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Tuesday, January 13, 2015

Health Care Reform Articles - January 13, 2015

The American Way over the Nordic Model? Are we crazy?

In my long nomadic life, I've been to both poles and most countries in between. I still remember when to be an American was to be envied. The country where I grew up after World War II seemed to be respected and admired around the world.
Today, as one of 1.6 million Americans living in Europe, I instead face hard questions about our nation. Wherever I travel, Europeans, Asians and Africans ask expatriates like me to explain everything odd or troubling about the conduct of the United States. Polite people, normally reluctant to risk offending a guest, ask pointedly about America's trigger-happiness, cutthroat free-marketeering, and "exceptionality."
Their questions share a single underlying theme: Have Americans gone over the edge? Are you crazy?


At the absolute top of the list: "Why would anyone oppose national healthcare?" Many countries have had some form of national healthcare since the 1930s, Germany since 1880. Some versions, as in France and Britain, have devolved into two-tier public and private systems. Yet even the privileged would not begrudge their fellow citizens government-funded comprehensive healthcare. That so many Americans do strikes Europeans as baffling, if not brutal.
In the Scandinavian countries, long considered to be the most socially progressive in the world, a national (physical and mental) health program is a big part — but only a part — of a more general social welfare system. In Norway, where I live, all citizens also have access to free education from age 6 through specialty training or university; low cost, subsidized preschool; unemployment benefits, job-placement and paid retraining; paid parental leave; old age pensions, and more. These benefits are not a "safety net" — that is, charitable payments grudgingly bestowed upon the needy. They are universal: equally available as a human right, promoting social harmony.
This is the Nordic Model: a balance of regulated capitalism, universal social welfare, political democracy and the highest levels of gender and economic equality on the planet. It's their system, begun in Sweden in the 1930s and developed across Scandinavia in the postwar period. Yes, they pay for it through high taxation. (Though compared with the U.S. tax code, Norway's progressive income tax is remarkably streamlined.) And despite the efforts of an occasional conservative government to muck it up, they maintain it. Why?
They like it. International rankings cite Norway as the best place to grow old, to be a woman and to raise a child. The title of "best" or "happiest" place to live on Earth comes down to a neighborly contest among Norway and the neighboring Nordic social democracies, Sweden, Denmark, Finland and Iceland.
All the Nordic countries broadly agree that only when people's basic needs are met — when they cease to worry about jobs, education, healthcare, transportation, etc. — can they truly be free to do as they like. While the U.S. settles for the fantasy that every kid has an equal shot at the American dream, Nordic social welfare systems lay the foundations for a more authentic equality and individualism.
These ideas are not novel. They are implied in the preamble to our own Constitution. You know, the part about "We the People" forming "a more perfect Union" to "promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity."


Knowing this, a Norwegian is appalled at what America is doing to its posterity today. That top chief executives are paid 300 to 400 times as much as an average employee. Or that Govs. Sam Brownback of Kansas and Chris Christie of New Jersey, having run up their state's debts by cutting taxes for the rich, now plan to cover the loss with money snatched from public pension funds. That two-thirds of American college students finish in the red, some owing $100,000 or more. That in the U.S., still the world's richest country, 1 in 3 children lives in poverty. Or that the multitrillion-dollar wars of Presidents George W. Bush and Obama were fought on a credit card, to be paid off by the kids.
Implications of America's uncivilized inhumanity lurk in the questions foreign observers ask me: Why can't you shut down that concentration camp in Cuba? Why can't you stop interfering with women's healthcare? What is it about science and climate change you can't understand?


And the most pressing question of all: Why do you send your military all over the world to stir up trouble for all of us?
Europeans often connect America's reckless conduct abroad to its refusal to put its own house in order. They've watched the United States unravel its flimsy safety net, fail to replace decaying infrastructure, weaken organized labor, bring its national legislature to a standstill and create the greatest degree of economic inequality in almost a century. As they see it, with ever less personal security and next to no social welfare system, Americans are bound to be anxious and fearful. They understand as well why so many Americans have lost trust in a national government that for three decades has done so little for them (save Obama's endlessly embattled modest healthcare effort).
In Norway's capital, where a statue of a contemplative President Franklin D. Roosevelt overlooks the harbor, many America-watchers think he may have been the last U.S. president who understood and could explain to the citizenry what government might do for all of them.
It's hard to pin down why America is as it is today, and — believe me — even harder to explain it to others. Some Europeans who interrogate me say that the U.S. is "crazy" — or "paranoid," "self-absorbed," or simply "behind the times." Others, more charitably, imply that Americans are merely "misguided" or "asleep" and may still recover sanity. But wherever I travel, the questions follow, each suggesting that the United States, if not exactly crazy, is decidedly a danger to itself and others.
Ann Jones is the author of "They Were Soldiers: How the Wounded Return From America's Wars — The Untold Story." A longer version of this piece appears at tomdispatch.com.

Steven Brill & 60 Minutes show why letting lobbyists write the ACA was an Enormous Blunder


In 2009 when the Affordable Care Act was being crafted together a calculation was made not to challenge the entrenched power of the big stakeholders in the American Health Care system no doubt to avoid provoking their opposition to the reforms in health care that would have probably prevented its passage. This Faustian bargain prevented any constraints being imposed on the revenue streams going to those powerful stakeholders like hospitals and Big Pharma. So  Democrats in the Congress Like Senator Max Baucus essentially let the stakeholders lobbyists like Liz Fowlerwrote protections for the inflated revenue streams for the powerful stakehilders into the A.C.A. Cost containment went by the wayside. Now we've got a reformed health care system that expands access to segments of the population that were being left out, but we still have a for profit healthcare system with its attendant very high costs.  
No one I know framed these problems with how the A.C.A. was crafted together largely by lobbyists to protect entrenched interests revenue streams better than Bill Moyers did back in the Fall of 2009.            
                     
So now we're saddled with this expensive for profit Rube Goldberg machine of a health care system instead of the single payer system many of us on the Left were clamoring for. The power of the entrenched interests has only grown since the Moyer piece described it in 2009. We now have a congress with Republican majorities in both houses looking for ways to dismember the A.C.A. as much as they can, threatening the reforms that are so desperately needed by millions of Americans. Its a predicament that's likely to get a lot worse the more Republicans meddle with the A.C.A.

Here is the link to the most recent 60 Minutes Obamacare show
-SPC

New Rules to Limit Tactics on Hospitals’ Fee Collections

By 

WASHINGTON — The Obama administration has adopted sweeping new rules to discourage nonprofit hospitals from using aggressive tactics to collect payments from low-income patients.
Under the rules, nonprofit hospitals must now offer discounts, free care or other financial assistance to certain needy patients. Additionally, hospitals must try to determine whether a patient is eligible for assistance before they refer a case to a debt collector, send negative information to a credit agency, place a lien on a patient’s home, file a lawsuit or seek a court order to seize a patient’s earnings.
The rules, issued at the end of last year by the TreasuryDepartment and the Internal Revenue Service, lay out detailed requirements for nonprofit hospitals that have or want tax-exempt status, about 60 percent of hospitals nationwide.
Health care lawyers said the rules could set an industry standard, influencing the practices of for-profit hospitals, because another federal agency, the Consumer Financial Protection Bureau, had endorsed them. The bureau has broad authority to supervise credit reporting companies and debt collectors.

$375 billion wasted on billing and health insurance-related paperwork annually: study

FOR IMMEDIATE RELEASE, January 12, 2015
Contact: Mark Almberg, PNHP communications director, 312-782-6006, mark@pnhp.org
Medical billing paperwork and insurance-related red tape cost the U.S. economy approximately $471 billion in 2012, 80 percent of which is waste due to the inefficiency of the nation’s complex, multi-payer way of financing care, a group of researchers say.
The researchers – physicians and health policy researchers with ties to the University of California, San Francisco, the City University of New York School of Public Health, and Harvard Medical School – note that a simplified, single-payer system of financing health care similar to Canada’s or the U.S. Medicare program could result in savings of approximately $375 billion annually, or more than $1 trillion over three years.
Such savings could be used to cover everyone who is currently uninsured and to upgrade coverage for the tens of millions of Americans who now have inadequate policies with no increase in national health spending, they say.
The four-member research team reports its findings in the peer-reviewed journal BMC Health Services Research. Their article was published in final form this week.
Aliya Jiwani, the article’s lead author, said, “Our team reviewed and combined all existing studies of the costs of billing and insurance-related administrative tasks across multiple health care sectors.
“Using a standard definition of ‘billing and insurance-related costs,’ or what we call BIR, we found that physician practices spent about $70 billion in 2012 on bureaucratic paperwork. Hospitals spent an estimated $74 billion on BIR, and other institutions, such as nursing homes, home health care agencies, prescription drug and medical supply companies, spent an estimated $94 billion on these money-chasing tasks.
She continued: “Private insurers spent $198 billion on BIR, whereas public insurers, e.g. Medicare and other government-sponsored programs, spent $35 billion on such activities.
“Most significant,” Jiwani said, “is our finding that were the U.S. to adopt a simplified health care financing system – either along the lines of Canada’s system or our Medicare program – 80 percent of those itemized expenditures would disappear. That’s how much administrative waste is embedded in our fragmented, dysfunctional system of paying for care.”
Jiwani, who obtained her master’s degree from Yale and is currently pursuing doctoral studies in public health at George Washington University, said that necessary administrative tasks such as patient scheduling and writing chart notes were excluded from the BIR totals.
Senior author Dr. James G. Kahn, who teaches and conducts health economics research at the Philip R. Lee Institute for Health Policy Studies at UC San Francisco, said that the study is the first scientific article to provide a comprehensive portrayal of the costs of BIR in the U.S. health care system.
“Synthesizing costing data on BIR costs from existing studies, using a uniform yardstick for defining BIR, and comparing those results with costs in simplified insurance systems in other countries, we see the true magnitude of administrative bloat in U.S. health care,” he said.
Kahn continued: “Money spent on such unnecessary bureaucratic tasks is money that could and should be spent on patient care.
“The potential savings of adopting a single-payer system is striking: at least $375 billion annually,” he said. “Such a system would enjoy powerful economies of scale, sharply reduce the burdens of claims processing, and obviate the need for marketing, advertising and underwriting expenses. Our nation’s patients, our physicians, and the U.S. economy all stand to gain from such a shift.”
http://www.pnhp.org/print/news/2015/january/375-billion-wasted-on-billing-and-health-insurance-related-paperwork-annually-stud


A New Study Shows Why Obamacare Should Have Been Single-Payer

By Sarah Kollmorgen
The New Republic, January 12, 2015
Last summer, with Obamacare's initial troubles fading from view, The New Republic's Brian Beutler noted that certain problems with the healthcare overhaul won't ever go away because they're inherent to its architecture.
Needless to say, this is a much more complex system than single payer. But it was the system Democrats settled upon, in part because it was theoretically less disruptive to existing insurance systems than other reforms, and in part because they mistakenly took Republicans at their word that it was the kind of universal health care system they would support. Massive industry opposition to single payer played a big role, too.
The main problem, Beutler wrote, was that you have to re-enroll every year—and there's no guarantee that you can keep your plan, that rates won't go up, or that the government subsidy won't go down. But a new study by a group of physicians and health-policy researchers in BMC Health Services Research highlights another problem with our complex healthcare system. 
In 2012, billing and insurance-related administrative costs—bureaucratic paperwork and red tape, essentially—cost the U.S. economy around $471 billion, and 80 percent of that was due to inefficiencies in our multi-payer system.
“That’s how much administrative waste is embedded in our fragmented, dysfunctional system of paying for care,” said Aliya Jiwani, the lead author of the study, in a press release. Dr. James G. Kahn, one of the study’s authors, said this is the first study to analyze the BIR costs across the entire U.S. health care system.
Their solution? A single-payer system akin to the Medicare program or Canada's national healthcare. The study found that the $375 billion saved annually with a single-payer system could be used to cover all of the nation's uninsured and upgrade coverage for millions of under-insured citizens.


With friends like these, who needed enemies in 2014?
In soccer it's called an "own goal," when a player inadvertently kicks the ball into his own net.
In politics, it's called being Jonathan Gruber.
Gruber, an economist at the Massachusetts Institute of Technology, did more than any other supporter of the 2010 healthcare law to increase its chances of being repealed. But he's hardly the only one whose words or deeds wound up hurting his own allies.
Here's a short list of the people whose actions in 2014 raised the question, "With friends like these, who needs enemies?"
Jonathan Gruber
As a consultant to the White House and congressional Democrats, Gruber developed the models that projected the positive economic effects of various provisions of the Patient Protection and Affordable Care Act. In particular, Gruber's work helped defend the individual mandate to buy insurance and the "Cadillac tax" on high-value health plans.
Then Gruber gave a series of speeches explaining the law, in which he called voters stupid, said the Cadillac tax provision was crafted in a way to mislead the public about its true intention, and declared that Congress intended to withhold subsidies from lower-income residents of states that did not set up their own insurance exchanges.
He has since backtracked vigorously from all those remarks and has apologized for holding himself out as more of an expert than he really was. Nevertheless, his comments have put defenders of the embattled Affordable Care Act in an even tougher position as Republicans, who bitterly oppose the law, assume control of both sides of the Capitol.

Don’t Look to States for New Ideas

By AARON CHATTERJI
DURHAM, N.C. — WITH Washington bitterly divided between a Democratic White House and a Republican Congress, it seems unlikely that America will see substantive progress on the grand challenges of the day, ranging from immigration to energy policy and entitlement programs.
At times like these, we have historically looked to our 50 states to be, as Justice Louis D. Brandeis memorably called them, laboratories of democracy, testing grounds for innovative policies that can be replicated by other states or translated to the federal level.
Some of the most notable federal policy innovations of the last generation have originated in the states, including school vouchers, energy efficiency standards, welfare reform and the Affordable Care Act. Governors like Bill Clinton and George W. Bush leveraged their state policy successes as springboards to the Oval Office.
The problem is, just when we need their innovative energies, the states are looking less and less likely to be fountainheads of new federal policy over the next generation.

Posted Jan. 11, 2015, at 6:01 a.m.

Universal care the answer

I would like to thank columnist Matthew Gagnon for publicly acknowledging that a bad economy results in actual human suffering rather than just reduced earnings and profits in his Jan. 7 Pine Tree Politics column. With this said, now we as a state can focus on what can be done about improving our economic circumstances to help Mainers and reduce their economic dependence on government help.
To be different, Maine needs to establish a taxpayer-funded single-payer health insurance system that covers everybody in the state. The insurance should be provided by a private, established operation that is given a five-year contract with state oversight. This needs to be top-level coverage and not the high-deductible, low-coverage plans that too many people have been forced to pay for in the past.
Here are the benefits of single-payer health for our economic growth: a healthy, ready-to-work labor pool; lower operating costs and less paperwork that interfere with business; lower per-unit production costs, because health benefits are not needed (years ago, I recall reading that $2,000 of an American-made automobile’s manufacturing price is health benefits costs). Lower production costs mean competitive lower wholesale prices or increased business profits.
In addition, people and their families will be willing to move to Maine without fearing the loss of good health insurance coverage or higher costs, and Maine entrepreneurs will be willing to take business risks without having to worry about losing their current employer’s health insurance plans. The self-employed will not be burdened with health insurance paperwork and costs while trying to earn a living.
Henry Dilts
Washington

Partners woos investors amid fiscal setback

SAN FRANCISCO — It owns some of the world’s most famous hospitals and one of the leading medical research engines in the United States. But when executives of Partners HealthCare System appeared before investors here Monday, they sheepishly displayed a chart showing that the health care giant last year posted its first financial loss in 15 years.
“No chief financial officer likes to get up and show the line going [down] like that,” admitted Partners’ top finance executive, Peter K. Markell, drawing laughter from hundreds of investors attending the annual J.P. Morgan Healthcare Conference.The $22 million operating loss, driven by problems at Partners’ health insurance business, may turn out to be a temporary blip. But in recent days two Wall Street investment houses have raised concerns about the finances of the renowned organization, which runs Massachusetts General, Brigham and Women’s, and eight other hospitals, as it prepares to sell $585 million in bonds next week to finance building projects and other capital needs.
Partners is also in the midst of changing its leader. Chief executive Gary L. Gottlieb is stepping down in 2015 and was not at the J.P. Morgan presentation on Monday. And its efforts to acquire three local hospitals have been hotly contested.
Markell assured bond investors that the Partners board of directors is searching for a successor who will embrace its strategy of better coordinating care between its Boston teaching hospitals and community institutions.
“The board has begun a search process,” said Markell, who is executive vice president of administration and finance at Partners. “It’s reaffirmed our strategy and it’s looking for a CEO who will execute on that strategy.” 
If the board chooses an internal candidate, that person could be in place by mid-March, he said, adding that an external hire would probably take longer.
Moody’s Investors Service last week downgraded Partners’ bond rating, from Aa2 to Aa3, potentially increasing its borrowing costs marginally. The agency cited losses at Partners-owned Neighborhood Health System, but also alluded to uncertainty over its long-running campaign to acquire South Shore Hospital and two Hallmark Health hospitals outside of Boston, deals that are now before a state judge. A decision is expected in the next six weeks.
The downgrade “comes amidst sizable capital spending plans and expectations of weaker consolidated financial performance,” the Moody’s analysts wrote. “Other key factors behind the downgrade are heightened political and public scrutiny that may constrain the organization’s future strategic options, and several developments (both internal and externally generated) that are likely to limit Partners’ revenue growth to levels below what the organization has historically enjoyed.”

When Diabetes Treatment Goes Too Far

By KASIA LIPSKA
NEW HAVEN — ONE of my elderly patients has Type 2 diabetes and heart disease. He takes a number of medications, including insulin to control his blood sugar levels. A few years ago, he was driving when his blood sugar suddenly dropped. He felt lightheaded for a moment, and then ran into a tree.
There are roughly 11 million Americans over age 65 with diabetes. Most of them take medications to reduce their blood sugar levels. The majority reach an average blood sugar target, or “hemoglobin A1C,” of less than 7 percent. Why? Early studies showed that this can reduce the risk of diabetes complications, including eye, kidney and nerve problems. As a result, for more than a decade, medical societies, pharmaceutical companies and diabetes groups have campaigned with a simple, concrete message — to get below seven. Many patients carry report cards with their scores to clinic appointments. Doctors are often rewarded based on how many of their patients hit the target.
All of this sounds great. But, at least for older people, there are serious problems with the below-seven paradigm.
To begin with, the health benefits of this strategy are uncertain for older people. Those early studies that were the rationale for going below seven were conducted in people with Type 1 diabetes or with younger patients with newly diagnosed Type 2 diabetes. Subsequent trials of older patients raised doubts about the benefits.
Worse, targeting low blood sugar levels can cause harm. In one instance, investigators actually had to stop a trial early because patients who were targeting hemoglobin A1C levels of six or below had significantly higher rates of death than patients targeting levels in the sevens. We don’t know exactly why this happened. What we do know is that aiming for levels below seven increases the risk for “hypoglycemia,” or low blood sugar reactions. Severe reactions can result in confusion, coma, falls, fractures, abnormal heart rhythms and even death.

How Medicaid for Children Recoups Much of Its Cost in the Long Run


When advocates talk about the advantages of government health care, they often talk about a moral obligation to ensure equal access. Or they describe the immediate health and economic rewards of giving people a way to pay for their care.
Now a novel study presents another argument for the medical safety net, at least for children: Giving them health coverage may boost their future earnings for decades. And the taxes they pay on those higher incomes may help pay the government back for some of its investment.
The study used newly available tax records measured over decades to examine the effects of providing Medicaid insurance to children. Instead of looking at the program’s immediate impact on those children and their families, it followed them once they became adults and began paying federal taxes.
People who had been eligible for Medicaid as children, as a group, earned higher wages and paid higher federal taxes than their peers who were not eligible for the federal-state health insurance program. And the more years they were eligible for the program, the larger the difference in earnings.
“If we examine kids that were eligible for different amounts of Medicaid over the course of their childhood, we see that the ones that were eligible for more Medicaid ended up paying more taxes through income and payroll taxes later in life,” said Amanda Kowalski, an assistant professor of economics at Yale and one of the study’s authors.


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