Guess Who Else Is a Socialist?
One of the side benefits of a well-watched national political debate is the exposure it brings to something obscure and forgotten — like Denmark. Who doesn’t love a country that gave us a dish of frikadeller and rugbrod to go with paid parental leave and universal health care?
“I love Denmark,” said Hillary Clinton during Tuesday’s debate, by way of dismissing a quasi-socialist nation of 5.7 million mostly white people as not the best place to look for solving the problems of a multiethnic democracy of 322 million.
But in fact, the United States may be closer to Denmark than many think. In the reddest of red states — say, Idaho — you can find the kind of socialism, through publicly owned utilities or the federal dam that farmers rely on for their water, that would be right at home among aquavit-sipping Danes.
Once you label something socialist, it brings to mind dour Soviet types trotting out dreary worker clothing for the spring fashion line. Or, here at home, those insufferable parlor room Marxists who think it would be utopia if only we nationalized every Starbucks. In that sense, the worst thing about socialism is the socialists.
Free of the label, a hybrid economy where health care, education and pensions for the elderly are provided, side-by-side-by-side with creative capitalism, works pretty well in the Nordic countries, Britain and Canada. And most of the tenets of what is considered democratic socialism have majority support in the United States.
But “socialism” as a word is poison in this country, except among the young, in large part because it’s associated with failed authoritarian Marxist states. A recent Gallup poll found that half of Americans would not vote for a socialist. More people said they could accept an atheist as president than someone with the scarlet S.
So we don’t like “them.” But we do like many of their ideas. We can thank Senator Bernie Sanders, self-proclaimed democratic socialist, for this healthy debate. This week, Donald Trump called him a “communist.” If so, you can find broad public support for most of the things advocated by the commie from Brooklyn.
A majority of Americans feel “money and wealth in this country should be more evenly distributed,” according to a CBS News/New York Times poll. Sanders wants to raise the minimum wage; so do 71 percent of Americans. Sanders believes corporations have too much influence on politics, as do 74 percent of Americans. And one of the biggest socialist programs — the single payer Medicare system that is a lifeline to more than 50 million people — is also one of the most popular.
Nearly one in four people in this country gets electricity from a consumer-owned or co-op utility — socialism throughout the heartland. And when President Obama considered privatizing a big government utility and dam operator, the Tennessee Valley Authority, he was met with squawks of protest from some of the most conservative precincts in America.
Obama is no socialist. A socialist would have nationalized General Motors, instead of returning it to capitalistic solvency. A socialist would not have presided over a doubling of the stock market, without adding significant new taxes to Wall Street’s biggest beneficiaries.
For true socialism in action, look to the billionaire Trump. As a developer, he’s tried to use eminent domain — “state-sanctioned thievery,” in the words of National Review Online — to get other people’s property. There’s your communist. He has no problem taking from others to serve the public “good.”
Capitalism at its best gives us iPhones and 400 kinds of ice cream and rewards enterprise and innovation. The free market has no small amount of magic. At its worst, capitalism produces pharmaceutical companies that gouge for lifesaving drugs, insurance companies that drop people once they get sick, and a system where secretaries pay a higher percentage of their earnings in taxes than billionaires who do nothing.
Socialism at its best can run an army, a health care system and provide quality education for those who otherwise couldn’t afford one. Libraries and fire departments are socialist institutions. So is the Interstate System of highways created under President Eisenhower. Ditto the nation’s most popular cultural enterprise, the National Football League, which shares its television billions with losers among the teams. At its worst, socialism is grim and stifling, a dead-end for creativity.
The key is to find a balance, as Hillary Clinton said in Tuesday’s debate. “Our job is to rein in the excesses of capitalism so it doesn’t run amok,” she said. In that sentiment, you could hear the historical echo of two great progressive presidents, Teddy Roosevelt and his cousin Franklin, both of whom sought to save capitalism from itself.
She also said, “We are not Denmark.” Nope. Not by any stretch. Denmark has a slightly higher tax load on its citizens than the United States. But it also has budget surpluses, universal health care, shorter working hours, and was recently rated by Forbes magazine as the best country in the world for business.
One of the side benefits of a well-watched national political debate is the exposure it brings to something obscure and forgotten — like Denmark. Who doesn’t love a country that gave us a dish of frikadeller and rugbrod to go with paid parental leave and universal health care?
“I love Denmark,” said Hillary Clinton during Tuesday’s debate, by way of dismissing a quasi-socialist nation of 5.7 million mostly white people as not the best place to look for solving the problems of a multiethnic democracy of 322 million.
But in fact, the United States may be closer to Denmark than many think. In the reddest of red states — say, Idaho — you can find the kind of socialism, through publicly owned utilities or the federal dam that farmers rely on for their water, that would be right at home among aquavit-sipping Danes.
Once you label something socialist, it brings to mind dour Soviet types trotting out dreary worker clothing for the spring fashion line. Or, here at home, those insufferable parlor room Marxists who think it would be utopia if only we nationalized every Starbucks. In that sense, the worst thing about socialism is the socialists.
Free of the label, a hybrid economy where health care, education and pensions for the elderly are provided, side-by-side-by-side with creative capitalism, works pretty well in the Nordic countries, Britain and Canada. And most of the tenets of what is considered democratic socialism have majority support in the United States.
But “socialism” as a word is poison in this country, except among the young, in large part because it’s associated with failed authoritarian Marxist states. A recent Gallup poll found that half of Americans would not vote for a socialist. More people said they could accept an atheist as president than someone with the scarlet S.
So we don’t like “them.” But we do like many of their ideas. We can thank Senator Bernie Sanders, self-proclaimed democratic socialist, for this healthy debate. This week, Donald Trump called him a “communist.” If so, you can find broad public support for most of the things advocated by the commie from Brooklyn.
A majority of Americans feel “money and wealth in this country should be more evenly distributed,” according to a CBS News/New York Times poll. Sanders wants to raise the minimum wage; so do 71 percent of Americans. Sanders believes corporations have too much influence on politics, as do 74 percent of Americans. And one of the biggest socialist programs — the single payer Medicare system that is a lifeline to more than 50 million people — is also one of the most popular.
Nearly one in four people in this country gets electricity from a consumer-owned or co-op utility — socialism throughout the heartland. And when President Obama considered privatizing a big government utility and dam operator, the Tennessee Valley Authority, he was met with squawks of protest from some of the most conservative precincts in America.
Obama is no socialist. A socialist would have nationalized General Motors, instead of returning it to capitalistic solvency. A socialist would not have presided over a doubling of the stock market, without adding significant new taxes to Wall Street’s biggest beneficiaries.
For true socialism in action, look to the billionaire Trump. As a developer, he’s tried to use eminent domain — “state-sanctioned thievery,” in the words of National Review Online — to get other people’s property. There’s your communist. He has no problem taking from others to serve the public “good.”
Capitalism at its best gives us iPhones and 400 kinds of ice cream and rewards enterprise and innovation. The free market has no small amount of magic. At its worst, capitalism produces pharmaceutical companies that gouge for lifesaving drugs, insurance companies that drop people once they get sick, and a system where secretaries pay a higher percentage of their earnings in taxes than billionaires who do nothing.
Socialism at its best can run an army, a health care system and provide quality education for those who otherwise couldn’t afford one. Libraries and fire departments are socialist institutions. So is the Interstate System of highways created under President Eisenhower. Ditto the nation’s most popular cultural enterprise, the National Football League, which shares its television billions with losers among the teams. At its worst, socialism is grim and stifling, a dead-end for creativity.
The key is to find a balance, as Hillary Clinton said in Tuesday’s debate. “Our job is to rein in the excesses of capitalism so it doesn’t run amok,” she said. In that sentiment, you could hear the historical echo of two great progressive presidents, Teddy Roosevelt and his cousin Franklin, both of whom sought to save capitalism from itself.
She also said, “We are not Denmark.” Nope. Not by any stretch. Denmark has a slightly higher tax load on its citizens than the United States. But it also has budget surpluses, universal health care, shorter working hours, and was recently rated by Forbes magazine as the best country in the world for business.
Insurance Dropouts Present a Challenge for Health Law
YAZOO CITY, Miss. — Stephanie Douglas signed up for health insurance in January with the best intentions. She had suffered a stroke and needed help paying for her medicines and care. The plan she chose from the federal insurance exchange sounded affordable — $58.17 a month after the subsidy she received under the Affordable Care Act.
But Ms. Douglas, 50, who was working about 30 hours a week as a dollar store cashier and a services coordinator at an apartment complex for older adults, soon realized that her insurance did not fit in her tight monthly budget. She stopped paying her premiums in April and lost her coverage a few months later.
“When you owe on your house, on your truck, when you’re a single parent of a college student and you have other bills,” she said, “it just doesn’t work.”
On Nov. 1, a new sign-up period for health insurance under the Affordable Care Act will begin, and insurers, health care providers and enrollment groups are ramping up campaigns to encourage 10.5 million eligible uninsured people to buy policies. But even as those efforts begin, the public insurance exchanges, also known as marketplaces, created by the law are facing another challenge: keeping the customers they already have.
About 9.9 million people were enrolled in the federal and state marketplaces at the end of June, a drop of about 15 percent from the 11.7 million who the Obama administration said selected plans during the open enrollment period that ended in February.
Though there is no comprehensive data on why people drop or lose their marketplace coverage, enrollment counselors, health care providers and consumers say cost is a factor. In some cases, people lost jobs or their income dropped after they enrolled. Other people signed up for coverage only to decide later that they could not afford it. Still others dropped their insurance after their federal subsidies — intended to help pay premiums — were reduced or eliminated because the government could not verify their incomes or concluded that they were earning more than they had reported on their applications.
The cost of marketplace coverage may be particularly challenging for some in Mississippi and 19 other states that have not expanded Medicaid to provide largely free health care for people earning up to 138 percent of the poverty line. Many of these people can receive federal subsidies to help pay for private plans. But the subsidies do not always help enough.
YAZOO CITY, Miss. — Stephanie Douglas signed up for health insurance in January with the best intentions. She had suffered a stroke and needed help paying for her medicines and care. The plan she chose from the federal insurance exchange sounded affordable — $58.17 a month after the subsidy she received under the Affordable Care Act.
But Ms. Douglas, 50, who was working about 30 hours a week as a dollar store cashier and a services coordinator at an apartment complex for older adults, soon realized that her insurance did not fit in her tight monthly budget. She stopped paying her premiums in April and lost her coverage a few months later.
“When you owe on your house, on your truck, when you’re a single parent of a college student and you have other bills,” she said, “it just doesn’t work.”
On Nov. 1, a new sign-up period for health insurance under the Affordable Care Act will begin, and insurers, health care providers and enrollment groups are ramping up campaigns to encourage 10.5 million eligible uninsured people to buy policies. But even as those efforts begin, the public insurance exchanges, also known as marketplaces, created by the law are facing another challenge: keeping the customers they already have.
About 9.9 million people were enrolled in the federal and state marketplaces at the end of June, a drop of about 15 percent from the 11.7 million who the Obama administration said selected plans during the open enrollment period that ended in February.
Though there is no comprehensive data on why people drop or lose their marketplace coverage, enrollment counselors, health care providers and consumers say cost is a factor. In some cases, people lost jobs or their income dropped after they enrolled. Other people signed up for coverage only to decide later that they could not afford it. Still others dropped their insurance after their federal subsidies — intended to help pay premiums — were reduced or eliminated because the government could not verify their incomes or concluded that they were earning more than they had reported on their applications.
The cost of marketplace coverage may be particularly challenging for some in Mississippi and 19 other states that have not expanded Medicaid to provide largely free health care for people earning up to 138 percent of the poverty line. Many of these people can receive federal subsidies to help pay for private plans. But the subsidies do not always help enough.
How to Keep People in Health Plans
There was a sharp drop earlier this year in the number of people enrolled in health insurance plans purchased through federal and state marketplaces established under the Affordable Care Act. That poses a big challenge for insurers, health care providers and enrollment counselors when a new open enrollment period starts on Nov. 1.
Health care reform has made considerable progress in reducing the number of uninsured Americans over the past several years, but there is still quite a distance to go before achieving near-universal coverage. Some 10.5 million people are currently uninsured even though the law requires most of them to obtain coverage. Beyond that, a lot of people who bought insurance policies earlier this year were forced to drop out, often because they couldn’t afford the premiums.
As Abby Goodnough reported in The Times on Monday, 11.7 million people had selected private plans during the open enrollment period that ended on Feb. 15. By the end of June, only 9.9 million people were enrolled, according to the Obama administration.
There are several reasons people drop out, but cost was clearly the big factor for those who lost their jobs or whose incomes fell. Some people lost their federal subsidies because the federal government could not verify their incomes or their citizenship or immigration status.
For the working poor, layoffs and other household changes can result in big financial setbacks, making it impossible for them to pay even modest monthly premiums. That’s why the health reform law always envisioned having expanded Medicaid coverage to help pick up the tab.
But many Republican-dominated states have refused to expand their Medicaid programs, which would cost them little or nothing through 2016 and not that much more in subsequent years. Under the A.C.A. as interpreted by the Supreme Court, states have the option of expanding Medicaid to provide largely free health care to people earning up to 138 percent of the federal poverty line, or about $33,000 for a family of four, with the federal government paying most of the cost. However, in 20 states that have not expanded Medicaid, poor people are forced to rely on federal subsidies to help them buy private insurance; those subsidies leave many of them exposed to premiums they can’t afford when they lose their jobs or have very little income.
One vexing problem is that many people are confused by the various notices telling them what information they need to submit to obtain subsidies. Some 423,000 people in 37 states that use the federal marketplace lost their 2015 coverage because they failed to document their citizenship or immigration status, and 967,000 households had their subsidies recalculated because of discrepancies in their original reports of household income. Often, problems arose because people failed to submit their Social Security numbers.
The Obama administration has been simplifying its messages to make enrollment easier. States that have not expanded Medicaid should do so to help their own low-income citizens, but the Republicans in those states would rather have their residents suffer. Stronger outreach efforts by enrollment counselors might also help people understand what documentation they need to provide.
The penalty for failing to obtain insurance will rise steadily in coming years, which could spur more enrollment. The penalties can’t be calculated precisely until a person files income tax returns. But if people were given more information about the penalties at the start of the enrollment season on Nov. 1, those who can afford to pay premiums might have even greater incentive to enroll.
There was a sharp drop earlier this year in the number of people enrolled in health insurance plans purchased through federal and state marketplaces established under the Affordable Care Act. That poses a big challenge for insurers, health care providers and enrollment counselors when a new open enrollment period starts on Nov. 1.
Health care reform has made considerable progress in reducing the number of uninsured Americans over the past several years, but there is still quite a distance to go before achieving near-universal coverage. Some 10.5 million people are currently uninsured even though the law requires most of them to obtain coverage. Beyond that, a lot of people who bought insurance policies earlier this year were forced to drop out, often because they couldn’t afford the premiums.
As Abby Goodnough reported in The Times on Monday, 11.7 million people had selected private plans during the open enrollment period that ended on Feb. 15. By the end of June, only 9.9 million people were enrolled, according to the Obama administration.
There are several reasons people drop out, but cost was clearly the big factor for those who lost their jobs or whose incomes fell. Some people lost their federal subsidies because the federal government could not verify their incomes or their citizenship or immigration status.
For the working poor, layoffs and other household changes can result in big financial setbacks, making it impossible for them to pay even modest monthly premiums. That’s why the health reform law always envisioned having expanded Medicaid coverage to help pick up the tab.
But many Republican-dominated states have refused to expand their Medicaid programs, which would cost them little or nothing through 2016 and not that much more in subsequent years. Under the A.C.A. as interpreted by the Supreme Court, states have the option of expanding Medicaid to provide largely free health care to people earning up to 138 percent of the federal poverty line, or about $33,000 for a family of four, with the federal government paying most of the cost. However, in 20 states that have not expanded Medicaid, poor people are forced to rely on federal subsidies to help them buy private insurance; those subsidies leave many of them exposed to premiums they can’t afford when they lose their jobs or have very little income.
One vexing problem is that many people are confused by the various notices telling them what information they need to submit to obtain subsidies. Some 423,000 people in 37 states that use the federal marketplace lost their 2015 coverage because they failed to document their citizenship or immigration status, and 967,000 households had their subsidies recalculated because of discrepancies in their original reports of household income. Often, problems arose because people failed to submit their Social Security numbers.
The Obama administration has been simplifying its messages to make enrollment easier. States that have not expanded Medicaid should do so to help their own low-income citizens, but the Republicans in those states would rather have their residents suffer. Stronger outreach efforts by enrollment counselors might also help people understand what documentation they need to provide.
The penalty for failing to obtain insurance will rise steadily in coming years, which could spur more enrollment. The penalties can’t be calculated precisely until a person files income tax returns. But if people were given more information about the penalties at the start of the enrollment season on Nov. 1, those who can afford to pay premiums might have even greater incentive to enroll.
Makeover Coming for HealthCare.gov
By ROBERT PEAR
WASHINGTON — Acknowledging at least tacitly the difficulties of some health care consumers, the Obama administration plans major changes to HealthCare.gov this year to make it easier for shoppers to find health insurance plans that include their doctors and to predict their health care costs for the coming year.
With substantial premium increases coming in some states in 2016, administration officials are expecting that many consumers already in the Affordable Care Act’s networks will have to switch health plans and find new doctors as they scramble for cheaper alternatives. And millions more Americans could be receiving health insurance through health care marketplaces for the first time.
But insurers in many counties are offering such a dizzying array of health insurance plans with so many subtle differences that consumers have struggled to determine which plan is best for them.
“Normal consumers just cannot assess the dollar consequences of their decisions,” said Robert M. Krughoff, the president of the Center for the Study of Services, also known as Consumers’ Checkbook. “Is a $200 deductible with a $10,000 out-of-pocket limit better for my family than a $2,000 deductible and a $4,000 out-of-pocket limit?”
WASHINGTON — Acknowledging at least tacitly the difficulties of some health care consumers, the Obama administration plans major changes to HealthCare.gov this year to make it easier for shoppers to find health insurance plans that include their doctors and to predict their health care costs for the coming year.
With substantial premium increases coming in some states in 2016, administration officials are expecting that many consumers already in the Affordable Care Act’s networks will have to switch health plans and find new doctors as they scramble for cheaper alternatives. And millions more Americans could be receiving health insurance through health care marketplaces for the first time.
But insurers in many counties are offering such a dizzying array of health insurance plans with so many subtle differences that consumers have struggled to determine which plan is best for them.
“Normal consumers just cannot assess the dollar consequences of their decisions,” said Robert M. Krughoff, the president of the Center for the Study of Services, also known as Consumers’ Checkbook. “Is a $200 deductible with a $10,000 out-of-pocket limit better for my family than a $2,000 deductible and a $4,000 out-of-pocket limit?”
Hillary Clinton’s Health Care Proposals, Focused on Cost, Go Well Beyond Obama’s
By ROBERT PEAR
WASHINGTON — Hillary Rodham Clinton, as she offered up a sheaf of new health care proposals, said she was “building on the Affordable Care Act.” But lurking in those proposals was a veiled criticism of President Obama’s signature domestic achievement: For many families, the Affordable Care Act has not made health care affordable.
Mr. Obama has spent five years minimizing cost issues still confronting many health care consumers. Mrs. Clinton is taking those on without apologies. She would go beyond the president’s 2010 law, capping a patient’s share of the bill for doctor visits and prescription drugs. She would repeal the law’s planned tax on high-cost employer-sponsored insurance — a tax the White House says is needed to constrain the growth of health spending.
And Mrs. Clinton, like Bill Clinton when he was president, appears to be more willing to confront insurers and drug makers over high prices. She said she would seek “authority to block or modify unreasonable health insurance rate increases” and stop “excessive profiteering” by drug companies.
Those comments echoed her criticism of the industry 22 years ago. As chief architect of her husband’s plan to remake the nation’s health care system in 1993, she accused insurance and pharmaceutical companies of “price gouging” and “unconscionable profiteering.”
“Health care is one of highest-ranking issues she hears about over and over,” said Chris Jennings, an informal adviser to Mrs. Clinton who worked on health issues in the Clinton White House.
Mrs. Clinton’s recent comments surprised and irked Obama administration officials. A White House spokeswoman said that, to her knowledge, the Clinton campaign had not consulted the administration.
The White House press office issued a statement describing the tax on high-cost health plans — the so-called Cadillac tax — as “a key part” of Mr. Obama’s health care law. Repealing it “would hurt our economy by increasing the deficit, raising health care cost growth and cutting workers’ paychecks,” the White House said. It would also blow an $87 billion hole in the government’s revenue stream over eight years, according to the Congressional Budget Office.
Even as she proposed changes in the health law, Mrs. Clinton said it was working, and she promised to fight Republican efforts to dismantle it. Republicans said she was trying to have it both ways, embracing popular parts of the law while rejecting those that are unpopular.
Jeb Bush Offers Health Plan That Would Undo Affordable Care Act
By ROBERT PEAR and MATT FLEGENHEIMER
WASHINGTON — Jeb Bush on Tuesday offered a detailed proposal to replace much of the Affordable Care Act with a more conservative health care plan that could lower individual insurance costs but would probably not protect as many people as President Obama’s initiative.
“Innovations, not mandates, will bring down health care costs,” Mr. Bush said at St. Anselm College in New Hampshire. “If we’re going to fix health care in this country, we need to wrest control away from Washington and give it back to the states, citizens and their care providers.”
Mr. Bush’s plan would make good on Republicans’ oft-stated pledge to repeal and replace Mr. Obama’s signature domestic achievement, but it also points up the trade-offs that he and other Republican presidential candidates face. His reliance on low-cost catastrophic health plans could reduce premiums for some consumers, but could also leave them with fewer health benefits, and he would also loosen the Affordable Care Act’s popular guarantee of coverage, regardless of a person’s pre-existing medical conditions.
Mr. Bush would dismantle the elaborate structure of the health care law, offer income-tax credits for people to buy catastrophic coverage and offer states a sort of block grant to finance care for low-income people.
He would allow states to impose work requirements on able-bodied Medicaidbeneficiaries, requirements that are opposed by the Obama administration but favored by some state officials.
Mr. Bush promised to work with states to develop a transition plan for 17 million people who are currently covered under the health law, or, as he put it, “entangled in Obamacare.”
The president’s health law was “written by special interests, for the special interests,” Mr. Bush said.
His proposals are consistent with priorities long favored by Republicans. He would give states more discretion over health care and more authority to regulate health insurance, rolling back many of the detailed federal standards set by the Affordable Care Act and in rules issued by the Obama administration.
Some of Mr. Bush’s proposals could upset some people with employer-provided coverage. For example, he would limit the amount of tax-free health benefits that employees can receive from employers, capping the value at $12,000 a year for an individual and $30,000 for a family. Under current law, the value of employer-sponsored insurance is not counted or taxed as income for employees.
Mr. Bush said the proposed limits would “encourage lower insurance premiums and higher wages.” His proposal would replace an excise tax that the Affordable Care Act imposed on certain high-cost, employer-sponsored insurance plans. Mr. Bush said employers were arbitrarily reducing benefits to avoid this “Cadillac tax,” which is to take effect in 2018.
But the goal of his proposed cap on tax-free benefits appears to be similar. Many economists say the current tax-free treatment of employee health benefits tends to encourage the overuse of health care by insulating consumers from the true costs.
Jeb Bush Has Found a Part of Obamacare to Love
In the United States, every dollar you earn as wages is subject to taxes, but every dollar you get in health insurance is not.
This system, which has been around since the 1940s, leads to some distortions in pay and health insurance. Companies may be more likely to give you a raise in the form of richer benefits than higher pay, because it’s a better value. And the federal government spends a lot more money, in the form of lost taxes, to help rich people buy health insurance than it does to help middle-income people.
When you ask economists to name their least favorite part of our health care system, the employer tax exclusion comes up a lot.
Buried in Obamacare is a provision meant to reverse some of those weird incentives: The so-called Cadillac tax would tax expensive employer health plans, making spending above a certain threshold more like ordinary wages. The idea is to reshape the kind of insurance that employers offer, and to drive down the overall cost of health care, as my colleague Josh Barro wrote recently. But many people who are not health economists hate this idea, because it means they end up with either higher taxes or less generous insurance.
This idea has a new and somewhat surprising defender: Jeb Bush. In recent weeks, Democratic presidential candidates have been lining up to reject this Obamacare provision. Both Bernie Sanders and Hillary Rodham Clinton have promised they would repeal it if elected.
In a new health care proposal released Tuesday, Mr. Bush promised to repeal the entire Affordable Care Act. But there’s one thing he would restore: a provision to tax high-cost health plans.
The details are slightly different from those of Obamacare. Starting in 2018, the Affordable Care Act imposes a 40 percent tax on any health benefits costing more than $10,200 for an individual, and $27,500 for a family. The Bush plan would simply impose normal payroll and income taxes on plans that cost more than $12,000 for individuals and $30,000 for families. But the effect would be close to the same: pushing employers to offer less expensive health plans by taxing them like wages.
InterMed joins Community Health Options
Members of the Affordable Care Act insurance co-op now have access to Maine's largest independent primary care practice.
Southern Maine health care provider InterMed PA has joined Community Health Options, a Lewiston-based co-op created in 2013 to offer health insurance plans under the Affordable Care Act.
The nonprofit Community Health Options said in a news release Monday that it entered into a partnership with InterMed to increase the number of choices available to its members.
InterMed is the largest physician-owned primary care practice in Maine, with 81 physicians in Portland, South Portland and Yarmouth, it said.
“InterMed is highly respected and an important source of care for more than 75,000 primary care patients in the community. Together we seek to achieve the triple aim of reducing costs of care while improving health outcomes and improving the patient experience,” Health Options CEO Kevin Lewis said in the release.
InterMed CEO Dan McCormack said he was impressed with the rapid membership growth Community Health Options has experienced in Maine and New Hampshire.
“It was clear from the beginning of our discussions that our interests are aligned with a shared desire to provide high-quality, high-value healthcare for our patients,” he said.
It's time to embrace single-payer system
By Andrew D. Coates, M.D.
Times Union (Albany, NY), Oct. 9, 2015
Why won't "single payer" — the call for one public health insurance program to cover all necessary medical care for every person in the United States — go away? Wasn't it dismissed already from the mainstream discourse?
Instead of vanishing from the public eye, "single payer" or "Medicare for All" has already entered the 2016 elections. The presidential campaign of Vermont's longtime single-payer advocate, Sen. Bernie Sanders, deserves much of the credit.
But perhaps "Obamacare" is the larger factor. Although the Affordable Care Act reduced the number of uninsured, after the "overhaul," health care in the U.S. today is even more about money and even less about the care of patients.
In our present moment, "post-reform," rising deductibles, rising co-pays and onerous co-insurance costs have become "the usual." Financial barriers to care are ubiquitous.
The Affordable Care Act did not regulate the rise of premiums. Nor did it prohibit the narrowing networks of providers, as so many plans do. Nor did the "reform" rein in skyrocketing drug prices.
Additionally, about 31 million people in our nation remain inadequately insured. Being "underinsured" is not the same as being uninsured. It is when one's health insurance fails to protect the household finances in the face of illness.
As for the uninsured, the Census Bureau reports 33 million people lacked any coverage at all last year, a number that is roughly expected to persist for a decade.
By so many measures, Obama's Affordable Care Act has failed as "reform."
One of the nation's top health care journalists, Ricardo Alonso-Zaldivar of The Associated Press, recently highlighted the emerging national discourse ("Again? Health care debate expands for 2016," Oct. 5). He outlined three basic positions: those for single payer; those for "repeal and replace" (without a credible alternative); and those for maintaining the status quo.
He asked renowned Princeton historian of the American medical system, Paul Starr, to comment. Starr succinctly amplified what both mainstream Democrats and Republicans have been saying about single payer. "It's a dead end," Starr said, because its supporters "don't face up to the significant tax changes that would be necessary."
Will the old cry "No new taxes!" effectively bury single payer in the upcoming election season — even though a nonprofit, streamlined single-payer system would actually save our nation and people hundreds of billions of dollars annually?
The problem for the establishment is that the fundamental contradiction that drove the passage of the Affordable Care Act — that the wealthiest nation on Earth fails to guarantee health care to all of its inhabitants, that the health of the nation overall is mediocre on a world scale — still drives the American debate.
The health care needs of the American people have yet to become the central focus of our health system.
A meaningful health care overhaul for the United States would be a program that would cover everyone, eliminate profiteering, control costs, improve quality and outcomes, lessen disparities, protect caregiver-patient relationships and guarantee maximum choice of provider.
Single payer could do all of these things.
Under single payer, equitable, progressive taxes would replace premiums, co-pays, deductibles and out-of-pocket costs for necessary care.
One study found that as many as 95 percent of all U.S. households would save money under a single-payer program — after taking into account the "significant tax changes that would be necessary."
The costs of health care are inescapable. In a democracy, the question should be how to share those costs and to pay for care in the fairest way, so that each person might gain the opportunity to be as healthy as possible.
Perhaps the idea of single payer won't go away simply because it would work.
http://www.pnhp.org/print/news/2015/october/its-time-to-embrace-single-payer-system
Times Union (Albany, NY), Oct. 9, 2015
Why won't "single payer" — the call for one public health insurance program to cover all necessary medical care for every person in the United States — go away? Wasn't it dismissed already from the mainstream discourse?
Instead of vanishing from the public eye, "single payer" or "Medicare for All" has already entered the 2016 elections. The presidential campaign of Vermont's longtime single-payer advocate, Sen. Bernie Sanders, deserves much of the credit.
But perhaps "Obamacare" is the larger factor. Although the Affordable Care Act reduced the number of uninsured, after the "overhaul," health care in the U.S. today is even more about money and even less about the care of patients.
In our present moment, "post-reform," rising deductibles, rising co-pays and onerous co-insurance costs have become "the usual." Financial barriers to care are ubiquitous.
The Affordable Care Act did not regulate the rise of premiums. Nor did it prohibit the narrowing networks of providers, as so many plans do. Nor did the "reform" rein in skyrocketing drug prices.
Additionally, about 31 million people in our nation remain inadequately insured. Being "underinsured" is not the same as being uninsured. It is when one's health insurance fails to protect the household finances in the face of illness.
As for the uninsured, the Census Bureau reports 33 million people lacked any coverage at all last year, a number that is roughly expected to persist for a decade.
By so many measures, Obama's Affordable Care Act has failed as "reform."
One of the nation's top health care journalists, Ricardo Alonso-Zaldivar of The Associated Press, recently highlighted the emerging national discourse ("Again? Health care debate expands for 2016," Oct. 5). He outlined three basic positions: those for single payer; those for "repeal and replace" (without a credible alternative); and those for maintaining the status quo.
He asked renowned Princeton historian of the American medical system, Paul Starr, to comment. Starr succinctly amplified what both mainstream Democrats and Republicans have been saying about single payer. "It's a dead end," Starr said, because its supporters "don't face up to the significant tax changes that would be necessary."
Will the old cry "No new taxes!" effectively bury single payer in the upcoming election season — even though a nonprofit, streamlined single-payer system would actually save our nation and people hundreds of billions of dollars annually?
The problem for the establishment is that the fundamental contradiction that drove the passage of the Affordable Care Act — that the wealthiest nation on Earth fails to guarantee health care to all of its inhabitants, that the health of the nation overall is mediocre on a world scale — still drives the American debate.
The health care needs of the American people have yet to become the central focus of our health system.
A meaningful health care overhaul for the United States would be a program that would cover everyone, eliminate profiteering, control costs, improve quality and outcomes, lessen disparities, protect caregiver-patient relationships and guarantee maximum choice of provider.
Single payer could do all of these things.
Under single payer, equitable, progressive taxes would replace premiums, co-pays, deductibles and out-of-pocket costs for necessary care.
One study found that as many as 95 percent of all U.S. households would save money under a single-payer program — after taking into account the "significant tax changes that would be necessary."
The costs of health care are inescapable. In a democracy, the question should be how to share those costs and to pay for care in the fairest way, so that each person might gain the opportunity to be as healthy as possible.
Perhaps the idea of single payer won't go away simply because it would work.
http://www.pnhp.org/print/news/2015/october/its-time-to-embrace-single-payer-system
Bring Back House Calls
A FEW weeks ago, in the hospital where I work, I was telling a 92-year-old patient about her discharge plan. I wanted her to follow up in my office in a week. Frail and soft-spoken, she asked me if instead I could visit her at home. “I’m afraid not,” I said automatically, but when she asked me why, I didn’t have a good answer.
Before World War II, about 40 percent of all doctor-patient encounters were house calls. Today, the proportion has dwindled to less than 1 percent. The major reason, not surprisingly, is money: Traveling to patients’ homes is inefficient and almost never profitable for doctors or hospitals. But I believe that if we revived the house call, the overall savings to the health care system, not to mention the impact on patient care, would be enormous.
I have made an occasional house call, and what I’ve learned about my patients has been invaluable. One patient of mine had severe heart failure that rendered him too weak to come see me, unless he was brought to the E.R. by ambulance. He lived only a mile from the hospital, so I went to visit him. In his kitchen sink was a mess of dirty dishes. I looked in the fridge; it was nearly empty. There were canned soups on the counter, all loaded with sodium, precisely what he should not have been consuming. His wife was sitting silently at the dining table, appearing exhausted. It was then that I learned she had stopped driving. It didn’t matter which medications I ordered at the pharmacy; he had no way to get them.
My patient had been hospitalized four times in six months — in part because we didn’t know what was going on at his home.
A FEW weeks ago, in the hospital where I work, I was telling a 92-year-old patient about her discharge plan. I wanted her to follow up in my office in a week. Frail and soft-spoken, she asked me if instead I could visit her at home. “I’m afraid not,” I said automatically, but when she asked me why, I didn’t have a good answer.
Before World War II, about 40 percent of all doctor-patient encounters were house calls. Today, the proportion has dwindled to less than 1 percent. The major reason, not surprisingly, is money: Traveling to patients’ homes is inefficient and almost never profitable for doctors or hospitals. But I believe that if we revived the house call, the overall savings to the health care system, not to mention the impact on patient care, would be enormous.
I have made an occasional house call, and what I’ve learned about my patients has been invaluable. One patient of mine had severe heart failure that rendered him too weak to come see me, unless he was brought to the E.R. by ambulance. He lived only a mile from the hospital, so I went to visit him. In his kitchen sink was a mess of dirty dishes. I looked in the fridge; it was nearly empty. There were canned soups on the counter, all loaded with sodium, precisely what he should not have been consuming. His wife was sitting silently at the dining table, appearing exhausted. It was then that I learned she had stopped driving. It didn’t matter which medications I ordered at the pharmacy; he had no way to get them.
My patient had been hospitalized four times in six months — in part because we didn’t know what was going on at his home.
Why Most People Don't Shop Around For Medical Procedures
We shop around when we get a plane ticket or buy a couch. But we spend thousands of dollars on health care without comparing prices. What happens when you pay patients to choose the cheaper option?
STEVE INSKEEP, HOST:
Now, suppose a store is selling a couch for $3,000. Suppose another store down the street sold the same couch for $500. You would likely shop at the store with the lower price, wouldn't you? But it's entirely different if you're getting an MRI. Most people do not shop around for medical procedures. You go where somebody sends you - and hope your insurance covers it. Now a company is trying to change that. Here's David Kestenbaum with NPR's Planet Money podcast.
DAVID KESTENBAUM, BYLINE: The company is called Vitals. Their pitch - before you get that MRI or get that gallbladder out, give us a call. We will make it worth your while.
CATHY TROMBI: Good morning. Thank you for calling SmartShopper. This is Cathy. How may I help you?
KESTENBAUM: Cathy Trombi works in company's call center in Manchester, N.H. It's small, just five people. The woman on the phone needs to get some bloodwork done. So Catchy looks up places she can go.
TROMBI: So what our system does is it searches a 20-mile radius from your home ZIP code.
KESTENBAUM: Even for a blood test, one place might charge $300, another just $75. Cathy does not tell the woman to go to the cheaper place. She explains that it's her choice. But she says if she does go, there's something in it for her. Vitals will send her a check for $25. She can spend it on whatever she wants. The woman says OK.
TROMBI: Thank you. Bye-bye.
Another happy customer (laughter).
KESTENBAUM: It's a fun call center job, where you get to give away money. How can they afford to pay that woman $25? Cathy's company, Vitals, has deals with insurance companies and employers. If the woman goes to the cheaper place, they are going to save hundreds of dollars. So they're happy to pay her 25 bucks. I asked Cathy what's the most money a patient could make? And she said probably someone getting Remicade infusions for rheumatoid arthritis.
TROMBI: It's a very expensive procedure. And so then they might call us if they've heard about us. And we switch them to a different location, and then they get $500 every month, you know, just for calling us.
KESTENBAUM: A $500 check every month?
Obama administration sets low bar for health law enrollment in 2016
The Obama administration is again dramatically scaling back projected enrollment in health plans purchased through the Affordable Care Act, predicting that about 10 million people will have coverage through the health law’s marketplaces by the end of next year.
That is only a small increase over 2015, when 9.1 million Americans are expected to have coverage through the marketplaces, according to the Department of Health and Human Services.
The 2016 target is also significantly lower than what the nonpartisan Congressional Budget Office had predicted. Earlier this year, the budget office estimated 21 million people would get coverage through the marketplaces next year.
Administration officials defended the slow growth in the marketplaces, noting that as the number of Americans lacking insurance goes down, reaching the remaining ones is difficult.
“We believe 10 million is a strong and realistic goal,” said Health and Human Services Secretary Sylvia M. Burwell. “We’ve seen high levels of satisfaction with the marketplace and expect the vast majority of our current customers will re-enroll.”
We shop around when we get a plane ticket or buy a couch. But we spend thousands of dollars on health care without comparing prices. What happens when you pay patients to choose the cheaper option?
STEVE INSKEEP, HOST:
Now, suppose a store is selling a couch for $3,000. Suppose another store down the street sold the same couch for $500. You would likely shop at the store with the lower price, wouldn't you? But it's entirely different if you're getting an MRI. Most people do not shop around for medical procedures. You go where somebody sends you - and hope your insurance covers it. Now a company is trying to change that. Here's David Kestenbaum with NPR's Planet Money podcast.
DAVID KESTENBAUM, BYLINE: The company is called Vitals. Their pitch - before you get that MRI or get that gallbladder out, give us a call. We will make it worth your while.
CATHY TROMBI: Good morning. Thank you for calling SmartShopper. This is Cathy. How may I help you?
KESTENBAUM: Cathy Trombi works in company's call center in Manchester, N.H. It's small, just five people. The woman on the phone needs to get some bloodwork done. So Catchy looks up places she can go.
TROMBI: So what our system does is it searches a 20-mile radius from your home ZIP code.
KESTENBAUM: Even for a blood test, one place might charge $300, another just $75. Cathy does not tell the woman to go to the cheaper place. She explains that it's her choice. But she says if she does go, there's something in it for her. Vitals will send her a check for $25. She can spend it on whatever she wants. The woman says OK.
TROMBI: Thank you. Bye-bye.
Another happy customer (laughter).
KESTENBAUM: It's a fun call center job, where you get to give away money. How can they afford to pay that woman $25? Cathy's company, Vitals, has deals with insurance companies and employers. If the woman goes to the cheaper place, they are going to save hundreds of dollars. So they're happy to pay her 25 bucks. I asked Cathy what's the most money a patient could make? And she said probably someone getting Remicade infusions for rheumatoid arthritis.
TROMBI: It's a very expensive procedure. And so then they might call us if they've heard about us. And we switch them to a different location, and then they get $500 every month, you know, just for calling us.
KESTENBAUM: A $500 check every month?
Obama administration sets low bar for health law enrollment in 2016
The Obama administration is again dramatically scaling back projected enrollment in health plans purchased through the Affordable Care Act, predicting that about 10 million people will have coverage through the health law’s marketplaces by the end of next year.
That is only a small increase over 2015, when 9.1 million Americans are expected to have coverage through the marketplaces, according to the Department of Health and Human Services.
The 2016 target is also significantly lower than what the nonpartisan Congressional Budget Office had predicted. Earlier this year, the budget office estimated 21 million people would get coverage through the marketplaces next year.
Administration officials defended the slow growth in the marketplaces, noting that as the number of Americans lacking insurance goes down, reaching the remaining ones is difficult.
“We believe 10 million is a strong and realistic goal,” said Health and Human Services Secretary Sylvia M. Burwell. “We’ve seen high levels of satisfaction with the marketplace and expect the vast majority of our current customers will re-enroll.”
