What Happened in Vermont: Implications of the Pullback from Single Payer
By Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D.
Gov. Peter Shumlin’s Dec. 17, 2014, announcement that he would not press forward with Vermont’s Green Mountain Care (GMC) reform arose from political calculus rather than fiscal necessity. GMC had veered away from a true single payer design over the past three years, forfeiting some potential cost savings. Yet even the diluted plan on the table before Shumlin’s announcement would probably have lowered total health spending in Vermont, while covering all of the state’s uninsured.
Background
Decades of exemplary grassroots organizing (and strong labor union support) in Vermont put single payer on the agenda. During Shumlin’s 2010 gubernatorial campaign, he promised to implement a single payer reform, which was a factor in the Progressive Party’s decision not to field a candidate. But the details of Shumlin’s plan weren’t fleshed out during the campaign.
After his victory, Shumlin and the legislature commissioned economist William Hsiao to study options for health reform in Vermont, including single payer. Rejecting a fully public single-payer plan, Hsiao instead proposed a “public-private hybrid” model and projected $580 million in savings, including large administrative cost savings, in the program’s first year.
Spurred by Hsiao’s positive projections, in 2011 the legislature passed a health reform law that laid out plans for implementing the Affordable Care Act in the short term, and called for a later transition to a single payer GMC plan. But while the law gave a detailed prescription for implementing the ACA (including construction of an exchange whose final cost was about $250 million), the sections on single payer were vague, and punted decisions on critical issues to the GMC Board to be appointed by the governor. That board would determine whether critical services like long-term care would be covered; the amount of copayments; how hospitals and doctors would be paid; and whether capital funds would be folded into operating budgets or allocated through separate capital grant (the sine qua non of effective health planning). Critically, the bill included no plan for funding the single payer program.
An early signal of trouble was Shumlin’s appointment of Anya Rader Wallack to chair the new GMC board. Wallack had deep ties to the private insurance industry, having held key positions (including the presidency) at the Blue Cross Blue Shield of Massachusetts Foundation. That foundation played a central role in designing and pushing for Massachusetts’ 2006 Romneycare reform, and subsequently issued a series of glowing evaluations of Romneycare that helped buttress the case for replicating its structure in the ACA.
By Steffie Woolhandler, M.D., M.P.H., and David U. Himmelstein, M.D.
Gov. Peter Shumlin’s Dec. 17, 2014, announcement that he would not press forward with Vermont’s Green Mountain Care (GMC) reform arose from political calculus rather than fiscal necessity. GMC had veered away from a true single payer design over the past three years, forfeiting some potential cost savings. Yet even the diluted plan on the table before Shumlin’s announcement would probably have lowered total health spending in Vermont, while covering all of the state’s uninsured.
Background
Decades of exemplary grassroots organizing (and strong labor union support) in Vermont put single payer on the agenda. During Shumlin’s 2010 gubernatorial campaign, he promised to implement a single payer reform, which was a factor in the Progressive Party’s decision not to field a candidate. But the details of Shumlin’s plan weren’t fleshed out during the campaign.
After his victory, Shumlin and the legislature commissioned economist William Hsiao to study options for health reform in Vermont, including single payer. Rejecting a fully public single-payer plan, Hsiao instead proposed a “public-private hybrid” model and projected $580 million in savings, including large administrative cost savings, in the program’s first year.
After his victory, Shumlin and the legislature commissioned economist William Hsiao to study options for health reform in Vermont, including single payer. Rejecting a fully public single-payer plan, Hsiao instead proposed a “public-private hybrid” model and projected $580 million in savings, including large administrative cost savings, in the program’s first year.
Spurred by Hsiao’s positive projections, in 2011 the legislature passed a health reform law that laid out plans for implementing the Affordable Care Act in the short term, and called for a later transition to a single payer GMC plan. But while the law gave a detailed prescription for implementing the ACA (including construction of an exchange whose final cost was about $250 million), the sections on single payer were vague, and punted decisions on critical issues to the GMC Board to be appointed by the governor. That board would determine whether critical services like long-term care would be covered; the amount of copayments; how hospitals and doctors would be paid; and whether capital funds would be folded into operating budgets or allocated through separate capital grant (the sine qua non of effective health planning). Critically, the bill included no plan for funding the single payer program.
An early signal of trouble was Shumlin’s appointment of Anya Rader Wallack to chair the new GMC board. Wallack had deep ties to the private insurance industry, having held key positions (including the presidency) at the Blue Cross Blue Shield of Massachusetts Foundation. That foundation played a central role in designing and pushing for Massachusetts’ 2006 Romneycare reform, and subsequently issued a series of glowing evaluations of Romneycare that helped buttress the case for replicating its structure in the ACA.
Economist Responds to Gov. Shumlin
Dec 19, 2014 — Thank you for supporting the movement to win healthcare as a human right in Vermont! I want to share with you a response from economist Gerald Friedman, who has authored economic studies of HR676 as well as almost a dozen state single-payer proposals.
Professor Friedman argues that Gov. Shumlin's single-payer paralysis is due to politics - not economics. The costs that Gov. Shumlin released, which he claims are unaffordable for Vermonters, are less than 4% higher than those originally projected by the William Hsiao study released in 2011, and they are lower than what Vermonters currently pay to private insurers. Read Professor Friedman's analysis and lessons for the movement here:
Professor Friedman argues that Gov. Shumlin's single-payer paralysis is due to politics - not economics. The costs that Gov. Shumlin released, which he claims are unaffordable for Vermonters, are less than 4% higher than those originally projected by the William Hsiao study released in 2011, and they are lower than what Vermonters currently pay to private insurers. Read Professor Friedman's analysis and lessons for the movement here:
Professor Friedman Responds to Gov. Shumlin’s Single-Payer Paralysis
Gerald Friedman is Professor of Economics at the University of Massachusetts – Amherst. He has authored half-a-dozen economic analyses of state-single payer proposals, as well as a report on HR676, the national single-payer legislation sponsored by Rep. John Conyers. Below is Professor Friedman’s analysis of Governor Peter Shumlin’s announcement that single-payer reform is too expensive for taxpayers in Vermont, and that now is “not the time” to move ahead with reform in the state:
Less has changed in the economics of Vermont single payer than in the politics.
Assuming large administrative savings, Hsiao-Gruber had estimated that a single-payer program with comprehensive benefits (like the 94% actuarial value in the Governor’s statement) would require payroll tax of about 17% in 2017 to raise $2.7 b. Last year, I estimated that a single payer plan with a comprehensive package and administrative savings like those of Hsiao-Gruber would require a payroll tax of 10% and a tax on dividends, rents, profits of 10%; without the tax on non-wage income, it would require a payroll tax of 16%. My proposal (back-of-the-envelope) anticipated raising $2.3 b in 2015 and $2.5 b in 2017.
The Governor’s report discounts administrative savings by an unspecified amount, and anticipates less federal support than previous Green Mountain Care reports, albeit more than I had anticipated. It concludes that in 2017 the program would require $2.8 b to be raised from a payroll tax of 11.5% and a sliding scale income tax. While $300 million more than I would expect from my funding plan and $100 million more than Hsiao-Gruber anticipated. The Governor is abandoning Vermont’s single payer plan because it is slightly more expensive than expected.
The Governor also mentions various unspecified transition costs, notably the need to give discounts to small businesses during the transition. No details are given but there is talk of added costs of $500 m. While these would add 3-4 percentage points to the needed tax rate, they would also be savings in reduced payroll taxes to some Vermonters; while throwing around large numbers gives the Governor more political cover, these expenses are a wash economically.
The Governor’s decision is political not economic.
Since his election, he has avoided discussing financing and the need for a very large increase in state taxes to fund an enormous government program. He did nothing to prepare the public for a program that would replace larger private insurance premiums with smaller taxes.
Lessons for our movement.
Lessons On The Struggle For Health Care As A Human Right
By Margaret Flowers, M.D.
For decades healthcare advocates in the state of Maryland worked with state senator Paul Pinsky who introduced a state health bill each year calling for a universal healthcare system that is publicly financed, a single payer system. Even when advocates educated lawmakers, gathered co-sponsors and testified in committees about the dire need for a health system that would solve the current healthcare crisis, one based on solid evidence, the bill fell flat. The closest we came was one vote short of getting it passed in one committee. We had all of the facts on our side, but no political muscle to move the bill.
The people in Vermont took a different approach starting in 2009, and we in Maryland have since followed their lead. The Vermont Workers’ Center and allies started by first building the grassroots movement necessary to provide that muscle. They focused on educating people throughout the state and used a human rights framework to do that.
After years of work to elect a favorable governor, pass legislation and implement it, the people of Vermont were recently spurned by Governor Peter Shumlin when he announced that the state would not go ahead with the health law as planned. This turn of events provides an important lens for examining what happened in the advocacy for health reform and what must be done now. The fight for universal healthcare has been going on for a century in the US and it is certainly not over because of Shumlin’s failure.
I want to say from the beginning that I applaud the people of Vermont. Hindsight is always clearer. The groups on the forefront of this struggle face many critical issues that need attention and lack adequate resources as it is for most groups that are working to change the system. So this article is not a criticism of them, but rather an analysis of the situation and what we can learn from it for current organizing efforts throughout the US as well as next steps in Vermont.
Human Rights Framework is Necessary
There has been hesitancy by some health reform advocates to embrace the human rights framework for single payer organizing. However, the human rights framework is necessary for organizing on all of the social, economic and environmental justice issues that are in crisis today. It helps us see that all of our issues are connected, know when our human rights are being violated and advocate for changes that respect all of our rights.
Many in the US don’t understand that they have human rights, let alone that their rights are being violated. The human rights framework is based on five core principles. Put simply, they are universality, that all people are included; equity, that all are able to participate; transparency, that all have access to information; accountability, that those who make decisions answer to the people; and participation, that all are able to participate in the process. It is the government’s responsibility to guarantee our human rights.
Once we have this understanding of our rights, we see the violation of our human rights across a broad sector of issues whether it is the right to housing, education, a job with a living wage, healthcare, clean water and air or other rights. Then we can look more deeply to understand why these rights are being denied and that there are systemic root causes that are the same for all of these issues. All of our struggles face the same obstacles of monstrous industries that are driven by profit through exploitation of people and the planet and that control not only the lawmakers but in most areas, the method by which they are elected.
Several studies were released last year documenting that public policy reflects the desires of the wealthy rather than the needs of the majority of people. We are facing a crisis of democracy. It will take all of us working together strategically to overcome these obstacles and shift the balance of political power to respect our rights.
The human rights framework teaches us that we cannot accept that rights are respected for some and not for others. A core principle is universality. For example, a health law that gains access to care for some but leaves others out does not fulfill the criteria. The human rights framework prevents the tried-and-true tactic of ‘divide and conquer’. It requires that our work is not done until we all have the same rights.
This human rights framework is especially relevant when it comes to health. The US spends the most per capita on health care in the world but our health outcomes are relatively poor. If our goal is a healthier population, then we must recognize that our fight is not only for access to health care, but is also for quality education, housing, a healthy environment, an end to systemic racism and all of the factors that constitute the social determinants of health.
And not only do we need to include all of these factors in our ultimate goal of health, but to succeed in changing the system we need to build a movement of movements that has the political muscle to overcome the for-profit health institutions that are heavily invested in maintaining the status quo. The healthcare movement needs to collaborate with those who are fighting for other rights.
Beyond the Human Rights Framework We Need Clarity
http://www.pnhp.org/print/news/2015/january/lessons-on-the-struggle-for-health-care-as-a-human-right
Three Vermonters respond to Gov. Shumlin’s decision on health reform
PNHP note: The following opinion pieces are from three prominent figures in the health reform movement in Vermont.
Shumlin never said ‘never’
By Terry Doran
VTDigger, Dec. 22, 2014
VTDigger, Dec. 22, 2014
It’s no surprise that Gov. Shumlin decided against presenting a financing plan for a universal health care system to the Legislature. Practically speaking, the numbers were unfavorable. Politically speaking, the Legislature’s mood was unfavorable.
Those of us who have long advocated for a publicly financed single payer universal health care system – often referred to somewhat inaccurately as a single payer system — and who attended the governor’s announcement did not hear him say the word “never,” or that Act 48 – the enabling law passed three years ago by many of the same legislators – is dead.
It will be interpreted that way. Funeral orations are being declaimed all over the state, and nation. But are they right? We think not for at least three reasons.
The first one is: high-quality, affordable health care for all (not just some) Vermonters depends entirely on a system of health care services that are financed by money collected from the public and managed in the public’s name. Opponents of this idea – and there are many from the purely self-interested to the ideologically motivated – can offer no workable alternative. Nearly every other country in the world does it this way, not in far-fetched theory but in practice. And it costs them about half of what it costs us and they generally get better health outcomes than we do.
So, to continue the first reason: For more than 30 years Vermont Legislatures have pursued the moral principle of high-quality, affordable health care for all (not just some) Vermonters without getting there. They’ve tried almost everything, under the guise of “coverage,” and still haven’t made it. Perfectly reasonable expectations tell us that eventually costs will compel adoption of a publicly financed system, or we will experience the slow-motion collapse of our health care services.
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We must keep trying
By Peter Sterling
Rutland (Vt.) Herald, Dec. 21, 2014
Rutland (Vt.) Herald, Dec. 21, 2014
The governor shocked the political world this past Wednesday by announcing his administration is no longer supporting a tax package to publicly finance health care.
The plan had been to eliminate insurance companies and the roughly $3 billion we Vermonters pay them each year in the form of deductibles, premiums, co-pays, etc., with an approximately $2 billion package of taxes to fund the nation’s first universal health care system. I truly believe the governor and his team left no stone unturned in their effort to develop a financing package for this new system that was workable.
But before I go into the details of the governor’s decision, it’s important to remember the most important reason why we must change the way we pay for health care — it has been, and always will be, about people. Every one of us — healthy, sick, young or old, rich or poor, employer or employee — is affected by the high cost of health care. And there are many reasons one could identify, but the main culprits are the lower wages we are paid at work to offset our employers’ rising health care premiums, the debt from unpaid medical bills and increased taxes to pay for the almost 50 percent of us already receiving some sort of publicly financed health care.
According to the last estimate, there are about 40,000 uninsured Vermonters, people living a single accident or unexpected illness away from financial catastrophe. There’s a reason that unpaid medical bills are the No. 1 reason for bankruptcy in our country. They add up fast. Even having insurance in today’s world is no guarantee of being free from harm. For example, nationally more than 100,000 people diagnosed with cancer file for bankruptcy every year despite being insured.
The Time magazine article “Bitter Pill: Why Medical Bills Are Killing Us” has one of the many examples of how outrageous payment for care under the current system is. According to the article, it was standard practice, and fully legal, for a hospital in Connecticut to mark up many times over what it charges patients for a variety of standard medical supplies such as $18 each for 88 diabetes-test strips that Amazon sells in boxes of 50 for $27.85.
And Vermont Health Connect, the health care exchange, mandated by Obamacare, doesn’t go nearly far enough to make health care truly accessible and affordable for low and middle-income Vermonters. For starters, its open enrollment period is only three months long. After that, you need a special qualifying event to get insurance. And as an example of its high costs, take a couple whose gross income is $47,000 a year who buys the most common plan. They are still on the hook for more than $11,000 every year in premiums, deductibles, etc., before insurance will cover all of their medical bills.
So what does all of this have to do with the governor’s decision to halt his pursuit of a universal, publicly funded health care system? Pretty much everything. Without a universal system, it is going to be nearly impossible to make sure people can actually afford the care they need, when they need it while truly reining in the rising cost of health care.
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Single payer is not dead
By Deb Richter, M.D.
Rutland (Vt.) Herald, Dec. 21, 2014
Rutland (Vt.) Herald, Dec. 21, 2014
I moved to Vermont more than 15 years ago to practice medicine and to engage in an educational, and ultimately political effort to achieve universal, publicly funded health care in one small state. The prospect of such reform happening at the federal level had always seemed very dim. The prospect just got dimmer in Vermont, but I am not giving up.
I am a primary-care physician. I help my patients to the extent I can, but there is little I can do when someone can’t afford their prescriptions or their surgery or their specialty care. Long ago, I realized I could not be true to my calling and merely witness health care injustice; I also had to be an agent for change. Thankfully I found many people in Vermont who believed as I did.
One of those people was Peter Shumlin. He had co-sponsored one of the first single-payer bills to be considered in the Legislature, and he was intensely interested, as I was, in figuring out the nuts and bolts of moving from our complex, wasteful and unfair nonsystem to something more akin to the successful health care programs in developed countries around the world.
Without Gov. Shumlin’s bold leadership I am sure we would not have passed Act 48 — the landmark 2011 legislation that laid the framework for Green Mountain Care. The only missing pieces were the benefit package, the financing mechanism, and a federal waiver, all to be put in place for a 2017 launch date.
Now, we are facing a political reality that makes passage of a financing package all but impossible in the near term. The governor and his team made a valiant attempt to devise something that legislators would approve, but in the end, I think they realized that even their best efforts would not create the political will to shift so much money from insurance premiums and out-of-pocket expenses to public revenue.
When I heard the governor’s announcement that for the time being he was pulling the plug on single payer, I was disappointed, but I was not surprised. For the past few years, I’ve watched a growing torrent of narrow-minded, cynical and misinformed attacks on the single-payer concept, and I’ve been dismayed to hear so many mean-spirited attacks on the governor’s character and motives.
Therefore, I do not fault Shumlin for his decision as much as I fault the vested interests that fought so hard against the idea that providing health care to all people is worthy of public finance. These vested interests include institutions with a commercial interest in health care, out-of-state PAC money and large businesses too miserly to provide decent health care to their employees or to pay a tax for that purpose.
Also at fault is our apathy as voters, our disengagement from meaningful political discourse, and our lack of appetite for change, even when change is sorely needed. I must also mention the media, which in its zeal to hold the governor accountable, often seemed to be adding to the drumbeat of the doubters.
'We Won't Back Down': Vermonters Launch Sit-In At Statehouse Demanding Universal Health Care 'Now!'
Burned by governor, protesters occupy House Chamber, saying they will not leave until Green Mountain Care law respected
Protesters occupied the chambers of the Vermont Statehouse Thursday afternoon, saying they refuse to leave until legislators meet their demands to respect the first-ever U.S. law for universal, publicly-funded health care, won by grassroots movements nearly four years ago yet stymied by the governor last month.
The demonstration is a response to the mid-December announcement by Vermont Governor Peter Shumlin that he seeks to unilaterally abandon the universal health care plan, passed into law in 2011 under Act 48 and named Green Mountain Care, even though the governor used the groundbreaking legislation to bolster his election.
Timed to coincide with Shumlin's re-inauguration, Thursday's sit-in—still ongoing at the time of publication—was staged by approximately 30 people, with "many supporters" rallying nearby, Keith Brunner of the Vermont Workers' Center, the organization that coordinates the state-wide "Health Care Is A Human Right" campaign, told Common Dreams over the phone.
"I am here because it is a human right to have health care," Skyler Wind, a member volunteer of the Vermont Workers' Center, told Common Dreams over the phone from the protest. "We all deserve to be treated the same way."
Wind explained she is a single mom living with disability, with a disabled child, in extreme poverty. "Too many poor people like myself, we're the ones whose teeth are falling out, whose cancers are discovered too late," she said. "Those like me, who are so-called 'welfare queens,' can't afford co-pays and have to mess around with medication. Why can't my son—why can't I—get care when we need it?"
Immediately preceding the occupation, nearly 200 protesters had filled the halls of the statehouse, singing, "We have come too far, we won't back down. We'll flood these halls with justice, the time is Now!"
"Respect Our Universal Health Care Law"
Act 48, which is requires the full implementation of universal, publicly-funded health care in Vermont by 2017, has already suffered a series of delays since it was passed in 2011. The state legislature was set to decide on a financing plan for the bill in 2015, but in mid-December, Shumlin announced he would no longer move forward on the law, citing economic reasons. "In my judgment, now is not the right time to ask our Legislature to take the step of passing a financial plan for Green Mountain Care," he said.
But it took Vermonters years to build a state-wide movement strong enough to pass Green Mountain Care, and grassroots organizations vow that they refuse to "acquiesce to this undemocratic decision," and in fact, will make their voices louder. The past few weeks have seen organizing drives, protest letters, and even a symbolic mass burning of medical bills in front of the Vermont statehouse to illustrate exactly what's at stake in a state where poverty is on the rise and incomes are falling.
"The health care crisis and economic crisis that so many poor and working class people in Vermont are facing hasn't changed," said Brunner. "The governor, for his own reasons, made the decision to throw in the towel. It was a political decision he framed as an economic decision. He is unwilling to have big businesses and wealthy individuals pay their fair share for health care."
An open letter delivered to state lawmakers earlier Thursday reads, "The Healthcare Is a Human Right Campaign asks all of our legislators to respect Act 48, our universal health care law, to review the governor’s report on Green Mountain Care (GMC) financing, and to develop plans for moving forward with equitable, public financing. This process must happen in a transparent and participatory way, unlike the governor’s discussions behind closed doors."
State-Wide Fight With Nation-Wide Relevence
Nationwide, eyes are on the Vermont fight, which has inspired similar organizing drives, from Maryland to Maine, to build popular movements, anchored in human rights principles, to win publicly-funded, single-payer health care for all people, regardless of income or documented status. A report released last summer by the Commonwealth Fund found that the U.S. health care system is the most costly in the world yet provides the worst care of 11 industrialized nations, adding fuel to charges that the for-profit U.S. health system is failing.
More than 50 organizations from across the country, including Grassroots Global Justice Alliance and Jobs With Justice, signed an open letter which was released Thursday and declares, "Governor Shumlin’s announcement is a blow not only for the determined people of Vermont but also for those who looked with hope and renewed energy at the successful effort to advance publicly financed, single-payer healthcare and to create a more just society."
"Now is not the time to give up or give in," the letter continues. "The people of Vermont can and will have the final say in how to establish and pay for a healthcare system that will serve all of their needs, rather than the profits of a few."
http://www.commondreams.org/news/2015/01/08/we-wont-back-down-
vermonters-launch-sit-statehouse-demanding-universal-health-care
vermonters-launch-sit-statehouse-demanding-universal-health-care
Why Vermont Failed to Enact Single Payer?
By Samuel Metz, M.D.
OPINION -- Drawing unwanted national attention to his tiny state, Governor Peter Shumlin pronounced Vermont’s quest for universal health care Dead On Arrival. This statement broke the hearts of activists who previously cheered passage by the 2011 Vermont legislature of Act 48, the first step toward America’s first statewide universal care plan.
But this collapse was no ordinary failure. It was not a failure of universal care, or of single payer, or even of Gov. Shumlin himself. This was a spectacular failure of a very different nature, and one with valuable lessons for Oregon. But we must learn the right lessons, not the wrong ones.
The Wall Street Journal called this a failure of universal care to reduce costs. Not true. Not only was the universal plan never implemented, all predictions in Vermont’s universal care study, prepared at the request of the legislature by Dr. William Hsiao, remain valid. Regardless of costs, universal care in Vermont would still provide better care to more people for less money. Dr. Hsiao’s conclusions are corroborated by more than two dozen other studies in 14 states that come to the same conclusion.
Megan McArdle of Bloomberg View called this a single payer failure. But this was not a single payer failure because Vermont did not enact single payer. Vermont made a valiant effort to provide universal health despite many federal laws, including Medicare, ERISA, and the Affordable Care Act, that make single payer impossible in any state. Instead, Vermont created a work-around in which Green Mountain Care, the proposed state health care program, would have included less than 60% of its population; Vermont’s proposal included multiple payers, not just the state single payer.
James Haslam, executive director of the Vermont Workers' Center and a respected leader in Vermont’s campaign for universal care, labeled this as Gov. Shumlin’s failure. But as tempting as it is to blame the messenger, this failure was not Gov. Shumlin’s. Governors do not enact legislation; legislatures enact legislation. Vermont’s 2011 legislature dared to establish a universal care plan, but it left enactment of the taxes to fund that care to the 2012 legislature. The 2012 legislature left the task to the 2013 legislature. The 2013 legislature left the task to the 2014 legislature. When the 2014 legislature left the task for the 2015 legislature, Gov. Shumlin did not need a Hebrew prophet to read the writing on that wall. He simply stated the obvious: No Vermont legislature in the foreseeable future would take that responsibility. He pronounced the death; he did not kill the patient.
Whining Harvard Professors Discover Obamacare
by Megan McArdle
"Deplorable, deeply regressive, a sign of the corporatization of the university." That's what Harvard Classics professor Richard F. Thomas calls the changes in Harvard's health plan, which have a large number of the faculty up in arms.
Are Harvard professors being forced onto Medicaid? Has their employer denied coverage for cancer treatment? Do they need to sign a corporate loyalty oath in order to access health insurance? Not exactly. But copayments are being raised and deductibles altered, making their plan ... well, actually, their plan is still extraordinarily generous by any standard:
The university is adopting standard features of most employer-sponsored health plans: Employees will now pay deductibles and a share of the costs, known as coinsurance, for hospitalization, surgery and certain advanced diagnostic tests. The plan has an annual deductible of $250 per individual and $750 for a family. For a doctor’s office visit, the charge is $20. For most other services, patients will pay 10 percent of the cost until they reach the out-of-pocket limit of $1,500 for an individual and $4,500 for a family.
The deepest irony is, of course, that Harvard professors helped to design Obamacare. And Obamacare is the reason that these changes are probably necessary.
Harvard is Exhibit A on why health reform is so challenging
January 6, 2015 at 10:00 am
Adrianna McIntyre
Robert Pear’s piece on Harvard’s tweaks to their health benefits—and the subsequent faculty “uproar”—has thoroughly made the rounds on the health policy blogosphere. For those of you who missed it, the university is going from one incredibly generous benefits package to a new benefits package that is still incredibly generous by any conventional standard:
The university is adopting standard features of most employer-sponsored health plans: Employees will now pay deductibles and a share of the costs, known as coinsurance, for hospitalization, surgery and certain advanced diagnostic tests. The plan has an annual deductible of $250 per individual and $750 for a family. For a doctor’s office visit, the charge is $20. For most other services, patients will pay 10 percent of the cost until they reach the out-of-pocket limit of $1,500 for an individual and $4,500 for a family.
The story is vague about the previous cost-sharing was, but various faculty—none of whom are the same faculty that advised on health reform, a point that seems waved aside in some of the glee from opponents—labeled the move “deplorable, deeply regressive, a sign of the corporatization of the university” and “equivalent to taxing the sick.” The comments, though doubtless sincere, seem oblivious to realities of health care trends. Two papers in this month’s issue of Health Affairs key in on growth in out-of-pockets spending before the ACA. These days, four in five workers have plans that require meeting a deductible before coverage kicks in, and the number of employees enrolled in plans with deductibles exceeding $1,000 (four times the new Harvard deductible) has grown from 10% in 2006 to 41% in 2014, at a pretty linear pace.
But not all deductibles are created equal: there’s a chasm between employer-sponsored coverage and the individual market. Jason Millman illustrates this usefully chart comparing Harvard’s new deductible against industry averages in his story. Lumping all employers together, though, obscures differences by firm size, differences that could have important political implications.
The Bitter Truth: Brill's 'Bitter Pill' Changed Nothing.
It takes the average person about seven minutes to read a 1,600-word blog post.
"Bitter Pill: Why Medical Bills Are Killing Us" -- Steven Brill's opus on the U.S. health care system -- clocks in at 24,000 words.
Do the math.
Yes, "Bitter Pill" asked a lot of its readers. But it delivered, too: For millions of Americans, the lengthy Time story was their first crash-course in health care finances.
And that was a key reason why the February 2013 article was "one of the most important stories of the decade," proclaimed Don Berwick, the outspoken ex-head of CMS.
"If this [had] appeared in a newspaper, it would be a heavy favorite for a Pulitzer Prize," predicted Paul Raeburn, the media critic for MIT's Knight Science Journalism program. "And it should win a National Magazine Award."
(One year later, it did.)
Brill is back, with a brand-new, book-length version of "Bitter Pill" that he promises will offer "much more" detail about the failings of American health care by focusing on the Affordable Care Act.
And the national media this week is treating Brill like a conquering hero, offering him:
- Lengthy interviews on NPR's "Fresh Air," Jon Stewart's "The Daily Show," CBS' "This Morning," and more;
- The cover of next week's New York Times "Book Review"; and
- Even the lead headline of Politico's morning "Playbook" email.
But is the attention deserved? For all its words -- for all its acclaim -- did the original "Bitter Pill" actually change anything?
"I am not sure it did," Princeton economist Uwe Reinhardt says now.
"Nothing shocks anyone anymore about U.S. health care, even the shocking stories that Brill told in his inimitable style."
What Brill's Story Told
Health-Law Suit Hints at G.O.P. Divide
Skip Your Annual Physical
by Ezekial Emanuel
WE all make resolutions and promises to live healthier and better lives, to make the world a better place. Not having my annual physical is one small way I can help reduce health care costs — and save myself time, worry and a worthless exam.
Around 45 million Americans are likely to have a routine physical this year — just as they have for many years running. A poke here, a listen there, a few tubes of blood, maybe an X-ray, a few reassuring words about diet, exercise and not smoking from the doctor, all just to be sure everything is in good working order. Most think of it as the human equivalent of a 15,000-mile checkup and fluid change, which can uncover hidden problems and ensure longer engine life.
There is only one problem: From a health perspective, the annual physical exam is basically worthless.
Patients Seek ‘Right to Try’ New Drugs
Obamacare penalties, payouts ahead for many tax filers
CHAD TERHUNE
CHAD TERHUNE
Uncle Sam could take a bigger bite at tax time for consumers who received too much government help last year with their Obamacare premiums.
That may be just one of several surprises for millions of Americans in advance of the first tax deadline involving the Affordable Care Act.
The majority of Americans who get their health insurance at work should see few changes when filing their taxes. Most will just need to check a box on their tax return indicating they had coverage in 2014.
It stands to be more complicated for those individuals who purchased a private health plan in government-run exchanges or went without insurance at some point last year.
Obamacare launched a year ago, but it's only now that people will incur tax penalties for being uninsured. Others will realize their federal premium subsidy was incorrect.
Experts project that 40% to 50% of families that qualified for financial assistance might have to repay some portion because their actual household income for 2014 was higher than what they estimated during enrollment.
Those repayments could range from a relatively small amount to thousands of dollars in some cases. In California, some of the first clues may emerge later this month when the state issues tax notices to 1 million consumers.
About 85% of the roughly 7 million Americans who signed up last year through government-run exchanges paid discounted premiums thanks to subsidies.
Since Obamacare, L.A. County ER visits show hospitals in 'state of flux'
key measure of hospital emergency room use in Los Angeles County shows continued growth during the first six months of Obamacare, but also points to shifting patterns of where patients are choosing to receive urgent medical treatment.
With the healthcare expansion last year, many are watching how the Affordable Care Act affects emergency room use.
President Obama has promised his signature health law will gradually reduce expensive ER visits as access to other kinds of care is expanded. Critics contend newly insured patients — especially those enrolled in Medi-Cal, the state's low-income health program that picks up most patient costs — aren't likely to seek care elsewhere, and will overwhelm emergency rooms.
Neither of those outcomes were clearly evident in the first months of the new healthcare system's operation in Los Angeles County, according to a Los Angeles Times analysis.
Data hospitals report to the state show that as insurance coverage was extended to hundreds of thousands of residents, ER visits for ailments not serious enough to require an admission grew 3.9% in the county in the first half of 2014, compared with the same period the previous year. The growth is in line with annual increases of 3% to 5% in the three years prior to the federal healthcare overhaul.
Despite little rise in overall emergency room use, the analysis found some significant changes in the distribution of those outpatient ER visits.
The county's three large public hospitals, which historically have cared for many uninsured patients, recorded a 9% drop in such cases. At the same time, several private hospitals reported double-digit percentage increases in outpatient visits, the analysis found.
What the uneven and changing usage patterns mean — and whether they signal the beginning of a long-term rearrangement of how patients will seek treatment — is not yet clear.
A just, healthy society can’t be based on corporate profits
Posted Jan. 11, 2015, at 9:11 a.m.
The nationwide die-ins following recent grand jury decisions may well be what’s to come, once people realize we all, white and black, liberal and conservative, Democrat and Republican, are being screwed alike by the wealthy and powerful elite.
The poorest in our society are lashing out at a system that oppresses them — instinctively at stores, malls and transportation systems — not just cops as the agents of control. What’s happening here may be about more than race. It may be realization that the system doesn’t care about any of us.
Our repressive economy, which increasingly gives more to the top and takes more from everyone else, is not going to change by itself. Once we understand that, there may be some hope of a populist turnaround. First, we need to accept responsibility for what the capitalist system has become. Then we must be fed up enough with the status quo to instigate and drive change by ourselves. Our elected officials are not going to do it because they survive and thrive by protecting the way things are.
Rigged rules and regulations are perpetuated by corrupt, self-serving, hypocrites in all three branches of government. That system will never care about improvements in democracy, economy, education, environment, health, human rights, immigration, infrastructure, jobs or anything else that stands in the way of corporate profits. We cannot have a just and healthy society based first and foremost on corporate profits, with an obscene percentage of wealth flowing to the top.
The fabric of our society is not being torn apart by cops and people in the streets but by the privileged few at the top, whose government lapdogs increase their power and sow the seeds of growing poverty and despair at every turn. The latest evidence is the congressional budget bill, supported by both parties and the president, once again allowing banks to deal in risky derivatives that ruined our country in 2008. Meanwhile, our watchdogs, the corporate news media, dutifully or unwittingly steer our attention to silly melodramas instead of the big problems not being solved for the common good.
But what can we do? Most of us are just trying to live our lives, largely oblivious or callously complacent, overeating unhealthful food, satisfied with mindless entertainment and desperately treading water or falling further behind. The economy is slowly coming back, but not for most of us.
First, we’ve got to recognize the way things are — but don’t have to be. Then we’ve got to care enough to do something about it ourselves. We’ve got to let specific corporate giants and their paid politicians know, through our votes, purchasing power, letters, social media and protests in the streets, that we demand change. This means paying attention to and questioning everything our so-called “leaders” are doing, calling them out at every turn, everywhere and all the time.
When we finally live up to the sacred responsibility our citizenship requires, things are going to change.
David Estey is a fine-arts painter in Belfast and a retired IRS regional manager of public affairs for five middle Atlantic states and Washington, D.C.
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