To Collect Debts, Nursing Homes Are Seizing Control Over Patients
Single-Payer: It's What the People Want
A majority of Americans support a single-payer, Medicare-for-all healthcare system, a new poll shows.
The results showed that just over 50 percent of the 1,500 likely voters surveyed indicated support for a single-payer system. Almost 80 percent of Democrats supported such a plan, while 25 of Republicans did.
The findings were first shared with The Hill by the Progressive Change Institute, an arm of the Progressive Change Campaign Committee.
The new poll comes on the heels of Vermont Governor Peter Shumlin's abandoning what was seen as a trailblazing plan to create a single-payer healthcare system in his state. The move was derided by Dr. Andrew D. Coates, president of Physicians for a National Health Program, who said, "Vermonters throughout the state understand that an equitable health care system must be truly universal and must remove all financial barriers to medically necessary care. They recognize that a public single payer is an essential incremental step toward these goals."
"The time for a single-payer system is now. Our patients in every state urgently need it," Coates added.
That sentiment is widely shared.
Costs derail Vermont’s dream of a single-payer health plan
By Jay FitzgeraldGLOBE CORRESPONDENT
For decades, liberal activists yearned for a European-style, single-payer health system that they argued would lead to more affordable, efficient, and comprehensive medical coverage for all citizens. When Vermont four years ago enacted a landmark bill to establish the nation’s first single-payer health care system, they saw their long-sought dream about to be fulfilled.
But reality hit last month. Governor Peter Shumlin released a financial report that showed the cost of the program would nearly double the size of the state’s budget in the first year alone and require large tax increases for residents and businesses. Shumlin, a Democrat and long-time single-payer advocate, said he would not seek funding for the law, effectively tabling the program called Green Mountain Care.
“In my judgment, now is not the time to ask our Legislature to take the step of passing a financing plan for Green Mountain Care,’’ Shumlin said.
The decision not only stunned and angered supporters in Vermont, but also signaled that the dream of universal, government-funded health care in the United States may be near its end. Vermont’s experience, analysts said, shows how difficult — and costly — it can be to shift from a system long-dominated by private health insurance, and that the future of universal health care lies within the private market.
In short, if a liberal state electing a Socialist (US Senator Bernie Sanders) to Congress can’t or won’t put a single-payer system into place, then who will?
“The idea of single-payer, or a Medicare-for-all type program, has always been a cherished dream for many in the Democratic Party,” said Henry J. Aaron, a senior fellow at the Brookings Institution, a liberal-leaning Washington think tank. “In truth, there had never been a hard, developed plan to implement such a dream. In Vermont, they finally developed a plan, and look what happened.”
A single-payer system has been the Holy Grail for progressives since the end of World War II, when President Harry Truman unsuccessfully pushed for a government-run National Health Insurance Plan to provide medical coverage for all Americans. In the 1970s, the late Senator Edward M. Kennedy of Massachusetts vainly battled for a variation of Truman’s national insurance plan.
In the 1990s, President Bill Clinton turned to the private market to provide universal care, requiring that employers furnish health insurance for their workers. But that plan was rejected, too. Finally, in 2010, after a momentous congressional battle, President Obama signed into law the Affordable Care Act, achieving universal coverage by expanding Medicaid, the government health care program for the poor, and mandating private insurance for others.
Vermont took Obamacare a step further. In 2011, Shumlin proudly signed a bill to establish a publicly financed, single-payer system. The law required Shumlin to submit a detailed financial plan by 2013.
Shumlin missed the deadline, raising fears among supporters and critics alike that single-payer health care would cost much more than anticipated. Those fears were realized on Dec. 17, when Shumlin, two years late and just a month from narrowly winning reelection, released the financial analysis.
The numbers were stunning. To implement single-payer, the analysis showed, it would cost $4.3 billion in 2017, with Vermont taxpayers picking up $2.6 billion and the federal government covering the rest. To put the figures into perspective, Vermont’s entire fiscal 2015 budget, including both state and federal funds, is about $4.9 billion.
Bernie Sanders Got Republicans To Make His Argument For Universal Health Care
WASHINGTON -- In their ongoing efforts to roll back or hamstring Obamacare, Republicans probably weren't hoping that the first Senate hearing on the matter this year would feature a self-described "democratic socialist" getting GOP witnesses to back a key argument for universal health care.
Thursday's hearing of the Committee on Health, Education, Labor and Pensions was devoted to the question of moving the full-time work standard under the Affordable Care Act from 30 hours a week to 40 hours, and whether more workers would be hurt by the higher or lower limit.
But to Sen. Bernie Sanders (I-Vt.), who has long supported the creation of a universal health care system, battling over that particular point began to seem absurd, and he opened his remarks by noting that in every other developed country, such a debate would make no sense at all.
"The argument of whether you provide health insurance to people who work 30 hours a week or whether they work 40 hours a week -- whoa," Sanders said. "In every major country on Earth, health care is a right of all people."
With that as his premise, he then asked three of the hearing's witnesses -- two business owners and a school superintendent -- whether their lives and daily endeavors would be improved if government lifted from them the burden of providing health care to their workers.
The panel's only Democratic witness, Joe Fugere, founder of the Seattle-area Tutta Bella Pizzeria chain, readily answered that it would.
And despite all the GOP's cries and criticisms of "socialized medicine" when the Affordable Care Act was making its way through Congress years ago, the two Republican panelists agreed nearly as readily.
"A question like that -- sure," said Betsy Webb, who runs the Bangor School Department in Maine. "But what is the reality?"
"The reality is that maybe it should not have to be the responsibility of the Bangor school district to provide health care, that maybe it should be a right of all of our people, whether they work at McDonald's in Bangor, whether they work for the school district, to have health care," said Sanders, before taking up the question with the next witness, Andrew Puzder, the CEO of CKE Restaurants, which runs the Carl's Jr. and Hardee's chains.
"If what you're saying, Senator, is that if we had a bill that was debated, that was vetted through congressional committees, and we looked at the health care system and really tried to come up with a more rational solution, I would say you're absolutely right," Puzder said.
He allowed that he and Sanders "might not agree on the ultimate solution," but when Sanders pressed Puzder on whether he would rather not have to worry about providing health care and instead focus on his products, the CEO was emphatic.
"From your lips to God's ear," he said.
End Obamacare, and people could die. That’s okay.
We make such trade-offs all the time.
Michael R. Strain is a resident scholar at the American Enterprise Institute.
Say conservatives have their way with Obamacare, and the Supreme Court deals it a death blow or a Republican president repeals it in 2017. Some people who got health insurance as a result of the Affordable Care Act may lose it. In which case, liberals like to say, some of Obamacare’s beneficiaries may die.
During the health-care debates of 2009, Rep. Alan Grayson (D-Fla.) brought a poster on the House floor: “The Republican Health Care Plan: Die Quickly.” In the summer of 2012, when Obamacare was threatened by a presidential election, writer Jonathan Alter argued that “repeal equals death. People will die in the United States if Obamacare is repealed.” Columnist Jonathan Chait wrote recently that those who may die are victims of ideology — “collateral damage” incurred in conservatives’ pursuit “of a larger goal.” If these are the stakes, many liberals argue, then ending Obamacare is immoral.
Except, it’s not.
In a world of scarce resources, a slightly higher mortality rate is an acceptable price to pay for certain goals — including more cash for other programs, such as those that help the poor; less government coercion and more individual liberty; more health-care choice for consumers, allowing them to find plans that better fit their needs; more money for taxpayers to spend themselves; and less federal health-care spending. This opinion is not immoral. Such choices are inevitable. They are made all the time.
Consider, for example, speed limits. By allowing people to drive their cars at speeds at which collisions result in death, our government has decided that the socially optimal number of traffic fatalities is not zero. Some poor souls die: There were more than 30,000 traffic fatalitieson America’s roads in 2013. If we didn’t accept that risk, we’d lower the speed limit to a rate at which accidents simply don’t kill, such as 10 mph. Instead, we’ve raised it periodically over the years, and you can now go as fast as 85 mph on a few highways.
It is tragic that thousands of people die each year in car crashes. At the same time, there are huge (if dispersed) benefits to a 70 mph speed limit over a 10 mph limit: a transportation sector that can deliver goods quickly across the country; increased productivity, because millions of commuters can spend more time at work than in transit; and more time at home with our children.
Health insurers may face tougher rules on Obamacare doctor lists
The proposed legislation also calls on state regulators to craft a standard format for directories to make the information simpler to use.
"In a world where we compel people to purchase health insurance," Hernandez said, "we must empower consumers to make accurate and informed decisions about the plans and policies they are choosing."
A health insurance trade group said companies are willing to work with lawmakers on the issue, but they noted that medical providers play a major role in giving patients accurate information.
"Health plans and providers have a shared responsibility in ensuring directories are updated in a timely manner," said Charles Bacchi, president of the California Assn. of Health Plans. "We look forward to working with Sen. Hernandez on his bill."
The rollout of Obamacare in California was marred by consumer frustration over limited networks and the inability of many people to find a doctor who accepted their policy.
In November, the California Department of Managed Health Care weighed in and said two major insurers had violated state law by overstating the number of doctors available to patients.
Can This Treatment Help Me? There’s a Statistic for That
By Austin Frakt and Aaron E. Carroll
In his State of the Union address last week, President Obama encouraged the development of “precision medicine,” which would tailor treatments based on individuals’ genetics or physiology. This is an effort to improve medical care’s effectiveness, which might cause some to wonder: Don’t we already have effective drugs and treatments? In truth, medical care is often far less effective than most believe. Just because you took some medicine for an illness and became well again, it doesn’t necessarily mean that the treatment provided the cure.
This fundamental lesson is conveyed by a metric known as the number needed to treat, or N.N.T. Developed in the 1980s, the N.N.T. tells us how many people must be treated for one person to derive benefit. An N.N.T. of one would mean every person treated improves and every person not treated fails to, which is how we tend to think most therapies work.
What may surprise you is that N.N.T.s are often much higher than one. Double- and even triple-digit N.N.T.s are common.
Consider aspirin for heart attack prevention. Based upon both modifiable risk factors like cholesterol level and smoking, and factors that are beyond one’s control, like family history and age, it is possible to calculate the chance that a person will have a first heart attack in the next 10 years. The American Heart Association recommends that people who have more than a 10 percent chance take a daily aspirin to avoid that heart attack.
How effective is aspirin for that aim? According to clinical trials, if about 2,000 people follow these guidelines over a two-year period, one additional first heart attack will be prevented.
That doesn’t mean the 1,999 other people have heart attacks. The fact is, on average about 3.6 of them would have a first heart attack regardless of whether they took the aspirin. Even more important, 1,995.4 people would never have a heart attack whether or not they took aspirin. Only one person is actually affected by aspirin. If he takes it, the number of people who remain heart attack-free rises to 1996.4. If he doesn’t, the number remains 1995.4. But for 1,999 of the 2,000 people, aspirin doesn’t make any difference at all.
Of course, nobody knows if they’re the lucky one for whom aspirin is helpful. So, if aspirin is cheap and doesn’t cause much harm, it might be worth taking, even if the chances of benefit are small. But this already reflects a trade-off we rarely consider rationally. (And many treatments do cause harm. There is a complementary metric known as the number needed to harm, or N.N.H., which says that if that number of people are treated, one additional person will have a specific negative outcome. For some treatments, N.N.T. can be higher than the number needed to harm, indicating more people are harmed than successfully treated.)
Not all N.N.T.s are as high as aspirin’s for heart attacks, but many are higher than you might think. A website developed by David Newman, a director of clinical research at Icahn School of Medicine at Mount Sinai hospital, and Dr. Graham Walker, an assistant clinical professor at the University of California, San Francisco, has become a clearinghouse of N.N.T. data, amassed from clinical trials. Among them, for example, are those for the effects of the Mediterranean diet.
Anatomy of a Health Care Mess
Steven Brill Tackles Health Care in ‘America’s Bitter Pill'
By Abigail Zuger
Never sign up for a tour of the sausage factory, not if you want to keep eating sausage. In the case of health care, unfortunately, no one gets to abstain. Journalists and legislators, doctors and nurses, reformers and reformed alike, all eventually land on the conveyor belt that feeds those grinding gears.
Is it better to go through the machinery with some understanding of how it works (or doesn’t)? Individual preferences will vary. For those who believe forewarned is forearmed, the veteran journalist Steven Brill has put together a comprehensive and suitably furious guide to the political landscape of American health care circa 2014 — a tour de force inspection of both sausage and factory.
Mr. Brill began his muckraking early in the rollout of the Affordable Care Act, with a comprehensive indictment of American health care costs that occupied an entire issue of Time magazine in early 2013. He continued to comment in the pages of Time on the disastrous debut of the act’s health insurance marketplaces that fall and the widespread repair work that still continues.
All this reporting reappears in the book, sometimes verbatim, reframed by several new sections. At the beginning comes a long back story detailing the years of politicking that created the new legislation. At the end, Mr. Brill offers a series of personal insights provoked in large part by his recent, unexpected detour from reporter to patient, and suggestions for how it might all be fixed.
Full disclosure here: It became clear early in the creation of the Affordable Care Act that my definition of the word "reform" differed substantially from that of our political leaders. After that, I stopped paying a lot of attention to the political Kabuki — a disgraceful if all too common reaction among us beleaguered sausage-makers.
Hence, I cannot assess the accuracy of Mr. Brill’s account of the negotiations that created Obamacare, but I found it persuasive, shocking and very sad. It is not an easy story to follow, a little like plowing through a long description of every can of paint flung onto a Jackson Pollock canvas. Still, the difficulty and occasional tedium of the narrative themselves inform the subject.
As Mr. Brill tells it, the legislation was from the very beginning all about profit, with all the relevant industries, from insurers to drug makers to hospitals, methodically seduced aboard with promises of big returns. The politicos spoke of broader insurance coverage, but what they actually meant was more health care dollars to spread around. The nonprofit “public option” never had a chance, and vanished.
The final legislation was a truly remarkable triumph of fiscal diplomacy. No wonder the act’s political parents were so exhausted by its creation that implementation took second place. The initial result: a deeply flawed federal enrollment website and phone banks of confused people diligently dispensing misinformation. Mr. Brill details these mishaps in full, along with the months of mopping up required.
Supreme Court Rules Against Retirees in Union Health Benefits Case
WASHINGTON — The Supreme Court on Monday ruledthat a chemical company may be able to cut the health benefits of its retired workers, unanimously reversing an appeals court ruling that said the benefits had vested for life.
“Courts should not construe ambiguous writings to create lifetime promises,” Justice Clarence Thomas wrote for the court, adding that “retiree health care benefits are not a form of deferred compensation.”
The Supreme Court returned the case to the appeals court, telling it to use ordinary principles of contract interpretation to determine whether the collective bargaining agreement at issue had granted free lifetime health care.
The appeals court erred, Justice Thomas wrote, “by placing a thumb on the scale in favor of vested retiree benefits in all collective bargaining agreements.”
The case concerned a union contract at the Point Pleasant Polyester Plant in Apple Grove, W.Va. Like many other collective bargaining agreements, it did not directly say whether health benefits for retirees would vest for life.
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