Health Care Reform Articles - October 7, 2016

Editor's note:

What follows is an excerpt for a state level universal health care system for Minnesota, published as a book by a state senator who has served for over 30 years in the Minnesota state senate. Well worth the time to read it.

-SPC

Proposed Minnesota Health Plan

WHAT IS THE MHP?

http://mnhealthplan.org/wp-content/uploads/2016/09/Healing-Health-Care.pdf

A comprehensive, coherent roadmap to universal health care.

In this new book, Minnesota Senator John Marty provides the most complete, well-researched, thoroughly documented proposal for universal health care; a blueprint not only for Minnesota but for people across the country who are eager to create a health care system that works.

People who read this short book cover-to-cover will come away with a fundamentally different understanding of our health care crisis, and a belief that we really can fix our health care system.

Senator Marty begins by spelling out principles we should expect our health care system to follow, then lays out a commonsense plan to meet those principles. Using Minnesota legislation as a model, he articulates a plan that covers all people for all of their medical needs in an accountable, comprehensible, fair, and affordable manner.

Marty cuts through and critiques layers of “reforms,” from the Nixon era to the Obama administration, that led to the bureaucratic nightmare that causes Americans to pay almost twice as much as other nations, with worse coverage and poor health outcomes. Our health care system is so dysfunctional, one business executive quipped, “If you tried to design a health care system that doesn’t work, you couldn’t have done a better job.”

Marty challenges the timidity of progressive politics: “If twenty-first century progressives had been leading the nineteenth century abolition movement, we would still have slavery, but we would have limited slavery to a 40-hour work week, and we would be congratulating each other on the progress we had made.”

As a long-time state senator, he argues that politicians retreated from a “politics of principle” to a misguided “politics of pragmatism,” which led President Obama to fight for, and pass a “universal” health care system that isn’t universal.

Marty points out that the United States squanders outstanding health care resources—excellent providers, clinics and hospitals, medical research and technology—on a broken system that makes it difficult and expensive for many people to get the care they need. He asks, “why would any society make it difficult for its people to access health care?”

Senator Marty concludes, “It’s time to develop the political will to build a system that gives health care to all instead of health insurance to some.”

The Minnesota Health Plan (MHP) would be a single, statewide plan that would cover all Minnesotans for all their medical needs.

Equally important, it would reduce the need for costly medical care through public health, education, prevention and early intervention. There are currently over 260,000 Minnesotans without any health insurance, and at least a million more who have insurance, but still cannot afford to pay their medical bills due to co-payments, deductibles, and care not covered by their insurance, on top of their premiums! The MN Health Plan is the only plan that would eliminate the problem of un-insurance and under-insurance.

Under the plan, patients would be able to see the medical providers of their choice when they need care, and their coverage by the health plan would not end when they lose their job or switch to a new employer.

Dental care, prescription drugs, optometry, mental health services, chemical dependency treatment, medical equipment and supplies would all be covered, as well as home care services, and nursing home care. Consumers would use the same doctors and medical professionals, the same hospitals and clinics, but all the payments, covering all of the costs, would be made by the MHP, and everyone would be covered. 

There would be no filing out of complex application forms, no worrying whether a provider is “in network” or not, no worrying about whether the treatment was covered or how you are going to pay for the drugs.

The Minnesota Health Plan would be prohibited from restricting, delaying, or denying care, or reducing the quality of care to save money, but would lower health care spending through prevention, efficiency and the elimination of paperwork. MHP would restore medical decision-making to the doctor and patient, removing health insurance staff from making treatment decisions. The plan would end not only access problems caused by cost, but also access problems caused by an inadequate number of health professionals and facilities around the state.

The plan would be funded by all Minnesotans, based on the ability to pay, and would cover all health care costs, replacing all premiums currently paid by employees and employers, as well as all co-payments, deductibles, all payments for care by the uninsured or under-insured, and all costs of government health care programs.

Although the Minnesota Health Plan is not cheap, it is significantly less expensive than our current system, and it would provide a full range of health care services to everyone, greatly improving the health of the population.

EXCERPTS FROM HEALING HEALTH CARE

DESIGNING THE HEALTH SYSTEM WE NEED

On the lack of political vision

If twenty-first century progressives had been leading the nineteenth century abolition movement, we would still have slavery, but we would have limited slavery to a 40-hour work week, and we would be congratulating each other on the progress we had made.

In earlier eras of U.S. history, progressives believed they could fight injustice and move society forward, and they did so—in the abolition movement, in women’s suffrage, in social security for the elderly. Today, however, many progressive-minded people seem to have lost faith in our ability to bring about significant change. Many believe we must be content simply to tinker with problems.

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Health Care Should Be Covered Like Police and Fire

Nobody goes without police and fire protection—nobody has to apply for new “police and fire coverage” each year, nobody has to worry that they may no longer be qualified, nobody has to worry about a $3,000 deductible before the fire department will come. Nobody has to worry that the local sheriff won’t accept their “police insurance” plan. And nobody gets a letter informing them that their police or fire coverage is being terminated at the end of the month, for any reason.

A civilized, humane society that takes care of its people with universal police and fire coverage needs to do the same with health and dental care.

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How do we design a health care system?

The American political system has never taken the time to spell out goals and design a health care system to meet them. Consequently, discussions about health care reform get wrapped up in ideology and efforts to score political points. The debate—pro and con—over the Affordable Care Act is a case in point. People put so much energy into the politics and the political strategy that they forgot what they were hoping to accomplish.

The result is a hodgepodge of policy that doesn’t make a lot of sense and has significant holes. The extent of dysfunction in our system is so great that one business executive quipped, “If you tried to design a health care system that didn’t work, you couldn’t have done a better job.”

Before starting out on a trip it is important to know where you are going: focus on your goals and where you are headed. The same is true for designing a health care system. Instead of simply trying to reduce costs or cover more people by tinkering within the current system, we should begin by laying out the requirements that we expect the system to meet. Only after spelling out the parameters is it time to design and implement a system to meet the goals.

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A logical health plan should be comprehensible without lawyers and accountants

In contrast to the thousands of pages of legislation required to create the ACA, the simplicity of the MHP requires legislation that takes only a few dozen pages and is readily understandable without requiring lawyers and accountants to interpret it. By eliminating existing government health care programs and the complex insurance system we currently have, the Minnesota Health Plan would remove literally thousands of pages from Minnesota law books.

Enrollment as simple as Medicare back in 1966

Similar to the start of Medicare back in 1966, the Minnesota Health Plan would be simple to enroll in, with a straightforward one or two-page enrollment form. It would be simple because all Minnesotans are eligible regardless of income, employment status, age, location or number of family members, and there is no need to choose a bronze, silver, gold, or platinum plan. It would be as quick and easy to enroll one’s family in the MHP as it is to enroll one’s child in the local elementary school.

It is not an overstatement to say that the MHP would eliminate the hassle faced by most families in selecting the appropriate plan. It would eliminate the hassle of determining whether a clinic or provider is “in network.” It would eliminate the hassle of guessing how much care one will need in the coming year for pre-tax medical expense accounts. It would also eliminate the hassle of guessing whether additional insurance is needed for things not usually covered by standard health insurance plans, like dental care or nursing home care.

Medicare Plus

For seniors, one could view the MN Health Plan as Medicare Plus—it would cover all Medicare benefits, plus dental care, plus long-term care, plus all of the benefits that currently require supplemental coverage, plus it would eliminate co-payments and deductibles. Plus, it would give those same benefits to people under age 65 as well.

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Delivering Flu Vaccinations through School Nurses

Compare the way we deliver flu shots to children now and how we could. Currently, parents need to make an appointment, take time off work, go to their children’s schools, drive them to a clinic to get the shot, return them to school, then return to work. In contrast, with a nurse in every school, delivering flu shots to students would require nothing more than sending consent forms to parents and providing the nurse with sufficient vaccines. With far less cost, far less disruption of the school day, and far less disruption of parents’ work days, we could deliver vaccinations to significantly more young people than we do now.

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What would health care look like for people on the day that the new health plan took effect?

The change would be easier than the transition when people switch to Medicare on their 65th birthday. There would be little change in how health care is accessed: Minnesotans would continue going to their medical providers and setting up future appointments with their doctors, dentists, optometrists, physical therapists, and clinics, as needed. However, there would be a big change in how health care is funded: Minnesota families stop paying deductibles, co-pays, co-insurance, and premiums to other health plans, and begin paying premiums to the MHP, which would provide all payments to providers.

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THE SYSTEM WE CURRENTLY HAVE

Powerful financial interests framed the Affordable Care Act

During the six years prior to passage of the Affordable Care Act, Senator Max Baucus, received $3.8 million in contributions from insurance and health industry donors. Baucus, Chair of the Senate Finance Committee which ultimately drafted the 2010 health care legislation, refused to even hear testimony from doctors and nurses who were pleading for universal health care.

After passage of the ACA, Baucus singled out Liz Fowler, his chief health advisor, as the person who put together his health team and who wrote the document that “became the basis, the foundation, the blueprint” for the ACA. Fowler was a former vice president for WellPoint, one of the nation’s largest health insurance companies.

It is not surprising that the end result of the ACA legislation reflected goals of those powerful financial interests more than the goal of affordable, universal health care.

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A costly bureaucratic nightmare

Contrast the expense and difficulties faced by the insurance exchanges to the enrollment of seniors in Medicare five decades ago. Using file cabinets and index cards—they had no computer technology—Medicare was able to enroll virtually all 19 million American seniors in a matter of months because the system was simple. They didn’t have to deal with multiple insurers with multiple plans offering multiple benefit sets and differing provider networks; instead, Medicare enrollees had one high quality plan that covered everyone over age 65.

Per enrollee, it cost at least ten times as much to enroll people in the ACA exchanges as it cost to enroll people in Medicare!

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With or without insurance, many people still cannot get the care they need

Even though the ACA has expanded coverage, almost 5% of Minnesotans remain uninsured. There are a number of other barriers to care post-ACA as well. Many among the 95% who have insurance still cannot access needed medical care because of high deductibles, co-pays, gaps in their coverage, and limited networks.

Many people with serious mental health, addiction, or other chronic health conditions, are struggling just to survive. Getting health insurance is not always on their agenda, even though they are the ones most in need of health care. On top of that, those who most need health care are often the people who have the worst coverage. Dental care is, for many who need it, a separate, expensive insurance plan that is not included in their health insurance.

These multiple gaps in access to health coverage cause, or aggravate, many health disparities. The only way to stop people from falling through the cracks is to eliminate those cracks and make health care available to all.

Patient Choice

The entire political debate about whether the ACA would take away “choice” presumed that the concern was over a choice of insurance plans. The real question that people care about is: “Will I be able to determine the type of care I receive and can I choose which doctors I use?”

The debate over “choice” of insurance plan is ridiculous: Minnesota seniors have over two dozen options for prescription drug coverage under Medicare Part D. Seniors don’t want a choice of prescription drug insurance plans—the choice they want is the ability to access the drugs that they need when they need them and to be able to choose whether to pick them up at their local pharmacy or have them shipped through mail-order.

ECONOMICS OF THE CURRENT SYSTEM VS A LOGICAL HEALTH SYSTEM

Won’t it cost more to cover everyone?

Despite covering additional people and providing comprehensive benefits for everyone, numerous studies and the actual experience of Medicare show that a health care system like the Minnesota Health Plan is actually less expensive than our current system due to administrative savings, more efficient delivery of care, savings from price negotiations, and other factors.

The clearest evidence of this counter-intuitive reality is a comparison with other nations. The U.S. is the only wealthy, industrialized nation on the planet that doesn’t provide universal health care, the only one where millions of people are uninsured and millions more are under-insured, and yet we spend almost twice as much as any other industrialized nation.

Cost studies of proposals that replace the multi-payer health insurance model with a single plan to pay medical bills—often referred to as “single-payer” systems—have consistently concluded that a single-payer plan will cover all people at less cost than the current system. These results have been reached by the Lewin Group, a research firm owned by United Health Group, the nation’s largest health insurance company. The Lewin Group is clearly not biased in favor of a single-payer system, because such a health care system would displace the business of its parent company.

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Our health care system overcharges for many medical products and services

A December 2015 paper reported that hospital prices for a basic knee replacement ranged from about $3,400 at the lowest price hospital to about $55,800 for the same procedure at the highest price hospital. A sixteen hundred percent variation in pricing is evidence of a dysfunctional market!

If public schools were funded the way we fund hospitals

If schools were funded the way we fund hospitals, each teacher would need to spend time calculating how much time they spent with each student, along with the amount of supplies each student consumed. Then, the school would need to allocate a portion of janitorial costs, facility costs, and administrative overhead to each student.

Also, the school would need a billing office to bill each student’s family or their “education insurance plan.” Each family’s plan would pay for different services at different rates, with different co-payments. Not all families would have “education insurance,” and many families would struggle to pay. As a result, the school would spend more resources to collect the payments.

Funding schools the way we fund hospitals would cost much more and absorb a significant portion of each teacher’s time, while doing nothing to improve the quality of education.

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Under-use? Over-use? – How about appropriate use of medical care?

Health care reform should not focus on reducing utilization, especially when many people already do not get the care they should have. The goal should be to focus on appropriate utilization. Americans visit doctors and hospitals less often than people in many other countries.

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The myth of “Skin in the Game” to avoid unnecessary use of health care

Co-pays and deductibles are a poor means of encouraging people to get appropriate care. They clearly discourage people from accessing care even when the care is needed and even when that care may prevent the need for more expensive treatment later.

For a wealthy individual, a co-pay of hundreds of dollars might be mere “pocket change” and have no impact, while a $3 co-pay can prevent a low-income person from picking up needed medication.

Co-pays and deductibles do not lead to more appropriate use of care; to the contrary, they prevent 2 out of every 5 Americans from getting the care they needed.

Despite spending about twice as much on health care per person than other industrialized nations, this high cost is not because Americans are always running to the doctor for unnecessary care. The average American visits the doctor 4 times per year. In contrast, Japanese residents average 13 doctor visits; residents of France 6 visits; Germans, 10; and Norwegians, 4 visits. Our costs are driven not by overuse of health care, but by a bloated, administrative system that fails to give appropriate care when it is needed.

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Reducing Welfare and Crime Costs

While chemical dependency treatment is expensive, there are numerous studies showing even greater savings as a result. By reducing the use of costly detox and emergency rooms, and by helping preserve families and reduce costly out-of-home placements for children, the savings can be huge. A 1993 CalData study showed that the money spent on chemical dependency treatment had better than a 700% rate of return. It saved taxpayers $7 in reduced crime, health care, and human service costs for each dollar spent, just within the first year of treatment.

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Closing Down the Insurance Exchange

Minnesota spent $189 million in federal grants to establish MNsure, the state insurance exchange, which is essentially an online “shopping center” for insurance plans. By replacing health insurance with health care, there would no longer be any need for people to shop for health insurance. Consequently, there would no longer be a need for MNsure.

This creates an additional permanent, on-going savings: Minnesotans would save $44 million per year by eliminating the operating costs for MNsure.

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PRIOR HEALTH CARE REFORMS HAVE NOT SAVED MONEY

Prior reforms increased administrative costs

There is one clear result from all of the health care reforms of the last 40 years: a huge growth in health care administrators: Since 1970, the number of health administrators has grown by almost 30-fold.

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“Quality” payment systems are expensive and counterproductive

Even if it were possible to accurately grade providers, there is no evidence that value-based purchasing would save money—certainly not enough to pay the enormous costs of conducting the measurements and administering the payment system.

Calling those administrative costs “enormous” is not an exaggeration. The title of a March 2016 study summarized the scope of the costs: “US Physician Practices Spend More Than $15.4 Billion Annually to Report Quality Measures.”

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Evidence-based health reform is needed

We rightly talk about the need for “evidence-based medicine,” but it is equally important that we use evidence-based health policy. As the health care system continues to rapidly implement and expand ACOs and other alternative payment models, it is not sufficient to simply call for robust evaluation. Instead, we should stop all expansion of these bureaucratic, complex payment systems until proponents can show evidence that they will not make the system worse.

POLITICS OF HEALTH CARE REFORM

What are the chances of winning support in conservative rural communities?

In small towns and farm communities, where health insurance is most expensive, it is an easy political sell to support health care for all, instead of trying to explain a complex program which requires people to buy insurance and creates a marketplace where they can buy insurance policies. Even now that the health insurance exchange is working better, success in shopping for a reasonable policy does not end concerns about whether one will be able to afford out-of-pocket costs, and it does nothing for families whose medical needs are dental problems, nor does it help those who need nursing home care.

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What about rationing?

Health care should not be rationed by either government or insurance companies. The reality is that people, when their doctors and providers have a chance to discuss options with them, tend to be very good at “rationing” their own health care. Just because various tests and treatments are available doesn’t make people want to go to the doctor and have more work done.

http://mnhealthplan.org/excerpts-from-healing-health-care/

Bill Clinton Is Right, For-Profit Healthcare Is the 'Craziest Thing in the World'

Beneath the misleading headlines and corporate spin, former president gave a robust argument in favor of single-payer system

By Lauren McCauley
Common Dreams, October 4, 2016

Bill Clinton gave a robust argument in favor of a single-payer healthcare system on Monday night—but you wouldn't know it if you read the news, or paid any attention to Republican nominee Donald Trump.

Speaking at Hillary Clinton campaign rally in Flint, Michigan, the former president discussed the importance of expanding access to Medicare and Medicaid while lambasting the for-profit insurance model that overcharges people and reaps enormous profit.

"The insurance model doesn't work here," he said, "it's not like life insurance, or casualty insurance. It doesn't work."

"The current system works fine," Clinton continued, referring to President Barack Obama's Affordable Care Act (ACA), "if you're eligible for Medicaid, if you're a lower-income working person; if you're already on Medicare, or if you get enough subsidies on a modest income that you can afford your health care. But the people that are getting killed in this deal are small business people and individuals who make just a little too much to get any of these subsidies."

"Why?" he asked, "because they are not organized, they don't have bargaining power with insurance companies and they are getting whacked." As Clinton explained, insurance companies assessing risk for a small pool of people "overcharge, just to make sure, and make a whopping profit off the people least able to pay."

"So you've got this crazy system where all of a sudden 25 million more people have health care and then the people who are out there busting it, sometimes 60 hours a week, wind up with their premiums doubled and their coverage cut in half. It's the craziest thing in the world," he continued.

Adding his voice to the growing call for a public option to be added to ACA, he said that the "simplest thing" is to let those individuals not eligible for subsidies buy into Medicaid and Medicare—a plan which is supported by Democratic nominee Hillary Clinton and her former challenger Sen. Bernie Sanders, as well as Obama.

After corporate media spun the remarks with the "grossly inaccurate" headline, "Bill Clinton calls Obamacare 'the craziest thing in the world,'" Trump's campaign predictably seized on the moment, issuing a statement that read: "even Democrats like Bill Clinton are coming to realize just what bad public policy ObamaCare really is."

But as Clinton himself pointed out, allowing the market to take over has left the United States with the most expensive health insurance system, with the least number of people covered. According to the most recently available U.S. Census Data, 29 million people went uninsured in 2015, including 3.7 million children, and despite ACA, deductibles and other out-of-pocket costs continued to rise.

As proponents have argued, the "simplest thing," in fact, would be to forgo the public option and enact a government-run, single-payer healthcare system, under which all citizens are covered.

Dr. Ida Hellander, director of policy and programs with Physicians for a National Health Program (PNHP), said that "when people talk about the public option, they are acknowledging that it's the public part of the program that's working."

Clinton, she told Common Dreams, "seems to understand that but he's not going all the way there," likely because Secretary Clinton has also stopped short of calling for a single-payer model. However, she points out that this is not the first time the former president has voiced support for a universal system.

Agreeing with Clinton's statement that "the insurance model doesn't work here," Hellander added: "The profit-driven, market-based healthcare model based on private insurance doesn't work, and it will never work."

http://www.pnhp.org/print/news/2016/october/bill-clinton-is-right-for-profit-healthcare-is-the-craziest-thing-in-the-world

Obamacare is no disaster. California is proving why

by Nosm Levey - LA Times

Even as turmoil in insurance markets nationwide fuels renewed election-year attacks on the Affordable Care Act, California is emerging as a clear illustration of what the law can achieve.

The state has recorded some of the nation’s most dramatic gains in health coverage since 2013 while building a competitive insurance marketplace that offers consumers enhanced protections from high medical bills.

Californians, unlike people in many states, have many insurance choices. That means that even with rising premiums, the vast majority of consumers should be able to find a plan that costs them, at most, 5% more than they are paying this year. 

And all health plans being sold in the state will cap how much patients must pay for prescriptions every month and for many doctor visits.

That reflects deliberate choices by California state officials who, unlike many states, used the health law to expand the Medicaid safety net and build a marketplace that put stringent requirements on insurance companies.

“California followed the blueprint. They did it right,” said Dr. J. Mario Molina, chief executive of Long Beach-based Molina Healthcare Inc., a leading national insurer that is selling marketplace plans in nine states in 2017.

“What has been lost in all the rhetoric and the politics is that the system can work,” Molina said. Open enrollment begins next month. 

California and its Obamacare marketplace, Covered California, still face challenges, including rising costs. Like consumers elsewhere, some Californians, particularly those who make too much money to qualify for government subsidies, are seeing substantial premium increases and narrowing networks.

But while health coverage has faltered in other states where politicians worked to undermine the law, California highlights what can be accomplished if government officials and industry leaders work together to expand insurance, control costs and protect consumers.

Many of the advances being pioneered in California have been incorporated into Democrat Hillary Clinton’s program to improve on the Affordable Care Act if she is elected president.

“We’re not just the biggest state and one of the states that’s most aggressively taken advantage of tools in the Affordable Care Act,” said Health Access California Executive Director Anthony Wright, a leading consumer advocate. “We are also one of the states that had the biggest problems to start with.

“Now we’re showing that you can use the law as a platform to benefit patients.”

Between 2013 and 2015, the share of working-age adults in California without coverage plummeted from 23.7% to 11.1%, according to federal data. Only three states saw larger declines over the same period.

The new coverage has dramatically improved patients’ access to medical care and reduced financial strains, other research indicates.

More than three-quarters of newly insured Californians said their health needs are now being met, a recent survey by the nonprofit Kaiser Family Foundation found.

By contrast, less than half said they were getting needed care before they got coverage through the health law.

At the same time, Californians who gained coverage reported fewer worries about paying for not just healthcare, but also housing, transportation, even food.

For Del Hunter-White, a Los Angeles actress who lost her insurance through the Screen Actors Guild when she didn’t work enough to qualify for the union plan, Covered California opened just in time.

“It was a lifesaver,” she said, noting she probably wouldn’t have been able to get coverage. “At my age, you don’t want to go without insurance.”

Hunter-White, who is 60, found a health plan that costs her $195.87 a month and allows her to see the doctors she wants. “It’s been great,” she said.

Overall, nearly 8 in 10 newly insured Californians feel positively about their coverage, Kaiser found.

Much of the insurance expansion in California has been fueled by the state’s decision to take advantage of federal funding in the health law to expand Medicaid eligibility to poor, childless adults, a population traditionally excluded from most states’ safety nets.

But Covered California has also played a critical role, with about 1.3 million direct customers and nearly 1 million more who get health plans that must meet Covered California standards even though consumers don’t use the marketplace to purchase them.

The large enrollment isn’t an accident.

Many states now facing the biggest problems with their insurance markets actively resisted the health law, refusing to expand Medicaid or to help build a new marketplace where consumers could shop for health plans. 

By contrast, state leaders in California, including former Republican Gov. Arnold Schwarzenegger, decided early that California’s insurance marketplace would set high standards for health plans and actively negotiate to control prices.

In the first two years of the marketplace, premiums increased an average of just 4%. 

The state made a difficult decision to terminate old plans that didn’t meet the health law’s higher standards, a crucial move that helped stabilize the market by bringing the healthier consumers who had these plans into the larger risk pool.

The state also worked closely with foundations, consumer advocates, hospitals and insurers to enroll customers, particularly younger, healthier people who are also critical to maintaining a good risk pool and keeping premiums in check.

“We all worked together to make sure the marketplace worked,” said Jay Gellert, former chief executive of Los Angeles-based insurer Health Net Inc., which merged this year with Centene Corp.

Now, Covered California is implementing consumer protections that exempt many routine office visits from deductibles.

That means that someone who has a health plan with a $2,500 deductible can still see a primary care doctor for just a $35 copay and see a specialist for just $70.

Covered California Executive Director Peter Lee said these new protections should make the health plans more appealing to customers who might have been resistant to buy a plan that required them to pay thousands of dollars out of their own pockets before they got any protection.

“No patient I know wants to pay $2,500 to see the doctor,” Lee said.

Lee and others acknowledge that even the new protections won’t alleviate all cost pressures on health plans and consumers.

In 2017, Covered California rates are increasing an average of 13.2%, driven in part by rising medical costs and the end of a federal program that helped hold down rates.

Premiums for several insurers, including Blue Shield of California and Anthem Inc., are increasing even more dramatically.

Preventing large rate hikes in the future will require adjustments to the marketplaces in California and elsewhere, many experts say.

But many states could start by taking steps California already has to make their markets work, said Molina, the health plan executive.

“Had states like Texas and Florida followed California’s lead, they might have seen more gains like California’s,” he said.

http://www.latimes.com/nation/la-na-obamacare-california-model-20161007-snap-story.html

Your Surgeon Is Probably a Republican, Your Psychiatrist Probably a Democrat

by Margot Sanger-Katz - NYT

We know that Americans are increasingly sorting themselves by political affiliation into friendships, even into neighborhoods. Something similar seems to be happening with doctors and their various specialties.

New data show that, in certain medical fields, large majorities of physicians tend to share the political leanings of their colleagues, and a study suggests ideology could affect some treatment recommendations. In surgery, anesthesiology and urology, for example, around two-thirds of doctors who have registered a political affiliation are Republicans. In infectious disease medicine, psychiatry and pediatrics, more than two-thirds are Democrats.

The conclusions are drawn from data compiled by researchers at Yale. They joined two large public data sets, one listing every doctor in the United States and another containing the party registration of every voter in 29 states.

Eitan Hersh, an assistant professor of political science, and Dr. Matthew Goldenberg, an assistant professor of psychiatry (guess his party!), shared their data with The Upshot. Using their numbers, we found that more than half of all doctors with party registration identify as Democrats. But the partisanship of physicians is not evenly distributed throughout the fields of medical practice.

Surgeons are Red, Psychiatrists are Blue 

Percent of doctors who have a party registration who are Republicans

The new research is the first to directly measure the political leanings of a large sample of all doctors. Earlier research — using surveys of physicians and medical students, and looking at doctors’ campaign contributions — has reached somewhat similar conclusions. What we found is that though doctors, over all, are roughly split between the parties, some specialties have developed distinct political preferences.

It’s possible that the experience of being, say, an infectious disease physician, who treats a lot of drug addicts with hepatitis C, might make a young physician more likely to align herself with Democratic candidates who support a social safety net. But it’s also possible that the differences resulted from some initial sorting by medical students as they were choosing their fields.

Dr. Ron Ackermann, the director of the institute for public health and medicine at Northwestern University, says he remembers his experience rotating through the specialties when he was in medical school. “You’ll be on a team that’s psychiatry, and a month later you’re on general surgery, and the culture is extraordinarily different,” he said. “It’s just sort of a feeling of whether you’re comfortable or not. At the end, most students have a strong feeling of where they want to gravitate.”

Dr. Ackermann, who trained as an internist, helped conduct a survey of physicians on the idea of a single-payer health care system, a liberal policy goal, in 2008. His work found similar trends of support and opposition clustering in certain specialties. (A co-author of that study is Aaron Carroll, an Indiana University medical school professor and an Upshot contributor.)

There is no way to know exactly why certain medical specialties attract Democrats or Republicans. But researchers who have studied the politics of physicians offered a few theories.

One explanation could be money. Doctors tend to earn very high salaries compared with average Americans, but the highest-paid doctors earn many times as much as those in the lower-paying specialties. The fields with higher average salaries tended to contain more doctors who were Republican, while the comparatively lower-paying fields were more popular among Democrats. That matches with national data, which show that, for people with a given level of education, richer ones are more likely to lean Republican (possibly because of a concern over the liberal policy goal of taxing the wealthiest at a higher rate).

Republicans Cluster in High-Paying Specialties 

Cause or effect? On average, the specialties with the highest salaries tend to have the most Republicans. 

The sorting may also reflect the changing demographics of medicine. As more women have become doctors in recent years, they have tended to cluster in certain specialties more than others. The data showed that female physicians were more likely to be Democrats than their male peers, mirroring another trend in the larger American population. So as women enter fields like pediatrics, obstetrics/gynecology and psychiatry, they may be making those fields more liberal.

Over all, the partisanship of doctors looks very different from a generation ago, when most physicians identified as Republicans. The influx of women may help explain that change, too. Adam Bonica, an assistant professor of political science at Stanford University, compared political donations by doctors in 1991 with those in 2011 and 2012. His study found that doctors had become substantially more likely to give to Democrats.

Younger Doctors Are More Liberal 

The trend can be explained, partly, by an increasing share of female physicians, who are more likely to be Democrats. 

Percent of doctors, by age

New doctors can’t explain all of the change, though. Even older doctors in the new data look close to evenly split between the parties. It’s likely that many older doctors have switched parties over the year. That’s true broadly for well-educated professionals in the United States, who have become increasingly Democratic in recent years.

The shift reflects how the practice of medicine has been changing, too. Doctors used to essentially be small-business owners. As such, they may have been more attracted to Republican aims of low taxes and limited regulation. These days, more and more doctors are employees of large companies or hospitals.

Should you care if your doctor is a Democrat or a Republican? Maybe. Professor Hersh and Dr. Goldenberg used their data on doctors’ partisan identification to conduct a study of primary care physicians, published in the Proceedings of the National Academy of Sciences this week.

They asked the doctors to consider a group of hypothetical patients: one who smoked, one who drank, one who was overweight, and so on. They found that doctors viewed most of their patients’ health with similar seriousness and would advise similar responses. But for three of the hypothetical patients, they found differences. Those patients were devised to have health problems closely tied to hot-button political issues: One used marijuana, one owned guns, and one had a history of abortions. For those patients, Republican and Democratic doctors registered different levels of concern and said they would respond differently.

When it came to the patient with a history of abortions, doctors who were Republican said they would be more likely to encourage the patient to seek counseling and express concern about mental health consequences; they also said they would be more likely to discourage the patient from seeking future abortions. For the patient who used marijuana, Republican doctors said they’d be more likely to ask the patient to cut back and to discuss legal risks of using the drug, which is banned under federal and most state laws. For the patient with guns, doctors who were Democrats indicated they’d be more likely to tell the patient not to keep guns at home. Republican doctors, on the other hand, would be more likely to discuss safe storage options.

“These findings suggest you are going to get different care,” Professor Hersh said, adding that the differences might not matter much for the average patient. But they might for patients whose needs were closely related to politically divisive subjects, like reproductive health, with issues like contraception, abortion and prenatal screening; or H.I.V. prevention, with risk factors that include sex and intravenous drug use.

Primary care doctors and obstetrician-gynecologists, the doctors most likely to consider such issues, were among the most evenly split in the study sample. That means that patients probably can’t guess the political leanings of their doctor without asking (or checking the voter file data). The current study is only a survey, but Professor Hersh said he hopes the research spurs more examinations of how ideology shapes medical practice.

Professor Hersh and Dr. Goldenberg constructed the data set by assembling a large sample of doctors from the federal government’s National Provider Index, a file of every physician in the United States who either bills insurance of shares data digitally. There are very few doctors who are not included in this file. 

They then matched each physician to data from state voter files maintained by Catalist LLC, a political data vendor. The researchers searched for doctors with matching names, living within a small geographic radius from their practice address. Not every doctor matched. Some had moved; some were not registered to vote; some had changed their names; some had common names that made it hard to make a definitive match; some lived nearby in states where the voter file does not include political information; and there may have been some mistakes in each file. But over all, the researchers were able to collect complete data for more than 55,000 physicians living in the 29 states where voter files include party registration. (Those states contain about 60 percent of the population, and are roughly, but not perfectly, representative of the country.)

For many of the measures in this article, we looked only at the percentage of “partisan” doctors, that is, doctors who recorded a political party. There was a substantial fraction of the physicians with no political affiliation, and there was a small fraction who were registered with smaller political parties. Altogether, the analysis looks at just over 36,000 doctors.

There are many more medical specialties than are included in our charts. With advice from Professor Hersh and Dr. Goldenberg, we combined many small subspecialties to form large specialties, such as “surgery.”

http://www.nytimes.com/2016/10/07/upshot/your-surgeon-is-probably-a-republican-your-psychiatrist-probably-a-democrat.html?hp&action=click&pgtype=Homepage&clickSource=story-heading&module=second-column-region&region=top-news&WT.nav=top-news

Advocates demand answers for why state ended Healthy Maine Partnerships

by Joe Lawlor - Portland Press Herald

State legislators and public health advocates are demanding answers from the LePage administration about why it discontinued the Healthy Maine Partnerships program and how it plans to transition to a more centralized approach to health education.

The 27 agencies that were part of the Healthy Maine Partnerships Coalition had their contracts terminated as of Friday. They were told that they could no longer use the Healthy Maine Partnership’s name and that five agencies will subcontract to local agencies for public health education.

Samantha Edwards, spokeswoman for the state Department of Health and Human Services, said Monday that the changes do not represent a reduction in health prevention services or funding. She did not provide an explanation for why the partnership’s name could no longer be used.

State officials said the new, more centralized approach will be an improvement over the localized organization of Healthy Maine Partnerships, a wide-ranging, grassroots effort that has worked to prevent obesity, smoking and substance abuse and promote healthy eating.

Advocates, however, argued that the local partnerships were effective.

Susan Deschene, senior manager for Aroostook Community Action Program, which discontinued its Healthy Aroostook partnership on Friday after losing $236,000 in state funding, said three employees were laid off, but she hopes that when the program is restructured the employees can return in similar roles.

“The partnerships as we’ve known them are gone,” she said.

Becky Smith, Maine’s director of government relations for the American Heart Association, said there’s been little communication from DHHS about the changes, and what the prevention services will look like in future years is unknown.

“Nobody knows quite yet. We know there’s going to be an interruption,” said Smith, who noted that it’s puzzling to see the Healthy Maine Partnerships name go away after more than 15 years of branding in communities across the state.

Joanne Joy, of the Maine Network of Healthy Communities, which advocates for Healthy Maine Partnerships, said that because the partnerships were so local, they did a great job of identifying the needs in each community. She’s not sure a more centralized approach as outlined by DHHS will be as effective.

Rep. Drew Gattine, D-Westbrook and co-chair of the Legislature’s health and human services committee, said the LePage administration has not been transparent with its public health efforts.

“We keep asking questions and not getting any answers,” Gattine said. “Nobody really knows what their plan is for providing public health.”

DHHS issued a letter Sept. 7 to agencies that were part of Healthy Maine Partnerships that said the department and the Maine CDC “are retiring the Healthy Maine Partnership brand at the end of the current grant cycle.”

Healthy Maine Partnerships, which started in 2001, was funded with $4.7 million per year in tobacco settlement money. The settlement money – about $50 million a year – is deposited into the Fund for a Healthy Maine and pays for a number of prevention and tobacco cessation efforts and other health initiatives, including the partnerships.

The state’s reorganization of Healthy Maine Partnerships dollars streamlines the state’s role in the effort, state officials said.

Instead of contracting with 27 groups, the state now contracts with four agencies that will subcontract to local agencies for public health education. The administration is in the process of awarding a bid for a fifth contractor to handle communications surrounding the initiatives.

Many of the subcontracts haven’t been signed yet. The new state contracts started Monday with MaineHealth, Opportunity Alliance, Let’s Go and the University of New England. The change has resulted in several layoffs or reduced hours during the transition, public health advocates said.

MaineHealth landed a $2.3 million contract for tobacco prevention; the University of New England secured a $2.5 million contract for substance abuse prevention; “Let’s Go,” a nonprofit that promotes healthy school lunches and exercise, won a $1.6 million obesity prevention contract; and the Opportunity Alliance in South Portland got a $1.2 million contract for youth empowerment.

In March, DHHS Commissioner Mary Mayhew said the state needed to change how it handles public health programs because of a “need to approach the work differently in order to adapt to the ever-changing public health landscape.” Mayhew said that a more centralized organization – in contrast to the dispersed, localized approach of Healthy Maine Partnerships – would give the state the ability to measure data and evaluate outcomes.

The Fund for a Healthy Maine was the subject of a 2015 political fight between the LePage administration and public health advocates after the administration proposed diverting $10 million from the fund to other areas of the state health budget. But after an outcry from public health advocates objecting to the cutbacks, the Legislature did not approve LePage’s proposal.

http://www.pressherald.com/2016/10/03/advocates-demand-answers-on-why-healthy-maine-partnerships-killed-off/

A Quest to Gather All My Medical Records in 72 Hours

by Ron Lieber - NYT

When Donald Trump challenged Hillary Clinton to a medical records disclosure throwdown not long ago, my colleague Margot Sanger-Katz wrote an articlepointing out that there’s often no such thing as a complete medical dossier on anyone.

After all, most of us have seen many doctors over many decades, with details scattered hither and yon. Tracking them down would be a nightmare, the specialists in medical records and technology say.

But that kind of quest is my kind of fun. So this week, I spent three full days pestering my pediatrician in Chicago for immunization records and wandering New York in search of the travel medicine specialist I saw in 2005. Then, I tried to figure out what life insurance underwriters would find out from services that gather prescription drug histories upon request. (Yes, such things exist, and you’re allowed to see what’s in them.)

I did not finish. Many doctors keep records in storage, and insurance companies need lots of time to look things up. But once everything is in hand, I will know what that drug was that did not work and be able to correct any database errors that make me look like a bad insurance bet.

This is an exercise that most people could benefit from. So here are the steps I took and the obstacles I encountered along the way.

PEDIATRICIAN This was an excuse to catch up with Dr. Frederick M. Cahan, “Uncle Fred” to me as I was growing up. He’s a family friend and still plying his trade.

He’s also a self-described hoarder, but he did not have my records. Within minutes, however, he put his hands on those of my twin siblings, who were born in 1976. So if you’re 40 and under, you might call the medical professional who gave you your first talk about “funny” cigarettes.

INSURANCE The biggest mystery I hoped to solve was that of occasional (and still unexplained) elevated liver enzymes. The result showed up in a 2006 life insurance medical screening. At some point after that, I saw a specialist and had an ultrasound, which didn’t show anything alarming.

But who was the doctor? There was nothing in my filing cabinet at home, and my primary care physician had no record of referring me. I was pretty sure that Aetna was my insurance provider at the time. Could it send me copies of every explanation of benefit it had ever produced for me?

The phone representative was encouraging, but first I had to sign a release. I had the choice of faxing it back or dropping it in the mail, and I chose fax. The reply would take weeks.

As soon as I started in with the various fax machines in my office, however, I knew I’d made a mistake. The first didn’t work. The second, a combination copier-fax-scanner, screeched a bit, at which point I remembered the stories I’d read about how they store images and leave users vulnerable to identity theft. That one didn’t seem to work either, so I moved to Machine 3.

The next day, a colleague approached my desk. She handed me 53 copies of the Aetna form, each of which had my Social Security number and date of birth on it. Machine 2 had belched them out, one by one, at some indeterminate point.

DATABASES I also hoped to figure out what drug I took in 2009 that did not agree with me. What was it again? At first, I couldn’t remember the name of the doctor who had prescribed it, so I checked in with two companies that provide reports on people’s prescription records. They sell access to life and other insurance companies, which ask applicants to grant them permission to do a sort of medical background check.

“Wouldn’t it be great if you could gather deeper insights into your applicant’s potential mortality risk?” the website of one of the services, ScriptCheck, cheerily asks insurance companies. It would also be great if consumers could see what ScriptCheck has on them, but the website doesn’t offer any information on how to do so. So here’s the phone number to request a free report: 844-225-8047.

I wasn’t able to get this one right away, but it turns out that I’m destined for disappointment. A spokeswoman for ScriptCheck’s owner, Quest Diagnostics, told me that the outgoing message on the above phone number’s voice mail asks for your insurance company’s name for a reason: ScriptCheck will give you only the prescription data that it gave the insurance company, going back seven years. So a request next week based on a 2013 insurance application will yield information from the application date and before. And my hunt for 2009 data based on my last life insurance application, which was in 2006, would yield nothing.

A ScriptCheck competitor, IntelliScript, moves more quickly and offers information for consumers on its website. Within 24 hours, I got an email response letting me know that the company had no information on me in its files.

According to the FAQ page on its website, no report exists until an insurance company asks for one. IntelliScript would not comment on why it had no information about me. It and ScriptCheck get their information from pharmacy benefit managers, who are legally allowed to pass it on.

I also requested my file from MIB, an organization of insurers, which may contain other data on my medical and insurance history. It, too, takes some time to arrive.

MENTAL HEALTH Intensely curious about what, if anything, your therapist is scribbling down about you? Alas, the federal law that grants you the right to request your medical records specifically gives mental health practitioners permission to withhold their psychotherapy notes.

According to the American Psychological Association, some state regulations may make it easier to get these notes. If you don’t believe that any observations in the file could lead to a psychological setback, ask for the notes and see what happens, keeping in mind that some notes may have been early musings about diagnoses that did not turn out to be accurate.

DOCTORS My encounters with various physicians yielded mixed results, and it didn’t always depend on the age of the records. My primary care doctor was an early adopter of electronic medical records, and I was able to confirm via his website that my last liver test several years ago was normal.

For another physician, who I’ve seen intermittently for back trouble over the years and visited once in the last year, I had to make my records request via fax. The person answering the phone at his office would not let me make my request by email.

This year, I broke a bone in my arm, so I wanted a scan of the initial X-ray. I thought I could show up at the office and scan the image with my phone, but the rules there prevented it. Instead, I have to wait for a full copy of the X-ray, which I don’t actually want.

But at least it was available. No one gave me a hard time for merely making these requests, which is a good thing, since federal law generally requires health practitioners to hand over your records, though they are allowed to charge reasonable copying and mailing fees. Only one of my doctors charged me anything, but it can be costly for people with more extensive records.

My best luck came in the place where I had the lowest expectations. I knew I’d had a round of travel vaccinations in 2005, but I wasn’t sure where, and my filing cabinet turned up nothing but an incomplete vaccination record with no doctor’s name on it. I had a vague sense that the office was in Greenwich Village, so I made a list of travel medicine specialists near there and started dropping in on them.

One looked familiar, and after talking to three people in the office and waiting around for 10 minutes, one of them ushered me to her workstation. My name didn’t turn up in her initial search, but when I told her the approximate dates of the possible visits, she started pulling thumb drives out of the top of her desk drawer. Within a few minutes, she found my file and hit the print button.

Thanks to my hounding and her doggedness, I won’t repeat the hepatitis A vaccine for at least another decade. She was pleased, too. Had the office sent all the records away to a scanning service, I asked? No, she said, she had done it all herself.

How long did that take? “Years,” she said. “Boxes and boxes and boxes.”

http://www.nytimes.com/2016/09/28/well/move/after-just-10-days-of-rest-brain-benefits-of-exercise-diminish.html?smprod=nytcore-iphone&smid=nytcore-iphone-share

Brain Benefits of Exercise Diminish After Short Rest

by Gretchen Reynolds - NYT

Before you skip another workout, you might think about your brain. A provocative new study finds that some of the benefits of exercise for brain health may evaporate if we take to the couch and stop being active, even just for a week or so.

I have frequently written about how physical activity, especially endurance exercise like running, aids our brains and minds. Studies with animals and people show that working out can lead to the creation of new neurons, blood vessels and synapses and greater overall volume in areas of the brain related to memory and higher-level thinking.

Presumably as a result, people and animals that exercise tend to have sturdier memories and cognitive skills than their sedentary counterparts.

Exercise prompts these changes in large part by increasing blood flow to the brain, many exercise scientists believe. Blood carries fuel and oxygen to brain cells, along with other substances that help to jump-start desirable biochemical processes there, so more blood circulating in the brain is generally a good thing.

Exercise is particularly important for brain health because it appears to ramp up blood flow through the skull not only during the actual activity, but throughout the rest of the day. In past neurological studies, when sedentary people began an exercise program, they soon developed augmented blood flow to their brains, even when they were resting and not running or otherwise moving.

But whether those improvements in blood flow are permanent or how long they might last was not clear.

So for the new study, which was published in August in Frontiers in Aging Neuroscience, researchers from the department of kinesiology at the University of Maryland in College Park decided to ask a group of exceedingly fit older men and women to stop exercising for awhile.

“We wanted to study longtime, serious endurance athletes because they would be expected to have a very high baseline” level of aerobic fitness and established habits of frequent exercise, says J. Carson Smith, an associate professor of kinesiology at the University of Maryland and senior author of the study. If these people abruptly stopped exercising, he says, the impacts could be expected to be more outsized than among people who worked out only lightly.

The researchers eventually found 12 competitive masters runners between the ages of 50 and 80 who agreed to join the study. All had been running and racing for at least 15 years and still regularly ran 35 miles a week or more.

At the start of the experiment, the runners visited the researchers’ lab for tests of their cognitive skills. They also had a special brain M.R.I. that tracks how much blood is flowing to various parts of the brain.

The researchers were particularly interested in blood flow to the hippocampus, a portion of the brain that is essential for memory function.

Then the athletes sat around for 10 days. They did not run or otherwise exercise and were asked to engage in as little physical activity as possible.

While some people might find such a directive easy to follow, these men and women loved to work out, Dr. Smith says, and might have been tempted to cheat and jog just a little. But researchers “called them frequently,” he says, to gently remind them to remain couch-bound.

After 10 days of being sedentary, the erstwhile runners returned to the lab to repeat the earlier tests, including the M.R.I. scan of their brains.

The results showed striking changes in blood flow now. Much less blood streamed to most of the areas in the runners’ brains, and the flow declined significantly to both the left and right lobes of the hippocampus.

Encouragingly, the volunteers did not perform noticeably worse now on the tests of cognitive function than they had at the start.

But the results do suggest that the improvements in brain blood flow because of exercise will diminish if you stop training, Dr. Smith says.

Dr. Smith also suspects that the runners regained their exercise-related boost in blood flow to the head after returning to training, though he and his colleagues did not retest their volunteers and so cannot say for certain.

They also do not know whether the effects on brain blood flow would be as pronounced among moderate exercisers who quit for 10 days or whether shorter or longer periods of exercise abstinence would have comparable effects.

“I would not want someone to think that if they are on deadline or on vacation for a week or so and don’t manage to work out,” that they have necessarily starved their brains of blood, he says.

He also points out that although brain blood flow dropped significantly after the 10 days of rest among the runners, their performance on cognitive tests did not decline.

“We need far more research” into the time course of changes to the brain and to thinking skills because of exercise and skipping workouts, he says.

But for now, the study’s message seems fairly straightforward. For the continued health of your brain, try to keep moving.

http://www.nytimes.com/2016/09/28/well/move/after-just-10-days-of-rest-brain-benefits-of-exercise-diminish.html?smprod=nytcore-iphone&smid=nytcore-iphone-share

Mainers are paying less for energy and way more for health care

by Darren Fishell

http://thelevel.bangordailynews.com/2016/10/04/economy/mainers-are-paying-less-for-energy-and-way-more-for-health-care/

Canadian Medicare on Trial

Could this be the beginning of the end for the Canadian single-payer system?

BY DANIELLE MARTIN

There’s an old joke that Canadians like to tell: What’s a Canadian? A gunless American with health care.

It’s only funny because we half-believe it’s true; despite the many things we have in common with our friends south of the 49^th parallel, Canada’s single-tier, publicly funded health care system has long been a point of differentiation—and pride—for most Canadians. A 2012 poll found that our health care system—known in Canada as “Medicare”—was almost universally loved, with 94% of those surveyed calling it an important source of collective pride. The notion that access to health care should be based only on need is a deeply ingrained Canadian value.

But we can’t take our Medicare system for granted.

The challenges to Canadian Medicare have always been ideological and political. But, as of this month, they are also legal.

In the western province of British Columbia, a trial underway in that province’s Supreme Court is challenging the very foundations of Medicare: providing care based solely on need, and not on ability to pay.

Cambie Surgeries Corporation and the Specialist Referral Clinic, represented by Dr. Brian Day, an orthopedic surgeon in Vancouver, are suing the government of B.C., trying to knock down the laws that protect our single-payer system. If successful, some Canadians will be able to pay out-of-pocket or through private insurance for hospital and physician services—and doctors will be able to charge them whatever the market will bear.

In British Columbia, as in all Canadian provinces, “Medicare” provides public funding for all medically necessary hospital and physician services to all legal residents. Core to the system are some key restrictions on physician behavior.

Let’s say you come to see me in my office about a rash, or a possible pneumonia, or diabetes. I would talk to you, examine you, perhaps propose some laboratory tests, perhaps write you a prescription. The public insurance plan in my province would pay me for that 15-minute visit, let’s say $50. As a Canadian physician choosing to be enrolled in Medicare, I bill the government that $50, but I am not permitted to then bill you an additional $20—meaning copayments, or “extra billing,” is not allowed. In other words, Canadian doctors who bill the public insurance plan may not bill patients at all.

These restrictions on dual practice and extra-billing, coupled with B.C.’s ban on any private insurance that duplicates Medicare coverage, are the targets of the court challenge currently being brought forth by Dr. Day’s private for-profit, investor-owned surgical clinic.

The essence of the claim is that, because wait times for some elective surgeries in that province are longer than we would like them to be, doctors should have a constitutionally protected right to provide them more quickly and at a higher price. This would be done by charging some patients privately, either out-of-pocket or through private insurance. They allege that existing limits on charging patients privately infringe on patients’ rights to life, liberty, and security of the person under Section 7 of the Canadian Charter of Rights and Freedoms.

This legal challenge emerged in response to an audit of Cambie Surgeries Corporation, which was carried out after patients complained to the B.C. government that they were being charged out-of-pocket for care. From a sample of Cambie’s billings, the auditors found that patients had been charged hundreds of thousands of dollars for health services already covered by Medicare. Championed by Dr. Day, Cambie Surgeries Corporation and the Specialist Referral Clinic then countered that the law preventing a doctor from charging patients more than the agreed upon fee schedule is unconstitutional—and a challenge to Canada’s Charter of Rights and Freedoms was born.

The opening statements, which began on September 6, 2016, are behind us now, but Canadians are following the case—expected to last at least 24 weeks—in the popular press, as Cambie’s lawyers try to paint a pretty dark picture of our health-care system. This, in spite of the fact that our outcomes are comparable to those in the United States and are achieved at a fraction of the price.

Meanwhile, the Attorneys General of B.C. and of the Government of Canada are countering that a multi-payer health care system would lure physicians from the public-pay sector to the private-pay sector, potentially reducing the availability, quality, and timeliness of care in the publicly funded system. Both governments will also argue that such a multi-payer health care system will drive up costs, forcing the public single payer to pay higher fees in order to “compete” with private insurers.

It is also worth noting recent efforts at tackling the main driver of this constitutional challenge: wait times for non-urgent surgery. These have come from within the public system, and include wait time targets, centralized intake for people with a common problem, and inter-professional health-care teams so that surgeons’ time does not create a bottleneck. Such initiatives show tremendous promise for reducing waits deemed unreasonable, but governments need to implement them, and health-care organizations and doctors need to help accelerate this kind of reform.

Whatever the decision of the trial judge in B.C., it is likely to be appealed to the Supreme Court of Canada. The foundational pillar of Canadian Medicare—equitable access to health care for all—could well be threatened from coast to coast to coast by the outcome of this decision.

It may be that the Cambie plaintiffs will be unsuccessful in their quest to dismantle the essence of Medicare, but clearly the stakes for ordinary Canadians are very high. Like all developed countries, Canada struggles to control growth in health-care costs, meet the needs of an aging population, and provide timely care of the highest standard. Whether we continue to work to do so for all Canadians, or only some, will, in part, be determined by the outcome of the Cambie case.

http://democracyjournal.org/arguments/canadian-medicare-on-trial/

Hospital charges couple $39.35 to hold their newborn baby

by: Brianna Chambers, Cox Media Group National Content Desk

A man who posted a photo of a hospital bill after his wife delivered their baby said they were charged to hold their newborn.

Reddit user halfthrottle said he and his wife "got a chuckle" when they saw the $39.35 charge, which was billed as "skin to skin after c sec."

"During the C-section, the nurse asked my wife if she would like to do skin to skin after the baby was born. Which of course anyone would say yes to. We just noticed it in the bill today," he wrote. "The nurse let me hold the baby on my wife's neck/chest. Even borrowed my camera to take a few pictures for us. Everyone involved in the process was great, and we had a positive experience." 

Many Reddit users voiced outrage about the charge, but one user who claimed to be a nurse said there was a valid explanation for the fee.

"I didn't know that hospitals charged for it, but doing 'skin to skin' in the operating room requires an additional staff member to be present just to watch the baby," user FiftySixer wrote. "We used to take all babies to the nursery once the NICU team made sure everything was OK. 'Skin to skin' in the OR is a relatively new thing and requires a second labor and delivery RN to come into the OR and make sure the baby is safe."

According to the La Leche League of Canada, skin-to-skin contact between mother and baby immediately after birth "helps regulate the baby's temperature, breathing, heart rate and sugar levels. It also calms the baby so he (or she) doesn't get stressed out or cry a lot."

"This is part of the operating procedure, where after the baby is removed, it is placed on the mother's chest and monitored while she is being stitched back up. It should be free, and it's ridiculous it's not," another Reddit user wrote.

http://www.fox25boston.com/news/hospital-charges-couple-3935-to-hold-their-newborn-baby/453425969

Fight ‘Big Soda’

by David Leonhardt - NYT

Over the next few weeks, I want to use this newsletter to call your attention to some big issues that are on the ballot this year but getting obscured by the presidential race.

One of them is obesity.

For years, the soda industry has been using the undeniable fact that the obesity epidemic has many causes to evade responsibility for its own role. Americans eat too much, the lobbyists for Coke and Pepsi will say. Or: Americans need more exercise!

All of which is true. Yet it’s also true that soda drinking is one of the biggest causes of the obesity increase.

Calorie consumption from soda roughly tripled from the late 1970s to the late 1990s, accounting for about half the country’s total increase in calories. Soda also has zero nutritional value. It is sugar water — empty calories that don’t make people feel full.

Fortunately, the public has started to realize this, and soda consumption has fallensince the late ’90s. But it’s still far too high. Coca-Cola and PepsiCo remain major purveyors of obesity, tooth decay, diabetes, heart disease and other scourges that damage people’s health and raise medical costs.

Next month, three California cities — San Francisco, Oakland and Albany — will each vote on a penny-per-ounce tax on sugary beverages, including soda. Philadelphia and Berkeley already have similar taxes.

And they work. Academic research has found that taxes reduce soda drinking, Margot Sanger-Katz of The Times reports. They do so without resorting to rules — such as the failed attempt to limit soda sizes in New York — that evoke a “nanny state” to many people. Often, the taxes don’t even pinch the budgets of low-income families, because they respond by drinking less soda.

As usual, Big Soda is spending a lot of money in California to fight a tax. Also as usual, the industry is resorting to dishonesty, by falsely claiming that a tax will somehow make other grocery items more expensive.

We shouldn’t be surprised when the soda industry claims it’s really just looking out for the rest of us. But we shouldn’t listen either. More soda taxes and less soda drinking will make for a healthier country.

http://www.nytimes.com/2016/10/06/opinion/fight-big-soda.html?smprod=nytcore-iphone&smid=nytcore-iphone-share&_r=0