HomeLatest ThreadsGreatest ThreadsForums & GroupsMy SubscriptionsMy Posts
DU Home » Latest Threads » eridani » Journal
Page: 1 2 Next »


Profile Information

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

How and Why Medicare for All Is a Realistic Goal


Those two expansions -- lowering the Medicare age and adding children -- would have been easy to explain and popular. They constitute excellent policy, and would have been easily understood by the electorate. A newly-elected Clinton administration, laser-focused on an incremental expansion of Medicare, would have had an excellent chance of success. President Obama could have built on that success, proposing lowering the Medicare age further, raising the Medikids age, and allowing those with pre-existing conditions and others to buy into Medicare at a reasonable price. Eventually, more and more people would have opted in, getting us ever closer to the goal of Medicare for All.

This strategy is still likely to work. It is completely compatible with Obamacare. Medicare is popular among conservatives and liberals alike. Many seniors, who have been a growing part of the Republican base, are hanging on until they reach their 65th birthdays. A Medicare expansion, polls show, is overwhelmingly popular, just as Social Security expansion is. As part of the expansion effort, a new push for a public option, in the form of a Medicare buy-in, would help reach the ultimate goal.

An incremental approach only works if one has a vision of where the incremental steps are leading. In a campaign, candidates present the ultimate goals, not a blueprint for incremental change. But to attack the ultimate goal as unrealistic, when incremental steps can get you there, is a disservice. It is a disservice to all of the millions of Americans who believe that high quality, affordable health care should be a right, not a privilege. It is a disservice to all those who want a more efficient health care system in order to have resources to spend on other pressing domestic needs. It is a disservice to those who see that a more efficient health care system will allow more compensation to be paid in the form of cash wages, as opposed to health insurance.

Claiming that such a noble, important and popular goal -- Medicare for all -- is unrealistic does not show pragmatism. Rather, it shows a lack of imagination.

Study: Some Marketplace Customers Spend 25 Percent of Income on Health Expenses


Even with subsidies to make coverage more affordable, many people who buy health insurance on the marketplaces spend more than 10 percent of their income on premiums, deductibles and other out-of-pocket payments, a recent study found. Among those hit hardest, the researchers said, are people who spend nearly a quarter of their income on health care expenses.

“There’s been a lot of talk about how high deductibles and out-of-pocket costs are in the Affordable Care Act, and a lot of anecdotes about that, and this [study] quantifies that in a more systematic way,” said John Holahan, a fellow at the Urban Institute’s Health Policy Center who co-authored the study.

The study used a model to estimate expected household spending on health insurance premiums and out-of-pocket expenses by individuals and families at different income levels using the marketplaces in 2016.

The analysis incorporated tax credits that are available on a sliding scale to people with incomes between 100 and 400 percent of the federal poverty level ($11,770 to $47,080 for an individual) to help subsidize the cost of premiums. It also included cost-sharing reductions that lower out-of-pocket spending for people with incomes up to 250 percent of the federal poverty level ($29,425 for one person) if they purchase silver plans on the online marketplaces.

Despite the financial assistance provided by the health law, people with modest incomes and average medical expenses have relatively heavy financial burdens for health care, the study found.

LTE from doctors to Krugman.on single payer


I’m glad to see that Paul Krugman acknowledges that “if we could start from scratch, many, perhaps most, health economists would recommend single-payer, a Medicare-type program covering everyone.” His argument that we should not work for it now is unconvincing.

Just because private insurers are powerful doesn’t mean a concerted national campaign can’t overcome their well-funded opposition. Already a majority of the general public (58 percent in a recent Kaiser poll) supports single-payer. Cost will never be controlled until we do away with the bloated administrative expenses of our hopelessly complex financing arrangements and for-profit medicine.

U.S. health system is already predominantly taxpayer funded


Americans pay the world’s highest health-related taxes. Yet many perceive that US health care financing system is predominantly private, in contrast to the universal tax-funded health care systems in nations such as Canada, France, or the United Kingdom. By 2024, government expenditures in the United States are expected to account for more than two thirds of national health spending. This is nearly the same proportion as in Canada, where official figures put government’s share at 70.7% (although this figure excludes modest tax subsidies for supplemental private coverage).

Public funds help the vast majority of Americans pay for care, but these funds flow through many different spigots. The funding streams for the poor, the elderly, veterans, family planning, and public sector workers are visible and hotly debated. Meanwhile, the hundreds of billions in tax subsidies that disproportionately benefit wealthier Americans have drawn far less public attention.

Although taxpayers fund the vast majority of health spending, overall priorities for this funding are rarely discussed.

Appreciation of the magnitude of government funding might encourage more explicit, appropriate, and equitable targeting of these expenditures as components of a total health budget.

Comment by Don McCanne of PNHP: We often hear that we cannot afford the taxes to pay for a single payer national health program - an improved Medicare for all. ed;Yet we are already paying most of the taxes that would be required-- it’s just that they are relatively obscure and thus not recognized by most taxpayers.

By 2024, government expenditures will pay for more than two-thirds of national health spending (up from 64.3% in 2013). “Government health expenditures in the United States account for a larger share of gross domestic product (11.2% in 2013) than do total health expenditures in any other nation,” according to this study. Our government health expenditures alone are more than both government and private health expenditures in any other nation. We are paying for a national health program, but we are not getting it.

Most people are aware of the insurance premiums and out of pocket expenses that they and their employers pay for health care, so they tend to think that most health care spending is private. They are aware of the payroll deduction for Medicare, but they do not tend to consciously connect other taxes, especially income taxes, with expenditures for Part B and Part D Medicare, Medicaid, CHIP, the VA system and other government health programs. Also, totally out of mind is the portion of personal and corporate income taxes that help pay for government health programs - taxes that are built into the pricing of consumer goods and services (not to mention that the cost of employee health benefit programs is also built into consumer prices). (This may be double counting for the tax tally, but higher health spending in the U.S. do pass on opaque employer plan health costs to the consumer.) And one of the largest silent taxes is the tax expenditure (tax subsidies) on the federal, state and local level that help pay for private, employer-sponsored health plans. Also, we are paying, through taxes, for most of the health benefits offered to federal, state and local government employees.

The roughly $300 billion we pay for tax expenditures for employer-sponsored health plans (will be over $500 billion by 2024) is a prime example of how dysfunctional our health care financing is. The subsidies are credited in direct proportion to income - the higher a person’s income, the greater the subsidy. That is really unfair to lower-income individuals and families who may be paying the same insurance premium, directly or indirectly through forgone wage increases, as the higher-income employees do, but at a greater dollar amount than those with higher incomes after the subsidy is applied, and at a much greater percentage of income. This is a highly regressive tax policy.

The point is, we are already spending our taxes on the health care system, and we can do it much more equitably through a well-designed single payer program. Not only would we increase transparency, we would also reduce inefficient spending by eliminating the private insurance industry, saving more in premiums than would be the increase in taxes. The next time someone says that we cannot afford the taxes for a single payer system - clue him or her in. Let everyone know that it is time to demand much greater value for the enormous amount of taxes that we are already paying for health care.

The Real Argument for Single-Payer


It’s two years later, and we are learning some things. ACA is regulation. More regulation than existed prior to its enactment, but regulation nonetheless. Predictably, the Health Care Industry is spending a lot of time and a lot of money to find perfectly legal ways to game the ACA. Premiums are up, as are deductibles and all costs borne by the “consumer” – that’s you and me.

No one should be surprised. The primary responsibility of the health care industrialists is not to their customers, it is of course to their shareholders on Wall Street. That’s where commodities are traded. Commodities like patients seeking treatment from doctors.

So yes, Obamacare is still better than the wild, wild west pre-ACA Health Care Industry heyday. But it fails on the most important and fundamental level.

Obamacare does nothing to break the death-grip of the for-profit American health care industry on the life-blood of American health care. As long as the point of medicine is profit, it’s bad medicine, and the human suffering continues. In fact, rather than challenge the validity of corporate ownership of American health care, the ACA actually codifies it.

Higher deductibles do NOT lead to more careful "shopping"


During their last use of medical care, HDHP enrollees were no more likely than enrollees in traditional plans to consider going to another health care professional for their care (n = 120 [10.9%] vs n = 85 [10.0%]; P = .67), or to compare out-of-pocket cost differences across health care professionals (n = 42 [3.8%] vs n = 23 [2.7%]; P = .37).

Simply increasing a deductible, which gives enrollees skin in the game, appears insufficient to facilitate price shopping. Members of HDHP and traditional plans are equally likely to price shop for medical care, and they hold similar attitudes about health care prices and quality.


It is true that high-deductible health plan enrollees have “skin in the game.” However, these enrollees are exposed to substantial out-of-pocket cost risk with little evidence that this risk exposure will incentivize higher-value health care decisions, meaning they are essentially playing the game blindfolded with one hand tied behind their back.

Comment by Don McCanne of PNHP: This study shows that individuals with high-deductible health plans (HDHP) are no more likely to select their care based on their out-of-pocket costs than do individuals enrolled in traditional health plans without high deductibles. As the editorial states, it is likely that “getting enrollees to make higher-value decisions remains a mirage.”

So high deductibles do not cause patients to be smart shoppers, but they do cause patients to decline beneficial health care services. They also create financial hardships for some patients.

Thus high deductibles have a net negative impact. We should get rid of them. A single payer system is a much more efficient and patient-friendly method of controlling health care spending

Competition can’t rein in health care costs


Proponents of competition to bring down costs have little data to support their position. It’s hard to imagine how consumer choice would bring down costs because the health care market differs from other markets in three fundamental ways. First, insurance keeps people from making health care decisions based on price, as they do with other goods (although copays and deductibles can keep people from getting needed care altogether). Second, putting aside insurance, there’s precious little reliable health care data that allows people to make decisions based on price and quality that would drive competition. And, third, even with good data, we generally defer to health care experts to decide the services we need. Medical professionals are trained, and we lack the skills to know better.

Furthermore, commercial insurers are unable or unwilling to use their market power to rein in prices in meaningful ways. In fact, the Medicare managed care plans tend to piggy back on the prices Medicare has negotiated for health care services. As Wendell Potter explains, insurers drive profits by dropping unprofitable business lines not by bringing down prices.

To make matters worse, consolidation of provider markets has led to insurers having even less clout today than they’ve had in the past to drive down prices. Areas with consolidated provider markets have been shown to drive up prices 12 percent in a year.

The health care marketplace is always in flux, with new entrants, as well as mergers and acquisitions of companies, which often drives up prices. And, while these market shifts also may drive innovations, it can be hard to see the value. No commercial business worth its salt is prone to share its best practices with its competitors.

In sharp contrast, an all-payer or single-payer system, like Medicare, can both drive system change and control prices. Medicare is our most powerful tool for driving system-wide improvements in the health care marketplace. It can offer price and quality transparency. It also reins in prices through negotiated rates. Some argue that if we extended Medicare to the entire marketplace it would disincentivize market winners and losers from innovating. But, many innovations happening today are not public and not benefiting our health care system.

81% of Democrats Support Single Payer, as well as 58% of all Americans


A reminder, given the discussion about Single Payer that Chelsea Clinton has given rise to:

From the Kaiser Health Tracking poll, December 2015:

When asked their opinion, nearly 6 in 10 Americans (58 percent) say they favor the idea of Medicare-for-all, including 34 percent who say they strongly favor it. This is compared to 34 percent who say they oppose it, including 25 percent who strongly oppose it. Opinions vary widely by political party identification, with 8 in 10 Democrats (81 percent) and 6 in 10 independents (60 percent) saying they favor the idea, while 63 percent of Republicans say they oppose it.

Hillary Clinton’s opposition to Single Payer, and it is worth Chelsea Clinton bemoaned the elimination of private insurance today, is a deeply minority position within the Democratic Party.

I have long thought Single Payer was a dividing line between third way types and liberals. The US spends an absurd amount of money on a corrupt system. Obamacare was an enormous improvement, but most in the party support the Medicare for all system that Sanders support.

Thomas L. Friedman comes out for single payer.


It’s time for a true nonpartisan extremist, one whose platform combines the following:

* A single-payer universal health care system. If it can work for Canada, Australia and Sweden and provide generally better health outcomes at lower prices, it can work for us, and get U.S. companies out of the health care business.

Comment by Don McCanne of PHNP: In his opinion piece, Thomas Friedman calls for electing a nonpartisan extremist for president.

The first in his recommended list of extremist policy positions is a single payer universal health care system. Great!

The significance of this is that the debate over health care reform is not limited to tweaking the irreparable deficiencies of the Affordable Care Act (Democrats) versus paring back the government role in health care by shifting more of the financial responsibility to patients (Republicans). Although single payer was rejected during the campaign that led to the election of President Obama, it is now clear that Obamacare has perpetuated a wasteful, inefficient system that is increasing financial burdens and further impairing access for patients, even if greater numbers are nominally insured. And the tentative Republican proposals would make affordability and access even worse.

There is now a much broader understanding that single payer would provide the infrastructure that would ensure affordable care for everyone. The spark which has injected this into the presidential campaign is the strong endorsement by Bernie Sanders along with a token acknowledgement by the poll-leading Republican candidate - Donald Trump. We are seeing more single payer endorsements along with limited press coverage confirming that single payer is in play in this election. We should continue our efforts to amplify that. Low odds admittedly, but it’s there.

Just a note on Friedman’s article. He calls for “a nonpartisan extremist for president who’s ready to go far left and far right — simultaneously.” His list of policy recommendations includes some that are simply not acceptable in an enlightened society (mind you, I’m a pacifist). So we should make it clear that, though we are quite pleased with Friedman’s endorsement of single payer, we cannot reciprocate with an endorsement of several of his other policy positions.

Even Insured Can Face Crushing Medical Debt, Study Finds


The number of uninsured Americans has fallen by an estimated 15 million since 2013, thanks largely to the Affordable Care Act. But a new survey, the first detailed study of Americans struggling with medical bills, shows that insurance often fails as a safety net. Health plans often require hundreds or thousands of dollars in out-of-pocket payments — sums that can create a cascade of financial troubles for the many households living paycheck to paycheck.

Carrie Cota learned the hard way that health insurance does not guarantee financial security. Ms. Cota, a 56-year-old travel agent from Rosamond, Calif., learned she had the autoimmune disease lupus in 2007. She ran up thousands of dollars in medical and dental bills and ended up losing her job, and eventually her house.

“I had to move in temporarily with my ex-husband,” she said in a recent interview. “I’m staying with him until I can figure out what to do.”

In the new poll, conducted by The New York Times and the Kaiser Family Foundation, roughly 20 percent of people under age 65 with health insurance nonetheless reported having problems paying their medical bills over the last year. By comparison, 53 percent of people without insurance said the same.

These financial vulnerabilities reflect the high costs of health care in the United States, the most expensive place in the world to get sick. They also highlight a substantial shift in the nature of health insurance. Since the late 1990s, insurance plans have begun asking their customers to pay an increasingly greater share of their bills out of pocket though risindeductibles and co-payments. The Affordable Care Act, signed by President Obama in 2010, protected many Americans from very high health costs by requiring insurance plans to be more comprehensive, but at the same time it allowed or even encouraged increases in deductibles.


Comment by Don McCanne of PNHP: These excerpts from the Kaiser Family Foundation/New York Times Medical Bills Survey of adults 18 to 64 confirm once again that our multi-payer health insurance system falls far short in preventing financial insecurity for those with medical needs. This survey expands on our knowledge base by demonstrating the deplorable consequences of the financial hardships created by this system.

These deficiencies cannot be corrected by merely tweaking our current dysfunctional financing system. A massive infusion of funds would be required under the current system if we wish to reduce the negative financial consequences, but the political and policy communities currently oppose any increase in spending. In fact, their current approach is to control spending by increasing barriers to care through unaffordable cost sharing and narrower networks designed to reduce access. Obstructing access to care might reduce spending, but preventing beneficial health care is the opposite of what a health care financing system should be doing.

Think of that. It is bad enough that people have the misfortune to suffer medical disorders, yet we add to that grief by perpetuating a system that dumps personal financial hardship on top of their medical misfortunes.

The efficiencies of a single payer system would save enough to more assuredly enable access to appropriate health care services by removing cost-sharing barriers to care, not to mention the benefit that absolutely everyone would be included. What are we waiting for? The status quo is unequivocally unacceptable.
Go to Page: 1 2 Next »