer health care system, they saw their long-sought dream about to be fulfilled.
But reality hit last month. Governor Peter Shumlin released a financial report that showed the cost of the program would nearly double the size of the state’s budget in the first year alone and require large tax increases for residents and businesses. Shumlin, a Democrat and long-time single-payer advocate, said he would not seek funding for the law, effectively tabling the program called Green Mountain Care.
“In my judgment, now is not the time to ask our Legislature to take the step of passing a financing plan for Green Mountain Care,’’ Shumlin said.
The decision not only stunned and angered supporters in Vermont, but also signaled that the dream of universal, government-funded health care in the United States may be near its end. Vermont’s experience, analysts said, shows how difficult — and costly — it can be to shift from a system long-dominated by private health insurance, and that the future of universal health care lies within the private market.
In short, if a liberal state electing a Socialist (US Senator Bernie Sanders) to Congress can’t or won’t put a single-payer system into place, then who will?
“The idea of single-payer, or a Medicare-for-all type program, has always been a cherished dream for many in the Democratic Party,” said Henry J. Aaron, a senior fellow at the Brookings Institution, a liberal-leaning Washington think tank. “In truth, there had never been a hard, developed plan to implement such a dream. In Vermont, they finally developed a plan, and look what happened.”
A single-payer system has been the Holy Grail for progressives since the end of World War II, when President Harry Truman unsuccessfully pushed for a government-run National Health Insurance Plan to provide medical coverage for all Americans. In the 1970s, the late Senator Edward M. Kennedy of Massachusetts vainly battled for a variation of Truman’s national insurance plan.
In the 1990s, President Bill Clinton turned to the private market to provide universal care, requiring that employers furnish health insurance for their workers. But that plan was rejected, too. Finally, in 2010, after a momentous congressional battle, President Obama signed into law the Affordable Care Act, achieving universal coverage by expanding Medicaid, the government health care program for the poor, and mandating private insurance for others.
Vermont took Obamacare a step further. In 2011, Shumlin proudly signed a bill to establish a publicly financed, single-payer system. The law required Shumlin to submit a detailed financial plan by 2013.
Shumlin missed the deadline, raising fears among supporters and critics alike that single-payer health care would cost much more than anticipated. Those fears were realized on Dec. 17, when Shumlin, two years late and just a month from narrowly winning reelection, released the financial analysis.
The numbers were stunning. To implement single-payer, the analysis showed, it would cost $4.3 billion in 2017, with Vermont taxpayers picking up $2.6 billion and the federal government covering the rest. To put the figures into perspective, Vermont’s entire fiscal 2015 budget, including both state and federal funds, is about $4.9 billion.

Bernie Sanders Got Republicans To Make His Argument For Universal Health Care

WASHINGTON -- In their ongoing efforts to roll back or hamstring Obamacare, Republicans probably weren't hoping that the first Senate hearing on the matter this year would feature a self-described "democratic socialist" getting GOP witnesses to back a key argument for universal health care.
Thursday's hearing of the Committee on Health, Education, Labor and Pensions was devoted to the question of moving the full-time work standard under the Affordable Care Act from 30 hours a week to 40 hours, and whether more workers would be hurt by the higher or lower limit.
But to Sen. Bernie Sanders (I-Vt.), who has long supported the creation of a universal health care system, battling over that particular point began to seem absurd, and he opened his remarks by noting that in every other developed country, such a debate would make no sense at all.
"The argument of whether you provide health insurance to people who work 30 hours a week or whether they work 40 hours a week -- whoa," Sanders said. "In every major country on Earth, health care is a right of all people."
With that as his premise, he then asked three of the hearing's witnesses -- two business owners and a school superintendent -- whether their lives and daily endeavors would be improved if government lifted from them the burden of providing health care to their workers.
The panel's only Democratic witness, Joe Fugere, founder of the Seattle-area Tutta Bella Pizzeria chain, readily answered that it would.
And despite all the GOP's cries and criticisms of "socialized medicine" when the Affordable Care Act was making its way through Congress years ago, the two Republican panelists agreed nearly as readily.
"A question like that -- sure," said Betsy Webb, who runs the Bangor School Department in Maine. "But what is the reality?"
"The reality is that maybe it should not have to be the responsibility of the Bangor school district to provide health care, that maybe it should be a right of all of our people, whether they work at McDonald's in Bangor, whether they work for the school district, to have health care," said Sanders, before taking up the question with the next witness, Andrew Puzder, the CEO of CKE Restaurants, which runs the Carl's Jr. and Hardee's chains.
"If what you're saying, Senator, is that if we had a bill that was debated, that was vetted through congressional committees, and we looked at the health care system and really tried to come up with a more rational solution, I would say you're absolutely right," Puzder said.
He allowed that he and Sanders "might not agree on the ultimate solution," but when Sanders pressed Puzder on whether he would rather not have to worry about providing health care and instead focus on his products, the CEO was emphatic.
"From your lips to God's ear," he said.

End Obamacare, and people could die. That’s okay.

We make such trade-offs all the time.

Michael R. Strain is a resident scholar at the American Enterprise Institute.
Say conservatives have their way with Obamacare, and the Supreme Court deals it a death blow or a Republican president repeals it in 2017. Some people who got health insurance as a result of the Affordable Care Act may lose it. In which case, liberals like to say, some of Obamacare’s beneficiaries may die.
During the health-care debates of 2009, Rep. Alan Grayson (D-Fla.) brought a poster on the House floor: “The Republican Health Care Plan: Die Quickly.” In the summer of 2012, when Obamacare was threatened by a presidential election, writer Jonathan Alter argued that “repeal equals death. People will die in the United States if Obamacare is repealed.” Columnist Jonathan Chait wrote recently that those who may die are victims of ideology — “collateral damage” incurred in conservatives’ pursuit “of a larger goal.” If these are the stakes, many liberals argue, then ending Obamacare is immoral.
Except, it’s not.
In a world of scarce resources, a slightly higher mortality rate is an acceptable price to pay for certain goals — including more cash for other programs, such as those that help the poor; less government coercion and more individual liberty; more health-care choice for consumers, allowing them to find plans that better fit their needs; more money for taxpayers to spend themselves; and less federal health-care spending. This opinion is not immoral. Such choices are inevitable. They are made all the time.
Consider, for example, speed limits. By allowing people to drive their cars at speeds at which collisions result in death, our government has decided that the socially optimal number of traffic fatalities is not zero. Some poor souls die: There were more than 30,000 traffic fatalitieson America’s roads in 2013. If we didn’t accept that risk, we’d lower the speed limit to a rate at which accidents simply don’t kill, such as 10 mph. Instead, we’ve raised it periodically over the years, and you can now go as fast as 85 mph on a few highways. 
It is tragic that thousands of people die each year in car crashes. At the same time, there are huge (if dispersed) benefits to a 70 mph speed limit over a 10 mph limit: a transportation sector that can deliver goods quickly across the country; increased productivity, because millions of commuters can spend more time at work than in transit; and more time at home with our children.

Health insurers may face tougher rules on Obamacare doctor lists