Follow this link to see what went on at the single-payer conference in Oakland.
http://singlepayer2014.wikidot.com/
The following clipping is fascinating. I've copied the "headlines" and pasted them below, but to get the full story, follow the hot-link at the end of the clipping. And take the time to follow the video links in the online version. Well worth the time.
8 facts that explain what’s wrong with American health care
1) Americans pay way, way, way more for health care than anyone else
Health care in the United States is expensive. Insanely, outlandishly expensive.
We spend $2.8 trillion on healthcare annually. That works out to about one-sixth of the total economy and more than $8,500 per person — and way more than any other country.
2) We pay doctors when they provide lots of health care, not when they provide good health care
The best way for a doctor to make money in the United States right now is simple: prescribe treatments.
The American health-care system by and large runs on what experts describe as a "fee-for-service" system. For every service a doctor provides — whether that's a primary care physician conducting an annual physical or an orthopedic surgeon replacing a knee — they typically get a lump sum of money.
That's how most businesses work. Apple gets more money when it sells more iPads and the Ford gets more money when it sells more cars. But health care isn't like iPads or cars. Or, at least, it's not supposed to be.
3) Half of all healthcare spending goes towards 5 percent of the population
Americans are not equal health care spenders. There's a handful of patients who use lots of medical services — and tens of millions of people who barely go to the doctor at all.
The National Institute for Health Care Management estimates that, in 2009, about half of health spending ($623 billion) went towards 5 percent of the population. On average, these are people who use $40,000 of health care annually.
4) Our health insurance system is the product of random WWII-era tax provisions
If you want to understand why we are the only developed country with an employer-based health insurance — really, the only one — then you had better get familiar with the 1954 Internal Revenue Service Tax Code.
The 1954 Internal Revenue Service Tax Code is the document in which the federal government codified into law that companies can provide health insurance benefits to workers tax-free. This affirmed a 1943 IRS Tax Court ruling that had also decreed health benefits to be non-taxable.
The early decisions were made in the context of a wartime tax code. There were overwhelming taxes meant to stop wartime profiteering and keep unions from shutting down production to extract wage gains. But when health care was protected from these taxes, it immediately became incredibly valuable to workers, and companies were able to keep it tax-free even after the war. The result is that a dollar in health benefits is worth more to a worker than a dollar in wages, because the dollar in health benefits is untaxed and the dollar in wages is taxed.
"That's a huge discount off the price of health insurance," says Melissa Thomasson, an economist at Miami University who has written extensively on the history of health insurance. "And it happened very quietly. I looked a few years ago to find out the name of who made the decision, and it's been lost to history."
Flash forward about 80 years or so, and the health insurance tax break is the biggest in the federal budget; the government loses out on $260 billion annually by not taxing health benefits. The majority of non-elderly Americans get their health insurance at work, and with good reason: the tax-free dollar can buy a lot more medical care.
5) Insurance companies have small profit margins
Health insurance companies are an incredibly easy target for any antipathy towards the American health care system. They're the ones that deny claims for the care that we want, but still charge an always rising premium for their coverage.
But here's one fact about insurers that often gets lost in the debate over health care: their profit margins tend to be relatively small. Yahoo Business estimates that the health-care sector as a whole runs a 15.4 percent profit margin. Health plans, meanwhile, have an average profit margin of 3.2 percent.
6) Getting health care in the United States is dangerous
We don't know exactly how many Americans are killed in hospitals each year, but we do know that it is a lot.
In 1999, the Institute of Medicine published a seminal report titled To Err is Human, which estimated that at least 44,000 patients — and as many as 98,000 — die in hospitals each year as results of medical errors.
Even using the lower-bound figure, that would mean medical errors in hospitals kill more people annually than "such feared threats as motor-vehicle wrecks, breast cancer, and AIDS."
7) One third of healthcare spending isn't helping
The United States spends $765 billion annually (about one third of our overall health care dollars) on things that do not make Americans any healthier.
"I'm always amazed at these conversations I have with physicians," says Amitabh Chandra, a health economist at Harvard. "They'll openly say that about 50 percent of what happens in medicine is waste, but it's hard to always know which care was wasteful and which wasn't."
Much of the waste in our system has to do with the fact that we run an inefficient health-care system, in which hundreds of health insurance plans all charge different prices for the same surgeries and scans. That requires lots of billing staff: for every three doctors in the United States, there are two administrative staff to handle all the paperwork. That's unique to the US system.
8) Obamacare is not universal health care
The United States does have a very recent, very large expansion of health insurance coverage — that's the program we all call Obamacare. It's expected to cover an additional 26 million people by 2024.
What the United States does not have, however, is universal coverage.
Obamacare doesn't eliminate uninsurance in America; instead, it cuts the number of people lacking coverage about in half. Even after Obamacare is fully implemented, budget forecasters still expect that 31 million Americans will lack insurance coverage — a bigger group than the people buying coverage on the exchanges. Our uninsured rate will still be in the double digits, hovering around 11 percent.
Massachusetts wants to upend health care. Again.
Massachusetts is running the country's most aggressive experiment in controlling health-care costs — and the first year results suggest it could be working.
Two years ago, Massachusetts set what seemed like an ambitious goal: it would be the first state in the entire country that would put a firm cap on health-care spending. By 2017, the state planned to have health-care costs grow slower than the rest of the economy — something that never happens anywhere in the United States.
Massachusetts' budget cap kicked in last year and, earlier this morning, the state reported a victory: it stayed within the 2013 growth limits.
Massachusetts set a target to have health-care costs grow no faster than 3.6 percent in 2013. New data from the Center for Health Information and Analysis (or, as its known by its amazing acronym, CHIA), shows that health costs grew by an average of 2.3 percent per person in Massachusetts.
The good news: per capita health-care costs grew slower than Massachusetts had hoped. The bad news: medical spending still grew faster than overall inflation in the state. And all of this is happening in an era when, across the country, health-care costs are growing at a slower-than-normal pace.
So while growth in health-care costs "was below the benchmark, it is also notable that the state economy also grew slowly over this period," the report notes. "Moreover, health care expenditure growth has been slowing nationwide. It is difficult to distinguish the effect of Massachusetts-specific policy … because the observed trend is broadly consistent with national trends."
The next few years will likely be a better test of Massachusetts' ability to control costs. By 2017, the state aims to have health-care costs growing 0.5 percent slower than the rest of the economy. That's a much more challenging goal to hit — and, if Massachusetts can pull it off, one that lots of other states will want to copy.
Bracing for New Challenges in Year 2 of Health Care Law
The first year of enrollment under the federal health care law was marred by the troubled start of HealthCare.gov, rampant confusion among consumers and a steep learning curve for insurers and government officials alike.
But insurance executives and managers of the online marketplaces are already girding for the coming open enrollment period, saying they fear it could be even more difficult than the last.
One challenge facing consumers will be wide swings in prices. Some insurers are seeking double-digit price increases, while others are hoping to snare more of the market by lowering premiums for the coming year. At the same time, the Obama administration is expected to try to persuade about five million more people to sign up while also trying to ensure that eight million people who now have coverage renew for another year.
Adding to the complexity is the shorter time frame for choosing a new policy: three months instead of six.
“In some respects, it’s going to be more complicated,” said Kevin Counihan, the former chief executive of Access Health CT, Connecticut’s online marketplace, who was just named as the head of the insurance marketplaces for the federal government. Connecticut’s marketplace was among the most successful state-based exchanges, sharply reducing the number of uninsured in the state. “Part of me thinks that this year is going to make last year look like the good old days.”
Smaller Military Hospitals Said to Put Patients at Risk
HINESVILLE, Ga. — Every year, more than 25,000 Americans undergo surgery to correct a hiatal hernia, a condition in which tissue from the stomach bulges into the chest cavity through a hole in the diaphragm. The hernias often return, but major complications are rare. Hospital stays are usually short.
Irene Smith, a 42-year-old cafeteria worker, wife of an Army sergeant and mother of three, was considered a good candidate for the procedure when she was evaluated in late 2007. A cardiologist’s report was especially positive. “Lost about 25 pounds, exercising daily, looks fantastic,” he wrote.
But more than a dozen operations later, Mrs. Smith has lost her stomach, her health, her job and almost all semblance of a normal life. She must purée most of her food. From her esophagus to her intestines, she is such a jumble of abnormalities that two years ago one specialist declined to treat even her chronic cough for fear of making her worse.
“I do not mean to be rude or disrespectful,” she recalled him saying, “but I would not touch you with a 10-foot pole.”
Mrs. Smith underwent hernia surgery at Winn Army Community Hospital in Fort Stewart, Ga., one of 40 hospitals across the country run by the armed forces. Her case illustrates what outside experts and dozens of current and former military hospital workers interviewed by The New York Times call a signal failing in a system that cares for 1.35 million active-duty service members and their families, among others.
Put simply, they say, many of the hospitals are so small and the trickle of patients so thin that it compromises the ability of doctors and nurses to capably diagnose and treat serious illnesses, much less take on surgeries like Mrs. Smith’s.
Comparing Military Hospitals
There are currently 54 military hospitals in the United States and overseas that provide inpatient services. Many compare poorly to leading civilian hospitals on measures of safety in maternity care. Of those independently evaluated for surgical care, half posted high rates of complications. Most of the hospitals serve an average of 30 or fewer inpatients a day. Some have been marked by the Pentagon for downsizing.
Medicare Spending in 2014 Dollars, Per Beneficiary
$10,000
5,000
0
$11,930
2006
2008
2010
2012
2014
2016
2018
2020
2022
2024
Projections begin in 2014
That Relatively Flat Line May Look Boring, but It’s a Big Deal
Medicare spending usually always goes up.
Medicare spending isn’t just lower than experts predicted a few years ago. On a per-person basis, Medicare spending is actually falling.
If the pattern continues, as the Congressional Budget Office forecasts, it will be a rarity in the Medicare program’s history. Spending per Medicare patient has almost always grown more rapidly than the economy as a whole, often by a wide margin.
Health economists call that difference “excess cost growth.”
Lately, though, some have taken to using the unwieldy phrase “negative excess cost growth.”
This year, Medicare, which covers those 65 and older and people with disabilities, will spend about $ 11,200 on average for every person enrolled in the program. By comparison, it spent $12,000 three years ago, in inflation-adjusted dollars. The Congressional Budget Office forecasts that the number will fall below $11,000 by 2017 and stay below this year’s number until 2020.
Full of ideas, Don Berwick looks for traction
First of three profiles of the Democratic candidates for governor. Visit our Politics section for more coverage.
He has been knighted by Queen Elizabeth II and rubbed elbows with the Dalai Lama. His medical work has reached 70 countries, tackling everything from tuberculosis in Peru to child mortality rates in Ghana.
But that global acclaim didn’t count for much on a recent Thursday afternoon when Don Berwick walked under a white tent in Waltham where the annual chamber of commerce barbecue was in full swing. Smoke billowed from a grill. Frank Sinatra crooned on the sound system.
As Berwick went from table to table, introducing himself to jewelry store clerks and realtors in golf shirts and sun dresses, he was met with blank stares.
“You’re running for governor?” one woman said, looking up from her pasta salad. “On what ticket?”
This is Berwick’s challenge as he struggles to make the jump from rock star in the rarefied realm of health care quality improvement to credible contender for governor of Massachusetts.
His high-flying résumé — parts of which would fit comfortably on Bono’s list of global achievements — has not translated easily onto the ground in Lowell and Worcester.
Though his background is wider-ranging than any Democrat in the race, and though he has the most distinctive policy positions, Berwick is trailing far behind Martha Coakley and Steve Grossman. Polls show 65 percent of likely voters in Tuesday’s primary don’t even know who he is.
A rumpled 67-year-old pediatrician from Newton who does crossword puzzles before bedtime, Berwick launched the Institute for Healthcare Improvement in Cambridge in 1991. The $40 million nonprofit helps governments and hospitals around the world reduce medical errors and improve care. In 2005, he earned knighthood for helping an entire country, Britain, overhaul its troubled health care system. And from 2010 to 2011, he ran Medicare and Medicaid for President Obama.
He is the only Democrat running for governor who opposes casinos and supports single-payer health care, a seismic shift that he says would save millions of dollars by using the government, rather than private insurers, to finance the health care system.
He calls himself “the most progressive candidate in the field by far” and likes to quote Hubert Humphrey’s rubric that government needs to meet a “moral test” of how it treats those on the margins of society.
Mercy Hospital in Portland plans growth, consolidation after EMHS takeover - Maine news, sports, obituaries, weather - Bangor Daily News
PORTLAND, Maine — Mercy Hospital has taken initial steps for a major expansion along the Fore River that will end the hospital’s presence downtown by 2018.
The hospital is seeking to amend a conditional zone agreement reached with the city in 2001 that paved the way for it to build on the Fore River Parkway in 2008. No specific language was proposed when the zoning agreement was discussed at an Aug. 26 Planning Board workshop.
Hospital spokeswoman Susan Corliss said there is “no definitive master plan” in place, but confirmed Tuesday the hospital would like to celebrate its centennial in 2018 by fully relocating to the Fore River Parkway from 144 State St.
Conceptual plans of the Fore River Parkway expansion, presented by Steve Bushey of the South Portland office of Fay, Spofford & Thorndike, call for a 250,000-square-foot addition to the 138,000-square-foot hospital completed in 2008, and a 72,000-square-foot ambulatory care center.
The expansion could require paving wetlands adjacent to the current hospital space at 175 Fore River Parkway. Permits for filling in the 3.5-acre pond and wetlands were granted by the Maine Department of Environmental Protection and U.S Army Corps of Engineers in 2013.
A storm-water management plan was approved by the DEP as part of its comprehensive site review.
Filling in the wetlands is unavoidable, according to a 126-page application filed by Bushey.
He said it “poses a significant constraint and, therefore, an enormous challenge for the Phase 2 expansion. Building Phase 2 of the Hospital to the south of the wetland is not an option.”
A second phase of expansion has been anticipated since the hospital filed a master plan with the city in 2006. However, the latest plan depicts a much more ambitious project, and holds the possibility of two more medical office buildings on the site, as well as parking garages.
The hospital already has a medical office building at 195 Fore River Parkway.
Not spending enough time filling out tax returns? Check out the following post from Health Affairs.
-SPC
Implementing Health Reform: Tax Form Instructions
August 29th, 2014
Editor’s note: This post has been updated to include several corrections of errors in the original post. The author wishes to thank Linda Mendel of Vorys, Sater, Seymour, and Pease for calling them to attention.
On August 28, 2014, the Internal Revenue Service re-released the draft forms that will be used by employer, insurers, and exchanges for reporting Affordable Care Act tax information to individuals and to the IRS for 2014 and 2015, as well as the instructions for completing those forms. The IRS also released in the Federal Register requests for public comments on three of those forms – the 1094-B, the 1094-C, and the 1095-C – under the Paperwork Reduction Act. This post reports on these forms and instructions and on a guidance released by the Centers for Medicare and Medicaid Services.
The tax forms had been published earlier and are described in an earlier post. The instructions for the forms, however, had not been available and had been eagerly awaited by employers, insurers, exchanges, and tax professionals. Forms 1094-C and 1095-C will be used by large employers with more than 50 full-time or full-time-equivalent employees to determine whether the employer is responsible for penalties under the employer shared responsibility requirements of the ACA. They will also be used to determine whether employees have received an affordable and adequate offer of coverage, rendering them ineligible for premium tax credits. Employers are required to provide each full-time employee with a form 1095-C and to file each of these together with a transmittal form 1095-B form with the IRS.
The instructions for the 1094-C and 1095-C are by far the most complex of the instructions released on August 28, filling 13 pages with dense, two column, print. Most of the complexity derives from the options for complying with the employer mandate and the transition exceptions to that mandate that the administration has created. These alternatives and exceptions were explored in my posts on the employer mandate final rule when it was issued in February, 2014. These forms are also complicated by the fact that the IRS decided to allow self-insured large employers to file only the large employer 1094-C and 1095-C, rather than requiring them to also fill out the 1094-B and 1095-B forms, which are filed by other entities that provide minimum essential coverage. Because the employer mandate has been delayed, large employers are not required to file these forms for 2014, although they may do so voluntarily.
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