Voters to decide ColoradoCare in November

By Anne C. Courtright, M.D.
The Pueblo (Colo.) Chieftain, Jan. 30, 2016
I would like to set the record straight regarding the ColoradoCare Amendment 69, which will be on the November 2016 ballot.
The movement for Expanded and Improved Medicare for All formally began in 1987 with the establishment of Physicians for a National Health Program, because a couple of young doctors were irate over the contrast between the lovely one- and two-bed rooms, many of which were empty, in the private hospital to which they were assigned in their training, contrasted with the waiting list and overcrowded wards with multiple beds in the Community Hospital, where they also worked.
State Sen. Irene Aguilar’s Amendment 69 is a variation of but a continuation of the work that Health Care for All Colorado has been doing in Colorado, since July 15, 2003. It is a movement to get affordable, quality health care available to all of the people of Colorado.
HCAC does not like to see people die or become disabled because they cannot afford to get needed health care or, all too often, go bankrupt when they do. Our current system is not working well.
The ColoradoCare Plan would be financed by a government-collected, designated fund, just as Medicare is nationally. Initially, it would be administered by an appointed board, which would be replaced by an elected board for the long term.
HCAC submitted a true single-payer plan to the 208 Commission in 2007. It was found by the Lewin Commission to be the only plan submitted that really covered everyone in the state, and it would have saved the state $4 billion a year. However, it was not recommended to the Legislature by the commission because it “was too disruptive to the present system.” Do you suppose that could have represented the influence of the health insurance companies?
The ColoradoCare plan would replace the Affordable Care Act in Colorado, which the ACA allows, as long as the plan provides care “as good as or better than the ACA.” Amendment 69 would undoubtedly do so and with a far less convoluted system. It would provide everyone in the state affordable, quality care and cost less than we are currently spending. It would not replace Medicare or the VA, but it would serve as a Medicare supplemental plan.
And, yes, it would likely mean the end of for-profit health insurance companies in the state except for cosmetic surgery, high-cost end of life care and such extra things that Amendment 69 would indeed, not cover. But all necessary health care would be covered, and you would no longer have the cost of your health insurance premiums, prescription drugs, deductibles and most co-pays.
Eighty percent of Coloradans would pay less overall for their medical care under Amendment 69 than they do now. There would be no more Medicaid or CHIP, people dying or becoming disabled because they could not afford needed treatment, or going bankrupt all too often if they got the needed care.
Rather than bankrupting the state, it would make Colorado one of the healthiest states in the union and one in which providers would enjoy practicing medicine, rather than having to spend half of their time fighting with the insurance companies over needed care or payments.
Providers, including hospitals, would save a great deal of money from the reduced need for staff in their billing departments, so costs would go down, not up. Individuals could go to the provider and hospital of their choice.
Providers and hospitals would send a simple bill to the elected board of trustees and be reimbursed. No longer would one third of our health care dollar in Colorado, go to administrative costs, huge CEO salaries and shareholder profits.
The only thing that would be better than Amendment 69, would be Expanded and Improved Medicare for All in the United States. Tell U.S. Rep. Scott Tipton to sign on to Rep. John Conyers’ bill, HR 676, which would make that happen. That is what we really need and HCAC and PNHP are working toward.
Amendment 69 would be a step in that direction, and Colorado would have the distinction of being the first state in the union to actually establish a single-payer type of plan. Groups in many other states are also working in this direction.

Anne C. Courtright is a psychiatrist, now retired from the Colorado Mental Health Institute at Pueblo.
http://www.pnhp.org/print/news/2016/february/voters-to-decide-coloradocare-in-november

Why Medicare for all is the best plan

Regarding the Jan. 29 editorial “The real problem with Mr. Sanders ”:

Single-payer expanded and improved Medicare for all would provide universality, affordability and cost containment. Single-payer would allow doctors to focus on their patients’ health needs, rather than on patients’ ability to pay. What Americans want is choice of doctor, not choice of health insurance. Americans want comprehensive, lifelong insurance that assures them they will get the care they deserve.

Although it may seem fantastical to provide more care to more people for less money, there is a preponderance of scientific data to support this claim. In the United States, we waste $375 billion a year on billing and insurance-related bureaucracy, and not a dime of it goes toward a doctor’s visit, vaccination, procedure or medication. In contrast with private insurance with double-digit administrative overhead, Medicare runs at less than 3 percent. The vast majority of Americans and physicians favor expanding and improving Medicare.

So what’s stopping us? Certainly not the facts, because the facts are on our side.

Robert Zarr, Washington

The writer is president of
Physicians for a National Health Program.

Tax Scams Are Targeting Uninsured, I.R.S. Warns

By ROBERT PEARJAN. 30, 2016

WASHINGTON — The Internal Revenue Service is warning consumers about tax scams involving the Affordable Care Act and penalties imposed under the law on people who go without health insurance.

In some cases, the agency said, unscrupulous tax preparers tell clients to pay the penalties directly to them, and they keep the money.

Most people do not owe the payment at all because they have health coverage, such as Medicaid or employer-sponsored insurance, or qualify for one of many available exemptions.

“However,” the I.R.S. said, “if you owe a payment, remember that it should be made only with your tax return or in response to a letter from the I.R.S. The payment should never be made directly to an individual or return preparer.”

The creators of these schemes have been “targeting taxpayers with limited English proficiency and, in particular, those who primarily speak Spanish,” the tax agency said last week in a bulletin for consumers.

Undocumented immigrants appear to be particularly vulnerable. They are sometimes told that they must make penalty payments directly to a tax preparer because of their immigration status, the agency said.

The health law requires most Americans to have health insurance. For those who flout the requirement, the penalty, also known as a shared responsibility payment, may be $695 or more this year. For many people, the last day to sign up for insurance is Sunday, when the third annual open enrollment season ends.

Unauthorized immigrants are not required to have insurance, though they are often required to pay taxes, and many do so. “If you are not a U.S. citizen or national, and are not lawfully present in the United States,” the Internal Revenue Service declared, “you are exempt from the individual shared responsibility provision and do not need to make a payment.”

The exemption also extends to young illegal immigrants who came to the United States as children and have received a temporary reprieve from deportation under a program created by President Obama in 2012 and known as Deferred Action for Childhood Arrivals.

Ana Cecilia Lopez, a tax lawyer in Bellingham, Wash., said many tax preparers did not ask enough questions to determine their clients’ citizenship status — a crucial factor in deciding if they owe a penalty or are exempt under the Affordable Care Act.

“Some tax preparers are not asking even the most basic questions about a person’s legal status,” Ms. Lopez said. “They just ask: ‘Did you receive insurance? Did your employer give you insurance? No. Did you get health insurance on your own? No. O.K., now you owe this penalty.’ ”

Ms. Lopez said she worked with migrant farmworkers who had been in the United States for decades without legal status but had paid income taxes. Tax compliance is considered to be evidence of good moral character and could be helpful if they seek immigration benefits or legal status in the future.

Christine Speidel, a tax lawyer at Vermont Legal Aid, welcomed the government’s effort to warn consumers, including undocumented workers in particular. “This population is very vulnerable to exploitation by tax preparers,” she said.

The I.R.S. has tried to regulate certain paid tax-return preparers, requiring them to pass certification tests, pay annual fees and take continuing education courses. But in 2014, the United States Court of Appeals for the District of Columbia Circuit struck down the rules, saying the agency had no authority to adopt them.

As a result, the I.R.S. said, some tax professionals who had been suspended or disbarred in disciplinary proceedings have again been allowed to prepare tax returns for consumers.

The national taxpayer advocate at the I.R.S., Nina E. Olson, has found problems with unlicensed tax preparers.

In the absence of natitandards, she said, “a person can hold himself out as a return preparer with almost no knowledge or skill by simply sitting with a taxpayer and working through” the questions in tax preparation software.

President Obama has proposed giving the I.R.S. more authority to regulate tax preparers. But Republicans, still angry with the agency over what they see as its improper scrutiny of Tea Party groups, have been reluctant to give it additional authority at this time.

http://www.nytimes.com/2016/01/31/us/tax-scams-are-targeting-uninsured-irs-warns.html?hpw&rref=us&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

Why you should be skeptical about an 'Uber for healthcare'

by Michael Hiltzik - LA Times

The worst aspect of the "Uberization" of our economy may not be the transformation of workers who could once earn a living wage into "independent contractors" who can barely make ends meet (though that's bad enough); it may be the spreading myth that any economic function can be shoehorned into the Uberformat of service-on-demand at a rock-bottom price.

A case in point is the mirage of an "Uber for healthcare." The latest and most prominent promoter of this notion is the conservative healthcare analyst Avik Roy of the Manhattan Institute. In a new issue brief he poses the question directly: "Why isn’t there an Uber of health care?" he asks. "Why can’t we deploy, in health care, the same forces that are improving quality and lowering costs in virtually every other sector of the economy?"

Millions of dollars in venture funding have already been deployed to answer Roy'squestion with a "Why not, indeed?" Pager, a mobile app company that arranges doctor house calls in New York and San Francisco, has attracted more than $24 million in early-round investment; Heal provides a similar service in the Los Angeles, San Francisco, and San Diego regions. But both have limitations that point to real difficulties in applying the Uber idea to healthcare. In fact, there are indications that the model makes healthcare less efficient.

Let's dismiss right off Roy's assertion that Uber necessarily has improved the quality or lowered the costs of transportation, much less any other service. Although Uber may have made local transportation more available in some places and some times of day, there's no evidence that its drivers are better, or safer, than taxi drivers, and some evidence that the form does less than taxi fleet owners or regulators to ensure the safety and quality of the person behind the wheel or the vehicle being driven.

As for lowering the costs, tell that to someone blindsided with a surge price for a ride late AT night or in a high-demand period. And that's the price, not the cost--for the latter, one has to factor in the cost to the driver of providing the service net of expenses, which in many cases can reduce the driver's take to minimum wage or less.

The real question is whether healthcare harbors the same inefficiencies that Uber has exploited. That involves the question of whether healthcare is a service that can be reduced to fundamentals like local transportation. Is diagnosing or treating a disease the same thing as driving a car?

Indications are that the answer is no.

http://www.latimes.com/business/hiltzik/la-fi-mh-why-an-uber-for-healthcare-may-not-happen-20160201-column.html

Reducing Preventable Harm in Hospitals

By DAVID BORNSTEIN

JANUARY 26, 2016

Each year, in the United States, millions of patients are harmed while receiving care in hospitals. They get infections, experience adverse reactions to drugs, develop dangerous bed sores, or come down with pneumonia from the very ventilators meant to help them breathe.

The estimates of the number of people who die each year as a result of hospital errors have ranged from as many as 98,000 in a landmark Institute of Medicine report from 1999 to as many as 440,000 in a 2013 study.

It’s believed that most of these deaths could be prevented if health care providers always adhered to evidence-informed practices. In recent years, the Centers for Medicare and Medicaid Services, an arm of the Department of Health and Human Services, has sought to drive improvements by linking payments to hospital performance, including patient safety.

But hospital care is astonishingly complex. In the United States each year, there are over 35 million hospital admissions and 136 million visits to emergency rooms. Doctors, nurses and technicians conduct so many procedures and dispense so much medication that even seemingly tiny error rates can translate to tens of thousands of patients harmed.

Amid the complexity, the chaotic pace, and the increasing need for coordination, how can hospitals do better to improve patient safety? How can they ensure, for example, that every single time a patient receives a medication, precautions are taken to reduce the risks of an adverse drug reaction?

Or that every time medical practitioners insert a central line catheter into a major artery or vein, they wash their hands, use sterile drapes, and remove it as soon as it’s no longer needed?

Or that every patient confined to a bed is regularly watched to prevent pressure sores, which can cause life-threatening infections?

The answer is systems with safeguards. One way to understand the problem is the “Swiss cheese model,” which was proposed by James Reason, an expert in the psychology of human error. In a good system, there are multiple layers of defense, each compensating for weaknesses in other layers. System failures occur when layers share the same vulnerabilities — and the holes go all the way through the cheese. That’s when mistakes harm patients.

http://opinionator.blogs.nytimes.com/2016/01/26/reducing-preventable-harm-in-hospitals/

How Hospitals Are Changing to Become Safer

By DAVID BORNSTEIN

FEBRUARY 2, 2016

Last week, I reported on the problem of preventable harm in hospitals. It has been estimated that each year between 98,000 and 440,000 people die as a result of preventable errors in hospital. Many readers wrote in with comments about family members who were victims of flawed care. They revealed a sense of betrayal and hurt. How could hospitals — institutions we turn to for comfort when we are most vulnerable — so often increase pain and suffering?

It’s natural to seek to assign blame when harm occurs. But patient safety experts say that medical errors are more a function of faulty systems than faulty people. In recent years, with leadership from the Institute for Healthcare Improvement, the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine, federal programs like the Partnership for Patients and many others, numerous hospitals have made focused efforts to reduce harm. Here’s a look at some of them.

Reducing hospital-acquired infections

About one in 25 patients contracts an infection in the hospital, resulting in 75,000 deaths each year, but hospitals have been cutting this risk by adhering to stricter protocols. The most basic is getting hospital staff members to wash their hands before touching patients. More than 160 years after Florence Nightingale cut the death rate by 95 percent in British military hospitals in Crimea largely by improving hygiene, hand washing remains inconsistent in American hospitals. It’s the most important cause of hospital-acquired infections. Without reminders and watchdogging, hospital workers forget to wash their hands most of the time before they touch patients.

My colleague Tina Rosenberg has reported on ways that hospitals are attacking the problem, including using video cameras, placing sinks in standard locations and installing sensors. Many hospitals also have prioritized hygiene around critical procedures like the insertion of catheters into major arteries or veins. Over the past four years, Ascension Health, the largest nonprofit health system in the United States, has halved its rate of bloodstream infections associated with these central line catheterizations, says Ann Hendrich, a registered nurse who heads Ascension’s quality and patient safety efforts.

Ascension Health created local patient safety teams, examined current practices, compared them with recommended practices, and brought teams together to agree on standardized “bundles” (sets of steps) — including things like how often to change a central line and how to dress it. It also instituted common standards for tracking infections, said Hendrich. Staff at Ascension Health facilities now avoid needless catheterizations and act quickly to remove them at the earliest possible moments.

http://opinionator.blogs.nytimes.com/2016/02/02/how-hospitals-are-changing-to-become-safer/?action=click&pgtype=Homepage&version=Moth-Visible&moduleDetail=inside-nyt-region-4&module=inside-nyt-region&region=inside-nyt-region&WT.nav=inside-nyt-region

The Real Reason Medicare Is a Lousy Drug Negotiator: It Can’t Say No

by Margot Sanger-Katz - New york times

A good negotiator needs to be able to walk away.

That is a rule that, surely, Donald Trump knows. And yet in suggesting that Medicare could find big discounts by letting the government negotiate directly over drug prices, he seems to have forgotten it.

Mr. Trump has joined Hillary Clinton and Bernie Sanders in calling for a federal government program to negotiate for Medicare’s drug prices. The current system has private insurance companies each negotiating separate deals on behalf of large groups of Medicare patients. Right now, the program is O.K. at negotiating, saving as much as 30 percent off the list price of drugs, according to government reports. But Medicare still pays much, much more than government health systems in other countries.

The idea of government directly negotiating with drug makers has been a liberal favorite ever since Medicare began paying for drugs 10 years ago. You can see the appeal. The thinking goes like this: Medicare’s drug plans cover about 37 million people. Maybe if it bargained on behalf of all those beneficiaries as one, instead of dividing them into a series of smaller groups, it could get better deals. Other countries, like Britain, where the government purchases drugs for everyone in bulk, pay much, much less for drugs than the United States. In those countries, private companies don’t do the negotiating; the government does. And they don’t split the big market.

“We don’t do it,” Mr. Trump said at a Farmington, N.H., campaign event, according to The Associated Press. “Why? Because of drug companies.”

But if you talk to experts who study the pharmaceutical market in the United States, they aren’t optimistic that, by itself, letting the government play drug negotiator would take a big bite out of prescription drug spending.

For one, the companies that run the Medicare drug plans aren’t really that small, because they also provide drug benefits to companies and individuals with health insurance. The largest pharmacy benefit manager, Express Scripts, covers more than 85 million Americans. Other big pharmacy benefit managers include CVS/Caremark and OptumRx.

But size isn’t the only issue. The real problem is that Medicare can very rarely say “No way” to a drug company. Medicare beneficiaries wanted the program to cover most drugs that older people would want to use. So Congress put in place rules that strengthen the hand of the drug companies in negotiations.

Medicare is required to cover almost every cancer treatment that is approved by the Food and Drug Administration, for example, one of six categories where the drug plans can almost never say no to the drug companies. If a drug maker comes out with a new cancer medicine with a sky-high price, there’s not much a Medicare plan can do to talk it down.

http://www.nytimes.com/2016/02/02/upshot/the-real-reason-medicare-is-a-lousy-drug-negotiator-it-cant-say-no.html?hpw&rref=upshot&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

When Doctors Took ‘Family Planning’ Into Their Own Hands

By MARCELA VALDESFEB. 1, 2016

Dolores Madrigal remembered being told that her sterilization could be reversed. Jovita Rivera and Georgina Hernández said they were bullied by doctors and nurses who declared their children burdens on California taxpayers. Melvina Hernandez did not find out that her tubes had been cut until four years after her son was born.

In 1975, these four women were among the 10 plaintiffs who filed a class-action lawsuit in federal court claiming that the Los Angeles County U.S.C. Medical Center was systematically sterilizing Spanish-speaking mothers who delivered their babies via cesarean section.

Madrigal v. Quilligan was, from its outset, the kind of striking David-versus-Goliath story that Hollywood and history books usually love — Erin Brockovich with an East L.A. twist. It was championed by a Latina fresh out of law school, and backed by the marginalized feminist wing of a growing Chicano activist movement. It was directed against some of most the powerful institutions in the state, including the Department of Health and the University of Southern California. The events in the trial even had a famous setting: For decades, Los Angeles County hospital served as an exterior shot for the soap opera “General Hospital.” And the claims were disturbing — that the hospital had made a practice of misleading women about sterilization and coercing them into giving consent.

Yet when Virginia Espino, a historian, began researching the case in 1994, almost all these details had been lost and forgotten. For years, Espino could not even obtain complete copies of the court documents at the County Hall of Records. “They said that it was lost, missing, somebody had borrowed it,” she told me. “They couldn’t find it.” And until Espino teamed up with her friend, the Academy-Award-nominated filmmaker Renee Tajima-Peña (“Who Killed Vincent Chin?”), the public had never heard any of the plaintiffs describe their own experiences with the ill-fated suit. The documentary that sprang from their collaboration — “No Más Bebés” (“No More Babies”), which is being broadcast on PBS tonight — aimed to change that.

Madrigal v. Quilligan revolved around two fundamental questions: Did obstetricians at County Hospital perform tubal ligations on their patients without proper consent? And did doctors single out Latinas for the procedures?

http://www.nytimes.com/2016/02/01/magazine/when-doctors-took-family-planning-into-their-own-hands.html?hpw&rref=magazine&action=click&pgtype=Homepage&module=well-region&region=bottom-well&WT.nav=bottom-well

Health Care Policy and Marketplace Review

A Health Care Reform Blog––Bob Laszewski's review of the latest developments in federal health policy, health care reform, and marketplace activities in the health care financing business.

MONDAY, FEBRUARY 1, 2016

Why the Obamacare 2016 Open Enrollment Stalled: The Big Unwritten Story About Obamacare––How Unaffordable It Is For the Working and Middle Class

Back on December 22nd when the President triumphantly announced 6 million enrollments on HealthCare.gov and the administration pointed to "unprecedented demand" on the exchanges, I was the skunk at the garden party arguing in the Washington Post that it was all just churn as existing customers were only trying to escape all of the big rate increases.

Well guess what? It was all churn.

The administration will shortly announce the total number of people who signed up for Obamacare under the Affordable Care Act.

The number signing up in 2016 will turn out to be not much more than the number who signed up last year after those who don't pay are netted out––no sizeable gain in enrollment has been accomplished on a national basis.

Why Obamacare's Enrollment Stalled in 2016

Those touting Obamacare often brag about how affordable it is.

According to the White House Website, "Many Americans can get a [health insurance] plan for less than $100 a month."

That's all true if you are poor. Obamacare has been very helpful to those on Medicaid and those with the lowest incomes on the insurance exchanges.

But if you are solidly in the working and middle-class in this country individual health insurance on the state and federal exchanges is anything but affordable.

http://healthpolicyandmarket.blogspot.com/2016/02/why-obamacare-2016-open-enrollment.html?utm_source=feedburner&utm_medium=email&utm_campaign=Feed%3A+HealthCarePolicyAndMarketplaceBlog+%28Health+Care+Policy+and+Marketplace+Blog%29

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Tuesday, February 2, 2016

Health Care Reform Articles - February 2, 2016