Single-payer health plan is not dead
By Froma Harrop
The Leaf Chronicle (Clarksville, Tenn.) and Gannett, Jan. 13, 2014
The prospects for single-payer health care – adored by many liberals, despised by private health insurers and looking better all the time to others – did not die in the Affordable Care Act. It was thrown a lifeline through a little-known provision tucked in the famously long legislation. Single-payer groups in several states are now lining up to make use of Section 1332.
Vermont is way ahead of the pack, but Hawaii, Oregon, New York, Washington, California, Colorado and Maryland have strong single-payer movements.
First, some definitions. Single-payer is a system where the government pays all medical bills. Canada has a single-payer system. By the way, Canada’s system is not socialized medicine but socialized insurance (like Medicare). In Canada, the doctors work for themselves.
Under Section 1332, states may apply for “innovation waivers” starting in 2017. They would let states try paths to health care reform different from those mapped out by the Affordable Care Act – as long as they meet certain of its goals. States must cover as many people and offer coverage as comprehensive and affordable. And they can’t increase the federal deficit. Qualifying states would receive the same federal funding that would have been available under Obamacare.
My conservative friends complain that the innovation waiver requirements would rule out everything but single-payer. No doubt they are diligently working on a more privatized alternative that would cover less, cost more and raise the federal deficit.
‘’Vermont is the only state where they’re thinking very concretely about using (the waiver) as part of their plan,” Judy Solomon, health care expert at the Center on Budget and Policy Priorities, told me.
Hawaii got close. Its Legislature passed a single-payer bill in 2009, which was vetoed by then-Gov. Linda Lingle, a Republican. Lawmakers overrode the veto, but Lingle refused to implement the law.
The quest remains rocky, Dr. Stephen Kemble, a single-payer advocate and past president of the Hawaii Medical Association, told me. “If Vermont can get things going, that would make things easier for others.”
In Washington state, “our focus is to work on grass-roots support,” says Dr. David McLanahan, Washington coordinator for Physicians for a National Health Program. “We’re laying the groundwork” for legislation and a request for an innovation waiver.
Problems in the Obamacare rollout have energized fans of single-payer. Computer glitches aside, the troubles stem chiefly from the law’s complexity. Single-payer is all about simplicity.
Under the Vermont plan, employers and individuals would no longer have to buy private health coverage. They would instead pay a tax. The state-run system would also cover more things, like dental. And oh, yes, Vermonters could choose their hospitals and doctors.
William Hsiao, an economist at the Harvard School of Public Health, has projected that Vermont’s annual health care spending could fall 25 percent. The savings would more than pay for the new benefits.
How? Fewer dollars would go to advertising, executive windfalls and payouts to investors. Doctors dealing with one insurer would save on office staff. Fraud and abuse would shrink as a comprehensive database makes crooks easier to spot.
It’s too bad that some liberals have turned single-payer into a religion and are whacking the Vermont plan for not being pure enough. Vermont is permitting continued private coverage for very practical reasons.
Bear in mind that the most acclaimed health care systems – in Germany, in France and our Medicare – combine single-payer for basics with private coverage for the extras.
Vermont intends to use its state health insurance exchange as the structure on which to build its single-payer system. By 2017, the road to an innovation waiver should be clear.
Go forth, Green Mountain State. Show us what you can do.
http://www.pnhp.org/print/news/2014/january/single-payer-health-plan-is-not-dead
Brian Schweitzer: No Obamacare apology
Former Montana Gov. Brian Schweitzer is continuing to position himself for a possible 2016 presidential run, talking about running a Democratic campaign against the policies of President Barack Obama in a new interview.
The outspoken Democrat told MSNBC in an interview published Wednesday that he believes Obamacare doesn’t go far enough, supporting a single-payer system based on a Canadian model.
“I’m a little bit like Michael Moore,” Schweitzer said. “I suppose I’m a Democrat, and I ought to roll over like a fat dog and get scratched by the pharmaceutical and insurance companies because, gee, we have to apologize for so-called Obamacare. I’m not going to apologize a damn bit.”
(PHOTOS: 12 Democrats criticizing the Obamacare rollout)
Schweitzer has been talking about a 2016 run, visiting Iowa and taking a thinly veiled swipe at presumed Democratic front-runner Hillary Clinton while there over her vote for the war in Iraq.
In the lengthy MSNBC profile, Schweitzer also had plenty of criticism for the Democratic Party’s current standard-bearer. Asked to name a single positive achievement by Obama, Schweitzer thought for some time.
“My mother, God rest her soul, told me ‘Brian, if you can’t think of something nice to say about something, change the subject,’” Schweitzer said, criticizing the National Security Agency surveillance, Obamacare and overall competency in the administration.
Obamacare: To Buy Or Not To Buy–––An Entrepreneur Would Have Done It Differently
The Leaf Chronicle (Clarksville, Tenn.) and Gannett, Jan. 13, 2014
The prospects for single-payer health care – adored by many liberals, despised by private health insurers and looking better all the time to others – did not die in the Affordable Care Act. It was thrown a lifeline through a little-known provision tucked in the famously long legislation. Single-payer groups in several states are now lining up to make use of Section 1332.
Vermont is way ahead of the pack, but Hawaii, Oregon, New York, Washington, California, Colorado and Maryland have strong single-payer movements.
First, some definitions. Single-payer is a system where the government pays all medical bills. Canada has a single-payer system. By the way, Canada’s system is not socialized medicine but socialized insurance (like Medicare). In Canada, the doctors work for themselves.
Under Section 1332, states may apply for “innovation waivers” starting in 2017. They would let states try paths to health care reform different from those mapped out by the Affordable Care Act – as long as they meet certain of its goals. States must cover as many people and offer coverage as comprehensive and affordable. And they can’t increase the federal deficit. Qualifying states would receive the same federal funding that would have been available under Obamacare.
My conservative friends complain that the innovation waiver requirements would rule out everything but single-payer. No doubt they are diligently working on a more privatized alternative that would cover less, cost more and raise the federal deficit.
‘’Vermont is the only state where they’re thinking very concretely about using (the waiver) as part of their plan,” Judy Solomon, health care expert at the Center on Budget and Policy Priorities, told me.
Hawaii got close. Its Legislature passed a single-payer bill in 2009, which was vetoed by then-Gov. Linda Lingle, a Republican. Lawmakers overrode the veto, but Lingle refused to implement the law.
The quest remains rocky, Dr. Stephen Kemble, a single-payer advocate and past president of the Hawaii Medical Association, told me. “If Vermont can get things going, that would make things easier for others.”
In Washington state, “our focus is to work on grass-roots support,” says Dr. David McLanahan, Washington coordinator for Physicians for a National Health Program. “We’re laying the groundwork” for legislation and a request for an innovation waiver.
Problems in the Obamacare rollout have energized fans of single-payer. Computer glitches aside, the troubles stem chiefly from the law’s complexity. Single-payer is all about simplicity.
Under the Vermont plan, employers and individuals would no longer have to buy private health coverage. They would instead pay a tax. The state-run system would also cover more things, like dental. And oh, yes, Vermonters could choose their hospitals and doctors.
William Hsiao, an economist at the Harvard School of Public Health, has projected that Vermont’s annual health care spending could fall 25 percent. The savings would more than pay for the new benefits.
How? Fewer dollars would go to advertising, executive windfalls and payouts to investors. Doctors dealing with one insurer would save on office staff. Fraud and abuse would shrink as a comprehensive database makes crooks easier to spot.
It’s too bad that some liberals have turned single-payer into a religion and are whacking the Vermont plan for not being pure enough. Vermont is permitting continued private coverage for very practical reasons.
Bear in mind that the most acclaimed health care systems – in Germany, in France and our Medicare – combine single-payer for basics with private coverage for the extras.
Vermont intends to use its state health insurance exchange as the structure on which to build its single-payer system. By 2017, the road to an innovation waiver should be clear.
Go forth, Green Mountain State. Show us what you can do.
http://www.pnhp.org/print/news/2014/january/single-payer-health-plan-is-not-dead
Brian Schweitzer: No Obamacare apology
| |
| Former Montana Gov. Brian Schweitzer is continuing to position himself for a possible 2016 presidential run, talking about running a Democratic campaign against the policies of President Barack Obama in a new interview. The outspoken Democrat told MSNBC in an interview published Wednesday that he believes Obamacare doesn’t go far enough, supporting a single-payer system based on a Canadian model. “I’m a little bit like Michael Moore,” Schweitzer said. “I suppose I’m a Democrat, and I ought to roll over like a fat dog and get scratched by the pharmaceutical and insurance companies because, gee, we have to apologize for so-called Obamacare. I’m not going to apologize a damn bit.” (PHOTOS: 12 Democrats criticizing the Obamacare rollout) Schweitzer has been talking about a 2016 run, visiting Iowa and taking a thinly veiled swipe at presumed Democratic front-runner Hillary Clinton while there over her vote for the war in Iraq. In the lengthy MSNBC profile, Schweitzer also had plenty of criticism for the Democratic Party’s current standard-bearer. Asked to name a single positive achievement by Obama, Schweitzer thought for some time. “My mother, God rest her soul, told me ‘Brian, if you can’t think of something nice to say about something, change the subject,’” Schweitzer said, criticizing the National Security Agency surveillance, Obamacare and overall competency in the administration. |
Now that consumers can generally make an efficient health insurance purchase at HealthCare.gov and most of the state-run exchanges, we can finally get to the real question.
Are the healthy uninsured going to buy it?
The big health insurance changes Obamacare made to the individual and small group market were arguably done in order to get everyone, sick and healthy, covered in a more equitable system.
To be clear, no one I know of wants to go back to the prior health insurance market that excluded people from being covered because of pre-existing conditions.
But what if most of the uninsured literally don't buy Obamacare?
Then people will question whether or not all of this change was worth it: Why did those who were in the old individual and small group market have to accept all of the expensive changes, narrower networks, higher deductibles, and fewer choices if the uninsured largely don't want it?
Are we moving away from a system where only the healthy could buy health insurance to a system where only the sick want to buy it?
As I have reported on this blog before, many working class and middle class subsidy eligible people will find health insurance premiums on the exchanges, after federal subsidies, at about 10% of their after-tax income. The average standard Silver plan deductible is almost $2,600 and the average Bronze deductible is $4,300 according toAvalere Health.
More than two-thirds of Silver plans sharply reduce the number of hospitals in their provider networks over typical employer plans according to a McKinsey study. That means most of the second lowest cost Silver plans––the plan the subsidy is tied to––will be a narrow network plan.
Are the healthy uninsured going to buy it?
The big health insurance changes Obamacare made to the individual and small group market were arguably done in order to get everyone, sick and healthy, covered in a more equitable system.
To be clear, no one I know of wants to go back to the prior health insurance market that excluded people from being covered because of pre-existing conditions.
But what if most of the uninsured literally don't buy Obamacare?
Then people will question whether or not all of this change was worth it: Why did those who were in the old individual and small group market have to accept all of the expensive changes, narrower networks, higher deductibles, and fewer choices if the uninsured largely don't want it?
Are we moving away from a system where only the healthy could buy health insurance to a system where only the sick want to buy it?
As I have reported on this blog before, many working class and middle class subsidy eligible people will find health insurance premiums on the exchanges, after federal subsidies, at about 10% of their after-tax income. The average standard Silver plan deductible is almost $2,600 and the average Bronze deductible is $4,300 according toAvalere Health.
More than two-thirds of Silver plans sharply reduce the number of hospitals in their provider networks over typical employer plans according to a McKinsey study. That means most of the second lowest cost Silver plans––the plan the subsidy is tied to––will be a narrow network plan.
Implementing Health Reform: Four Years Later
January 1, 2014, was to be a day of triumph for Affordable Care Act (ACA) supporters. All Americans, regardless of income or preexisting medical conditions, would have access to health insurance. Medicaid would cover all low-income Americans under age sixty-five. Premium tax credits would make health insurance affordable for families with incomes up to four times the poverty level—well above the median income level. Although Americans with employer-sponsored insurance would see their coverage continue largely unchanged, benefits in the individual and small-group market would become more comprehensive, and out-of-pocket costs would be capped. Medicare benefits would continue to improve as the Part D prescription drug “doughnut hole” closed. Millions of Americans long denied access to health care would have insurance, just like the rest of us.
To read the headlines as 2014 arrives, however, it doesn’t appear to have turned out that way. The news is dominated by reports that Americans in the individual insurance market have received “cancellation” notices telling them that their 2013 policies are no longer available. Millions of Americans with incomes below 100 percent of poverty will be too poor to qualify for coverage in states that are refusing to expand Medicaid. Employers are reportedly cutting back the hours of part-time employees to avoid providing them health coverage.
Worst of all, the health insurance Marketplaces, which were supposed to enroll seven million Americans in coverage for 2014, largely failed for their first two months, and most are still not fully functional, blocking potential enrollees from getting coverage.
How did things go so wrong? Why is there so much bad news? When can we expect the news to get better?
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