Spending More and Getting Less for Health Care
By PAULINE W. CHEN, M.D.
The patient, lean and in his 60s, was in the hospital for the second time in a month with blood sugar levels that were out of control and he was not happy. Despite the nurses’ earnest attempts to cheer him up, he scowled and insisted that all he needed was for us to “fix it” so he could go back home.
“We have to keep looking because you may have other serious problems that caused your blood sugar to go up,” I said, preparing to rattle off a list of potential causes.
“You bet I have other problems, Doc,” he growled back. I watched the color in his face rise as he described the death of one of his adult children in a car accident several years earlier. His mouth quivered as he spoke of another child who had became seriously disabled while fighting in the military. And his eyes teared up as he described losing his job as a custodian at a local office building.
“I can’t pay for my medications, I can’t do enough for my son, and I miss my baby,” he said, now weeping.
At that moment, I knew that I could diagnose as much as I wanted, prescribe, operate and enlist the help of an army of primary care and specialty colleagues; but he would be back. Whatever the reason for his elevated blood sugar levels this time, sooner or later his grief would envelop him, he would be overwhelmed with his caretaking duties or he would run out of money for his medications, and he would be back at the hospital once more.
What I could take care of was only the tip of his health care concerns.
I remembered this patient, and many more like him that I have encountered in practice, while reading a new book, “The American Health Care Paradox.”
Studies since the 1980s have shown that despite spending enormous sums on health care, Americans are less healthy than their counterparts in other developed countries. In the most recent studies comparing the United States to 17 other wealthy industrialized nations including France, Japan, Canada and Britain, Americans had a shorter life expectancy, higher rates of disease, the highest rates of infant mortality and the lowest chance over all of surviving to middle age.
These dismal findings have so befuddled health care experts, policymakers and politicians that they have come to be known simply as “the American health care paradox,” or among the more candid, “the U.S. healthcare disadvantage.” Some experts have attributed the abysmal outcomes to the greed, waste and inefficiency of the payment system, practitioners and the pharmaceutical industry. Others have postulated that the lack of patient access and the American desire for the most sophisticated and newest therapy are the reasons. Still others have pointed to the American malpractice system as a key culprit.
But in 2011, in a well-respected professional journal and in The New York Times, Dr. Elizabeth H. Bradley, director of Yale University’s Global Health Leadership Institute, Lauren A. Taylor, a former program manager at the institute, and their colleagues offered one of the most compelling and cohesive explanations yet.
As with other researchers, they had found that the United States spends a significantly higher percentage of its gross domestic product — as much as 50 percent more than other developed countries — on health services like acute hospital care, rehabilitative care, diagnostic imaging, laboratory tests and health insurance. But when that percentage is combined with the much smaller amounts spent on education, old age pensions, disability and sickness benefits, family support and employment programs, unemployment benefits and housing support, the United States ranking drops precipitously to one more in line with its poor health care outcomes.
Small Group Health Insurance "Cancellations"––The Next Shoe to Drop But a More Complicated One
The patient, lean and in his 60s, was in the hospital for the second time in a month with blood sugar levels that were out of control and he was not happy. Despite the nurses’ earnest attempts to cheer him up, he scowled and insisted that all he needed was for us to “fix it” so he could go back home.
“We have to keep looking because you may have other serious problems that caused your blood sugar to go up,” I said, preparing to rattle off a list of potential causes.
“You bet I have other problems, Doc,” he growled back. I watched the color in his face rise as he described the death of one of his adult children in a car accident several years earlier. His mouth quivered as he spoke of another child who had became seriously disabled while fighting in the military. And his eyes teared up as he described losing his job as a custodian at a local office building.
“I can’t pay for my medications, I can’t do enough for my son, and I miss my baby,” he said, now weeping.
At that moment, I knew that I could diagnose as much as I wanted, prescribe, operate and enlist the help of an army of primary care and specialty colleagues; but he would be back. Whatever the reason for his elevated blood sugar levels this time, sooner or later his grief would envelop him, he would be overwhelmed with his caretaking duties or he would run out of money for his medications, and he would be back at the hospital once more.
What I could take care of was only the tip of his health care concerns.
I remembered this patient, and many more like him that I have encountered in practice, while reading a new book, “The American Health Care Paradox.”
Studies since the 1980s have shown that despite spending enormous sums on health care, Americans are less healthy than their counterparts in other developed countries. In the most recent studies comparing the United States to 17 other wealthy industrialized nations including France, Japan, Canada and Britain, Americans had a shorter life expectancy, higher rates of disease, the highest rates of infant mortality and the lowest chance over all of surviving to middle age.
These dismal findings have so befuddled health care experts, policymakers and politicians that they have come to be known simply as “the American health care paradox,” or among the more candid, “the U.S. healthcare disadvantage.” Some experts have attributed the abysmal outcomes to the greed, waste and inefficiency of the payment system, practitioners and the pharmaceutical industry. Others have postulated that the lack of patient access and the American desire for the most sophisticated and newest therapy are the reasons. Still others have pointed to the American malpractice system as a key culprit.
But in 2011, in a well-respected professional journal and in The New York Times, Dr. Elizabeth H. Bradley, director of Yale University’s Global Health Leadership Institute, Lauren A. Taylor, a former program manager at the institute, and their colleagues offered one of the most compelling and cohesive explanations yet.
As with other researchers, they had found that the United States spends a significantly higher percentage of its gross domestic product — as much as 50 percent more than other developed countries — on health services like acute hospital care, rehabilitative care, diagnostic imaging, laboratory tests and health insurance. But when that percentage is combined with the much smaller amounts spent on education, old age pensions, disability and sickness benefits, family support and employment programs, unemployment benefits and housing support, the United States ranking drops precipitously to one more in line with its poor health care outcomes.
Small Group Health Insurance "Cancellations"––The Next Shoe to Drop But a More Complicated One
Obamacare is impacting the small group insurance market in many of the same ways as the individual health insurance market. While employers with less than 50 workers don't have to provide coverage, if they do they are required to comply with the same essential benefit mandates, age rating changes, and pre-existing condition reforms the individual market faces.
That means essentially all small group policies cannot continue as they are––they have to be discontinued.
What makes things a bit easier, if not any less expensive, is that small employers typically have health insurance brokers to run interference for them and help them through this change where individual consumers often get that dreaded cancellation letter telling them they will not have health insurance after a certain date if they do not act quickly in what is a confusing marketplace in the best of times.
The first small group renewals are now occurring––the January 1 renewals that typically have to be delivered during the month of November under state law.
Many employers are facing significant changes in order to comply with Obamacare and therefore price increases. One Maryland broker I spoke to this week has 90 small group accounts and he reports his smallest increase was 15%, his largest was 69%, and most are in the 30% - 40% range. (By comparison, Mercer just announced the average large employer health care cost increase for 2014 will be 5.2%, meaning small groups could have reasonably expected an increase under 10% without Obamacare.) The biggest rate increases are generally going to those employers with the youngest groups the most impacted by the new "age compression" rules.
Does this mean these small employers' coverage has been outright cancelled and they will now send their workers to the exchanges, as I have heard some commentators argue?
That means essentially all small group policies cannot continue as they are––they have to be discontinued.
What makes things a bit easier, if not any less expensive, is that small employers typically have health insurance brokers to run interference for them and help them through this change where individual consumers often get that dreaded cancellation letter telling them they will not have health insurance after a certain date if they do not act quickly in what is a confusing marketplace in the best of times.
The first small group renewals are now occurring––the January 1 renewals that typically have to be delivered during the month of November under state law.
Many employers are facing significant changes in order to comply with Obamacare and therefore price increases. One Maryland broker I spoke to this week has 90 small group accounts and he reports his smallest increase was 15%, his largest was 69%, and most are in the 30% - 40% range. (By comparison, Mercer just announced the average large employer health care cost increase for 2014 will be 5.2%, meaning small groups could have reasonably expected an increase under 10% without Obamacare.) The biggest rate increases are generally going to those employers with the youngest groups the most impacted by the new "age compression" rules.
Does this mean these small employers' coverage has been outright cancelled and they will now send their workers to the exchanges, as I have heard some commentators argue?
The G.O.P.’s Health Reform Playbook
By DAVID FIRESTONE
The last thing Republicans want right now is to repeal the Affordable Care Act.
They may claim it is destroying the country, but they need it, and desperately, to rebuild their party. They even have a detailed playbook to exploit it, outlining how and when to stage attacks against Democrats who support it in order to inflict maximum damage in the months before the 2014 midterm elections.
As Jonathan Weisman and Sheryl Gay Stolberg reported in this morning’s Times, House Republicans have been organizing their strategy behind closed doors for the last month. They began by capitalizing on the gifts given them by the White House in the form of the malfunctioning health care website and President Obama’s false promise that no one need lose an insurance policy. Then they moved on to claims that personal data is insecure on the insurance exchanges.
Next, according to the playbook, will come criticism of premium price hikes, and breast-beating about changes to Medicare Advantage plans, as well as the possibility that people will lose their doctors under some policies.
Next, according to the playbook, will come criticism of premium price hikes, and breast-beating about changes to Medicare Advantage plans, as well as the possibility that people will lose their doctors under some policies.
Republicans will also hold hearings, and come armed with anecdotes from outraged citizens who suddenly find their new health insurance options aren’t perfect.
Reform has given new life to a party that was in the depths after the shutdown debacle just last month.
This deep concern about Americans’ access to quality insurance is entirely new and utterly insincere, of course. Nearly one in 10 people on Medicare — 4 million people — are dissatisfied with that program, according to surveys, but you don’t hear their complaints broadcast at hearings or at Republican news conferences. In 2010, long before the health reform law took effect, 20 percent of people on employer-based insurance expressed dissatisfaction with their plans, as did a third of people on the individual market. They complained about high deductibles and constrained networks of doctors and hospitals, just as many of them will under the new system. And they complained about cancelled policies.
Republicans never cared about those concerns before the Affordable Care Act came around, and they don’t really care now, even though they’re doing a great job of feigning outrage. They’re simply using these grievances, magnified by anecdotal media coverage, to batter Democrats who are still standing up for the president’s program.
Some of those Democrats are fighting back. They’re pointing out, as the White House did yesterday, that the growth in health care costs is slowing significantly. They’re trying to highlight people who are saving money on their new policies, or who can buy insurance even if they are sick. And they will try to broadcast the voices of the previously uninsured, who have never appeared in a Republican diatribe and never will.
But the most attention, as always, will be paid to the shrillest critics. Just remember, as their attacks pick up in volume in the months to come, that they were prepared long in advance, as cheap as canned laughter.
The South’s New Lost Cause
By TIMOTHY EGAN
Before he was immortalized for saving the union, freeing the slaves and giving the best political speech in American history, Abraham Lincoln was just an unpopular new president handed a colossal crisis. Elected with 39.7 percent of the vote, Lincoln told a big lie in his inaugural address of 1861.
“I have no purpose, directly or indirectly, to interfere with the institution of slavery in the states where it exists,” he said, reaching out to the breakaway South. “I believe I have no lawful right to do so, and I have no inclination to do so.”
He was saying to a Confederacy that would enshrine owning another human being in its new constitution: If you like the slaves you’ve got now, you can keep them. It was a lie in the sense that Lincoln made a promise, changed by circumstances, that he broke less than two years later -- and probably never meant to keep.
The comparisons of President Obama to Lincoln fade with every day of the shrinking modern presidency. As for the broken-promise scale: Lincoln said an entire section of the country could continue to enslave more than one in three of its people. Obama wrongly assured about five million people that they could keep their bare-bones health plans if they liked them (later amended when it turned not to be true).
As inapt as those comparisons are, what is distressingly similar today is how the South is once again committed to taking a backward path. By refusing to expand health care for the working poor through Medicaid, which is paid for by the federal government under Obamacare, most of the old Confederacy is committed to keeping millions of its own fellow citizens in poverty and poor health. They are dooming themselves, further, as the Left-Behind States.
And they are doing it out of spite. Elsewhere, the expansion of Medicaid, the health care program for the poor, has been one of the few success stories of Obamacare. It may be too complicated for the one-dimensional Beltway press. Either that, or it doesn’t fit the narrative of failure.
But in the states that have embraced a program that reaches out to low-wage workers, almost 500,000 people have signed up for health care in less than two months time. This is good for business, good for state taxpayers (because the federal government is subsidizing the expansion) and can do much to lessen the collateral damages of poverty, from crime to poor diets. In Kentucky, which has bravely tried to buck the retrograde tide, Medicaid expansion is projected to create 17,000 jobs. In Washington, the state predicts 10,000 new jobs and savings of $300 million in the first 18 months of expansion.
Beyond Medicaid, the states that have diligently tried to make the private health care exchanges work are putting their regions on a path that will make them far more livable, easing the burden of crippling, uninsured medical bills -- the leading cause of personal bankruptcy.
And those states aren’t going to turn back the clock and revert to the bad old days, no matter how Republicans try to kill health care reform in the wake of the federal rollout. Many are refusing to accept Obama’s “fix” of allowing people to keep sketchy health care policies. If they follow the pattern of Massachusetts -- where a mere 123 people enrolled in the first month of Romneycare, after which it gradually took off -- the progressive states could end up with more than 95 percent of their residents insured.
November 22, 2013
As Governor:
- On day one, I will convene a summit of all stakeholders to conduct a top to bottom review of Chapter 224 and develop an action plan to ensure it meets Triple Aim goals of better care, better health, and lower cost. If Chapter 224 results lag behind, within my first 100 days I will work with the Legislature to craft a new wave of stronger legislation to incentivize increased transparency, payment changes, and care reorganization.
- It is time to explore seriously the possibility of a single payer system in Massachusetts. The complexity of our health care payment system adds costs, uncertainties, and hassles for everyone - patients, families, clinicians, and employers. I will work with the Legislature assemble a multi-stakeholder Single Payer Advisory Panel to investigate and report back within one year on whether and how Massachusetts should consider a single payer option.
- I will personally lead a statewide initiative to make Massachusetts the healthiest state in the nation, through smoking cessation, obesity prevention and reduction, and specific programs to curb domestic and physical violence.
- We will stop the obesity epidemic in Massachusetts. I will strengthen our state’s disease prevention and health improvement programs, with a special emphasis on innovations adopted from best practices from all over the world.
- I will assure that high-quality mental health care is more and more incorporated into the center of our health care system, in full parity with other components of care. We will reduce substance abuse and suicide rates by 50% in Massachusetts in the next decade.
- Massachusetts will be the national leader in patient safety. Many of our hospitals have made progress toward safer care - reducing infections and complications in hospitals, reducing medication errors, and more. This is the moment to bring patient safety to full scale in the Commonwealth, in every hospital and in every community. I will convene the stakeholders in Massachusetts health care and launch a five-year, comprehensive, collaborative, statewide project to bring the levels of injuries to patients due to errors in care to the lowest level in the nation. http://www.berwickforgovernor.com/health-care
The Obamacare Disaster and the Poison of Party Loyalty
Four years ago, countless Democratic leaders and allies pushed for passage of Barack Obama’s complex healthcare act while arguing that his entire presidency was at stake. The party hierarchy whipped the Congressional Progressive Caucus into line, while MoveOn and other loyal groups stayed in step along with many liberal pundits.
Lauding the president’s healthcare plan for its structure of “regulation, mandates, subsidies and competition,” New York Times columnist Paul Krugman wrote in July 2009 that the administration’s fate hung in the balance: “Knock away any of the four main pillars of reform, and the whole thing will collapse—and probably take the Obama presidency down with it.” Such warnings were habitual until Obamacare became law eight months later.
Meanwhile, some progressives were pointing out that—contrary to the right-wing fantasy of a “government takeover of healthcare”—Obama’s Affordable Care Act actually further enthroned for-profit insurance firms atop the system. As I wrote at the time, “The continued dominance of the insurance industry is the key subtext of the healthcare battle that has been raging in Washington. But that dominance is routinely left out of the news media's laser-beam concentration on whether a monumental healthcare law will emerge to save Obama's presidency.”
"Obamacare is a mess largely because it builds a revamped healthcare system around the retrenched and extended power of insurance companies—setting back prospects for real healthcare reform for a decade or more."
Today, in terms of healthcare policy, the merits and downsides of Obamacare deserve progressive debate. But at this point there’s no doubt it’s a disaster in political terms—igniting the Mad Hatter Tea Party’s phony populism, heightening prospects for major right-wing electoral gains next year and propagating the rancid notion that the government should stay out of healthcare.
That ominous takeaway notion was flagged days ago on the PBS NewsHour by commentator Mark Shields, who worried aloud that “this is beyond the Obama administration. If this goes down, if … the Affordable Care Act is deemed a failure, this is the end—I really mean it—of liberal government, in the sense of any sense that government as an instrument of social justice, an engine of economic progress… Time and again, social programs have made the difference in this country. The public confidence in that will be so depleted, so diminished, that I really think the change—the equation of American politics changes.”
At this pivotal, historic, teachable moment, progressives should not leave the messaging battle about the ACA to right wingers and Obama loyalists. While critiquing the law for its entanglement with the profit-voracious insurance industry, we should fight for quality healthcare for everyone—definitely including the people who live in states where right-wing officials are blocking expansion of Medicaid coverage. (In a recent Nation article, historian Rick Perlstein cited a grim example of a chronic mentality: “the policy wizards in the Obama White House build a Rube Goldberg healthcare law that relies on states to expand Medicaid and create healthcare exchanges, and then are utterly blindsided when red-state legislatures and governors decline.”) We should challenge all efforts to deny the human right of healthcare.
What we should not be doing is what MoveOn.org is now doing—proclaiming that the Obamacare law is just fine. In a November 14 email blast, subject-lined “Obamacare in serious trouble,” MoveOn acknowledged that the rollout “has been badly botched” but flatly declared: “Obviously, the law itself is still really good.”
Huh?
The problems with Obamacare involve far more than simply bad website coding. They’re bound up in the enormous complexity of the law’s design, wrapped around a huge corporate steeplechase for maximizing profits. As a Maine physician, Philip Caper, wrote this fall, the ACA “is far too complicated and therefore too expensive to manage, full of holes, will be applied unevenly and unfairly, be full of unintended consequences, and be easily exploited by those looking to make a quick buck.” The ACA is so complicated because it has been so relentlessly written for the benefit of—and largely written by—insurance companies.
Tension and Flaws Before Health Website Crash
By ERIC LIPTON, IAN AUSTEN and SHARON LaFRANIERE
WASHINGTON — On a sultry day in late August, a dozen staff members of the Centers for Medicare and Medicaid Services gathered at the agency’s Baltimore headquarters with managers from the major contractors building HealthCare.gov to review numerous problems with President’s Obama’s online health insurance initiative. The mood was grim.
The prime contractor, CGI Federal, had long before concluded that the administration was blindly enamored of an unrealistic goal: creating a cutting-edge website that would use the latest technologies to dazzle consumers with its many features. Knowing how long it would take to complete and test the software, the company’s officials and other vendors believed that it was impossible to open a fully functioning exchange on Oct. 1.
Government officials, on the other hand, insisted that Oct. 1 was not negotiable. And they were fed up with what they saw as CGI’s pattern of excuses for missed deadlines. Michelle Snyder, the agency’s chief operating officer, was telling colleagues outright, “If we could fire them, we would.”
Interviews with current and former Obama administration officials and specialists involved in the project, as well as a review of hundreds of pages of government and contractor documents, offer new details into how tensions between the government and its contractors, questionable decisions and weak leadership within the Medicare agency turned the rollout of the president’s signature program into a major humiliation.
The online exchange was crippled, people involved with building it said in recent interviews, because of a huge gap between the administration’s grand hopes and the practicalities of building a website that could function on opening day.
Vital components were never secured, including sufficient access to a data center to prevent the website from crashing. A backup system that could go live if it did crash was not created, a weakness the administration has never disclosed. And the architecture of the system that interacts with the data center where information is stored is so poorly configured that it must be redesigned, a process that experts said typically takes months. An initial assessment identified more than 600 hardware and software defects — “the longest list anybody had ever seen,” one person involved with the project said.
Gynecologists Run Afoul of Panel When Patient Is Male
By DENISE GRADY
About two months ago, Dr. Elizabeth Stier was shocked to learn that she would lose a vital credential, board certification as a gynecologist, unless she gave up an important part of her medical practice and her research: taking care of men at high risk for anal cancer.
The disease is rare, but it can be fatal and its incidence is increasing, especially among men and women infected with H.I.V. Like cervical cancer, anal cancer is usually caused by the human papillomavirus, or HPV, which is sexually transmitted.
Though most of her patients are women, Dr. Stier, who works at Boston Medical Center, also treated about 110 men last year, using techniques adapted from those developed to screen women for cervical cancer.
But in September, the American Board of Obstetrics and Gynecology insisted that its members treat only women, with few exceptions, and identified the procedure in which Dr. Stier has expertise as one that gynecologists are not allowed to perform on men. Doctors cannot ignore such directives from a specialty board, because most need certification to keep their jobs.
Now Dr. Stier’s studies are in limbo, her research colleagues are irate, and her male patients are distraught. Other gynecologists who had translated their skills to help male patients are in similar straits.
And researchers about to start a major clinical trial that is aimed at preventing anal cancer, with $5.6 million from the National Cancer Institute, say the board’s decision will keep some of the best qualified, most highly skilled doctors in the United States from treating male patients in the study. The director of the planned study and Dr. Stier have asked the gynecology board to reconsider its position.
But the board, based in Dallas, has not budged.
Obama’s Bay of Pigs
By JOE NOCERA
This week, when we are remembering John F. Kennedy, I’d like to touch briefly on the greatest fiasco of his presidency: the Bay of Pigs invasion. No sooner had Kennedy taken the oath of office than he discovered that the Pentagon and C.I.A. were preparing to send 1,500 Cuban exiles to invade Cuba. Though they would be greatly outnumbered by Cuban troops, the American military and the C.I.A. assumed that once the attack began, the Cuban people would rise up and overthrow Fidel Castro.
Kennedy was privately skeptical, but he didn’t yet have the confidence in his own judgment to override the experts he was surrounded by. So he gave the go-ahead — only to discover that the experts didn’t know what they were talking about. The exiles were quickly routed, America was humiliated and Kennedy was left to take the blame.
So far, at least, the implementation of the Affordable Care Act has been President Obama’s Bay of Pigs. Led to believe that the preparation for Obamacare was on track, Obama was blindsided when that turned out not to be the case. The website where people are supposed to enroll,HealthCare.gov, is a train wreck. People with individual policies saw that they were set to be canceled — and then couldn’t enroll in Obamacare because the website had collapsed. In other cases, people discovered that even the least expensive plan available to them under Obamacare cost more than their old plan. And on and on.
There are two primary reasons Obamacare has gotten off to such a terrible start. The first is that it is one of the most complicated things that the federal government has ever tried to do; it was inevitable that there would be problems.
An insurance executive friend says that the systems Obamacare required were an order of magnitude more complex than even the most complicated insurance company systems. That complexity, says Drew Altman, the president of the Kaiser Family Foundation, was necessitated by the many compromises that were required to pass the bill into law. Ted Marmor, a former Yale professor and an expert on entitlement programs, says that it has to coexist within the extraordinarily complicated “patchwork” that is the American health care system.
Marmor was a young special assistant in the old Department of Health, Education and Welfare when Medicare rolled out in 1966 — a rollout that was as smooth as Obamacare’s has been rocky. (“Our biggest worry was getting Southern hospitals to treat black people,” Marmor told me.) Partly that was because Medicare was a relatively straightforward program. But Marmor also believes that it was because the men in charge of the new Medicare program were seasoned pros who knew how to get the job done.
Extra Time to Sign Up for Health Coverage
By ROBERT PEAR and MICHAEL D. SHEAR
WASHINGTON — The Obama administration said Friday that it would give people eight more days, until Dec. 23, to sign up for health insurance coverage that takes effect on Jan. 1 under the new health care law.
Julie Bataille, a spokeswoman for the federal Centers for Medicare and Medicaid Services, said the government recognized that consumers might need more time to compare and select health insurance plans because of technical problems that have plagued the online federal insurance marketplace since it opened on Oct. 1.
The administration also said it would delay the 2015 insurance enrollment period for the Affordable Care Act by a month, pushing it beyond the 2014 elections.
The decision means that people who have not signed up for insurance by the end of March will generally have to wait until Nov. 15, 2014, to apply. The second enrollment period was previously scheduled to begin on Oct. 15, 2014.
Jeffrey D. Zients, President Obama’s troubleshooter on the federal exchange repair effort, said Friday that the performance of the website, as measured by response times and error rates, was improving. But he and Ms. Bataille were unable to say how many people were now enrolling.
Enrollment started slowly last month, with just over 106,000 people picking private plans through the federal and state insurance marketplaces. The administration has said it expects seven million people to sign up for such plans by the end of the six-month open enrollment period on March 31.
The original deadline required people to sign up by Dec. 15 for coverage beginning in January. Though the new deadline for such coverage is Dec. 23, Ms. Bataille said that consumers would have until Dec. 31 to pay their share of premiums for the first month.
Insurers and Obama administration officials said they expected to see a large number of people sign up in December, meaning that the government and insurers may need to process a lot of applications in a short time. Whether the federal website, HealthCare.gov, can handle the demand is unclear.
Healthcare industry vested in success of Obamacare
Many in the industry have reservations about the Affordable Care Act. Even so, they have invested billions of dollars to help make the healthcare law work.
By Noam N. Levey
4:51 PM PST, November 21, 2013
| advertisement |
WASHINGTON — President Obama's healthcare law, struggling to survive its botched rollout, now depends more than ever on insurance companies, doctor groups and hospitals — major forces in the industry that are committed to the law's success despite persistent tensions with the White House.
Many healthcare industry leaders are increasingly frustrated with the Obama administration's clumsy implementation of the Affordable Care Act. Nearly all harbor reservations about parts of the sweeping law. Some played key roles in killing previous Democratic efforts to widen healthcare coverage.
But since 2010, they have invested billions of dollars to overhaul their businesses, design new insurance plans and physician practices and develop better ways to monitor quality and control costs.
Few industry leaders want to go back to a system that most had concluded was failing, as costs skyrocketed and the ranks of the uninsured swelled.
Nor do they see much that is promising from the law's Republican critics. The GOP has focused on repealing Obamacare, but has devoted less energy to developing a replacement.
Healthcare industry officials generally view several GOP proposals, such as limiting coverage for the poor and scuttling new insurance marketplaces created by the law, as more damaging than helpful to the nation's healthcare system.
"The principle of providing the opportunity for everyone to get health coverage and of joining everybody together in shared responsibility is the right one," said James Roosevelt Jr., president of Tufts Health Plan, one of Massachusetts' largest insurers. "No one has presented a credible alternative."
The value of the alliance between the administration and major insurers, hospitals, clinics and others in the healthcare industry can readily be seen in steps they have taken to help the White House overcome the rocky start of the law's new insurance marketplaces.
Free clinic in Ellsworth set to close at year’s end
Posted Nov. 23, 2013, at 12:50 p.m.
ELLSWORTH, Maine — The Ellsworth Free Medical Clinic, a nonprofit that provides care to patients with no insurance, will close at the end of this year, said Marshall Smith, a doctor who volunteers at the clinic.
Though the clinic sees about 2,500 patients a year and typically has a waiting list for appointments, long-standing financial troubles will force it to shut its doors on Dec. 31.
“There’s been a consensus among [members of] the board that we will not continue in the new year,” said Kenneth Senter, who works as a volunteer physician at the clinic and serves on the board. “We’re trying to make arrangements for our patients.”
Until 2012, the clinic’s main source of funding came in the form of $50,000 grants from the Stephen and Tabitha King Foundation. The foundation awarded the clinic grants between 2003 and 2011, though not every year. But the organization is not meant to be a source of emergency funding or a constant revenue stream, the foundation’s administrator, Stephanie Leonard told the BDN last year.
“They have been generous with us to a fault,” said Linda Firlotte Grindle, office coordinator at the clinic.
Smith said that at least two applications submitted this year for grants from other organizations have not been accepted. Individual donations have kept the clinic open throughout 2013.
“The administration at Maine Coast Memorial Hospital has agreed to help us try and find physicians in the area that will take some of our patients,” Senter said.
Some of the clinic’s patients may be able to get health insurance under the Affordable Care Act, which will go into effect on Jan. 1, 2014, but Senter and Smith said they are certain that others will fall through the cracks and go without health care for the foreseeable future.
“There is a group of patients who are making too much to get on MaineCare but not enough to get the federal subsidy,” said Smith. “That’s the group that’s going to need us.”
LePage spending a lot of money for welfare consultant to sit by his side and say ‘atta boy’
Posted Nov. 22, 2013, at 3:12 p.m.
First, know this as we continue down the painstaking path toward the next gubernatorial election:
Gov. Paul LePage most likely doesn’t care what you think about his decision to pay nearly $1 million to a Rhode Island consulting firm to examine Maine’s welfare system.
Nor, I would suggest, does he care if anyone is concerned that he failed to notify anyone in the Legislature about his plan or that he chose not to put the job out to bid to try to get the best product at the best price.
If we’ve learned nothing else about our governor during the past three years, we have learned that he puts little stock in any opinion that might possibly counter his own and rarely ever feels the need to explain himself or his actions.
Thus, as far as he is concerned, paying Gary Alexander and his firm that amount of money to produce a report that I dare guess will fall directly into line with LePage’s philosophy on Medicaid expansion and fraudulent welfare recipients is worth it.
It’s a lot of money to spend for someone to sit by your side and say “atta boy,” but every governor has their priorities.
Alexander was a controversial figure when he was the public welfare secretary in Pennsylvania. According to the Philadelphia Inquirer, he cut 88,000 children from Medicaid during a five-month period and made it more difficult for low-income single parents to get day care. He also charged taxpayers for his weekly commute to Rhode Island, where he lived while serving in the Pennsylvania position.
This is not to say of course that Maine’s welfare system doesn’t need a significant overhaul and that it is not fraught with blatant abuse. Alexander seemed able to make those cuts in Pennsylvania himself while serving as its secretary of public welfare, the equivalent of DHHS Commissioner Mary Mayhew’s job.
Apparently Mayhew needs some extra help — some very expensive extra help — to do the same job.
Single-payer is the cure
By the Editorial Board
San Francisco Bay Guardian, Nov. 19, 2013
We're sorry to see all the problems surrounding President Obama's Affordable Care Act, which has made some important improvements to the country's healthcare system, such as helping those with preexisting conditions get coverage and preventing those who do have coverage from being arbitrarily dropped. Given a break from being exploited by the insurance industry, there's no way this country's citizens will want to go back to how things were.
But the convoluted Obamacare system was a foreseeable mess, one that is now causing unnecessary anxiety across the country and bringing right-wing extremists back from the political dead as the mid-term elections approach. Republicans may not be correct when they trumpet the old system as the best on the world, but their criticisms of Obamacare are already finding increasing resonance, and we haven't even gotten to the point yet where it will be illegal not to have health insurance.
It doesn't make sense to leave something as important as our healthcare system in the hands of for-profit corporations with the incentive to drive up costs. The New York Times has done some excellent work this year showing how US residents pay astronomically more for every procedure and drug than citizens of other countries. We should have all been suspicious when the insurance industry cooperated with enacting Obamacare and helped preclude a public option, leaving us with the insurance exchanges that have been so problematic.
There's really only one remedy to this country's ailing healthcare system, which we said at the time that Obamacare was being passed and we'll repeat again now that there's even more evidence supporting our position: We need socialized medicine in this country.
Conservatives who read that assertion are probably shaking their heads in disbelief right now, believing that Obamacare's shortcomings prove that government can't run a healthcare system. And the inexcusable technical problems with the federal healthcare.gov website and its related state exchanges unfortunately reinforce that view. But they're wrong, and the single-payer advocates have been right all along, noting among other things that the government runs Medicare well and with far lower overhead than insurance companies.
Single-Payer Advocates: It Hurts To Say I Told You So
By Jeffrey Young
Huffington Post, November 22, 2013
The botched implementation of Obamacare has created a bittersweet moment for advocates of a universal, single-payer health care system: They saw this coming, but they can't gloat about it.
"We may have an 'I-told-you-so' moment, but it's hard to get any pleasure out of it knowing how many people are actually going to get hurt," said Stephanie Woolhandler, a New York-based doctor who co-founded Physicians for a National Health Program, a group that pushes for universal health care. "You had a bad system, and you're putting a patch on it using the same flawed insurance companies that got us here in the first place," she said.
In the seven weeks since the insurance exchanges created by the Affordable Care Act debuted, Obamacare has been defined by faulty websites, millions of canceled health plans and uncertainty about whether President Barack Obama's administration can set up a new marketplace for private health insurance that protects consumers against industry practices like excluding the sick, while ensuring less-well-off Americans can afford coverage.
Single-payer advocates favor scrapping private health insurance and enrolling everyone in a program akin to Medicare with a comprehensive set of benefits that is financed through taxation, one whose primary focus is providing medical care, not earning profits.
To them, the messiness of Obamacare's infancy was inevitable; the law is built upon a fragmented health care system and a private insurance industry that they believe, by definition, is focused on profit first and the needs of its customers second.
"What you're seeing right now is the kind of compromise that was reached, kind of cobbled together, for the Affordable Care Act," said Sen. Bernie Sanders (I-Vt.) a vocal single-payer supporter who voted for the bill in 2010 after shelving his amendment to create a single-payer plan. "What's happening now just reinforces to me that what we need is a simple system focused on providing health care," he said.
21 Ways the Canadian Health Care System is Better than Obamacare
Dear America:
Costly complexity is baked into Obamacare. No health insurance system is without problems but Canadian style single-payer full Medicare for all is simple, affordable, comprehensive and universal.
In the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months. There were no websites. They did it with index cards!
Below please find 21 Ways the Canadian Health Care System is Better than Obamacare.
Repeal Obamacare and replace it with the much more efficient single-payer, everybody in, nobody out, free choice of doctor and hospital.
Love, Canada
Number 21:
In Canada, everyone is covered automatically at birth – everybody in, nobody out.
In Canada, everyone is covered automatically at birth – everybody in, nobody out.
In the United States, under Obamacare, 31 million Americans will still be uninsured by 2023 and millions more will remain underinsured.
Number 20:
In Canada, the health system is designed to put people, not profits, first.
In Canada, the health system is designed to put people, not profits, first.
In the United States, Obamacare will do little to curb insurance industry profits and will actually enhance insurance industry profits.
Number 19:
In Canada, coverage is not tied to a job or dependent on your income – rich and poor are in the same system, the best guaranty of quality.
In Canada, coverage is not tied to a job or dependent on your income – rich and poor are in the same system, the best guaranty of quality.
News Cycle Delusions
Today’s big event was the filibuster busted, and I have absolutely nothing original to say. So instead let me say something about the GOP planned attack on Obamacare — also not original, but maybe blunter than you’ll read elsewhere.
Here it is: They’re fools.
Consider two states of the world. In one, the technical disaster of healthcare.gov proves so intractable that by March 31, when open enrollment ends, the program has just failed to launch. In that case, Democrats have suffered a crushing defeat no matter what Republicans do.
In the other, which looks more likely, the enrollment process becomes sufficiently workable that by March 31 millions of people who previously lacked insurance or had more or less worthless policies have acquired real coverage. In that case reform is irreversible, Republican scorched-earth opposition turns into a political liability, and it’s a political win for Democrats — not as big a win as if the thing had worked well from the start, but still a win.
Nothing else matters. Republicans can win every news cycle for the next month and nobody will remember it come November.
Troubled launch doesn’t lessen importance of ACA success, hospital leader tells UM audience
Posted Nov. 21, 2013, at 2:15 p.m.
ORONO, Maine — The chaotic launch of the Affordable Care Act and its companion website, HealthCare.gov, doesn’t lessen the law’s importance to the future of health care in the United States, according to the president of one of the nation’s top hospitals who spoke at the University of Maine on Wednesday.
Dr. David Bronson, president of Cleveland Clinic Regional Hospitals, which U.S. News & World Report ranked as the fourth-best overall hospital in the country, graduated from the University of Maine in 1969. He returned Wednesday to deliver the 2013 Distinguished Honors Graduate lecture, which he called “Healthcare Reform and the Bumpy Road to Universal Access.”
“We’ve got to be patient, it’s a very complex act, a very complex piece of legislation to begin with, and it hasn’t been handled well thus far,” Bronson, an advocate for an eventual transition to universal health care, said. “We’ve invested too much for this not to work; we have to give it a chance.”
Enrollments are increasing as officials appear to be making progress sorting out crippling problems with HealthCare.gov. In October, the website’s first month, just 106,000 Americans, including 271 in Maine, were able to sign up for coverage as the glitch-ridden website prevented many from completing the enrollment process.
The situation has improved slowly through November. As of the middle of this month, most states operating their own marketplaces were reporting sharp increases in the number of residents signing up for insurance, according to the Los Angeles Times. Still, the number of enrollees could fall well short of the 700,000 peoplethe government hoped would sign on before the end of November.
“I think HealthCare.gov will work eventually,” perhaps by next spring, Bronson said. “It’s just a website for crying out loud. I mean, hire people to fix it.”
“It’s a tragedy that it wasn’t planned as well as it should have been, but that doesn’t take away the benefit people have by being able to get health insurance,” Bronson said.
Bronson said there are about 51 million uninsured Americans and many of them are poor. He said most estimates are that 21 million to 31 million Americans will become insured by signing up under the Affordable Care Act, but the remaining 20 million or 30 million will remain uninsured because they just won’t want to sign up after their employers cancel their plans or they will consider themselves healthy and refuse to sign up until their health becomes a problem.
No comments:
Post a Comment