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eridani
eridani's Journal
eridani's Journal
July 9, 2013
Deficit hawk Pete Peterson just cut a check to Social Security Works--WA. Bwahhhaaaa!
See the following thread for the winning video
http://www.democraticunderground.com/1251295306#post46
http://psara.org/wp-content/uploads/2013/05/june-2013-advocate.pdf
Conservative billionaire Pete Peterson, a major financier in the effortto dismantle Social Security, Medicare, and Medicaid, just got some egg on his face courtesy of the Social Security Works- Washington coalition, the Economic Opportunity Institute and PSARA.
The winning video in the Pete Peterson Foundation’s video contest – which had the goal of “compiling videos of people across the country letting Congress and the President know why fixing our nation- al debt is so important” – was “Just Scrap the Cap”, which represents the antithesis of Peterson’s austerity agenda.
If you haven’t seen it, “Just Scrap the Cap” is a humorous plea to shore up Social Security’s long-term finances by eliminating the current FICA wage cap of $113,700. Also known as “Scrapping the Cap”, this change would require billionaires like Peterson to pay the same Social Security tax rate as the guy who shines his shoes. Watch it here: www.justscrapthecap.com
Here’s the best part: After the votes were tallied and it was determined "Just Scrap the Cap" received the “Fan Favorite” award, Peterson was forced to cut a $500 check to Robby Stern, Social Security Works Washington Chair. Robby signed the check over to Social Security Works Washington and has promised that the coalition will use the money wisely: “We will use the $500 to finance our educational efforts and our Scrap the Cap campaign. We want to save Social Security from Peterson and his band of wealthy supporters.” Surely Mr. Peterson will be pleased to hear his money is going to a good cause.
Alex Stone is Communications & Technology Manager at Economic Opportunity Institute & a PSARA member. He helped direct and acted in the award winning video.
July 3, 2013
Bright-Sided: How the Relentless Promotion of Positive Thinking Has Undermined America
Book by Barbara Ehrenreich Some quotes below.
http://www.goodreads.com/work/quotes/6642954-bright-sided-how-the-relentless-promotion-of-positive-thinking-has-unde
“Breast cancer, I can now report, did not make me prettier or stronger, more feminine or spiritual. What it gave me, if you want to call this a “gift,” was a very personal, agonizing encounter with an ideological force in American culture that I had not been aware of before—one that encourages us to deny reality, submit cheerfully to misfortune, and blame only ourselves for our fate.”
“There is a vast difference between positive thinking and existential courage.”
“I couldn't help noticing that the existential space in which a friend had earnestly advised me to 'confront [my] mortality' bore a striking resemblance to the mall.”
“But the economic meltdown should have undone, once and for all, the idea of poverty as a personal shortcoming or dysfunctional state of mind. The lines at unemployment offices and churches offering free food includes strivers as well as slackers, habitual optimists as well as the chronically depressed. When and if the economy recovers we can never allow ourselves to forget how widespread our vulnerability is, how easy it is to spiral down toward destitution.”
“I do not write this in a spirit of sourness or personal disappointment of any kind, nor do I have any romantic attachment to suffering as a source of insight or virtue. On the contrary, I would like to see more smiles, more laughter, more hugs, more happiness and, better yet, joy. In my own vision of utopia, there is not only more comfort, and security for everyone — better jobs, health care, and so forth — there are also more parties, festivities, and opportunities for dancing in the streets. Once our basic material needs are met — in my utopia, anyway — life becomes a perpetual celebration in which everyone has a talent to contribute. But we cannot levitate ourselves into that blessed condition by wishing it. We need to brace ourselves for a struggle against terrifying obstacles, both of our own making and imposed by the natural world. And the first step is to recover from the mass delusion that is positive thinking.”
June 25, 2013
Comment by Don McCanne of PNHP: An important role of private health insurers is to control prices through provider contracting. The current trend is to narrow their networks of providers even more. This allows them to further squeeze payments to the providers, in exchange for reducing the numbers of their competitors. If that will slow the increase in insurance premiums, then shouldn't patients be supportive? No, and here's why.
When patients obtain their care outside of provider networks, they are inflicted with severe financial penalties, sometimes receiving no coverage at all, plus losing the controlled rates that the insurers have negotiated. This study shows that using out-of-network providers is frequently unavoidable. The problem is particularly severe with in-hospital care, adding to the already burdensome expenditures for high-deductibles and coinsurance.
This is a direct result of placing private insurers in the role of financial intermediaries for our health care. They profit by selling us an inordinate amount of administrative services that we don't want and shouldn't need, while penalizing us for obtaining care that we need when we are unable to access providers within their narrow networks.
The model is all wrong. We need to dump the intrusive and wasteful private insurers who are forcing on us services that we don't want but have to pay for - like taking away our choice under threat of financial penalty. We need to replace them with our own public program that is designed to ensure that we get the care we need, without penalizing us for doing so.
My comment: I don't mind initial resteriction of providers nearly so much as I mind the prerogative of insurers to disrupt ongoing relationships with providers arbitrarily.
Private insurers continue to restrict provider networks
Out-of-Network Physicians: How Prevalent Are Involuntary Use and Cost Transparency?
http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12007/abstract
Principal Findings
Eight percent of respondents used an out-of-network physician. Approximately 40 percent of individuals using out-of-network physicians experienced involuntary out-of-network care. Among out-of-network physician contacts, 58 percent of inpatient contacts and 15 percent of outpatient contacts were involuntary. The majority of inpatient involuntary contacts were due to medical emergencies (68 percent). In an additional 31 percent, the physician's out-of-network status was unknown at the time of the contact. Half (52 percent) of individuals using out-of-network services experienced at least one contact with an out-of-network physician where cost was not transparent at the time of care.
Conclusions
The frequency of involuntary out-of-network care is not inconsequential. Policy interventions can increase receipt of cost information prior to using out-of-network physician services, but they may be less helpful when patients have constrained physician choice due to emergent problems or limited in-hospital physician networks.
http://onlinelibrary.wiley.com/doi/10.1111/1475-6773.12007/abstract
Principal Findings
Eight percent of respondents used an out-of-network physician. Approximately 40 percent of individuals using out-of-network physicians experienced involuntary out-of-network care. Among out-of-network physician contacts, 58 percent of inpatient contacts and 15 percent of outpatient contacts were involuntary. The majority of inpatient involuntary contacts were due to medical emergencies (68 percent). In an additional 31 percent, the physician's out-of-network status was unknown at the time of the contact. Half (52 percent) of individuals using out-of-network services experienced at least one contact with an out-of-network physician where cost was not transparent at the time of care.
Conclusions
The frequency of involuntary out-of-network care is not inconsequential. Policy interventions can increase receipt of cost information prior to using out-of-network physician services, but they may be less helpful when patients have constrained physician choice due to emergent problems or limited in-hospital physician networks.
Comment by Don McCanne of PNHP: An important role of private health insurers is to control prices through provider contracting. The current trend is to narrow their networks of providers even more. This allows them to further squeeze payments to the providers, in exchange for reducing the numbers of their competitors. If that will slow the increase in insurance premiums, then shouldn't patients be supportive? No, and here's why.
When patients obtain their care outside of provider networks, they are inflicted with severe financial penalties, sometimes receiving no coverage at all, plus losing the controlled rates that the insurers have negotiated. This study shows that using out-of-network providers is frequently unavoidable. The problem is particularly severe with in-hospital care, adding to the already burdensome expenditures for high-deductibles and coinsurance.
This is a direct result of placing private insurers in the role of financial intermediaries for our health care. They profit by selling us an inordinate amount of administrative services that we don't want and shouldn't need, while penalizing us for obtaining care that we need when we are unable to access providers within their narrow networks.
The model is all wrong. We need to dump the intrusive and wasteful private insurers who are forcing on us services that we don't want but have to pay for - like taking away our choice under threat of financial penalty. We need to replace them with our own public program that is designed to ensure that we get the care we need, without penalizing us for doing so.
My comment: I don't mind initial resteriction of providers nearly so much as I mind the prerogative of insurers to disrupt ongoing relationships with providers arbitrarily.
June 20, 2013
Comment by Don McCanne of PNHP: The primary purpose of accountable care organizations is to reduce health care spending. By participating in these schemes - accepting financial rewards for reducing care - physicians are exposing themselves not only to malpractice claims for negligence through failure to provide adequate health care services, but they are also exposing themselves to punitive damages for participating in institutional malfeasance related to cost-saving efforts. Surely during the trials the plaintiffs' attorneys will let slip out the "G" word - GREED!
Greed: The secret word a la Groucho Marx (15 seconds):
Single payer saves money by reducing waste and improving resource allocation. It does not do it by paying physicians incentives for reducing health care. Most physicians surely would want to avoid even the least semblance of greed.
My comment: The average malpractice cost per month for a general practitioner in other developed countries is $100/month, reflecting a situation where it is not the norm for patients to sue in order to get health care. They don't sue because elsewhere health care is regarded as a right of citizenship.
ACOs--rewarding practitioners for reducing care could lead to more malpractice suits
The Looming Threat of Liability for Accountable Care Organizations and What to Do About It
http://jama.jamanetwork.com/article.aspx?articleID=1697985
Unlike MCOs (managed care organizations), ACOs will generally not have the benefit of ERISA, which does not cover them; nor are they slated to get comparable federal liability protections. As a result, ACO cost-containment efforts may be scrutinized by the court when poor patient outcomes result in malpractice litigation. For example, if a poor outcome occurs in a patient with congestive heart failure (CHF), a plaintiff could challenge an ACO's more stringent CHF hospital admissions criteria, asserting a prioritization of cost savings over patient care. In the absence of a federal law that could offer protection, this medical liability claim would be judged by state-based standards, which do not consider federal cost containment goals when determining whether a medical decision was appropriate. Based on MCO liability case law, state courts may hold ACOs liable in this situation.
Under "agency theory" in tort law, a plaintiff in a malpractice suit is permitted to hold a health system liable for the negligent actions of its employee, ie, the treating clinician. A patient may also sue a health system directly, claiming that policies or actions of the health system are negligent. Thus, whether ACOs or not, health systems are exposed to institutional liability related to medical malpractice. How big of a divergence is ACO liability from the existing forms of institutional liability common to health systems? The key difference is the introduction of a new dimension of medical malpractice liability that goes hand in hand with the cost containment charge: the claim that the ACO's actions or policies prioritized cost savings over patient safety, contributing to the plaintiff's harm.
Allegations of institutional malfeasance related to cost-saving efforts could increase liability costs and create a chilling effect on ACOs. Moreover, these suits need not progress to trial to threaten ACOs. The assertion of institutional malfeasance alone adds strength to a lawsuit and introduces the potential for punitive damages. This could increase jury awards and settlement amounts. In addition, the broader nature of the claims will enable more robust discovery beyond the care received by the patient. Discovery could now reach into the corporate boardroom as a plaintiff attempts to show that institutional policies regarding resource utilization or physician compensation stifled appropriate treatment. For the ACO, this increased complexity means greater defense costs and increased pressure to settle. Beyond cost increases from more garden-variety medical malpractice cases, ACOs also could be exposed to new theories of liability. It is possible to envision a class action suit seeking injunctive relief or damages against institutional policies felt to be potentially harmful to patients, such as physician incentives payments
.
http://jama.jamanetwork.com/article.aspx?articleID=1697985
Unlike MCOs (managed care organizations), ACOs will generally not have the benefit of ERISA, which does not cover them; nor are they slated to get comparable federal liability protections. As a result, ACO cost-containment efforts may be scrutinized by the court when poor patient outcomes result in malpractice litigation. For example, if a poor outcome occurs in a patient with congestive heart failure (CHF), a plaintiff could challenge an ACO's more stringent CHF hospital admissions criteria, asserting a prioritization of cost savings over patient care. In the absence of a federal law that could offer protection, this medical liability claim would be judged by state-based standards, which do not consider federal cost containment goals when determining whether a medical decision was appropriate. Based on MCO liability case law, state courts may hold ACOs liable in this situation.
Under "agency theory" in tort law, a plaintiff in a malpractice suit is permitted to hold a health system liable for the negligent actions of its employee, ie, the treating clinician. A patient may also sue a health system directly, claiming that policies or actions of the health system are negligent. Thus, whether ACOs or not, health systems are exposed to institutional liability related to medical malpractice. How big of a divergence is ACO liability from the existing forms of institutional liability common to health systems? The key difference is the introduction of a new dimension of medical malpractice liability that goes hand in hand with the cost containment charge: the claim that the ACO's actions or policies prioritized cost savings over patient safety, contributing to the plaintiff's harm.
Allegations of institutional malfeasance related to cost-saving efforts could increase liability costs and create a chilling effect on ACOs. Moreover, these suits need not progress to trial to threaten ACOs. The assertion of institutional malfeasance alone adds strength to a lawsuit and introduces the potential for punitive damages. This could increase jury awards and settlement amounts. In addition, the broader nature of the claims will enable more robust discovery beyond the care received by the patient. Discovery could now reach into the corporate boardroom as a plaintiff attempts to show that institutional policies regarding resource utilization or physician compensation stifled appropriate treatment. For the ACO, this increased complexity means greater defense costs and increased pressure to settle. Beyond cost increases from more garden-variety medical malpractice cases, ACOs also could be exposed to new theories of liability. It is possible to envision a class action suit seeking injunctive relief or damages against institutional policies felt to be potentially harmful to patients, such as physician incentives payments
Comment by Don McCanne of PNHP: The primary purpose of accountable care organizations is to reduce health care spending. By participating in these schemes - accepting financial rewards for reducing care - physicians are exposing themselves not only to malpractice claims for negligence through failure to provide adequate health care services, but they are also exposing themselves to punitive damages for participating in institutional malfeasance related to cost-saving efforts. Surely during the trials the plaintiffs' attorneys will let slip out the "G" word - GREED!
Greed: The secret word a la Groucho Marx (15 seconds):
Single payer saves money by reducing waste and improving resource allocation. It does not do it by paying physicians incentives for reducing health care. Most physicians surely would want to avoid even the least semblance of greed.
My comment: The average malpractice cost per month for a general practitioner in other developed countries is $100/month, reflecting a situation where it is not the norm for patients to sue in order to get health care. They don't sue because elsewhere health care is regarded as a right of citizenship.
June 12, 2013
http://www.dailykos.com/story/2013/06/11/1215275/-GOP-Hospital-Executive-Calls-For-Single-Payer-Medicare-For-All-As-Solution-To-Health-Care-Crisis
Well, here's great proof from the Charlotte Observer that single-payer health insurance is indeed a mainstream -- dare I say conservative -- idea. Republican Hospital Executive Jack Bernard -- from pretty-damn-red Georgia -- expounds
Single payer would drive down costs because Medicare (or a utility-like private single payer insurer) would have leverage to keep costs down. With no other game in town, providers would be forced to operate more efficiently. Drug companies would be pressured to give Americans the same drug pricing that is found elsewhere
= = = = =
For more information about health care reform in Georgia, including the Lewin cost analysis for a single-payer system - see: http://www.hctalk.com/viewforum.php?f=6
Georgia - GOP Hospital Executive Calls For Single-Payer (Medicare For All)
Georgia - GOP Hospital Executive Calls For Single-Payer (Medicare For All) As Solution To Health Care Crisishttp://www.dailykos.com/story/2013/06/11/1215275/-GOP-Hospital-Executive-Calls-For-Single-Payer-Medicare-For-All-As-Solution-To-Health-Care-Crisis
Well, here's great proof from the Charlotte Observer that single-payer health insurance is indeed a mainstream -- dare I say conservative -- idea. Republican Hospital Executive Jack Bernard -- from pretty-damn-red Georgia -- expounds
Single payer would drive down costs because Medicare (or a utility-like private single payer insurer) would have leverage to keep costs down. With no other game in town, providers would be forced to operate more efficiently. Drug companies would be pressured to give Americans the same drug pricing that is found elsewhere
= = = = =
For more information about health care reform in Georgia, including the Lewin cost analysis for a single-payer system - see: http://www.hctalk.com/viewforum.php?f=6
June 12, 2013
Comment by Don McCanne of PNHP: A major objective of health care reform was to slow the intolerable escalation in health care spending. Most of the pilot initiatives included in the Affordable Care Act (ACA), such as accountable care organizations and bundled payments, will likely have very little impact on our national health expenditures. But one important policy approach - the subject of this EPI brief - began before ACA was enacted and is probably responsible for most of the slowing in health care spending that was not directly due to the recession.
That policy is placing a financial burden on individuals who need care, especially through higher deductibles, but also through other forms of cost sharing. The impact of this policy is expressed well in the title of the brief: "Increased health care cost sharing works as intended - It burdens patients who need care the most"
Talk about a flawed policy! We are attempting to cover as many people as possible considering the limitations of ACA, and yet, at the same time, we are expanding the use of policies that keep patients away from care that they should have - by erecting these financial barriers. We are increasing the spending on private insurance plans while reducing the spending on health care by preventing insured people from getting the care they need!
How many times do we have to say it? Many other nations provide first dollar coverage - not charging any fees when health care is accessed - yet they have been much more effective in slowing cost escalation. You do not have to expose patients to potential financial hardship to bring costs under control.
This is one of the most important flaws of ACA (and there are many of them). It not only allows, but it actually encourages, through low actuarial value plans, the expansion of these financial disincentives to obtaining health care. If you read the full EPI brief, you will understand better why we must abandon this approach. Unfortunately, the author provides only a couple of feeble suggestions as to alternative approaches, but you will not find in the brief what we really need to do.
It is astounding that when it comes down to the obvious - that we need a well designed single payer national health program - so many knowledgeable people in the policy community choke up. Let's let them know that it is okay to say it: WE NEED A SINGLE PAYER NATIONAL HEALTH PROGRAM!
I guess we really don't have to shout. But we should explain to our colleagues and the public at large the reasons contained in this EPI brief explaining why cost sharing is harmful to our health and how it leads to financial insecurity. Then we can explain, in a calm voice, how we can fix this by improving Medicare (partly by including first dollar coverage) and then providing it for everyone. Naw. They're not listening. We'd better shout.
Increased health care cost sharing works as intended: It burdens patients who need care the most
http://www.epi.org/files/2013/increased-health-care-cost-sharing-works.pdf
A number of different health care policy proposals that have emerged in recent years share a common goal: make households directly pay for a larger share of most health expenditures by encouraging higher deductibles, higher copays, or higher co-insurance rates. The rationale of such proposals is that too-generous insurance policies (either those provided by employers or public insurance such as Medicare) distort the prices consumers face, and that removing this distortion would allow patients to choose their health care more wisely, hence slowing health care cost growth.
This brief argues that this is a flawed strategy for health care cost containment. The health care market is unlike other markets; thus, forcing increased cost sharing on American households is a deeply inefficient strategy for trying to contain health care costs. Forcing Americans to pay a higher share of health costs will not induce them to shop around and compare prices when they are experiencing chest pains or their child is suffering from an asthma attack. Further, consumers of health care are in no position to second-guess their doctor when she tells them an MRI is better than an X-ray (and hence worth the higher price) to diagnose a condition. Lastly, unlike other markets, prices of health care services faced by consumers bear very little relation to providers' cost to supply these services. Hence, these prices provide little to no information for consumers looking to judge the relative efficacy of various health care interventions.
In addition, increased health cost sharing is unlikely to make American health care more affordable to those currently unable to afford it, and will instead likely place the largest burdens on those who need care the most.
Most cost-sharing proposals lead to higher out-of-pocket medical costs, hitting those who require a high degree of medical care especially hard. The short-term cost savings achieved as patients respond to increasing out-of-pocket burdens may be realized by reducing medically necessary health care--a penny-wise, pound-foolish result.
Most cost-sharing proposals are poorly targeted for containing overall system costs. They miss the expensive cost drivers. Any cost containment would be driven by reduced medical care, not reduced prices.
* Not all moral hazard is inefficient
* Cost sharing can lead to medically and economically inefficient decisions
* Cost sharing is a poorly targeted cost-containment device
A number of different health care policy proposals that have emerged in recent years share a common goal: make households directly pay for a larger share of most health expenditures by encouraging higher deductibles, higher copays, or higher co-insurance rates. The rationale of such proposals is that too-generous insurance policies (either those provided by employers or public insurance such as Medicare) distort the prices consumers face, and that removing this distortion would allow patients to choose their health care more wisely, hence slowing health care cost growth.
This brief argues that this is a flawed strategy for health care cost containment. The health care market is unlike other markets; thus, forcing increased cost sharing on American households is a deeply inefficient strategy for trying to contain health care costs. Forcing Americans to pay a higher share of health costs will not induce them to shop around and compare prices when they are experiencing chest pains or their child is suffering from an asthma attack. Further, consumers of health care are in no position to second-guess their doctor when she tells them an MRI is better than an X-ray (and hence worth the higher price) to diagnose a condition. Lastly, unlike other markets, prices of health care services faced by consumers bear very little relation to providers' cost to supply these services. Hence, these prices provide little to no information for consumers looking to judge the relative efficacy of various health care interventions.
In addition, increased health cost sharing is unlikely to make American health care more affordable to those currently unable to afford it, and will instead likely place the largest burdens on those who need care the most.
Most cost-sharing proposals lead to higher out-of-pocket medical costs, hitting those who require a high degree of medical care especially hard. The short-term cost savings achieved as patients respond to increasing out-of-pocket burdens may be realized by reducing medically necessary health care--a penny-wise, pound-foolish result.
Most cost-sharing proposals are poorly targeted for containing overall system costs. They miss the expensive cost drivers. Any cost containment would be driven by reduced medical care, not reduced prices.
* Not all moral hazard is inefficient
* Cost sharing can lead to medically and economically inefficient decisions
* Cost sharing is a poorly targeted cost-containment device
Comment by Don McCanne of PNHP: A major objective of health care reform was to slow the intolerable escalation in health care spending. Most of the pilot initiatives included in the Affordable Care Act (ACA), such as accountable care organizations and bundled payments, will likely have very little impact on our national health expenditures. But one important policy approach - the subject of this EPI brief - began before ACA was enacted and is probably responsible for most of the slowing in health care spending that was not directly due to the recession.
That policy is placing a financial burden on individuals who need care, especially through higher deductibles, but also through other forms of cost sharing. The impact of this policy is expressed well in the title of the brief: "Increased health care cost sharing works as intended - It burdens patients who need care the most"
Talk about a flawed policy! We are attempting to cover as many people as possible considering the limitations of ACA, and yet, at the same time, we are expanding the use of policies that keep patients away from care that they should have - by erecting these financial barriers. We are increasing the spending on private insurance plans while reducing the spending on health care by preventing insured people from getting the care they need!
How many times do we have to say it? Many other nations provide first dollar coverage - not charging any fees when health care is accessed - yet they have been much more effective in slowing cost escalation. You do not have to expose patients to potential financial hardship to bring costs under control.
This is one of the most important flaws of ACA (and there are many of them). It not only allows, but it actually encourages, through low actuarial value plans, the expansion of these financial disincentives to obtaining health care. If you read the full EPI brief, you will understand better why we must abandon this approach. Unfortunately, the author provides only a couple of feeble suggestions as to alternative approaches, but you will not find in the brief what we really need to do.
It is astounding that when it comes down to the obvious - that we need a well designed single payer national health program - so many knowledgeable people in the policy community choke up. Let's let them know that it is okay to say it: WE NEED A SINGLE PAYER NATIONAL HEALTH PROGRAM!
I guess we really don't have to shout. But we should explain to our colleagues and the public at large the reasons contained in this EPI brief explaining why cost sharing is harmful to our health and how it leads to financial insecurity. Then we can explain, in a calm voice, how we can fix this by improving Medicare (partly by including first dollar coverage) and then providing it for everyone. Naw. They're not listening. We'd better shout.
June 6, 2013
Comment by Don McCanne of PNHP: In this article, Richard Eskow of Campaign for America's Future scores the effectiveness of several features of the Affordable Care Act (Obamacare) as it is being implemented. His take is that Obamacare provides only marginal improvements to a "fundamentally broken system."
The importance of this observation is that it comes from a prominent and respected organization that provides strategy for the progressive movement. They provided crucial support to Health Care for America Now! (HCAN), a coalition of over 1000 organizations dedicated to achieving quality, affordable health care for all.
HCAN was part of the massive shift of progressives away from single payer to the "politically feasible" Clinton/Obama/Edwards version of the conservative reform model of the Heritage Foundation. They were distracted by the concept that if we could just get a public option, we would be well on our way towards achieving a truly universal, affordable system. Little did it matter that the public option would not have been much different from a traditional Blue Cross/Blue Shield plan. It would have been only a marginal improvement, if that, on a "fundamentally broken system."
We can't back up history, but we can assess where we are now, where we are headed, and, most importantly, where we need to go instead. Now that more individuals in the progressive community are acknowledging that Obamacare can have no more than a marginal impact on a "fundamentally broken system," we need to dump it and enact a single payer national health program - an improved Medicare for all.
My comment: ACA will help a considerable number of people for the first few years. After that, the massive federal subsidies granted for setting the exchanges will be cancelled, whereupon the exchanges will have to become self-supporting. That means heavy surcharges on all the exchange plans. The sticker shock will make ACA massively unpopular, giving us only a narrow window to move to single payer. Luckily, ACA authorizes state innovation starting in 2017.
Our Continuing Healthcare Crisis, Part 3: The Obamacare Scorecard
Campaign for America's Future
http://blog.ourfuture.org/20130530/introducing-the-obamacare-scorecard
Conclusion
We'll be updating this scorecard as its provisions take effect, but one thing's already clear: While the law does some good things, it will only marginally improve upon a fundamentally broken system.
http://blog.ourfuture.org/20130530/introducing-the-obamacare-scorecard
Conclusion
We'll be updating this scorecard as its provisions take effect, but one thing's already clear: While the law does some good things, it will only marginally improve upon a fundamentally broken system.
Comment by Don McCanne of PNHP: In this article, Richard Eskow of Campaign for America's Future scores the effectiveness of several features of the Affordable Care Act (Obamacare) as it is being implemented. His take is that Obamacare provides only marginal improvements to a "fundamentally broken system."
The importance of this observation is that it comes from a prominent and respected organization that provides strategy for the progressive movement. They provided crucial support to Health Care for America Now! (HCAN), a coalition of over 1000 organizations dedicated to achieving quality, affordable health care for all.
HCAN was part of the massive shift of progressives away from single payer to the "politically feasible" Clinton/Obama/Edwards version of the conservative reform model of the Heritage Foundation. They were distracted by the concept that if we could just get a public option, we would be well on our way towards achieving a truly universal, affordable system. Little did it matter that the public option would not have been much different from a traditional Blue Cross/Blue Shield plan. It would have been only a marginal improvement, if that, on a "fundamentally broken system."
We can't back up history, but we can assess where we are now, where we are headed, and, most importantly, where we need to go instead. Now that more individuals in the progressive community are acknowledging that Obamacare can have no more than a marginal impact on a "fundamentally broken system," we need to dump it and enact a single payer national health program - an improved Medicare for all.
My comment: ACA will help a considerable number of people for the first few years. After that, the massive federal subsidies granted for setting the exchanges will be cancelled, whereupon the exchanges will have to become self-supporting. That means heavy surcharges on all the exchange plans. The sticker shock will make ACA massively unpopular, giving us only a narrow window to move to single payer. Luckily, ACA authorizes state innovation starting in 2017.
June 3, 2013
Among Massachusetts bankruptcy filers in 2009, 53 percent cited illness or medical bills as a cause of their bankruptcy, a percentage that was statistically indistinguishable from the 59 percent figure we found before reform. Indeed, because the total number of bankruptcies had risen, the actual number of medical bankruptcies in the state increased from 7,504 in 2007 to 10,093 in 2009.[7] Surveys by others indicate that the reform had little impact on access to care.
Why are so many Massachusetts residents still suffering medical bankruptcies despite health reform? Although health-care reform cut the number of uninsured in the state by more than half (to about 219,000), much of the new coverage is so limited that serious illness still leaves families with medical bills they cannot pay.
Consider that the cheapest coverage available through the state’s health insurance exchange to a single 56-year-old Bostonian who is not eligible for subsidies (in other words, one who has an income above 300 percent of poverty) costs $4,744 and comes with numerous restrictions on which doctors’ and hospitals’ bills it will pay. If the policyholder is sick, the policy doesn’t start paying bills until after the policyholder has taken care of the $2,000 deductible. The patient also is responsible for about 20 percent of the next $15,000 in medical expenses.
Nationally, the Kaiser Foundation estimates that in high-cost regions like New England, the unsubsidized premium in 2014 under the ACA will run $10,585 with additional out-of-pocket costs adding up to 6,250.[8] Such costs will predictably leave tens of millions with large medical debts and drive more than a million into medical bankruptcy every year.
Medical Debt: A Curable Affliction Health Reform Won’t Fix
http://www.pnhp.org/news/2013/june/medical-debt-a-curable-affliction-health-reform-won%E2%80%99t-fixAmong Massachusetts bankruptcy filers in 2009, 53 percent cited illness or medical bills as a cause of their bankruptcy, a percentage that was statistically indistinguishable from the 59 percent figure we found before reform. Indeed, because the total number of bankruptcies had risen, the actual number of medical bankruptcies in the state increased from 7,504 in 2007 to 10,093 in 2009.[7] Surveys by others indicate that the reform had little impact on access to care.
Why are so many Massachusetts residents still suffering medical bankruptcies despite health reform? Although health-care reform cut the number of uninsured in the state by more than half (to about 219,000), much of the new coverage is so limited that serious illness still leaves families with medical bills they cannot pay.
Consider that the cheapest coverage available through the state’s health insurance exchange to a single 56-year-old Bostonian who is not eligible for subsidies (in other words, one who has an income above 300 percent of poverty) costs $4,744 and comes with numerous restrictions on which doctors’ and hospitals’ bills it will pay. If the policyholder is sick, the policy doesn’t start paying bills until after the policyholder has taken care of the $2,000 deductible. The patient also is responsible for about 20 percent of the next $15,000 in medical expenses.
Nationally, the Kaiser Foundation estimates that in high-cost regions like New England, the unsubsidized premium in 2014 under the ACA will run $10,585 with additional out-of-pocket costs adding up to 6,250.[8] Such costs will predictably leave tens of millions with large medical debts and drive more than a million into medical bankruptcy every year.
June 2, 2013
Comment by Don McCanne of PNHP: There was quite a celebration amongst Affordable Care Act (ACA) enthusiasts when California, a leader in health care financing innovation, announced that premiums for plans to be offered through the state exchange would not increase sharply over current health plan rates. What is now evident is that the anticipated increases were at least partially offset by further limiting the number of in-network hospitals and physicians, made possible by insurers negotiating lower provider payments in exchange for a promise of greater volume.
This exposes the big lie of the ACA promise of "Choice." As has been stated so many times, the choice we really want - the choice of health care professionals and institutions - was taken away by the insurers by means of their restricted networks of providers.
Now choice is being restricted even further by narrowing down these networks of providers. These further restrictions in choice are also being in the employer-sponsored market. It can be anticipated that narrow networks will become the new standard in health plans.
At least the traditional Medicare program does not restrict patients to networks, though the private Medicare Advantage plans do. It is true that physicians can totally opt out of Medicare, but very few do. If an improved version of the traditional Medicare program covered all of us, this injustice of taking away patient choice would not exist.
My comment: I don't really mind restriction of initial choice of provider. What really pisses me off is the power of insurance companies to disrupt an established relationship with a provider.
Insurers limit doctors, hospitals in state-run exchange plans
http://www.latimes.com/business/la-fi-health-rates-deals-20130525,0,4396720.storyCalifornia's health insurance rates for a new state-run marketplace came inlower than expected this week, but one downside for many consumers will be far fewer doctors and hospitals to choose from.
People who want UCLA Medical Center and its doctors in their health plan network next year, for instance, may have only one choice in California's exchange: Anthem Blue Cross. Another major insurer in the state-run market, Blue Shield of California, said its exchange customers will be restricted to 36% of its regular physician network statewide.
Paul Markovich, chief executive of Blue Shield, said renegotiating with hospitals and physician groups for lower reimbursements was a key factor for insurers in holding down rates. Medical providers are sometimes willing to accept lower payments in return for higher patient volume from these narrow networks.
And Cedars-Sinai Medical Center, one of Southern California's most prestigious and expensive hospitals, said it's not included in any exchange plans at the moment.
People who want UCLA Medical Center and its doctors in their health plan network next year, for instance, may have only one choice in California's exchange: Anthem Blue Cross. Another major insurer in the state-run market, Blue Shield of California, said its exchange customers will be restricted to 36% of its regular physician network statewide.
Paul Markovich, chief executive of Blue Shield, said renegotiating with hospitals and physician groups for lower reimbursements was a key factor for insurers in holding down rates. Medical providers are sometimes willing to accept lower payments in return for higher patient volume from these narrow networks.
And Cedars-Sinai Medical Center, one of Southern California's most prestigious and expensive hospitals, said it's not included in any exchange plans at the moment.
Comment by Don McCanne of PNHP: There was quite a celebration amongst Affordable Care Act (ACA) enthusiasts when California, a leader in health care financing innovation, announced that premiums for plans to be offered through the state exchange would not increase sharply over current health plan rates. What is now evident is that the anticipated increases were at least partially offset by further limiting the number of in-network hospitals and physicians, made possible by insurers negotiating lower provider payments in exchange for a promise of greater volume.
This exposes the big lie of the ACA promise of "Choice." As has been stated so many times, the choice we really want - the choice of health care professionals and institutions - was taken away by the insurers by means of their restricted networks of providers.
Now choice is being restricted even further by narrowing down these networks of providers. These further restrictions in choice are also being in the employer-sponsored market. It can be anticipated that narrow networks will become the new standard in health plans.
At least the traditional Medicare program does not restrict patients to networks, though the private Medicare Advantage plans do. It is true that physicians can totally opt out of Medicare, but very few do. If an improved version of the traditional Medicare program covered all of us, this injustice of taking away patient choice would not exist.
My comment: I don't really mind restriction of initial choice of provider. What really pisses me off is the power of insurance companies to disrupt an established relationship with a provider.
May 26, 2013
Comment by Don McCanne of PNHP: This looks like another provision of the Affordable Care Act (ACA) designed specifically to protect insurers, at least partially, from untoward losses.
To protect patients who have financial hardships that prevent them from paying their premiums on time, ACA requires that their insurance remain in force for three months before it can be cancelled for non-payment. Physicians contracted with the insurers providing plans through the exchanges will have to continue to provide services for three months after non-payment begins. The insurers, on the other hand, are required to pay the bills for only the first month. After that, the physicians bear the losses.
This is one more example of the role played by the private insurers in both creating ACA and then in implementing it, taking care of their own interests first.
This particular defect is directly related to the fact that Congress, with the support of the Obama administration, selected a highly flawed model of reform - expanding our fragmented, dysfunctional system of private and public plans.
A much greater problem than this transitional coverage issue for non-payment is what then follows. After three months, the patient may remain uninsured, especially if not eligible for Medicaid. The financial hardship that caused the lapse of insurance in many instances will prevent the person from obtaining any other coverage.
Although we can be angry with the insurers for dumping on the physicians, we should hold greater contempt for the politicians and policy makers who brought us this highly flawed financing system. They know that we could have prevented these problems by enacting an improved Medicare that automatically includes everyone, forever, but they didn't do it.
We still can, you know.
Loophole in health care law could stick doctors with tab
http://www.sacbee.com/2013/05/21/5438115/loophole-in-health-care-law-could.html
A loophole in California's upcoming health care overhaul could be exploited by families gaming the system or responding to hardship in a way that doctors say could leave a pile of unpaid bills.
A chain of events would create a two-month period during which a family has medical coverage but no insurer must pay its claims.
Nonpayment of premiums for subsidized policies would trigger the oddity: Federal law provides a three-month grace period before cancellation - but insurers are responsible only for the first month.
The U.S. Department of Health and Human Services, in written comments, conceded that nonpayment of premiums would "increase uncertainty for providers and increase the burden of uncompensated care." But it rejected a handful of proposals for cracking down on families whose policies lapse.
During the three-month grace period, insurers are required to pay claims for the first month, after which policyholders would be asked to pay their doctor's bill or their insurance premium. If they pay neither, doctors get stuck with the tab.
A loophole in California's upcoming health care overhaul could be exploited by families gaming the system or responding to hardship in a way that doctors say could leave a pile of unpaid bills.
A chain of events would create a two-month period during which a family has medical coverage but no insurer must pay its claims.
Nonpayment of premiums for subsidized policies would trigger the oddity: Federal law provides a three-month grace period before cancellation - but insurers are responsible only for the first month.
The U.S. Department of Health and Human Services, in written comments, conceded that nonpayment of premiums would "increase uncertainty for providers and increase the burden of uncompensated care." But it rejected a handful of proposals for cracking down on families whose policies lapse.
During the three-month grace period, insurers are required to pay claims for the first month, after which policyholders would be asked to pay their doctor's bill or their insurance premium. If they pay neither, doctors get stuck with the tab.
Comment by Don McCanne of PNHP: This looks like another provision of the Affordable Care Act (ACA) designed specifically to protect insurers, at least partially, from untoward losses.
To protect patients who have financial hardships that prevent them from paying their premiums on time, ACA requires that their insurance remain in force for three months before it can be cancelled for non-payment. Physicians contracted with the insurers providing plans through the exchanges will have to continue to provide services for three months after non-payment begins. The insurers, on the other hand, are required to pay the bills for only the first month. After that, the physicians bear the losses.
This is one more example of the role played by the private insurers in both creating ACA and then in implementing it, taking care of their own interests first.
This particular defect is directly related to the fact that Congress, with the support of the Obama administration, selected a highly flawed model of reform - expanding our fragmented, dysfunctional system of private and public plans.
A much greater problem than this transitional coverage issue for non-payment is what then follows. After three months, the patient may remain uninsured, especially if not eligible for Medicaid. The financial hardship that caused the lapse of insurance in many instances will prevent the person from obtaining any other coverage.
Although we can be angry with the insurers for dumping on the physicians, we should hold greater contempt for the politicians and policy makers who brought us this highly flawed financing system. They know that we could have prevented these problems by enacting an improved Medicare that automatically includes everyone, forever, but they didn't do it.
We still can, you know.
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