‘America’s Bitter Pill,’ by Steven Brill
Why did Swiss voters reject single-payer health care?
By Claudia Chaufan, M.D.
Labor Notes, Dec. 31, 2014
Supporters of a single-payer, Medicare-for-all health care system in the U.S. were puzzled September 27 when Swiss voters rejected a reform proposal by 62 percent.
The new law would have replaced the current system, where about 60 insurance companies offer mandatory health coverage, with a single insurer, the government. It would have offered all medically necessary care, paid for by taxes adjusted to each person’s ability to pay.
To Americans who’ve worked for such a system here, nationally and state by state, it was a blow. What’s not to like about single payer?
Swiss and American media, academia, and business sectors rushed to interpret the results. Virtually all crowed that the Swiss people had rejected government-run national health insurance because they preferred private insurers.
But these convenient interpretations rely on false assumptions to justify a model of health insurance that is unraveling—less conspicuously in Switzerland, but dramatically in the U.S.
Let’s look at what’s wrong with these pro-business interpretations, and see what lessons the Swiss referendum has for single-payer advocates here.
He notes that in 1996, the Swiss voted for an individual mandate that compels everyone to buy a basic package of health services. That law eliminated discrimination for pre-existing conditions, meaning companies have to sell equal plans at equal prices to all customers. The government subsidizes low-income people. In Millman’s view, the resulting Swiss system is very much like Obamacare.
Another policy reporter, Avi Roy from Forbes, asserted that Obamacare (and Romneycare before it) was modeled on the Swiss system: people shopping among competing private plans with little government interference.
Roy says the referendum demonstrates the “political popularity” of universal coverage via private insurance. He concludes that because the Swiss have rejected single payer, there’s good reason to believe Americans will reject it, too.
http://www.pnhp.org/print/news/2015/january/why-did-swiss-voters-reject-single-payer-health-care
Labor Notes, Dec. 31, 2014
Supporters of a single-payer, Medicare-for-all health care system in the U.S. were puzzled September 27 when Swiss voters rejected a reform proposal by 62 percent.
The new law would have replaced the current system, where about 60 insurance companies offer mandatory health coverage, with a single insurer, the government. It would have offered all medically necessary care, paid for by taxes adjusted to each person’s ability to pay.
To Americans who’ve worked for such a system here, nationally and state by state, it was a blow. What’s not to like about single payer?
Swiss and American media, academia, and business sectors rushed to interpret the results. Virtually all crowed that the Swiss people had rejected government-run national health insurance because they preferred private insurers.
But these convenient interpretations rely on false assumptions to justify a model of health insurance that is unraveling—less conspicuously in Switzerland, but dramatically in the U.S.
Let’s look at what’s wrong with these pro-business interpretations, and see what lessons the Swiss referendum has for single-payer advocates here.
Mainstream Answers
Washington Post “policy wonk” Jason Millman wrote that the Swiss rejection shows that single-payer has little chance of gaining popular support in the U.S.He notes that in 1996, the Swiss voted for an individual mandate that compels everyone to buy a basic package of health services. That law eliminated discrimination for pre-existing conditions, meaning companies have to sell equal plans at equal prices to all customers. The government subsidizes low-income people. In Millman’s view, the resulting Swiss system is very much like Obamacare.
Another policy reporter, Avi Roy from Forbes, asserted that Obamacare (and Romneycare before it) was modeled on the Swiss system: people shopping among competing private plans with little government interference.
Roy says the referendum demonstrates the “political popularity” of universal coverage via private insurance. He concludes that because the Swiss have rejected single payer, there’s good reason to believe Americans will reject it, too.
What’s Wrong with the ‘Official View’?
These interpretations are based more on ideology than on facts. Why?http://www.pnhp.org/print/news/2015/january/why-did-swiss-voters-reject-single-payer-health-care
Patient, Heal Thyself
‘The Patient Will See You Now’ Envisions a New Era of Digitally Perfected Care
Dr. Eric Topol and I appear to practice medicine on two different planets. This fact makes it difficult for me to comment sensibly on his books, let alone critique them. Instead, I read along with mouth slightly agape, marveling at this missive from a far-off place whose atmosphere, physical laws and inhabitants bear no resemblance to the ones I know.
Dr. Topol is a cardiologist who directs the Scripps Translational Science Institute in La Jolla, Calif., and also serves as editor in chief of the website Medscape. His title at Scripps, “Professor of Innovative Medicine,” says it all: Like a fundamentalist preacher heralding the apocalypse, he preaches the end of medicine as we know it and the dawn of rigorous, digitally perfected, accurate and cost-effective care.
Dr. Topol’s last book, “The Creative Destruction of Medicine” (2012), described the tools of this new world, including genomic analysis, smartphone sensors and giant crowd-sourced databanks. His new book, ‘The Patient Will See You Now,” provides more detail on all of these, recapitulating pretty much all the futuristic medical chatter of the last decade. Dr. Topol’s overriding thesis is that the old days of “doctor knows best” are as good as gone. No longer will doctors control medical data, treatment or profits. Instead, thanks to the newest science, humanity will finally achieve truly democratic health care: Up with patients! “Our Bodies, Our Selves” for all!
Will Tax Season Be Obamacare's Next Big Challenge? Is There Really an Individual Mandate?
By Robert Lazewski
Will tax-filing season be the next reason for consumers to complain about the new health law? Come tax time, will the Obama administration really enforce the individual health insurance mandate?
The IRS is out with a 21-page publication––Publication 5187––describing what taxpayers need to know about Obamacare in order to file their 2014 taxes.
On page six you will find this:
So, if the taxpayer checks the box on line 61 "no further action is required"––no proof of insurance needs to be furnished. Presumably, the taxpayer is subject to an audit––from an understaffed IRS suffering from more budget cuts.
What happens if you don't check box 61? You have to pay the tax for not having health insurance.
Anyone who doesn't check that box can apply for an exemption from the individual mandate.
According to the Wall Street Journal, "The instructions for completing the mandate exemption form run 12 pages, list 19 types of exemptions (with multiple codes), and include worksheets that may require individuals to go to their state exchange's Web site to find the monthly premiums that will determine whether they had access to 'affordable coverage."
For the last year we have heard that a taxpayer that got too large a subsidy will have to pay the excess back––and a taxpayer that got too little will get a refund. How will this be reconciled? The directions for doing this fill up pages 10 to 15 in IRS Publication 5187 and explain how Form 8962 must be prepared.
Anyone who got an Obamacare insurance subsidy in 2014 must complete Form 8962. Here below is Form 8962.
Luckily, the President never said, If you like your Form 1040EZ you can keep your Form 1040EZ!
The IRS is out with a 21-page publication––Publication 5187––describing what taxpayers need to know about Obamacare in order to file their 2014 taxes.
On page six you will find this:
So, if the taxpayer checks the box on line 61 "no further action is required"––no proof of insurance needs to be furnished. Presumably, the taxpayer is subject to an audit––from an understaffed IRS suffering from more budget cuts.
What happens if you don't check box 61? You have to pay the tax for not having health insurance.
Anyone who doesn't check that box can apply for an exemption from the individual mandate.
According to the Wall Street Journal, "The instructions for completing the mandate exemption form run 12 pages, list 19 types of exemptions (with multiple codes), and include worksheets that may require individuals to go to their state exchange's Web site to find the monthly premiums that will determine whether they had access to 'affordable coverage."
For the last year we have heard that a taxpayer that got too large a subsidy will have to pay the excess back––and a taxpayer that got too little will get a refund. How will this be reconciled? The directions for doing this fill up pages 10 to 15 in IRS Publication 5187 and explain how Form 8962 must be prepared.
Anyone who got an Obamacare insurance subsidy in 2014 must complete Form 8962. Here below is Form 8962.
Luckily, the President never said, If you like your Form 1040EZ you can keep your Form 1040EZ!
Food aid to 249,000 Mainers at risk in DHHS fight with feds over photo IDs
by Mario Moretto - Bangor Daily News
AUGUSTA, Maine — Roughly 249,000 Mainers who receive federal food assistance could see that aid vanish if a dispute between state and federal agencies over a new program that urges recipients to put their photos on their benefit cards is not resolved.
Food and Nutrition Service — the U.S. Department of Agriculture agency which has oversight of the federal Supplemental Nutrition Assistance Program, commonly known as food stamps — says several changes are necessary to Maine’s new photo ID requirement to keep it from running afoul of federal guidelines.
The agency also says current implementation of the photo ID component could represent a civil rights violation.
Maine administers SNAP on behalf of the federal government, which funds the entire cost of benefits and roughly half the costs to run the program. Food and Nutrition Service has threatened to pull its share of administrative funding, roughly $8.9 million, if Maine does not change the photo ID policy to meet its requirements. The agency has stressed that it would not pull funding for SNAP benefits.
Still, Department of Health and Human Services Commissioner Mary Mayhew has said the state will continue the photo ID program, and said Monday that if the federal government curtails administrative funding, the state could stop administering the program altogether.
“If the federal government takes a financial action against us that is baseless, we will have to question our ability to administer the program,” Mayhew said in an interview.
When asked who would administer SNAP if Maine dropped the program, Mayhew said, “the federal government would have to figure out another way. We simply cannot replace federal funding with state funding.”
However, one expert on SNAP said that if the state stopped running the program, it’s likely food assistance in Maine would stop flowing entirely.
Latest Republican tweak of Obamacare draws fire on both sides
Posted Jan. 06, 2015, at 3:07 p.m.
WASHINGTON — The first congressional Republican attempt to weaken Obamacare with legislation boasting Democratic support appeared to be headed for troubled waters on both sides of the partisan aisle on Tuesday, only days before an expected vote.
The bill, introduced in the U.S. House of Representatives, seeks to reduce the law’s burden on companies by requiring them to offer private health coverage to full-time employees who work 40 hours a week rather than the 30 hours stipulated by President Barack Obama’s Affordable Care Act.
A House vote is expected Thursday. Companion legislation is due to be introduced in the Senate on Wednesday by U.S. Sens. Susan Collins, R-Maine, and Joe Donnelly, D–Indiana, according to a news release from Collins’ office.
A Republican Senate aide said no Senate vote is scheduled, while a second aide said much of the party’s Obamacare strategy will be ironed out at next week’s Republican retreat for House and Senate members.
But congressional aides, lobbyists and analysts say the measure represents the opening salvo for a Republican strategy to tweak Obamacare by altering or repealing narrow segments of the law that are unpopular with Republicans and some Democrats. Those include taxes on medical devices and health insurers, as well as penalties that await businesses and individuals who fail to comply with insurance requirements.
Republican aides say the aim is to produce “bipartisan” bills that Obama might sign into law. But White House officials said the president, who threatened to veto an identical House measure last year, is likely to issue a new veto threat this week.
The 40-hour focus has also stirred misgivings among some conservative commentators. Both sides warn that pegging employer coverage to a 40-hour week would put more workers at risk for reduced hours.
Maine to fill funding gap in Medicaid payments to physicians
The state will spend $7.8 million to cover federal cuts in reimbursements to doctors who treat MaineCare patients.
Maine will spend $7.8 million to cover federal cuts in reimbursements to doctors treating MaineCare patients.
More than 500 physicians won’t face reductions in MaineCare reimbursement rates despite cutbacks in federal funding, LePage administration officials said, because keeping rates at current levels is part of the state’s strategy to invest in primary care.
Maine will spend an extra $7.8 million annually to make up for lost federal funding in two programs, administration officials said.
An extra $2.9 million in state money will keep MaineCare doctor reimbursement rates from being reduced, and another $4.9 million for a separate MaineCare program will boost reimbursement rates for about 200 physician practices. Details will be unveiled when the administration releases its two-year, 2015-17 budget on Friday.
“We believe in, and see the value of, a strong primary care system,” said Mary Mayhew, health and human services commissioner. “We are building this into the budget for the long term.”
That means a doctor who had been receiving $100 for an office visit for a MaineCare patient in 2014 will still be paid that $100 in 2015, despite the federal reduction in reimbursement rates. If Maine had not filled the gap, the doctor’s reimbursement for the same patient visit would have been about $67.
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