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Thursday, July 30, 2015

Health Care Reform Articles - July 30, 2015

This week CMS established a new webpage for Section 1332 waivers of the
ACA. It includes Fact Sheets and FAQs.



Rep. Jim McDermott
Statement Introducing the State-Based Universal Health Care Act of 2015
U.S. House of Representatives
July 28, 2015

Mr. Speaker, I rise today to introduce legislation that will give states the tools they need to guarantee the health security of their citizens. The State-Based Universal Health Care Act of 2015 establishes a new procedure through which states may apply for a waiver of federal law in order to design and implement single-payer health care systems. This will allow states to achieve universal coverage and control costs by removing greed and inefficiency from the system.

One of the many achievements of the Affordable Care Act is its provisions that grant states the authority to innovate in their health care systems. Under Section 1332 of the law, a state may apply for a State Innovation Waiver that will provide it with control of federal dollars that otherwise would have been spent on premium tax credits and cost-sharing reductions for its residents. Through this waiver, a state may design a system to cover its residents, so long as benefits are at least as comprehensive and affordable as those offered by Qualified Health Plans available on the Exchanges.

However, even with this flexibility, numerous barriers limit states’ ability to design true single-payer systems. Existing waivers are narrow in scope, requiring states to seek out imperfect and convoluted solutions to circumvent federal limitations. A sweeping preemption provision in the Employee Retirement Income Security Act (ERISA) denies states authority to regulate employer-sponsored health plans. And, due to the complexities of our existing federal health programs, it is essentially impossible for a state to design a single benefit package that can be administered simply and efficiently on behalf of all of its residents.

The State-Based Universal Health Care Act removes these barriers. It builds upon the ACA’s State Innovation Waiver by offering states new tools that will allow them to truly innovate in health care. Under this legislation, a state may apply for a Universal Health Care Waiver that will grant it authority over federal health care dollars that otherwise would have been spent on the state’s residents. To the extent necessary to design a universal system, a state may waive provisions of federal law relating to the following:

* The rules governing premium tax credits and cost-sharing reductions, as provided for in existing waiver authority under Section 1332 of the ACA.

* Provisions necessary for states to pool funds that otherwise would be spent on behalf of residents enrolled in Medicare, Medicaid, CHIP, TRICARE, and the Federal Employee Health Benefits Program.

* ERISA’s preemption clause, which currently forbids states from enacting legislation relating to employee health benefit programs.

Any state seeking a Universal Health Care Waiver must design a system that covers substantially all of its residents. The benefits that each citizen receives must be at least as comprehensive and no less affordable than what would have been provided under any federal health programs for which its residents otherwise would have been eligible. Once enacted, the state plan must be publicly administered, and it may not add to the federal deficit.

The Affordable Care Act was a landmark achievement and a strong first step toward achieving health security in this country. However, we still have a tremendous amount of work left to do. The United States spends by far the most per capita on health care, yet we fail to achieve superior outcomes or even guarantee coverage as a basic human right. Insurance companies are a powerful force in our economy, enjoying billions in profits and growing power in the marketplace. Meanwhile, hospitals are consolidating at an astonishing rate, raising new questions about the quality of patient care and the future of medicine. What’s more, we have failed to make meaningful efforts to combat the skyrocketing costs of prescription drugs, threatening patient access to treatments and the financial sustainability of the entire system.

As we explore ways to build upon the successes of the ACA, it is critical that we look for creative solutions to the challenges that still exist. Granting states tools to design single-payer systems will help spur necessary innovation, achieve universal coverage, and control costs. It is time to take this next step as we continue to move forward in our historic effort to guarantee the health security of every American.

H.R.3241: State-Based Universal Health Care Act of 2015



What I Learned at the Weed Dispensary

By DAVID CASARETT
THE first time you meet Robin, it’s easy to be misled by her fragile appearance. She’s in her 40s and painfully thin, and she grips her aluminum walker with hands that have been twisted by rheumatoid arthritis. But she’s both tough and resourceful, and she doesn’t give up easily.
I met Robin and many others like her at a California medical marijuana clinic where I was doing research for a book. She was one of almost a dozen patients seeking recommendation letters that would let them buy marijuana at designated dispensaries.
I asked how marijuana helped her.
“I can’t live without it,” she told me.
She said it helped her sleep, and it relieved the constant pain in her joints. But Robin was most eager to talk about how medical marijuana put her in charge. She can decide whether to use it, when to use it and how much she needs. She doesn’t have to rely on a doctor.
“I’m in control,” she said.
That simple declaration might be a rallying cry for proponents of medical marijuana, which is legal in 23 states and the District of Columbia. By some estimates, at least one million people in the United States are registered medical marijuana users. There are likely to be many more who obtain it without registering, and still more who obtain marijuana illegally.
In the past year I’ve talked to dozens of these patients in states where medical marijuana is legal, as well as in Colorado, Washington and Oregon, which allow recreational use. Many people with serious illnesses turn to medical marijuana because they’re not getting the careful, comprehensive treatment they need for symptoms like pain or nausea or anxiety. That was certainly true for Robin, whose physicians didn’t seem to have the time or the skills to help her.

Priceless safety net reaches Golden Anniversary

Medicare's impressive milestone is reason to celebrate the safety net and time for supporters to wake up to threat of increased privatization

  • By 
  • July 23, 2015
  • Happy birthday, Medicare! Happy Golden Anniversary!
    If you’re just a few decades old, you might be surprised to learn that Medicare, the publicly financed health insurance program for America’s senior (65 and older) and disabled citizens is just turning 50 this month. It has become such a part of the nation’s fabric that, unless you know its history, you might think our founding fathers created it.
    Not by a long shot. It was many years in the making, even though it had the support of many presidents. That it Congress took so long to create it is a testament to the ability of wealthy and entrenched special interests to delay – and in many cases prevent – legislation they feared might cause their income to take a hit, even though it would do immense public good.
    The fact that we have such a special milestone to celebrate means that the opposition of wealthy, entrenched special interests can be overcome. But, as we will see, an entirely different group of special interests is now profiting as a result of a very favorable financial arrangement with what has become an immense federal program. They are making such rapid inroads that the original Medicare program may all but cease to exist over the next decade if the program’s supporters don’t wake up to what is a real existential threat.

    It almost never happened



    U.S. health-care costs expected to climb

    BY RICARDO ALONSO-ZALDIVARTHE ASSOCIATED PRESS
    WASHINGTON — The nation’s respite from accelerating health care costs appears to be over.
    Spending on health care will outpace the nation’s overall economic growth over the next decade, the government forecast on Tuesday, underscoring a coming challenge for the next president, not to mention taxpayers and businesses.
    A combination of expanded insurance coverage under President Obama’s law, an aging population and rising demand, will be squeezing society’s ability to pay.
    By 2019, midway through the next president’s term, health care spending will be increasing at roughly 6 percent a year, compared to an average annual rise of 4 percent from 2008 through 2013.
    FUTURE PRESIDENT BE WARNED
    “I do think this becomes something of a liability for anybody coming into office, and they need to have a very proactive policy to address it,” said Dan Mendelson, CEO of Avalere Health, a market analysis and consulting firm. Mendelson served in the Clinton White House as a health policy expert.
    Health care as a share of the nation’s overall economy is projected to grow from 17.4 percent in 2013 to 19.6 percent in 2024, the report says, accounting for nearly $1 of every $5 spent.
    Growth in the nation’s health care tab slowed dramatically during the 2007-2009 economic recession.
    Then came several years when health care increases tracked closely with the economy as it started to stir again.
    COVERAGE AT A COST
    As taxpayers, Americans benefited from the slowdown, which reduced projected Medicare costs. But many people saw their own medical bills rise, as employers shifted costs to workers.
    Things changed in 2014, the report says, with coverage expansion under the new health care law. Some 8.4 million gained coverage that year, and people with health insurance use more medical services and prescriptions than do the uninsured.
    At the same time, expensive new drugs that can cure hepatitis C are boosting spending on medications. In 2013, prescription drug spending rose by 2.5 percent. For 2014, the projected increase is 12.6 percent.
    Spending on Medicaid, the federal-state health insurance program for low-income people, also has jumped.
    The 2013 increase was 6.1 percent. But the program is projected to have grown by 12 percent in 2014, again boosted by coverage expansion under the health care law.

    Maine Health Care Professionals Celebrate Medicare's 50th Birthday 

    By  
    BANGOR, Maine — This week Medicare reaches a milestone. The program will officially turn 50 on Thursday, and proponents are celebrating at events across the state and the country.
    Amidst the fanfare, some are calling for improvements to Medicare, and even an expansion of the government program to cover all U.S. citizens.
    Democratic congressional hopeful Emily Cain sponsored a Medicare birthday party at the Sylvia Ross Home in Bangor on Wednesday. Before indulging in some birthday cake, 72-year-old Diane Grandmaison addressed the party-goers.
    "Have you ever heard that famous commercial, 'What's in Your Wallet?" she says.
    Grandmaison, who is the vice president of the Maine Alliance for Retired Americans, says the most important card in her wallet is the red, white and blue Medicare card.
    The vice president of Eastern Maine Health Care Systems, Lisa Harvey McPhearson, who was also at the party, agrees that Medicare is indispensable for the roughly 300,000 Mainers enrolled in the program.
    "Without the Medicare benefit, every individual here, as well as thousands of Mainers, would be impoverished," she says.
    In the lead-up to Medicare in the late 1950s and early '60s, some, including the American Medical Association, opposed what they saw as socialized medicine. Back then, the AMA launched Operation Coffee Cup, in which doctors' wives held coffee socials and urged attendees to write to Congress to oppose government-sponsored health care.
    A half century later, the executive director of the Maine Association of Area Agencies on Aging, Jessica Maurer, says the program has dispelled many early detractors' fears.
    "It's clearly worked, meaning our older adults are living considerably longer than anyone ever anticipated they would, and they are in good health, generally," she says.
    That isn't to say Medicare couldn't stand some improvements. States provide extra financial support to Medicare enrollees with limited incomes who can't afford the program's out-of-pocket health expenses and premiums, and Maurer says the federal government should kick in more.
    "And it really helps to keep them living well and long and in the community much longer," she says.
    Others, such as the Maine Hospital Association, say while Medicare provides needed access to affordable insurance for millions of seniors, the program's low reimbursement rates are a challenge.
    But Cokie Giles, a nurse at Eastern Maine Medical Center and president of Maine State Nurses Association, sees Medicare as one of the country's' greatest achievements — so much so that it should expand.
    "Why we're celebrating it is we feel that everyone should have a single standard of care," she says. "We would like everybody to pay into Medicare, and everyone to receive it, young and old."
    The Maine State Nurses Association and others will rally in Monument Square in Portland Thursday evening to support a federal bill introduced by Democratic Representative John Conyers of Michigan that would expand Medicare to cover all Americans.
    Dr. Julie Pease of Maine AllCare, which advocates for universal health coverage, says Medicare is the right health coverage model to expand.
    "Medicare is already working well," she says. "It's a good public-private partnership. Publicly funded, privately delivered. The system is already in place."
    Barring universal coverage for all Americans, Robyn Merrill of Maine Equal Justice Partners says expanding Medicaid coverage would be an important step to increase access to health care for low-income Mainers.
    But expanding that program is not favored by Gov. Paul LePage, who says despite federal reimbursement to do so, it will ultimately cost the state too much.

    Celebrate Medicare’s 50th Birthday By Expanding It To All

    By Garrett Adams, M.D.
    Common Dreams, July 29, 2015
    The nation has a lot to celebrate when Medicare turns 50 on July 30.
    Medicare has brought care and dignity to millions of seniors, relieving their suffering and extending their lives. 
    Before President Lyndon Johnson signed Medicare into law in Independence, Missouri, in 1965, only about half of those over 65 had health insurance. In the 50 years since then, life expectancy has risen by more than nine years to a little over 79 years.
    Medicare ended segregation in our country’s hospitals when federal reimbursements for patient care were made contingent on ending discrimination. Within a few months the walls tumbled in the face of sound public policy and financing based on social justice.
    Today, Medicare covers about 17 percent of our population, over 55 million people, including those other than the elderly whom the private insurance industry has abandoned – the permanently disabled and those on dialysis from kidney failure.
    Medicare has important lessons for our entire health care system. It was implemented within 10 months of enactment with no computerized records – only a system of notecards.
    The program’s rapid rollout flowed from the simplicity of its basic principle: virtually everyone 65 and older was automatically eligible for government health insurance. In contrast, the complicated, problem-prone, private-insurance-based Affordable Care Act is unfolding over a period of 10 years and will still leave 30 million people without coverage – and millions more who are nominally covered but cannot afford care. 
    Patients in traditional Medicare go to the doctors and hospitals of their choice. There are no limited networks to get in the way of care.
    Traditional Medicare spends about 2 percent (according to the 2014 Medicare trustees’ report) on administration and overhead. Medicare is efficient and frugal compared to private insurance, whose overhead and profits are 12 to 14 percent or more (individual market overhead typically amounts to 20 percent to 30 percent).
    On July 30, in Washington, D.C., longtime single-payer advocates Sen. Bernie Sanders, Rep. John Conyers (chief sponsor of HR 676, the Expanded and Improved Medicare for All Act), and others will speak at a rally for Medicare’s 50th anniversary in Upper Senate Park, starting at 9:30 a.m.
    Later that day, starting at 1 p.m., Rep. Conyers will host a Medicare 50th Celebration Panel in Room 2237 of the Rayburn House Office Building.
    Across the country, people in more than 70 cities will join in rallies and celebrations.
    The theme of all the events is to Protect, Improve, and Expand Medicare – PIE:
    • Protect it, because many in Congress would like to place our best-yet health care program on the chopping block and privatize it.
    • Improve it, because despite its valuable contributions, Medicare falls short on dental and drugs and leaves some people still unable to afford care. 
    • Expand it – to the entire population – allowing us to end the waste of $400 billion annually that is currently spent on the needless bureaucracy and paperwork associated with the private health insurance industry. 
    By applying the savings to assuring universal care, Rep. Conyers’ single-payer legislation would make health care a human right. H.R. 676 currently has 49 co-sponsors.
    I believe our nation has a compassionate heart and a deep national desire for universal care. What better time to make these yearnings manifest – and to demand that they be realized – than Medicare’s golden anniversary? Tell your lawmakers: we want an improved Medicare for All.
    Dr. Garrett Adams is a longtime pediatrician in Louisville, Ky. He is past president of Physicians for a National Health Program.
    This work is licensed under a Creative Commons Attribution-Share Alike 3.0 License


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Wednesday, July 22, 2015

Health Care Reform Articles - July 22, 2015

A Pharma Payment A Day Keeps Docs’ Finances Okay

New data on payments from drug and device companies to doctors show that many doctors received payments on 100 or more days last year. Some received payments on more days than they didn’t.
by Charles Ornstein and Ryann Grochowski Jones
Few days went by last year when New Hampshire nephrologist Ana Stankovic didn't receive a payment from a drug company.
All told, 29 different pharmaceutical companies paid her $594,363 in 2014, mostly for promotional speaking and consulting, but also for travel expenses and meals, according to data released Tuesday detailing payments by drug and device companies to U.S. doctors and teaching hospitals. (You can search for your doctor on ProPublica's updated Dollars for Docs interactive database.)
Stankovic's earnings were certainly high, ranking her about 250th among 606,000 doctors who received payments nationwide last year. What was more remarkable, though, was that she received payments on 242 different days — nearly every workday of last year.
Reached by telephone Tuesday, Stankovic declined to comment. On her LinkedIn page, Stankovic lists herself as vice chief of staff at Parkland Medical Center HCA Inc. in Derry, New Hampshire, and as medical director of peritoneal dialysis at DaVita Inc., also in Derry.
That doctors receive big money from the pharmaceutical industry is no surprise. The new data released by the Centers for Medicare and Medicaid Services shows that such interactions are widespread, with not only doctors, but thousands of dentists, optometrists, podiatrists and chiropractors receiving at least one industry payment from August 2013 to December 2014.
What is being seen for the first time now is how ingrained pharmaceutical companies and their sales reps are in the lives of those who write prescriptions for their products. A ProPublica analysis found that 768 doctors received payments on more than half of the days in 2014. More than 14,600 doctors received payments on at least 100 days in 2014.
Take Juichih Hsu, a Maryland doctor whose specialty is family medicine. She received payments on 286 days of 365, more than anyone else. Sometimes, she received meals from several drug companies on the same day. Hsu's payments totaled $5,959 in 2014. She declined to comment when reached on Tuesday.
"There are physician practices which have very deep relationships with pharmaceutical representatives, where they are a very integral part of the practice," said Dr. Aaron Kesselheim, an associate professor of medicine at Harvard Medical School who has written about industry relationships with doctors. "Every day it's another drug company coming in for a lunch. Sometimes it may be some drug companies are bringing breakfast and some are bringing lunch and it's just part of the culture of the practice."


Medicare to Try a Blend of Hospice Care and Treatment

Most older Americans close to death have to make a difficult choice: continue with traditional medical treatment or switch to hospice care, which focuses not on a cure but on easing their remaining days.
Now, Medicare is testing a third alternative: both.
The new pilot program, designed to affect the care of about 150,000 Medicare patients over the next four years, will allow patients with terminal diseases to receive hospice care to manage suffering and counseling to plan for the end of life — but still see doctors and get medical treatments, like chemotherapy or hospitalization, intended to fight their illnesses.
The test program is based on research that shows that patients with access to both so-called palliative care and traditional medicine often end up with a better quality of life and less expensive, intense medical treatment. The approach may even offer the patients a longer life spanthan those treated with traditional medicine alone.

Will Maine share in health reform’s success or follow Old Confederacy?

By Theda Skocpol
For the last five years, never-ending Obamacare battles have been accompanied by quiet progress in implementation.
Maine has been front and center in ideological warfare and quiet progress. But the state’s final health reform chapters remain to be written. When disputes in Augusta reach an end, will all the state’s people and businesses be able to reap the full benefits of reform? Let’s review the state of play.
In Washington, D.C., congressional Republicans have voted more than 50 times for repeal — even though most Americans prefer to keep the law and improve itand President Barack Obama would veto any such legislation that reaches his desk. Meanwhile, serious challenges to the health law worked their way through the federal courts to twice reach the Supreme Court.
Through it all, the Affordable Care Act has survived. In its latest ruling on the law last month, the high court preserved subsidies for purchases on Obamacare insurance exchanges and even made it clear it is unlikely to entertain any more challenges. Health reform is here to stay.
For Mainers, this is excellent news, because nearly 75,000 people have purchased health insurance plans on the state’s exchange. A higher percentage of eligible Maine customers signed up — more than 60 percent — than in any other New England state except Vermont. Had the court ruled the other way, the majority of these Maine customers probably would have lost their coverage, because nine out of 10 — including rural people and lobstermen and their families in coastal communities — need the federal subsidies to help pay their insurance premiums.
Across the country, health reform surprisingly is working well. More than 10 million Americans have gained new coverage as a direct result of the law, another 9 million are newly included in employer plans and still others have better insurance for the price they pay. Of course, the health law could be improved — for example, by reducing regulations on small businesses — but that can happen only after Republicans stop pushing for repeal and join with Democrats to enact changes with bipartisan support.
Dozens of new insurance companies started offering plans on the state exchanges in 2015, creating more choices and keeping prices down. New Hampshire went from one to five insurers on its exchange, and Maine went from two to three. Depending on how regulators respond to insurance company requests, premiums may go up more for 2016 than they did this year, but consumers would be able to switch plans if they want to pay less. We need to remember health insurance premiums were rising fast before the Affordable Care Act, even though millions of Americans were losing coverage and had no recourse. Things are better now. Still, health care providers must keep looking for new ways to deliver quality care at reasonable prices. Maine hospitals and community health centers already are participating in experiments encouraged by the health reform law.

Surprise! That urgent care center may send you a big bill, even if you’re insured

By Julie Appleby, Kaiser Health News
Posted July 20, 2015, at 11:43 a.m.
Sallyann Johnson considers herself a pretty savvy health care consumer. When she fell and injured her hands and wrists, she didn’t head for an expensive emergency room, choosing an urgent care clinic near her Milwaukee home instead.
Before seeking treatment, she asked the key question: Did the center accept her insurance? Yes, Johnson was assured, both on the phone and then again when she arrived at the clinic.
After X-rays and a visit with a physician assistant, Johnson learned her wrists were sprained, but weeks later, it was her wallet that sustained the most damage.
“I received a bill from a doctor for $356,” said Johnson, 62. “I felt I asked all the right questions. I even re-asked the questions.”
Long seen as a lower-cost alternative to hospital emergency rooms for minor illnesses or injuries, urgent care centers are increasingly popular with consumers – and their insurers. Maine is home to more than 20 urgent care clinics, many affiliated with major health systems and others run by private, for-profit companies.
But like doctors and hospital ERs, urgent care can also present payment headaches if they are not part of a patient’s insurance network. And consumers may need to ask specifically about network participation to find out.
Earlier this month, the New York State attorney general wrote businesses that operate dozens of urgent care clinic locations, saying the health plan participation information on their websites may be “deceptive” and asking for specific information about which insurance plans they participate in as in-network partners. The inquiries went to stand-alone clinics, as well as those affiliated with hospital systems and retail outlets, including Duane Reade and CVS stores.
In New York and nationally, insurance coverage information provided on urgent care clinic websites is often unclear. Some centers’ websites say they “accept most major insurance plans” while others list specific insurers they “accept,” or “work with” or “bill.” But what does that mean?
Accepting insurance might mean a consumer will owe the balance between what the clinic charges and what an insurer pays toward an out-of-network visit, which is generally far less than payment for an in-network provider.
Such statements “may lead consumers to believe that an out-of-network urgent care center is … ‘in network’ with their health plan,” say the July 2 letters from N.Y. Attorney General Eric T. Schneiderman.
The centers may well be in-network with some insurers. But if they’re not, “consumers may receive unexpected, and often costly, bills … when they believed that they would be responsible solely for their copayment …,” the letters say.

Medicare turns 50, and we have much to celebrate

By Theresa Chalich, R.N.
Pittsburgh Post-Gazette, Letters, July 19, 2015
Nicholas Kristof’s commentary “Poverty: Yes, It’s About Personal Responsibility but It’s Also About the Choices We Make as a Society” (July 12 Forum) on the need for collective responsibility was written at an opportune time. This July we celebrate the 50th anniversary of Medicare. What an impact this social program has made on improving health and financial stability.
This publicly funded program financed by our employee Medicare taxes has been and is a practical solution to a severe need. Fifty years ago one-half of seniors were without hospital insurance. One in three lived in poverty. Today nearly all seniors and younger people with permanent disabilities have access to affordable health care.
Mr. Kristof wrote about our nation’s blame-the-victim mentality. It is important to know that Medicare addressed our systemic problem of racism by stopping payments to segregated hospitals and by allowing African-American doctors to get hospital admitting privileges. For these doctors, the legacy of discrimination held back their economic growth. Medicare has truly been a collective response.
On July 14 Pittsburgh City Council recognized the 50th anniversary of Medicare and its goals with a proclamation sponsored by Councilman Corey O’Connor.
So, happy birthday, Medicare! May our birthday wish be that we will have Medicare for all!
Theresa Chalich, R.N., resides in Squirrel Hill. She is a member of HealthCare 4 All PA.
http://www.post-gazette.com/opinion/letters/2015/07/19/Medicare-turns-50-and-we-have-much-to-celebrate/stories/201507170176

Medicare turns 50 this month

By Ray Bellamy, M.D.
Tallahassee Democrat, July 18, 2015
In 1963 or so, a group of us UF second year medical students tramped upstairs to listen to some of a spirited discussion among Gainesville-area physicians along with UF faculty regarding providing nearly universal health coverage to seniors. I remember little of the discussion other than some inflammatory rhetoric about “government overreach and what it would do to or for Granny.”
Most folks now are not aware that in those days, the AMA had only recently come off its traditional opposition to group medical practice. (Yes, they felt all physicians should be working solo.) So now, on July 30, we will herald arguably one of this country’s most successful social programs ever — the establishment of Medicare. We should also acknowledge the role Medicare played in speeding the integration of hospitals.
There is much one can complain about Medicare — that it will begin running a deficit in 17 years, that some providers are not reimbursed adequately to cover expenses, that the first day of inpatient care costs a thousand dollars out of pocket. However, with a strong approval among seniors — 92-percent satisfaction, a low overhead of about 2.5-percent, and the benefit of safety net coverage for a part of the population which is stressed to pay bills (elderly women average a third of their income for medical expenses), the goal of sharing risk broadly over a large population has been been met. Note that the sickest 20 percent of this group accounts for 80 percent of the cost.
Presidential candidate Vermont Senator Bernie Sanders is advocating for an improved Medicare for All, properly funded, as he has for decades. Since the simplicity of everyone having the same comprehensive plan and a Smart Card to swipe at the physician’s office or pharmacy would save several hundred billion dollars a year in reduced overhead, it is easy to understand how most developed nations use some version of a single payer system. Because prevention is often less expensive than treatment, but the payoff may take years to realize, enrollees in private insurance who tend to stay with one plan for only a short time are unlikely to see this cost reduction passed to them.
But we muddle on, and costs in health care keep rising, inflammatory opposition rhetoric about “death panels” and “socialized medicine” gets bandied about, and our overall healthcare non-system struggles from day to day.
So here we are with Medicare at 50, struggling with proposals for vouchers, the higher costs of Advantage plans, the need to more adequately fund the trust fund. The latest assault comes from a “bribe” to help passage of the TPP Fast Track international deal. It would take $700 million from Medicare and use those funds to support job retraining and assistance for workers who lose their jobs due to offshoring, etc.
And with our political paralysis, along with suspicion of all things government does, even when government has demonstrated it can do many tasks better than the private sector, stay tuned.

Paralyzed by Gunfire, but Denied Care

By RONI CARYN RABIN
JULY 20, 2015
There’s no video of the altercation between Monroe Bird III, a 21-year-old sitting in a car with a friend, and Ricky Leroy Stone, 56, a security guard who found them one night in the parking lot of an apartment complex in Tulsa, Okla.
But the tragic culmination of their encounter is not disputed: Mr. Stone drew his gun and shot Mr. Bird, leaving him paralyzed from the neck down.
Three months later, as he lay in the hospital hooked to a ventilator, Mr. Bird’s insurance company declined to cover his medical bills. The reason? His injuries resulted from “illegal activity.”
Yet Mr. Bird was not convicted of any crime in connection with the incident. He was not even charged.
Without insurance, Mr. Bird’s family could not move him to a rehabilitation center specializing in spinal cord injuries. He was discharged from the hospital and died at home last month from a preventable complication often seen in paralyzed patients.
The incident joins a disturbing litany of cases in which black men have been shot by white men in law-enforcement capacities. Mr. Bird’s family and their supporters believe racial bias motivated the shooting, at least in part, and protected the guard from criminal prosecution.
But Mr. Bird’s story comes with a particularly bitter sequel relevant to Americans of any background: The plan’s refusal to pay has left his family owing as much as $1 million in medical bills and, experts say, shines a light on a little-known loophole buried in the fine print of many health plans.

Will Hospitals Lose Money Under Obamacare?

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