Is Obamacare Enough? Without Single-Payer, Patchwork U.S. Healthcare Leaves Millions Uninsured
Despite helping expanding affordable insurance, "Obamacare" maintains the patchwork U.S. healthcare system that will still mean high costs, weak plans and, in many cases, no insurance for millions of Americans. We host a debate on whether the Affordable Care Act goes far enough to address the nation’s health crisis with two guests: Dr. Steffie Woolhandler, a primary care physician and co-founder of Physicians for a National Health Program; and John McDonough, a professor at the Harvard School of Public Health and former senior adviser on national health reform to the U.S. Senate Committee on Health, Education, Labor, and Pensions. Between 2003 and 2008, McDonough served as executive director of Health Care for All in Massachusetts, playing a key role in the passage of the 2006 Massachusetts health reform law, known as "Romneycare," regarded by many as the model for the current federal healthcare law.
King's right: Health insurance saves lives
Sen. Angus King may have gotten a little carried away last week when he denounced those trying to prevent uninsured people from signing up for health insurance under the Affordable Care Act as "guilty of murder."
But only a little.
King feels passionately about this issue, in part because he credits the availability of health insurance for saving him from a life-threatening skin cancer when he was 29.
It is a well-established fact that people without health insurance are more likely to die than those who have it.
This correlation has been established in a variety of studies dating back to the early 1990s.
Between 25,000 and 45,000 people die unnecessarily each year because they lack access to health care.
They pay the ultimate penalty because the U.S. can't figure out how to do what practically every industrialized nation has done — insure all of their people at a reasonable cost.
It's a sad kind of American exceptionalism
Health Exchange Delays Tied to Software Crash in Early Rush
By MICHAEL D. SHEAR and ROBERT PEAR
WASHINGTON — The technical problems that have hampered enrollment in the online health insurance exchanges resulted from the failure of a major software component, designed by private contractors, that crashed under the weight of millions of users last week, federal officials said Monday.
Todd Park, President Obama’s top technology adviser, said the failure occurred in the part of the Web site that lets people create user accounts at the beginning of the insurance sign-up process. The crash prevented many people from viewing any of their insurance options or gaining access to information on what federal subsidies might be available.
“At lower volumes, it would work fine,” Mr. Park said of the Web site, healthcare.gov. “At higher volumes, it has problems.”
“Right now,” he added, “we’ve got what we think we need. The contractors have sent reinforcements. They are working 24-7. We just wish there was more time in a day.”
In some cases, the Web site does not recognize users who established accounts before Oct. 1, when the online marketplaces opened for consumers to shop for insurance. Other users are prevented from establishing accounts. Some who successfully established a marketplace account received an e-mail asking them to verify their e-mail addresses, but the link provided did not work.
The identification of the software component as the main cause of the Web site’s problems was the most detailed explanation that federal officials have given since the online marketplaces opened. The officials also rejected mounting criticism about the Web site’s overall design, saying that the rest of the site appears ready to handle the large volume of traffic.
But because of the initial failures, other parts of the complex system have yet to be proved under the intense strain of real-world conditions. And outside experts said that White House officials should have spent more time tending to the computer code and technology of the Web site, rather than recruiting Hollywood celebrities to promote it.
Uninsured Find More Success via Health Exchanges Run by States
By ROBERT PEAR and ABBY GOODNOUGH
WASHINGTON — Robyn J. Skrebes of Minneapolis said she was able to sign up for health insurance in about two hours on Monday using the Web site of the state-run insurance exchange in Minnesota, known as MNsure. Ms. Skrebes, who is 32 and uninsured, said she had selected a policy costing $179 a month, before tax credit subsidies, and also had obtained Medicaid coverage for her 2-year-old daughter, Emma.
“I am thrilled,” Ms. Skrebes said, referring to her policy. “It’s affordable, good coverage. And the Web site of the Minnesota exchange was pretty simple to use, pretty straightforward. The language was really clear.”
The experience described by Ms. Skrebes is in stark contrast to reports of widespread technical problems that have hampered enrollment in the online health insurance marketplace run by the federal government since it opened on Oct. 1. While many people have been frustrated in their efforts to obtain coverage through the federal exchange, which is used by more than 30 states, consumers have had more success signing up for health insurance through many of the state-run exchanges, federal and state officials and outside experts say.
Alan R. Weil, the executive director of the National Academy for State Health Policy, an independent nonpartisan group, credited the relative early success of some state exchanges to the fact that they could leap on problems more quickly than the sprawling, complex federal marketplace.
“Individual state operations are more adaptable,” Mr. Weil said. “That does not mean that states get everything right. But they can respond more quickly to solve problems as they arise.”
In addition, some states allow consumers to shop for insurance, comparing costs and benefits of different policies, without first creating an online account — a barrier for many people trying to use the federal exchange.
The state-run exchange in New York announced Tuesday that it had signed up more than 40,000 people who applied for insurance and were found eligible.
“This fast pace of sign-ups shows that New York State’s exchange is working smoothly with an overwhelming response from New Yorkers eager to get access to low-cost health insurance,” said Donna Frescatore, the executive director of the state exchange.
In Washington State, the state-run exchange had a rocky start on Oct. 1, but managed to turn things around quickly by adjusting certain parameters on its Web site to alleviate bottlenecks. By Monday, more than 9,400 people had signed up for coverage. The Washington Health Benefit Exchange does not require users to create an account before browsing plans.
“The site is up and running smoothly,” said Michael Marchand, a spokesman for the Washington exchange. “We’re seeing a lot of use, a lot of people coming to the Web site. If anything, I think it’s increasing.”
Other states reporting a steady stream of enrollments in recent days include California, Connecticut, Kentucky and Rhode Island.
In Connecticut, a spokesman for the state-run exchange, Access Health CT, said users have generally had a smooth experience with the Web site other than “a couple of bumps and hiccups on the first day.”
By Monday afternoon, the Connecticut exchange had processed 1,175 applications, said the spokesman, Jason Madrak.
Daniel N. Mendelson, the chief executive of Avalere Health, a research and consulting company, said: “On balance, the state exchanges are doing better than the federal exchange. The federal exchange has, for all practical purposes, been impenetrable. Systems problems are preventing any sort of meaningful engagement.”
“By contrast,” said Mr. Mendelson, who was a White House budget official under President Bill Clinton, “in most states, we can get information about what is being offered and the prices, and some states are allowing full enrollment. All the state exchanges that we have visited are doing better than the federal exchange at this point.”
In California, Peter V. Lee, the executive director of the state-run exchange, said that more than 16,000 applications had been completed in the first five days of open enrollment. Mr. Lee said that while the consumer experience “hasn’t been perfect,” it has been “pretty darn good.”
L.A. County officials vote to create Obamacare marketing plan
County supervisors direct health officials and others to attend and sponsor community events to alert people about the new healthcare law's effects.
By Seema Mehta
9:47 PM PDT, October 8, 2013
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Because of the vast number of uninsured people living in Los Angeles County, it is going to be one of the primary places in the nation to measure the effectiveness of Obamacare. On Tuesday, county leaders voted to create a marketing plan to inform residents of their options under the Affordable Care Act.
"This is one of the most significant and important things that is going to go on in Los Angeles and [it] still has tremendous challenges," county Supervisor Gloria Molina said. "We know that there are people that are concerned about it. I think at the end of the day, it's going to have some bumps along the way. The most important part is for the community to have a clear understanding of how it's going to function for them, how they're going to negotiate through the process."
The county Board of Supervisors directed local health officials and others to attend and sponsor community events such as health fairs to alert people about the new healthcare law's effects. It was approved on a 4-1 vote, with Supervisor Michael D. Antonovich opposing it because of his concerns about the law, given reports of businesses turning full-time workers into part-time workers to avoid having to provide health coverage.
"There are too many problems," Antonovich said. "I think we're not doing [this in] the best interest of the public in telling them about a project that has these types of problems associated with it."
The heads of the departments of health services and public social services also briefed the board about how the county is gearing up for implementation of the act. Sign-ups began Oct. 1, with the coverage beginning Jan. 1. Officials said they are receiving many calls from people having trouble accessing Covered California, the state's new insurance marketplace.
The county is receiving "a large number of questions about Covered California," said Mitch Katz, director of the county Department of Health Services. "We are helping people to understand the computer glitches that have occurred at the state and federal level."
Open enrollment will continue through March, Katz noted.
http://www.latimes.com/local/la-me-obamacare-update-20131009,0,2568702,print.story
Plagued by glitches, health care website has flaw
Posted:TodayUpdated: 12:11 AM
Healthcare.gov requires users to create accounts before they can browse, resulting in bottlenecks.
The Associated Press
WASHINGTON – A decision by the Obama administration to require that consumers create online accounts before they can browse health overhaul insurance plans appears to have led to many of the glitches that have frustrated customers, independent experts say.
Consumers trying to create their accounts multiplied the volume of online transactions that overwhelmed the website last week, causing long waits and exasperation. Many people were stopped by a balky security questions page.
The administration threw in additional computing hardware to handle the volume, and deployed software experts to patch the mechanism for creating accounts, but reports of delays persisted Tuesday.
For President Obama, glitches involving his signature legislation are an unwelcome twist. A devoted smartphone user, his political campaigns were models of high-tech efficiency. Yet the problems that have surfaced so far with healthcare.gov don’t even involve the site’s more complicated functions.
Allowing consumers to browse anonymously was one of the recommendations of Enroll UX 2014, a $3 million, 14-month project to design an optimal user experience for the insurance marketplaces. The well-known San Francisco design firm IDEO led the project and undertook extensive consumer interviews to create an easy-to-use site.
“The first thing people said to us is, ‘I need to be able to understand what my options are,’ ”said Sam Karp, vice president of programs at the California HealthCare Foundation. The nonprofit helped organize and finance Enroll UX 2014, which also involved the federal government and 11 states.
http://www.pressherald.com/news/Plagued_by_glitches__health_care_website_has_flaw_.html
Jon Stewart Grills Kathleen Sebelius On Obamacare Issues, Makes Strong Case For Single-Payer
By Paige Lavender & Nick Wing
Huffington Post, October 8, 2013
Huffington Post, October 8, 2013
Department of Health and Human Services Secretary Kathleen Sebelius was grilled by Jon Stewart on Comedy Central's "The Daily Show" on Monday, where she appeared to address glitches that have plagued the Obamacare website in its first week since going online.
Stewart challenged Sebelius on why individuals aren't able to delay Obamacare, even though businesses have been given option.
“If I’m if an individual I'm wondering -- well, an individual who doesn't want this because there are individuals clearly that want this -- but if I'm an individual that doesn’t want it, it would be hard for me to look at big business getting a waiver and not having to do it and me having to because I would think, 'geez, it looks like because I don't have a lobbying group,'" Stewart said. "I would feel like you are favoring big business because they lobbied you to delay it because they didn’t want to do this year but you are not allowing individuals that same courtesy.”
"Why is it that individuals, though, couldn’t say they didn’t want to do it just for a year?” Stewart continued.
“Well they can. They pay a fine," Sebelius said. "They pay a fine at the end of the year, but they don't have to -- they can say, 'I don't want to do it.' The theory is they can’t pick and choose if they are hit by a bus or diagnosed with an illness."
In the second interview segment, Stewart admitted that he had broader concerns about what many saw as "incompetence" in Obamacare's implementation over the last week.
hen Sebelius again defended the importance of making sure more people have health insurance and aren't relying on treatment at the emergency room, Stewart said he believed this goal would have been best achieved through a single-payer system.
"I don't understand the idea of staying with a market-based solution for a problem where people can't be smart consumers. There are too many externalities in health care that I honestly don't understand, why businesses would jump at the chance to decouple health insurance from their responsibility, and why the government wouldn't jump at the chance to create a single-payer that simplifies this whole gobbledegook and creates the program that I think America deserves," Stewart said.
Sebelius said she understood Stewart's point, but thought "the president did not want to dismantle the health care that 85 percent of the country have and start all over again." She also noted that the Republican response to Obamacare suggested that they wouldn't have been too excited about the idea of a single-payer system run by the federal government.
Exercise as Preventive Medicine
By NICHOLAS BAKALAR
A structured exercise program may be as good or better than frequently prescribed drugs for some common cardiovascular ailments, a large meta-analysis has found.
Researchers evaluated 57 randomized trials testing the effect on mortality of exercise and drugs in four prevention regimens: the secondary prevention of coronary heart disease, rehabilitation from stroke, treatment of heart failure, and prevention of Type 2 diabetes. The review, published online in BMJ, involved more than 14,000 patients.
The studies used a variety of drugs — for example, statins for the prevention of coronary heart disease, blood thinners for stroke, diuretics for heart failure, and biguanides like Glucophage and Metaglip for impending diabetes.
They found no difference in mortality between exercise and drug interventions in the secondary prevention of coronary heart disease or Type 2 diabetes. For stroke prevention, exercise programs were more effective than anticoagulants or antiplatelet medicines. And for treating heart failure, diuretic drugs were more effective than exercise.
The lead author, Huseyin Naci, a fellow at Harvard Medical School, said that in most of the trials, patients were doing structured exercise programs in combination with drugs. “These findings do not imply that patients should go off their medications and start exercising instead,” he said. “We weren’t able to find many exercise trials, which adds to the limitations of the findings. But what we don’t know about exercise may be harming us.”
District 12 candidate wants health care for all
By Amanda Yeager, ayeager@tribune.com
12:15 PM EDT, October 8, 2013
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Last week, Adam Sachs became the eighth candidate to file for a shot at a House of Delegates seat in District 12. He said he hopes a platform focused on health care will help him stand out from the still-growing list of hopefuls.
The 50-year-old Democrat from Columbia said he wants to bring health care to every Maryland resident, and streamline the health care system to eliminate costly administrative fees and reduce lofty executive salaries.
He said his vision is for Maryland to have a system "where health care is treated as a human right instead of a privilege, and health care is a public good, instead of a private benefit."
Sachs wants Maryland to create a single-payer, nonprofit health care system that would cover every state resident and be run through a single administrative entity. That way, he argues, the system could cut down on administrative costs and have stronger bargaining power with pharmaceutical and medical supply companies.
Though the system would be created by a legislative bill, it would not necessarily be run by the government, he said.
Health care is a familiar issue for Sachs, who worked for about four years for CareFirst BlueCross BlueShield before leaving to become a public relations specialist at the American Nurses Association in Silver Spring.
While he says his ideas on health care represent his views and not those of the ANA, his involvement on both sides of the health care aisle helped him gain perspective on the issue.
"It's a very costly system that we have in America, and a lot of the costs don't really go to actual health care," he said.
Sachs said his decision to run in District 12, which includes parts of Howard and Baltimore counties, was the result of a confluence of circumstances. With President Barack Obama's signature Affordable Care Act beginning enrollment earlier this month, health care has been at the forefront of public debate. And the departure of all three of District 12's incumbent delegates at the end of this term provided an open field and, he said, a good shot at a seat.
Sachs said the Affordable Care Act, popularly known as Obamacare, has its advantages — notably, making health care available to people with pre-existing conditions — but he also called it a piecemeal approach to a complex system.
http://www.baltimoresun.com/news/maryland/howard/columbia/ph-ho-cf-ca-at-sachs-1010-20131008,0,989512,print.story
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