'Make Your Stand': Medicare for All Supporters Ready to Hold Dems to Account
by Jessica Corbett - Common Dreams - August 8, 2017
As popular support for single-payer continues to grow and Sen. Bernie Sanders (I-Vt.) prepares to introduce Medicare for All legislation, the Establishment wing of the Democratic Party is reportedly "alarmed" by the shifting dynamics and fearful "of primary election challenges" if they don't support Sanders's proposal.
"Democrats who don't get behind it could find themselves on the wrong side of the most energetic wing of the party," Politico reportedMonday.
Political organizers and supporters of Sanders are already speaking out about how lawmakers' responses could impact upcoming elections.
"Any Democrat worth their salt that doesn't unequivocally say Medicare for All is the way to go? To me, there's something wrong with them," Nina Turner, president of Our Revolution—the political group that formed out of Sanders's presidential campaign—told Politico. "We're not going to accept no more hemming and hawing. No more game playing. Make your stand."
"Our view is that within the Democratic Party, this is fast-emerging as a litmus test," Ben Tulchin, the pollster for Sanders's presidential run, told Politico.
RoseAnn DeMoro, executive director of the Sanders-aligned National Nurses United union, agrees. "It's a litmus test," DeMoro told NBC News last month. "It's a clarifying issue like none I've ever seen. We're talking about people's lives and health and money."
Mounting public support of a Medicare for All national healthcare system could sway centrist Democrats, and perhaps even Senate Republicans, who are up for reelection in 2018 or 2020.
A national poll released by Quinnipiac last week found that a majority of American voters overall, and 67 percent of Democrats, believe that replacing the nation's current healthcare system with a single-payer system—"in which the federal government would expand Medicare to cover the medical expenses of every American citizen"—is a good idea.
Growing support for related legislation in the House also suggests that Democratic senators could be pressured by public opinion to support Sen. Sanders's proposal.
For more than a decade, Rep. John Conyers (D-Mich.) has consistently introduced House single-payer legislation, but his bill introduced earlier this year—"The Expanded And Improved Medicare For All Act" or H.R. 676 (pdf)—has received unprecedented support from House Democrats, with more than 100 of them signing on as co-sponsors.
Rep. Keith Ellison (D-Minn.), deputy chair of the Democratic National Committee, acknowledged how impactful a candidate's position on the Medicare for All issue can be on Congressional races in a May interview with the Huffington Post.
Although Rep. Ellison emphasized that the DNC won't tell candidates which positions to take on any issues, he also said: "I recommend that you win your election, and I think a good way to do it is to support the Conyers bill."
Looking toward the 2020 presidential race, Rep. Conyers told NBC News: "I don't know how many of the candidates will support Medicare for All.... But it's pretty obvious at this point that the winning one will."
Despite the efforts of lawmakers like Sen. Sanders and Rep. Conyers, as well as growing public support of Medicare for All, many establishment Democrats within and beyond Congress remain apprehensive about supporting it.
"In the name of political reality, some liberal pundits, politicians and policy wonksare scolding progressives to give up on Medicare for All," noted Michael Lightly, National Nurses United's director of public policy, in a Common Dreams op-ed on Tuesday.
Citing Paul Krugman's latest New York Times column warning against the push for Medicare for All, Lightly argues that "progressives are badly served" by such "shallow political advice," which "obscures the reality working people actually face, and undermines the fight for our values and program."
The program Lightly envisions aligns with the proposals of Sen. Sanders and Rep. Conyers: improving Medicare, and expanding it to all Americans, which, he writes, would establish a national system to "confront the industry, contain prices and restore the values of caring, compassion and community to our healthcare system."
"Democrats who don't get behind it could find themselves on the wrong side of the most energetic wing of the party," Politico reportedMonday.
Political organizers and supporters of Sanders are already speaking out about how lawmakers' responses could impact upcoming elections.
"Any Democrat worth their salt that doesn't unequivocally say Medicare for All is the way to go? To me, there's something wrong with them," Nina Turner, president of Our Revolution—the political group that formed out of Sanders's presidential campaign—told Politico. "We're not going to accept no more hemming and hawing. No more game playing. Make your stand."
"Our view is that within the Democratic Party, this is fast-emerging as a litmus test," Ben Tulchin, the pollster for Sanders's presidential run, told Politico.
RoseAnn DeMoro, executive director of the Sanders-aligned National Nurses United union, agrees. "It's a litmus test," DeMoro told NBC News last month. "It's a clarifying issue like none I've ever seen. We're talking about people's lives and health and money."
Mounting public support of a Medicare for All national healthcare system could sway centrist Democrats, and perhaps even Senate Republicans, who are up for reelection in 2018 or 2020.
A national poll released by Quinnipiac last week found that a majority of American voters overall, and 67 percent of Democrats, believe that replacing the nation's current healthcare system with a single-payer system—"in which the federal government would expand Medicare to cover the medical expenses of every American citizen"—is a good idea.
Growing support for related legislation in the House also suggests that Democratic senators could be pressured by public opinion to support Sen. Sanders's proposal.
For more than a decade, Rep. John Conyers (D-Mich.) has consistently introduced House single-payer legislation, but his bill introduced earlier this year—"The Expanded And Improved Medicare For All Act" or H.R. 676 (pdf)—has received unprecedented support from House Democrats, with more than 100 of them signing on as co-sponsors.
Rep. Keith Ellison (D-Minn.), deputy chair of the Democratic National Committee, acknowledged how impactful a candidate's position on the Medicare for All issue can be on Congressional races in a May interview with the Huffington Post.
Although Rep. Ellison emphasized that the DNC won't tell candidates which positions to take on any issues, he also said: "I recommend that you win your election, and I think a good way to do it is to support the Conyers bill."
Looking toward the 2020 presidential race, Rep. Conyers told NBC News: "I don't know how many of the candidates will support Medicare for All.... But it's pretty obvious at this point that the winning one will."
Despite the efforts of lawmakers like Sen. Sanders and Rep. Conyers, as well as growing public support of Medicare for All, many establishment Democrats within and beyond Congress remain apprehensive about supporting it.
"In the name of political reality, some liberal pundits, politicians and policy wonksare scolding progressives to give up on Medicare for All," noted Michael Lightly, National Nurses United's director of public policy, in a Common Dreams op-ed on Tuesday.
Citing Paul Krugman's latest New York Times column warning against the push for Medicare for All, Lightly argues that "progressives are badly served" by such "shallow political advice," which "obscures the reality working people actually face, and undermines the fight for our values and program."
The program Lightly envisions aligns with the proposals of Sen. Sanders and Rep. Conyers: improving Medicare, and expanding it to all Americans, which, he writes, would establish a national system to "confront the industry, contain prices and restore the values of caring, compassion and community to our healthcare system."
Liberals Strike Back... Against Single Payer
by Michael Lighty - Common Dreams - August 8, 2017
In the name of political reality, some liberal pundits, politicians and policy wonks are scolding progressives to give up on Medicare for All. They are dead wrong.
With the explosive growth of the movement for single payer healthcare, it should not be a surprise to see the Empire Strike Back.
In the name of political reality, some liberal pundits, politicians and policy wonks are scolding progressives to give up on Medicare for All. There are many ways to achieve "universal coverage," we're told. "Overhauling" the entire system is too hard, healthcare is too big a part of the economy, and politicians will not take out the health insurance companies.
"Our health is not a commodity—it doesn't belong in the "market"—it is a human right."
Yet, the alternative approaches to reform pose the same political problems: the insurance industry is likely to fight the elimination of their profits (Dutch and German health insurers, for example, are non-profit), and the severe reductions in executive compensation, elimination of shareholder dividends, and rate setting, all of which go away under European-style health insurance. The benefits and rates are government mandated, the companies are essentially payment administrators.
Either this regulated system of private health plans lowers prices through government—by setting rates and negotiations—or it fails to do so and costs shift to individuals. But it is still the government role as rate setter/price negotiator that matters. Wouldn't it be more straightforward and simpler to improve and expand Medicare?
Still, the pundits say it's best to search for incremental reform of the insurance-based system, and live (or not!) with the results. In other words, the best health reform we can do is a version of what we have. Worse, it props up and reinforces a profit-focused system that is antithetical to the very concept of healing. Advocates of Medicare for all, and other non-reformist reforms, are looking to solve problems immediately, not accommodating the status quo.
Progressives are badly served by shallow political advice from the likes of Paul Krugman. It obscures the reality working people actually face and undermines the fight for our values and program.
Our health is not a commodity—it doesn't belong in the "market"—it is a human right. Those who advise us to settle for models of national health systems in other countries are missing the fundamental difference from the broken U.S. scheme. What Australia, the Netherlands and Switzerland all have in common is they do not conflate "coverage" with healthcare. Those countries guarantee healthcare.
Having health insurance in America doesn't prevent medical bankruptcy or denied care. In the U.S., employer based healthcare creates great uncertainty for workers, as premiums and out of pocket costs increase, reflecting costs shifted from the company to workers to fund the profits of the insurance companies.
"Why would we try to buttress a system that is failing workers, hurting business, and shrinking?"
Only 55 percent of employers offer coverage. Why would we try to buttress a system that is failing workers, hurting business, and shrinking? From 60 to 70 percent of healthcare spending comes from taxes. We're just not getting our monies worth. We are wasting 20 cents on the dollar when we pay for private health insurance, wasting huge resources that could go to higher wages, child care, and pensions.
Alternatively, single payer is the reform that establishes health security and enables greater equality and freedom—values worth fighting for.
Ironically, healthcare reform efforts have sought to "improve and expand" every element of the present system, except the program that is popular and works best: Medicare. The Clintons tried to expand HMOs, Obama expanded private health insurance and Medicaid, the GOP tried to expand "individual purchase," so we'd all be on our own when dealing with insurance companies, drug companies and hospital corporations.
It is precisely profit-focused healthcare industry that has caused the problems of escalating costs and restricted access. Rising premiums pay for rising prescription drug costs, which hospital corporations pass on to patients and drive up their own rates as they leverage their market share. As a result, each sector's revenues and profits increase. The industry imperative of revenue and profits has replaced caregiving as the basis of healthcare in the US (see Elizabeth Rosenthal’s book, "American Sickness.")
We are not "starting from scratch," as Krugman contends (which he did not in 2005) but instead there exists a model in the U.S. for how single-payer financing could work: Medicare—which if improved and expanded to all—could confront the industry, contain prices and restore the values of caring, compassion and community to our healthcare system.
Alternative approaches to universal coverage (though even with the Affordable Care Act, 28 million people remain uninsured) depend on using huge tax subsidies to enable individuals and businesses to buy insurance coverage. Without those subsidies—in California alone they amount to over $100 billion—health insurance is a failed business model. Taxpayers prop up the insurers profits for the honor of paying $2000 in deductibles and potentially under the ACA over 9.5 percent of our income in out of pocket costs. In California, this means 15 million people are uninsured or underinsured.
Truly controlling costs requires eliminating the waste and inefficiency of the private payers – Medicare administrations are cost 4-5 percent compared to up to 12 percent for insurance companies (before profits). The inherently wasteful insurance company bureaucracy doesn't go away when everybody has to buy one of their health plans.
Ultimately, what we must face is an issue of power. Can we collectively organize a healthcare system without the imperatives of revenue and profit? Only if we build a movement for health justice that demands guaranteed healthcare for all as a human right. Only collectively through government do we as a society have the resources and standing to secure that right. Only through an Improved Medicare for All can we achieve health security, not subject to the market power of healthcare corporations.
Facing Trump Subsidy Cuts, Health Insurance Officials Seek a Backup Plan
by Robert Pear - NYT - August 7, 2017
PHILADELPHIA — Congress is on vacation, but state insurance commissioners have no time off. They have spent the past three days debating what to do if President Trump stops subsidies paid to insurance companies on behalf of millions of low-income people.
For administration officials and many in Congress, the subsidies are a political and legal issue in a fight over the future of the Affordable Care Act. But for state officials, gathered here at the summer meeting of the National Association of Insurance Commissioners, the subsidies are a more immediate, practical concern.
The insurance commissioners are frustrated with the gridlock in Washington, which they say threatens coverage for consumers and the solvency of some insurers. Without the payments, they say, consumers will face higher premiums in 2018, and more insurers will pull back from the individual insurance market.
Mr. Trump has repeatedly threatened to cut off the payments, which reimburse insurers for reducing the deductibles, co-payments and other out-of-pocket costs for low-income people.
If the government continues providing funds for the subsidies, insurers will have “a small profit,” said Craig Wright, the chief actuary at the Florida Office of Insurance Regulation. “If the subsidies are not funded, carriers would face the prospect of large financial losses, which could increase the risk to their solvency.”
“It could be very damaging,” Mr. Wright said. “Our market wouldn’t recover.”
With no guidance or clarity from the Trump administration, state officials are agonizing over what to do. Many expressed a sense of urgency, saying they needed to make decisions soon on rates to be charged in 2018.
Trump administration officials were invited to speak to state insurance regulators and were listed in the program for at least one public session, but they did not show up at that event to provide the promised update on federal policy.
“Most of us are hoping and praying that this gets resolved,” said David Shea, a health actuary at the Virginia Bureau of Insurance. “But that’s not the case right now.”
Without the federal subsidies, insurers would need to get the money — estimated at $7 billion to $10 billion next year — from another source. And that means higher premiums, state officials said.
The officials here are wrestling with several questions: How much should premiums be increased? Who should pay the higher premiums? Is there any way to minimize the effect on low-income people? Is it better to assume that the cost-sharing subsidy payments will or will not be made in 2018? What happens if state officials guess wrong?
State officials said they would allow insurers to impose a surcharge on premiums if the federal government cuts off funds for the cost-sharing subsidies.
Paul Lombardo, a health actuary at the Connecticut Insurance Department, said officials there might direct insurers to spread the cost across all of their health plans, both on and off the insurance exchange created under the Affordable Care Act.
By contrast, Florida has asked insurers to load all of the extra cost into the prices charged for midlevel “silver plans” sold on the exchange. The federal government would then absorb almost all of the cost through another subsidy program, which provides tax credits to help low-income people pay premiums, Mr. Wright said. The tax credits generally increase when premiums rise.
J. P. Wieske, the deputy insurance commissioner in Wisconsin, said that two companies, Anthem and Molina Healthcare, were leaving the state’s marketplace in 2018 and that two others, Humana and UnitedHealth, exited in previous years. As a result, he said, more people will be enrolled in smaller local health plans that could be more affected by a termination of federal subsidy payments.
“Carriers left in the Wisconsin market are smaller, local plans,” Mr. Wieske said. “Particular carriers could have huge surges in population, going from 7 or 8 percent of their business in the individual market to 30 or 40 percent. If that’s the case, if it’s 30 or 40 percent of their business in the individual market, that’s obviously a gargantuan risk.”
The risks for consumers are also high, Mr. Wieske said. “Consumers,” he said, “could be stuck in a zombie plan, an insurer that is essentially no longer able to do business in the worst-case scenario, or consumers may have to move to another insurer with different health care providers.”
Officials in many states must decide this month on insurance rates for next year.
“We are holding off making those decisions until the very last possible minute,” said Julie Mix McPeak, the Tennessee insurance commissioner. “In doing so, we are really making it difficult for consumers who need information about open enrollment — who’s participating in the market and what the rates might be. We don’t know the answers to any of those questions.”
The uncertainty stems not only from the White House and Congress, but also from federal courts.
House Republicans challenged the cost-sharing payments in a lawsuit in 2014. A federal judge ruled last year that the Obama administration had been illegally making the payments, in the absence of a law explicitly providing money for the purpose. The case is pending before the United States Court of Appeals for the District of Columbia Circuit, which has held it “in abeyance” at the request of House Republicans and the Trump administration.
The administration has been providing funds for cost-sharing subsidies month to month, with no commitment to pay for the remainder of this year, much less for 2018.
“I am very fearful that we’ll have insurers make a decision to leave markets as a result of the uncertainty,” said Ms. McPeak, who is the president-elect of the National Association of Insurance Commissioners. “It’s somewhat inequitable to ask insurers to sign a contract that binds them but may not bind the federal government.”
The Affordable Care Act requires an annual review of health insurance rate increases, and states are taking different approaches.
Nebraska initially told insurers to file 2018 rates on the assumption that the cost-sharing subsidies would continue. But “because of the confusion in Washington,” said Martin W. Swanson of the Nebraska Insurance Department, the state later told insurers to assume that they would not receive the subsidy payments.
Mike Chaney, the Mississippi insurance commissioner, and Allen W. Kerr, the Arkansas insurance commissioner, said they had instructed companies to assume that they would receive the cost-sharing subsidies next year. Michigan has told insurers to submit two sets of rates, one with the subsidies and one without.
Michael F. Consedine, the chief executive of the National Association of Insurance Commissioners, said that without a firm commitment of federal funds for the cost-sharing subsidies, “we have grave concerns about the long-term viability of the individual health insurance market in a number of states.”
“We need some step right away,” Mr. Consedine said, “either by action of Congress or by direction of the administration, to ensure that Americans continue to have access to coverage.”
A businessman makes the case for a single-payer health care system
by Richard Master - The Morning Call - August 1, 2017
With all due respect to President Trump, he is wrong about the single-payer model of health insurance.
Single payer — centralized public financing of a continued privately operated health system — will not "bankrupt the United States." In fact, the opposite is true.
Single payer is the only internationally proven strategy to transition the U.S. out of its current crisis of runaway health care costs to economic sustainability, where overall system cost growth is consistent with overall economic growth and inflation.
At one-sixth of our economy and over 25 percent of the federal budget, health care will continue to be a focus in Congress until real progress is made and the angst of the American people about the system is resolved. It is clear to most Americans that runaway health care costs translate into flat wages and also a deterioration of real disposable income that drags down our 70 percent consumer-driven economy.
But recent efforts in Congress to confront the crisis have been misguided. Congress has focused on cost shifting — moving the burden of our health system away from the federal government to the states and also to employers and to working families across the country, who will pay higher private insurance premiums to cover the expected cost of increased uncompensated care as the system absorbs the loss of Medicaid funds.
Going forward, the focus of the administration and its allies in Congress should be on controlling the real drivers of cost of care, such as prices of pharmaceuticals, which are rising at double digits a year, and addressing wasteful administrative costs associated with our complex, multipayer-financing model, which costs U.S. private doctors $83,000 a year to interact with multiple health plans vs. $22,000 for doctors in Canada, according to a 2011 Commonwealth Fund study. And it costs hospitals nearly double in administrative costs vs. other countries, according to a 2014 Commonwealth Fund study.
We do not need to reinvent the wheel. Single payer is the recognized best practice. Warren Buffet points out that, in the 1970s, Canada and the U.S. had roughly equivalent health system expense — 7 percent of gross domestic product. Canada went the single-payer route; the U.S. did not. Canada covers all of its citizens, has better health outcomes and today spends 11.4 percent of GDP. Our cost went to 18 percent of GDP. France, the highest ranked health system in the world, spends 11.8 percent of GDP, and Japan, 8.5 percent
We need to investigate and follow the examples of successful health systems operating throughout the world where all citizens are covered, public health outcomes are measurably superior and the overall cost to society is less.
We need to also review closely the many in-depth studies by prominent American economists reporting overall system savings from a transition to centralized financing. Consider in particular the May study, "Economic analysis of the healthy California single-payer health care proposal (SB-562)." That study, from four economists at the University of Massachusetts, demonstrated how single payer would reduce California's overall health care expense by 10 percent, even with universal care for all residents and assuming comprehensive benefits. (The bill has been referred to a legislative committee.)
The study found substantial savings in administration and pharmaceutical pricing and on mitigating the current high variance in fees for service providers. Today 7.5 percent of Californians have no health coverage and an additional 30 percent of those insured are considered underinsured and are particularly vulnerable to the economic consequence of serious illness. The status quo in California and throughout the country is unacceptable. The solution is single payer.
What do Americans want? According to an April Economist/YouGov poll, 60 percent of Americans favor a Medicare-for-all solution to replace the Affordable Care Act, and only 24 percent oppose it. Medicare for all is single payer.
During his campaign, President Trump promised to take on cronyism and refresh Washington. No better place to start than with the health care commercial sector. They spend more on lobbying Congress than any other business sector, and they get what they pay for — a Congress that focuses more on the commercial interests of an industry than it does on the well-being of patients, working families and the overall economy.
This is our big chance to do something great. Let's fix health care with single payer.
Richard Master is founder and CEO of MCS Industries Inc., Palmer Township, and executive producer of two documentaries,"Fix It: Healthcare at the Tipping Point" and "Big Pharma: Market Failure."
http://www.mcall.com/opinion/yourview/mc-single-payer-health-care-master-yv-0802-20170801-story.html
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