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eridani's Journal
eridani's Journal
July 31, 2015

Wishing Happy Birthday to Medicare, Communities Demand Healthcare for All


From California to Florida to Maine, communities in 25 cities across the United States are staging rallies, picnics, and flash mobs this week to celebrate Thursday's 50th anniversary of Medicare—and call for its expansion into a system that provides publicly-funded healthcare for all.

"It is urgent that we continue organizing for the right to healthcare by fighting efforts to roll back or privatize Medicare and joining with movements around the country to establish a publicly-financed healthcare system that includes all people," Ellen Schwartz, president of the Vermont Workers' Center, told Common Dreams.

The nationwide actions marking President Lyndon B. Johnson's July 30, 1965 signing of the bill that created Medicare were organized by a broad array of organizations including Physicians for a National Health Program, Alliance for Retired Americans, National Nurses United (NNU), and Public Citizen.

They also include high-profile supporters, among them 2016 presidential hopeful Sen. Bernie Sanders (I-Vt.), who spoke at a Washington, D.C. rally on Thursday morning. "Healthcare is a right for all people, not a privilege," Sanders told a cheering crowd.

The nationwide actions come at a time of dramatic consolidation in the health insurance industry, giving way to monopolies that critics charge reveal the shortcomings of the Affordable Care Act's for-profit model. Meanwhile, Medicare faces a fresh flurry of attacks from the right, as conservatives call for cuts and privatization, despite the program's broad popularity.
July 29, 2015

Jim McDermott (D, WA-07) Introduces State-Based Universal Health Care Legislation

July 28, 2015
Contact: Dan Rubin, (202) 225-3106

McDermott Introduces State-Based Universal Health Care Legislation

WASHINGTON, D.C. – Congressman Jim McDermott (D-WA), ranking member of the Ways & Means Health Subcommittee, has introduced legislation to provide states the tools they need to guarantee the health security of their citizens. This legislation, the State-Based Universal Health Care Act of 2015 (H.R. 3241), establishes a new framework through which states may apply for a waiver of federal law in order to design and implement a single-payer health care system.

“The Affordable Care Act was a landmark achievement and a strong first step toward achieving health security in this country,” said Congressman McDermott. “However, we still have a tremendous amount of work left to do. As we explore ways to build upon the successes of the ACA, it is critical that we look for creative solutions to the challenges that still exist. Granting states tools to design single-payer systems will help spur necessary innovation, achieve universal coverage, and control costs.”

The State-Based Universal Health Care Act removes barriers in federal law that currently prevent states from establishing single-payer systems. Under this legislation, a state may apply for a Universal Health Care Waiver that will grant it authority over federal health care dollars that otherwise would have been spent on the state’s residents. It will also give states the power to regulate employee health benefits, authority which is currently preempted by federal law.

Any state seeking a Universal Health Care Waiver must design a system that covers substantially all of its residents. The benefits that each citizen receives must be at least as comprehensive and no less affordable than under existing federal health programs. Once enacted, the state plan must be publicly administered, and it may not add to the federal deficit.

July 28, 2015

Krugman: Zombies against Medicare


And second, while raising the Medicare age has long been a favorite idea of Washington’s Very Serious People, a couple of years ago the Congressional Budget Office did a careful study and discovered that it would hardly save any money. That is, at this point raising the Medicare age is a zombie idea, which should have been killed by analysis and evidence, but is still out there eating some people’s brains.

But then, Mr. Bush’s real argument, as opposed to his campaign’s lame attempt at a rewrite, is just a bigger zombie.

The real reason conservatives want to do away with Medicare has always been political: It’s the very idea of the government providing a universal safety net that they hate, and they hate it even more when such programs are successful.
But when they make their case to the public they usually shy away from making their real case, and have even, incredibly, sometimes posed as the program’s defenders against liberals and their death panels.

What Medicare’s would-be killers usually argue, instead, is that the program as we know it is unaffordable — that we must destroy the system in order to save it, that, as Mr. Bush put it, we must “move to a new system that allows [seniors] to have something — because they’re not going to have anything.” And the new system they usually advocate is, as I said, vouchers that can be applied to the purchase of private insurance.

The underlying premise here is that Medicare as we know it is incapable of controlling costs, that only the only way to keep health care affordable going forward is to rely on the magic of privatization.
July 26, 2015

Robert Reich: Happy Birthday Medicare


Medicare turns fifty next week. It was signed into law July 30, 1965 – the crowning achievement of Lyndon Johnson’s Great Society. It’s more popular than ever.

Yet Medicare continues to be blamed for America’s present and future budget problems. That’s baloney.

A few days ago Jeb Bush even suggested phasing it out. Seniors already receiving benefits should continue to receive them, he said, but “we need to figure out a way to phase out this program for others and move to a new system that allows them to have something, because they’re not going to have anything.”

Bush praised Rep. Paul Ryan’s plan to give seniors vouchers instead. What Bush didn’t say was that Ryan’s vouchers wouldn’t keep up with increases in medical costs – leaving seniors with less coverage.

The fact is, Medicare isn’t the problem. In fact, it’s the solution.

Its costs are being pushed upward by the rising costs of health care overall – which have slowed somewhat since the Affordable Care Act was introduced but are still rising faster than inflation.

Medicare costs are also rising because of the growing ranks of boomers becoming eligible for Medicare.

July 11, 2015

High health spending is more persistent than you might think


Surprisingly little is known about long-term spending patterns in the under-65 population. Such information could inform efforts to improve coverage and control costs. Using the MarketScan claims database, we characterize the persistence of health care spending in the privately insured, under-65 population. Over a 6-year period, 69.8% of enrollees never had annual spending in the top 10% of the distribution and the bottom 50% of spenders accounted for less than 10% of spending. Those in the top 10% in 2003 were almost as likely (34.4%) to be in the top 10% five years later as one year later (43.4%). Many comorbid conditions retained much of their predictive power even 5 years later. The persistence at both ends of the spending distribution indicates the potential for adverse selection and cream skimming and supports the use of disease management, particularly for those with the conditions that remained strong predictors of high spending throughout the follow-up period.


If you’re unlucky enough to get hit with a very costly health condition, consider yourself relatively lucky if it’s not highly persistent. The new work by Hirth and colleagues shows that such persistence is surprisingly common and remarkably long. This is how sickness saps savings, for those with coverage that comes with high enough deductibles and copayments. Today, we call that “insurance.” Is it?

Comment by Don McCanne of PNHP: We already know that high deductibles and other cost sharing can result in financial hardships for individuals who develop major medical problems. But how many face the additional burden of having to pay the high deductibles in the years following? This study provides an answer.

Of health plan members or their family members who were in the top 10 percent of spending in a given year, 43 percent were still in the top 10 percent the following year, and an astonishing 34 percent were still in the top 10 percent five years later.

These are workers and their family members - largely middle-income Americans - who had employer-sponsored health plans. These are the plans that the Affordable Care Act was designed to protect. Now that employers are are switching to “consumer-directed” high-deductible health plans, these plans are devastating to the personal finances of these families that must meet the high-deductibles and other cost sharing year after year. Forget retirement funds, college funds, vacations, and the like and plan to spend time with bill collectors and bankruptcy referees.

When you think about the financial protection that you should be receiving from your health plan, it is deplorable that one-third of those who have the greatest needs for health care are exposed to years of recurrent, persisting financial burdens simply because of the fundamentally flawed design of our private health plans. Austin Frakt is right to question if this is even "insurance."

The authors of the study suggest that the solution is found in disease management. What? Disease management only tweaks spending on major medical problems and would have no impact on the high-deductibles that patients would have to pay before their coverage kicks in. Let’s get real.

A single payer system with first dollar coverage would eliminate the burden of high medical bills that these unfortunate individuals face under our current, dysfunctional health care financing system. Yes, they need qualified health professionals to help them manage their diseases, but that’s a function of the health care delivery system. Intrusive, private, third-party money managers need to get out of the way.
July 10, 2015

Seidman and Pollack: ACA versus Medicare for All

Remember--ACA allows state waivers which could be used to get state-level single payer.


Many problems facing the Affordable Care Act would disappear if the nation were instead implementing Medicare for All — the extension of Medicare to every age-group. Every American would be automatically covered for life. Premiums would be replaced with a set of Medicare taxes. There would be no patient cost sharing. Individuals would have free choice of doctors. Medicare’s single-payer bargaining power would slow price increases and reduce medical cost as a percentage of gross domestic product (GDP). Taxes as a percentage of GDP would rise from below average to average for economically advanced nations. Medicare for All would be phased in by age.


Medicare for All would be fundamentally more disruptive for tens of millions of people. As a matter of basic accounting, a huge reform that creates millions of winners creates millions of losers, too: affluent workers receiving generous tax expenditures, too many constituencies to count across the supply side of the medical economy who are likely to be squeezed in a new system, individuals subject to small or large tax increases, to name a few. This list includes some of the most powerful and organized constituencies in American politics. They would have to be accommodated in complex, sometimes unappetizing, ways.

ill Doctors Be An Impediment To Reform?


On the left, there are Physicians for a National Health Care Program. (I happen to dislike PNHP leaders’ unhelpful stance in the current debate, but that is another story.)


One can make a principled decision to withdraw from the incremental politics of American health policy. I understand why single-payer advocates are tempted to take this course. Most do so with greater awareness of the attendant tensions and costs. PNHP was a sideline, not always very civil participant in the political fight to enact and preserve health care reform. Indeed its leaders denigrate important provisions of ACA that expand access for 32 million people and protect millions against catastrophic financial risks. I wish the group would talk and act rather differently in this debate.

Comment by Don McCanne of PNHP: This pair of Point-Counterpoint articles from the Journal of Health Politics, Policy and Law renew the debate over the Affordable Care Act versus Medicare for All. Laurence Seidman presents the solid case for the policy superiority of the single payer Medicare for All model while Harold Pollack also acknowledges the superior policies of single payer, yet rejects it based on our dysfunctional health care politics.

Policy is not the issue in this particular debate; it is the politics. You do not compromise clearly superior policy to conform with the dysfunctional politics, but rather you change the politics in order to support optimal policy.

PNHP’s mission is to educate the public on the single payer model - an essential step in changing the politics. Harold Pollack instead supports incremental changes, such as those of ACA, as a means of negotiating the politics. Both approaches are reasonable and neither should be completely rejected in deference to the other one. The ultimate goal should always be the utopian version of single payer, and every effort must be made to achieve that goal. In the interim, incremental measures that improve health care should be supported. But it is important to continue to inform the public on the inadequacies of these interim measures that perpetuate hardship and suffering, lest inertia set in.

Harold Pollack writes about “pursuing the messy, frustratingly incremental process of health reform,” and says, “I’m not sure what else we can do.” Yet he concedes that “a well-conceived, well-implemented Medicare for All system would offer powerful advantages over our current health care financing system.” He says that he wishes PNHP “would talk and act rather differently in this debate.” This defies any interpretation other than that PNHP should abandon their mission of single payer and join him in supporting his incremental pathway to reform. Yet he suggests that “the best outcome” may be “the possibility of public insurance carving out a complicated coexistence with private coverage.” PNHP emphatically disagrees that this would be the best outcome.

Recognizing that policy goals must not be compromised and that the politics must change, we wish the incrementalists “would talk and act rather differently in this debate.” After all, we do share the ultimate goal of health care justice for all.
July 7, 2015

Health Insurance Companies Seek Big Rate Increases for 2016


Health insurance companies around the country are seeking rate increases of 20 percent to 40 percent or more, saying their new customers under the Affordable Care Act turned out to be sicker than expected. Federal officials say they are determined to see that the requests are scaled back.

The rate requests, from some of the more popular health plans, suggest that insurance markets are still adjusting to shock waves set off by the Affordable Care Act.

It is far from certain how many of the rate increases will hold up on review, or how much they might change. But already the proposals, buttressed with reams of actuarial data, are fueling fierce debate about the effectiveness of the health law.

A study of 11 cities in different states by the Kaiser Family Foundation found that consumers would see relatively modest increases in premiums if they were willing to switch plans. But if they switch plans, consumers would have no guarantee that they can keep their doctors. And to get low premiums, they sometimes need to accept a more limited choice of doctors and hospitals.

Comment by Don McCanne of PNHP: Although it will be about three months before we have the final health insurance premiums for 2016, the information we have already can warrant a few preliminary observations.

* The Affordable Care Act appears to have failed on delivering its promise of controlling global health care costs. The primary reason given by the insurers when submitting requests for much higher premiums for 2016 is that health care costs were much higher than their actuaries anticipated.

* Some complain that new enrollees were less healthy and thus drove spending up, but under the individual mandate, increases in enrollment were across the board and not concentrated amongst the less healthy.

* There may have been some pent up demand amongst new enrollees (e.g., joint replacement) but that is only a transient surge which does not warrant long term premium increases. Much of the pent up demand will have been ventilated as most of the remaining uninsured are ineligible by immigration status or by personal hardship. The numbers who are eligible but decline coverage will only trickle in as health care needs develop.

* It appears that the increases in the benchmark silver plans will not be as great as the increases currently receiving considerable publicity. Requests over a ten percent increase were required to be made public whereas increases under ten percent will not be known until plans are marketed prior to the November 1 beginning of open enrollment.

* Because rate increases vary considerably amongst the plans, many individuals will be forced to choose between paying higher rates by staying in their current plans or changing to plans with lower rates but with different narrow provider networks thereby potentially sacrificing continuity of care.

* Respected institutions such as Geisinger in Pennsylvania and Scott and White in Texas are asking staggering premium increases, indicating that the supposed cost containment features of ACA are having a negligible impact on legitimate spending.

* Little is being said about the insurance underwriting cycle. Large, well capitalized insurers are able to price their products more competitively, decreasing the market presence of less competitive insurers. Once market dominance is established, insurers are free to drive up premiums as much as 20 to 40 percent, as reported in this New York Times article. The regulated medical loss ratios are generous enough to allow market performance (profits) to excel, as confirmed by current Wall Street activity in health insurance equities.

So are we going to wait until October when the premium rates are announced, and then do nothing other than continue to stand back and observe because the insurers will reassure us that silver benchmark plans didn’t go up that much - maybe 4.4 percent - even if it means that the enrollees have to switch plans and find new providers in a different narrow network? Is this the good that’s coming out of all of this? What about those who want to continue with their current providers, but face a 20 to 40 percent premium increase? Will the death spiral bleed over from insurers to patients?

Enough. Single payer.
July 7, 2015

Robert Reich: The Choice Ahead: A Private Health-Insurance Monopoly or a Single Payer


Last week, Aetna announced it would spend $35 billion to buy rival Humana in a deal that will create the second-largest health insurer in the nation, with 33 million members.

The combination will claim a large share of the insurance market in many states – 88 percent in Kansas and 58 percent in Iowa, for example.

A week before Aetna’s announcement, Anthem disclosed its $47 billion offer for giant insurer Cigna. If the deal goes through, the combined firm will become the largest health insurer in America.

Meanwhile, middle-sized and small insurers are being gobbled up. Centene just announced a $6.3 billion deal to acquire Health Net. Earlier this year Anthem bought Simply Healthcare Holdings for $800 million.

Executives say these combinations will make their companies more efficient, allowing them to gain economies of scale and squeeze waste out of the system.

This is what big companies always say when they acquire rivals.

Their real purpose is to give the giant health insurers more bargaining leverage over employees, consumers, state regulators, and healthcare providers (which have also been consolidating).

The big health insurers have money to make these acquisitions because their Medicare businesses have been growing and Obamacare is bringing in hundreds of thousands of new customers. They’ve also been cutting payrolls and squeezing more work out of their employees.

This is also why their stock values have skyrocketed. A few months ago the Standard & Poor’s (S&P) 500 Managed Health Care Index hit its highest level in more than twenty years. Since 2010, the biggest for-profit insurers have outperformed the entire S&P 500.
July 6, 2015

There are two kinds of people who want to cut Social Security--

—liars, and people who believe the lies. They’ve heard the conservative talking points. “Social Security is going broke.” “Social Security won’t be there for me when I retire.” “The only way to save Social Security is to cut benefits.”

nfortunately, these Wall Street funded lies have gotten plenty of traction in recent years. So much so that a recent survey shows that 43 percent of young people believe that Social Security won’t be there for them when they retire—no matter how much that same survey shows that these same young people want it to.

It’s time to set the record straight. This 4th of July weekend, when you’re speaking with your Chris Christie-loving cousin at the family BBQ, you have the facts on your side:

Social Security has a $2.8 trillion surplus and can pay out every benefit owed to every eligible person for nearly two decades. After that, even if we do nothing, it will pay out approximately 80% of benefits owed for the next 75 years.
--Social Security has not contributed one penny to the deficit because it is independently funded by the FICA payroll tax.
--Proposed “tweaks” to Social Security would hurt seniors, disabled veterans and people with disabilities.
--All we need is to ask millionaires and billionaires to start paying into Social Security at the same rate as the rest of us and we not only extend the life of the Social Security trust fund, but we can expand benefits to the majority of Americans

With the facts on our side, we have begun to see a dramatic shift in the national conversation around Social Security. It wasn’t that long ago that we were still fighting a “chained CPI” benefit cut being proposed by President Obama, all Republicans and some Democrats in Congress. Today, 44 out of 46 Senate Democrats and 116 out of 188 House Democrats have gone on record supporting expansion. And 79% of likely voters – Democrats, Republicans and Independents – support expansion!

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Gender: Female
Hometown: Washington state
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Member since: Sat Aug 16, 2003, 01:52 AM
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About eridani

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

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