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Gender: Female
Hometown: Washington state
Home country: USA
Current location: Directly above the center of the earth
Member since: Sat Aug 16, 2003, 02:52 AM
Number of posts: 51,907

About Me

Major policy wonk interests: health care, Social Security/Medicare/Medicaid, election integrity

Journal Archives

PNHP statement on the Supreme Court deliberation of the Affordable Care Act

Physicians for a National Health Program
March 26, 2012
Press Release
Health law, constitutional or no, fails to remedy ailment: doctors group

Leaders of Physicians for a National Health Program, an organization of 18,000 doctors who advocate for single-payer national health insurance, released the following statement today:

Regardless of whether the Supreme Court upholds or overturns the Affordable Care Act in whole or in part, the unfortunate reality is that federal health law of 2010 will not work: (1) it will not achieve universal coverage, as it leaves at least 26 million uninsured, (2) it will not make health care affordable to Americans with insurance, because gaps in their policies will leave them vulnerable to bankruptcy in the event of major illness, and (3) it will not control costs.

Why? Because the ACA perpetuates a dominant role for the private insurance industry. That industry siphons off hundreds of billions of health care dollars annually for overhead, profit and the paperwork it demands from doctors and hospitals; it denies care in order to increase insurers’ bottom line; and it obstructs any serious effort to control costs.

In contrast, a single-payer, improved-Medicare-for-all system would achieve all three goals – truly universal, comprehensive coverage; health security for our patients and their families; and cost control. It would do so by replacing private insurers with a single, nonprofit agency like Medicare that pays all medical bills, streamlines administration, and reins in costs for medications and other supplies through its bargaining clout.

The major provisions of the ACA do not go into effect until 2014. Although we will be counseled to “wait and see” how this reform plays out, we’ve seen how comparable reforms in Massachusetts and other states have worked over the past few decades. They have invariably failed our patients, foundering on the shoals of skyrocketing costs – even as they have profited the big private insurers and Big Pharma.

The Supreme Court’s ruling is not expected until June. Regardless of how it rules, we cannot wait for an effective remedy to our health care woes any longer, nor can our patients. The stakes are too high.

We pledge to continue our work for the only equitable, financially responsible and humane cure for our health care mess: single-payer national health insurance, an expanded and improved Medicare for all.

There is no federal control over increases in health insurance premiums

March 22, 2012
2012 Progress Report: Health Reform is Opening the Insurance Market and Protecting Consumers


The Affordable Care Act?s Rate Review policies bring an unprecedented level of scrutiny and transparency to health insurance rate increases. They ensure that, in every state, every proposed increase of 10% or more is evaluated by independent experts to assess whether they are based on reasonable assumptions and sound data.

Rate review is expected to help moderate premium increases and provide consumers with greater value for their premium dollar. Additionally, health insurance companies must provide easy to understand information to their customers about their reasons for significant rate increases, as well as publicly justify and post on their website any unreasonable rate increases.

The Affordable Care Act?s Rate Review program started for most individual and small group plans on September 1, 2011.

Through March 10, 2012, 186 increases affecting more than 1.3 million people have been posted on companyprofiles.healthcare.gov. Each provides an explanation from the insurer, including the rate increases determined to be unreasonable rate increases.

States are taking a strong lead in reviewing proposed rate increases. Of the 186 requested increases posted on HealthCare.gov as of March 10, 2012, two-thirds (125 filings) of these are being reviewed by rate review programs in the states. Only one-third (61 filings) is under review by HHS.

In the 61 instances to date where HHS is charged with conducting reviews, the Department has completed 28 determinations. HHS has determined that 20 of the 28 proposed rate increases are unreasonable. The most common reason for this determination is that the proposal would result in projected medical loss ratios (MLRs) below the 80% applicable threshold.

Commentby Don McCanne of PNHP: The title of today's message, "Controlling costs through HHS rate reviews," is deliberately deceptive to make a point. Supposedly, the Affordable Care Act (ACA) was designed to help control spending in health care, and the insurance premium Rate Review process was a component of cost containment. In fact, not only does the process have no impact on health care spending, it doesn't even have any federal control over increases in health insurance premiums.

ACA regulations require that any plan with premium increases of 10 percentor more be reviewed. Although states may have some influence over rate increases, the federal government has no authority to do anything about the increases other than expose the insurers to public ridicule.

In the last six months, 20 rate increases reviewed by the federal government have been found to be unreasonable, primarily because they exceeded the 20 percent of the premium that they could use for
administrative services and profits. Many of these insurers in the individual market will find that their inefficiencies are so great that they will be unable to comply with this requirement, so they really don't
need ridicule to drive home this point.

In the meantime, insurers will be able to increase their premiums 9.9 percent each year with no questions asked, at least not by the federal government. Compound that rate over several years, and then where will we be?

Obviously this ACA measure to "control costs" will have very little impact, if any, on insurance premiums and absolutely no impact on total health care spending.

There is a much more efficient model of health care financing that actually would slow the increase in health care spending while ensuring health care for everyone. Instead of playing ACA games, we should move forward with an improved Medicare for everyone.

Plans to use health care reform as an excuse to eliminate Medicare entirely

Voters over 55 now trust Repukes over Obama and Democrats on Medicare and Social Security, despite the firm commitment of the former to abolish both. I picked up a 56% button at Senior Lobby Day last month. It stands for the percentage of likely voters over 55 this November.


But if Obama is re-elected and his health care law is upheld by the Supreme Court, Wyden sees Medicare exchanges and a premium support system as the basis for a deal to reduce health care costs. He said Democrats would be hard pressed to argue against the idea if it is working for people under 65 as a result of the health care overhaul.

Oh--we'll only go after Medicare for those under 55. We'll leave current recipients strictly alone!

Surely if you give the school bully your lunch money on the first day of school he'll leave you alone for the rest of the year. If Dems don't make big politial hay out of this, we deserve to lose.


But DeMint and his colleagues think the time to end Medicare is now — with a cold-turkey conversion to a private program, effective in 2014. “I think if Americans actually find out the truth about what we’re doing, it will be a very big positive for Republicans in the fall,” DeMint forecast.

All the details aren’t out, but Paul says his plan would cut funding of Medicare by $1 trillion over 10 years and reduce Medicare’s liabilities by $16 trillion. It would do that by enrolling Medicare recipients in the health plan now used by federal workers. The government would pay 75 percent of the insurance premium on average but 30 percent or less for those who earned more than $100,000 a year. The eligibility age would gradually be raised to 70 from 65. If seniors can’t afford their share of the premium, they can apply for Medicaid, the health program for the poor.

With each answer, the senators seemed in danger of sparking an all-out Mediscare in the populace. No, seniors could not opt to keep Medicare as it now exists. Yes, this would sharply increase insurance costs for federal workers.

With all due respect to FDL, it was refusal to defend Medicare in 2010 that killed Dems

In reference to the thread discussing this--

The Repukes lied about cutting Medicare in 2010, and this was their winning message, as Dems refused to defend the GOVERNMENT traditional Medicare over Medicare Advantage, which merely had its subsidies cut. If the private sector is so much better and more efficient, then why would it need help from the government?

That the Repukes want to destroy Medicare and Social Security does NOT prevent them from sending out stuff like the following.



For The Record…It Was Obama Who Offered To Cut Hundreds Of Billions In Medicare During The Debt Debate


USA Today: “Cuts in Medicare and other entitlement programs are on the table.” (Susan Page and Fredreka Schouten, “Political Damage Even If A Debt Deal Is Done,” USA Today, 7/31/11)

Obama Agreed To Medicare Cuts In Debt Ceiling Deal. “The deal announced on Sunday by Congressional leaders and the White House would make across-the-board cuts in military spending, education, transportation and Medicare payments to health care providers if Congress does not enact further deficit-cutting legislation by the end of the year.” (Robert Pear, “Congress Must Trim Deficit To Avoid Broader Cuts,” The New York Times, 7/31/11)

Obama Said “Adjustments” Must Be Made To Medicare. OBAMA: “Yes, that means making some adjustments to protect health care programs like Medicare so they’re there for future generations.” (President Barack Obama, Remarks On Budget Control Act, Washington, D.C., 8/2/11)


Obama Put “Major Changes” To Medicare On The Table During Debt Ceiling Negotiations. “To hit the $1.5 trillion in spending cuts, the congressional committee is likely to reconsider major changes to Medicare that the White House and congressional leaders put on the table during this summer's debt-ceiling negotiations.” (Janet Adamy, “Debt Deal May Hit Medicare,” The Wall Street Journal, 8/2/11)

Analysis by Democratic pollster—

Her bottom line: It is an even more important political issue now than in the past. “It’s not just a seniors’ issue by any matter or means,” she said. The Medicare changes in the budget plan advanced by House Budget Committee Chairman Paul Ryan, R-Wis., “really elevated it, because it was such a clear distinction” between the Democratic and Republican positions. ”You saw it play out in the N.Y. special . And it is the top testing message in congressional races right now,” Lake added.

She’ll be watching how aggressively Democrats rally around protecting Medicare but believes it will be harder for the party “to draw the distinction that many of us believe in” because President Barack Obama talked about Medicare cuts in the context of the budget deal. “So I think it’s going to depend on how strong a stance Democrats take or whether they muddle it.” Regardless, she adds, “it has the potential to be THE voting issue in 2012.”

Obama's wussiness on "entitlement" reform is further eroding the Dem brand on protecting our lifeling programs. On Senior Lobby Day in Olympia, WA, the AARP was passing out 56% buttons, to emphasize that in 2012, 56% of voters are expected to be over 55. PAY ATTENTION, DAMMIT!! Despite Eric Cantor's pledge to eventually eliminate Social Security, voters trusted REPUKES over Dems on this issue in 2010!

Social Security and the Future of the Democratic Party
Preliminary research from Strengthen Social Security

1. Public support for Social Security is very high – it is a core value for people so Democrats take it away at their peril.
• Numerous surveys show that 75% to 80% oppose cutting Social Security benefits to reduce the federal deficit. The public understands it has no relationship to the federal deficit because they pay special taxes for it.
• 2010 election eve/day poll showed STRONG opposition to Social Security cuts – 73% Democrats, 72% Independents, 72% Republicans, 61% Tea Party.
• 7 out of 10 voters oppose raising the retirement age. It is especially strong among blue collar voters: non-college men and especially non-college women, which are core labor constituencies in the key battleground states.

2. Democrats have limited credibility on Social Security issue at this point in time.
• Democrats used to crush Republicans when voters were asked: who do you trust to better handle Social Security? Today, they are losing badly to Republicans.
Election Day 2010 voters favored Republicans on Social Security 31% to 28%. But
• Oct. 2006 poll: 48% Democrats to 20% Republicans
• Oct 2002 poll: 43% Democrats to 20% Republicans
• Oct. 1998 poll: 44% Democrats to 21% Republicans
• Same pattern is true for Presidents:
• Obama on 2010 Election Day: Voters said Republicans could be more trusted than Obama on Social Security by 33% to 26%.
• Bush in 2005: Democrats in Congress were favored over Bush on Social Security by 50% to 37%.
• Clinton in 1995: He was favored over Republicans in handling Social Security by 53% to 34%.

3. A damaged Democratic brand on Social Security will spell electoral disaster in 2012 and beyond. [This section is still being researched; we are looking at Senate races to make the strongest case. Obama believes he can win in 2012 even with a large loss among seniors, as long as he comes close to replicating his large surge in 2008 (a big if), although they have not said how large the seniors loss can be.]
• Democrats will not win seniors in 2012, but we must hold down our losses to a manageable level – maybe a 10% advantage for Republicans – if we are to hold (or at least minimize losses in the Senate and make up lost ground in the House.
• 2006: Republicans had no advantage among seniors – 49%-49%, when Democrats won big in congressional races.
• 2010: Republicans had a 21% point advantage among seniors – 59% vs. 38%.
• 2008: Republicans had an 8% point advantage among seniors – 53% vs. 45% in a wave election favoring Democrats
• 2004: Republicans had a 5% point advantage among seniors – 52% to 47%
• 2000: Democrats had a 3% point advantage among seniors – 50% to 47%
• 1996: Democrats had a 7% point advantage among seniors – 50% to 43%
• Beyond 2012, Republicans will have an easier time garnering the support of baby boomers if Democratic support for Social Security becomes blurred, an outcome that could impact national politics for many years.

4. Cutting Social Security will demoralize the Democratic base.
• It will be very hard to motivate activists in the party if the President leads the effort to cut Social Security. It will be seen as a betrayal of everything we have worked decades for.
• For unions in particular, the union leader’s credibility with its own members will be at great risk if the President leads the effort to cut Social Security.

5. The President can and should build support for his reelection and congressional Democrats by embracing Social Security as a crucial component of the economic security of American families. He should emphasize that:
• In an economy that is increasingly risky, it is the only program American families can count on to provide effective life insurance for their young children, disability insurance and retirement protection.
• Social Security as a core part of his commitment to protecting the middle class.

6. Protecting Social Security would be a bipartisan bonanza for the President and regain ground lost due to Republicans on Medicare.
• The President wants to be seen as working with Republicans. Why not ask them to join him in pledging to not cut Social Security. He will hit a grand slam with the public, which wants no cuts to the program and would like both parties to work together to protect the program. It will be a surprise move to the Republicans and put them in a box.
Republicans were very effective in the 2010 campaign skewering Democrats as Medicare cutters. This was probably the single greatest attack Republicans had on Democrats with older voters. This could happen again with Social Security. The way to get this age group back is to go on offense on Social Security.

My addendum to the SSW report--we also must defend Medicare against "bipartisan" voucher proposals like that of Ron Wyden/Paul Ryan, or be prepared to lose all of Congress.

One in five families have trouble paying medical bills

National Center for Health Statistics
March 2012
Financial Burden of Medical Care: Early Release of Estimates From the National Health Interview Survey, January-June 2011

Previous work has shown that in 2010, more than one in five Americans were in families reporting problems paying medical bills. In 2011, three new questions addressing financial burden of medical care were added to the National Health Interview Survey (NHIS) Family component. These questions addressed problems paying medical bills, paying medical bills over time, and having medical bills that cannot be paid at all.

In the first 6 months of 2011, one in three persons was in a family experiencing financial burden of medical care. One in 5 persons was in a family having problems paying medical bills, 1 in 4 persons was in a family paying medical bills over time, and 1 in 10 persons was in a family that had medical bills they were unable to pay at all.

Comment by Don McCanne of PNHP: This new report adds to the profusion of policy studies confirming that Americans continue to experience financial burdens in paying their medical bills. Unfortunately, this problem will not go away after the Affordable Care Act is fully implemented.

Well over 20 million people will remain uninsured, and perhaps a third or more of our population will be under-insured, due to the low actuarial value plans to be offered in the exchanges, and especially due to the increasing prevalence of high-deductibles in employer-sponsored plans. In fact. under-insurance likely will soon be the norm.

Contrast that with John Conyers' HR 676, the "Expanded and Improved Medicare for All Act," which states, "The health care benefits under this Act cover all medically necessary services... No deductibles, copayments, coinsurance, or other cost-sharing shall be imposed with respect to covered benefits."

For those who say we can't afford this, many other nations provide all of their people comprehensive care with no out-of-pocket expenses, at an average cost of only half of what we are spending on health care.

We can't afford not to do it.

My comment: We are altready paying for universal health care--we just aren't getting it.

Been proposed before, but not gotten much traction

Good idea, though.
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