Why corruption is the new normal in health care (and what we can do about it)
by Vikas Saini and Shannon Brownlee - Lown Institute - June 1, 2017
Industry payouts to providers, unnecessary admissions to meet quotas, manipulating data for greater reimbursements: In The Huffington Post this week, Shannon Brownlee and Vikas Saini of the Lown Institute call out these ubiquitous practices for what they are – corruption.
“Our health care system is no longer about relieving the suffering of patients or the intrinsic value of maintaining the health of our population. It’s about making money,” Brownlee and Saini write. This systemic corruption contributes to ballooning health care costs and causes immeasurable harm to patients.
Just this week, The Seattle Times revealed that top brain and spine surgeons at Swedish Health in Seattle conducted simultaneous surgeries more than half the time between 2014 and 2016. Simultaneous surgeries allow hospitals and providers to increase revenue by effectively double-booking patients, and most of the time patients are not informed that their surgeon will not be present for part or even most of their surgery. Several patients who had complications from their surgeries at Swedish told The Times they would not have gotten the surgery if they knew their doctor was in multiple operating rooms at once.
In another particularly egregious example of corruption, some rehab centers are capitalizing on the opioid crisis by taking advantage of patients. STAT reports this week on “patient brokers,” middlemen hired by rehab centers to convince people struggling with addiction to check into treatment centers that bill patients for all they can, without providing help for rehabilitation.
There is no simple cure for corruption, say Brownlee and Saini. With so much money in the health care system, profit-mongering is bound to happen. But there are things we can do to make corruption less normalized. Speaking out against it is the first step. Take Dr. James Holsapple, who objected to simultaneous surgeries at his hospital and was forced to resign. He recently won a lawsuit against the hospital for wrongful termination, paving the way for other doctors to speak up.
Editor's Note: The following clippings are from some of my Bangor Daily News columns written in the past that relate to the preceding article by Saini and Brownlee. I though they may be of interest.
-SPC
Selling expensive health care lemons
By Dr. Philip Caper, Special to the BDN
Posted March 14, 2013, at 11:11 a.m.
In 1970, University of California economist George Akerlof wrote a paper titled “Selling Lemons.” In it he
explained that a market characterized by a large asymmetry of information between seller and buyer would also
soon become characterized by a decrease in the quality of goods and dominated by crooked sellers and gullible
buyers. In 2001 he won the Nobel Prize for his work.
Sad to say, I can think of no market that better fits these criteria than health care. In a March 4 TIME Magazine
cover story, “The Bitter Pill: Why Medical Bills Are Killing Us,” reporter Steven Brill dissects a number of hospital
bills and traces the detailed charges back to their origins. He concludes, “everyone along the supply chain – from
hospital administrators (who enjoy multimillion-dollar salaries) to the salesmen, executives and shareholders of
drug and equipment makers — was reaping a bonanza. The only exceptions, I found, were those actually treating
the patients — the nurses and doctors.”
When you need medical care there is absolutely no way you can accurately determine ahead of time what that
care will cost you. Don’t hope to get anything approaching a rational explanation for what you are charged after
the fact, either. The best you can hope for is that whatever insurance you have will cover most of the costs. If not,
you are at the mercy of the hospital and, if you can’t pay, its collection agency.
So you can’t know much about the prices of health care. How about the appropriateness or quality of that care?
Again, unless you are a doctor you have very few ways to independently judge the safety or benefits of tests,
procedures or prescriptions.
And sometimes not even then. Even among well-trained and conscientious doctors, a great deal of uncertainty
exists about the risks and benefits of tests and procedures they order and perform.
As the number of doctors who have become employees of profit or nonprofit corporations has increased (now
about 80 percent of Maine doctors and rising), they have come under pressure to increase the number of “units
of service” they provide — visits, tests, procedures and prescriptions — in order to maximize the revenues and
profits of the institutions that employ them.
Lately, the need for many commonly performed procedures has come under question by both government and
private health care organizations. The U.S. Preventive Services Task Force recently warned against the routine
performance of some, including mammograms for young women, hormone replacement therapy for older
women, prostate cancer tests for older men and drug treatment to prevent osteoporosis. Many are now thought
to do more harm than good.
Similarly, the American Board of Internal Medicine, one of the medical profession’s most important credentialing
bodies, recently launched a program called “Choosing Wisely.” Its purpose is to identify tests and procedures that
are overused, and to persuade doctors and patients to use fewer of them. More than 35 medical specialty societies
have joined this campaign, each selecting five or more tests or procedures that they believe are significantly
overused. Among these are imaging procedures, such a CT scans and MRI, the use of which has exploded in
frequency and cost in recent years. It is almost impossible for patients to accurately assess the need for and
quality of care.
I still believe that most health care workers want to do the right thing by our patients. But our corporatized and
business-oriented health care system is making it increasingly difficult.
Businesses try to optimize prices and sales in order to maximize revenues. When “consumers” (patients) have
little or no information about what they’re buying, Akerlof’s prediction that maximization of profits rather than
value will dominate decision-making comes true. In other words, the asymmetry of information between patients
(who possess little) and health care providers and administrators (who possess a lot) makes anything like a
rational market in health care services impossible.
That hasn’t stopped free market ideologues from peddling their flawed and self-serving ideas to anyone who will
listen, including some uninformed and perhaps naive lawmakers. One result is legislation like Maine’s new
health insurance reform law, passed two years ago.
In his article, Brill documents that Medicare is much more efficient and does a much better job of controlling
costs than private insurance. It seems to me that he makes a compelling case for expanding Medicare to
everyone. But, in the end, he backs off of actually recommending it because, as he explained in an interview, he
fears the power of a health care industry that generates huge profits and spends four times as much on lobbying
as does the defense industry.
I’m not so sure he’s right about that. I believe people power can overcome corporate power, especially in states
such as Maine.
The next time you hear somebody saying “let the market work in health care,” the most reasonable response
would be to pat them on the head and have a good laugh.
But our profit-driven health care system is bankrupting individuals, putting enormous stress on businesses and
state and federal governments and destroying the therapeutic doctor-patient bond of trust. So, I guess it’s no
laughing matter.
The business interests behind America’s costly
medical care
By Dr. Philip Caper, Special to the BDN
Posted April 17, 2014, at 3:38 p.m.
The United States spends far more on medical care than other wealthy countries, due mostly to higher prices for
health care goods and services. There is a reason for this. In U.S. politics, social progress comes at a high price if
it threatens business interests.
In 1965, at the insistence of the American Medical Association, Lyndon B. Johnson agreed to insert language into
the Medicare law that prohibited the government from interfering in the practice of medicine, and assuring
doctors that they would continue to receive their usual, customary and reasonable fees.
In creating the Medicare prescription drug benefit in 2003, Congress inserted a provision prohibiting Medicare
from negotiating prices for drugs to placate pharmaceutical companies, costing the government billions of
dollars.
In 2009, with the Affordable Care Act, the political price paid for expanding access to federally funded health
care was coercing young and healthy Americans to buy private health insurance and directing billions of federal
dollars to subsidies for private insurance companies. Not satisfied with that, pharmaceutical and medical device
manufacturers insisted on weakening cost controls. Even the modest tax on medical devices and supplies
included to help pay for the law is very likely to be repealed, with support from both parties, to mollify medical
device manufacturers.
The complexity of the ACA and the poor quality of some of the most popular coverage has created new business
opportunities. Accounting firms are now jumping into the fray, offering their services as tax advisers and
consultants to help folks navigate their way through the ACA maze. The ongoing shift in the burden of health-
care costs from insurance companies to individuals through larger out-of-pocket payments creates new
opportunities for banks to offer credit card services for medical debt, often at usurious levels of fees and interest.
All of this further raises health-care costs.
Unlike most other wealthy countries, the U.S. lacks any central mechanism to constrain overall health-care
spending. This has led us instead to rely on piecemeal, half-hearted and largely ineffective regulation of fees by
Medicare, and micromanagement of medical decision-making by private insurers at a level unheard of, and that
would not be tolerated in other wealthy countries.
Those attempts at health care cost control have failed.
When government requires individuals and businesses to purchase private health insurance, it must also assure
that insurance costs remain affordable, or the law will unravel. The federal government will soon have to
abandon its “hands off” approach to restraining the overall costs of medical care. Every country that has moved
toward making health care a human right as a matter of public policy has quickly turned its attention to ways to
control its overall costs, private as well as public.
We’re already seeing more attention being paid by government, the media, and professional organizations not
only to the prices charged by health-care providers, but to ways to restrain the use of unnecessary services and
administrative costs, fraud, waste and abuse, and preventing illness in the first place. It should come as no
surprise that Medicare data about payments to doctors has recently been released showing some very large
payouts, and huge variations across the country. Although this data is incomplete and should be treated
cautiously, it raises troubling questions.
The ACA is a work in progress. There is almost universal agreement that it has to be fixed, but plenty of
disagreement about how to fix it. The architects of the law anticipated that likelihood. Section 1332 of the ACA
provides great latitude for future experimentation by states, beginning in 2017. It allows them to discard most of
the ACA’s key requirements if they can come up with something better at no additional cost.
Vermont has already taken a number of important steps toward replacing the ACA with a single-payer system.
Such a system would allow them to expand coverage to everybody, reduce total spending, and restrain the growth
of future health-care costs to a sustainable level through budgeting.
Earlier this month, the Maine Legislature passed a resolve by a wide bipartisan margin that takes the first step
toward following Vermont’s example. The handwriting is on the wall. If the Legislature is unable to effectively
deal with this problem, we in Maine can always express ourselves through a ballot initiative.
How ACA fuels corporatization of American health
care
By Dr. Philip Caper, Special to the BDN
Posted Nov. 20, 2014, at 11:01 a.m.
A new Harvard study has found that Americans’ trust in the medical profession has dropped
dramatically in recent years and lags behind that in many other wealthy countries. At the same
time, doctors are becoming increasingly unhappy with our profession. In his new memoir, “
Doctored,” Dr. Sandeep Jauhar eloquently explains why: More and more doctors are coming to
view our profession as just another job.
We now have a situation where patients are losing confidence in their doctors, while doctors are
losing confidence in our ability to do the right thing for our patients. We have a health care system
becoming more hostile to doctors and patients and more friendly to health care corporations.
These trends are collateral damage caused by another trend: our increasingly corporatized,
commodified and commercialized U.S. health care “industry” that is being put into hyper drive by
the Affordable Care Act. The ACA is accelerating an ongoing wave of hospital consolidations and
acquisition of doctors’ practices by large corporations, such as Eastern Maine Healthcare Systems
and MaineHealth.
As we continue down this road, doctors see our clinical autonomy disappearing as more and more
of us become corporate employees subject to pressure to meet corporate financial goals that often
differ from what is best for our patients. Patients sense that pressure as they are rushed through
exams and are subject to more tests and procedures, some of them of questionable clinical value.
They can almost hear the cash registers ringing as they move through their doctors’ offices, as more
wealth is transferred from patients to those selling health care goods and services.
Why is American medicine, once the crown jewel of American professionalism and a proud and
respected calling, becoming just another commercial enterprise? In his 2010 book “ Hijacked,” Dr.
John Geyman, chairman emeritus of the department of family practice at the University of
Washington, explains how during the year-long Congressional debate leading up to enactment of
the ACA, the interests of the public, including doctors and patients, were subverted to those of
large health care corporations.
The highjacking of health care reform is paying off handsomely. Robert Pear of the New York
Times recently described how the federal government and the commercial health insurance
industry have morphed into one big fan club for the ACA. He quotes the libertarian Cato Institute’s
Michael Cannon explaining that since the ACA’s enactment, “Insurers and the government have
developed a symbiotic relationship, nurtured by tens of billions of dollars that flow from the federal
Treasury to insurers each year.”
Pear goes on to report that, “Since Mr. Obama signed the law, share prices for four of the major
insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled,
while the Standard & Poor’s 500-stock index has increased about 70 percent.”
Pharmaceutical companies also have done very well. The ACA contains no authority for the
government to negotiate pharmaceutical prices but continues the federal prohibition on the
importation by U.S. residents of lower priced prescription drugs from many foreign countries.
This situation won’t change anytime soon. Congress is gridlocked. What is widely recognized as a
drafting error in the ACA — which, in saner times, could have been fixed quickly without attracting
much attention — is now headed to the Supreme Court.
Of course, health care is just one of many examples in which the welfare of corporations has been
put ahead of the interests of the public, but it may be the poster child. Health care is now more
than a sixth of our economy, and human lives and dollars are at stake.
Corporate stranglehold of our public policy traces back to the increasingly corrupt way our political
campaigns are financed. The recent midterm elections were a stark reminder of that, setting record
levels for corporate spending, even on local races, and saturating voters with negative, intrusive
and often obnoxious messages.
What’s at stake is the future of health care and many other issues that will determine what kind of a
country our children will live in. That future depends on how active and informed the public is
willing to become in electing public officials who place the welfare of their constituents ahead of
the wishes of their corporate contributors.
The results of the recent elections are not encouraging. But what’s becoming clearer is that our
struggle is not between Democrats and Republicans, liberals and conservatives, or occupiers and
tea partiers. It is between real American people and corporations.
I, for one, intend to continue pointing that out. That’s where our attention should be focused.
How American health care turned patients into
consumers
By Dr. Philip Caper, Special to the BDN
Posted March 19, 2015, at 11:05 a.m.
A clash of cultures is rapidly developing among those of us who see the mission of the health care
system to be primarily the diagnosis and healing of illness and those who see it primarily as an
opportunity to create personal wealth.
The concept of health care primarily as a business is uniquely American, and it has gained
ascendancy during the last few decades. While there have always been a few greedy doctors,
businessmen-wealth-seekers — not doctors — now dominate the medical-industrial complex. They
include for-profit insurance, medical device and pharmaceutical companies as well as for-profit
and nonprofit corporate providers of health care services, such as the three large hospital systems
in Maine.
Partly because of the Affordable Care Act, they also include a rapidly growing army of lawyers,
consultants and policy wonks who are creating lucrative businesses helping hapless “consumers” —
formerly “patients” — “navigate” their way through the grotesquely byzantine maze our health care
system has become.
This shift in emphasis from patient care to money profoundly has affected the practice of medicine
and resulted in the clash of cultures within health care. As increasing numbers of “providers” —
formerly “doctors” — become employees of large health care corporations — formerly community
hospitals — we have come under increasing pressure to diagnose profitable diseases and order
profitable tests and procedures without enough regard to the benefits or harm accruing to patients.
Hospital “CEOs” — formerly “administrators” — trained in the ethics and practices of business
rather than health care are incentivized to configure their “product lines” — formerly “services” —
to produce the largest “profits” — formerly “margins.”
Those of us in the health care “business” — formerly “profession” — have been slow to react to this
hijacking of our health care calling. Patients, despite sensing something is deeply wrong, feel
helpless to push back. That now seems to be changing.
For the past three years The Lown Institute, founded by Dr. Bernard Lown, renowned cardiologist
and advocate for universal health care, has held conferences designed to point out the growing
problem of overtreatment in medicine. Recently they also have turned their attention to the equally
disturbing problem of impaired access to health care and undertreatment. They now advocate for
RightCare — not too much treatment and not too little.
Arguably some of the most important effects of Obamacare have been the destabilization of our
deeply dysfunctional health care system and an order-of-magnitude increase in the amount of
attention given to its dysfunction by the media and the public. Elisabeth Rosenthal’s excellent New
York Times series “Pay Till It Hurts” and Steven Brill’s Time magazine cover story and book titled
“America’s Bitter Pill” are two of the most recent examples. These two factors have created an
opportunity for real structural and cultural change.
There are many advocacy groups — Physicians for a National Health Program, HealthCare-NOW,
Maine AllCare — trying to highlight these issues and to propose ways to turn this runaway train
around.
While they are necessary, attempts at education and persuasion are not sufficient. Unlike past
human rights movements, such as women’s suffrage and marriage equality, the fight for the right
to health care for all Americans will require redirecting huge sums of money away from deeply
entrenched, profit-oriented private corporations to not-for-profit programs that directly promote
the public’s health and wellbeing.
The Institute of Medicine estimates that the convoluted American health care system wastes $750
billion per year in inefficiency and fraud, unnecessary administrative complexity and medical
services, unjustifiably high prices and missed prevention opportunities. That waste creates a lot of
jobs but does not pay for one Band-Aid or aspirin.
I attended the latest Lown conference, held last week in San Diego, to talk about the “Heal-In” held
at Boston City Hospital in 1967 as an example of direct action taken by doctors, nurses and other
healers to achieve a political goal without compromising patient care. The capstone of the
conference was to announce the expansion of Lown’s mission, previously focused on education and
discussion, to include creation of a national grassroots movement that will include direct action.
Their first foray will be called RightCare Action week and is scheduled for the fall. Stay tuned.
Changing our health care system is as much about persuasion through power as it is about the
power of persuasion. We as patients have power through the ballot box, and we as health care
workers have power through our key roles in the “business” of health care to return and redirect its
mission toward healing and away from its increasingly singular obsession with profitability.
All we have to do is summon the will and the courage to exercise that power.
http://www.pnhp.org/news/2015/march/how-american-health-care-turned-patients-into-consumers
Industry payouts to providers, unnecessary admissions to meet quotas, manipulating data for greater reimbursements: In The Huffington Post this week, Shannon Brownlee and Vikas Saini of the Lown Institute call out these ubiquitous practices for what they are – corruption.
“Our health care system is no longer about relieving the suffering of patients or the intrinsic value of maintaining the health of our population. It’s about making money,” Brownlee and Saini write. This systemic corruption contributes to ballooning health care costs and causes immeasurable harm to patients.
Just this week, The Seattle Times revealed that top brain and spine surgeons at Swedish Health in Seattle conducted simultaneous surgeries more than half the time between 2014 and 2016. Simultaneous surgeries allow hospitals and providers to increase revenue by effectively double-booking patients, and most of the time patients are not informed that their surgeon will not be present for part or even most of their surgery. Several patients who had complications from their surgeries at Swedish told The Times they would not have gotten the surgery if they knew their doctor was in multiple operating rooms at once.
In another particularly egregious example of corruption, some rehab centers are capitalizing on the opioid crisis by taking advantage of patients. STAT reports this week on “patient brokers,” middlemen hired by rehab centers to convince people struggling with addiction to check into treatment centers that bill patients for all they can, without providing help for rehabilitation.
There is no simple cure for corruption, say Brownlee and Saini. With so much money in the health care system, profit-mongering is bound to happen. But there are things we can do to make corruption less normalized. Speaking out against it is the first step. Take Dr. James Holsapple, who objected to simultaneous surgeries at his hospital and was forced to resign. He recently won a lawsuit against the hospital for wrongful termination, paving the way for other doctors to speak up.
Editor's Note: The following clippings are from some of my Bangor Daily News columns written in the past that relate to the preceding article by Saini and Brownlee. I though they may be of interest.
-SPC
Selling expensive health care lemons
By Dr. Philip Caper, Special to the BDN
Posted March 14, 2013, at 11:11 a.m.
In 1970, University of California economist George Akerlof wrote a paper titled “Selling Lemons.” In it he
explained that a market characterized by a large asymmetry of information between seller and buyer would also
soon become characterized by a decrease in the quality of goods and dominated by crooked sellers and gullible
buyers. In 2001 he won the Nobel Prize for his work.
Sad to say, I can think of no market that better fits these criteria than health care. In a March 4 TIME Magazine
cover story, “The Bitter Pill: Why Medical Bills Are Killing Us,” reporter Steven Brill dissects a number of hospital
bills and traces the detailed charges back to their origins. He concludes, “everyone along the supply chain – from
hospital administrators (who enjoy multimillion-dollar salaries) to the salesmen, executives and shareholders of
drug and equipment makers — was reaping a bonanza. The only exceptions, I found, were those actually treating
the patients — the nurses and doctors.”
When you need medical care there is absolutely no way you can accurately determine ahead of time what that
care will cost you. Don’t hope to get anything approaching a rational explanation for what you are charged after
the fact, either. The best you can hope for is that whatever insurance you have will cover most of the costs. If not,
you are at the mercy of the hospital and, if you can’t pay, its collection agency.
So you can’t know much about the prices of health care. How about the appropriateness or quality of that care?
Again, unless you are a doctor you have very few ways to independently judge the safety or benefits of tests,
procedures or prescriptions.
And sometimes not even then. Even among well-trained and conscientious doctors, a great deal of uncertainty
exists about the risks and benefits of tests and procedures they order and perform.
As the number of doctors who have become employees of profit or nonprofit corporations has increased (now
about 80 percent of Maine doctors and rising), they have come under pressure to increase the number of “units
of service” they provide — visits, tests, procedures and prescriptions — in order to maximize the revenues and
profits of the institutions that employ them.
Lately, the need for many commonly performed procedures has come under question by both government and
private health care organizations. The U.S. Preventive Services Task Force recently warned against the routine
performance of some, including mammograms for young women, hormone replacement therapy for older
women, prostate cancer tests for older men and drug treatment to prevent osteoporosis. Many are now thought
to do more harm than good.
Similarly, the American Board of Internal Medicine, one of the medical profession’s most important credentialing
bodies, recently launched a program called “Choosing Wisely.” Its purpose is to identify tests and procedures that
are overused, and to persuade doctors and patients to use fewer of them. More than 35 medical specialty societies
have joined this campaign, each selecting five or more tests or procedures that they believe are significantly
overused. Among these are imaging procedures, such a CT scans and MRI, the use of which has exploded in
frequency and cost in recent years. It is almost impossible for patients to accurately assess the need for and
quality of care.
I still believe that most health care workers want to do the right thing by our patients. But our corporatized and
business-oriented health care system is making it increasingly difficult.
Businesses try to optimize prices and sales in order to maximize revenues. When “consumers” (patients) have
little or no information about what they’re buying, Akerlof’s prediction that maximization of profits rather than
value will dominate decision-making comes true. In other words, the asymmetry of information between patients
(who possess little) and health care providers and administrators (who possess a lot) makes anything like a
rational market in health care services impossible.
That hasn’t stopped free market ideologues from peddling their flawed and self-serving ideas to anyone who will
listen, including some uninformed and perhaps naive lawmakers. One result is legislation like Maine’s new
health insurance reform law, passed two years ago.
In his article, Brill documents that Medicare is much more efficient and does a much better job of controlling
costs than private insurance. It seems to me that he makes a compelling case for expanding Medicare to
everyone. But, in the end, he backs off of actually recommending it because, as he explained in an interview, he
fears the power of a health care industry that generates huge profits and spends four times as much on lobbying
as does the defense industry.
I’m not so sure he’s right about that. I believe people power can overcome corporate power, especially in states
such as Maine.
The next time you hear somebody saying “let the market work in health care,” the most reasonable response
would be to pat them on the head and have a good laugh.
But our profit-driven health care system is bankrupting individuals, putting enormous stress on businesses and
state and federal governments and destroying the therapeutic doctor-patient bond of trust. So, I guess it’s no
laughing matter.
The business interests behind America’s costly
medical care
By Dr. Philip Caper, Special to the BDN
Posted April 17, 2014, at 3:38 p.m.
The United States spends far more on medical care than other wealthy countries, due mostly to higher prices for
health care goods and services. There is a reason for this. In U.S. politics, social progress comes at a high price if
it threatens business interests.
In 1965, at the insistence of the American Medical Association, Lyndon B. Johnson agreed to insert language into
the Medicare law that prohibited the government from interfering in the practice of medicine, and assuring
doctors that they would continue to receive their usual, customary and reasonable fees.
In creating the Medicare prescription drug benefit in 2003, Congress inserted a provision prohibiting Medicare
from negotiating prices for drugs to placate pharmaceutical companies, costing the government billions of
dollars.
In 2009, with the Affordable Care Act, the political price paid for expanding access to federally funded health
care was coercing young and healthy Americans to buy private health insurance and directing billions of federal
dollars to subsidies for private insurance companies. Not satisfied with that, pharmaceutical and medical device
manufacturers insisted on weakening cost controls. Even the modest tax on medical devices and supplies
included to help pay for the law is very likely to be repealed, with support from both parties, to mollify medical
device manufacturers.
The complexity of the ACA and the poor quality of some of the most popular coverage has created new business
opportunities. Accounting firms are now jumping into the fray, offering their services as tax advisers and
consultants to help folks navigate their way through the ACA maze. The ongoing shift in the burden of health-
care costs from insurance companies to individuals through larger out-of-pocket payments creates new
opportunities for banks to offer credit card services for medical debt, often at usurious levels of fees and interest.
All of this further raises health-care costs.
Unlike most other wealthy countries, the U.S. lacks any central mechanism to constrain overall health-care
spending. This has led us instead to rely on piecemeal, half-hearted and largely ineffective regulation of fees by
Medicare, and micromanagement of medical decision-making by private insurers at a level unheard of, and that
would not be tolerated in other wealthy countries.
Those attempts at health care cost control have failed.
When government requires individuals and businesses to purchase private health insurance, it must also assure
that insurance costs remain affordable, or the law will unravel. The federal government will soon have to
abandon its “hands off” approach to restraining the overall costs of medical care. Every country that has moved
toward making health care a human right as a matter of public policy has quickly turned its attention to ways to
control its overall costs, private as well as public.
We’re already seeing more attention being paid by government, the media, and professional organizations not
only to the prices charged by health-care providers, but to ways to restrain the use of unnecessary services and
administrative costs, fraud, waste and abuse, and preventing illness in the first place. It should come as no
surprise that Medicare data about payments to doctors has recently been released showing some very large
payouts, and huge variations across the country. Although this data is incomplete and should be treated
cautiously, it raises troubling questions.
The ACA is a work in progress. There is almost universal agreement that it has to be fixed, but plenty of
disagreement about how to fix it. The architects of the law anticipated that likelihood. Section 1332 of the ACA
provides great latitude for future experimentation by states, beginning in 2017. It allows them to discard most of
the ACA’s key requirements if they can come up with something better at no additional cost.
Vermont has already taken a number of important steps toward replacing the ACA with a single-payer system.
Such a system would allow them to expand coverage to everybody, reduce total spending, and restrain the growth
of future health-care costs to a sustainable level through budgeting.
Earlier this month, the Maine Legislature passed a resolve by a wide bipartisan margin that takes the first step
toward following Vermont’s example. The handwriting is on the wall. If the Legislature is unable to effectively
deal with this problem, we in Maine can always express ourselves through a ballot initiative.
How ACA fuels corporatization of American health
care
By Dr. Philip Caper, Special to the BDN
Posted Nov. 20, 2014, at 11:01 a.m.
A new Harvard study has found that Americans’ trust in the medical profession has dropped
dramatically in recent years and lags behind that in many other wealthy countries. At the same
time, doctors are becoming increasingly unhappy with our profession. In his new memoir, “
Doctored,” Dr. Sandeep Jauhar eloquently explains why: More and more doctors are coming to
view our profession as just another job.
We now have a situation where patients are losing confidence in their doctors, while doctors are
losing confidence in our ability to do the right thing for our patients. We have a health care system
becoming more hostile to doctors and patients and more friendly to health care corporations.
These trends are collateral damage caused by another trend: our increasingly corporatized,
commodified and commercialized U.S. health care “industry” that is being put into hyper drive by
the Affordable Care Act. The ACA is accelerating an ongoing wave of hospital consolidations and
acquisition of doctors’ practices by large corporations, such as Eastern Maine Healthcare Systems
and MaineHealth.
As we continue down this road, doctors see our clinical autonomy disappearing as more and more
of us become corporate employees subject to pressure to meet corporate financial goals that often
differ from what is best for our patients. Patients sense that pressure as they are rushed through
exams and are subject to more tests and procedures, some of them of questionable clinical value.
They can almost hear the cash registers ringing as they move through their doctors’ offices, as more
wealth is transferred from patients to those selling health care goods and services.
Why is American medicine, once the crown jewel of American professionalism and a proud and
respected calling, becoming just another commercial enterprise? In his 2010 book “ Hijacked,” Dr.
John Geyman, chairman emeritus of the department of family practice at the University of
Washington, explains how during the year-long Congressional debate leading up to enactment of
the ACA, the interests of the public, including doctors and patients, were subverted to those of
large health care corporations.
The highjacking of health care reform is paying off handsomely. Robert Pear of the New York
Times recently described how the federal government and the commercial health insurance
industry have morphed into one big fan club for the ACA. He quotes the libertarian Cato Institute’s
Michael Cannon explaining that since the ACA’s enactment, “Insurers and the government have
developed a symbiotic relationship, nurtured by tens of billions of dollars that flow from the federal
Treasury to insurers each year.”
Pear goes on to report that, “Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70 percent.”
Pharmaceutical companies also have done very well. The ACA contains no authority for the government to negotiate pharmaceutical prices but continues the federal prohibition on the importation by U.S. residents of lower priced prescription drugs from many foreign countries.
This situation won’t change anytime soon. Congress is gridlocked. What is widely recognized as a drafting error in the ACA — which, in saner times, could have been fixed quickly without attracting much attention — is now headed to the Supreme Court.
Of course, health care is just one of many examples in which the welfare of corporations has been put ahead of the interests of the public, but it may be the poster child. Health care is now more than a sixth of our economy, and human lives and dollars are at stake.
Corporate stranglehold of our public policy traces back to the increasingly corrupt way our political campaigns are financed. The recent midterm elections were a stark reminder of that, setting record levels for corporate spending, even on local races, and saturating voters with negative, intrusive and often obnoxious messages.
What’s at stake is the future of health care and many other issues that will determine what kind of a country our children will live in. That future depends on how active and informed the public is willing to become in electing public officials who place the welfare of their constituents ahead of the wishes of their corporate contributors.
The results of the recent elections are not encouraging. But what’s becoming clearer is that our struggle is not between Democrats and Republicans, liberals and conservatives, or occupiers and tea partiers. It is between real American people and corporations.
Pear goes on to report that, “Since Mr. Obama signed the law, share prices for four of the major insurance companies — Aetna, Cigna, Humana and UnitedHealth — have more than doubled, while the Standard & Poor’s 500-stock index has increased about 70 percent.”
Pharmaceutical companies also have done very well. The ACA contains no authority for the government to negotiate pharmaceutical prices but continues the federal prohibition on the importation by U.S. residents of lower priced prescription drugs from many foreign countries.
This situation won’t change anytime soon. Congress is gridlocked. What is widely recognized as a drafting error in the ACA — which, in saner times, could have been fixed quickly without attracting much attention — is now headed to the Supreme Court.
Of course, health care is just one of many examples in which the welfare of corporations has been put ahead of the interests of the public, but it may be the poster child. Health care is now more than a sixth of our economy, and human lives and dollars are at stake.
Corporate stranglehold of our public policy traces back to the increasingly corrupt way our political campaigns are financed. The recent midterm elections were a stark reminder of that, setting record levels for corporate spending, even on local races, and saturating voters with negative, intrusive and often obnoxious messages.
What’s at stake is the future of health care and many other issues that will determine what kind of a country our children will live in. That future depends on how active and informed the public is willing to become in electing public officials who place the welfare of their constituents ahead of the wishes of their corporate contributors.
The results of the recent elections are not encouraging. But what’s becoming clearer is that our struggle is not between Democrats and Republicans, liberals and conservatives, or occupiers and tea partiers. It is between real American people and corporations.
I, for one, intend to continue pointing that out. That’s where our attention should be focused.
How American health care turned patients into
consumers
By Dr. Philip Caper, Special to the BDN
Posted March 19, 2015, at 11:05 a.m.
A clash of cultures is rapidly developing among those of us who see the mission of the health care
system to be primarily the diagnosis and healing of illness and those who see it primarily as an
opportunity to create personal wealth.
The concept of health care primarily as a business is uniquely American, and it has gained
ascendancy during the last few decades. While there have always been a few greedy doctors,
businessmen-wealth-seekers — not doctors — now dominate the medical-industrial complex. They
include for-profit insurance, medical device and pharmaceutical companies as well as for-profit
and nonprofit corporate providers of health care services, such as the three large hospital systems
in Maine.
Partly because of the Affordable Care Act, they also include a rapidly growing army of lawyers,
consultants and policy wonks who are creating lucrative businesses helping hapless “consumers” —
formerly “patients” — “navigate” their way through the grotesquely byzantine maze our health care
system has become.
This shift in emphasis from patient care to money profoundly has affected the practice of medicine
and resulted in the clash of cultures within health care. As increasing numbers of “providers” —
formerly “doctors” — become employees of large health care corporations — formerly community
hospitals — we have come under increasing pressure to diagnose profitable diseases and order
profitable tests and procedures without enough regard to the benefits or harm accruing to patients.
Hospital “CEOs” — formerly “administrators” — trained in the ethics and practices of business
rather than health care are incentivized to configure their “product lines” — formerly “services” —
to produce the largest “profits” — formerly “margins.”
Those of us in the health care “business” — formerly “profession” — have been slow to react to this
hijacking of our health care calling. Patients, despite sensing something is deeply wrong, feel
helpless to push back. That now seems to be changing.
For the past three years The Lown Institute, founded by Dr. Bernard Lown, renowned cardiologist
and advocate for universal health care, has held conferences designed to point out the growing
problem of overtreatment in medicine. Recently they also have turned their attention to the equally
disturbing problem of impaired access to health care and undertreatment. They now advocate for
RightCare — not too much treatment and not too little.
Arguably some of the most important effects of Obamacare have been the destabilization of our deeply dysfunctional health care system and an order-of-magnitude increase in the amount of attention given to its dysfunction by the media and the public. Elisabeth Rosenthal’s excellent New York Times series “Pay Till It Hurts” and Steven Brill’s Time magazine cover story and book titled “America’s Bitter Pill” are two of the most recent examples. These two factors have created an opportunity for real structural and cultural change.
There are many advocacy groups — Physicians for a National Health Program, HealthCare-NOW, Maine AllCare — trying to highlight these issues and to propose ways to turn this runaway train around.
While they are necessary, attempts at education and persuasion are not sufficient. Unlike past human rights movements, such as women’s suffrage and marriage equality, the fight for the right to health care for all Americans will require redirecting huge sums of money away from deeply entrenched, profit-oriented private corporations to not-for-profit programs that directly promote the public’s health and wellbeing.
The Institute of Medicine estimates that the convoluted American health care system wastes $750 billion per year in inefficiency and fraud, unnecessary administrative complexity and medical services, unjustifiably high prices and missed prevention opportunities. That waste creates a lot of jobs but does not pay for one Band-Aid or aspirin.
I attended the latest Lown conference, held last week in San Diego, to talk about the “Heal-In” held at Boston City Hospital in 1967 as an example of direct action taken by doctors, nurses and other healers to achieve a political goal without compromising patient care. The capstone of the conference was to announce the expansion of Lown’s mission, previously focused on education and discussion, to include creation of a national grassroots movement that will include direct action. Their first foray will be called RightCare Action week and is scheduled for the fall. Stay tuned.
Changing our health care system is as much about persuasion through power as it is about the power of persuasion. We as patients have power through the ballot box, and we as health care workers have power through our key roles in the “business” of health care to return and redirect its mission toward healing and away from its increasingly singular obsession with profitability.
All we have to do is summon the will and the courage to exercise that power.
http://www.pnhp.org/news/2015/march/how-american-health-care-turned-patients-into-consumers
Arguably some of the most important effects of Obamacare have been the destabilization of our deeply dysfunctional health care system and an order-of-magnitude increase in the amount of attention given to its dysfunction by the media and the public. Elisabeth Rosenthal’s excellent New York Times series “Pay Till It Hurts” and Steven Brill’s Time magazine cover story and book titled “America’s Bitter Pill” are two of the most recent examples. These two factors have created an opportunity for real structural and cultural change.
There are many advocacy groups — Physicians for a National Health Program, HealthCare-NOW, Maine AllCare — trying to highlight these issues and to propose ways to turn this runaway train around.
While they are necessary, attempts at education and persuasion are not sufficient. Unlike past human rights movements, such as women’s suffrage and marriage equality, the fight for the right to health care for all Americans will require redirecting huge sums of money away from deeply entrenched, profit-oriented private corporations to not-for-profit programs that directly promote the public’s health and wellbeing.
The Institute of Medicine estimates that the convoluted American health care system wastes $750 billion per year in inefficiency and fraud, unnecessary administrative complexity and medical services, unjustifiably high prices and missed prevention opportunities. That waste creates a lot of jobs but does not pay for one Band-Aid or aspirin.
I attended the latest Lown conference, held last week in San Diego, to talk about the “Heal-In” held at Boston City Hospital in 1967 as an example of direct action taken by doctors, nurses and other healers to achieve a political goal without compromising patient care. The capstone of the conference was to announce the expansion of Lown’s mission, previously focused on education and discussion, to include creation of a national grassroots movement that will include direct action. Their first foray will be called RightCare Action week and is scheduled for the fall. Stay tuned.
Changing our health care system is as much about persuasion through power as it is about the power of persuasion. We as patients have power through the ballot box, and we as health care workers have power through our key roles in the “business” of health care to return and redirect its mission toward healing and away from its increasingly singular obsession with profitability.
All we have to do is summon the will and the courage to exercise that power.
http://www.pnhp.org/news/2015/march/how-american-health-care-turned-patients-into-consumers
New Findings – SB 562 Would Cut State Spending on Healthcare by 18% -- and Guarantee Care for All
National Nurses United - Common Dreams - Marcy 31,2017
Big Healthcare Savings for California Families and Businesses
OAKLAND, Calif. - SB 562, the Healthy California Act, would cut current spending on healthcare in California by 18 percent – and produce substantial savings for households in healthcare costs as a share of their income, and California businesses, which would also see reduced payroll costs for health care expenditures, according to new research findings released today.
Most importantly, the bill would guarantee full health coverage for all Californians, without the devastating deductibles and co-pays that prompt many to ration needed care. The study notes that 36 percent of all insured Californians, 12 million people, remain underinsured – paying for premiums but often unable to access care due to high out of pocket costs – and another 7.5 percent, 2.7 million Californians, remain fully uninsured, even with improvements under the Affordable Care Act.
Significantly the proposed plan would sharply reduce what middle-income California families now spend out of pocket for health care costs as a share of their income by up to 9 percent.
In sum- the savings amount to a 9 percent raise for California workers.
California businesses who currently provide health benefits for employees would also see a decline in their payroll costs by up to 22 percent for small businesses and up to 13 percent for medium size businesses – with the added benefit of a healthier, more productive population.
That’s the findings of an “Economic Analysis of the Healthy California Single-Payer Health Care Proposal (SB 562),” a research study by a team of economists at the Political Economy Research Institute (PERI) at the University of Massachusetts Amherst, led by Dr. Robert Pollin, a premiere U.S. economist and author of a number of books on economic policy. Dr. James Heintz, Dr. Peter Arno, and Dr. Jeannette Wicks-Lim, all of PERI, also authored the study. The California Nurses Association/National Nurses United sponsored the study.
Under the Healthy California Act, California’s total spending on health care, with savings of 18 percent produced by reductions in administrative costs, the use of state bulk purchasing power, and improved patient care delivery, would drop to $331 billion. But that figure includes $225 billion of current taxpayer funded spending on Medicare, Medicaid, tax subsidies paid to insurers for health expenses of families and households.
With the savings produced by a single payer financing system, and the transfer of the 71 percent of taxpayer funded spending currently by Medicare, Medicaid and taxpayer subsidies to insurers for partial payment private insurance costs for families and households, an additional $106 billion will be needed – replacing the huge burden of what Californians now pay to insurers and other health care corporations in premiums, deductibles, co-pays and other out-of-pocket health care costs, and the social impact that imposes for people who skip needed care due to debilitating cost.
The study proposes achieving that added revenue through two modest taxes, a 2.3 percent on gross business revenue receipts – exempting the first $2 million in receipts to eliminate the cost for small businesses – and a new 2.3 percent sales tax that would exempt all spending on housing, utilities, services, and food at home, to mitigate the impact for low and moderate income Californians. The lowest income Californians would receive a tax credit, fully offsetting their tax share.
“What this new study proves is that we can finally achieve the dream of guaranteeing health care for all Californians, without the punishment of crippling out of pocket costs, at far less than what was predicted by those who make enormous profits off the pain and suffering of everyday Californians,” said RoseAnn DeMoro, CNA/NNU executive director.
“We know from the experiences of other countries across the world that we can reduce overall spending, and produce a more effective, humane health care system. Now it is up to us as a society to decide what are our priorities, what we consider should be the responsibility to ensure that health care is a right, a public good, and the moral choice to make as a people,” DeMoro said.
SB 562 is eligible for a vote by the California Senate this week. It would establish an improved Medicare for all type system in California. State Senators Ricardo Lara and Toni G. Atkins introduced the bill, joined by Senators Benjamin Allen, Cathleen Galgiani, Mike McGuire, Nancy Skinner, and Scott Wiener as co-authors. CNA is the primary sponsor of the bill, joined by the Healthy California Campaign http://www.healthycaliforniaact.org/
Assembly Members Rob Bonta, David Chiu, Laura Friedman, Ash Kalra, Kevin McCarty, Adrin Nazarian, Mark Stone, and Tony Thurmond are also co-authors of the bill.
The threat of repeal of the ACA by Congress and the Trump Administration would further exacerbate the health crisis for many, making SB 562 even more timely.
Key features of SB 562 include:
• Every Californian eligible to enroll, regardless of age, income, employment or other status.
• No out of pocket costs, such as high deductibles and co-pays, for covered health services
• Comprehensive coverage, including hospital and outpatient medical care, primary and preventive care, vision, dental, hearing, women’s reproductive health services, mental health, lab tests, rehab and other basic medical needs
• Lower prescription drug costs
• Long term care services provided under Medi-Cal continue, and will be expanded with an emphasis on community and in-home care
• No narrow insurance networks, one medical card, real patient choice of provider
• No insurance claims denials based on corporate profit goals
Big Healthcare Savings for California Families and Businesses
OAKLAND, Calif. - SB 562, the Healthy California Act, would cut current spending on healthcare in California by 18 percent – and produce substantial savings for households in healthcare costs as a share of their income, and California businesses, which would also see reduced payroll costs for health care expenditures, according to new research findings released today.
Most importantly, the bill would guarantee full health coverage for all Californians, without the devastating deductibles and co-pays that prompt many to ration needed care. The study notes that 36 percent of all insured Californians, 12 million people, remain underinsured – paying for premiums but often unable to access care due to high out of pocket costs – and another 7.5 percent, 2.7 million Californians, remain fully uninsured, even with improvements under the Affordable Care Act.
Significantly the proposed plan would sharply reduce what middle-income California families now spend out of pocket for health care costs as a share of their income by up to 9 percent.
In sum- the savings amount to a 9 percent raise for California workers.
California businesses who currently provide health benefits for employees would also see a decline in their payroll costs by up to 22 percent for small businesses and up to 13 percent for medium size businesses – with the added benefit of a healthier, more productive population.
That’s the findings of an “Economic Analysis of the Healthy California Single-Payer Health Care Proposal (SB 562),” a research study by a team of economists at the Political Economy Research Institute (PERI) at the University of Massachusetts Amherst, led by Dr. Robert Pollin, a premiere U.S. economist and author of a number of books on economic policy. Dr. James Heintz, Dr. Peter Arno, and Dr. Jeannette Wicks-Lim, all of PERI, also authored the study. The California Nurses Association/National Nurses United sponsored the study.
Under the Healthy California Act, California’s total spending on health care, with savings of 18 percent produced by reductions in administrative costs, the use of state bulk purchasing power, and improved patient care delivery, would drop to $331 billion. But that figure includes $225 billion of current taxpayer funded spending on Medicare, Medicaid, tax subsidies paid to insurers for health expenses of families and households.
With the savings produced by a single payer financing system, and the transfer of the 71 percent of taxpayer funded spending currently by Medicare, Medicaid and taxpayer subsidies to insurers for partial payment private insurance costs for families and households, an additional $106 billion will be needed – replacing the huge burden of what Californians now pay to insurers and other health care corporations in premiums, deductibles, co-pays and other out-of-pocket health care costs, and the social impact that imposes for people who skip needed care due to debilitating cost.
The study proposes achieving that added revenue through two modest taxes, a 2.3 percent on gross business revenue receipts – exempting the first $2 million in receipts to eliminate the cost for small businesses – and a new 2.3 percent sales tax that would exempt all spending on housing, utilities, services, and food at home, to mitigate the impact for low and moderate income Californians. The lowest income Californians would receive a tax credit, fully offsetting their tax share.
“What this new study proves is that we can finally achieve the dream of guaranteeing health care for all Californians, without the punishment of crippling out of pocket costs, at far less than what was predicted by those who make enormous profits off the pain and suffering of everyday Californians,” said RoseAnn DeMoro, CNA/NNU executive director.
“We know from the experiences of other countries across the world that we can reduce overall spending, and produce a more effective, humane health care system. Now it is up to us as a society to decide what are our priorities, what we consider should be the responsibility to ensure that health care is a right, a public good, and the moral choice to make as a people,” DeMoro said.
SB 562 is eligible for a vote by the California Senate this week. It would establish an improved Medicare for all type system in California. State Senators Ricardo Lara and Toni G. Atkins introduced the bill, joined by Senators Benjamin Allen, Cathleen Galgiani, Mike McGuire, Nancy Skinner, and Scott Wiener as co-authors. CNA is the primary sponsor of the bill, joined by the Healthy California Campaign http://www.healthycaliforniaact.org/
Assembly Members Rob Bonta, David Chiu, Laura Friedman, Ash Kalra, Kevin McCarty, Adrin Nazarian, Mark Stone, and Tony Thurmond are also co-authors of the bill.
The threat of repeal of the ACA by Congress and the Trump Administration would further exacerbate the health crisis for many, making SB 562 even more timely.
Key features of SB 562 include:
• Every Californian eligible to enroll, regardless of age, income, employment or other status.• No out of pocket costs, such as high deductibles and co-pays, for covered health services• Comprehensive coverage, including hospital and outpatient medical care, primary and preventive care, vision, dental, hearing, women’s reproductive health services, mental health, lab tests, rehab and other basic medical needs• Lower prescription drug costs• Long term care services provided under Medi-Cal continue, and will be expanded with an emphasis on community and in-home care• No narrow insurance networks, one medical card, real patient choice of provider• No insurance claims denials based on corporate profit goals
In Historic Vote, California Senate Passes Single-Payer Bill to Provide Comprehensive Health Care to All Residents
by Steven Rosenfeld - Alternate - June 1, 2017
The California Senate voted Thursday to approve a statewide single-payer health care system. The 23-14 vote, mostly following party lines, came after a lengthy debate in which Democratic backers admitted the bill’s details were far from finalized, while Republicans bemoaned creating a government-run system they predicted would leave the state in ruins.
“SB-652 will establish a state-based universal care system and provide comprehensive care coverage to every single Californian. This bill, I know, is a work-in-progress—Sen. Atkins and I know there is a lot more work to do,” said Sen. Ricardo Lara, D-Bell Gardens, the bill’s co-sponsor, primarily referring to its lack of a financing mechanism.
“This legislature believes it can fund a $400 billion bureaucracy—it seems glib to me that it’s ‘a work-in-progress,’” said Sen. John Moorlach, R-Costa Mesa. “I don’t know how we complain about Washington, D.C. making changes to health care and saying they’re vague, when we’re vague… I see this is as being on the wrong road heading straight for a fiscal cliff.”
The bill passed the Senate, where Democrats hold a 27-13 majority, though did not say how the estimated $400 billion cost in providing comprehensive health care to every resident would be paid for. Currently, the combined state and federal government health care subsidies add up to $225 billion annually. The rest, if it replaces private insurance premiums for individuals and businesses, would need to come from some combination of revenue-raising measures.
What’s been proposed so far are two vastly different approaches. The Senate Appropriations Committee staff said it could come from a 15 percent hike in the state payroll tax, essentially doubling it. The bill’s sponsors and the largest institutional supporter, the California Nurses Association, released an analysis Wednesday that said single-payer would cut statewide coverage costs by $60 billion from the current system, and could be paid by raising two taxes by 2.3 percent each: the gross receipts tax paid by businesses after their first $2 million in income, and a similar-sized increase in the sales tax.
The Senate floor debate did not discuss these details, but mostly focused on whether the state legislature needed to keep working on the bill or not. Everyone agreed that Friday’s crossover deadline—when bills have to pass from one body to another to possibly become law—was unfortunate. However, most Democrats said that the issue was too important to stop.
“I see a zillion holes in it, but I am going to vote for it today because I think at the end of the day the question is worth debating,” said Sen. Bob Hertzberg, D-Van Nuys. “At the end of the day we are a legislative branch of government and our job is to deliberate. Our job is to ask hard questions. Our job is to take a look at what is coming at us and try to figure it out. And the message to those people who say we’re irresponsible, I tell you do not judge us based upon a vote in a day; judge us based upon our work at the end of the day.”
Republicans took the opposite position, saying single payer would be a disaster and repeating the health care industry’s talking points.
“This bill, as written, will force people out of their current health care system and embracing a purely governmental-run system, run by government bureaucrats who have failed us too often,” said Sen. Jeff Stone, R-Indio. “For those of my constituents that have Kaiser, if this law gets passed, Kaiser said at the committee hearing they will close their doors here in California. Aetna will leave. HealthNet will leave. Blue Cross, Blue Shield, non-profit hospitals. So much for freedom of choice.”
Some Democrats, however, said the bill is premature.
“As its supporters said, it is a work-in-progress,” said Sen. Steven Glazer, D-Orinda. “And for me, rather than rushing to pass it before it’s complete, we should keep it here and finish the work. The voters will ultimately have to have a final say on any plan of this scope because it conflicts with existing provisions in the [state’s] constitution. My view is we should finish the policy work, pair it with real sustainable funding sources, and then we should put it on the ballot in 2018.”
Senate president Kevin De Leon, D-Los Angeles, closed the debate by saying the process was at a midway point and it did not have a funding mechanism—which would require a super-majority to pass—to keep the proposal moving through the legislative process.
“But I’m not sure if we had this fully cooked, if in fact, everyone would actually vote for this measure. That’s another issue unto itself,” he said. “We are at a halfway point with this measure. If we move this measure, we will engage still with our colleagues, our friends on the Assembly side. And I invite my Republican friends and colleagues to be part of this discussion.”
The California Nurses Association was quick to praise the Senate's vote.
“This is a banner day for California, and a moral model for the nation,” said RoseAnn DeMoro, executive director of the California Nurses Association and National Nurses United, lead sponsor of SB 562, the Healthy California Act. “California senators have sent an unmistakable message today to every Californian and people across the nation. We can act to end the nightmare of families who live in fear of getting sick and unable to get the care they need due to the enormous cost. We’ve shown that health care is not only a humanitarian imperative for the nation, it is politically feasible, and it is even the fiscally responsible step to take.”
End the Greedy Silence – Enough Already!
by Ralph Nadar - Common Dreams - March 31, 2017
Why do we tolerate our fellow Americans dying in the tens of thousands each year because they cannot afford health insurance to get diagnosed and treated in time?
It is time Americans rise up against the corruption, inefficiency, and cruelty of our healthcare system and tell its corporate captors and Congress – Enough Already!
For decades other countries have guaranteed universal health insurance for all their people, at lower costs and better outcomes (President Truman proposed it 72 years ago in the US). When are we going to break out of this taxpayer-subsidized prison built by the giant insurance companies, drug goliaths and monopolizing hospital chains?
How long is Uncle Sucker going to pay through the nose for gouging drug prices, patient-denying health insurance companies and all the brutal fine print rules in consumer contracts whose trap doors are maddening tens of millions of Americans?
Deductibles, exclusions, waivers, co-pays, corporate immunities from injured patients, disqualifying changes in patients’ status and just plain stonewalling are just some examples of this cruel madness.
Not to mention the endless electronic bills with their inscrutable codes and unchallengeable charges – that is if you can get anyone on the phone to answer your questions. Billing fraud and abuses alone cost us up to $330 billion a year!
Why do we put up with “pay or die” drug prices? Why do we tolerate our fellow Americans dying in the tens of thousands each year because they cannot afford health insurance to get diagnosed and treated in time?
Do we know that the profiteering drug companies regularly are given a slew of handouts, including huge tax breaks, free drugs developed by our National Institutes of Health, and few restraints on their high pressure sales of dangerous and addictive drugs (eg opioids) or, together with their corporate middlemen, return the favor by charging Americans the highest prices in the world? Other countries put limits on such blatant greed and exploitation.
Groping for ever more profits, the big drug companies offshore production to less regulated labs in China and India, which amount to 60% of the drugs we buy and 80% of the active ingredients in all medicines sold in the US. Unpatriotic in the extreme!
Compounding these inhumane practices is a supine Congress, with few exceptions like Rep. Lloyd Doggett (D, TX), and state legislatures, misusing the power we entrusted to them. These legislators see large pharmaceutical companies as honey pots for campaign cash that work as hush money paid by hordes of drug industry lobbyists. So craven was the majority in Congress in 2003 that, when the drug benefits bill was passed, it prohibited Medicare from negotiating volume discounts for this lucrative corporate sales bonanza (Past Congresses authorized the Pentagon and Veterans Administration to bargain and they get lower prices as a result).
Despite the fact that these healthcare challenges have been dealt with more humanely and economically by other Western countries in the world, Americans are consistently told to tolerate an aggravating status quo. Scores of books, articles and television exposés highlight all the ways we’re pushed around, denied, excluded, harmed, overcharged and deceived, yet so many of these authors still maintain that our system of health insurance/healthcare can’t be replaced with a much better one? So these writers continue to advise us how to duck, slide and swivel our escape from a few of these commercials chains and scams.
In all the fine articles written to help consumers navigate Obamacare, Medicare, and private health plans, the authors trap themselves in this vast corporate cul-de-sac by never mentioning the way out.
That way is Single Payer or Full Medicare for all, everybody in, nobody out, with free choice of doctors and hospitals – at far lower costs, mortality and morbidity. These narrow reformers can’t escape their “it ain’t going to happen here” syndrome.
Really? Don’t they know that the public has long viewed Single Payer favorably (including a majority of doctors and nurses), even without political leaders standing up for it or mass media reporting this proven safe path.
The surrender to corporate tyranny infects the 112 members of the House of Representatives who have co-signed HR 676 to create full Medicare for all. They signed, but then gave in to a silent resignation by not fighting for it in Congress and back home.
When the companies and their apologists argue for a “free market” approach to healthcare, you can retort – what free market? Half the money coming to these companies is from the federal, state and local governments. Taxpayers also pay tens of billions of dollars for much of the discovery and testing of drugs. Tax breaks and loopholes in patent laws block generic drugs and distort the free market.
Drug patents are by definition monopolies. Concentration by mergers and acquisitions of hospitals, clinics and physician practices (note dwindling independent cardiology practices) raise serious anti-trust issues. Fine print contract peonage takes away the consumers’ freedom of contract, as do the daily buy and sell equations, so often rendered by third parties for patients. Corporate billing and other crimes are endemic. What free market?
Each of you can help the Single Payer movement build momentum. Ask your members of Congress in writing if they support HR 676 and, if not, demand their appearance in person at a town meeting arranged by people like you to answer why. If they refuse, peacefully picket their local offices.
Ask the newspapers, radio and television stations, including the culpable public radio and public television, when are they going to cover the basic full Medicare reform supported by tens of millions of their listeners and viewers?
Finally, go to the website SinglePayerAction.org to find out what other people are doing and what more you can do with your friends and co-workers.
One percent of you, together with popular backing, can make it happen, through a persistent civic hobby. Remember, you only have to turn around less than 450 members of Congress.
Enough Already?
https://www.commondreams.org/views/2017/05/31/end-greedy-silence-enough-already
Obamacare premiums are up in Maine, and here’s why
by Jackie Farwell - Bangor Daily News - June 1, 2017
The Trump administration recently released a report showing that health insurance premiums in Maine have jumped 55 percent under Obamacare. Nationally, monthly premiums have doubled for Americans in the Obamacare market since the health reform law took effect, it found.
The timing was notable. The report came out just before the Congressional Budget Office released its eagerly anticipated scoring of House Republicans’ plan to replace Obamacare. The CBO — tasked with projecting the law’s real-world costs — expects their legislation to leave 23 million Americans without health insurance over the next decade.
The CBO didn’t release state figures, but a separate analysis by the progressive Center for American Progress estimates that 117,000 individuals would lose coverage in Maine.
With that backdrop, the new report on premiums gave Republicans some handy ammunition to fire back and remind everyone just how terrible (they think) Obamacare is.
The headline on a Maine GOP statement about Obamacare last week:
“Cost for Mainers Rose 55% Since 2013, Mainers Now Have Less Choice And A Higher Premium”
As you might expect, there’s more to this story than the headline figures. Here are the major points to keep in mind:
Average premiums under Obamacare are undoubtedly up.
The report, issued by an agency that advises the U.S. Department of Health and Human Services on policy issues, examines premiums in the “individual market.” That’s people who buy their own health insurance (the self-employed, early retirees, etc.) through Healthcare.gov. So we’re not talking about people with coverage through work or government programs such as Medicaid and Medicare.
The report compares average premiums in 2013, the last year before new health policies had to fully conform to Obamacare regulations, to those in 2017. The feds had to use two different data sources to cover the full four-year period, but they stated that upfront, recognizing that it’s not a “perfect comparison.”
In Maine, the average monthly premium in 2013 was $335. It jumped to $518 in 2017, an increase of nearly 55 percent. Not great for Obamacare.
But context is everything.
Most Obamacare consumers don’t actually pay those premiums.
Under Obamacare, most Healthcare.gov shoppers receive financial assistance to help them afford their premiums. So the majority aren’t actually paying the amount that the report cites. In Maine, about 85 percent of the roughly 80,000 residents insured under Obamacare in 2017 qualified for the subsidies, based on their income.
In an earlier report, the same agency, called the Office of the Assistant Secretary for Planning and Evaluation (ASPE), projected that even with a premium jump of 50 percent this year, 77 percent of Maine residents could still buy a plan for $100 or less a month.
Taxpayers foot the bill for those subsidies, and critics of Obamacare argue that premiums aren’t really “affordable” if the rest of America has to pay for them.
Pre- and post-Obamacare premiums are apples and oranges.
Before Obamacare, health insurers could do a lot of things to keep their costs, and therefore their customers’ premiums, down. They could deny coverage to people with pre-existing conditions, such as cancer, HIV/AIDS, or hepatitis. If insurers aren’t paying for people to get treatment for all those ailments, it’s much easier to keep costs lower.
Insurers could cut off coverage when policyholders hit annual or lifetime limits on their benefits. That saved them money too.
Plans were also skimpier before Obamacare. Many wouldn’t cover mental health or maternity care, for example.
You can see how comparing premiums from before the law’s implementation to after, when health insurance as a product improved greatly for millions of people, is tricky business.
That being said, Maine banned all three of these limits on coverage even before Obamacare, although with some important exceptions and not to the same extent. So pre- and post-Obamacare premiums are more comparable here than in other states.
Premiums were increasing before Obamacare.
In all this talk of rate hikes under Obamacare, I think many people get the impression that premiums were falling before the law. That’s not the case. Rising premiums are a big part of why Obamacare was passed in the first place.
Here’s what average premiums in the individual market looked like in Maine before the law. They jumped to $334.28 a month in 2012, up nearly 10 percent from 2011. Rates rose again but not by much in 2013 (read about how Maine Republicans take credit for that and skeptics doubt their claims here).
That raises a question, posed by, among others, Charles Gaba, a Michigan web developer who has gained attention for his analysis of Obamacare enrollment numbers:
“How much would the premiums have gone up otherwise if the ACA hadn’t been signed into law? If you’re going to ‘blame’ the ACA for rate hikes, you have to subtract the difference between how much they would have gone up in the absence of the law.”
Given the inflation rate and the rising costs of the medical care that insurance pays for, he estimates that Obamacare is responsible for an 83 percent average net increase in premiums nationally, not 105 percent as the new report found. Still a big increase, but that’s primarily because insurers “have to actually cover healthcare and carriers can no longer cherry-pick who they’re sold to,” he writes.
Under congressional Republicans’ plan, the American Health Care Act, average premiums would drop overall, but older, sicker Americans could pay much more and insurance would cover less, according to the CBO analysis.
In Washington state, a healthcare repeal lesson learned the hard way
by Noam Levey - LA Times - May 31, 2017
Republicans in the state of Washington didn’t wait long in the spring of 1995 to fulfill their pledge to roll back a sweeping law expanding health coverage in the state.
Coming off historic electoral gains, the GOP legislators scrapped much of the law while pledging to make health insurance affordable and to free state residents from onerous government mandates.
It didn’t work out that way: The repeal left the state’s insurance market in shambles, sent premiums skyrocketing and drove health insurers from the state. It took nearly five years to repair the damage.
Two decades later, the ill-fated experiment, largely relegated to academic journals, offers a caution to lawmakers at the national level as Republicans in the U.S. Senaterace to write a bill to repeal and replace the federal Affordable Care Act.
“It’s much easier to break something,” said Pam MacEwan, who served on a Washington state commission charged with implementing the law in the mid-1990s and now oversees the state insurance market there. “It’s more difficult to put Humpty Dumpty back together again. … And that’s when people get hurt.”
The nonpartisan Congressional Budget Office echoed that warning last week, when it concluded that the healthcare bill passed by the House last month would destabilize insurance markets in a sixth of the country and nearly double the number of people without health insurance over the next decade.
Senate Republican leaders contend that their legislation will be different. “We're working to lower the costs and give people more personal, individual freedom,” Sen. John Barrasso (R-Wyo.) said last week.
There were similar assurances in the Washington statehouse when legislators there began to pull apart the Washington Health Services Act in the mid-1990s.
“We will do everything we can to stop the government healthcare bureaucracy that is now poised to limit personal choices,” Clyde Ballard, the Republican speaker of the Washington House of Representatives, said at the time.
The Health Services Act, which Democratic Gov. Mike Lowry signed in May 1993, was an ambitious effort to overhaul the state healthcare system by guaranteeing residents health insurance and putting new government controls on rising healthcare costs. It was designed to complement the national healthcare overhaul that President Clinton and First Lady Hillary Clinton were pursuing at the time.
Washington state prohibited insurers from denying coverage to consumers, even if they were sick, a revolutionary protection then.
A state commission was empowered to clamp down on insurance premiums to limit increases.
And to get all Washingtonians covered, the state became the first in the nation to both require residents to have coverage and to require employers to offer health benefits.
The law was controversial from its inception, as major business groups and insurers balked at its many new regulations. Just a few Republicans joined Democrats in the state Legislature to pass the legislation.
Within a few months, it became clear that there would be problems implementing it, in part because the state couldn’t secure necessary federal approval to require employers to provide coverage.
“We had to reform the reform,” said Phil Dyer, a Republican who would help lead the repeal effort as chairman of the Senate health committee.
GOP legislative candidates railed against the law on the campaign trail in 1994. And that fall, the party picked up 30 seats, taking control of the House and coming within one seat of taking the Senate.
When the new Legislature convened in 1995, GOP lawmakers set about pulling apart the law, bringing along Democrats who feared Republicans would repeal it through a ballot measure if they didn’t cooperate.
The hastily crafted repeal — which the Legislature sent to the governor in three months — kept some popular parts of the law such as the guarantee that everyone could get coverage, even if they were sick. It scrapped parts voters didn’t like, including the requirement that state residents have health insurance.
The state’s insurance market started teetering soon afterward.
First, health insurers sought a series of double-digit rate hikes in 1995 and 1996. The health plans warned that with no requirement to have coverage, people were signing up for insurance only when they got sick, sending costs skyrocketing.
Then, in November 1998, Premera Blue Cross, one of the state’s leading insurers, announced it would stop selling health plans, citing more than $100 million in losses. Regence and Group Health Cooperative, the state’s other two leading plans, quickly followed.
“This was a crisis,” former Gov. Gary Locke said in a recent interview. “It was totally unacceptable.”
Locke, a Democrat elected in 1996, brought together insurance executives, state legislators and others, who began meeting regularly to try to salvage the market.
The rescue effort took until 2000. That year, state lawmakers passed legislation allowing insurers to once again screen out sick customers and reestablishing a special government “high-risk pool” plan for those who couldn’t get health coverage because of a preexisting medical condition.
Even those who worked on the rescue package acknowledge it was an imperfect solution. When President Obama signed the Affordable Care Act in 2010, 1 in 7 Washington state residents still lacked health coverage, according to federal data.
Today, the uninsured rate in the state has been cut in half, thanks to the federal healthcare law.
Obamacare not only guarantees coverage, it requires Americans to have insurance. The law also provides federal money to help states offer Medicaid coverage to very low-income Americans. And it funds subsidies for low- and moderate-income people to offset the cost of private health plans they can buy on insurance marketplaces.
Washington’s Obamacare marketplace, which the state runs itself, has done better than most, though even its defenders acknowledge that more must be done to control premiums, which have risen dramatically for some consumers in recent years.
But many state leaders, including former insurance executives, caution that congressional Republicans rushing to roll back Obamacare risk sowing the same kind of chaos that crippled Washington state’s insurance market two decades ago.
“That’s what scares me,” warned Cheryl Scott, the former chief executive of Group Health Cooperative, who worked with the governor to rescue the market in the late 1990s.
“If we’re not careful, we are going to be repeating history.”
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