Quote of the Day
November 13, 2009
A conservative Republican sees the light
How about that! A conservative Republican who has decided that single payer is the best way to go. Wow!
November 12, 2009
Misguided fixation on premiums
From the very start, the two most important goals for reform allegedly were to cover everyone and to control health care costs. But the precondition that reform be based on an expansion of private health plans within our dysfunctional, fragmented financing system immediately eliminated universal coverage as a goal. It proved to be impossible to balance all of the variables in this dysfunctional system to ensure that everyone would be covered. So they gave up.
November 10, 2009
Uninsured veterans
How can we continue to support a fragmented, dysfunctional financing system that allows some of our veterans (not to mention tens of thousands of others of us) to die merely because we have placed a higher priority on nurturing the private insurance industry than we have on improving access for everyone through a more effective health care financing system? Our veterans. How can we let them down like this?
November 09, 2009
eHealth is ready to connect America
eHealth is ready to become the nation's broker for private health insurance. Watching the two minute video at the "Ready to Connect" link above will demonstrate just how ambitious their plans are.
November 06, 2009
Rep. Weiner withdraws single payer amendment
The fact that single payer got so far along in the House is a testament to the strength of our single payer movement. The huge number of calls by single payer advocates in support of single payer and the Weiner amendment in recent days have been noted by several members of Congress.
November 05, 2009
Harvard Professor William Hsiao on effective reform
There is no person more qualified to discuss health system design than William Hsiao.
November 04, 2009
CBO on premiums and cost sharing of the House bill
Of the many flaws in the very expensive and highly inefficient model of health care reform that Congress has selected, one of the more important is the financial impact that it will have on middle- and upper-middle income individuals and families. Let's look at the example of a family of four with a very good income: $102,100.
November 03, 2009
Drew Altman on Americans affording health care
Drew Altman is a very intelligent and very well informed advocate of a health care system that works well for all of us. His only handicap is that, as President and CEO of the Henry J. Kaiser Family Foundation, he must maintain his reputation as a highly credible but impartial voice on health care reform. That requires diligently negotiating his way through the minefield of Washington politics.
November 02, 2009
Expanding Medicaid to save money
The version of the House health care reform bill released last week would further expand Medicaid eligibility to individuals with incomes up to 150 percent of the federal poverty level. This expansion was prompted by the self-imposed requirement to avoid any deficit spending as a result of this legislation. It will cost the government less to enroll these individuals in Medicaid than it would cost to provide them with subsidies to purchase private health plans.
October 30, 2009
CBO report on the public option
What happened to that public option that the liberals promised us when they decided not to try to enact the golden standard of a single payer national health program? You know, that government program, like Medicare, designed to be less expensive, more efficient and more equitable, and that each of us could choose in place of private health plans. Really, what happened to it?
October 29, 2009
Weiner single payer amendment tanks
What the... !?
October 28, 2009
The ethics of health care reform
I'll be brief because I want to make only one very simple point: An ethical health care system is designed to take care of patients. What could be more obvious? If the health care system is doing its job in taking care of patients then the health care system itself is being taken care of. Special interests legitimately involved in health care delivery will do just fine.
October 27, 2009
The actuarial squeeze on low and middle income families
The best private insurance available today - employer-sponsored health plans - have an actuarial value of 80%. That means that the insurance pays 80% of the covered costs of health care and patients are responsible for the other 20%. Patients also are usually responsible for out-of-network services and for services and products that are not benefits of the plans.
October 26, 2009
Is health insurers' profit 2% or 22%?
In simple accounting terms, profit represents the difference between gross revenues and the cost of producing and marketing the products or services sold. So what is the product that the private insurers are selling us? Administrative services.
October 21, 2009
Kitzhaber on health care costs
The five reform bills passed by House and Senate committees will not control health care costs, and yet these are to be merged into one bill - that will not control health care costs.
October 20, 2009
Insurance promotes awareness and control of chronic disorders
This study confirms that being insured not only improves the control of chronic diseases, it also improves the diagnosis in individuals who are not even aware of their disorders. Insuring the uninsured can delay or even totally prevent the disastrous complications of these chronic disorders.
October 16, 2009
Dartmouth variations - looking back and looking forward
As the nation attempts to identify ways of slowing the excessive growth in our health care costs, it is only natural that we would look at the great variability in health care spending that does not seem to correlate with health care outcomes. John Wennberg and his colleagues, in producing the Dartmouth Atlas, have confirmed that these variations are very real, though more recent refinements have demonstrated that the differences are not quite as great when corrected for other factors.
October 15, 2009
Regence blames the patients
How many people do you know that request health care that they know they don't need but they want to have "because it's covered"? In over thirty years of my very busy family practice, I cannot recall one single patient with such a request. Yet the thrust of this Regence BlueCross BlueShield campaign is to blame the patient for requesting too much health care.
October 14, 2009
Guardian gets rid of the "dogs"
Although the individual private insurance market is infamous for discriminating against individuals with a potential for high health care costs, regulations largely prohibit group plans from singling out individuals for exclusion.
October 13, 2009
What about primary care?
The report by Dr. Cooper and his colleagues, cited by Dr. Freeman, was "A Report to the President and the Congress." Since it was released only one month ago, this report likely did not influence the current legislation, but it is important because it does represent the cavalier views of all too many within and outside of the health care arena.
October 09, 2009
Rodberg - Is There Any Way Out for Obama?
You hear that phrase in almost every speech made in support of the "Plan" - the reform proposal of President Obama and the Democrats in Congress. It has the implicit threat that if the Plan is not passed, we will be condemned to continue to live with the deteriorating health care mess that we now have. If we do pass the Plan, we will be condemned to live with the deteriorating health care mess that we will have - the mess that Professor Rodberg so adeptly describes.
October 08, 2009
What is the right penalty to enforce an individual mandate?
The current reform proposal before Congress would encourage more uninsured individuals to purchase health care coverage by assessing a financial penalty on those who fail to do so, thus enforcing an individual mandate to purchase insurance.
October 07, 2009
IBM CEO Palmisano on single payer
So IBM CEO Sam Palmisano says that single payer, government health systems have an advantage over fragmented systems (like ours in the U.S.) since they can create incentives for change. That seems counter to those who claim (falsely) that government systems suppress innovation.
October 06, 2009
Bad advice from the OECD
The OECD has a mission of bringing together governments "committed to democracy and the market economy." Their release of a paper supporting a private insurance model of reform for the United States seemed to be a fulfillment of this mission. But even their paper added nothing that would refute what we already know from our efforts at reform: the private insurance model is an expensive, wasteful, inequitable, and a fairly ineffective model of ensuring affordable, high quality care for everyone.
October 05, 2009
Continued insurer discrimination assured
No matter how tightly regulated, investor-owned private insurers will always find ways to avoid enrolling those with greater health care needs. To fulfill their business responsibilities they are mandated to control costs in any way possible. To remain competitive and survive, nonprofit insurers must follow their lead.
October 02, 2009
Two unacceptable policy flaws
Two difficult issues that stem from using private health plans as the model for reform include: 1) Can you mandate individuals to buy an insurance plan they can't afford?, and 2) Can you allow insurers free rein on using premium dollars for their own purposes rather than spending them on health care? Let's see how the Senate Finance Committee approached these.
September 30, 2009
Will the insurance exchange be as effective as FEHBP?
Members of Congress are promising reform that will give us choices of coverage, just like they have in the Federal Employees Health Benefits Program (FEHBP). They will do this by establishing an FEHBP-like insurance exchange for the purchase of health plans.
September 29, 2009
Are physicians fleeing Medicare?
In the debate on health care reform we hear that physicians are leaving the Medicare program because they cannot continue to accept the low fees paid by the government. Not true, according to this new GAO report. Physicians are more willing to serve Medicare beneficiaries and to accept Medicare fees as payments in full.
September 25, 2009
Does the U.S. have the best health care?
This paper (14 pages) brings together numerous credible studies on the quality of health care in the United States, as compared with other nations. Anyone reading this message already knows that the United States is paying enough for exceptional care for everyone, but many of us are not receiving it. On average, our health care is mediocre.
September 24, 2009
Where are the price controls?
One of the more unique features of the health care system in the United States is that we spend far more on care even though our use of health care services is comparable to other nations. The difference is in the prices. Other nations use government regulation to improve pricing, but the United States persists in refusing to intervene in market pricing.
September 23, 2009
Insurance and Equity in Primary Care and Specialist Office Visits
Much of the discussion on health care reform centers around financing reform, with goals of achieving universality and affordability. Effective reform that would actually accomplish that (i.e., single payer) would be a crucial first step toward the even more important goal of reducing the socioeconomic disparities in care. The record on disparities in the United States is shameful.
September 22, 2009
Lessons from California on the insurance mandate
The health care reform proposal before Congress would increase regulatory oversight of the private insurers, mandate individuals to purchase their plans, and penalize those who fail to do so. The experience with auto insurance in California should provide us with at least a hint as to whether that is a rational response to the health care crisis.
September 21, 2009
NYT Blog: Medicare for all?
Several readers found fault with Katharine Seelye's dismissal of "Medicare for all" single payer reform as being too complicated, imposing a big tax increase on the middle class, and driving doctors and hospitals out of business because of low reimbursement rates. She also quoted Stuart Altman as saying it would be too disruptive, and Robert Moffit as saying that it would mean too much government intrusion.
September 18, 2009
45,000 deaths attributable to uninsurance
This study analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III) conducted by the National Center for Health Statistics (NCHS). This was a scientifically rigid analysis of a highly credible data source. The study concludes that the deaths of about 45,000 people each year are associated with the lack of health insurance.
September 17, 2009
Americans are satisfied with their insurance - Not!
According to this study conducted last month, 90% of insured Americans rated their insurance coverage either excellent or good. Yet when asked about specifics, only 14% of those rating their coverage excellent or good reported that they did not have any problems with paying their medical bills in the last 12 months and that they were satisfied with the elements of coverage listed above.
September 16, 2009
What does a $13,375 premium mean for reform?
Employer-sponsored health plans insure not only the largest sector of our society, but also the healthiest: the healthy workforce and their young healthy families. Because of the greater purchasing leverage of employers, economies of group plans, better regulatory oversight, and the lower average health care needs of the beneficiaries, premiums being paid for employer-sponsored plans represent the greatest value that we can expect in health care financing. Today a working family pays $13,375 for its coverage (which includes the employer contribution paid indirectly by the employee in forgone wage or salary increases).
September 15, 2009
Compassion for some; Solidarity for all
The subtitle of this article is "Why Obama Needed Single Payer on the Table." The full article is well worth reading.
September 14, 2009
Insurance exchange loopholes
In health care, we spend more and receive less, and everyone agrees that has to change. The decision has been made that we will do that by regulating our dysfunctional health insurance market, and then mandate that everyone who is not covered by other qualifying programs be required to purchase private health plans. To be certain that everyone has access to a plan, an insurance exchange will be established.
September 11, 2009
Sarah Palin feeds the fact checkers
The heated debate over health care reform was certainly not unexpected. What has been a surprise to many of us is the intensity of the nastiness of the opponents of reform.
September 10, 2009
Census Bureau report on health insurance coverage
President Obama, in his speech before the joint session of Congress last evening, did not break new ground on the current proposal for reform being developed by Congress and the administration. So, based on the framework that has been advanced, what impact will the current proposal have on the numbers of uninsured?
September 09, 2009
Implications of growth in health care spending
Average-income Americans - the majority of us - are finding the impact of health spending growth to be onerous, and it will get worse.
September 08, 2009
Fooled by the public option debate
In his Labor Day speech yesterday, President Obama, in using his "I continue to believe..." phrasing when mentioning a public option, made it quite clear that he will not tell the joint session of Congress tomorrow that the lack of a public option in the reform bill will result in a veto.
September 07, 2009
"Sick and Wrong" by Matt Taibbi
This may be the most important week in this window of opportunity for health care reform. Matt Taibbi's well researched article tells us where we are and how we got here. It's a must read for those who care. Hopefully it will motivate us to put down our Hallmark cards and join in the fight for real health care justice for all.
September 04, 2009
How much will reform cost me?
Under the House bill for reform (HR 3200), a family of four with an income of $88,200 that had health care needs could be responsible for $19,708 of their health care costs, which is 22% of their income (23% under the Energy and Commerce amendments). That would leave them with an income of $68,492 for all of their other needs and wants (and some of that could be burnt up in out-of-network costs and non-covered services that do not apply to the cap).
September 03, 2009
More lessons from Massachusetts
Although there are many reports on the deficiencies of the Massachusetts reforms, this report stresses two serious design flaws that impair affordability and access for low and middle income patients: 1) both public and private plans often fail to provide adequate financial protection even for those with only modest health care needs, and 2) the complex maze of programs and plans are very difficult to navigate with ever changing eligibility for the various programs, leading to frequent unavoidable lapses in coverage or no coverage at all.
September 02, 2009
Paying for community health centers
Regardless of what proposals for health care reform are adopted, it is essential that financing be included for non-profit community health centers in underserved rural, urban and suburban communities. Would these centers be better served by health insurance exchanges and their private plans, or by a public financing program?
September 01, 2009
Over 2.2 million Californians have medical debt
Most individuals who are following health care reform are already aware of the fact that medical debt often contributes to personal bankruptcy, even for those who had been insured. This report adds to that data by demonstrating that medical debt is much more common than is reflected in the bankruptcy data, and is serious enough to have adverse consequences since it often results in individuals delaying or forgoing needed health care.
August 31, 2009
IT'S THE INSURANCE COMPANIES, STUPID!
What's beautiful about the Medicare Advantage program is that it has provided us with a real-life laboratory experiment which allows us to compare the functioning of highly-regulated private insurance plans as contrasted with the functioning of a public insurance program: traditional Medicare. The results are in, though that would be tough to ascertain if you simply observe the response of Congress.
August 28, 2009
Former Jasper County Republican Chairman on Single Payer
If you set politics aside and look at proposed policies for reform, the logic of a single-payer, improved Medicare for all should unite those with views as diverse as a Democrat fighting for health care justice and a Republican demanding common sense business principles that would provide all of us with much greater value in health care.
August 27, 2009
Employers Face 10.5 Percent Health Care Cost Increases
Under the management of private insurers health care costs continue to increase at outrageous rates - this year at 10.5 percent. With the decision of Congress to leave private insurers in charge, and with no measures that would have any major impact on slowing health care spending, it can be anticipated that these outrageous increases will continue even after reform is enacted.
August 26, 2009
JHPPL: Exploring the Concept of Single Payer
The fact that the entire August issue of the Journal of Health Politics, Policy and Law is devoted to exploring single payer certainly indicates that the concept has not died within the policy community.
August 25, 2009
Europe leads in pharmaceutical research
Our uniquely American health care system is noted for its high prices for relative mediocrity. Some contend that our pharmaceutical industry provides an exception. It doesn't. We are paying high prices for new chemical entities that over 85 percent of the time are providing us with no real benefit over existing products.
August 24, 2009
T.R. Reid's "The Healing of America"
In "The Healing of America" and in last year's PBS Frontline presentation, "Sick Around the World," T.R. Reid has demonstrated how other nations have higher performance health care systems that take care of everyone and at a much lower cost than in the United States.
August 21, 2009
Uwe Reinhardt on the public option
The brouhaha over the public option is more than just symbolic. The accusation is correct: the public option was perceived as a means to move us toward single payer, while respecting the right of others to continue with their current coverage if they so preferred. The progressive camp was divided over this strategy since some of us believed that jettisoning single payer in favor of the public option would result in a bargaining position in which the public option would have to be traded away in exchange for some insurance market reforms. Those single payer advocates who agreed to support the public option now feel betrayed.
August 20, 2009
Concerns about reform efforts
A PhD thesis could be written over just what this survey tells us, but we're certainly not going to do that here.
Give this some thought. Think about what this might mean. Then think about what we should be doing in response. And then do it!
August 19, 2009
Policies to address out-of-network charges
What are private insurers selling us? Their primary product is a network of health care providers that have contracted to accept the insurers' rates. The benefit of that is that it has helped to slow the rate of increase in health insurance premiums. One major problem with that is individuals frequently obtain care from out-of-network providers - usually not by choice, but by medical circumstances not really under the control of the patient. Under most insurance plans, the individual then becomes responsible for payment of most or all of the out-of-network charges.
August 18, 2009
Obama on choice of physician
Obviously, giving someone who lives in Maine the choice of having the option for an expense-paid trip to California to receive health care is not one of the goals of health care reform. That's not exactly what is meant by choice. This was an exaggeration on the part of the President to make the point that, of course, we can't have choice.
August 17, 2009
Conservative leader David Cameron on the NHS
For those of us in the United States who want to know more about the horrors of their government-run, socialist system of health care, Conservative David Cameron would be the first to expose how government ownership and management are a threat to the health of the people. But that is not his message.
August 14, 2009
Uwe Reinhardt on ethics and economics of end-of-life care
Ethics meets economics not only at the end of life, but throughout a lifetime of health care. Economics provides us with various alternatives on financing health care, and ethics provides us with the decency to do it the right way.
August 13, 2009
Helen Thomas on single payer
Helen Thomas doesn't ever give up, thank goodness. As she writes, President Obama "still has time to do the right thing."
August 12, 2009
AHIP explains why private insurance is a bad deal
As we look at comprehensive health care reform, we really have to ask ourselves just what is it that the private insurance plans are providing us in exchange for their exorbitantly high administrative costs and the costly administrative burden they place on the health care delivery system?
August 11, 2009
Prevention and wellness - phantom savings and real costs
Prevention and wellness programs frequently can be very beneficial for our physical health and our sense of well being, and when they are, they may well be worth the investment of our time and money.
August 10, 2009
Nicholas Skala
We at Physicians for a National Health Program are terribly saddened to report the sudden and unexpected loss of one of our staff members, Nicholas Skala, who died over the weekend in his Chicago home at the age of 27 of unknown causes.
August 07, 2009
UnitedHealthcare: 1) Health Tracker and 2) Winning the War
What a nice thing UnitedHealthcare is doing. Being dedicated to the health care consumer, they are helping their commercial plan enrollees manage their health-related finances and information through the Quicken Health Expense Tracker developed by Intuit jointly with their own Ingenix division. This is the industry's solution for reducing the administrative complexity and waste of our fragmented, multi-payer system. Or is it?
August 06, 2009
Bending the cost curve
Once again. The stated goals of health care reform are 1) to cover everyone, and 2) to slow the growth in health care costs so that health care is affordable. So what is Congress doing?
August 05, 2009
Health Insurance Exchange? Lessons from California
Most progressive policy wonks observing the reform process taking place in Washington have been quite smug. As the battles take place over a public option, over taxing employer-sponsored plans, or over the eligibility thresholds for government subsidies, these wonks are complacent knowing that the really important reform taking place is the establishment of the Health Insurance Exchange. Or so they believe.
August 04, 2009
Marilyn Clement
Marilyn never gave up, though she left us yesterday, August 3, 2009.
August 03, 2009
QOTD: A Canadian doctor diagnoses U.S. health care
When the distortions and lies about Canada are brought up, interrupt (they do) with the response that Canada has a health care financing system that includes everyone and keeps health care affordable.
July 31, 2009
BREAKING NEWS: Speaker Pelosi promises floor vote on single payer
Call out the troops. We have work to do!
Poisoning thought with words
Click on the link above now. At the bottom of this article you will find another link to the full PDF version (2 pages). Download it now. It will be a very important resource during the August recess when tens of millions of dollars will be spent to keep our thought processes suppressed by the poisonous rhetoric of carefully-crafted nice words - a process that has permeated our national dialogue on health reform. It is ideas, not words, that count.
July 30, 2009
President Obama's hardship waivers
Play with the numbers all you want. Using the model of reform selected by the President and Congress automatically limits the total subsidies to an amount that will not increase the deficit in the federal budget. Even if the majority of employers continue to displace wage or salary increases in exchange for health benefits, the number of hardship waivers issued will have to be much larger than most are projecting. If employers finally bail out, the majority of us would require hardship waivers.
July 29, 2009
Steve Burd's magic elixir
Safeway's Steve Burd has been making the rounds in Washington and elsewhere claiming that his program would reduce our national health care bill by $550 billion, even though there is absolutely no verification of that.
July 28, 2009
John Geyman's "The Cancer Generation"
No topic could serve as a better proxy for the deficiencies in the financing and delivery of health care in the United States than the ever increasing prevalence and expense of cancer. In The Cancer Generation, John Geyman describes the tragic and costly impact of the cancer burden, but then provides us with hope by describing a plan that would reduce these burdens of cancer.
July 24, 2009
Public option leads nosedive on reform
The progressive community has really blown it. The decision was to make "choice" the rallying cry for comprehensive reform - choosing to keep the insurance you have if that's what you want, or to choose a program like the members of Congress have. It seemed not to matter that the public didn't understand that FEHBP was basically an exchange of private plans offered to government employees, much less how a Medicare-like program might play a role.
July 23, 2009
President Obama speaks the truth about single payer
President Obama: I want to cover everybody. Now, the truth is that unless you have a what's called a single-payer system in which everybody is automatically covered, then you're probably not going to reach every single individual...
July 22, 2009
Would a MedPAC-like IMAC effectively control costs?
There has been intense interest in providing the administration with greater control over Medicare spending in order to bend down the trajectory of projected increases in spending. Members of Congress and the administration have been considering an Independent Medical Advisory Council (IMAC) much like the Medicare Payment Advisory Commission (MedPAC), but with one very important difference.
July 21, 2009
Biotech lobbyists cast their nets
The vote on the data exclusivity amendment was covered in a qotd last week, at the link above. More background information is provided by Lisa Wangsness in her Boston Globe article. Because of the implications for the reform process unfolding in Washington, we are taking a second look.
July 17, 2009
Is restraining federal health care spending the goal?
Is the health care cost debate limited to concerns about federal spending on health care, or is it about total health care spending? The distinction is very important because, if policies are limited to slowing the increase in the rate of federal health spending, many of those policies simply transfer costs from the government to individuals and businesses. It will give us little consolation to see the health care component of the federal budget in balance if individuals and businesses can't afford health care.
July 16, 2009
False promise of choice
Imagine presidential candidate Barack Obama telling his audiences during the campaign, "We promise you choice. For most of you already receiving your health insurance through your place on employment, we will provide you with the choice of keeping that insurance plan or paying heavy financial penalties for dropping off the plan, no matter how unhappy you are with it. For a select few of you, we will offer the choice of private plans within an insurance exchange, even if you can't afford them, and maybe even throw in a public plan that a couple of you may be able to purchase, if you meet our rigid enrollment criteria."
July 15, 2009
House bill includes transfer from wealthy
Health insurance and health care are no longer affordable for average-income individuals. Any reform proposal that would make health care affordable for everyone must include a transfer from the wealthy to average- and low-income individuals.
July 14, 2009
Senate HELP rejects enabling legislation for state single payer experiments
Sen. Bernie Sanders just offered an amendment to the Senate HELP health care reform bill that would allow a limited number of state experiments with single payer systems. The proposal would have provided waivers from federal regulations such as ERISA, and would have authorized current federal spending on programs such as Medicare and Medicaid to be transferred to the state to be used in the single payer program.
Senate HELP amendment on "data exclusivity"
For the past week or so I've been live-streaming the Executive Session of the Senate HELP Committee as they have been marking up the Kennedy health care reform bill, the Affordable Health Choices Act. It has been running at the corner of my computer screen while I have worked on other projects. Since I am not competent at multi-tasking, I'm pretty jaded right now.
July 13, 2009
Bill Moyers on "The Select Few"
The public option was the strategy of a large group of progressives to circumvent "the select few" who have continued to make sure that comprehensive reform was not politically feasible. With the favorable election results and with their campaign to market "your choice of health plans," the progressives were confidant that they would be able to use the public option as a backdoor entry to affordable health care for all.
July 10, 2009
Excluding seasonal agricultural workers
Everyone should have health care. Everyone.
July 09, 2009
Premium increases in non-profit health plans
Once Congress passes a mandate for individuals to purchase health plans, presumably non-profit Regence BlueShield, as the largest provider of individual plans in the state of Washington, would be a provider of those plans. Also, Group Health Cooperative is the co-op that has been proposed to serve as a model for the public option.
July 08, 2009
Can Medicaid fill the gap?
From the start it was recognized that insurance exchanges, even if they included a public option, could never provide affordable coverage for low-income individuals. The Medicaid program would have to be expanded to cover this more vulnerable population.
July 07, 2009
Pay-go that builds rather than destroys
As expected, Congress ran into problems when they tried to figure out how to pay for health care reform. They stubbornly adhered to the principle that reform must be built on our dysfunctional system of profitable private plans for the healthy and taxpayer-financed public programs for the sick, even though numerous studies have shown that this is the most expensive model of reform.
July 06, 2009
Insurance disruptions due to spousal Medicare transitions
Most individuals experience a sense of relief on turning 65 because they know that they have the security of being covered by Medicare for the remainder of their lives. But that relief is often tempered by concerns over the transitional problem of having a wife who is not yet 65, but who experiences a disruption in her insurance because she had been covered as a dependent on her husband's plan. This study demonstrates that such disruptions can have adverse consequences for health care.
July 02, 2009
NHIS numbers, and building on what works
Everywhere you turn those rejecting single payer, including President Obama, say that we want to build on what works and fix what's broken. They say that what works is our employer-sponsored system of coverage. But does it?
July 01, 2009
Does US Chamber soft talk hide their agenda?
"So I think Congress is realizing that it's gonna be trouble if they try to roll us," and "I'm sorry that things have gotten to the point where we're having to beat up on members of Congress." Was this guy nurtured on "The Sopranos," or is he the real thing?
Regardless, are the owners of America's businesses really as heartless as this jerk implies? Do they really believe that their workers would be "getting the shaft" by having health insurance with adequate benefits?
June 30, 2009
Starr, Reich and Kuttner on the public option
To rephrase the very important point that Paul Starr brings to this debate, it is not the design of the public option that is crucial to successful reform under the model being advanced in Congress, but rather it is that the design of the insurance exchanges must be absolutely compliant with the rules of social insurance. If the exchanges are poorly designed, the public option would become a Medicaid-like dumping ground for low-income people with high-cost problems, and would suffer from a lack of willing providers because of chronic underfunding. And poorly designed exchanges could never meet the test of social insurance.
June 29, 2009
Uninsured by choice
By now you must be annoyed by those on the right who repeatedly claim that we do not have a problem with uninsured individuals. They say that the actual problem is that we are not counting them properly. Most of the uninsured would be insured, if only they showed a little more personal responsibility.
June 26, 2009
An insurance insider speaks up
Wendell Potter, a former CIGNA executive, provides an insider's view as to what type of behavior we can expect from the private insurance industry after reform is enacted. No matter the details of the reform legislation, the industry will always find innovative ways to advance the interests of their executives and their investors. It is absolutely inevitable that these innovations will be to the detriment of patients and payers.
June 24, 2009
PNHP testimony before two House committees today
Single payer is now a part of the dialogue in Congress. Now if only we can convert the single payer dialogue into single payer policy.
June 23, 2009
David Brooks - Kill this effort and start over
You state that John Sheils has shown that building on the existing system is the single most expensive option for reform. What you didn't state is that Sheils has also shown that a single payer national health program is the least expensive, and is the most effective in achieving the goals of universality and cost containment.
June 22, 2009
House Tri-Committee public option
With the release of the discussion draft of the House Tri-Committee reform proposal, the progressive community is celebrating the decision to include a "strong public option" within the health insurance exchange. Its innovative feature, different from other public option proposals, is that it would use lower Medicare-based rates for the first three years, enabling the public option to displace some higher-premium private plans within the insurance exchange. Then in the fourth year, rates would be adjusted to provide a level playing field with the private plans.
June 19, 2009
Senate Finance proposes unaffordable underinsurance
The Senate Finance Committee members were informed by the Congressional Budget Office that the impact their preliminary reform proposal would have on the federal budget would be much greater than a bipartisan consensus would permit. Before moving further forward with the legislative process, the committee is considering changes to reduce the amount of funds that would have to be budgeted. The draft proposal cited above is not a definitive recommendation but merely presents ideas for discussion.
June 18, 2009
Scrushy and the medical-industrial complex: a lesson for reformers
In a landmark 1980 New England Journal of Medicine editorial, former Editor-in-Chief Arnold Relman warned us of the new "Medical-Industrial Complex," referring to "a medical care system that had begun to attract investors, and in which business interests had started to reshape the behavior of doctors and health care facilities."
June 17, 2009
Sen. Bernie Sanders' Petition to Congress
Let's let Congress know how many of us there are who really care.
June 16, 2009
CBO score: everyone covered, except 37 million
Since the Affordable Health Choices Act and the CBO analysis of it are works in progress, the estimates of the net numbers who will gain insurance coverage and the net cost to the government are only preliminary and will likely change with refinements in the legislation and the analysis. What will not change are the fundamental implications of financing health care through government subsidized private health plans plus public programs.
June 15, 2009
President Obama's proposal to pay for reform
What does President Obama mean when he says that this is how we're going to pay for most of his health care reform proposals? Is he referring to savings in the actual costs of health care that would offset the increased spending that would result from expanding coverage? Or is he merely referring to a decrease in government spending that helps with government budgets, but doesn't really have much impact on our total national health expenditures (NHE)?
June 12, 2009
The view of those in the trenches supporting health care for all
The Health Care Council of Orange County (California) has a mission of promoting access to improved health care for all Orange County residents through unified efforts to identify and address areas of need through research, collaboration, education and advocacy. The audience attending the annual meeting was composed of individuals who are quite well informed on the problems with our health care system, and they have been following the reform efforts taking place in Washington. Their opinions should matter to us.
June 11, 2009
AMA and PNHP on public insurance
In opposing a government-sponsored insurance plan, why would the AMA limit its objection to a public plan that would cover only non-disabled individuals under age 65? What about those over 65 and those with long-term disabilities? Of course, they are covered by Medicare, a plan that the AMA continues to lobby for, even though they were vehemently opposed to it before it was enacted.
June 10, 2009
House HELP Committee hearing on single payer
Although there are many individual heroes in the single payer movement, joint citizen activism has played a crucial role in bringing the single payer message to a formal, official hearing before a committee of the House of Representatives - a hearing devoted exclusively to single payer.
June 09, 2009
Expand state programs for low-income individuals?
Because of the very high costs of health care, the private insurers have not been able to offer products to low-income individuals that they can afford. In response, the federal and state governments have enacted programs designed to meet the health care needs of low-income individuals, usually financed jointly by the federal and state governments and administered by the states.
June 08, 2009
Kaiser Health Tracking Poll
Pretending that the majority of Americans would risk their current health security for a more egalitarian system for everyone will not move the process for reform forward. Only when people understand that a single payer system would benefit them individually would they be willing to support reform that incidentally benefits everyone else as well.
We still have work to do.
June 05, 2009
President Obama on the individual mandate
He said that if we make people responsible for their own insurance (individual mandate), then we must grant a hardship waiver to exempt people who cannot afford it. But the primary reason that people have not purchased insurance in the individual market is that the plans are not affordable. Most of these individuals will be eligible for the hardship waiver and will remain uninsured.
June 04, 2009
Medical bankruptcies increasing
In the United States, medical bankruptcy is very real, it is common, and it impacts primarily the insured middle class. And Congress is going to fix it with more of the same broken financing system?
June 03, 2009
Will WellPoint support any reform?
WellPoint/Anthem/Blue Cross has become the largest provider of private health plans through its highly successful business model that has kept their premiums very competitive. How have they done that? In the individual market, they have limited their exposure to risk by medical underwriting - not selling policies to individuals who might need health care. In the small-business market, they also limit loss by increasing premiums to unaffordable levels for any business that has an unfavorable claims experience, causing those firms to drop coverage.
June 02, 2009
Growth of employer-sponsored underinsurance
With the reform debate having been diverted to issues such as offering a public option, changing the tax status of employer-sponsored coverage, or mandating individuals to purchase insurance, little attention is being paid to some of the most fundamental flaws in our dysfunctional system of financing health care. One of the most important has been the ever-increasing incidence of underinsurance that has created financial hardship for individuals and families who do have health insurance coverage.
May 26, 2009
More small firms drop health care
Rampant health care cost escalation is a problem for everyone. In bad economic times the problems are compounded, threatening the viability of employer-sponsored coverage. Small businesses that operate on very narrow margins have no choice but to reduce health benefits by either shifting more of the health care costs to their employees, or by eliminating health plans altogether. The fault lies not with the small business owners, but with the flawed U.S. system of financing health care.
May 22, 2009
Sen. Baucus defines universal coverage
So according to Sen. Baucus, a key to reform is "everyone having health insurance." By that he means that everyone will have health insurance - except the 12 to 18 million who won't. That's "pretty good," he says.
May 21, 2009
2009 Milliman Medical Index
The Milliman Medical Index (MMI) provides us with a very important measure of health care spending in the United States. For 2009, average annual medical spending for a typical American family of four covered by an employer-sponsored preferred provider organization (PPO) program is $16,771. That number should be front and center in our national dialogue on reform. It is important that we understand what it means.
May 20, 2009
The reform proposal of the conservative Republicans
"The Patients' Choice Act of 2009" is one of two Republican proposals for health care reform being released today and is considered to be the more conservative version. (The other, "The Medical Rights Act," is being introduced by the "Tuesday Group" of centrist Republicans in the House, though their report has not been released as of this moment.)
May 19, 2009
Senate Finance report on financing health care reform
Tomorrow the members of the Senate Finance Committee will retreat to a closed-door session, taking this report with them to walk through their options for financing comprehensive health care reform. Sen. Baucus and others have said that the success of the reform effort is dependent on their ability to find ways to pay for it. What are their prospects for success?
May 18, 2009
Relman/Angell letter in The New York Times
Although single payer advocates were not allowed to testify at the Senate Finance Committee roundtable on reform, the New York Times seems to agree that the concept of comprehensive reform is worthy of their Letters page.
May 15, 2009
Medicare beats employer-sponsored plans
Very few individuals, especially those already covered by Medicare, will be surprised by this study. It demonstrates that, compared to people under 65 with private employer-sponsored coverage, Medicare beneficiaries over 65 have fewer problems with access to care, have less financial hardship due to medical bills, and have higher overall satisfaction with their coverage.
May 13, 2009
Health Insurance Exchange and private plan behavior
Although no final decisions have been made, our congressional leaders have made it clear that reform will be built on the existing model of private plans and public programs. Although the private insurance industry has promised full cooperation with reform, most moderates and progressives understand that legislated insurance market reforms will be essential if the industry is expected to live up to its promises.
May 12, 2009
Marcia Angell's testimony before Senate Finance
It didn't happen. After nurses and physicians supporting single payer were removed from the audience, single payer was mentioned once only parenthetically.
May 11, 2009
Finance Committee member assignments
Sen. Max Baucus has set an agenda to send a comprehensive health care reform bill to President Obama within the next few months. The significance of the assignments given to each of the Democratic members of the Senate Finance Committee is that they provide considerable insight as to the policies that are likely to be included in the legislative package.
May 08, 2009
Ed Schultz interviews Dr. Margaret Flowers
When you have 11 minutes, view this video. Then share it with others.
May 07, 2009
Frank Luntz's "The Language of Healthcare 2009"
This is an important document. It is Frank Luntz's recommendation to the Republican politicians on how to frame the debate over health care reform. If you have been listening to the Republicans speak on reform, you have already heard some of the rhetoric, and you will recognize it as you read this report.
May 06, 2009
Sen. Schumer kills reform
The success of the effort to reform health care seemed to be threatened by the disagreement over whether or not a public insurance option should be offered to compete with private health plans. All Republicans have expressed opposition to the public option, indicating that it would be a deal breaker if included. The Progressive Caucus in the House, which actually wants single payer, has taken a position that leaving the public option out of the reform legislation would be a deal breaker.
May 05, 2009
Sen. Baucus respects our views
Apparently the single payer views must have been held very deeply, hidden in the minds of the Senators and the witnesses, since at no time during the hearing was single payer discussed as an option for reform.
May 04, 2009
Medical student debt and specialty selection
This statement from a highly respected executive of a not-for-profit managed care organization, and this new GAO report, both further confirm what we already knew. Medical students are graduating with excessive debt, and this is likely contributing to the decline in the numbers choosing the primary care specialties.
May 01, 2009
Uwe Reinhardt's prescience on the auto industry
It was almost six years ago that Uwe Reinhardt called the Big Three "a social insurance system that sells cars to finance itself." We have frequently quoted him, even though the statement was an exaggeration to make a point. But how prescient!
April 30, 2009
Dr. Chaoulli's private clinic waiting room death
Dr. Chaoulli's patient did not die while on a waiting list for an elective orthopedic procedure. He collapsed and died in Dr. Chaoulli's private waiting room. Dr. Chaoulli withheld cardiopulmonary resuscitation - a standard of care that surely would have been provided in any public health care facility - with questions over whether or not he had adequately trained staff and appropriate equipment to initiate such care. Dr. Chaoulli then asked his nurse to call 911 (to have the body removed), and he returned to his work. Only after the ambulance team arrived was cardiopulmonary resuscitation instituted.
April 29, 2009
Ed Show: Bernie Sanders on single payer
When the people lead, Congress will follow.
April 28, 2009
New York HMO/POS death spiral
So in New York County, for a premium of about $50,000 per year, you can have a choice of physicians and hospitals for your family, although you will have to pay more in out-of-pocket expenses if you select out-of-network providers. If you don't mind losing choice by staying within the HMO for all of your care, you can have your family covered for under $40,000 per year.
April 27, 2009
Marie Cocco on insurers' definition of reform
For the insurance industry, reform means expanding their successful business model to include more individuals in their plans while shifting the higher costs to the government (taxpayers). Most people do not want to be required to purchase health plans at premiums they cannot afford, and then be stuck with inadequate coverage designed to keep premiums from climbing even higher. Yet, as Marie Cocco makes clear, the insurance industry's version of reform would reinforce precisely what is wrong with our health care financing.
April 24, 2009
Merton Bernstein and Nancy Pelosi on applying science to health care reform
Whether you call it Medicare-for-all, or national health insurance, or single payer, Merton Bernstein describes well the irrational, unscientific effort to keep off the table the concept of a truly universal, efficient, publicly administered and publicly financed national health program.
April 23, 2009
David Himmelstein's testimony
The definitive legislation on health care reform that will be supported by the Democratic leadership in Congress has not yet been written. This important testimony by PNHP's David Himmelstein confirms that single payer reform is still in play, in spite of dismissive comments by many of those involved.
April 22, 2009
Reinhardt's Ways and Means testimony on insurance market reforms
In a comparatively brief statement, Uwe Reinhardt explained to the members of the House Ways and Means Committee the principles and rationale of social insurance. His statement should be downloaded as a valuable resource for supporting some of the important policies for reform, and for refuting those policies that perpetuate inequities and injustices and may cause even further harm.
April 21, 2009
Do Americans support an individual mandate?
If this article gains traction, the conclusion that likely will be reported is that Americans support an individual mandate to purchase insurance as long as it incorporates "shared responsibility."
April 20, 2009
Jonathan Cohn interviews Taiwan's Dr. Michael Chen
Our political leaders keep telling us that Americans don't want single payer, but instead we want a uniquely American solution for all Americans. So what did Taiwan do? They looked at health care systems throughout the world, and they chose a uniquely American system for Taiwan! - Medicare! - except that they expanded its benefits and included everyone. And it really works well.
April 15, 2009
Hacker says that public option/private exchange would EXPAND private insurance market
The opponents of the public option, especially the private insurance industry and the Republican members of Congress, insist that a government-sponsored plan would be an unfair competitor and drive the private insurance industry out of business. Theoretically, the government would do this by extracting unfair concessions from the health care providers, pricing the public option at a lower level than the private insurance sector could ever meet. (This ignores the more important evidence such as the demonstrated greater efficiencies of our public Medicare program when contrasted with the private Medicare Advantage plans.)
April 14, 2009
Options for health care cost control
High health care costs are the primary driving force behind the renewed effort for reform. Everyone agrees that high costs are straining personal, business and government budgets, and something must be done to make health care affordable for all of us.
April 10, 2009
Josh Freeman on the question of a national policy on the right to health care
Joshua Freeman, MD is Professor and Chair of the Department of Family Medicine at the University of Kansas School of Medicine. I was fortunate to have been in the audience when Josh delivered his comments above at the Twentieth National Conference on Primary Health Care Access, sponsored by The Coastal Research Group.
April 09, 2009
Jacob Hacker provides details for public option
This is a very important paper because addresses one of the most controversial issues in the current health care reform debate: Should a Medicare-like plan be offered in competition with a market of private health plans? UC Berkeley Professor Jacob Hacker adds to his previous contributions on the private plan/public option model of reform by describing in detail what a properly-designed Medicare -like option would look like.
April 08, 2009
Lewin report on the public option
No details have been released by either Congress or the administration about the specifics of a potential public insurance option that could be offered in competition within a market of private health plans. Nevertheless, to provide an analysis of how such a plan might work, The Lewin Group used certain assumptions to prepare this simulation.
April 06, 2009
McClellan asks, "What would be the point?"
Mark McClellan has it right. The only hope for gaining the support of Republicans is to make the government option "look like another private sector choice, and then what would be the point?"
April 03, 2009
How many doctors support single payer?
This study supports the findings of other surveys that confirm that almost all physicians want reform of our current health care system, but they remain divided over whether or not we should replace the private insurance system with a government-run, taxpayer-financed program.
FRONTLINE's "Sick Around America"
T.R. Reid had hosted FRONTLINE's "Sick Around the World," an important documentary describing successful health programs in several other nations that provide care for everyone at a fraction of the costs of our fragmented, inefficient health care system that leaves so many out.
We were looking forward to T.R. Reid's sequel, "Sick Around America," describing the problems with our private insurance system. Many of us were disappointed with the format of the program, believing that they missed a great opportunity to educate the nation on several health policies that would work well for all of us. Thus it was no surprise to us that T.R. Reid was not mentioned during the program, nor in the credits.
April 01, 2009
Views on IRAs and HSAs contrast sharply
Much has already been written about the wisdom, or lack thereof, of health savings accounts (HSAs) and the high-deductible health plans that are linked with them. By design, they benefit higher-income individuals who are able to take advantage of the regressive tax policies, and who remain healthy, allowing the savings to accumulate for use in their retirement years. But they don't work for individuals with modest incomes who have significant health care needs.
March 31, 2009
Insurers waste your dollars to invade your privacy and cheat you
The health care financing systems in other nations are designed to assist patients in paying for their health care. Computerized searches of personal drug use as described in this article is yet one more example of how our private insurance industry adopts policies that are designed to avoid paying for the patients' health care.
March 30, 2009
STAKEHOLDERS AGREE! (to block reform)
This report, "Health Reform Dialogue," contains a few modest but obvious recommendations that any reasonable reform effort must include. Much more important is that the primary theme of this report, as exemplified by the sampling of recommendations listed above, is that we should continue with the status quo, dumping more of our dollars into our dysfunctional, wasteful, inefficient, fragmented system of financing health care.
March 27, 2009
Sen. Bernie Sanders introduces single payer bill
At a rare time in our history when comprehensive reform may become a reality, it is important that the single payer model be represented in the legislative process. The House already has Rep. John Conyers' H.R.676 and Rep. Jim McDermott's H.R.1200, and now the Senate has Sen. Bernie Sanders' S.703.
March 26, 2009
Himmelstein and Woolhandler on a public plan option
The option to purchase a public plan within a market of private health insurance plans would merely provide one more player in our inefficient, dysfunctional, fragmented, multi-payer system of financing health care, that is if the public option even survives the political process. It would leave in place the deficiencies that have resulted in very high costs with the poorest health care value of all nations (i.e., overpriced mediocrity in health care).
March 25, 2009
Culling dependent coverage a great return on investment
Doing eligibility audits of dependents covered by employer-sponsored plans is yet one more example wherein our current dysfunctional system of financing health care actually promotes administrative waste. A rational system uses administrative services efficiently to pay for the health care that patients need. In the United States, much of the administrative cost of health care financing is due to efforts to avoid paying for health care.
March 24, 2009
Battle over public option to private insurance plans
Perhaps the surest sign of trouble for the proposal to offer a public Medicare-like plan to compete with private insurance plans is the commitment of Finance Chairman Max Baucus that reform will be bipartisan along with the adamant opposition of a public option by Ranking Member Charles Grassley. Having discarded other public insurance proposals such as single payer, even before the negotiations began, the competing Medicare-like option is standing alone as the obvious trade-away for achieving political consensus.
March 23, 2009
Bayh howls with the Blue Dogs
The Blue Dog coalition in the House of Representatives has often assisted Republicans in preventing the advancement or even the introduction of progressive legislation that increases government spending. Supposedly their mission is merely to avoid deficit spending by enforcing "paygo" rules (all new spending is offset with other program cuts or with new revenues), but all too often they seem to not only support elimination of deficit spending, but also the policy of "no new taxes." It appears that they are not only concerned about deficits, but they also seem to want to avoid an increase in the size of the federal budget.
March 20, 2009
Real life medical debt bankruptcies
Landmark studies have confirmed beyond any doubt that medical debt is a significant contributor to personal bankruptcy. Yet the opponents of comprehensive reform continue to challenge the data. In the report of John Goodman and his colleagues discussed in yesterday's message, they stated, "Well-designed economic studies have found no statistical link between bankruptcies and health problems."
March 19, 2009
John Goodman hides the rest of the story
John Goodman says that he wants us to hear the rest of the story, but then he doesn’t tell it to us.
March 18, 2009
Tenet paid overtime hours by math, not money
Although PNHP is most noted for its advocacy of a single payer national health program, we also oppose the perversities of for-profit health care corporations in which the primary responsibility of the board of directors is to their investors. Tenet Healthcare has provided us with innumerable examples of these perversities. A quick Google of the PNHP website, in a fraction of a second, produced these lines and many more.
March 17, 2009
SCHIP - a lesson on demographic incrementalism
Incrementalism: the crossroads of policy and politics.
March 16, 2009
Health insurance and eye care
This study confirms that what we already know about the importance of insurance in improving access and utilization of health care also applies specifically to eye care. Individuals with insurance have higher rates of access and utilization of eye care than those who are uninsured and those have have interruptions of their insurance coverage.
March 13, 2009
President Bill Clinton on single payer
Former President Bill Clinton makes two very important points here. (1) Single payer dramatically reduces administrative waste, and he implies that it would be popular, as is Medicare now. (2) The private insurers "make a lot of money through saying no," and "we can't go on basically giving them more and more dollars every year -- the insurance industry -- and getting people sicker and sicker and leaving more and more people behind." Single payer is good; private insurers are bad.
March 12, 2009
Blog debate - PNHP versus HCAN reform strategy
Members of Physicians for a National Health Program (PNHP) and supporters of the Health Care for America Now! coalition (HCAN) are all passionately dedicated to the goal of achieving reform that will provide affordable, high quality care for everyone. We are bothers and sisters in the cause. The ultimate goals of both organizations are the same, but the strategies are quite different.
March 11, 2009
Bloomberg columnist on single payer
Single payer should not only be back in the national dialogue on reform, it should be front and center as the golden standard by which all other options are compared.
March 10, 2009
A health insurance broker speaks up
John Sinibaldi has provided a consistent voice behind the scenes expressing many of the problems with our private insurance industry and the clear need for reform. His observations have been very helpful to me in providing insight to many of these issues, from the industry's perspective.
March 09, 2009
AHIP's phony epiphany
In December, when America's Health Insurance Plans (AHIP) released their new report indicating that they were fully committed to reform that would cover everyone, I responded in a Quote of the Day (12/4/08) with the following: "You could not possibly describe a proposal that would better serve the interests of the private insurance industry. They would create a standard of underinsurance, require all of us to purchase their products, and pretend to address affordability issues through tax credits."
March 05, 2009
Report of Health Care Community Discussions
For those who were expecting a Quote of the Day on today's White House Health Care Reform Summit, here is the the full discussion of single payer:
March 04, 2009
Professor Bradley Herring on single payer
Should we care what Johns Hopkins Professor Bradley Herring has to say about single payer? Emphatically, yes. Prof. Herring is theoretically an academic purist, and has no relationship with the single payer community. Many of his policy studies on private health insurance have been done with Mark Pauly, of "moral hazard" fame. That would certainly place him outside of the single payer camp.
March 03, 2009
Deliberate, explicit rationing of hospital beds - in the U.S.!
This article points out that a final decision has not been made, but it is nevertheless shocking that a non-profit university hospital has had under consideration a proposal to reduce the number of beds in an emergency room that already has a strained capacity.
March 02, 2009
Sen. Baucus wants CBO to be "creative"
In this closing exchange, Sen. Max Baucus seems to be annoyed with Douglas Elmendorf, Director of the Congressional Budget Office. What is the background here?
February 27, 2009
David Himmelstein and Len Nichols debate
Primarily because of political perceptions, Len Nichols continues to support what he believes to be the pragmatic approach of covering everyone with regulated private plans. However, when experts like David Himmelstein continue to confront him with the facts about our flawed financing system, Nichols' support for private insurance seems to be shifting from knowing that it would work, to wishing that it could, even though "our system is a mess." He needs to take the next step of acknowledging that private insurance can't work so that we can move forward and fix the "mess" by enacting a single payer national health program.
February 26, 2009
Nobel Laureate Joseph Stiglitz on single payer
Joseph Stiglitz's response must be shared with the nation, and especially with those in Washington who say that single payer is not feasible. We should inundate Washington with his statement that single payer is "the only alternative."
February 25, 2009
Health care spending for 2009
These are the most reliable numbers to use that represent our health care spending for this year. Rounding off these numbers makes them easier to remember and eases communication of the amounts.
February 24, 2009
IOM report: America's Uninsured Crisis
In six previous reports, published from 2001 to 2004, the Institute of Medicine concluded that "being uninsured was hazardous to people’s health and recommended that the nation move quickly to implement a strategy to achieve health insurance coverage for all."
February 23, 2009
OECD: Health Care Reform in the United States
OECD reports are important not only because of their credible studies of economic conditions throughout the world, but also because they are used for policy decisions in the thirty member nations (including the U.S.) plus more than one hundred other countries and economies. Thus it is important to understand this new OECD report, "Health Care Reform in the United States," especially at this time when intensive reform efforts are taking place in Washington.
February 20, 2009
Who is behind those closed doors in the Senate?
What?! In this time of transparency and Change, when we have an open window of opportunity to finally fix our very sick health care system, we are reverting to a closed door process dominated by the most powerful lobbyists in the nation whose interests take precedence over the American patient?!
February 19, 2009
Single payer - over on the side table
The good news is that individuals from the media and from the policy community are acknowledging, on the side, that single payer would cover everyone, would improve health outcomes, and would cost less than the other current proposals for reform. Today's quotes are only a few examples of a multitude of such comments. Single payer has not been removed from the national dialogue on reform.
February 18, 2009
Massachusetts' plan is the wrong model for the U.S.
Those supporting the leading Democratic model for reform frequently cite the Massachusetts plan as an example of how building on our current system of health care financing is the best path to success. Unfortunately, they use selected positive numbers to define success, while ignoring the fact that Massachusetts has failed in its efforts to achieve the real goals of reform. You can understand how pathological the politics of reform has become when they have to dig into the data of a failed reform effort in order to redefine failure as a success.
February 17, 2009
"Divided We Fail" is divided and failing
"Divided We Fail" presented itself as a broad coalition of diverse interests that could come together and agree on health care reform. But it isn't a broad coalition. It is a coalition that primarily represents business interests - big business through the Business Roundtable, and small business through the National Federation of Independent Business (NFIB).
February 16, 2009
Richard Gottfried on private and public coverage decisions
Richard Gottfried points out an extremely important distinction between the nature of coverage decisions in public health care financing systems, and in private insurance financing systems, whether employer-sponsored or individual coverage.
February 13, 2009
Virtual colonoscopy as a proxy for high-tech excesses
This CMS decision to not pay for computed tomography colonography (CTC or "virtual colonoscopy") when used as a screening test for colorectal cancer has already caused considerable controversy even before the final public comment period has closed. Before we start deciding who is right and who is wrong, we should look at the issues. (What? Make decisions based on facts!?)
February 12, 2009
Himmelstein responds to Gawande on single payer
The problem is that Atul Gawande is flat out wrong. He implies that other nations merely made adjustments in their existing systems to expand coverage to everyone. In fact, these were not simple adjustments to systems that weren't working; they were revolutionary transformations of their health care financing systems.
February 11, 2009
Care coordination - a wrong way and a right way
Most of the leading proposals for health financing reform include magical (sleight-of-hand) concepts that purportedly would reduce health care costs. One of these is disease management, or chronic care coordination, or whatever label you want to give it.
February 10, 2009
CBO's Elmendorf on single payer, and a Medicare-like option
In his testimony before the Senate Budget Committee, CBO Director Douglas Elmendorf discussed considerations for expanding coverage, and considerations and options for controlling costs and improving efficiency, including a discussion of options under consideration that might not be effective in controlling spending. Most of his comments were confined to various policies that currently are hot topics in the Washington dialogue on reform.
February 09, 2009
Consumer-driven fire department (lesson for Canada and U.S.)
Though not quite so graphic, free market private health insurance is not unlike the rescue purchased by this unfortunate lady. Just as she purchased a contract to avoid hitting the ground when she jumped from this burning building, private health insurance is purchased to prevent financial hardship or bankruptcy in the face of medical need. It doesn't always work.
February 06, 2009
Insurance failing cancer patients
An excellent test of how well our insurance system is working is to determine how well it serves those individuals who have the tragic misfortune of developing cancer. This report shows that all too often the insurance system fails to protect cancer patients from the additional burden of financial hardship, defeating one of the most important reasons for having health insurance in the first place.
February 05, 2009
Bipartisanship breaks down over "public option"
Well, we are there now. The progressive community had decided that the political barriers that have prevented reform over the past century must be brought down. A solution that would appease the conservative community must leave in place a private market of financing options. The progressives have agreed, and have asked only for one more option - a plan administered by the government.
February 04, 2009
Baucus and Reinhardt on single payer
So with Tom Daschle stepping out of the picture, Sen. Max Baucus is maneuvering to take the lead on reform by advocating for a "uniquely American result" with "more of an entrepreneurial sense" since "we're constituted differently than European countries."
February 03, 2009
Jacob Hacker is a nice guy, but...
In [Hacker's] proposal he was looking for a political solution to satisfy those with good employer-sponsored plans who are uncomfortable with trading them in for a public plan that has not yet been precisely defined (since any proposed public plan must clear the hurdles in Congress). In so doing he compromised on policy, trading away many of the advantages of the single payer model.
February 02, 2009
Part D insurers overcharging
The determination of the Bush administration and the Republican-controlled Congress to turn the Medicare Part D drug program over to private insurers produced no surprises. Medicare was overcharged, and the patients were overcharged.
January 30, 2009
Waxman ready to move - but where?
House Majority Whip James Clyburn (D-S.C.), obviously an insider, recently confused observers of the Washington scene by stating that health care reform would be incremental. This appeared to conflict with the position of other important players - Barack Obama, Tom Daschle, Ted Kennedy, Max Baucus, Pete Stark, amongst others - who have indicated that comprehensive reform would be as expeditious as possible - presumably this year or early 2010 at the very latest. The statement by Henry Waxman seems to confirm the fact that the House of Representatives is aligned with the Senate and The White House to move forward expeditiously with comprehensive reform.
January 29, 2009
Recession is good news for WellPoint
Let's see. It's really good news that 288,000 people lost their WellPoint insurance primarily due to job cuts, because the resultant reduction in spending on health care "outweighed the loss of subscribers." So the expanded profit margins made possible by paying for less health care "is much more important to earnings per share than changes in enrollment."
January 28, 2009
Uwe Reinhardt on comparing U.S. to Canada
Save this link until you have 27 minutes to watch the complete video. It will be well worth your time.
January 27, 2009
"Managed consumerism"
Managed care, consumer-driven health care, managed consumerism - these are just labels for a private insurance industry that has evolved from a role of indemnifying individuals and families against loss in the face of medical need, to an industry that has introduced innovative plan designs to enhance the success of its own business model.
January 26, 2009
Journalism professor on reporting about Canadian health system
How did it happen that our memories/knowledge of the Canadian system are so distorted? One of the more important reasons is that we have little exposure to the routine functioning of the Canadian health care system. It's not that the information isn't available. The Canadian Institute for Health Information is a highly credible resource for such information. You can learn quite a bit just by reading their 2008 report, Health Care in Canada.
January 23, 2009
Gawande's pseudo-pragmatism
Atul Gawande is a highly respected physician who has a well deserved reputation as a gifted writer. This commentary should not be construed as an attack on him; rather, it is an attack on his message. On his writing skills I give him an A, but on his content, a D-.
January 22, 2009
Current political status on reform
Jonathan Oberlander is one of the nation's more astute observers of the politics of health care reform. After a long dry spell of pessimism, he is finally able to justify a very cautious note of optimism, though it still risks being a fleeting message. The most reassuring component of his message is that Congressional Democrats, especially Sen. Baucus and Sen. Kennedy, are rapidly moving forward with comprehensive reform in a process designed to prevent as much as possible the errors of the past.
January 21, 2009
Commonwealth on the Swiss and Dutch systems
The Commonwealth Fund is joining the chorus of those who say that we should look to the Swiss and Dutch systems as potential models for universal coverage in the United States. What is meant by universal coverage? It means that everyone is covered (except for the one percent or so who are not, and the one and one-half percent who have been suspended for failure to pay their premiums).
January 20, 2009
Inaugural Address
President Barack Obama
The question we ask today is not whether our government is too big or too small, but whether it works - whether it helps families find jobs at a decent wage, care they can afford, a retirement that is dignified. Where the answer is yes, we intend to move forward. Where the answer is no, programs will end. And those of us who manage the public's dollars will be held to account - to spend wisely, reform bad habits, and do our business in the light of day - because only then can we restore the vital trust between a people and their government.
January 19, 2009
Medicare vote, MLK and BHO
As we reflect today on Martin Luther King's gift to the nation, and on tomorrow's historic inauguration, it seems fitting to look back at the vote that brought us Medicare. This was a vote for health care justice for our seniors, and a first step towards the dream, shared by Martin Luther King Jr then and Barack Obama now, of health care justice for all of us.
January 16, 2009
KFF poll on health reform
There are no real surprises in this new poll on the public's attitude toward health care reform. Most do believe that we are in a window of opportunity for reform based on the fact that the public ranks health care reform as one of the top priorities for President-elect Obama and Congress. But the feasibility of comprehensive reform comes into question when noting that 62 percent of Republicans believe that the nation cannot afford to take on health reform now, and only 23 percent of them believe that reform is even a priority.
January 15, 2009
Are AHIP and PhRMA the enemies?
The lobby organizations, America's Health Insurance Plans (AHIP) and the Pharmaceutical Research and Manufacturers of America (PhRMA), have been amongst the most visible targets of those of us who have been fighting for comprehensive reform that would best meet the health care needs of all of us.
Are AHIP and PhRMA the enemies?
The lobby organizations, America's Health Insurance Plans (AHIP) and the Pharmaceutical Research and Manufacturers of America (PhRMA), have been amongst the most visible targets of those of us who have been fighting for comprehensive reform that would best meet the health care needs of all of us.
January 14, 2009
RAND COMPARE
RAND COMPARE provides both a valuable information resource on U.S. health care today, and an interactive tool that can be used to evaluate the impact of various policy options under different models of reform. It has now been released for public use.
January 13, 2009
UnitedHealth "praised for major leadership effort"
The administrative waste of private insurers along with the excessive administrative burden they place on the health care delivery system alone is more than enough to warrant dismissing them as stewards of our health care dollars. A more fundamental moral reason to dismiss them is that they place service to patients in a secondary position to their efforts to achieve business success, frequently using dishonest deception to do so.
January 12, 2009
Families USA report on COBRA
Families USA has continued to be a source of highly credible studies demonstrating the severe deficiencies in health care financing in the United States. A prime example is this study of COBRA benefits. Although the intent of COBRA was to allow individuals and families to maintain their employer-sponsored coverage after losing their jobs, this study demonstrates that this is yet another failed policy as unemployed individuals are unable to pay for that coverage.
January 09, 2009
Commonwealth - analysis of health care bills
For those who would like to have a better understanding of the various Congressional approaches to reform, this report is very helpful. The Lewin Group analysis brings reality to the claims being made by the proponents of each approach.
January 08, 2009
CMS requirements for medical suppliers - a bureaucratic boondoggle?
A frequent complaint about government financing of health care is that government bureaucrats place an excessive administrative burden on the health care delivery system. This charge has already been refuted by studies demonstrating the much greater administrative excesses and waste of the private insurance industry when contrasted with a public program such as Medicare.
January 07, 2009
UnitedHealth's Evercare
So, another ho-hum report on the bad behavior of a private insurer. And more fines that for these insurers are only a nominal and routine part of doing business.
Is this really the way we should be financing care in the United States? Set up rules for the private insurers and then rap their knuckles when they misbehave?
January 06, 2009
Headlines on slowing in health care spending miss the real story
This annual CMS report on health care spending is being celebrated in headlines throughout the nation as demonstrating a slowing in the growth of health care spending. Such headlines are missing the terrible news in this report.
January 05, 2009
Another middleman, with a Donald Trump wig!
As long as we insist that health care continue to be financed through our dysfunctional, fragmented multi-payer system, we will continue to see more innovative middlemen organizations capturing and siphoning away dollars that should be directed to health care instead.
January 02, 2009
Student Debt, Resident Hours, and Primary Care
Josh Freeman's comments were selected to start off this year of reform (hopefully) because they set the theme that reform should not be simply about tweaking private and public insurance options; reform needs to be about fundamental restructuring of our health care financing and delivery systems.
December 31, 2008
Health economists: Their facts, but our values
Almost all of us want 2009 to be the Year of Health Care Reform. Almost all of us agree on the facts. We agree not only on what the deficiencies are in our health care financing and delivery systems, but we also largely agree on what the impact would be of various public policies that might be enacted during the reform process.
December 23, 2008
House party attendees in agreement
And for reform, our nation's political leaders are going to bring us... even more of the same?
December 22, 2008
Ovation extorts innocent premature babies
Imagine if we had a publicly-financed and publicly-administered national health program covering everyone that included a comprehensive drug benefit. Would we be reading this story? Of course not. This does not mean that pharmaceutical firms will not engage in other criminal activities, but this one would have been prevented if we had a rational system of financing health care.
December 19, 2008
CBO's deficient report on analyzing health insurance proposals
Everyone who is participating in the efforts to reform health care financing in the United Sates should have a copy of this CBO report. It describes in considerable detail the various policy decisions that must be made as we approach the goal of affordable health care for everyone, but only those policies that would apply to a multi-payer system of private and public programs.
December 18, 2008
Family budgets strained by out-of-pocket health spending
The leading proposals for health care reform are designed primarily to make health insurance affordable, when what we really need to do is make health care affordable. These proposals use insurance product design and tax policies to try to balance the health benefits provided with the ability of the individual to contribute to the premium. In an effort to keep the premium affordable, patient cost sharing is included as an incentive to reduce utilization of both beneficial and marginal health care services and products.
December 17, 2008
The public insurance option and AHIP's battle against it
In this window of opportunity for health care reform, the model that has gained traction and is moving forward is reform based on a combination of employer-sponsored plans, an individual mandate to purchase regulated private plans through an insurance pool or insurance exchange, and an option to purchase a public plan based on an improved version of Medicare.
December 16, 2008
Speak up at Sen. Daschle's house parties
Throughout the nation during the next two weeks HHS Secretary-designate Tom Daschle is encouraging grassroots, community level discussions of health care reform. The purpose is to give the public a sense that they are actively involved in the reform process, avoiding a repetition of the Clinton political error of crafting reform behind closed doors.
December 15, 2008
OECD Economic Survey of the United States
The OECD is an important and highly credible resource for economic studies for the 30 member nations. An Economic Survey is published every 1 1/2 to 2 years for each OECD country. The newly released economic survey of the United States will be widely distributed amongst U.S. economists and policy makers.
December 12, 2008
Jeanne Lambrew guides our future
To understand the approach to reform that will be supported by President Barack Obama and HHS Secretary Tom Daschle, you need only understand the views of Jeanne Lambrew. Those who have read Sen. Daschle's "Critical" already have an impression of her views since she was the policy consultant for his book. It is now official that, as deputy director of the new White House health policy office, she will oversee planning efforts for the Obama/Daschle reform program.
December 11, 2008
Hospital mortality rates by payment source
Although it is tempting to say that being uninsured causes an 80 percent higher death rate for hospitalized patients, and being on Medi-Cal (California's Medicaid) causes a 60 percent increase in deaths, these population sectors undoubtedly varied in factors other than simply the source of payment for their hospital bills.
December 10, 2008
AARP/UnitedHealth bait and switch
This is yet another example of the profound administrative waste that characterizes health care financing in the United States. Beyond the administrative excesses of AARP's insurer, UnitedHealth, AARP has inserted itself as another middleman, providing yet another layer of administration, with none of those extra funds going to pay for health care.
December 09, 2008
Lawrence Livermore retirees lose choice of keeping their health plan
The current Democratic proposals for health care reform promise that you can keep the health insurance you have, if that's what you prefer. This policy was included in the reform models to avoid losing the support of those who have been promised life-long coverage with very generous plans. Career scientists and engineers at the prestigious Lawrence Livermore Laboratory, managed by the University of California, were secure in knowing that nothing could happen to their excellent, life-long coverage offered as a perk to attract the best.
December 08, 2008
Sen. Daschle's "Critical"
When it was announced that Tom Daschle was Barack Obama's choice to be Secretary of Health and Human Services, it was also announced that he would not only be an administrator, but also he would lead the team that is crafting the definitive health care reform proposal for the Obama administration. That is why Sen. Daschle's book, "Critical," is important to us. It provides us with the views of the person who will be working with Congress to reform our health care system.
December 05, 2008
Private insurers and fairness of balance billing
Balance billing is a payment required by physicians that is in excess of the benefits covered by the patient's insurer. It is a prime example of the unfairness that permeates our system of health care financing. It can be unfair for all parties.
December 04, 2008
Does AHIP have a plan for us!
As the momentum for reform builds in our nation's capitol, the board of directors of AHIP has made the wise decision to provide a definitive statement of their concepts of reform. Very soon the future role of their industry in the financing of health care in America may well be defined by political policy makers. Obviously the industry wants policies that will ensure a robust market for their products.
December 03, 2008
UnitedHealth puts a price on your rights
One of the many reasons that there is a push for comprehensive reform is that, in most states, individuals who have medical problems are denied the opportunity to purchase insurance on their own. This is one of the more serious flaws in insurance markets since this defeats the primary purpose of insurance - providing individuals with health care needs affordable access to health care.
December 02, 2008
The policy lesson of BC/BS of Michigan
The individual health insurance market in the United States has presented a policy challenge to those attempting to craft a health care financing system that includes everyone. In most states, insurers marketing individual plans have slowed the increase in their premiums by selling exclusively to healthy individuals. This is important because it takes only a modest number of individuals with health care needs to drive up premiums to ever less affordable levels.
December 01, 2008
Alain Enthoven responds on reform of the Dutch system
We share with Alain Enthoven the concern over our very high and ever increasing spending for a mediocre health care system that leaves so many out. We have disagreed with him (sometimes obnoxiously so) on the best approach to return value and high performance to our health care delivery system. He supports "universal health insurance based on regulated competition in the private sector," whereas we support a publicly administered and publicly financed single payer national health program.
November 28, 2008
Lessons from the Netherlands
Why is this article so important? Simply because there is a rapidly building momentum for similar health care reform in the United States built on a model of competing private insurance plans (possibly with a public plan offered as an additional option). The recent Dutch reform has important lessons for us.
November 26, 2008
AHIP: tax credits for moderate-income individuals and working families
This quote from AHIP was buried in another Quote of the Day last week, but it is being repeated here because of its importance in the health reform dialogue.
November 25, 2008
The Medicare Advantage lesson on what not to do
These three online reports from Health Affairs give us an update on a decade of experience with private health plan options in the Medicare program. The plans were sold to us as a private sector solution that would provide higher quality care at a lower cost than the traditional public Medicare program.
November 24, 2008
Uwe Reinhardt on indefensible administrative costs
Professor Reinhardt already said it: "More and more Americans are being priced out of health care as we know it. The question is how long American health policy makers, and particularly the leaders of our private health insurance, can justify this enormous and costly administrative burden to the American people and to the harried providers of health care."
November 21, 2008
Is administrative savings a myth?
The authors understand that a single payer or "Medicare for all" model of reform is the most rational competitor to their preferred model of reform - thus their attack on the administrative savings that a single payer system would bring us. They concede that the savings are not a myth as they are considerable, but they still understate the savings because they exclude the tremendous financial burden that our dysfunctional, fragmented, multi-payer system places on the health care delivery system. They also incorrectly state that the administrative savings are a one-time event. In fact, the efficiencies that are achieved are permanent, shifting the trajectory of health care cost increases downward.
November 20, 2008
AHIP & BCBSA support guaranteed issue and individual mandate
If anyone has any remaining doubt that comprehensive reform is close at hand, just look at the response of the private insurance industry. AHIP, representing 1,300 insurance companies, and BlueCross BlueShield Association, insuring over 100 million individuals, in simultaneous press releases have confirmed that they understand that, if they want to continue to insure the majority of Americans, they must abandon their current business model and come to the table with policies that work. Policies that work means that everyone must be included, and that risk must be distributed in an equitable manner, based on ability to pay.
November 19, 2008
HHS Secretary-elect Daschle's plan for reform
Today's quote leads to a question: Can Sen. Daschle's Federal Health Board do for the crisis in health care what the Federal Reserve Board has done for nation's financial crisis?
November 18, 2008
The uninsured give but rarely receive transplants
Because of the mismatch between the numbers of individuals who are candidates to receive organ transplants and the numbers of donors available, sometimes difficult decisions have to be made as to who will receive the transplants. As complex as these decisions are, it is a sad commentary that, in the United States, we add one additional complicating factor: Does the potential recipient have insurance?
November 17, 2008
Aetna creates "Medical Home." Really?
Aetna, in partnership with Partners in Care, has usurped the "medical home" label to... provide us with a comprehensive primary care system? Well... No. On top of our flawed systems of financing and delivering care, they are adding "customizable product and service lines." With our system already weighted down with an excess of egregiously wasteful administrative services, they are using the medical home label to sell us even more egregiously wasteful administrative services!
November 14, 2008
Uwe Reinhardt on why health care costs so much
There is an important reason to present the economic data, and that is that we need to approach health care reform using highly credible factual data. Many individuals have an opinion as to why heath care costs in the United States are so high, but those views are often based on nothing more than hearsay, and often are incorrect. Reform must be based on solid facts.
November 13, 2008
Lessons from the U.K.
What can we learn from the U.K.? Through a single payer system the U.K. has been able to build a strong primary care infrastructure with teams organized to provide high-quality coordinated care for everyone. They have done this at a fraction of the costs of U.S. health care, while compensating their primary care physicians very generously.
November 12, 2008
Reform proposal of Sen. Baucus
As the powerful chairman of the Senate Finance Committee, and as a person passionately dedicated to comprehensive health care reform, we need to listen to what Sen. Max Baucus has to say. "Call to Action, Health Reform 2009" is his white paper describing serious problems with our health care system, and includes a collection of legislative proposals to address those problems. It is an important report because it does represent what seems to be the prevailing views in Washington, D.C. on the direction for reform.
November 11, 2008
Medical group challenge of getting paid
Medical groups certainly have many challenges, but one of the more important is getting paid. This survey of Medical Group Management Association members provides some important lessons.
November 10, 2008
U.S. health care ranks first - as worst value
The United States spends far more per capita on health care than any other nation, yet we are obtaining very poor value for our spending. How many times have we heard that? And it doesn't change.
November 07, 2008
Uwe Reinhardt explains family health care costs
If we are truly serious about establishing an affordable system that would provide all necessary care for everyone, we have to seriously look at the Milliman Medical Index numbers. We are already spending an average of $15,609 for a family of four, with a typical family income of maybe $60,000. Those numbers no longer compute.
November 06, 2008
AMA's Heal that Claim Month
The AMA has selected November as the first national Heal that Claim Month. The problems that this addresses must be fairly significant if they are going to declare a special month to address them; so what are these problems?
November 05, 2008
Yes we can
Yes we can!
November 04, 2008
UK halts cancer drug penalty
There have been many reports from the U.S. opponents of government health programs proclaiming that "life saving drugs are denied" for cancer patients in UK's NHS. Generally, these are cancer drugs which had been evaluated by the National Institute of Health and Clinical Excellence (NICE) and found to have very little benefit, if any, especially when considering the high prices of these drugs.
November 03, 2008
Choices in coverage during open enrollment
What health insurance coverage will you need next year? Do you determine that by taking an honest look at where health care dollars were spent in the previous year? You are healthy, your health care spending has been negligible, so do you opt for the least expensive plan?
October 31, 2008
AMA position on single payer
The AMA is trying. During this presidential election season, the AMA has initiated an intensive "Voice for the Uninsured" campaign in support of their model of reform. Unfortunately, the policies behind their version of reform would fall far short of achieving the goal of affordable, comprehensive health care for everyone. Their feeble and deceptive effort to explain why their proposal is better than single payer reveals the fact that that the AMA is still controlled by those ideologically opposed to a national health program.
October 30, 2008
Medical tourism causes complications
Previous studies have shown that one of the reasons that health care is so expensive in the United States is that, quite simply, our prices are very high. Since other nations have been demonstrated to be capable of selectively providing high quality care at much lower prices, it is not surprising that medical tourism has become an attractive option for those paying the bills, including cash-paying patients, some insurers and some employers.
October 29, 2008
The World Health Report 2008
The World Health Report 2008 provides a critical assessment of health care systems throughout the world. It describes how all nations, regardless of national wealth, can benefit by enacting reforms organized around primary health care.
October 28, 2008
California's high-risk pool is sick
The concept of health insurance is quite simple. When everyone pays into an insurance risk pool, the many who are healthy are subsidizing the higher costs of those with greater health care needs. Thus everyone receives whatever medical care they need without facing financial barriers to care.
October 27, 2008
U.S. rationing eliminated by hallway admissions
The United States has 2.9 hospital beds per 1000 individuals. The median number of beds for OECD nations is 3.7 (OECD, 2002). Not only do we have fewer beds, the distribution is less even than in other nations with their more egalitarian systems. The supply of beds tends to be quite adequate in affluent regions, but is inadequate in other areas, especially those served by safety-net institutions.
October 24, 2008
Sen. Kennedy's grand finale
Everyone has profound admiration for Sen. Edward Kennedy's valiant effort to finally overcome the stubborn political barriers, and bring health care to everyone in the nation. At a time that the people are demanding reform, Sen. Kennedy is positioned to provide us with his grand finale - and what a great one that would be - health care for everyone.
October 23, 2008
Los Angeles Times series on private insurers
This important series of three articles published this week in the Los Angeles Times explains why the private insurance industry has neither the efficiency nor the moral authority to continue to manage our health care dollars. Each of the excerpts above provides an example of the management perversities of the industry, along with an example of the impact on a real-life patient. Much more can be found in the articles.
October 22, 2008
Fragmentation of family health care
It has long been recognized that one of the deficiencies of the children's health insurance program (SCHIP) is that parents in these lower income families often remain uninsured. This study demonstrates that the reverse also occurs. Even though one or both parents may be insured, often through their employment, the children may be left without coverage, primarily due to eligibility and affordability issues.
October 21, 2008
Marcia Angell on U.S. lessons for Canada
Those who are well informed on health policy are quite aware of the advantages and disadvantages of the health care financing systems in both the United States and Canada. Although the greater effectiveness and efficiency of the Canadian single payer system are well understood by supporters of a national health program in the United States, there has been a reluctance to use the positive features of the Canadian experience as an example of what we could achieve here. Why? Inevitably, bringing up Canada results in challenges that are a distraction from the primary message on reform.
October 20, 2008
Hawaii's "crowd out" crowds out children
Although Hawaii's Keiki Care for uninsured children was promoted as a program that would ensure that all children had health care coverage, it never would have achieved universality, partly because of various eligibility and enrollment issues. Also the coverage was not as comprehensive as coverage under Medicaid. Nevertheless, it did provide limited coverage for about 2,000 of the state's uninsured children (out of an uncertain number estimated between 3,500 and 16,000).
October 17, 2008
Underinsurance in Massachusetts
Many news reports now tout the success of the Massachusetts health care reform program in reducing the numbers of the uninsured, even though falling far short of universal coverage. This new report also suggests that the rate of underinsurance may have declined, an important point since it was feared that efforts to make the plans more affordable would defeat the financial security that the plans should provide.
October 14, 2008
Medicaid reform for the clairvoyant
Medicaid was designed as a welfare program to pay for all necessary care for those who could not otherwise afford it. The program has not worked as well as it should, primarily because of chronic underfunding. Access has been impaired because of the lack of providers willing to participate in a program that often doesn't even pay overhead expenses.
October 13, 2008
Nobel Laureate Paul Krugman on single payer
With today's announcement that Paul Krugman is the 2008 recipient of the Nobel Prize, it seems appropriate to distribute once again one if the most important articles he has ever written, and the message could not be more timely.
October 10, 2008
McCain and Obama perceptions of health financing flaws
As we near election time, we are seeing numerous reports, some excellent and some distorted, on how effective the McCain and Obama proposals would be in reducing the numbers of uninsured. Rather than digressing into disputes over the details of these analyses, it would be more instructive to step back and look at the fundamental goals of each proposal.
October 09, 2008
Lewin analysis of candidates' proposals
The release of this report from The Lewin Group has provoked a debate on whether it accurately reflects the numbers of individuals that would gain coverage under the McCain and Obama proposals respectively. Although this debate is legitimate, it misses the most important point. We don't really care how many people nominally have health insurance; we want to know whether or not people are protected from financial hardship should they need health care.
October 08, 2008
Presidential debate - health care as a right
Asking whether health care is a privilege or a right often leads to a not very productive 'tis so, 'tis not debate. But when the question is asked with the added choice of responsibility, and then answered, the answers can be very revealing.
October 07, 2008
What reform does business want?
Employers remain very concerned about rising health care costs. Because of our failure to reform our health care financing system, employers have been responding by shifting more responsibility to their employees. There has been an increase in the use of high-deductible health plans, which slow the rate of premium increases for the employer, but makes health care less affordable for the employees by requiring greater out-of-pocket payments when health care is accessed. Many employers now have decided not to offer health plans; the rate of coverage through employer-sponsored plans has continued to decline, especially amongst small businesses.
October 06, 2008
Medical causes of home mortgage foreclosures
The authors of this study indicate that the results are only preliminary, primarily due to limitations in methodology. Although we cannot quantify precisely the extent of the problem, the qualitative conclusion is certainly valid. Just as with personal bankruptcy, medical debt in both insured and uninsured individuals contributes to loss of homes through mortgage foreclosures.
October 03, 2008
The V.P. debate and the agenda for health reform
If you really care about the future of our health care system, you should give some thought to the motivation of the McCain/Palin camp in selecting this closing statement for her debate.
October 02, 2008
Commonwealth Fund on candidates' proposals
So these are the "choices for America." We currently have 46 million people who are uninsured. After ten years of McCain's plan, we would have 65 million uninsured, but ten years of Obama's plan would leave only 33 million people without insurance. Only 33 million!?
October 01, 2008
Gov. Schwarzenegger again vetoes single payer bill
This was Gov. Schwarzenegger's year for comprehensive healthcare reform in California. By the end of this year all Californians were going to have affordable health care.
September 30, 2008
Fraser: Canadian patients worse off than uninsured Americans
This report will be used by the opponents of single payer health reform in the United States. You should be aware of it so that you can dismiss it as a resource lacking credibility.
September 29, 2008
Germany's lessons for H. Aaron and his cautious approach
The logic of Henry Aaron and other incrementalists seems to be as follows: Comprehensive reform of health care financing is not feasible because, if it were, we would have it by now; therefore we should abandon any thoughts of a single comprehensive reform package and move forward with tinkering around with various steps to see "what works and what doesn't." Of course, the discontinuity of this framing belies the alleged logic.
September 26, 2008
FEHBP basic premium up 13 percent
So you want the health insurance program that the members of Congress have? This is it: the Federal Employees Health Benefits Program (FEHBP). This is the plan that several politicians have supported as an option to purchase in place of your current coverage, if you should no longer want to keep that.
September 25, 2008
NAFTA-based suit threatens Canada's medicare
Canadians, who much prefer their public medicare system to the U.S. private-market version of health care, have long feared that NAFTA would open up their health care system to an invasion of U.S.-style, investor-owned, market-based insurers and providers. The U.S. experience has proven that these entrepreneurs can cause health care costs to skyrocket, while greatly impairing equitable coverage and access.
September 24, 2008
The increasing burden of medical debt
The bad (but not unexpected) news is that there is no relief from the unrelenting increases in health care costs for individuals and their families. But there is one number that should alarm all of us: 42.5 million people WITH INSURANCE COVERAGE have medical bill problems in spite of their coverage.
September 23, 2008
A.M. Best revises health insurance rating to negative
When the economy goes South, and unemployment rates increase, publicly financed programs face budget constraints because of the decline in tax revenues. Think of our public education system. Publicly financed health programs (over half of all health care spending today) face similar constraints.
September 20, 2008
McCain: Deregulate health insurance, like banking
Let there be no doubt about John McCain's plans for health care in America: Just as reducing the burden of government regulation of real estate lending has allowed more individuals to achieve the American dream of owning their own homes, reducing regulatory oversight of private insurers will make health care more affordable for all of us.
September 18, 2008
William Brody on risk pooling
There could not be a more explicit endorsement of social insurance, especially significant since it comes from one of the nation's more important health care leaders. Once we all agree that we need one big risk pool to spread and share risk, the remaining efforts in health care reform would be limited to working out the details of the mechanics of funding and administering that pool.
September 17, 2008
KFF's three options includes single payer
Listening to the national dialogue on health financing reform, you would think that we have only two options: 1) Don't start from scratch with a better program, but build on the current system (Obama), or 2) Reform the tax code to shift incentives for purchasing insurance from employers to individuals (McCain). Replacing our dysfunctional financing system with a single payer national health program, if even mentioned, is immediately dismissed from the dialogue.
September 16, 2008
BC Calif creates dual networks to cheat patients and physicians
Those supporting health care reform based on the model of private health plans competing in the marketplace have looked to Blue Cross of California (BCC) as the nation's leader in innovative market solutions. BCC has been very effective in providing insurance products with competitive premiums by using these innovations to limit what is paid for health care benefits, in an environment of ever-increasing health care costs.
September 15, 2008
F. A. Hayek on social insurance
"The Road to Serfdom," the work of Nobel Laureate F. A. Hayek, has been one of the most influential books of the last century. It has been an inspiration to those who are opposed to socialism and who support free markets and libertarianism. The teachings of Hayek are frequently cited by those opposing government involvement in health insurance markets. But what did Hayek actually say?
September 12, 2008
10 Excellent Reasons for National Health Care
This insightful book will provide you with the information you need to be an informed participant in the public debate about how to achieve health care for all. This information is especially important now, during this election year.
September 11, 2008
Health policy expertise and presidential politics
Politics is represented by the great legislative battles that we are witnessing wherein one side advocates for policies that are wrong, largely because they're inadequate, and the other side advocates for policies that are completely wrong because they make matters worse.
Without the continual involvement of members of the policy community who emphatically support that which is right, we'll continue to witness politics that results in wrong, wronger and wrongest policies.
September 10, 2008
Is the window for reform really open?
All we need to achieve comprehensive health care reform is to elect a new Congress and a new administration, and use the momentum of the first 100 days to push through Congress the voters' mandate for reform. Right? Hmmm.
September 09, 2008
Doctors pressured by the intrusion of private insurers
No person disputes the fact that it is wise to use a less expensive generic medication when a newer product on patent is more expensive, has not been shown to be a better therapeutic agent, and has not been in use long enough to identify potential adverse effects that only post-marketing surveys could demonstrate.
September 05, 2008
Libertarian supports single payer
What is unprecedented about this debate is that one Libertarian has decided that the single payer model is the "best solution to our current problem." The other Libertarian doesn't have an answer but believes that the Libertarian anti-government ideology should have precedence over a solution that would work, merely because effective solutions include a role for government.
September 04, 2008
Employers shift to underinsurance
Is it good news that employers' health benefit cost growth is easing slightly? No. If you look at the full picture, it's terrible news. Health care costs are continuing to increase at an unsustainable rate, but employers are dumping the problem onto the backs of their employees by "the tried and true method of shifting cost to employees."
September 03, 2008
Supreme Court acknowledges insurers' conflict of interest
In this important decision the Court affirmed the obvious. Employer-sponsored plans and their administrators, whether private insurers or self-insured plans, have a conflict of interest when making benefit decisions. Denial of claims benefit the employers and/or insurers, and approval of claims benefit the employees. On this, the justices were in unanimous agreement.
September 02, 2008
Sen. Kuehl's single payer bill goes to Gov. Schwarzenegger again
In passing SB 840 once again, the California State Legislature is giving Gov. Schwarzenegger another opportunity to sign legislation that actually would provide health care for everyone through a model that would use our health care dollars much more efficiently. It will be a test to see if his goal of ensuring health care for all Californians is more important to him than his personal anti-government ideology. Let's hope that he leaves his intellectual exercises on ideology in his cigar tent as he comes out and signs a bill that benefits the health of the people.
September 01, 2008
WHO report on inequities that kill
On this Labor Day weekend, a time that we celebrate the great contributions of American workers, the release of this report could not be more timely. Hard working Americans are experiencing the adverse consequences of the increasing inequities in the social determinants of health, inequities that really only society is equipped to address. Today, Hurricane Gustav is descending on our Gulf Coast, testing further whether we as a society can join together to meet our challenges, or if instead those affected are simply left on their own.
August 29, 2008
Bernstein and Marmor on "Yes But"
Professor Bernstein and Professor Marmor are amongst the most qualified and experienced experts on both health policy and the politics of Medicare and social insurance in general. We need to listen to what they have to say. Be sure to click the link above to read their full message.
August 28, 2008
Lessons of 401(k) plans for health care
The theme of this report is that lessons can be learned from the behavior of employees regarding their individual 401(k) retirement plans that can be applied to their participation in consumer-driven health plans, but the importance of these observations is far greater than merely providing suggestions to "nudge" employees into these programs. The behavioral observations are precisely those that would be anticipated in programs that are designed to shift the responsibility for retirement and health security from the employer to the individual.
August 27, 2008
Census report already takes a hit
The good news in yesterday's Census Bureau release was that increased enrollment in government health programs more than offset the decline in private insurance coverage, especially for children. Nationally, there were 512,000 fewer uninsured children in 2007 than there were in 2006, primarily because of increased Medicaid and SCHIP enrollment.
Only one year later, over 200,000 children in California alone are projected to lose their coverage.
Think about that.
August 26, 2008
Census Bureau on the uninsured
The Associated Press story just released on the decline of 1.3 million in the numbers of uninsured will surely be welcome news. It was especially good news for those who gained coverage in 2007. Should we be celebrating? Let's look at some of the statistics.
August 25, 2008
Cost of covering the uninsured
Previous studies by Jack Hadley and his colleagues have shown that the increase in medical spending that would result from expanding insurance coverage to the uninsured would have been about $55 billion in 2001. For 2008, because of rapid increases in health care costs, continuing growth in the number of uninsured people, and changes in the characteristics of the uninsured population, that estimate has increased to about $122.6 billion. Even at this level, the cost of expanding coverage to everyone would be "remarkably small -- about the same as the growth of real health care spending over eighteen months" (Aaron, Health Affairs blog, 8/25).
August 22, 2008
Adult children covered by parents' plans
For those who contend that comprehensive reform is not politically feasible and that reform must occur in incremental steps, this is precisely the type of legislation that they support. Young adults frequently fall through the cracks in health insurance coverage, having one of the highest rates of uninsurance. This legislation provides them with another option for health insurance and, theoretically, should reduce the total numbers of uninsured.
August 21, 2008
Shattuck Lecture on coverage for all Americans
It would be worth your time to either watch the video or read the transcript of this very unusual Shattuck Lecture. For one hour Arthur Miller prods this panel on a discussion of important challenges to the American health care system. Comments are invited at the link above.
August 20, 2008
Insurance falls as medical bills rise
How well is our health care financing system working? Two-thirds of adults under 65 have problems with their health insurance and paying for health care. Forty-one percent have medical bill problems or are paying off medical debt, even though sixty-one percent of these individuals were insured at the time care was provided.
August 19, 2008
Will the real Harry and Louise please stand up
What a refreshing change. In fourteen years, Harry and Louise's breakfast table conversation has changed from, "If we let the government choose, we lose," to "Bring everyone to the table and make it happen." But what does this mean?
August 18, 2008
Maximum coverage as defined by Anthem Blue Cross
What's this? Why would a generous offer from a health insurer to assist an insured in receiving maximum coverage benefits be included in a health policy forum? The reason is that the apparent intent of this request is very different from its true purpose, and that difference exemplifies one of the most fundamental flaws in our current health care financing system.
August 15, 2008
Health care cost increases continue to plague employers
The health care cost data from these two consulting firms are important because they represent the increases in the costs of employer-sponsored coverage - the Aon survey representing the costs of private health insurance plans, and the PricewaterhouseCoopers survey representing the costs for self-insured employers. A few conclusions can be drawn from these surveys.
August 04, 2008
Winners and losers in balance billing
The issue of balance billing stems from a conflict between contracts (health plans) that patients have with their managed care organizations and contracts that physicians and hospitals do not have with the managed care organizations covering patients that they are required to provide services for in emergency situations.
August 01, 2008
Medicare national coverage determinations
Medicare national coverage determinations (NCDs) are inevitably controversial. Decisions on what procedures, devices and drugs are to be covered must balance the wishes of patients to have unlimited access to all possible care, regardless of demonstrated benefit or lack thereof, with the responsibility of the stewards of our tax funds to not waste them on care that is of no benefit and often is detrimental.
July 31, 2008
MedPoint and IntelliScript - harmful additions to the administrative excesses
MedPoint and IntelliScript represent the type of administrative services that the private insurance industry is selling us. These services are not for the purpose of assisting individuals in gaining access to the health care that they need. These services are for the purpose of allowing the insurance industry to exclude from their plans anyone who might actually need health care. And we're paying more in administrative costs to defeat this risk pooling function of insurance.
July 28, 2008
Woolhandler on the ethics of reform
The [President's Council on Bioethics] was formed in 2001 in response to the controversy over President Bush's decision to deny funds for embryonic stem cell research. With a touch of irony for which this administration is famous, many thought that political ethics were compromised in the selection of supposed ethicists who had already expressed biases incompatible with the ability to objectively assess important issues of bioethics. When one of the members of the Council states that they are incompetent to assess the ethical issues in the reform proposals, it does make you wonder.
July 25, 2008
The "dual-eligibles" scam
To understand the basis for the problems with the Medicare Part D drug benefit, you need only to recall that the program was designed by the Medicare privatizers in Congress, with the support of two of the largest lobby interests in the nation: the private insurers and the pharmaceutical firms.
July 24, 2008
Is preventing genetic discrimination enough?
The need for the Genetic Information Nondiscrimination Act was obvious. The members of Congress recognized that it would be unfair for private insurers to discriminate against individuals based on their family history or genetic makeup. What is perhaps not so obvious is why Congress chose to ignore all other forms of discrimination by private insurers.
July 23, 2008
"The Measure of America"
When we are addressing the narrower problem of health insurance for everyone, does the broader issue of human development really matter? Well, yes, and here's why.
July 22, 2008
A decade of change for those with chronic conditions
It would have been sad if this report had demonstrated that there had been no improvement in access and affordability in the past decade for this expensive, non-elderly population with chronic conditions. What it did show is that access and affordability deteriorated further, even amongst the insured. That's not sad; that's tragic.
July 21, 2008
Means-testing Medicare benefits?
Everyone agrees that health care is now so expensive that those of modest means cannot be expected to contribute as much to the financing of health care as those who are more affluent. Traditionally, the Medicare program has been financed primarily through a common risk pool with contributions paid based on income levels. Now, instead of establishing equity through the revenue side of the balance sheet, efforts are being made to shift equity, or the appearance of equity, over to the benefit/expenditure side.
July 18, 2008
AHIP's Campaign for an American Solution
So the insurance industry wants to sign up 100,000 individuals in its fan club to provide free marketing for the private insurance concept. In spite of criticisms, the industry has not changed its goals. They want taxpayers to provide coverage for those too expensive to insure - the 20 percent of people who are responsible for 80 percent of health care costs, but the industry is quite willing to offer guaranteed coverage to everyone else - the 80 percent of people who are quite healthy.
July 17, 2008
These GM retirees didn't have a choice
Last week, a Quote of the Day message discussed why the overwhelming majority of individuals, except those enrolled in the traditional Medicare program, do not have a choice of keeping indefinitely the private health insurance that they currently have. The largest private health benefit program in the nation, that of General Motors, was used as an example of how even the best could not provide absolute security that you could keep the insurance you have.
July 16, 2008
Response to TNR's Jonathan Cohn
The real debate over health care reform today centers over one fundamental choice. Are we going to continue to try to finance health care through private plans competing in the marketplace, a guarantee that access and equity problems would only grow worse, or are we going to use our own government resources to fix our financing system so that it works for everyone?
July 15, 2008
qotd: National health insurance makes the green journal
Reading a message in support of a Medicare-like national health insurance program is certainly not a new experience for single payer advocates. What is astonishing is that this was published in "the green journal," The American Journal of Medicine, one of the most prestigious medical publications in this nation. Furthermore, it was coauthored by the Editor-in-Chief, Joseph Alpert.
July 14, 2008
Uwe Reinhardt on the Dutch system
As Professor Reinhardt states, the Dutch system is not even vaguely close to the U.S. system, but rather is a social insurance system in disguise. Merely expanding our private plans to cover more people would not in any way emulate the Dutch system.
July 11, 2008
"Keeping the insurance you have" - Don't believe it!
Pause for a minute. Think back to the insurance you had twenty years ago. Remember? Now… do you still have precisely that same coverage? Unless you are over 85 and have been in the traditional Medicare program for the past twenty years, it is highly likely that you do not.
July 10, 2008
China's failed experiment with the market
Some of the intellectuals in China had decided that using market dynamics was just the solution that they needed to help modernize the Chinese health care system. Sterile, amoral business decisions allow the leeway to bring out the best in us... and the worst. China got the best for a few, and the worst for the many.
July 09, 2008
PNHP's New Blog
It's your turn to contribute to the national dialogue on health care reform. Frequent postings will be made by some of the leaders in the movement for a single payer national health program. Your responses are not only invited, they are encouraged.
July 08, 2008
What is "Health Care for America Now" doing?
The private insurance industry, as it functions today, clearly must be replaced with a system that works. So what is the solution proposed by the HCAN coalition? Let's replace the private insurance industry with... the private insurance industry. Only let's regulate it by requiring the insurers to provide us with the comprehensive coverage that we need "through the largest possible pools" - thus ensuring that their products will have premiums that only the very wealthiest of us can afford.
July 07, 2008
Failing grades for individual health insurance market
Looking at this Families USA report card of private plans in the individual market, it is clear that the private insurance utopia that they envision does not exist. Because of the lax regulatory requirements in far too many states, the insurers have been able to dodge their responsibility to cover everyone regardless of their health care needs.
July 03, 2008
Britain's NICE and social solidarity
We can learn much from the National Institute for Health and Clinical Excellence (NICE), an independent organization that provides Britain's National Health Service with "national guidance on promoting good health and preventing and treating ill health." Sadly, much of the publicity in the U.S. on NICE has come from the opponents of a government role in health care, claiming that NICE is depriving British citizens of life-saving cures. In fact, NICE is reducing the waste of taxpayer funds by providing better guidance on how those funds should be spent.
July 02, 2008
Let's end the Medicare Advantage shell game
This week, the AMA and AHIP (America's Health Insurance Plans) have each begun intensive campaigns to influence Congress on the anticipated Medicare adjustments that will be made when the members return from their recess. The AMA wants to prevent the disastrous 10 percent reduction in physicians' reimbursement rates, and AHIP does not want that to be paid for by a reduction in overpayments to the private Medicare Advantage plans. It is crucial that we understand what we are purchasing with these Medicare Advantage overpayments.
July 01, 2008
California's Medicaid disaster
As a welfare program representing patients lacking an adequate political voice, Medicaid has been chronically underfunded. The problem is especially severe in California (where it is called Medi-Cal) with one of the lowest Medicaid reimbursement rates in the nation, and a very large population of low-income individuals who might otherwise qualify for the program. We have more uninsured individuals in California than the entire population of Massachusetts.
June 30, 2008
AMA supports progressive tax policies for health care
From a policy perspective, this is really great news. The AMA already is on record for supporting progressive financing of our health care system through the use of refundable, advanceable, inversely-income-indexed tax credits to purchase private health plans. The current additional actions of the AMA House of Delegates even more explicitly support the concept of progressive financing of health care, based on ability to pay.
June 27, 2008
Senate advances plot to privatize Medicare
The political defeat of the measure to prevent Medicare pay cuts for physicians was not partisan. Enough Republicans joined Democrats in the House to form a veto-proof majority in support of the legislation. Though many Republicans also joined the Democrats in the Senate, they came up one vote short on cloture. Sens. Obama and Clinton interrupted campaign activities to vote, but Sen. McCain was a no-show.
June 26, 2008
Insured experience a larger relative increase in access problems
Access to health care in the United States is bad and getting worse. Particularly shocking are some of the factors that are associated with impaired access: increasing rates of uninsurance, deterioration in the financial protection afforded those who are insured, rising rates of health plan barriers, children being in families with low incomes (reversing prior gains), excessive increases in health care costs, and, most shocking of all, actually having a need for health care, insured or not.
June 25, 2008
Strong support for universal risk pool
The most reassuring finding in this poll is that almost twice as many people believe that "we need to get everyone into the same insurance pool so we can spread the costs of sick and healthy people over the whole population" as do those who believe that the healthy "should not be asked to pay more to subsidize sicker people by being in the same insurance pool with them."
June 24, 2008
United States Conference of Mayors endorses HR 676
The next politician who tells you that national health insurance is not politically feasible, tell him or her to discuss that opinion with the nation's mayors. For those who say that all politics is local, national health insurance is the only reform that is politically feasible.
June 23, 2008
Private insurers take on women
Representatives of the insurance industry contend that they provide consumer value for their very high administrative costs. Foremost are the preventive services that they encourage. But pap smears and mammograms? Their actuarial studies confirm that women actually use those services, and, of course, it is unfair to make men pay for them.
June 19, 2008
Senate Finance summit missed the message
The politicians in Washington are not in sync with the health care needs of the nation, but are tuned in to the concerns that the private insurance industry has about its own role in the future of health care financing. They seem to believe that all we need is more of the same: unaffordable private health plans that often fail to prevent financial hardship for those with significant health care needs. They are paralyzed by the meme that replacing our current system of financing health care with a system that would actually work is "not politically feasible."
June 18, 2008
Sen. Sheila Kuehl on the LAO report
When you hear criticisms of single payer based on this report, keep in mind the facts. The Legislative Analyst did not find any significant problems with the single payer model. It would provide all essential services for everyone while slowing increases in health care costs. What it did show is that delaying reform is increasing costs by tens of billions of dollars, and the failure to address our flat wage scales is creating the need to use even more progressive methods of financing health care.
June 16, 2008
LAO report on SB 840 (California)
California's single payer bill, SB 840, authored by Sen. Sheila Kuehl, has already been approved once by the California State Legislature, only to be vetoed by Gov. Arnold Schwarzenegger. It is back before the legislature, has passed in the Senate and is now in the Assembly Appropriations Committee.
June 11, 2008
Congressional Quarterly article on Taiwan's single payer system
There will be a two week break in the Quote of the Day messages, which will give you plenty of time to read this article on Taiwan's single payer system.
June 10, 2008
Well off and underinsured
The current trend to address the issue of affordability through innovative private insurance product design is driving the dramatic increase in the incidence of underinsurance. Because of the skew in rates of illness, these efforts have had little impact in reducing overall health care spending, but they have impaired health care access, and they have had a major negative impact on family finances.
June 09, 2008
Why the Massachusetts reform is not a model for the nation
Numerous media reports have covered the success of the Massachusetts health reform program, citing this Urban Institute report released this week. Reducing the numbers of uninsured by almost one-half is certainly a significant accomplishment. As to whether the Massachusetts plan has been a success or a failure, we should look at the accomplishments as contrasted with the goals.
UnitedHealthcare - source of identity theft
The private insurance industry has certainly been doing a shabby job of fulfilling its primary obligation to pool risk. The insurers have been quite successful in avoiding paying for health care by selectively marketing their products to the healthy (like these graduate students), and by using underinsurance to shift more of the costs of care to individuals who actually need it. They use amoral business practices that sometimes challenge the regulators, and occasionally even move into the criminal sphere to achieve their business goals.
June 05, 2008
The example of South Los Angeles
There are a great many problems that must be addressed if we are to ensure that people in underserved regions, such as South Los Angeles, have access to adequate health care services. But there is one absolutely essential resource that must be available to establish the necessary health care infrastructure: money.
June 04, 2008
Congressional response to Obama as president
Those of us who have long been advocating for health care reform are encouraged by the the window of opportunity that has opened with the change in political climate. There is a high probability that in January, Barack Obama will be president, we will have a strong Democratic majority in the House of Representatives, and Democrats may even constitute a filibuster-proof majority in the Senate.
June 03, 2008
Auctioneers of medical debt
By far, the highest per capita health care spending in the world... the money is already there... and, yet, we are unique amongst industrialized nations in forcing into debt individuals who have the misfortune of becoming ill or injured.
Of all of the problems we face, this is one of the simplest. We do not need more money. We merely need to reform our system of financing health care.
June 02, 2008
Sen. McCain's proposal for high-risk pools
Sen. John McCain's initial proposal for health care reform was simply to change tax incentives, reducing support for moderately-regulated, employer-sponsored health plans, and providing tax credit incentives that would encourage individuals to shop in the less-regulated, individual insurance market - a market capable of providing a much greater choice of innovative health plans. It quickly became obvious that these innovative products would be designed to avoid paying for much of our health care. He had to come up with a proposal to answer critics of his plan.
May 30, 2008
Message trumps policy?
There is currently an intensive effort within the progressive community to establish unity in support of a message on health care reform that will resonate with swing voters as well as progressives. Those driving that effort contend that the policy debate is over, and it is now time to move forward unified behind one message.
May 29, 2008
AHIP's proposal to reduce costs
Health care costs have become intolerable for most individuals, employers, and the government, and the prospect is that costs will continue to increase well in excess of the rate of inflation. Most current political proposals are focused on expanding coverage. Although the proposals include token programs for cost containment, most are not much more than rhetorical fluff except for the consumer-directed proposals that would make health care access even less affordable by shifting payment responsibility to patients in need of care. This is not the direction in which we should be headed.
May 28, 2008
Perceptions of quality not related to Medicare spending
There are now a plethora of studies that demonstrate that the current lowest-expenditure quintile may serve us well as the benchmark for optimal health care spending in the United States in that further spending produces diminishing returns.
That does not mean that we should establish a health care budget funded at that lower level and then use a meat cleaver approach to slash spending. We are seeing that in state Medicaid programs, and it is a disaster.
May 27, 2008
Howard Dean on single payer
Let's assume that in 2009 we will have a Democratic president, a solid Democratic majority in the House of Representatives, and sixty filibuster-proof Democrats in the Senate. We also know that, amongst Democrats, there is tremendous support for the single payer model of health care reform. That's all we need to enact a single payer national health program. Right?
May 26, 2008
Geyman's Do not resuscitate the insurance industry
John Geyman's new book could not be more timely. There is a surge in activity to move forward with political solutions to our health care crisis. There is a loud call to end the policy debate and move forward with UNITY behind models that build on private insurance plans. But Geyman shows us that private plans are rapidly deteriorating in their ability to provide the health care needs of the individual and in their ability to provide affordable, comprehensive health care financing for the nation. Instead of improving both sides of the balance, health plans are weighting down the scales and causing both sides to crash.
May 23, 2008
Gov. Crist's victory for unaffordable underinsurance
This weekend, Florida's Gov. Charlie Crist travels to Sen. John McCain's ranch in Arizona for further vetting as a member of the short list of potential nominees for vice-president. With him he takes his health reform legislative victory that can serve as "a model for the rest of the nation."
May 16, 2008
Employees nominally pay 40% of family costs
Since the employer's contribution to the premium is actually paid by the employee in foregone wage increases, the entire $15,609 in typical family medical costs comes out of the employee's total compensation package. Just think of how much more those who actually need health care would be paying. The increasing shift of costs from the employer to the employee, although only nominal, does make more explicit the employee's role in paying for health care.
May 15, 2008
Tie contributions to wages, not benefits
The 2008 FEHBP monthly premium for the standard Blue Cross/Blue Shield family plan is $1,027.95, or $12,335.40 per year. Policy analysts have recommended that premiums be limited to 10 percent of income. At this rate, the family would have to have an income of $123,000 just to pay the premium, excluding out-of-pocket expenses for health care. If the premium for a standard Blues plan for a relatively healthy population is no longer affordable, a premium for a plan that includes those who need health care (risk adjusted insurance pools in a universal system) you can forget about.
May 14, 2008
Insurers choose between profits and members
So the private health insurance companies "will not sacrifice profitability for membership." Yet the presidential candidates insist on keeping this industry in charge. Whose arrogance is this?
May 13, 2008
Health Affairs excludes single payer
Ouch! In this special issue of Health Affairs, we hear once again that the politics of reform requires compromise. The current political dynamic moves forward with the assumption that a single payer national health program represents an uncompromising position on health policy that ignores political realities. That may be true, but does that warrant the exclusion of consideration of policies that would improve the efficiency, equity and affordability of health care merely because the political alignment is not yet optimum?
May 12, 2008
UnitedHeathcare's plan with a 10% medical loss ratio
It is astounding that UnitedHealthcare has been able to achieve a medical loss ratio as low as 10%, retaining 90% of the premiums for administration and profit, simply by selling college students nearly worthless products that fail to prevent financial hardship in the face of medical need.
May 09, 2008
Herzlinger and McCanne on "choice" in candidates' proposals
Anyone following the national dialogue on reform is certainly aware of the rhetoric over "choice." Those supporting reform that builds on private health plans use "choice" to mean choice of health plans. Those supporting a publicly financed and publicly administered national health program use "choice" to mean choice of physicians and hospitals and other health care professionals and institutions.
May 08, 2008
AHIP on Medigap's Impact On Medicare Costs
Medigap plans are standardized supplemental private insurance plans that fill in some of the gaps in Medicare coverage. Medigap plans, as a group, have amongst the lowest medical loss ratios of all private insurance plans; that is, they pay out the least for health care benefits. Thus the plans are very lucrative for the private insurers, but they are amongst the worst values in private health care coverage.
May 07, 2008
Millennials support a government health insurance plan
The bad news is that Millennials face "lower rates of healthcare coverage, worsening job prospects, and higher levels of student loan debt." The good news is that they now "reject the conservative viewpoint that government is the problem, and that free markets always produce the best results for society."
May 06, 2008
Who determines whether we have coverage?
These two studies released today add to the great body of policy literature that demonstrates that the decision to have health insurance is often removed from the individual and is under the control of extraneous factors.
May 05, 2008
Health Care for Latinos
Dr. Torres is absolutely correct, except that we don't need to make it a moral issue. It already is.
May 02, 2008
Understanding your own insurance
Although this was a J.D. Power study of consumer satisfaction, it does reveal a very important point. Only 45 percent of health plan members self-reported that they understood their health insurance coverage. The other half didn't, and that was correlated with lower satisfaction ratings.
May 01, 2008
CBO looks at Wyden/Bennett S. 334
Although the bill has provisions that nominally would slow the increase in health care costs, they are similar to the cost-containing provisions of the proposals of the presidential candidates that actually would have very little impact, if any, on slowing cost escalation. It became apparent that adjustments would have to be made in S. 334 to prevent increasing demands on future federal budgets.
AHIP on "Health Savings Account Plans"
So anyone who can read plain English now knows that the are more than six million health savings accounts. But wait a minute. This study shows only that there are more than six million high-deductible health plans (HDHPs) which meet the qualifications to establish a health savings account. They have only partial information on less than 800,000 actual health savings accounts and cannot tell us whether the other five million accounts were even established, much less funded.
April 29, 2008
Sen. McCain's Guaranteed Access Plan
This speech was promoted as a major policy address that would flesh out Sen. McCain's proposal for health care reform, according to his campaign spokesman Jeff Sadosky. Until now, the only real substance of his proposal was to offer a tax credit, $2500 for individuals and $5000 for families, to purchase health plans in a competitive, deregulated private insurance market. Most of the rest of his proposal is simply rhetorical fluff.
April 28, 2008
Is LipiScan a gizmo?
Think of how often a medical technology firm has suggested simple, inexpensive clinical management of a condition that would obviate the need to use their very expensive technology. Never? Yet those supporting market financing of our health care system insist that it encourages technological advances which provide higher quality care at lower costs. What we are receiving instead is much more expensive care, often of dubious value.
April 24, 2008
Marcia Angell on relationship between coverage and costs
By Marcia Angell | The American Prospect
All of these variations in the Democrats' plans run into this intractable dilemma: If the system stays essentially as it is and we try to expand coverage, costs will inevitably rise. On the other hand, attempts to control costs will inevitably reduce coverage.
April 23, 2008
KFF Primer on private coverage
Much of the discussion on reform that will take place in the next couple of years will be on reform of the private insurance market. Of course, that is not the discussion we need to have. We should be discussing how to replace the private insurance market with a single payer national health program.
April 22, 2008
AHIP's lessons learned
Those of us who contend that private insurance is an obsolete method of financing health care are not the least surprised by AHIP's statement that "many companies accepted applications for insurance that they should have refused as bad risks." AHIP's contemporary position is that private insurers should not cover individuals with significant health care needs because that drives premiums so high that they are priced out of the market. Instead they support taxpayer-funded programs to pay for the 80 percent of health care used by the 20 percent of people who have higher health care needs.
April 18, 2008
The political rhetoric of "socialized medicine"
For political reasons efforts often are made to obfuscate the definition of "socialized medicine," but it is important to understand the meaning of the term. A socialized medicine system is one in which the government is the owner of the health care delivery system, and professionals providing the health care are employees of the government.
April 17, 2008
ANA position on single payer
It is gratifying to see that the American Nurses Association ultimately supports a single payer mechanism.
April 16, 2008
"Sick Around the World"
Washington Post reporter T. R. Reid takes a look at the health care systems of the United Kingdom, Japan, Germany, Taiwan, and Switzerland, and shows how each has settled on different models that are simpler, fairer, cheaper, and include everyone. He contrasts these nations with the United States which is "unlike every other country because it maintains so many separate systems for separate classes of people."
April 15, 2008
ACS testimony on underinsurance
To keep premiums affordable, the private insurance industry has no choice other than to pass more of the costs of health care on to individuals who have greater health care needs - thus the epidemic of underinsurance.
April 14, 2008
Tax evasion through HSAs
HSAs are a tax scheme in which we taxpayers subsidize the health care of individuals with incomes high enough to qualify for the tax relief. It would be inappropriate if these taxpayer-subsidized funds were used to purchase entertainment centers or expensive vacation trips. Unfortunately, the only way to ensure that these funds are used for health care is to establish an administrative process to clear each payment made out of the accounts. Otherwise, the temptation for individuals with HSAs to cheat their fellow taxpayers is just too great. It is far better to remove the temptation in advance than to penalize it after the fact.
April 11, 2008
WellPoint and UCLA privacy breaches
Although EMRs and IT systems are helpful tools, they introduce exposure to privacy breaches that have implications far beyond those of paper records. Looking through a patient's paper chart is one thing, but obtaining digital information that can be unleashed over the Internet for all the world to see, without any possibility of retracting the release of that information, is quite another.
April 10, 2008
AHIP's definition of equity
So the private insurance industry, in order to establish equity, would set their premiums based on health care costs of $1970 each (plus administrative costs and profits, less cost-sharing) for four-fifths of us. But what about the one-fifth with health care costs averaging $31,400 each? They simply avoid that market.
April 09, 2008
Health reform lessons from Chile
This article is worth reading in its entirety because of the important lessons that would apply to reform in the United States.
April 08, 2008
Medicare's failed experiment with disease management
The presidential candidates claim that they will pay for expanding coverage to everyone by using the savings made possible though chronic disease management. But what is disease management, and will it save money?
April 07, 2008
2008 Dartmouth Atlas of Health Care
Just imagine how effective a single payer national health program would be in "transforming the management of chronic illness to a rational system where what happens to patients is based primarily on illness severity, medical evidence, and the patient's wishes, and where resource allocation can be guided more and more by knowledge of what is needed to produce cost-effective, high-quality care."
April 04, 2008
Health insurance in small firms
This report provides extensive data documenting the increased burden of employer-sponsored health insurance, especially in small firms. Those interested in defining and quantifying the extent of this problem would be interested in downloading this report.
April 03, 2008
WellPoint tanks
WellPoint has been the leader in marketing innovative "affordable-but-barebones plans that do not offer consumers a compelling value." So now the industry will need to reverse its downturn by creating "affordable health insurance plans that consumers really want to buy."
April 02, 2008
OECD paper on the economics of prevention
This paper is important to policy advocates since it will arm you with the confidence to reply to questions about and proposals for prevention. It is also a paper that you can recommend to individuals who are locked into the concept that health care reform is all about prevention. You can show that that prevention is crucial, but that it alone does not adequately address the very important issue of making access to the health care delivery system affordable for everyone.
April 01, 2008
Twice as many physicians support National Health Insurance as oppose it
The debate over physician support of national health insurance is over. A majority of physicians are clearly in support, and that support continues to grow.
March 31, 2008
The insurance industry elephant
Wake up America! There's an insurance industry elephant in the room!
March 28, 2008
Hillary Clinton on single payer
Is she suggesting that the private insurance industry will be able to provide us with an insurance product that includes all of the bells and whistles at a premium that is affordable? If such a plan were to be offered it would have a very small market limited to only the wealthiest of us. Insurers typically shun small markets.
March 27, 2008
Hospitals requesting payments upfront
The hospitals are not the villains here. By introducing high-deductible plans, the private insurers have relieved themselves of the responsibility of paying for the initial costs of the medical and surgical procedures and services. In so doing, they have placed the burden of obtaining payment of the upfront charges onto the hospitals and health care professionals. Since large medical bills are more difficult to collect after the services have been provided, it is only natural that the hospitals would request payment in advance.
March 26, 2008
AFL-CIO/Peter Hart health care survey
This twenty-eight page reports provides statistical data in tables and graphs that demonstrate the level of dissatisfaction with our health care system. Two of the more revealing numbers are that "ninety-five percent say they are somewhat or very concerned about being able to afford health insurance in the coming years," and "ninety-five percent of respondents say America's health care system needs fundamental change or to be completely rebuilt."
March 25, 2008
Federal outsourcing increases uninsured
We won't get it right until we're ready to automatically enroll absolutely everyone in a single national health program. Until then, even the government will game the system.
March 24, 2008
More on wages and health care costs
This report is further confirmation that increases in health care costs are not being absorbed by employers but are being passed on to employees in the form of forgone wage or salary increases.
March 10, 2008
Do health benefits reduce wages?
Everyone agrees that health benefits provided by the employer are part of the employee compensation package. And there is considerable evidence that employees do accept lower wages in order to be able to participate in the employer's health benefits program.
Yet when employees are left on their own to secure their health insurance, they do not purchase it.
March 07, 2008
Consider signing PNHP's letter to the candidates
If you would like to join us in sending this message to the presidential candidates then use the link above to add your name to the list of those endorsing this letter. Your name and city will be posted as a signer to the letter.
February 29, 2008
Minnesota physicians prefer single payer
When you hear that the AMA is opposed to single payer reform, keep in mind that it represents only a minority of American physicians, and within their organization there is a diversity of opinion.
February 28, 2008
AHIP's recommendation for rescissions
Our goal is to bring everyone under the health care financing umbrella, including those with significant health care needs. The goal of the insurance industry is to bring the healthy under their umbrella, while excluding those with health care needs.
Focusing on coverage, or costs?
Ezekiel Emanuel is certainly correct when he states that we must focus on health care costs as we expand health care to everyone. He is also correct when he implies that current political proposals such as electronic medical records, wellness programs, quality incentives, and disease management programs would not have any significant impact on controlling spending. But he is wrong when he implies that there is no reform proposal that would both control costs and cover everyone.
February 26, 2008
Health care spending for 2008
The projected numbers for 2008 are the most reliable estimates of our current health care spending. They are the numbers you should use in your advocacy work.
February 22, 2008
Making Medicaid patients better shoppers
So under the new rules, a family of four living at the federal poverty level ($21,200) can be granted "greater control over their health care decisions" by being granted the opportunity to use $1060 of their own income in order to make them better health care shoppers.
February 21, 2008
The Corrosion of Medicine
Although physicians have been complicit in the processes leading to the corrosion of medicine, their blame lies not with an active role in commercializing health care, but rather with passive acceptance of their role in our current model of health care that is controlled by business and market interests.
February 20, 2008
Will targeted policies work for the uninsured?
The fact that the number of uninsured continues to increase is certainly not news. But there are a couple of points in this article that should alarm us.
A rebounding economy was unable to stop the decline in coverage. In spite of favorable economic trends, employers found their health benefit programs to be less affordable, and more dropped their employees from coverage. Clearly we will not be able to rely on improvements in the economy alone to expand coverage to more individuals.
February 19, 2008
Lewin Group analysis of "Health Care for America"
Rather than crafting health care financing based on individual plans, whether public or private, it would be far more efficient and equitable to totally separate health care financing from the delivery of health care services. Establish a single, universal risk pool, funded equitably through the tax system, and then use that common pool to fund health care.
February 14, 2008
Insurers' IT innovations shift costs to patients
Most current proposals for reform call for an expansion of IT (information technology) services to help control health care costs. Ingenix is demonstrating just how the private insurance industry adapts IT innovations to our health care system. It is using IT to shift more costs to patients while "increasing the profitability of a typical health plan by up to 16.7 percent."
February 13, 2008
Grumbach and GAO on primary care crisis
The current dialogue on reform is often more narrowly focused on topics such as disease management and electronic medical records. More attention needs to be directed to reform that would put all of this together: reinforcing our primary care infrastructure.
February 12, 2008
Blue Cross asks doctors to rat on patients
As we have seen before, Blue Cross's very successful business model is often in conflict with the mission of physicians and other professionals to provide the health care that patients need. This letter to physicians has a particularly nefarious intent.
February 11, 2008
End fringe debate over mandates - Kuttner
Talk about incompetent framing of the health care reform debate. Clinton and Obama are engaged in a cat fight over coercing the purchase of unaffordable and inadequate private plans, versus allowing individuals to go without coverage because it is unaffordable. Neither is acceptable.
February 08, 2008
Get ready for a Blue Cross/Blue Shield retailer near you
Placing the consumer in charge of his or her own health care has been touted by the supporters of consumer-directed health care as the answer to our health care cost crisis. This includes providing consumers with a choice of coverage options in the individual private insurance market.
February 07, 2008
Kuttner on market-based failure
How many articles have you seen or speeches that you've heard begin with the premise that we must first eliminate the waste in our health care system before we can provide health care coverage for everyone?
February 06, 2008
Is "keeping the insurance you have" your choice?
Quick! How many of you, under age 85, have the same health insurance plan that you had twenty years ago? None?
OK. Then how many of you changed plans simply because the private insurance market offered new plans with improved benefits and lower premiums? None?
February 05, 2008
More administrative fraud
Accepting accounts receivable as security for short term loans is a process know as factoring. Based on this report, it appears that National Century was yet another administrative intermediary that used a variation of factoring to divert 10 to 20 percent of health care dollars to its own interests. As if we didn't have enough administrative excesses in our system already, this is an atrocious waste of resources.
February 04, 2008
Krugman on Gruber on individual mandates
Jonathan Gruber and Paul Krugman deserve their reputations as being amongst the most respected economists in the nation. But their fixation on individual mandates provides about the same level of insight as to what we need in the way of health financing reform as does the insight provided by the proctologist who tries to tell us our general state of health from his perspective.
February 01, 2008
Oregon's health care lottery
Oregon has long been admired for its innovative efforts to expand coverage in an environment of limited state resources. It has even seriously considered single payer reform.
But a lottery to provide coverage for 10,000 to 12,000 of Oregon's 600,000 uninsured adults? Come on!
January 31, 2008
Eliminating broker fraud
In a single payer national health program enrollment is automatic and permanent. Churning, twisting, misrepresentations of coverage, and falsified applications wouldn't even exist.
January 30, 2008
Contingent workers and health care
"Only 13% of contingent workers had health insurance provided by their employer, compared with 72% of noncontingent workers."
It is unrealistic to expect employers to provide long-term health benefits to these employees who move in and out of their workforce. Because of changes in income, residency, dependent status, and so forth, it is also very difficult to provide stable enrollment in public insurance programs.
January 29, 2008
California reform defeat and UnitedHealth
There is no celebration in California. We are back to the status quo. Although those who call for compromising fundamental health policy principles say that the status quo is everyone's second choice, it isn't. It's our last choice.
January 28, 2008
Caps on catastrophic losses
Those of us who support single payer national health insurance believe that access to health care should not be impaired by erecting financial barriers to care. Others believe that individuals should be responsible for "modest" costs that enable access to care, such as high-deductible plans (conceding that low-income individuals would need some assistance). But everyone agrees that we should all be protected from catastrophic health care expenses. So why do private health plans place a cap on catastrophic losses, forcing financial ruin on those with the greatest of catastrophic health circumstances?
January 25, 2008
IOM report: Knowing What Works
Our mishmash that we call a health care system has two general characteristics that must be rectified. First, we provide both insufficient and excessive health care services that fall far short of the goals of high quality health care and optimal health care outcomes. Second, we waste an enormous amount of funds on poor quality, ineffective care while failing to spend enough on efficient, high quality services.
January 24, 2008
The fantasy numbers of the Schwarzenegger/Nunez proposal
Although this analysis was done for the compromise reform legislation currently under consideration in California (ABX1 1), the general principles apply to all comprehensive proposals that would mandate individuals to purchase private insurance plans.
January 23, 2008
Initiating a market for organs
Vendors? Of their own organs?
Those who support treating health care as a commodity surely didn't imply that we should go to this extreme. Or did they?
January 22, 2008
Prior authorization without payment authorization
UnitedHealthcare's "Advance Notification" protocol is very similar to established preauthorization protocols in that the insurer can deny payment if the process is not followed prior to the provision of health care services. The physician must submit the same information, in advance, that is required for preauthorization. The important difference is that fulfilling this identical notification requirement no longer ensures that the physician will be paid.
January 18, 2008
Americans lack understanding of their private health plans
Although this survey was designed to be used in the promotion of eHealthInsurance, an online health insurance broker, it does provide information that is useful to health care reform advocates.
January 17, 2008
Understanding insurer profits
Although the diversion of health care profits to the private insurers makes us angry, we have to keep in mind what the greater problem is. The private insurers are a major component of our highly flawed, fragmented, multi-payer system of financing health care. Between the administrative excesses of the insurers and the administrative burden placed on the providers of health care, we waste about $350 billion that could be recovered by changing to an administratively efficient single payer system. We do want to recover that $12 billion from the core underwriting business, but it is far more important to recover the $350 billion through structural reform of our system of health care financing.
January 16, 2008
Rex Nutting on health care reform
Supporters of national health insurance certainly can identify with these comments. But why are they worth sending out as a Quote of the Day? It's the source of the comments. Rex Nutting is Washington bureau chief of MarketWatch, a subsidiary of Dow Jones and Company.
January 15, 2008
Commonwealth Fund on candidates' reform proposals
The policy principles listed above are key to moving us toward a high-performance health system - except one. Avoiding "dislocation" by allowing an individual to elect to continue with a private plan that limits choice of providers, limits benefits, and requires greater cost sharing does not move us closer to a high-performance system but is included for pure political reasons to appease those individuals who remain uncomfortable with the concept of a public insurance program that they don't fully understand. All of the other principles listed should be an integral part of comprehensive reform.
January 14, 2008
Employers spend more to insure fewer
Under our current system of financing health care, it certainly seems only fair that an employer who is generous enough to offer dependent coverage (even if nudged by union negotiators) should not be expected to cover additional relatives or friends of employees if those individuals are not eligible dependents.
January 11, 2008
High burden hits middle-income America
The policy lesson? One-fifth of privately insured, middle-income people are already classified as "high-burden individuals" because they live in families that spend more than ten percent of their family income on health care, "and this number is likely to increase in future years as health care costs continue to outpace growth in family incomes."
January 10, 2008
Make that 22,000 uninsured deaths
More numbers...
Is this what the health care reform movement is all about?
Do we just keep tallying casualties? Body counts that aren't real body counts? Policy studies from statistical tables that are devoid of any references to real human beings that we knew and loved?
January 09, 2008
United States has worst rate of amenable mortality
Amenable mortality is defined in this study as "deaths from certain causes that should not occur in the presence of timely and effective health care."
January 08, 2008
Health spending growth slower than what?
Increases in health care spending continue to outpace increases in wages, and it is only going to get much worse. Paul Ginsburg tells us why. The players in the health care delivery system are busy chasing the buck with ever more excessive high-tech services and facilities, while only cursory attention is being given to actual health care needs (or sometimes no attention, as in mental health).
January 07, 2008
Missing the Boat on Health Care?
John Geyman's Tikkun article on whether we are about to miss the boat on health care reform is an important piece that you may want to share with others. The policies that we need to enact are clear, but they are taking a back seat to politics, being an election year.
January 04, 2008
Market justice and moral compass
The quasi-electromagnetic fields of market justice have screwed up our moral compass. Let's take it over to the terrain of social justice and see if we can get it to work again.
January 03, 2008
Denying care or denying payment?
Blue Cross has been a leader in insurance plan innovations that slow the rate of premium increases (to a smaller multiple of the rate of inflation) in order to remain competitive in the health insurance market. Blue Cross suggests that they are balancing "assuring access" with "keeping costs as affordable as possible for all of our members." But their scales are locked in at (barely) affordable premiums, which requires that they increase financial barriers to access. Changing the copayment for Pulmozyme from $30 to $784 is a good example. They continue to have "access" since Pulmozyme is still covered in another drug tier, and they continue to have "affordable" insurance premiums.
January 02, 2008
Where are we on reform? Part 2 (Hacker)
The final Quote of the Day for 2007 discussed the disconnect between a new poll indicating strong support (65%) for "a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers," and a rapidly growing movement within the progressive community to support a model based on allowing you to keep the insurance you have.
December 31, 2007
Where are we on reform?
From a policy perspective, the nation now believes that "the United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers." The majority also supports the concept framed as "single payer," though the Medicare framing elicits stronger support.
December 21, 2007
The insured should be very, very afraid
For health reform advocates, this report is well worth downloading. It confirms not only the enormity of the financial burdens of health care, but also the alarming rate of increase in those burdens.
December 20, 2007
Insurance and cancer
There are many factors that influence access and outcomes for cancer patients. This comprehensive study confirms that insurance status is one of the most important factors. The uninsured are screened less frequently; they are diagnosed at a later stage, and they have a lower survival rate.
December 19, 2007
AHIP's Guarantee Access Plans
AHIP is proposing that they be relieved of covering any individual that the actuaries predict might cost twice the average of claims in this very low cost group. Everyone who might actually need care is transferred to the Guarantee Access Plans managed by the state. These plans would be funded by a premium with a 50 percent penalty added, plus financing that the state obtains from "a broad base of sources." That broad base, of course, is the taxpayers.
December 18, 2007
Scrap the California victory celebration
The millions who do not qualify for the medical welfare programs, and don't have enough income to pay the premium for the "minimum creditable coverage" are excused from being included in our universal health care program.
December 17, 2007
Yet another administrative siphon
What we do not need is more administrators that find innovative ways to move health dollars around while taking their percentage of every dollar they touch. HMS wouldn't even exist if we had a single payer national health program.
December 15, 2007
Mandate model repeatedly tested in U.S. and always fails
Again, proven repeatedly, the “mandate model” for reform is economic nonsense. The reliance on private insurers makes universal coverage unaffordable.
December 14, 2007
David Himmelstein speaks
Harvard professor and PNHP cofounder David Himmelstein presented his remarks following a roundtable discussion by the health policy representatives of the leading Republican and Democratic candidates for president.
December 13, 2007
The new Dutch health insurance system
The recently adopted financing reform for health care in the Netherlands has received considerable attention in the United States, and is being proposed as a private sector model that would be especially compatible with American ideals. The Dutch have discontinued their public insurance program and replaced it with an individual mandate to purchase private health plans competing in the marketplace.
December 12, 2007
Watch your medFICO score!
You can get an idea of the magnitude of the growth in the market of inadequate underinsurance products when the industry has identified yet another administrative service that they can sell us: a medical FICO score to determine the creditworthiness of patients who have significant out-of-pocket expenses as a result of today's higher cost-sharing requirements.
December 11, 2007
Australia learns wrong lesson from U.S.
It is often said that private insurers in other nations with less expensive, universal health care systems are very different from those in the United States. They are highly regulated, non-profit entities that serve patients well. But is that always true? Step back and take a look at what is happening in Australia.
December 10, 2007
Better morale with no insurance?
You know that we have serious problems with our health care financing system when a policy expert states that it is better for morale if new small business owners never offer their employees health insurance in the first place.
December 07, 2007
Anthem's bare-bones plan for employers
Although the numbers of uninsured continue to rise, the fastest growing problem in health care financing is underinsurance. In an effort to make health insurance premiums affordable, plans are shifting more of the costs to patients, making health care access unaffordable for many.
December 06, 2007
Maine's policy lesson to the U.S. - update
Today's lesson: Most of the nation's leading politicians who claim that their proposals will achieve health care coverage for everyone are being dishonest with us. Worse, their positions are being supported by highly respected, presumably credible members of the policy community. Politics is displacing policy science in the national discourse on reform.
December 05, 2007
Reform that women need
Health care reform is very much a women's issue, though a high-performance health care system that works for women works for men and children as well. If we do it right, we'll all benefit.
December 04, 2007
ACP's position on single payer reform
The American College of Physicians agrees that there are really only two options, though they are both government solutions: (1) an efficient, single payer national health program, or (2) a more expensive, administratively complex, inefficient, highly regulated and heavily subsidized fragmented system of a multitude of private plans plus public programs, with means testing and mandates to participate. It doesn't seem like a difficult choice.
December 03, 2007
Pervasiveness of California rescissions
Although California has been in the news because of the rescission practices of its private insurers, this article demonstrates the pervasiveness of this practice.
November 30, 2007
Woolhandler and Himmelstein on competition and public funds
Although this article is targeted to policymakers in other countries who currently are experimenting with American-style privatization, it actually is a good resource article for health care reformers in the United States. It is worth downloading in its entirety.
November 29, 2007
Genentech bumps $40 drug with $2000 version
The pricing of drugs is not based simply on their development and production costs but rather is based more on what the market will bear. The ability of compounding pharmacists to greatly dilute the dose of Avastin to levels appropriate for treatment of the retina resulted in a plummeting of the price per dose compared to that of Lucentis.
As any successful business would do, Genentech made a decision to destroy its own competition with itself by prohibiting the legal sale of Avastin to the compounding pharmacists.
November 28, 2007
Medicare out-of-pocket spending
Most of us are grateful that our seniors have Medicare coverage so that they don't have to face financial hardship in the event of medical need. But is that assumption valid?
About 40 percent of Medicare beneficiaries spend more than 20 percent of their incomes on health care. For most of them that does constitute a financial hardship that is severe enough such that some will decline beneficial health care services simply because they can't afford to pay for them.
November 27, 2007
Access barriers for low-income families
This is yet another study of coverage, access and costs for low-income families. The findings are intuitive, not to mention having been supported by many other studies.
November 26, 2007
Insurance payment confusion leads to bad credit reports
So you have excellent coverage. About six months ago you received medical care for what proved to be a minor problem. The care included a couple of office visits, a few laboratory tests, medical imaging, two prescriptions, and you're fine now.
November 23, 2007
Democratic candidates question reform proposals
There seems to be a consensus that the Democratic presidential candidates are leading on the issue of health care reform. But what are they leading with?
November 20, 2007
Candidates propose opportunities for private insurers
All proposals of the leading Republican and Democratic candidates for president would use various tax policies to increase funds available for the purchase of private health plans, especially in the individual market. Does this really provide greater opportunities for private insurers to expand their markets and increase their revenues?
November 19, 2007
Employers are shifting more costs to employees
The continued escalation of employers' health benefit costs at twice the rate of inflation is bad news, but what is much worse is that employers have responded by shifting even more of the costs to their employees. These increases compound each year.
November 16, 2007
Roadblocks in the private insurance maze
Although this article provides considerable detail, no attempt has been made here to extract from it some of the numerous barriers faced by Barbara Calder - barriers deliberately erected in our system of private insurance plans. Suffice it to say that our fragmented system resulted in "a year battling numerous roadblocks," and her battle isn't through.
November 15, 2007
Renew it or lose it
One crucial feature of a health care program that covers everyone is that enrollment must be automatic and permanent. Obviously we fall far short of that now, but disenrolling an employee because of passive inaction is certainly a further step backwards.
November 14, 2007
The AMA and single payer policies
The AMA calls for coverage to be universal, continuous and portable. Those goals would be automatic with a single payer system, but they would be almost impossible to achieve with a fragmented market of private plans that change their benefits frequently and enter and leave various markets at their own discretion. The only person who can say that he or she has the same continuous, portable plan for the past forty years is a 105 year old Medicare beneficiary.
November 13, 2007
Is reform to benefit underwriters, or patients?
A very recent Quote of the Day message included the comments of Janet Trautwein who represents the National Association of Health Underwriters. She stated that we need to consider "free-market reform, and just say no to single payer." It was followed by my criticism of underwriters whose role is to deny coverage of individuals with health care needs in order to protect insurers from the costs of that care.
November 12, 2007
Does universal health care suppress innovation?
You should immediately download the entire article and save it for a time that you can read it in its entirety. More importantly, the full article should be used in your advocacy work to explain why innovation would not be suppressed - and actually may be made more efficient - by enactment of a universal health care program.
November 09, 2007
Underwriting is part of the problem
The Quote of the Day for October 31, 2007 was from a Modern Healthcare article, "Universal healthcare crosses the partisan divide," which mentioned that many attendees at the meeting of the Health Industry Group Purchasing Association seemed to believe that, "Like it or not, within the next few years the U.S. is going to have a nationwide, single-payer system." Following is a response to that article, and two responses to the response.
November 08, 2007
Highmark's Healthcare Gift Card
Any innovation that the health insurance industry can devise to drum up more administrative fees, they'll do. In this instance, Highmark wants not only more fees, but they also want other insurers' administrative fees as well, claiming its patent rights to the intellectual capital.
November 07, 2007
Oregon rejects health care for children?
This measure couldn't fail. Everyone supports health care for children, and almost everyone supports tobacco taxes that would give smokers a greater incentive to quit. Only the evildoers in the tobacco industry would be opposed.
Well, people in Oregon watch TV, and the vested interests with a lot of money control the message. The tobacco companies were able to frame this as an issue over taxes and government accountability. Who believes that we need more taxes? Who supports the ubiquitous inefficiencies of government bureaucracies?
November 06, 2007
Why would Big Business defend ERISA?
With the escalating push toward comprehensive reform, Big Business has an opportunity to dump its health benefits headache onto others through individual mandates to purchase private plans, or onto a national health insurance program. Why should they want to protect ERISA and their self-funded health benefit programs?
November 05, 2007
Expensive mediocrity
Nothing new. This is yet another international study of health care experiences demonstrating that the United States has the most expensive and least efficient system and that we have the most negative views of all the nations studied. We have a lousy system, and we don't like it.
October 31, 2007
Conservative businessmen sound out single payer
What is remarkable about this report is how far the debate on reform has come. This was a meeting of conservative businessmen in the health industry. The debate is no longer over whether we need comprehensive reform; that is now a given. The debate has progressed to considering the financing mechanism, or, as Pat Buchanan said, "How are we going to pay for it?"
October 30, 2007
Zycher's dishonest report on administrative costs
Normally we wouldn't respond to a dishonest study like this since it would give it further unwarranted exposure and provide it with a limited degree of credibility merely because we thought it was worth our time to comment on it. Unfortunately, The Wall Street Journal has granted it their editorial stamp-of-approval, and the conservative and libertarian non-think tanks are gearing up to be certain that the conclusions in Zycher's report are widely distributed. We will be hearing more about this, and we should be prepared to respond.
Primary care turnover in private plans
One of the most important goals of health care reform is to provide everyone with access to a primary care medical home. Not only would that enhance the quality and cost effectiveness of health care, but it would also provide each person with a long term relationship with a trusted health care professional.
October 26, 2007
AHIP's deceptive release on CDHC
Wait a minute. That's what the press release would have you believe. But what did this study really show?
Individuals with their own health savings accounts (HSA) spent $6 less than those with traditional plan without a deductible (2.8% less). That's not very impressive.
October 25, 2007
Oberlander on learning from failure
It would be a shame to see so much more suffering occur before we could achieve reform. What would the healthy want to hear now, before their personal finances are threatened by medical costs, that would make them want to change to a public program ?
October 24, 2007
Rewarding physicians for providing less care
By using "mountains of billing information," the "best dollar value" will be determined by the frequency and intensity of services. Physicians who see their patients less frequently, do fewer procedures, and provide fewer intensive visits will be paid more for the services that they do deliver. The physicians who are most successful at selecting a larger number of healthy patients and dumping the sick ones will receive the highest compensation.
October 23, 2007
Schwarzenegger and Clinton plans similar
Gov. Schwarzenegger and Sen. Clinton insist that the solution is to require individuals to purchase private plans that they cannot afford. That might work for the wealthy, and for the poor on welfare programs, but that does not work for the majority of us who are just trying to make ends meet.
October 22, 2007
Same health care program that covers Congress
So to make federal coverage more affordable we would convert it into catastrophic coverage that still wouldn't be affordable for most average-income individuals, and would expose many of those who are covered to financial hardship? And to do that we would sacrifice efficiency, equity, and the ability to effect positive changes in public health?
George Lakoff: Don't Think of a Sick Child
Professor Lakoff and his colleagues at the Rockridge Institute now provide us with important guidance for understanding and framing the health care debate.
October 18, 2007
Affordability threshold for family health care
A median family income is no longer enough to pay for premiums plus out-of-pocket expenses for a family facing chronic conditions or facing a significant injury or major illness. Furthermore, there is no standard income level above which individuals could be assured that health care would be affordable.
October 17, 2007
One minute with Al Gore
Al Gore: "I strongly support universal, single payer, government-provided or government-funded health care."
October 16, 2007
Nobel Prize in economics, and why
The next time someone insists that we must keep the government out of health care and allow the free market to work, stop him or her right there. Insist that he/she first read the Milbank Quarterly article by Joseph White so that you can have an informed discussion based on knowledge and understanding of the realities and complexities of marketplace and government interactions and the impact that they have on health care.
October 15, 2007
Letter to Gov. Schwarzenegger
Following is a letter that I sent to the governor last month making the point that affordable, comprehensive health care for everyone is attainable if we truly accept his call for a post-partisan solution with shared responsibility. Although the negotiations are not public, there is no evidence that the policy discussions have extended beyond the obsolete model of private health plan financing. This letter is being distributed in hopes that others will join in the call for reform that will achieve our goal of comprehensive health care for everyone. Please share this message with others who do care.
October 09, 2007
"No Worry" health plan
No worry. Employers can now lock in their premium rates by merely agreeing in advance to pass on health care cost increases to their employees through yet higher deductibles and co-payments.
Private plans fail Medicare audits
So Democrats "are likely to cite the findings as evidence that private insurers cannot be trusted to care for the sickest, most vulnerable Medicare recipients." So why do the leading Democratic candidates insist that private insurers be included in their models of health care reform for the rest of us?
David Lazarus gets personal
David Lazarus now not only reports it; he lives it.
October 03, 2007
Being drugged into prevention
Uh-oh. Are we being dragged (drugged) into a process that places our health care system in the hands of the pharmaceutical industry?
October 02, 2007
High chronic disease prevalence and high spending
Are we spending so much more on health care than the other OECD nations because we have a much higher prevalence of chronic disease in older individuals, or are we spending much more merely because our prices are higher?
October 01, 2007
Stories from the marketplace
What do these stories have in common? They are examples of the marketplace at work, and it is our health care system and those it serves that are the victims.
September 28, 2007
Privatized "Big Brother"
Big Brother is watching you. Only he is not from the government. He is an agent of the Invisible Hand.
Intrusive micromanagement of health care today is not coming from an oppressive government, but rather it is an innovation of the free marketplace.
September 27, 2007
Employers offer private underinsurance
Although the numbers of uninsured continue to increase, the fastest growing problem in health care financing today is the transformation from insurance to underinsurance.
Private insurers have shifted much of the individual market into various innovative underinsurance products. Until recently, employers have attempted to maintain more comprehensive coverage. That has changed.
September 26, 2007
Cost savings through prevention and wellness
Prevention and wellness programs are certainly to be encouraged for their beneficial impact on health. They should be an integral part of our health care delivery system. Much more importantly, they should be incorporated into all other appropriate public and private endeavors.
September 25, 2007
Inexorably rising costs
Providing health care coverage for everyone and making health care affordable are two different issues, though they are both problems that are inversely related to income.
September 24, 2007
Cracks in the moral hazard foundation
This landmark report turns upside down the policy basis of moral hazard. The entire article should be downloaded so that it can be used to refute those who insist that patients who decline health care when they have to pay for it out-of-pocket will not adversely affect their own health because they will decline only that care that has no measurable benefit on their health outcomes.
September 17, 2007
Hillary Clinton's "American Health Choices Plan"
Hillary Clinton's proposal "preserves existing health insurance," and includes the responsibility of individuals "to get and keep insurance" through the current private insurance market, or through a "Health Choices Menu" of private FEHBP-type plans, or through a Medicare-type public program.
Thus her proposal is an individual mandate to purchase private insurance that is no longer affordable for average-income individuals, or to purchase a public plan that will be even more expensive because of adverse selection.
September 14, 2007
Is it the prices?
So we pay far more for health care, but we are not receiving any more care than is delivered in other nations. In fact, this article states, "the availability of health care resources and the actual use of services in the United States were below those of most industrialized countries."
September 13, 2007
Decline in premium increases is still an intolerable increase
This year's premium will be used as the basis for next year's increase. This year it is 3.5 percentage points more than the rate of inflation. That greater-than-inflation increase will never be recovered, and will be added to next year's increase, and to the increase in every year thereafter. Not only this year's increase, but the greater-than-inflation increases of each prior year and of each future year are also added. In the past six years alone, the greater-than-inflation increase has been 61 percent.
September 11, 2007
California legislation set for veto and special session
In a classic example of political irony, Democrats are abandoning their preferred option, single payer reform, in order to reach a compromise with the Republicans and the private insurance industry. They have crafted a model that they believe does not repeat the mistake of the Massachusetts reform program. California Democrats proudly proclaim that they will not require individuals who cannot afford private insurance to be covered by a program that is being inappropriately characterized as universal.
September 10, 2007
AHIP/Milliman report on guaranteed issue and community rating
The implicit conclusion presented is that guaranteed issue and community rating should be rejected in order to "stabilize the insurance marketplace and provide consumers more choice and access to coverage." The problem is that this stabilizes the market only for healthy consumers.
September 07, 2007
Age related burden of out-of-pocket health spending
The results of this study are intuitive. Older individuals with greater health care needs and lower incomes spend a greater percentage of their incomes on health care than do younger, healthier individuals with higher incomes. But there are a couple of other extrapolations from this study that are also important.
September 05, 2007
More administrative services
As the government continues to ignore the health care financing crisis, the market responds - by selling us even more wasteful administrative services.
September 04, 2007
Uninsured by choice?
As anticipated, the opponents of comprehensive reform are framing the increase in the numbers of uninsured as a matter of personal choice for many.
August 31, 2007
ACS campaign on health insurance
The message of the American Cancer Society is clear. The most important single measure that would improve access to care that could save lives would be to provide everyone with comprehensive health insurance.
August 30, 2007
The moneylenders move in
Are these interest-free loans really free? Not when your complicit health care provider gives your cash discount of 10 percent to 25 percent to the moneylender, and you pay rack price. And it's especially not free when one late payment throws you into an exorbitant default rate.
August 29, 2007
Middle-income losing coverage
The public welfare programs continue to putter along. The dramatic decline in coverage has been primarily in employer-sponsored plans. Therefore it is no surprise that most of the 2 million plus individuals who lost coverage in 2006 were in the middle and upper-middle income sectors.
August 28, 2007
Census numbers of uninsured - only in America
The numbers to commit to memory: for 2006, 47.0 million were uninsured, which is 15.8 percent of the population.
These are the standard numbers used by the policy community to express the magnitude of the problem of the uninsured.
August 27, 2007
Will COBRA be there when you need it?
Another incremental improvement in health care coverage was the introduction of the COBRA regulations which allowed an individual to continue to purchase prior employer-sponsored coverage during limited transitional periods of unemployment.
One problem with the program is that many unemployed individuals simply are not able to pay the insurance premium and consequently lose their coverage.
August 24, 2007
Lewin Group analysis of Colorado proposals
Once again. The models of reform that build on our highly flawed, fragmented system of financing health care actually increase health care spending while falling far short on the goals of reform. In contrast, the single payer model would provide truly comprehensive care for absolutely everyone while significantly reducing health care spending.
August 23, 2007
Hudson's Chapin on health insurance
Whether we call Medicare "insurance" or "healthcare" is not really important. What is important is that we need to stop relying on private insurance and adopt a public program that is "permanent, portable, and simple and inexpensive to administer."
August 22, 2007
Californians shift views on reform
This poll does demonstrate a significant increase in the perceived dissatisfaction with the health care system in California in the past eight months, with the total dissatisfied increasing from 44% to 69%.
August 21, 2007
OECD report on private insurance impact on costs
As we address reform in the United States, high health care costs are a concern that we all share. This highly credible OECD report reveals that reform based on private health plans would add even more to our total health expenditure - not exactly the solution we seek.
August 20, 2007
Medicare fee reduction for ASCs
Why should Medicare pay higher prices for procedures done in a hospital outpatient setting than it does for procedures done in an efficient, free-standing ambulatory surgery center (ASC)? This is our tax money. Shouldn't we be receiving a better value?
August 17, 2007
The tragedy of a man throwing his ill wife off of their balcony
What a tragedy. None of us can really understand the desperation of this man that caused him to do this terrible thing. It is too easy for us to accept the media reports that he did this because of medical bills and no insurance to pay them. It is much more likely that his grief over her suffering was his primary motivating factor.
August 16, 2007
Was your $100 in drug marketing worth it?
The $30 billion spent by the pharmaceutical firms in promoting their drugs amounts to an astonishing $100 per each man, woman and child in the United States. That is a lot of money that must be built into the price of drugs. Are we receiving any value for this investment?
August 15, 2007
Medicare Advantage plan in receivership
Congress and the administration established the private sector Medicare Advantage plans to compete with the traditional Medicare program, arguing that the market is always more efficient than the government. Just to be certain that these private plans were successful, they were given an average of 12 percent more funds than were allocated for traditional Medicare. That wasn't enough of a buffer for this plan to avoid receivership.
August 14, 2007
Defining success for Illinois' All Kids
Illinois' All Kids was developed and promoted as a program that would provide health insurance coverage for all children in the state. A goal was set to cover 50,000 (one-fifth) of the uninsured children within the first year. This report celebrates the success of this program in that it achieved this target in only nine months. But is a celebration really warranted?
August 13, 2007
World's Best Medical Care? (New York Times)
We have the money. We should have "the best health care system in the world." But building on mediocrity will only bring us more mediocrity at ever greater levels of spending.
August 10, 2007
CMA testimony on Blue Cross
Wall Street analysts have continued to praise Blue Cross of California and its parent company (WellPoint) as being leaders in private insurance innovations that have led to stellar performances in the equities markets. Blue Cross/WellPoint has led, and in order to remain competitive, the others (including the non-profits) have followed.
August 09, 2007
WHO report on private insurance and cost sharing
Even though released three years ago, this primer on private health care funding of Western European countries is especially informative for the dialogue on health care reform now taking place in the United States.
August 08, 2007
For vaccines, underinsurance worse than no insurance
The crisis in the affordability of private health insurance can only result in an expansion in the current epidemic of underinsurance. If insurers are to maintain a market for their products, they must continue to find innovative methods of not paying for health care.
August 07, 2007
Children harmed by static SCHIP eligibility
If the politicians are serious about initiating comprehensive reform by covering all children, they must come up with a proposal that enrolls all children automatically and permanently. Watching them stumble around with the SCHIP program proves that building on our public and private plans will never get us there, and unfortunately most seemed resigned to that fact that we can't do it.
August 06, 2007
Consumer Reports on the underinsured
Private health plans work for people who do not and never will need health care. But what if medical needs arise? How well do they work?
August 03, 2007
The economics and morality of Sicko
The economic benefit of the single payer model is firmly established in the health policy literature. That does not stop the conservative and/or libertarian think tanks from using highly selected data to create the impression that there is a compelling economic argument for rejecting single payer reform. As David Felix's article suggests, these arguments are made to appear valid by remaining silent on the overwhelming body of information that would refute their deviously crafted premises.
August 02, 2007
Canadian Medical Association's proposal for Medicare Plus
Health Minister Tony Clement has rebuffed the Canadian Medical Association in its call for greater privatization of medicare.
Clement said the federal government will not allow so-called dual practice, which allows doctors to work in both the public and private health systems. In an interview, he referred to such an arrangement as a two-tier system.
August 01, 2007
Rudy Giuliani's health care proposal
Rudy Giuliani's choice of health care advisors is all you need to know to understand his positions on reform. His decision to trump rational health policy with extremist libertarian ideology does tend to make you question his political skills. He obviously isn't poll driven.
July 31, 2007
Presbyterian Health fought Whipple at M. D. Anderson
The appropriate medical decision could not be more straightforward. A Whipple procedure should always be done in a center with an experienced team. To attempt this operation at a local level with an inexperienced team is almost tantamount to a death sentence.
July 30, 2007
Single payer debate with AMA President-Elect Nancy Nielsen
I would like to mention one point of disagreement that could not be clarified during the limited time of the broadcast. I mentioned that the AMA's version of choice was the choice of private health plans, allowing individuals to purchase plans with lower premiums, but at a cost of reducing the insurance function of the private plans.
July 27, 2007
The best of the Blues
Those who believe that private insurers should continue to have a prominent role in health care financing often point to the Blue Cross and Blue Shield companies as effective, efficient and ethical insurers. How has that played out in California?
July 26, 2007
Lessons from Massachusetts on affordability
The issue of affordability was of primary concern from day one. But rather than addressing the crucial problem of the affordability of health care, the architects of the program decided to tackle the problem of the affordability of private insurance plans.
July 25, 2007
Queues in the U.S. - for the uninsured
The opponents of reform frequently claim that a program of national health insurance would introduce queues into the United States. But they're already here. As an example, for one quarter of the adult population in Los Angeles, excessive queues are already very much a fact of life.
July 23, 2007
UnitedHealth turns to public sector for profits
Those who still insist that health care reform cannot be achieved without continuing to include private insurers should take a closer look at this report.
UnitedHealth, the largest private health insurer, is having problems servicing the private commercial market and so is turning to our publicly financed programs.
July 19, 2007
Hospital consolidation increases disparities in insurance coverage
What is the purpose of our health care system? Is it to create successful business models that fulfill the goals of the American entrepreneurial spirit? Or is it to provide health care for all of the people of our nation?
July 18, 2007
Premium subsidies are not the answer
Amazing. Using government subsidies to cut health insurance premiums in half would reduce the numbers of uninsured by only 3 percent if participation were voluntary. The initial experience in Massachusetts also indicates that mandating participation, even with government subsidies and penalties for non-compliance, also fails to achieve universal health insurance coverage.
July 17, 2007
Health insurance for the 21st Century
Private health insurance was an idea that worked during part of the last century; it will not succeed through the 21st Century. With jobs increasingly service-based and short-term, the large employment-based risk pools that made this insurance system possible no longer exist. Medical care has become more effective and more essential to the ordinary person, but also more costly and capital-intensive. The multiple private insurance carriers that emerged during the last century can no longer provide a sound basis for financing our modern health care system.
July 16, 2007
Rationing under U.S. Medicare and Canadian Medicare
Paul Krugman's comments apply not only to hip replacement, but also to other queue problems reported in Canada, such as cataract surgery, cancer therapy, and non-urgent cardiac surgery. In the United States, these services are provided predominantly under Medicare, our public insurance program.
July 02, 2007
Keep your insurance and lose your doctor
Single payer opponents claim that the government would take away your choice of physician under a program of national health insurance. But do you lose your choice in the traditional, government-run Medicare program? Only if you sign up for a private insurance plan through Medicare Advantage are you limited in your choices of physicians.
June 29, 2007
Assets, debts and health insurance for middle-income families
This paper is an important addition to the dialogue on health care reform. Its primary contribution is that it demonstrates that middle-income families now have too few assets and too much debt to be able to tolerate the additional financial burden of out-of-pocket costs that result from plans with high-deductibles and reduced benefits - plans that are designed to keep premiums affordable.
June 28, 2007
The future is specialists and in-store clinics?
We know how to reduce waste while improving the overall quality of our system. We can eliminate a tremendous amount of administrative waste, due to our fragmented system of financing care, by changing to a single, efficient insurance system. We can improve quality and reduce costs by realigning incentives to support our rapidly deteriorating primary care infrastructure.
June 27, 2007
How many are uninsured?
This does not stop others from manipulating these numbers further. Conservative groups have suggested that many of the uninsured should be ignored for various reasons, and that the uninsured status is only of concern for less than 10 million individuals. Progressive groups have suggested that these counts understate the severity of the problem in that, over a two year period, more than 80 million individuals are without insurance at some point during that time.
Imaging as a proxy for government cost control
There have been some disturbing developments in medical imaging in recent years. There has been an increase in independent, entrepreneurial imaging centers which are not linked to hospitals. Specialty groups that order many scans frequently purchase their own units, providing physicians with even more incentives to order scans. This increased capacity has been demonstrated to increase the number of imaging procedures performed. Elliot Fisher and his Dartmouth colleagues have demonstrated that this increase in volume has not improved outcomes, yet it has decreased value of our Medicare purchasing. It is this over-utilization that is targeted by the reductions in Medicare rates for imaging services.
June 25, 2007
Political status of insurance mandates in California
The California Democratic leadership, Speaker Nunez and President Pro Tem Perata, introduced similar bills, with one very important difference. Though they both included an employer mandate, Perata's bill also included an individual mandate. When it was clear that you cannot require individuals to purchase a plan that they cannot afford, they agreed to drop the individual mandate. But that would leave a few million Californians without coverage.
The political priority of EMRs
Those politicians touting electronic medical records (EMRs) as a major component of their reform proposals should take note of this study. Diabetic patients in family practices that did not use EMRs received better care than those in family practices that did.
June 21, 2007
Woolhandler testimony on uninsured veterans
Woolhandler said the data are sound. She has firsthand experience with the issue as well, she said, because as a physician she has seen uninsured veterans with untreated high blood pressure, diabetes and other conditions.
"It breaks my heart," she said.
June 20, 2007
PricewaterhouseCoopers on cost trends for 2008
When health care costs continue to increase well in excess of the rate of inflation, it seems counter-intuitive to celebrate the success of the role of consumerism in the deceleration of the rate of health care cost increases. Furthermore, is the celebration of the success of consumerism even warranted? Let's look at the four influences identified by PricewaterhouseCoopers.
June 19, 2007
Doctors agree that insurance matters
Most of us cringe when we hear a physician state that being uninsured doesn't prevent access to health care, noting that the emergency room is always available. This survey provides reassurance that most physicians do not share that view. When asked what the one single biggest impediment to access is, two-thirds of physicians state that it is the lack of health insurance. Though it is acknowledged that other factors are also important, being insured is absolutely crucial.
June 18, 2007
Blue Healthcare Bank
When they say it's not about the money, it's about the money.
June 15, 2007
Employers support competing market of benefit administrators
Most of America's largest employers are self-insured for their employee health benefit programs. Rather than insurers, they use benefit administrators in compliance with the Employee Retirement Income Security Act (ERISA), which are exempt from the requirements of state insurance regulators.
June 14, 2007
Actuarial values of individual coverage plummet
No surprise. As has been shown over and over, for average-income individuals either insurance premiums are unaffordable, or out-of-pocket expenses for health care are unaffordable (or both).
June 13, 2007
Why do nurses support Moore's Sicko?
Our nurses really do care about patients. They are in a unique position to recognize the tragedies caused by the barriers to care erected within our fragmented method of financing care, using a multitude of private insurance plans. The nurses have had it.
June 12, 2007
California's Battle of the Blues
If you want to know why the private insurance industry should no longer have a role in financing health care, just ask representatives of the private insurance industry to comment on their competitors.
June 11, 2007
WellPoint delivers on its promises (to Wall Street)
For those of us who continue to fight for comprehensive, affordable health care for everyone, listening to this webcast or reading the transcript is a very painful half-hour experience. WellPoint is 100 percent committed to "delivering on our financial promises to Wall Street."
June 08, 2007
Health insurance after divorce
Everyone should have health insurance coverage, automatically and permanently. It is wrong to require a link to extraneous qualifiers such as employment, location of residence, membership in organizations, age, or, in this instance, continuation of marriage to an individual with employer-sponsored coverage. Requiring such links satisfies the business model of the private insurers, but does so at the cost of leaving many without coverage. This remains one of the most serious flaws in our expensive, fragmented, and highly inequitable method of financing health care.
The Taming of the Queue IV
While Canada moves forward with queue management and fine tuning of capacity, we continue to hang our heads in shame over the financial barriers we place in front of tens of millions of Americans, which prevent access to the most generously funded health care system ever known. And we refuse to act because a humane system that covers everyone might expose us to the alleged threat of preventable queues?!
June 06, 2007
Blue Cross of California's $1 billion leak
If you read the "Undertakings" agreement you will see that it reflects an appropriate distrust of the private insurance industry, that it might not fulfill its responsibilities to its beneficiaries to see that they receive adequate coverage at a reasonable value. No such document would need to be created in a publicly-funded and publicly-administered insurance program. It represents yet more administrative waste resulting from keeping the private plans in play.
June 05, 2007
John Geyman on disease management
This article could not be timelier. In response to growing concerns about the affordability of health care, the political arena is awash with proposals to control health care spending. Unfortunately, because of the timidity of the politicians in confronting the powerful vested interests that are wasting so much of our resources, they are turning to pseudo-solutions such as the commercial variety of disease management.
June 04, 2007
Defining affordability of health care
Although there is no accepted economic definition of affordability, this paper makes an attempt to set an affordability standard for health care by defining what people are willfully paying for health insurance premiums plus out-of-pocket expenses in our voluntary private health insurance market. Presumably, the uninsured are individuals who find these costs to be unaffordable, and many objective studies confirm that the great majority of the uninsured simply do not have the funds to pay these costs.
May 25, 2007
Blue Cross commences health reform war
Blue Cross has led the way in excluding from coverage individuals with potential health risks, in rescissions for those who do submit claims, in shifting more costs to patients through aggressive marketing of high-deductible plans, in marketing stripped-down coverage such as the TONIK plans for the young invincibles, and in marketing strategies that avoid high-cost employer-sponsored groups.
May 24, 2007
Towers Perrin update on HSAs
Towers Perrin states that the future of [account-based health plans] ABHPs may be in question if employers do not clear up this alleged confusion on the part of their employees. It is much more likely that Towers Perrin is confused if they really believe that gaining support for ABHPs is merely a matter of employee education. In reality, the employees are not confused. They understand the effort to con them through this ABHP snow job, and they don't like it.
May 23, 2007
The AMA on Medicare Advantage
So the AMA supports adequate funding of the traditional Medicare program and opposes "a federal handout to the insurance industry," especially when the experience of physicians is failing to match the pro-market rhetoric of the private insurance industry.
May 22, 2007
All children, or everyone?
The SCHIP enrollment lessons are quite clear. If we really do want to have all children insured, enrollment must be completely automatic for every child. That will never happen with a fragmented system of multiple public and private plans with varying thresholds of eligibility and changes in eligibility status.
May 21, 2007
Health policy lessons from Indiana
Indiana likely will end up providing coverage for less than one-tenth of their uninsured residents, but with coverage that is inadequate and still unaffordable for most. Lack of a mechanism for automatic enrollment, continual changes in eligibility status, and a funding source which is capped will further destabilize the pool of individuals covered by this program. This patchwork program is not worthy of being labeled "reform."
May 18, 2007
California family physicians support single payer
Although this is not a scientific poll, it does demonstrate strong support by family physicians for single payer reform.
Feasible or not, the revolution is coming.
May 17, 2007
Regence BlueShield's bait-and-switch
Some years insurers will hold their premiums down in order to gain market share. After their enrollment increases and their competition is diminished, they then raise premiums sharply to recover deferred profits plus provide an additional generous profit margin for current insurance sales. Wall Street dignifies this process by calling it the insurance underwriting cycle, but it is nothing more than a devious bait-and-switch scheme.
May 16, 2007
Marsha Gold on Medicare Advantage and the market
Paying these private, fee-for-service Medicare Advantage plans 119 percent of the costs of the traditional Medicare program, and then pretending that this represents market competition, is utter nonsense.
U.S. health care ranks last again
To really understand this report, you do need to read it in full. Based on the performance measures surveyed, of the six nations studied, the United States does have the least equitable and most expensive system, and places last in overall ranking. Clearly, the American health care system is NOT the best in the world.
May 14, 2007
Blue Cross settlement on rescission
The purpose of rescission is to prevent individuals from obtaining a free ride by not purchasing insurance while they are healthy, but then purchasing it when a major problem develops. For insurance to work, the healthy have to pay into the risk pool to cover the costs of the sick.
May 11, 2007
New polls on universal, tax-supported health care
If these poll numbers were cast at the ballot box, this would constitute a clear mandate from the American public. So why do we keep hearing that national health insurance is not politically feasible?
May 10, 2007
Is SCHIP reauthorization enough for now?
About two-thirds of Americans now believe that we need comprehensive reform of health care financing to make health care affordable for everyone. Yet incrementalists, those currently in control of Congress, say that we should take care of children first. What politician would go on recored as opposing health care for children, especially when their health care costs are quite low?
May 09, 2007
EPO and market competition
In financing health care, the United States depends more on market forces while other nations utilize greater government oversight. The EPO story demonstrates that even physicians, when offered a legal, lucrative business deal, will modify their practice patterns to increase profit, even though those market incentives may work to the detriment of their patients' health. It is easy to ignore outcomes and talk about "healthier hemoglobins" when the financial rewards for doing so are great.
May 08, 2007
Private insurers depleting Medicare Trust Fund
In the traditional Medicare program, profits for health plans are not a consideration since middlemen do not even exist. Nor does the traditional Medicare program need to deal with marketing expenses and other superfluous administrative excesses.
Congress insists that private plans are necessary to help prevent the "bankruptcy" of the Medicare Hospital Insurance Trust Fund. Yet their private solution for a government problem, according to Medicare's own actuary, is speeding up the depletion of the Trust Fund.
May 07, 2007
Steve Burd's Coalition to Advance Healthcare Reform
Burd's proposal is an individual mandate to purchase unaffordable or inadequate private insurance, using regressive tax policies, with greater administrative excesses of care management programs, and it depends on the
fiction of consumer cost management through transparency.
April 28, 2007
Kennedy/Dingell Medicare for All Act
Congressman Dingell and Senator Kennedy for decades have been leaders in the effort to obtain comprehensive health care coverage for everyone. The introduction of their Medicare for All Act is a very welcome addition to the national dialogue on reform. Their proposal would result in a definite improvement over our current dysfunctional system of financing health care. That's the good news.
So what could be bad about this? Well, first a brief word about the respective roles of those of us involved in the health care reform movement. John Dingell and Ted Kennedy are politicians, in fact, master politicians. Their role is to negotiate the political process, carefully traversing the minefields, to make reform a reality.
April 27, 2007
Presidential candidates on health care reform
The American people are ready for reform. What we now need is leadership.
Only one of these leading candidates has a serious proposal for reform, and that is John Edwards. Of other candidates, Dennis Kucinich has a proposal that is already before Congress, HR 676, which has 67 cosponsors in the House. In fact, HR 676, by providing affordable, comprehensive health care for everyone, is the golden standard against which all other proposals should be judged.
April 26, 2007
Reinhardt does the math on HSAs
Dr. Reinhardt's objective analysis provides us with a more than adequate basis for booting from the forums on reform the HSA advocates who would require those feeling physical pain also feel fiscal pain. Once they are out of the way, we can then get serious about reform that actually benefits patients.
April 25, 2007
Small businesses support national health insurance
Small businesses have been struggling with the costs of health insurance, and the problem only grows worse. In fact, in the past 15 years, the percentage of small business owners even offering health insurance to their employees has dropped from two-thirds to two-fifths.
April 24, 2007
Wal-Mart's version of affordable access
The Wal-Mart clinics actually will improve accessibility to the limited services that they offer, and do so at affordable rates. But the clinics would further fragment services that should be provided at the primary care medical home. They skim off the easy, low-cost, bread-and-butter medical services that help pay the overhead expenses of primary care practices. They also fragment patients' medical records, such as creating uncertainty as to their immunization status, uncertainty in monitoring of their chronic diseases such as hypertension and diabetes, and uncertainty as to medication compliance and drug incompatibilities. These clinics threaten to accelerate the further demise of the medical home.
April 23, 2007
WellPoint advocates shift to underinsurance
To survive, the private insurers must continue to restrict their markets to the healthy, while supporting public policies that shift the real costs of health care to the taxpayers. Also, and this should set off alarms throughout our nation, they must continue to create more products that are affordable for the healthy by dramatically reducing the financial security that health insurance should be providing. Since their administrative costs are fixed or even increasing (selling new administrative products such as disease management, HSA administration, credit card services, etc.), the reduction in premiums must come from a greater reduction in benefits paid out for health care services.
April 20, 2007
Paul O'Neill wants an honest discussion on reform
It is refreshing to hear such words coming from a prominent Republican member of the business community. He is explicitly calling for providing health care to everyone (as a right), through a common health care fund (pool), paid for equitably (an obligation of the better off), and achieving it through an honest political process (give us the truth).
April 19, 2007
Employers flip labels in vending machines
Large employers do want to be relieved of the burden of very high health care costs. Most recognize that it will require a national solution, and that the government will have to play a significant role. The stumbling block is that they have not yet conceded that we must reform financing by adopting a universal program of social insurance, even though a national, government solution, by definition, is, basically, social insurance.
April 18, 2007
Canada controls costs without compromising health outcomes
The important policy lesson: Canada's government-funded and government-administered single payer system dramatically reduced their rate of health care cost increases without having a negative impact on health outcomes. The cost savings alone is a compelling reason to adopt a national health insurance program in the United States.
April 13, 2007
Andy Grove on electronic medical records
We can't allow the debate on health care reform to be hijacked by those who would suggest that electronic information systems are the answer, perhaps along with expanding the children's health insurance program.
When the politicians extol the virtues of information technology, remind them that they're off topic. They need to tell us how they would reform health care financing for all of us.
April 12, 2007
Jonathan Cohn pretends to oppose single payer
This is a part of the continuing dialogue this week on TPMCafe Book Club, led by Jonathan Cohn, timed with the release of his new book, "Sick: The Untold Story of America's Health Care Crisis--and the People Who Pay the Price."
April 11, 2007
Influence of out-of-pocket costs on physicians' decisions
This is yet one more study which demonstrates that attempting to control costs by requiring patients to pay more out-of-pocket when accessing health care has only limited impact on the more complex services which account for most of our health care spending.
April 10, 2007
TPMCafe on Jonathan Cohn's "Sick"
This week, TPMCafe Book Club features an ongoing discussion on health care reform led off by Jonathan Cohn, timed with release of his new book, "Sick: The Untold Story of America's Health Care Crisis--and the People Who Pay the Price."
April 09, 2007
Insured, but claim can be denied for recreational injury
Think about this for a minute. Private insurers have found a loophole that would allow them to refuse to pay for medical care for an individual for whom they have provided coverage and collected premiums. They don't even have to refund the premiums. They merely make an arbitrary judgement that their insured shouldn't have engaged in hazardous recreation, and decide that they shouldn't have to pay for care for injuries that result from those activities.
Australia's Medicare and private plans
Australia's experiment with a public Medicare program and private insurance plans has provided a very important policy lesson for the United States: Establishing policies that encourage the purchase of private insurance while simultaneously limiting the funding of public insurance will inevitably result in a two-tiered system. More affluent individuals will have the best care money can buy, whereas those remaining in an underfunded public program will have impaired access and impaired health outcomes. Keep in mind that impaired health outcomes means chronic suffering and death.
April 05, 2007
Uninsured have increased rates of stroke and death
Lack of health insurance maims and kills. How can anyone with the slightest sense of decency state that that is meaningless?
April 02, 2007
Can we set ideology aside?
The pressure is on for health care reform, and politicians and the policy community clearly understand that. The consensus seems to be that everyone should have the health care that they need, without having to face the added burden of financial hardship. That is a view from the political left that is now shared by an increasing number of moderates and even some from the right.
March 29, 2007
Pew report on political values and core attitudes
This highly credible report does confirm that there has been a genuine shift in political values and core attitudes of the American public. Increasing concerns about personal financial security and about the plight of the disadvantaged add further support to the prevailing view that we have reached yet another point in history wherein comprehensive health care reform may be achievable.
March 28, 2007
Administrative costs of tax credits
One of the more important objections that many of us have had to the concept of using tax credits to help with the purchase of private insurance is that it would add to the administrative burden of a system already sinking from administrative overload. This study confirms that the increased administrative costs are not merely theoretical, but are very real.
March 27, 2007
Association-sponsored coverage plummets
How many more examples do we need? Segregated health insurance risk pools are not effective for financing care of those individuals who have significant health care needs. We desperately need to establish one single risk pool, include everyone, and fund it equitably.
March 26, 2007
The Sacramento Bee on pooling risk
The Bee's editorial board understands: "What is important is to throw everyone into the pool."
Segregated pools of healthy individuals won't do it. Yet that is the specialty of the private insurance industry - pooling risks of the healthy workforce and their healthy families.
March 23, 2007
Extra benefits of Medicare Advantage plans
To advance the conservatives' agenda of privatizing Medicare, private health plans had to be enticed to submit bids by being offered an average of an additional twelve percent over the costs of providing care within the traditional FFS (fee-for-service) Medicare program. In turn, the private plans could use a modest portion of this higher payment to offer greater benefits to entice patients to join the plans. It worked.
March 22, 2007
The illusion of private insurance coverage
This report is important. It shows through the personal experiences of real people the severe deficiencies of our private insurance plans. Those who have significant health care needs are sounding the alarm for many of the rest of us who are complacent in believing that our private plans will provide us with adequate financial protection should we ever need to rely on them. Sadly, this report confirms that today's health insurance plans frequently provide only the illusion of coverage.
March 21, 2007
Less satisfaction with publicly-traded insurers
Investor-owned, publicly-traded health insurance companies provide a lower level of "customer satisfaction" (this is a J. D. Power study) than do non-profit BlueCross BlueShield and other privately held companies.
March 20, 2007
UnitedHealth sets standards for market success
And our national policies are designed to keep big government out of our health care and allow market forces to play out? If you step back and look at how Medicare functions and then look at how UnitedHealth and the other private insurers function, how could anyone seriously contend, when it comes to health insurance, that big market forces provide greater value than big government?
March 19, 2007
Accepting new patients based on payment source
Most office-based primary-care physicians are accepting new patients, but they understandably are concerned about the prospect of receiving adequate payment for their services.
How many of these physicians do you believe enjoy making practice policy decisions based on various potential payment sources? Doesn't it seem logical that physicians would prefer to make decisions based strictly on the patients' health care needs, without having to consider how the care is to be funded?
Massachusetts' "humane exemption" from universal coverage
Does universal mean everyone? Or does it mean everyone, except for those who cannot afford health care access because we insist on a convoluted model of reform that is designed to preserve the interests of those very entities most responsible for the intolerable injustices of our high-cost health care system merely because the politics of protecting those interests are more easily negotiated than the politics of obtaining affordable health care for everyone?
March 16, 2007
Watson Wyatt on employer costs and CDHPs
This report from the industry confirms that more employers are offering high-deductible health plans (HDHPs), and in some instances as the only option for the employee. Many employers are not including the other component of consumer-directed health plans (CDHPs) - health savings accounts (HSAs).
March 15, 2007
Bush administration rejects citizens' health care recommendations
Quoting from the final report of the Working Group: "The overriding message was consistent across every venue we explored: Americans should have a health care system where everyone participates, regardless of their financial resources or health status, with benefits that are sufficiently comprehensive to ensure access to appropriate, high-quality care without endangering individual or family financial security."
March 14, 2007
Underinsurance is bad for your heart
Do barriers make a difference? Emphatically, yes. As an example, this study confirms that victims of heart attacks have worse outcomes when they have financial barriers to followup care and medications.
March 13, 2007
High deductibles are bad for children's health
High-deductible health plans are bad for children's health. The Academy should be condemning these plans and supporting comprehensive solutions that would enhance the health of the nation's children. A national health insurance program would not only cover preventive services, but it would also remove financial barriers to beneficial acute and chronic health care services.
March 12, 2007
Swiss voters reject single payer
In evaluating health care reform proposals, one of the first questions individuals ask is, "What is it going to cost me?"
The Swiss organization representing Switzerland's private health insurers, santésuisse, was ready with an answer. Although the measure would require that premiums would be set according to a person's economic capacity (means tested premiums), santésuisse made the assumption that lower-income individuals would have smaller premiums or no premiums, whereas the wealthy would not have an increase in premiums. The impact of that would be to shift most of the cost of reduced premiums to the middle-income citizens.
March 09, 2007
Jonathan Gruber on the RAND HIE
Dr. Gruber states that the RAND Health Insurance Experiment (RAND HIE) has been "conveniently misinterpreted by parties on both sides of the debate." He then takes one side, stating that the lessons are that "medical care is price sensitive," that "on average, the extra medical care consumed by those who received care for free had no beneficial impact on health, but that "there were some health benefits for low-income, chronically ill populations." It would be incorrect to characterize this as a misinterpretation, because these statements are, "on average," true.
But there is another side as to the importance of the findings of the RAND HIE, which also should not be characterized as a misinterpretation.
March 08, 2007
Humana shifts risk to competitor
In the business world, premium increases due to adverse selection are known as the death spiral, which results in withdrawal of those insurance products from the market. Humana escaped from its death spiral by forcing a new death spiral on a competitor. As a result, comprehensive Part D coverage will no longer be available for those with very high drug costs. The business model works for the investors, but not for the patients.
March 07, 2007
AFL-CIO statement on comprehensive reform
To repeat, "Universal health care does not mean mandating that everyone must buy a health insurance policy and then handing them the bills."
It means abandoning the "incredibly ineffective piecemeal approach of the past 10 years," and moving forward with meaningful reform that meets the tests of an equitable, efficient, high quality, affordable, comprehensive system that covers everyone.
March 06, 2007
The Des Moines Register on mandating private insurance
This is the message that the nation must hear. The private insurers are incapable of providing us with coverage that is both affordable and effective in preventing financial hardship for those with health care needs.
March 05, 2007
Massachusetts redefines "affordable"
At an average premium of $305 per month, plus a $2,000 deductible, a person earning $29,400 per year must pay $5,660 before receiving help with medical bills. That leaves less than $2,000 per month to live on. That's affordable?
March 02, 2007
Public opinion on health care reform
Polls continue to show that Americans are very concerned about the problem of the uninsured and about our high health care costs. They believe that the government should guarantee insurance for everyone, and a clear majority are even willing to pay more taxes to accomplish that.
March 01, 2007
Medicare Advantage private fee-for-service plans
If the private fee-for-service plans work like the traditional Medicare program, then why is the government paying them 119 percent of the costs of the traditional program? That's much more than the other Medicare Advantage plans receive. Weren't the private sector plans authorized because they would be much more efficient than the traditional Medicare program run by a government bureaucracy? Aren't they supposed to be saving the taxpayers money?
February 28, 2007
What every policy expert knows, but won't say
Request to the policy community: Please come out of the closet. We need you!
February 27, 2007
Aetna perfects cream skimming for Medicare Advantage
Cream skimming? Well, let's see.
Aetna has designed these plans to resemble their Medicare Advantage plans. By enrolling individuals in the decade before Medicare eligibility, presumably the patients will become comfortable with their Aetna physicians and want to continue with them under the Medicare Advantage version. Aetna makes the transition very easy by making enrollment essentially automatic unless the beneficiary specifically elects to opt out.
February 26, 2007
Is Medicaid Sustainable?
This study indicates that growth in government revenues will be adequate to sustain the Medicaid program for the coming decades. The immediate policy implication is that current political attacks on Medicaid as an "unsustainable" program are not warranted. Until we are ready to adopt a more efficient and effective health care financing system, it is important to protect Medicaid from efforts to further underfund the program.
February 23, 2007
Business Roundtable is ready?
In spite of a flurry of new reform proposals, there are really only three basic options: (1) single payer national health insurance, (2) expansion of our public programs and private health plans, and (3) continued gridlock while tweaking the welfare programs.
February 22, 2007
Reform plan of investor-owned hospitals
The Federation of American Hospitals represents investor-owned hospitals. Their plan would provide relief from the need to continue to provide uncompensated care, especially for lower-income individuals. No surprise here. The interests of the investors must be protected.
February 21, 2007
Health care spending for 2007
"This year, 2007, we are spending over $2.2 trillion on health care, which is 16.2 percent of our gross domestic product. That amounts to $7,500 per each person in the United States."
February 20, 2007
Important links to Mayes and Berenson's "Medicare Prospective Payment"
A recent Quote of the Day message discussed the new book, "Medicare Prospective Payment and the Shaping of U.S. Health Care," by Rick Mayes, Ph.D. and Robert Berenson, M.D. The authors have demonstrated that Medicare has not only slowed the excess growth in health care costs, but has actually improved quality and efficiency and has an even greater potential to further expand on health care value.
February 19, 2007
Bernanke on health care reform
It is unfortunate that Federal Reserve Chairman Ben Bernanke used the framing of the conservatives to define the problems with our health care system, as he seemed to stumble through an explanation of why we need more market competition in health care. He might have been more convincing had he used the framing of his Princeton colleague, Paul Krugman.
February 16, 2007
Excess administration of administrative excesses
Let's see. Our health care system is plagued with highly burdensome, expensive, inefficient, wasteful administrative excesses due to our ineffective, fragmented system of financing health care.
February 15, 2007
UnitedHealth's lab contract disruptive
Except for single payer (Medicare for All), most of the leading proposals for reform would require individuals and/or employers to contract with this uncaring, wasteful, middleman insurance industry in order to gain access to health care.
February 14, 2007
Instability of federal employees' premiums
So you would like to have the health care coverage that members of Congress have - even if that means that your premium could increase 50 percent in one year?
It's important to understand the Federal Employees Health Benefit Program (FEHBP) since many reform proposals recommend using similar private plans to expand coverage to everyone. The plans are mostly PPOs and HMOs. They do vary in their benefits and in their required cost sharing. Consequently, premiums vary considerably.
February 13, 2007
Genetic discrimination by insurers
Should genetic information ever be used to deny an otherwise healthy person health care coverage? Should actual genetic disease ever be used to deny a person health care coverage? Is there any reason at all to separate genetic information from medical information in making decisions about health care coverage?
February 12, 2007
Restructured health insurance for So. California grocery workers
In this age of two-worker households, employment as a grocery worker provided a very important benefit. Not only was the job a good second income source, it also provided the family with generous, union-negotiated, employer-sponsored health benefits coverage. This allowed the spouse greater options in employment, including self-employment, as quality and availability of employer-sponsored coverage continued to decline.
February 09, 2007
Urban Institute report on SCHIP
The State Children's Health Insurance Program (SCHIP) continues to fall far short of its goal to insure all lower-income children who qualify. The fact that uninsurance in children is on the rise again suggests that the SCHIP program may have reached its fully predictable steady state in which attrition in enrollment offsets new gains.
Expanding uninsurance through premiums
As long as individuals are required to pay some portion, if not all, of the premium for health insurance, take-up will never be 100 percent. Even with an individual mandate to purchase insurance, take-up will still not be 100 percent since too many individuals simply do not have the funds to pay the required contribution.
February 07, 2007
Buy or die
Massachusetts is proving to the rest of the nation what we already know: the traditional model of a multitude of private insurers is obsolete.
February 06, 2007
Migration of Canadian physicians
How often have you heard that Canadian doctors are fleeing en masse their disastrous health care system? Besides being a gross distortion, the numbers have actually been declining, and, in the last two years, the migration has actually reversed. More Physicians are moving into Canada than are leaving.
February 05, 2007
Harry and Louise on John Edwards' plan
One of the more important reasons that John Edwards wants to be president is that he really wants to reform health care.
February 02, 2007
How would single payer control costs?
A single payer system, such as the proposed Medicare for all, would have the very powerful economic advantage of being a public monopsony: the single purchaser of health care. Although private monopsonies raise havoc in marketplaces, monopsonies owned by the citizens play a much more beneficial role. The mission of a publicly-owned, single payer monopsony would be to obtain the best health care value for all of us. That means not only reducing waste and inefficiency, but it also means providing adequate resources to develop and maintain the necessary health delivery infrastructure and to attract dedicated professionals that provide our care. It means obtaining truly beneficial care at the fairest prices.
February 01, 2007
Maine provides another lesson - for failure
When the Maine legislature passed the Dirigo Health bill in June, 2003, it was hailed as a bill that promised "affordable coverage to all Mainers." A Quote of the Day message at that time stated that the policies developed sacrificed "the goal of an affordable, comprehensive and truly universal system."
January 31, 2007
A Connecticut lesson for state reformers
The "single plan" above technically is not a single payer proposal since it leaves Medicare in place, and it defines benefits as those typical of employer-sponsored plans. But it does include important features of the single payer model in that everyone is automatically enrolled, and the plan is administered by a state commission. Thus the impact demonstrated by the modeling of the "single plan" approaches that of the the beneficial effects previously demonstrated by other studies modeling bona fide single payer plans.
January 30, 2007
Gov. Corzine will call it "a universal system"
Quick! Which was the first state to enact a universal system?
Those of you who have been working on health care reform for many years likely came up with Hawaii. Yet you don't hear much anymore about Hawaii's universal system. Why is that?
Soon after the enactment of Hawaii's health insurance law in 1974, those lacking insurance dropped to 2 percent. Now it's about 10 percent. Enough said.
January 29, 2007
Fixing insurer rescission
Who is the bad actor here? Is it the insurer that rejects a claim and rescinds an insurance policy based on a look-back at the application process to see if an error, omission of false statement can be discovered that would allow the insurer to back out of this agreement? Or is it the insured individual who either made an honest error or omission, or, out of desperation for coverage, avoided full disclosure on the medical history form?
January 26, 2007
Mayes and Berenson on Medicare Prospective Payment
Getting health care spending right means balancing the need to provide adequate funding to ensure patient access to beneficial services, while limiting spending to covering legitimate costs and fair profits for the delivery system.
Mayes and Berenson have demonstrated that Medicare has been quite effective in this endeavor, whereas the private sector has largely limited its role to following Medicare's lead. In fact, the private sector's experiment with managed care demonstrated that they could achieve payment control only by distorting this balance, which impaired patient access and failed to establish compensation tied to legitimate overhead plus fair profit.
January 25, 2007
Buying only the insurance you need - Tonik
Many contend that individuals should no longer have to pay for insurance benefits that they will never use, but instead they should insure themselves only for the risks that they are more likely to experience. An example of this coverage is the Tonik program for young, invincible thrill seekers. Use of high deductibles in a young, healthy population can keep premiums affordable. Is this wise from the policy perspective?
January 24, 2007
Thomas is the Canary in the Health Care 'Coal Mine'
The private insurance model is fundamentally different from a universal, publicly-funded social insurance model. The former works well for the healthy, but not so well for the sick and injured; the latter always works for everyone. When will the nation finally learn this lesson?
January 23, 2007
Reform lesson from Massachusetts
It is astonishing that former Gov. Romney and the Massachusetts legislature are basking in the glory of having enacted a universal health program for the state, considering the process that is taking place.
January 22, 2007
The president's new reform proposal
By giving every family with health insurance a $15,000 deduction from their taxable income, the president provides incentives to buy less expensive plans, since the tax benefit is the same for the cheapest plan and every other plan up to a value of $15,000.
January 19, 2007
TNR Editorial on Compromise
The voices of compromise are very loud right now. Ours must be heard loud and clear above the din.
January 18, 2007
Proposal of the Health Coverage Coalition for the Uninsured
What a tragedy. Health care coverage, affordability and access are rapidly deteriorating at an accelerated pace, and this is the best that this coalition of influential organizations can come up with.
January 17, 2007
Credit cards and the "medically indebted"
Affordable, stripped-down private insurance options will further compound debt problems for patients. Comprehensive private plans are not a solution either, because those plans are unaffordable. A family policy is now 18 percent of median family income!
January 15, 2007
AHRQ Disparities Report
Multivariate analyses suggest that uninsurance is an important mediator of racial, ethnic, and socioeconomic disparities, although race, ethnicity, and socioeconomic position often have independent effects as well.
January 12, 2007
Realtors face health care crisis
Small business employers and the self-employed, including real estate firms and agents, are facing a growing challenge in accessing and providing affordable health insurance, Pat Vredevoogd Combs, president of the National Association of Realtors, told a congressional panel today.
January 11, 2007
Jacob Hacker's "Health Care for America"
His proposal does not break new ground in health policy. He has merely combined various concepts that have been under consideration for some time. What is very different about this proposal is that the design features comply with the perceptions of most Americans as to how they want our health care to be financed. It is just possible that he may have crossed the threshold of political feasibility.
January 10, 2007
The truth about health savings accounts (HSAs)
[T]he report exposes HSAs for what they really are: powerful tax-advantaged savings vehicles for the wealthy.
January 09, 2007
Gov. Schwarzenegger's health care proposal
Affordability and cost containment are crucial to reform. But what does the governor offer? He would require that insurers and hospitals limit their administrative costs and profits to 15% of premiums paid. The current administrative waste is due to our fragmented system of financing health care, and he would do nothing to bring about the structural reform required. It will be very difficult to reduce the 31% spent on administration without an efficient system such as single payer.
January 08, 2007
Private insurers deny individual coverage based on occupation
Protecting the markets for private plans is terrible when it is done so by destroying the risk pooling function of insurance. Policies that create intolerable financial burdens for those with health care needs are the opposite of what we should be striving for.
January 05, 2007
Gov. Schwarzenegger must tackle the private insurers
California, led by the efforts of Gov. Schwarzenegger, is now tackling the difficult problem of covering the 6 million uninsured. Jamie Court and Judy Dugan of the Foundation for Taxpayer and Consumer Rights make the case that all Californians should be granted access to the well-run, low-overhead CalPERS program. How well would that work?
January 04, 2007
Private health insurance is a drag on the economy
Let's see. Hundreds of thousands or even millions of people nationally are denied health insurance coverage because of their prior medical histories, even for trivial disorders. That seems like a problem.
So what solution is California considering? They are attempting to establish specific guidelines for the insurers in order to protect them from penalties when they rescind coverage for individuals who successfully negotiated their underwriting process, but then obtained care for injuries or illnesses often unrelated to any preexisting problem.
January 03, 2007
U.S. has highest spending rate increase
For policy analysts, the most important exhibit in this report demonstrates that the United States has not only had the highest percentage of GDP devoted to health care, but we also continue to have the highest percentage point increase in total health expenditures as a share of GDP. Although there has been some slowing of the rate of increase since 1990, ours is still the highest.
January 02, 2007
Insurers say they have to be picky
In the debates on health care reform, those supporting private insurance solutions are frequently confronted with the problem of those denied coverage due to medical underwriting. Their glib answer usually cites the various state high-risk insurance pools that, though not perfect, take care of that problem. Most audiences accept that response and move on. But should we?
December 29, 2006
Lessons for 2007
Wise lessons for 2007... and beyond.
December 28, 2006
The Washington Post on the feasibility of single payer
The significance of the publication of this letter and the editorial on which it is based cannot be understated. Although very subtle, the national dialogue on reform has changed.
December 22, 2006
Private insurance risk pooling in Ireland and U.S.
What is the primary function of health insurance? Pooling risk. All participants make an equitable contribution into the pool of funds that pay for health care for everyone. Disease and injury can never be equitably distributed, but the financial consequences can be.
December 21, 2006
Shiraz insurance? (proper framing, part 2)
How many times have you heard this ridiculous food insurance argument? Though it makes most of us angry, the opponents of reform keep bringing it up. Let's review the lessons from yesterday's message on framing.
December 20, 2006
Get real! (by proper framing)
In the example, Dr. Geller has linked together, in a single frame, dismissing the role of government in health financing and relying on individual responsibility. Without entering his framing of rights and responsibilities, we have destroyed his credibility by exposing his fallacies - that the United States is not "economically equipped" for the task, and that personally assuming the financial burden of health care incredibly improves health, when all of the data is to the contrary.
December 19, 2006
Can we learn from Oregon?
The most difficult problem that Oregon and all other states have faced is the continuing escalation of medical costs. Now that there seems to be a growing political consensus that comprehensive reform must occur at the state level, we need to ask whether the states would be capable of stabilizing the system by controlling costs.
December 18, 2006
Would Europe's health-care-for-all model work here?
Would Europe's health-care-for-all model work here? Since no two European nations have the same model, the question really is whether an insurance program that covers everyone would work in the United States. Since we already spend far more per capita on health care than the European nations, there is absolutely no doubt that a properly designed universal insurance program would work as a "health-care-for-all" model (or Medicare for All).
December 15, 2006
Change players or rules?
In commenting on the move of commercial insurers into our public programs - Medicare and Medicaid - Marsha Gold has made it clear that cost problems will not be solved by merely changing the players when the rules of the game need to be changed.
December 14, 2006
Lewin Group analysis of Sen. Wyden's plan
Sen. Wyden's proposal is an individual mandate to purchase private health plans. Much has been written about the flaws of such models, and no attempt will be made to address most of those issues here. Rather only one serious fundamental flaw in the application of economic theory will be discussed.
December 13, 2006
The shocking extent of underinsurance
This is not a study of the numbers of uninsured (we already know those numbers), nor is it a study of the numbers with inadequate insurance or underinsurance (we don't know those numbers). Rather, it is a study of the numbers of individuals under 65 who experienced financial hardship in a single year because their health care costs were greater than our health care financing system was capable of protecting against. It is not a study of the potential risks, but rather it is a study of actual financial harm done.
December 12, 2006
Insurance broker fraud
Health care injustice is not only tragic, it is also infuriating when it is due to criminal misdeeds of entrusted advisors. But the problem of dishonest insurance agents is negligible compared to the problems inherent in the way individual plans are marketed and sold. It is the honest, ethical agents who are trying to do their best for their clients who are the real problem, though through no fault of their own.
December 11, 2006
Robert Gumbiner on single payer
What is remarkable about this quote in support of single payer is its source: Robert Gumbiner was the founder of FHP, one of the nation's largest managed care companies.
December 08, 2006
No funds for children's insurance, only for HSAs for the rich
It is stunning that as one of its final acts, Congress chose to attach to the tax extenders bill a provision making Health Savings Accounts more lucrative as tax shelters for wealthy individuals even as Congress refused to provide funds needed to ensure that up to 600,000 low-income children keep their health insurance through the State Children’s Health Insurance Program in 2007.
December 07, 2006
OneCare single payer video
The OneCareNow campaign is designed to inform the citizens of California about the advantages of single payer reform and Sen. Sheila Kuehl's legislation to enact it. Although SB 840 was vetoed by Gov. Schwarzenegger, it will be re-introduced in the next legislative session.
December 06, 2006
Public and private spending in Canada and the United States
Do not let anyone ever again claim that the new taxes required to fund a single payer system would require an intolerable drain on the economy. We are already paying those taxes, and the economy has not suffered as a result.
December 05, 2006
Physicians, hospitals and quality
A well functioning health care system continues to strive for optimal value. That requires balancing efforts to maximize quality while controlling spending. (Some suggest that access is a third variable, but access to appropriate services and facilities should be a given.)
What role should money play in achieving this balance? Should providers receive explicit financial rewards for meeting quality goals that should be expected as part of the individual's professional duties? Should providers (physicians) receive explicit financial rewards merely for reducing another provider's costs (hospitals)?
December 04, 2006
Private plans pay so little for so many
So two-thirds of health care spending already is through our tax system. Percentage-wise that is close to what most other nations with universal systems pay in public funds. Thus the contention that we cannot afford the taxes to pay for a universal system is untrue; we are already paying them. We merely need to establish a financing system that would spend these same funds much more efficiently so that we can include everyone.
December 01, 2006
Is San Francisco's reform a model for the nation?
San Francisco's intent to bring health care to everyone is certainly admirable. That said, there are so many complex policy flaws in our current system of financing health care that it is impossible to address them on a city-county basis (San Francisco's unique form of government).
November 30, 2006
Can the uninsured afford insurance?
The conservatives imply that the only real problem is the modest number of low-income adults, mostly without children, who cannot afford coverage. They suggest that all we need to do is to make available refundable tax credits limited to the poor, and the problem of the uninsured would largely vanish. What is the reality?
November 29, 2006
Make corporate executives sensitive to their own health carecosts?
Corporate executives, of course, are sensitive to health care costs - of their employees. But the question they should be asking themselves is, "Should we be controlling health care spending by making beneficial services for our employees unaffordable, or should we act like the businessmen we are and support structural reform of health care financing that would make the comprehensive health benefits that we receive affordable for everyone?"
November 28, 2006
DrSteveB's single payer blog on Daily Kos
Many have suggested that we need a blog on single payer health care reform. Well, it's here.
November 27, 2006
Will Congress reform health care?
Is covering everyone an idea that is only half right? Is funding health care equitably so that it is affordable for each individual an idea that is only half right? Is improving efficiency by reducing administrative waste an idea that is only half right? If the right solution means that we fix the financing of health care so that it works for everyone, then we really do understand how to do that.
Cigna sticks it to entertainers
A $29,820 annual premium for family coverage!? And we have "robust competition" to thank for this?
November 21, 2006
Medicaid coverage worse than private insurance?
It is important to understand this study because it will be used by the opponents of government health insurance programs to "prove" that private plans provide higher quality care and improved health care outcomes compared to government programs.
Perhaps the most important point to note is that private plans were contrasted with two different government programs - Medicaid and Medicare - and the conclusions were that only Medicaid was associated with worse outcomes, and Medicare was not.
November 20, 2006
The catastrophe of cancer - money or health?
How many times have you heard the opponents of health reform say that insurance should not pay for an oil change for your automobile, nor for a bag of potato chips at the supermarket? They contend that the only purpose of insurance is to indemnify an individual against catastrophic financial loss.
November 17, 2006
AHIP's welfare plan for private insurers
AHIP, representing the nation's private insurers, is currently being lauded for taking a leadership role in promoting policies encouraging universal access to affordable health care coverage. Are the accolades warranted?
November 13, 2006
Major impact of small shifts from adverse selection
This study demonstrates the simple fact that shifting a very few high-cost patients from one insurance pool to another (adverse selection) can have a very dramatic impact on the premiums that must be charged to cover health care costs for the pools.
November 10, 2006
PPOs' pattern of underpayment
If a government-run single payer program reduced compensation by two dollars, it would have done so, by design, only after negotiating and reaching an agreement with the providers. Apparently private insurers use market arguments to operate on a different ethical plane. If you are caught violating the terms of a contract, then the marketplace will take care of that. Or will it?
November 09, 2006
Court upholds insurer's fine print
"Caveat emptor" is an axiom in commerce that the buyer alone bears the responsibility for purchasing decisions. As long as we leave the private insurance industry in charge, it is an axiom that applies to health care financing.
November 08, 2006
Elections and health care reform
So this election wasn't about health care reform, but the next one can be. Get to work!
November 07, 2006
Deterioration of employer-sponsored coverage
The insurers in the individual market have survived by introducing products with affordable premiums, but they have been able to do so only by sharply curtailing the financial security offered by these plans (by reducing benefits and increasing cost sharing). These plans have provided a (false) sense of security for those who remain healthy, but they have defeated the purpose of insurance by creating financial hardships for those with significant health care needs.
What's good about a 5 percent cut in physician payments?
As is typical for this administration, this release places a very positive spin on the message that announces a 5 percent reduction in the payment for physician services. For those who believe that they read that payment for an intermediate office visit is increasing by 37 percent, read it again. The 37 percent increase applies only to the work component (physician labor) and not to the practice expenses (office overhead).
Action and Reaction
By Matthew Holt | Spot On Blog | San Francisco | Nov 6, 2006
Back in the day when there was some vague interest from Democrats in fixing our health care system, a kindly millionaire gave a pile of money to a lobbying pressure group that had quite some influence behind the ill-fated Clinton Health Plan. Not too much has been heard since from Families USA and its leader Ron Pollack. Sadly, those of us of a certain age felt that its day in the sun had come and gone.
November 01, 2006
Amerigroup's marketing reps commended for excluding pregnant women
Amerigroup has provided us with a prime example of why the single payer reform model is not only publicly funded but also publicly administered. Contracting to private intermediaries, such as Medicaid HMOs or Medicare Advantage plans, is an open invitation for the plans to manipulate the system to achieve their primary goal of enhancing profits.
October 30, 2006
J. Gruber on lessons from the RAND HIE
Jonathan Gruber provides an excellent analysis of the RAND HIE and of more recent studies on the impact of co-insurance. His conclusions are warranted based on a sterile, broad overview of the current knowledge on the topic, but only if you accept the principle that cost sharing should be an essential component of health care cost containment simply because it has been proven to reduce spending.
October 27, 2006
The public believes that the Democrats would reform healthcare?
Would a Democratic Congress be likely to pass legislation to provide coverage for the uninsured? With the exception of improving outreach for children through the SCHIP program, the Democratic leadership has made it clear that comprehensive reform will not be on the agenda. The 60 percent of Americans who believe reform is likely in 2007 simply haven't been listening.
October 26, 2006
Does insurance money buy Congressional votes?
What will the body politic bear? Can a politician maintain objectivity on an issue that can have a major impact on a large donor? Does the appearance of a conflict necessarily translate into an actual conflict? Maybe the voters should tell Senator Clinton "something interesting" when it is time to select the next Democratic candidate for president.
Americans dissatisfied with rising health care cost
With health care, the opponents will claim that patients aren't paying enough, and that more responsible health care spending will occur only when patients are required to pay more of the costs (consumer-directed health care). In response, we must contend with two realities: (1) Current national policies are resulting in the transfer of wealth from average-income Americans to the wealthy, and (2) health care costs are continuing to increase at a rate well in excess of inflation.
October 24, 2006
How much will CDHC reduce spending?
The primary argument for consumer-directed health care (CDHC) is that it reduces health care spending. Since CDHC does decrease the use of beneficial health care services, it is appropriate to ask if the savings are enough to warrant instituting these financial barriers to beneficial care.
October 23, 2006
Kaiser's retroactive denial of a twenty-year patient
43 states allow medical underwriting in the individual and small group health insurance market. Although situations such as the one described in this article would seem silly if they weren't so tragic, nevertheless, the great majority of individuals with serious medical problems who lose their group insurance because of termination of employment are denied coverage in the individual market once their COBRA benefits run out. This is a very serious structural flaw in the way we provide health care coverage.
October 20, 2006
Are the Swiss ready for single payer?
The producers of this report are supporters of the free market in health care, with its current incarnation as consumer-directed health care. As expected, the report is saturated with anti-government rhetoric, containing their requisite criticisms of universal systems. Still it is a report worth reading since it is important to understand the rhetoric of the opponents of national health insurance, and it also does identify some genuine weaknesses of other systems, even if biased, distorted and sometimes false.
October 19, 2006
Private equity investment in health care
For the last few years, a growing pool of private equity investment money has been pouring into health care firms, swelling these enterprises until they are big enough to crest in rewards for investors.
October 18, 2006
CHCF's three options for reform
California is ripe for comprehensive reform. There is strong support for the single payer model with a bill having recently been passed by the state legislature, only to be vetoed by Gov. Schwarzenegger. The governor has promised to introduce his plan for reform in January.
October 17, 2006
Are Americans concerned about health care costs?
Americans believe that aggregate health care spending should be increased, especially the contribution by the government. This is in sharp contrast to the concerns that Americans have about their own individual out-of-pocket spending for health care, including the cost of health insurance.
October 16, 2006
Moral high ground elusive to UnitedHealth and WellPoint/BlueCross
Dr. William W. McGuire, a medical entrepreneur who built the UnitedHealth Group into a colossus in its field, was forced to resign from the company yesterday and to give up a portion of the $1.1 billion he holds in harshly criticized stock options.
October 12, 2006
Alan Maynard on Porter and Teisberg's reinvention of the wheel
"The American health care systems perform impressively, producing what they are designed to deliver: cost inflation, inefficiency, and inequity." This first line in Alan Maynard's comment leads us to our bottom line. The United States needs a new design that would address cost inflation, inefficiency, and inequity. The first step would be to establish an equitable, efficient national health insurance program that could begin to tackle the rapidly rising costs of health care. That won't be easy, but it's impossible under the status quo.
October 11, 2006
California legitimizes health discount card parasites
One of the most unique characteristics of health care financing in the United States has been our acceptance of a middleman industry that diverts hundreds of billions of dollars from health care to profoundly wasteful administrative services.
October 10, 2006
Marie Cocco on the Citizens' Working Group report
In a previous Quote-of-the-Day, I condemned the recommendations of the Citizens' Health Care Working Group as being the product of a partisan hack job. What I did not emphasize in that message (but had
stated in previous messages) was the overwhelming consensus of the public participants on what should be done about improving our health care system. Americans want a system that provides reasonably comprehensive coverage for absolutely everyone, that prevents financial hardship and is funded in an equitable manner.
HSAs are not an option for low-income families
Any student of health policy already fully understands the message in this report: Health savings accounts and high-deductible health plans do not work for lower-income individuals with significant health problems.
October 03, 2006
Spending for privately insured Americans remains high
We need solutions that specifically address these flaws. As this article indicates, current political efforts are neglecting the fundamental defects, but instead are diverting reform efforts by tinkering at the periphery with measures that will have negligible impact compared to the enormity of the problems.
September 28, 2006
America's uninsured children
Incrementalists have been touting the one health care reform "success" of the past few decades: the State Children's Health Insurance Program (SCHIP). Yet, after a decade under the program, 9 million children remain uninsured and the numbers are increasing, and those children have five times the amount of unmet health care needs as insured children. If this is the definition of success, then how would they define failure?
September 27, 2006
Employer-sponsored premium increases
Some reports of this study suggest that this is good news because employer-sponsored premium increases are now down to only twice the rate of inflation, as if a "down" isn't an "up."
September 26, 2006
Final Recommendations of the Citizens' Health Care WorkingGroup
I think that it is safe to say that nothing in the process warranted the "very high costs" recommendation, but it is also safe to say that the Comptroller General achieved his goal of producing a report that places "a greater emphasis on increasing price sensitivity for patients while decreasing the financial insulation provided by insurance."
September 25, 2006
Illinois Health Care Justice Act
Once again, the single payer model ranked the highest based on the ideals of a universal system. Yet the voices still clamor for a compromise merely to protect the private insurance industry that has failed miserably in achieving the ideals we are seeking.
September 22, 2006
Private insurers offering traditional Medicare coverage
Why would Congress do this? They are paying more money to private insurers for the same fees as traditional Medicare and for the same providers (all willing physicians). They also allow them to market exclusively in more lucrative markets. In addition, patients currently in treatment programs will be less likely to change coverage, whereas less expensive, healthy patients may be attracted by potential incentives such as a single package which adds a Part D drug benefit.
September 21, 2006
IOM report on rewarding performance
This Institute of Medicine report sheds further light on the subject. In elaborating on the pay-for-performance concept, the Institute of Medicine makes it very clear that the administrative burden is significant and will divert time and resources away from patient care.
September 20, 2006
Health care scorecard assigns numbers to our national disgrace
The first annual scores are now in. They're not good. We need to address immediately the "single most important determinant" by eliminating the scourge of uninsurance and underinsurance.
September 19, 2006
GAO report - Don't choose an HSA if you need health care
This GAO study confirms that the healthy-wealthy benefit of the plans is recognized by the participants. Not only do they understand the benefit for themselves, but they also understand the disadvantages for those with greater health care needs. The healthy and wealthy do not recommend these plans for the sick and poor. This GAO report should put an end to that debate.
September 18, 2006
Why do the uininsured decline to buy individual plans?
Comment By Don McCanne, MD:
The facts are clear. Most individuals who are confronted with a health insurance premium that they cannot afford do not bother to submit an application. Karen Ignagni's (of America's Health Insurance Plans) statement that "coverage purchased in the individual market is accessible and affordable" applies to only the very small percentage of individuals who actually purchased coverage because they could afford it.
September 08, 2006
BC/BS of Minnesota's individual mandate proposal
The BC/BS of Minnesota plan is obviously self-serving. It would expand their market to everyone, allow them to sell innovative plans with increased administrative income but decreased protection for patients, and would shift the losses of high-risk patients to the taxpayers.
September 07, 2006
It's all about health information technology?
As leaders in Congress and in the administration dodge the issue of their failure to address the real problems in health care, they frequently attempt to divert our attention by advocating for their surrogate solution for our health care problems: health information technology.
September 06, 2006
The political reality of the California veto
Those of us in the health professions who have watched so many suffer and die merely because of the flaws in our dysfunctional system of financing health care are greatly offended when we see that there is enough money already being spent to provide the care needed to prevent these adverse outcomes.
September 05, 2006
Gov. Schwarzenegger announces veto of SB 840
Gov. Arnold Schwarzenegger's statement on vetoing SB 840
Is P4P about patients, or providers?
Pay for performance (P4P); what a simple concept. When the providers (physicians and hospitals) demonstrate higher performance on quality and costs, reward them with extra payment. To maintain zero-sum budget neutrality, fund those rewards with financial penalties against those with lower performance scores; that will motivate them to shape up.
September 01, 2006
Will primary care survive?
"Crisis" is a word that has been thrown around lately to describe many of the trends that are resulting in higher health care costs, but without an improvement in coverage and access. When it comes to the deterioration that is taking place within our primary care infrastructure, "crisis" is not an adequate term. It's much worse.
August 31, 2006
$145,000 for an additional year of life
Identifying the acceleration in cost trends is the first step. The second is to identify which spending is providing value. The final step is to direct spending away from expensive services with no benefit and toward health care services that do provide value. This process would be much simpler under a single payer health insurance system, whereas it is almost impossible with our current fragmented method of funding care.
August 30, 2006
Price transparency solves what problem?
All too often in the debate on reform we see advocates lead with policy solutions and extrapolate backwards to the problem that is being addressed. The debate over price transparency certainly exemplifies this.
August 29, 2006
1,272,000 more people without health insurance
It just keeps getting worse.
Sen. Kuehl's single payer bill passes!
SB 840 has already been passed by the California State Senate. It will return there for concurrence in an amendment calling for a commission to establish the mechanics of a premium structure, and then will move on to Gov. Schwarzenegger's desk.
August 28, 2006
Gladwell's "The Risk Pool"
Malcolm Gladwell's article describes one important reason for General Motors' problem. By maintaining their own segregated risk pool, G.M. experienced the impact of a large growth of individuals dependent on their health benefits program without a commensurate increase in their active labor force. A single national risk pool would have diluted this impact through the fundamental insurance principle of spreading the risk as widely as possible.
August 24, 2006
Queue management in U.S. emergency departments
Excessive queues (wait times), whether for acute problems in emergency departments or for non-urgent specialized services, are often claimed by opponents of reform to be an inevitable consequence of universal, publicly-financed health systems. The truth is that they are an inevitable consequence of any health care system that is not monitoring patient flow and making appropriate adjustments when warranted.
August 18, 2006
MedPAC on the increase in volume of physician services
One of the most important features of a well-functioning national health insurance program is that it can use budgets to slow the growth in health care costs to a level closer to the growth in GDP. But what a nightmare that creates.
August 17, 2006
Affordability concerns are moving up the income ladder
From the perspective of reforming health care financing in the United States, the most important finding in this report is that the concerns about affordability of health insurance and health care have moved up the income ladder. The concerns of average-income families are now as great as lower-income families (more than half!), and now even higher-income families are concerned (one-third!).
August 16, 2006
U.S. capacity for mammograms adequate, but...
So the United States has the capacity to provide every women with appropriate mammography screening, except for those who have low income or lack health insurance.
August 15, 2006
Aetna's "Vital Savings on Health"
So what is the product that Aetna is selling here? Aetna is selling the right to dictate which patients will receive a discount and what the amount of the discount will be.
August 14, 2006
PacAdvantage failure a bad omen for small business coverage
The proponents of association health plans (AHPs) claim that they will make health insurance affordable for small businesses by using the power of group purchasing in the private insurance market. The Pacific Business Group on Health, through PacAdvantage, has demonstrated that group purchasing by itself has no impact on controlling health insurance costs.
August 11, 2006
Blue Cross comingles professional fees and business referralfees
Commingling business income with professional income is troubling. Many of us would insist that the physician fee be the same for the same service, and not dependent on the facility used. Some of us would insist that the competing facility be non-profit thereby avoiding the self-referral conflict of interest. Others would take the opposite view that, in this age of third party control of compensation, any additional business arrangement that can increase physician income should be acceptable.
August 10, 2006
HSA/HDHPs may actually reduce price sensitivity
For the 80 percent of individuals who use 20 percent of health care services, the HSA component provides about the same amount of financial disincentive to care as do our other current insurance products.
August 09, 2006
SCHIP's success, and failure
All barriers should be removed. Health insurance enrollment should as automatic as the recording of a birth certificate, not only for all children, but for everyone.
August 08, 2006
Private insurance better than public for Colorado children?
The private insurers cannot claim that they have some marketplace magic that saves lives and reduces costs. Private insurers waste money, diverting resources away from patient care. Worse, they make every effort to avoid covering those with the greatest needs, and they are making health care less affordable by shifting more costs to those with needs.
August 07, 2006
Milton Friedman on U.S. medical care
Professor Friedman seems to prefer Utopia, even if it is a fiction. Charity, as health policy, has been studied extensively. Unfortunately, it is the least effective method of addressing our health care financing problems, having almost no impact at all. 300 million people, each acting as an independent agent, would never contribute the $7000 apiece required to fund our health care system.
Callahan and Wasunna's Medicine and the Market
Do we engage in an intensive, expensive, time-consuming effort to identify market manipulations that might produce a slightly favorable tweak to the system, merely to placate the market ideologues? Or do we move forward immediately with enacting a proven, equitable and efficient system for all?
August 03, 2006
Reduction in disparities requires both insurance and a medical home
A single payer national health insurance program not only would ensure that care would be paid for, but it also has the capability of correcting many of the structural defects in our health care system. One of the most important is that it could realign incentives to improve and expand our primary care infrastructure, ensuring that everyone would have access to a medical home.
August 02, 2006
Medicare more effective in controlling excess spending
The Medicare payment document just released by CMS demonstrates how well this can work. Policies are being adopted that will reduce excess spending in some sectors while shifting funds to important services that were losing money, and further modifications were made based on input during the public comment period. Isn't that what we should expect from the stewards of our tax funds?
August 01, 2006
Shorter waiting times in Ireland's public system
The infrastructure of a single payer system for the United States would include queue management and is ideally suited to do so, especially when compared to our current fragmented system of funding care. You should emphatically reject the claim of those who state that excessive delays are inevitable in a single payer system and non-existent in the privately insured market.
July 31, 2006
eHealthInsurance exposes the false promise of cheaphigh-deductible insurance
The private insurance industry will never provide coverage that pools all risks, eliminates financial barriers to care, and charges a premium based on ability to pay. Single payer national health insurance is the answer. Why do we keep evading the obvious?
June 30, 2006
Illinois' dubious claim of first to cover all kids
This is that giant incremental step of covering all children that everyone is talking about. It is a truly beneficial program. But it fails to provide universal coverage. It fails to reduce costly administrative excesses but rather adds more to our fragmented system of funding care. It fails to remove financial barriers to access. It fails to provide free choice of health care providers.
June 29, 2006
Porter and Teisberg's Redefining Health Care
This book is also an important resource for avid supporters of market competition in health care. Since the best that these noted authors can come up with is the bizarre concept of competing medical-condition teams without geographical boundaries, then you know that you no longer have to look for the magic of the marketplace in health care. There's no magic there.
June 28, 2006
OECD Health Data 2006 for the United States
The OECD calculations do not include two important sources of government funding of health care: (1) the funding of private insurance for government employees, an undisputed government expense, and (2) the tax subsidy received by employers providing insurance for their employees, since employer-sponsored coverage is deductible to the employer but is not taxable income to the employee. When these are included, the United States government funds 60 percent of health care.
June 27, 2006
Fragmented system of coverage vulnerable to budget
As long as we have a fragmented system of providing health care coverage, the political debates will center not simply over how much we can "afford" to budget for health care, but also about which citizens we will exclude from any coverage whatsoever.
June 26, 2006
Connecticut's study of three models of reform
We now have yet one more highly credible study from other independent sources demonstrating that single payer is the only model of the three which meets the reform criteria of the Institute of Medicine, while also being the most effective in reducing health care spending.
June 23, 2006
Private innovation using credit cards
The cards and credit programs have been around for many years but they're becoming more prevalent as credit card companies look to create new products. New consumer-driven health plans could also drive up demand. Under those plans, patients face higher co-pays and deductibles. They may look to put those payments on credit cards.
June 22, 2006
Is employer-sponsored insurance a tax problem or a structural problem?
Single payer won't fix all of the problems in our health care system, but it will fix all of the problems with the financing of health care. And isn't that what the debate is all about?
June 21, 2006
CalPERS rejects copays, but at a cost
Facing solid opposition from powerful public employee unions, the CalPERS health benefits committee turned down all staff proposals to hike co-payments for visits to doctors, emergency rooms, outpatient surgical centers and hospital stays.
June 20, 2006
Remedy for insurers' actions that resulted in racketeeringallegations
Filed June 19, 2006) United States District Court for the Southern District of Florida Miami Division Master File No. 00-1334-MD-Moreno (U.S. District Judge Federico Moreno) IN RE: MANAGED CARE LITIGATION Order Granting Summary Judgment in Favor of Remaining Defendants United...
June 19, 2006
Why copays?
Retail clinics: The competition heats up By Ken Terry Medical Economics June 16, 2006 “Retail” walk-in clinics, located in supermarkets and stores like CVS and Target, are already competing with physicians in many communities. Now Blue Cross and Blue Shield...
June 17, 2006
APA President Urges Support For Single-Payer InsuranceSystem
APA President Urges Support For Single-Payer Insurance System American Psychiatric Association Psychiatric News June 16, 2006 The events that (APA President Steven) Sharfstein weathered this past year underscored the importance of the advocacy mission in which he had challenged his...
June 16, 2006
Is the NBT an individual mandate?
State health law could be template By Bob Kievra Worcester Telegram & Gazette June 16, 2006 The state’s 65-day-old health care law could have national significance - legislation that might alter presidential politics in 2008 and shift the vexing topic...
June 15, 2006
HMO rate increases decline to a mere 11.7 percent
These rate increases are well in excess of inflation, and costs are being shifted to employees at a time when their wages are failing to keep up with the rest of the economy. Patients are bearing much of the brunt of our failed health care funding policies.
June 14, 2006
AMA supports individual mandate for higher-income individuals
2006 Annual Meeting of the House of Delegates Reference Committee highlights AMA The AMA voted to support a requirement that individuals and families earning greater than 500 percent of the federal poverty level obtain, at a minimum, coverage for catastrophic...
June 13, 2006
How Hillary Clinton could work with the Republicans on health care reform
The Huffington Post The Blog (Accessed June 13, 2006) In today’s NY Times (June 10), Hillary Clinton states, “I think you should cover all children who don’t have other access to coverage. We shouldn’t have any uninsured children. But we...
June 12, 2006
Kevin Drum and Uwe Reinhardt on social insurance
Washington Monthly Political Animal By Kevin Drum June 11, 2006 THE S-WORD.…Ezra Klein, practicing for his career as a TV talking head, responds to a question about whether national healthcare is socialist “We should stop running from that moniker. If...
June 09, 2006
MedPAC update of Medicare Advantage overpayments
Medicare Advantage benchmarks and payments compared with average Medicare FFS spending MedPAC Medicare Briefs The purpose of this report is to present data on the level of Medicare Advantage (MA) payments for Parts A and B services relative to the...
June 08, 2006
Interim Recommendations of the Citizens' Health Care Working Group
Interim Recommendations of the Citizens’ Health Care Working Group June 1, 2006 The Citizens’ Health Care Working Group was created by the Medicare Prescription Drug, Improvement and Modernization Act of 2003, Sec. 1014 to provide for the American public to...
May 26, 2006
The World Bank report on health financing
As developing countries design and implement their health financing policies, they can learn from high-income countries... "with the exception of the United States."
May 25, 2006
How to keep young adults uninsured
Incremental efforts have already been tested, and they have failed. Only fundamental structural reform will accomplish our goal of equitably-funded, comprehensive coverage for everyone.
May 24, 2006
Health care reform lesson from Hungary
As Hungary surveyed the various health care models in other nations, they decided to adopt the U.S. model - the most expensive, least efficient, least equitable, and most wasteful system of all, but one that richly rewards the private insurance industry.
May 23, 2006
What do the affluent believe about health care?
What is clear is that, like the rest of us, they do want affordable access to comprehensive care. The solutions they support fail to address the real cost drivers and will leave them facing ever escalating costs. Those costs will not be contained until we agree to adopt structural reform of health care funding that addresses the actual inefficiencies and waste in our system.
May 22, 2006
Medicare Advantage plans often shift costs to the sick
It is shocking to see that many of the private Medicare Advantage plans, in spite of being granted extra payments by the government, are shifting more of the costs to sick enrollees than they would have to pay in the traditional Medicare with Medigap program, despite the well-documented shortcomings of Medigap coverage.
The price of insurance
For Kruger, who returned to a war zone for his third tour in December, the danger of losing his family's health insurance was more real and immediate than the danger of dying in combat.
May 19, 2006
Mandating Cover Tennesee insurers to bear all risk for $150per month
The insurers don't want to insure our risk pools, and we don't want to waste our funds on their administrative excesses. The solution seems obvious. Throw them out and establish our own publicly-funded and publicly-administered health insurance program.
May 18, 2006
Now President Clinton gets it
"It is insane," said Clinton. "It is a colossal waste of money. Don't go down that road. Don't do anything that will lead to increased administrative costs."
May 17, 2006
David Baltimore on national health insurance
Science For Life: A Conversation With Nobel Laureate David Baltimore By Barbara J. Culliton Health Affairs May 16, 2006 (David Baltimore is the new president of the American Association for the Advancement of Science, soon-to-retire president of the California Institute...
May 16, 2006
Dartmouth Atlas - Major overhaul of health care required
If we had a single, publicly-administered national health insurance program, a Medicare-for-All, then we would be in a position to allocate our health care spending in a manner that would integrate our entire health care delivery system.
May 15, 2006
Target targets employee health plans
Tough health care medicine for Target workers By Chris Serres Star Tribune May 11, 2006 Stung by rising health costs, Target Corp. is now offering private health accounts funded in large part by individual employees. The Minneapolis-based retailer also is...
May 12, 2006
Single payer's bold move into the political arena
Let's keep working to be sure that the business community fully understands all options for reform. A model that finally truly contains costs while allowing the additional luxury of providing comprehensive coverage for everyone just might be what they are looking for. Let's be sure that they know what single payer really does, and that it's available now.
May 11, 2006
Robert Bazell on health care reform
When a highly credible representative of the mainstream media is willing to speak up in support of government financing of health care... well... we're making real progress.
May 10, 2006
Why employer-sponsored coverage is unstable
Once you are insured through an individual plan, you have no assurance that coverage will continue, especially since it has been shown that over two-thirds have left their plans by three years.
May 09, 2006
Proof that insurers selectively advertise to healthy
Advocates of free markets insist that competition between private health plans (e.g., Medicare Advantage) will always result in lower costs than is possible through a single public insurance program (e.g., traditional Medicare). All evidence to date indicates that this is simply not true. The government spends more per Medicare beneficiary in private plans than it does for Medicare beneficiaries, with equivalent health status, in the traditional public program.
May 08, 2006
Consumer decisions in the individual insurance market
The primary lesson for policymakers should be that we need efficient, affordable, comprehensive coverage for everyone through a single, national health insurance program. As a think tank, RAND should go back and do some more thinking on this one.
May 04, 2006
Higher-income uninsured do not receive recommended services
Some of us are passionate supporters of national health insurance simply because we believe that everyone should have the right to affordable health care. For those who don't really share this belief, just the simple concept of fairness dictates that we should eliminate free riders by including everyone in an equitably funded risk pool. And common business sense dictates that the most efficient and effective method would be through a single payer system. We should all be able to agree on this.
May 02, 2006
FOX NEWS on the single-payer solution
By including a comment by former AMA president Donald Palmisano dredged from their 2003 files, FOX NEWS has provided a "fair and balanced" report. But even FOX NEWS couldn't deny that all physicians interviewed for this report were unanimous is seeing "a single-payer universal health plan as the answer."
May 01, 2006
Krugman - Death by Insurance
Many pundits see red at the words "single-payer system." They think it means low-quality socialized medicine; they start telling horror stories - almost all of them false - about the problems of other countries' health care. Yet there's nothing foreign or exotic about the concept: Medicare is a single-payer system. It's not perfect, it could certainly be improved, but it works.
April 28, 2006
Political momentum building for single payer reform
Those who state that single payer reform is not politically feasible need to listen to the candidates. When the candidates are competing for the claim of being the one that really, really, really does support single payer, the feasibility argument fades into oblivion.
April 27, 2006
Enthoven and Herzlinger on consumer-driven health care
A single payer system would also control prices, but it would do so through mechanisms that would improve resource allocation for the benefit of all of us rather through the current mechanisms that are designed to benefit the third party payers at the cost of efficiency and equity.
April 26, 2006
Uninsurance is no longer just for low-income families
Gaps in Health Insurance: An All-American Problem By Sara R. Collins, Ph.D., Karen Davis, Ph.D., Michelle M. Doty, Ph.D., Jennifer L. Kriss, and Alyssa L. Holmgren The Commonwealth Fund April 2006 Gaps in health insurance coverage - a problem that...
April 25, 2006
$1.6 billion for UnitedHealth's McGuire
The Wall Street Journal first reported that the timing of McGuire's stock options, when UnitedHealth stock was at its lowest so he would benefit as much as possible, raised the possibility that they had been backdated.
Compensation consultant Paul R. Dorf, managing director of Compensation Resources Inc., called backdating options "highly unethical, if not illegal."
April 24, 2006
WSJ: Government-Funded Care Is the Best Health Solution
Many were surprised to see this frank endorsement of single payer reform appearing in The Wall Street Journal. Perhaps even more remarkable was the decision of the editors to provide free access to this particular article, ensuring much broader distribution than most of the Journal's subscription-only content.
April 21, 2006
Allan Hubbard explains the president's health reform plan
Since it doesn't work for either acute or chronic problems, apparently the president's proposal works only for those without significant medical needs. Are healthy individuals really the appropriate target for health care reform?
April 20, 2006
Single Payer, By Default
Regardless of personal ideology or political persuasion, everyone in the policy community understands the strengths of the single-payer model of national health insurance. It would provide truly comprehensive coverage for absolutely everyone while putting into place mechanisms that would slow the rate of healthcare inflation.
April 19, 2006
Private insurers' control of the marketplace (AMA report)
(Today’s message addresses one of the most important perversities in our flawed system of funding health care. It needs to be included in every dialogue on reform. Please share this message with others who really do care about the future...
April 18, 2006
The government protects public employees' health benefits
Public Employees’ Health Benefits Survive Major Threats, So Far Public-sector workers continue to receive benefits that help offset their more modest salaries compared with their private-sector peers. Health Affairs By Robert E. Hurley, Laurie Felland, Anneliese Gerland, and Jeremy Pickreign...
April 17, 2006
Marcia Angell on the flawed structure of the Massachusetts plan
Healthcare plan needs dose of common sense By Marcia Angell The Boston Globe April 17, 2006 If Governor Romney thinks the state’s new plan for universal health coverage will carry him to the White House, he should think again. This...
April 14, 2006
Hoffa supports national health care
Health costs destroying our economy National health plan only way to protect workers and employers Detroit News April 14, 2006 By James P. Hoffa, president of the International Brotherhood of Teamsters Our nation’s health care system is broken. America must...
April 13, 2006
State overreach on national problems
State Governments Overreach in Taking on Problems Best Solved at the National Level The New York Times April 13, 2006 By Robert H. Frank In most of the world… the primary responsibility for ensuring access to health care, regulating environmental...
April 12, 2006
Reform strategy from Harvard's greatest minds
The Harvard Interfaculty Program for Health Systems Improvement April 2006 A Strategy for Health Care Reform: Catalyzing Change from the Bottom Up The American health care system seems in an accelerating downward spiral: wasteful, unsustainably costly, inadequate in quality, and...
April 05, 2006
Massachusetts to fund private insurers instead of health care
Conference Committee Report Health Care Access and Affordability The Commonwealth of Massachusetts 4/3/2006 This Conference Committee Report contains a comprehensive plan for increasing health insurance coverage for all residents of Massachusetts. This bill is a bridge between principles in the...
March 31, 2006
Single Payer vs. CDHC: A Dialogue
Because of other commitments, there will be a break in the Quote of the Day messages. In the meantime, you may be interested in reading the following dialogue. San Diego County Medical Society Single Payer vs. CDHC: A Dialogue By...
March 29, 2006
Online dating as a ticket to health insurance
CoverTheUninsured.org Source: Rubenstein, Wall Street Journal, 3/22/06 In the Online Dating World, Being Insured is Sexy A Wall Street Journal article examined a trend in online dating in which having health insurance is a draw for a potential date. According...
March 28, 2006
So you think you're insured?
Former Members Sue Blue Cross By Lisa Girion Los Angeles Times March 28, 2006 The state’s largest health insurer systematically - and illegally - cancels coverage retroactively for people who need expensive care, 10 former Blue Cross members claimed in...
March 27, 2006
Cigna's Custom Benefit Builder dismantles coverage
Cigna to allow consumers to customize their health plans By Jonathan G. Bethely American Medical News April 3, 2006 Cigna’s Custom Benefit Builder allows members to personalize various aspects of their coverage, from co-payment and coinsurance levels to deductibles and...
March 24, 2006
Join David Broder in supporting the Citizens' Health Care Working Group survey
Broder on Politics Live Discussion with Post Columnist David S. Broder washingtonpost.com March 24, 2006 San Juan Capistrano, Calif. (Don McCanne): Do you believe that the report to be produced by the Citizens’ Health Care Working Group (Wyden and Hatch...
March 23, 2006
Decline in physician charity care
A Growing Hole in the Safety Net: Physician Charity Care Declines Again By Peter J. Cunningham and Jessica H. May Center for Studying Health System Change March 2006 Continuing a decade-long trend, the proportion of U.S. physicians providing charity care...
March 22, 2006
J. Gruber on rationing and national health insurance
America’s Health Insurance Plans 2006 National Policy Forum 3/7/2006 Prospects and Implications of Tax Policy for the Health Care Industry Jonathan Gruber, Ph.D., professor of economics, Massachusetts Institute of Technology; co-editor, Journal of Health Economics; and associate editor, Journal of...
March 21, 2006
Marmor and Mashaw on social insurance
Understanding Social Insurance: Fairness, Affordability, and the ‘Modernization’ of Social Security and Medicare By Theodore R. Marmor and Jerry L. Mashaw Health Affairs March 21, 2006 In our view, the fate of Social Security and Medicare should be neither stasis...
March 20, 2006
Medical-loss ratios of largest for-profit insurers
Health plans make more, spend less in 2005 By Jonathan G. Bethely American Medical News March 6, 2006 If physicians needed any more indication of tightening reimbursement, how about this - not only did profits for the biggest health plans...
March 17, 2006
Kinsley's reform we should try before we go single payer
Before We Go ‘Single Payer’: Insurance Reforms We Should Try By Michael Kinsley The Washington Post March 17, 2006 The small fraction of people involved in auto accidents in any year is responsible for almost all of the cost of...
March 16, 2006
Is medical care lacking but equal?
Who Is at Greatest Risk for Receiving Poor-Quality Health Care? By Steven M. Asch, M.D., M.P.H., Eve A. Kerr, M.D., M.P.H., Joan Keesey, B.A., John L. Adams, Ph.D., Claude M. Setodji, Ph.D., Shaista Malik, M.D., M.P.H., and Elizabeth A. McGlynn,...
March 10, 2006
America's quality care is going to the dogs
Toronto Star Mar. 5, 2006 Canadian taxpayers should have full access to the system - and doctors - they pay for By Linda McQuaig The wonderful thing about the Canadian system is that it operates on a higher principle than...
March 09, 2006
Los Angeles Times notes momentum of single payer
Why pick on Wal-Mart? Editorial Los Angeles Times March 2, 2006 Although healthcare spending is expected to jump to $4 trillion in the next decade - to 20% of the nation’s gross domestic product - the number of uninsured is...
March 08, 2006
Medicaid's Health Opportunity Accounts
Medicaid to offer HSA pilot program By Amy Snow Landa American Medical News March 13, 2006 Health savings accounts aren’t just for the private market anymore. President Bush has signed legislation that will allow up to 10 states to offer...
March 07, 2006
Stretching the brittle Medicaid dollar
Can States Stretch The Medicaid Dollar Without Passing The Buck? Lessons From Utah By Samantha Artiga, David Rousseau, Barbara Lyons, Stephen Smith and Daniel S. Gaylin Health Affairs March/April 2006 In some states, Medicaid restructuring has already begun through waivers....
Is European-style insurance the answer?
Does someone want to tell Steven Hill and his colleagues at the New America Foundation that the take-home lesson is that we don't have to settle for the ancient model of multiple private insurers and sickness funds, when we have
the opportunity to adopt an improved universal system by applying modern single payer innovations?
March 06, 2006
The health care crisis and what to do about it
The Health Care Crisis and What to Do About It By Paul Krugman, Robin Wells The New York Review of Books March 23, 2006 The good news is that we know more about the economics of health care than we...
March 03, 2006
AHPs for the Blues
Sen. Enzi To Introduce Compromise Legislation on Association Health Plans Kaiser Daily Health Policy Report March 3, 2006 Senate Health, Education, Labor and Pensions Committee Chair Michael Enzi (R-Wyo.) early next week plans to introduce a bill (S 1955) that...
March 02, 2006
More community health centers, but fewer clinicians
Shortages of Medical Personnel at Community Health Centers Implications for Planned Expansion By Roger A. Rosenblatt, MD, MPH; C. Holly A. Andrilla, MS; Thomas Curtin, MD; L. Gary Hart, PhD JAMA March 1, 2006 Residents of the United States lack...
March 01, 2006
Managed care is alive and sick
Doctors object to ultimatum on health care By Cheryl Clark The San Diego Union-Tribune February 26, 2006 Dozens of doctors are protesting a Sharp physician network’s demand that their senior patients enroll in one health plan, Secure Horizons, if they...
February 28, 2006
Dr. Martin Luther King, Jr.'s Favorite Union Endorses HR 676
The Executive Board of 1199SEIU United Healthcare Workers East has unanimously endorsed HR 676, a bill to legislate a single payer health care system in the U.S. The union represents 275,000 members in Maryland, Washington DC, New York and Massachusetts....
AHIP pays for Dranove and Millenson's swift boat tickets
Medical Bankruptcy: Myth Versus Fact This response to a widely cited paper by David Himmelstein and colleagues challenges the basis of its conclusions. By David Dranove and Michael L. Millenson Health Affairs 28 February 2006 The great enemy of the...
February 27, 2006
Medical debt is not created by deadbeats
Bankruptcy Reform’s Impact: Where are all the “deadbeats”? National Association of Consumer Bankruptcy Attorneys February 22, 2006 The following are key findings from a National Association of Consumer Bankruptcy Attorneys (NACBA) survey of six major credit counseling agencies that have...
February 24, 2006
Desperation over medical bills drives woman to crime
Online armor sales net prison, fine By Steve Liewer The San Diego Union-Tribune February 23, 2006 A Vista woman was sentenced to prison yesterday for buying from Camp Pendleton Marines stolen body armor meant for Iraq-bound troops, then selling it...
February 23, 2006
Brailer implicitly supports Wygod's next big thing
WebMD Wants to Go Beyond Information By Milt Freudenheim The New York Times February 23, 2006 Marty Wygod, the entrepreneurial deal maker who built WebMD Health into one of the most-visited medical information sites on the Internet, is promoting the...
February 22, 2006
Health care spending in 2006
Health Spending Projections Through 2015: Changes On The Horizon By Christine Borger, Sheila Smith, Christopher Truffer, Sean Keehan, Andrea Sisko, John Poisal, M. Kent Clemens (from the Office of the Actuary, Centers for Medicare and Medicaid Services) Health Affairs February...
February 21, 2006
Half of small business owners believe single payer is inevitable
SMC Business Councils Releases Health Care Survey Results PR Newswire February 20, 2006 (SMC Business Councils is a non-profit trade association representing 3,500 small business owners in western and central Pennsylvania.) SMC Business Councils conducted an online survey last week...
February 20, 2006
"National Health Access" isn't
Top firms’ plan for uninsured stumbles By Bruce Japsen Chicago Tribune February 18, 2006 A landmark health-care plan offering benefits to millions of uninsured workers and initially sponsored by more than 50 blue-chip companies has failed to gain traction in...
February 17, 2006
Projected increased public health spending in OECD nations
Projecting OECD health and long-term care expenditures: What are the main drivers? Organisation for Economic Co-operation and Development (OECD) ECO/WKP5 February 3, 2006 Rising expenditure on health and long-term care is putting pressure on government budgets in most OECD countries....
February 16, 2006
Are $100,000 drugs a right?
British Clinic Is Allowed to Deny Medicine By Sarah Lyall The New York Times February 16, 2006 When her local health service refused to treat her (early-stage) breast cancer with the drug Herceptin, 54-year-old Ann Marie Rogers sued. But on...
February 15, 2006
Uwe Reinhardt on administrative incompetence
Hospitals probed on free-care billing By Christopher Rowland The Boston Globe February 11, 2006 Attorney General Thomas Reilly’s office is investigating excessive billing by hospitals to the state’s $800 million free-care pool, a fund used to pay hospitals for treating...
February 14, 2006
Low physician density does not impair access,unless you're uninsured
How Adults’ Access to Outpatient Physician Services Relates to the Local Supply of Primary Care Physicians in the Rural Southeast By Donald E. Pathman, Thomas C. Ricketts III, and Thomas R. Konrad HSR February 2006 Objective: To examine how access...
February 13, 2006
Federal funding of high risk pools
H.R. 4519 The Library of Congress THOMAS 2/3/2006 - Presented to President. State High Risk Pool Funding Extension Act of 2006 Seed grants to states for creation and initial operation of a high risk pool for fiscal year 2006: $15,000,000....
February 10, 2006
It's the high deductible, not the HSA cash account
Pearlstein Live washingtonpost.com February 8, 2006 Steven Pearlstein writes about business and the economy for The Washington Post. This is from a transcript of his online discussion. Washington, D.C.: I’m hoping you can clarify a key point during your discussion....
February 09, 2006
Using technology better
Is Technological Change In Medicine Always Worth It? The Case Of Acute Myocardial Infarction By Jonathan S. Skinner, Douglas O. Staiger, Elliott S. Fisher Health Affairs February 7, 2006 Abstract: We examine Medicare costs and survival gains for acute myocardial...
February 08, 2006
Reinhardt on HSAs and having "skin in the game"
Economist bashes Bush HSA proposal United Press International February 6, 2006 President Bush’s health savings account (HSA) plan will mean income-based healthcare rationing, an economist said Tuesday. “Should healthcare be cheaper for high-income people?” asked Princeton economics professor Uwe Reinhart...
February 07, 2006
Internal and external validity and the RAND HIE
By Don McCanne, M.D. In a KPBS debate between James Knight and Don McCanne on consumer-directed health care and health savings accounts, Dr. Knight stated, “… the Rand Health Insurance Experiment… shows that people who pay for their own health...
February 06, 2006
RAND - Eliminating copays can reduce health care spending
Varying Pharmacy Benefits With Clinical Status: The Case of Cholesterol-lowering Therapy By Dana P. Goldman, PhD; Geoffrey F. Joyce, PhD; and Pinar Karaca-Mandic, PhD (From the RAND Corporation, Santa Monica, Calif.) The American Journal of Managed Care January 2006 Methods:...
February 03, 2006
FEHBP's initial experience with HDHPs & HSAs
Federal Employees Health Benefits Program First-Year Experience with High-Deductible Health Plans and Health Savings Accounts GAO January 2006 Like many large employers, the FEHBP has expanded enrollee health plan choices by offering HDHPs combined with HSAs. Forty-three percent of actively...
February 02, 2006
KPBS debate on HSAs
These Days: What is consumer-directed health care? Tom Fudge KPBS Feb. 1, 2006 In his State of the Union address, President Bush pushed for the expansion of tax-free health savings accounts. Host Tom Fudge talks with two doctors on opposing...
February 01, 2006
State of the Union on health care
State of the Union Address President George W. Bush The White House January 31, 2006 Keeping America competitive requires affordable health care. (Applause.) Our government has a responsibility to provide health care for the poor and the elderly, and we...
January 31, 2006
The collapse of primary care, and the SGR
The Impending Collapse of Primary Care Medicine and Its Implications for the State of the Nation’s Health Care American College of Physicians January 30, 2006 Conclusion Unless immediate and comprehensive reforms are implemented by Congress and CMS, primary care-the backbone...
January 30, 2006
Henry Aaron on rationing
A healthcare prescription that’s hard to swallow Rationing may be the only way to ensure that access for all remains affordable By Henry Aaron Los Angeles Times January 30, 2006 Something needs to be done, but no one seems quite...
January 27, 2006
HSAs as IRAs, and The Economist's take on the Bush plan
Savings Accounts for Health Costs Attract Wall Street By Eric Dash The New York Times January 27, 2006 Even after the Bush administration began pushing for the creation of health savings accounts with the Medicare Modernization Act of 2003, the...
January 26, 2006
More HSAs, but where's the money?
HSAs Triple in 10 Months America’s Health Insurance Plans January 26, 2006 At least three million consumers currently receive health coverage through high-deductible health insurance plans offered in conjunction with health saving accounts (HSAs), according to preliminary results of a...
January 25, 2006
Specialty hospitals reveal the perversities of pseudo-markets
Do Specialty Hospitals Promote Price Competition? By Robert A. Berenson, Gloria J. Bazzoli, Melanie Au Center for Studying Health System Change January 2006 In three Center for Studying Health System Change (HSC) sites with significant specialty hospital development-Indianapolis, Little Rock...
January 24, 2006
$22 billion taxpayer gift to private Medicare Advantage plans
Closed-Door Deal Makes $22 Billion Difference By Jonathan Weisman The Washington Post January 24, 2006 House and Senate GOP negotiators, meeting behind closed doors last month to complete a major budget-cutting bill, agreed on a change to Senate-passed Medicare legislation...
January 23, 2006
Tami understands
An email that I received this morning from my daughter-in-law, Tami, who lives in Berkeley: i thought of you this weekend as i was taking a training workshop for a clinic i will be volunteering at. the clinic serves low...
January 20, 2006
VA care is rated superior
VA Care Is Rated Superior to That in Private Hospitals By Rob Stein The Washington Post January 20, 2006 The Department of Veterans Affairs medical system once epitomized poor-quality care. But after a series of changes, the system has been...
January 19, 2006
John Sweeney on covering everybody
John J. Sweeney, President of the AFL-CIO National Press Club January 18, 2006 … if I were President of the United States, I’d use this State of the Union speech to… challenge Congress to quit stalling and pass universal health...
January 18, 2006
Citizens' Health Care Working Group
Citizens’ Health Care Working Group “Health Care that Works for All Americans” Note: This message is a call for action on your part. If you are already well informed on the Citizens’ Health Care Working Group, then skip to the...
January 17, 2006
No kidding - wealth improves access to specialized services
Inequalities in access to medical care by income in developed countries By Eddy van Doorslaer, Cristina Masseria, Xander Koolman for the OECD Health Equity Research Group CMAJ January 17, 2006 The member states of the Organization for Economic Cooperation and...
January 16, 2006
Business Group and PNHP both have the right prescription
The Wrong Prescription Letter to the Editor The Washington Post January 16, 2006 I hope that The Post’s Jan. 10 editorial “Certificate of Need? Yes!” helps stop the plan to build another hospital in a city that does not need...
January 13, 2006
Do we need private solutions to control queues?
Public Solutions to Health Care Wait Lists By Michael M. Rachlis Canadian Centre for Policy Alternatives December 2005 Executive Summary Waits for care are the biggest political issue facing Canadian health care. Both citizens and providers are concerned that too...
January 11, 2006
CAHI's claim of Medicare's hidden administrative costs
Medicare’s Hidden Administrative Costs: A Comparison of Medicare and the Private Sector By Merrill Matthews, Ph.D. The Council for Affordable Health Insurance January 10, 2006 Executive Summary One of the most common, and least challenged, assertions in the debate over...
January 10, 2006
Health spending up, but who pays?
National Health Spending In 2004: Recent Slowdown Led By Prescription Drug Spending By Cynthia Smith, Cathy Cowan, Stephen Heffler, Aaron Catlin the National Health Accounts Team (Office of the Actuary, Centers for Medicare and Medicaid Services) Health Affairs January/February 2006...
January 09, 2006
Stable physician Medicare participation may represent anunstable system
Physician Acceptance of New Medicare Patients Stabilizes in 2004-05 By Peter J. Cunningham, Andrea Staiti, Paul B. Ginsburg Center for Studying Health System Change January 2006 Despite an earlier Medicare payment rate reduction, the proportion of U.S. physicians accepting Medicare...
January 06, 2006
Is state by state Fair Share Health Care the answer?
AFL-CIO President John Sweeney Remarks on Fair Share Health Care Campaign AFL-CIO January 5, 2006 …AFL-CIO unions are taking bold steps and paving the way — state-by-state and piece-by-piece — towards health care reform through our landmark Fair Share Health...
January 05, 2006
U.K. Conservative Party reverses stand on health policy?
U.K. Conservative Party Reverses Health-Care Policy Bloomberg.com January 4, 2006 U.K. Conservative leader David Cameron reversed his party’s policy on health care, abandoning a pledge to help fund private treatment and promising to support the state-funded National Health Service. Cameron’s...
January 04, 2006
Medi-Cal's 5 percent rate reduction
Cuts to Medi-Cal threaten program’s future By Sandy Kleffman Contra Costa Times January 3, 2006 Beginning this week, the state will cut by 5 percent its reimbursement rate for doctors who treat California’s poorest residents. Some people fear this will...
January 03, 2006
Public system in Alberta reduces queues
Public system achieved health-care success Letter by Doris Grinspun, RN, Executive Director, Registered Nurses’ Association of Ontario, Toronto Toronto Star Dec. 30, 2005 … in Alberta, health-care success has come through much-needed reforms within the public system, not through privatization....
December 30, 2005
Romanow has the last word for 2005
For-profit health care costly, inefficient Toronto Star Sep. 19, 2005 An edited excerpt of a speech by former Saskatchewan premier Roy Romanow about the June 9 Supreme Court decision that quashed Quebec’s ban on private health insurance. Romanow conducted a...
December 29, 2005
Health Affairs most-read article, and two women with cancer
2005 Year in Review: Health Affairs’ 25 Most-Read Articles Health Affairs December 28, 2005 (e-mail) In 2005, Health Affairs’ Web readership topped 9 million pageviews. The article on medical bankruptcy by David Himmelstein and colleagues of Harvard University tops the...
December 23, 2005
Swiss government rejects single payer
Government turns down national health scheme Swissinfo NZZ Online December 10, 2005 The cabinet has come out against a proposal to set up a national health insurance scheme, saying that it would not help to reduce spiraling health costs. The...
December 22, 2005
Urban Institute's view of incrementalism
Lowering Financial Burdens and Increasing Health Insurance Coverage for Those with High Medical Costs By Linda J. Blumberg, Lisa Clemans-Cope, and Fredric Blavin The Urban Institute December 2005 Health care expenses associated with high-cost medical cases in the United States...
December 21, 2005
GM's Wagoner and single payer
In G.M.’s Sight Lines: Washington and Tokyo By William J. Holstein The New York Times December 18, 2005 An interview with Rick Wagoner, the chairman and chief executive of General Motors Q. Were your problems caused by internal decisions, or...
December 20, 2005
Congress' gift for Tiny Tim
Budget Accord Could Mean Payments by Medicaid Recipients By Robert Pear The New York Times December 20, 2005 The final Congressional agreement on a budget bill gives states sweeping new authority to impose premiums and co-payments on Medicaid recipients… Under...
December 19, 2005
The inefficiency of tax credits for private insurance
Health Care for All, Just a (Big) Step Away By Eduardo Porter The New York Times December 18, 2005 Next year, the federal government expects to provide about $130 billion for Americans to buy health insurance (through the tax break...
December 16, 2005
Aetna's Rowe on high-deductible coverage
Consumer-Directed Health Insurance: The Next Generation An interview: John Rowe, a physician, is chairman and chief executive officer of Aetna, one of the nation’s largest insurance companies. James Robinson is the Kaiser Permanente Distinguished Professor of Health Economics at the...
December 15, 2005
The fallacy of hospital price shopping
Price Check: The Mystery of Hospital Pricing California HealthCare Foundation December 2005 In 2004, the California Legislature passed… AB 1626, requiring hospitals to provide information to patients on fees for 25 common services and to post notices informing patients that...
December 14, 2005
The political vulnerability of Medicaid
State Plans Medi-Cal Rate Pinch By Evan Halper Los Angeles Times December 13, 2005 Gov. Arnold Schwarzenegger is planning to cut the rates the state pays doctors to treat the poor, a move medical groups warn would result in more...
December 13, 2005
The HDHP and CDHP experiment has already failed
Early Experience With High-Deductible and Consumer-Driven Health Plans: Findings From the EBRI/ Commonwealth Fund Consumerism in Health Care Survey By Paul Fronstin, EBRI, and Sara R. Collins, The Commonwealth Fund Employee Benefit Research Institute December 2005 This report presents findings...
December 08, 2005
Des Moines Register editorial - A system that works for America
A system that works for America By Register Editorial Board The Des Moines Register December 7, 2005 The U.S. health-care system doesn’t work for ordinary people. It doesn’t work for Bill Cotton of Des Moines, who is spending his life...
December 07, 2005
Blue Bank and Blue VISA to administer HSAs
Blue Cross starting bank for health-related matters By Sarah Skidmore The San Diego Union-Tribune December 6, 2005 The Blue Cross and Blue Shield Association announced yesterday that it will start its own bank (Blue Healthcare Bank) to provide members a...
December 06, 2005
Widening rift in health-care access
A Widening Rift In Access And Quality: Growing Evidence Of Economic Disparities By Robert E. Hurley, Hoangmai H. Pham, Gary Claxton Health Affairs December 6, 2005 Data from the Community Tracking Study provide a valuable perspective from which to observe...
December 05, 2005
BC of California loses 68% of premiums to health care
Health Plan Costs Come Under Fire At a hearing in L.A., Garamendi grills insurance company executives about why premiums have soared 60% in four years. By Lisa Girion Los Angeles Times December 2, 2005 (California Insurance Commissioner John) Garamendi singled...
December 04, 2005
Our health-care system is not what the best minds woulddevise
Editorial: Fractured system hurts everyone By Register Editorial Board The Des Moines Register December 4, 2005 If the best minds in the world gathered to devise a health-care system for the United States, it would look nothing like what we...
December 02, 2005
We're almost there with three single payer bills
H.R.676, H.R.1200, and SB 840 Do not waste your time studying these bill summaries, but merely skim through them rapidly. You will see how a fairly simple concept, single payer reform, can become quite complex when reduced to legislative language....
December 01, 2005
No problem - Just set up an insurance purchasing pool
What Health Insurance Pools Can and Can’t Do By Rick Curtis and Ed Neuschler California HealthCare Foundation November 2005 Introduction Policymakers are often attracted to purchasing pools as a way to make health insurance less expensive for small employers and...
November 30, 2005
Is targeting subsidies to small business the answer?
Is Small Business the Key to Insuring More Californians? By Richard Kronick California HealthCare Foundation November 2005 Coverage Expansion Introduction There is substantial interest among policy analysts and politicians in increasing health insurance coverage among Californians who work for small...
November 29, 2005
BC/BS of Tennessee - a profitable nonprofit
The Best Of Times And The Worst Of Times: A Conversation With Vicky Gregg Health Affairs November 29, 2005 The CEO of BlueCross BlueShield of Tennessee describes what it’s like to be a profitable nonprofit in a state with a...
November 28, 2005
Single payer as an issue for "Unpartisans"
It’s my party, and I’ll vie if I want to By Brad Warthen, Editorial Page Editor The State.com Nov. 27, 2005 Why is it so hard for partisans and ideologues to understand that we might hold our own values and...
November 25, 2005
Cost-sharing can increase health care spending
When patients have to pay a share of drug costs: effects on frequency of physician visits, hospital admissions and filling of prescriptions By Aslam H. Anis, Daphne P. Guh, Diane Lacaille, Carlo A. Marra, Amir A. Rashidi, Xin Li and...
November 23, 2005
So you want the same insurance as members of Congress
Health insurance open season is opportunity to save By Tim Kauffman Federal Times November 21, 2005 Federal employees and retirees can save hundreds, even thousands, of dollars next year by switching health care plans during the annual enrollment period. Those...
November 22, 2005
Lessons for U.S. from China's health care privatization
Privatization and Its Discontents - The Evolving Chinese Health Care System By David Blumenthal, M.D., M.P.P., and William Hsiao, Ph.D. The New England Journal of Medicine September 15, 2005 …the means of China’s ascendancy probably would have infuriated Mao. Instead...
November 21, 2005
Mercer survey of employer-sponsored health plans
Health benefit cost slows for a third year, rising just 6.1% in 2005 Mercer Human Resource Consulting November 21, 2005 When annual health benefit cost increases peaked three years ago at nearly 15%, employers responded with an unprecedented flurry of...
November 18, 2005
Donald Berwick speaks up
‘A Deficiency Of Will And Ambition’: A Conversation With Donald Berwick By Robert Galvin Health Affairs January 12, 2005 Donald Berwick is president and chief executive officer of the Institute for Healthcare Improvement (IHI) in Boston, Massachusetts. Bob Galvin is...
November 17, 2005
Can we afford long-term care?
Developing a Better Long-Term Care Policy: A Vision and Strategy for America’s Future Sheila P. Burke, Judith Feder, and Paul N. Van de Water (eds.) National Academy of Social Insurance November 2005 Two Promising Approaches Transforming long-term care ultimately requires...
November 16, 2005
John Wennberg is howling in the wind
Important notice: It is likely that you will read the abstract of this report, yawn, and then delete the message. Don’t delete it! This study addresses one of the most important issues in health care today. It is crucial that...
November 15, 2005
Krugman on free markets for health insurance
Health Economics 101 By Paul Krugman The New York Times November 14, 2005 Several readers have asked me a good question: we rely on free markets to deliver most goods and services, so why shouldn’t we do the same thing...
November 14, 2005
Medicare Part D will bring us national health insurance
Medicare complexity may scare off seniors By Brooke Adams The Salt Lake Tribune 11/08/2005 As a tax attorney, Bill Vogel was not easily stumped by complex calculations. Wife Donna, a retired nurse recruiter, navigated the health care world with ease....
November 11, 2005
And now (trumpets please): Managed Consumerism!
Managed Consumerism In Health Care James C. Robinson Health Affairs November/December 2005 The future of market-oriented health policy and practice lies in “managed consumerism,” a blend of the patient-centric focus of consumer-driven health care and the provider-centric focus of managed...
November 10, 2005
Landmark study: Much administrative waste really is caused by private insurers
The Cost Of Health Insurance Administration In California: Estimates For Insurers, Physicians, And Hospitals By James G. Kahn, Richard Kronick, Mary Kreger and David N. Gans Health Affairs November/December 2005 Estimates of administrative costs in the U.S. health care system...
November 09, 2005
PPOs up, HMOs down
Uncertain prognosis: California workers face a whirlwind of change as employers seek alternatives to costly HMOs By Clea Benson The Sacramento Bee November 9, 2005 Because HMOs are more tightly regulated than other types of health insurance, most of the...
November 08, 2005
Canadian socioeconomic status and utilization of imaging services
Socioeconomic status and the utilization of diagnostic imaging in an urban setting By Sandor Demeter, Martin Reed, Lisa Lix, Leonard MacWilliam and William D. Leslie CMAJ November 8, 2005 The pillars of the Canada Health Act are that health care...
November 07, 2005
Krugman's solution for employment-based health insurance
Pride, Prejudice, Insurance By Paul Krugman The New York Times November 7, 2005 Employment-based health insurance is the only serious source of coverage for Americans too young to receive Medicare and insufficiently destitute to receive Medicaid, but it’s an institution...
November 04, 2005
The safety net is tattered
Kaiser Commission on Medicaid and the Uninsured November 4, 2005 Covering the Uninsured - Growing Need, Strained Resources In 2004, America’s 46 million uninsured received about $41 billion dollars in uncompensated care - care that was not paid for either...
November 03, 2005
Health systems provide mediocrity for sicker adults
Taking The Pulse Of Health Care Systems: Experiences Of Patients With Health Problems In Six Countries By Cathy Schoen, Robin Osborn, Phuong Trang Huynh, Michelle Doty, Kinga Zapert, Jordan Peugh, Karen Davis Health Affairs November 3, 2005 This paper reports...
November 02, 2005
Unintended over-utilization by ethical physicians
Variation in the Tendency of Primary Care Physicians to Intervene By Brenda E. Sirovich, MD, MS; Daniel J. Gottlieb, MS; H. Gilbert Welch, MD, MPH; Elliott S. Fisher, MD, MPH Archives of Internal Medicine October 24, 2005 There is widespread...
November 01, 2005
Increase in uninsured will save our economy
Changes In Economic Conditions And Health Insurance Coverage, 2000-2004 By John Holahan and Allison Cook Health Affairs November 1, 2005 Between 2000 and 2004, the number of uninsured Americans increased by six million, primarily because of a decline in employer-sponsored...
October 31, 2005
The danger of consumer-driven health care
The Danger of Consumer-Driven Health Care Crash Course by Jonathan Cohn The New Republic Nov. 7, 2005 Health care operates by what economists commonly call an “80/20” rule. In any given year, most of the money being spent on medical...
October 28, 2005
Medicare catastrophic drug coverage is a catastrophe
Medicare Drug Benefit May Expand ‘Catastrophic’ Protection By Karen Pallarito Forbes.com Oct. 26, 2005 The number of seniors protected against formidably high drug costs will increase sharply under the new Medicare prescription drug program, a new analysis finds. The study...
October 27, 2005
A Republican Senate candidate supports single payer principles
Tarrant’s healthy idea Brattleboro Reformer October 26, 2005 IDX co-founder Richard Tarrant may be running for the Republican U.S. Senate nomination in 2006, but when it comes to health care, he has some ideas that are quite different from the...
October 26, 2005
Taking good care of WellPoint
WellPoint’s 3Q Profit More Than Doubles By The Associated Press The New York Times October 26, 2005 WellPoint Inc. on Wednesday said earnings for the third quarter more than doubled as the company continued to reap the benefits of last...
October 25, 2005
Entrepreneurial physicians and their specialty hospitals
Effects Of Physician-Owned Limited-Service Hospitals: Evidence From Arizona By Jean M. Mitchell Health Affairs October 25, 2005 In recent years physician ownership of so-called limited-service hospitals has become commonplace in many states lacking certificate-of-need regulations. Empirical evidence documenting the effects...
October 24, 2005
Wal-Mart creates pseudo-insurance
Wal-Mart to Expand Health Plan for Workers By Michael Barbaro The New York Times October 24, 2005 Wal-Mart, which has long been criticized for the benefits it offers to its workers, is introducing a cheaper health insurance plan, with monthly...
October 21, 2005
Significance of the GM/UAW deal
GM DEAL: Cries of pain mix with sighs of relief By Michael Ellis Detroit Free Press October 21, 2005 The UAW unveiled details of the much-anticipated health plan Thursday. Under it, retirees would have to pay monthly premiums and annual...
UAW statement on tentative agreement with GM
UAW statement on tentative agreement with GM UAW October 20, 2005 UAW President Ron Gettelfinger and Vice President Richard Shoemaker: “The tentative agreement asks every UAW-GM member, active and retired, to make sacrifices so that everyone can continue to receive...
October 20, 2005
WSJ/Harris - 75% support universal health insurance
The Wall Street Journal October 20, 2005 The Harris Poll “Please indicate whether you support or oppose the policy.” “Universal health insurance” 75% - Strongly/Somewhat Favor 17% - Strongly/Somewhat Oppose http://online.wsj.com/article/SB112973460667273222.html...
Uninsured do not receive the care they know they need
Center for Studying Health System Change October 2005 Perception, Reality and Health Insurance: Uninsured as Likely as Insured to Perceive Need for Care but Half as Likely to Get Care By Jack Hadley and Peter J. Cunningham While considerable research...
October 19, 2005
15th Fraser alarm on queues in Canada
Waiting Your Turn: Hospital Waiting Lists in Canada, 15th Edition By Nadeem Esmail and Michael Walker The Fraser Institute October 2005 Total waiting time between referral from a general practitioner and treatment, averaged across all 12 specialties and 10 provinces...
October 18, 2005
Americans value employment-based health coverage, but...
2005 Health Confidence Survey: Cost and Quality Not Linked By Ruth Helman, Mathew Greenwald & Associates, and Paul Fronstin, EBRI Employment Benefit Research Institute EBRI Notes November 2005 Increasing health care costs continue to be strongly related to dissatisfaction with...
October 17, 2005
Instability of employer-sponsored coverage
Big Changes for Health Plans By Kathy M. Kristof Los Angeles Times October 9, 2005 Every year, workers are advised to look closely at their benefits package during open enrollment season. This year, they have even more reasons to read...
October 13, 2005
Drowning in insurance paperwork
Treated for Illness, Then Lost in Labyrinth of Bills By Katie Hafner The New York Times October 13, 2005 Medical paperwork is a world of co-payments and co-insurers, deductibles, exclusions and contracted fees. Nothing is as it seems: patients receive...
October 06, 2005
Big-box health insurance discounts
Big-box retail stores add health insurance to wares By Barbara Marquand Sacramento Business Journal September 30, 2005 Shoppers look for deals on everything from paper towels to computers at big-box warehouse stores. Now they can get health insurance too. Costco...
October 05, 2005
Lack of insurance is lethal for injured children
Injured kids: no insurance, no chance? Florida children who are hospitalized without insurance are more that twice as likely to die there, a study shows. By Lisa Greene St. Petersburg Times October 4, 2005 Children stream into Florida hospitals every...
October 04, 2005
Medicare Part E
Medicare Extra: A Comprehensive Benefit Option For Medicare Beneficiaries By Karen Davis, Marilyn Moon, Barbara Cooper, Cathy Schoen Health Affairs October 4, 2005 Abstract The proposed Part E, Medicare Extra, outlined in this paper adds a comprehensive benefit option to...
October 03, 2005
Pandemic of under-insurance
Medical Debt and Access to Health Care Prepared by Catherine Hoffman, Diane Rowland and Elizabeth C. Hamel The Kaiser Commission on Medicaid and the Uninsured September 2005 Health insurance alone is no longer a guarantee of financial protection from the...
September 30, 2005
Tax cuts, health spending, and reviving the economy
Medicaid Responsiveness, Health Coverage, and Economic Resilience: A Preliminary Analysis By Stan Dorn (The Economic and Social Research Institute), Barbara Markham Smith (Health Policy Innovation, Inc.) and Bowen Garrett (The Urban Institute) The Health Policy Institute of the Joint Center...
September 29, 2005
Priced out of health insurance, or health care?
‘Skeletal’ benefits in doubt Critics say cut-rate policies offer little coverage in need By Victoria Colliver San Francisco Chronicle September 21, 2005 As health care costs soar, insurers are offering a growing array of low-cost policies with high deductibles and...
September 28, 2005
Correlating societal health with religiosity and secularism
Note: The following Quote of the Day is highly controversial. If you are not in the mood to contemplate difficult societal issues, you may want to delete this message at this point. Cross-National Correlations of Quantifiable Societal Health with Popular...
September 27, 2005
Politics of the progressive-liberal agenda - Lakoff and Dionne
The Post-Katrina Era By George Lakoff The Huffington Post September 8, 2005 It is impossible for me, as it is for most Americans, to watch the horror and suffering from Hurricane Katrina and not feel physically sore, pained, bereft, empty,...
September 26, 2005
Health insurance churning
Entrances and Exits: Health Insurance Churning, 1998-2000 By Kathryn Klein, Sherry Glied, and Danielle Ferry The Commonwealth Fund September 2005 Abstract: Analysis of 1998-2000 health insurance data from the Medical Expenditure Panel Survey shows large numbers of people with unstable...
September 23, 2005
Beth Capell responds on the Medicaid waivers
Beth Capell, Ph.D., Policy Consultant for Health Access California, responds on the Medicaid waivers: Don: As bleak as your assessment is, it is not bleak enough. In Utah as elsewhere, the cuts envisioned under the waivers approved by the Bush...
September 22, 2005
Medicaid waiver extortion
Waiting for Action Right Words but Little Practical Help for Poor By David S. Broder The Washington Post September 22, 2005 Medical care for the evacuees from Louisiana, Mississippi and Alabama is urgently required. As Mark McClellan, the top federal...
"Choice" in Health Care: What Do People Really Want?
“Choice” in Health Care: What Do People Really Want? By Jeanne M. Lambrew, Ph.D. The Commonwealth Fund September 2005 Abstract: Proposals to expand the individual health insurance market and promote health savings accounts are intended to provide consumers with more...
September 21, 2005
Aetna makes it easier to buy "under-insurance"
Aetna Launches New Health Insurance Website with Online Enrollment Capability for Individuals and Their Families Aetna Press Release September 20, 2005 “Aetna is making it as simple as possible for individuals to choose the appropriate, affordable plans that match their...
September 20, 2005
Spending on biomedical and health services research
Financial Anatomy of Biomedical Research By Hamilton Moses III, MD; E. Ray Dorsey, MD, MBA; David H. M. Matheson, JD, MBA; Samuel O. Thier, MD JAMA September 21, 2005 The United States spent an estimated 5.6% of its total health...
September 19, 2005
Canadian and British researchers receive Lasker Awards
Five Pioneers Are Awarded Lasker Medical Prizes By Lawrence K. Altman The New York Times September 18, 2005 The 2005 Lasker Awards for medical research are going to scientists who discovered stem cells, invented genetic fingerprinting and developed a powerful...
September 17, 2005
Iraqi Constitution guarantees health insurance
Text of the Draft Iraqi Constitution (Translated from the Arabic by The Associated Press) Chapter Two: Rights and Freedoms Article (30): 1st - The state guarantees social and health insurance, the basics for a free and honourable life for the...
September 16, 2005
Attitudes of Business Leaders Regarding Health Care Coverage
Attitudes of Business Leaders Regarding Health Care Coverage The Robert Wood Johnson Foundation September 2005 The Robert Wood Johnson Foundation commissioned a survey of business owners and persons in charge of health care benefits at American businesses… to determine attitudes...
September 15, 2005
Milliman and cost sharing
The Price of Illness: Cost Sharing and Health Plan Benefits By Arthur L. Baldwin III (principal and consulting actuary, Milliman, Inc.), Marian Mulkey and Matthew Kagan California HealthCare Foundation September 2005 From the Conclusion: In the individual market, trends toward...
September 14, 2005
Can Electronic Medical Record Systems Transform Health Care?
Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs By Richard Hillestad, James Bigelow, Anthony Bower, Federico Girosi, Robin Meili, Richard Scoville and Roger Taylor Health Affairs September/October 2005 Abstract To broadly examine the potential...
September 13, 2005
Excess consumer demand?
Letters to Business By Richard T. Landres, M.D., Stockton San Francisco Chronicle September 11, 2005 SB840, the (single payer) bill proposed by state Sen. Sheila Kuehl, D-Santa Monica, would increase the cost of health care rather than reduce it. This...
September 12, 2005
Medicare PPOs' gain is taxpayers' loss
Defective Design: Regional Competition In Medicare An inconsistent approach to regional competition in the Medicare Modernization Act will be very costly for taxpayers. by Steven D. Pizer, Roger Feldman, and Austin B. Frakt Health Affairs August 23, 2005 Abstract: The...
September 11, 2005
President Bush on 9/11
The White House September 10, 2005 President’s Radio Address On Sunday, our nation will observe the fourth anniversary of the September the 11th terrorist attacks. Every American has memories of that day that will never leave them. We remember the...
September 09, 2005
Should a city council set health policy?
Hospitals defeated in bid to block rival By Darrell R. Santschi The Press-Enterprise September 7, 2005 More than a month into one of the most bitterly divisive public debates in Loma Linda’s 35-year history, three City Council members voted Tuesday...
September 08, 2005
Garamendi's "Priced Out"
Priced Out Health Care in California 2005 John Garamendi, Insurance Commissioner Table of Contents Chapter 1 The State of California Health Care: The National Context Crisis in Health Insurance: Skyrocketing Health Insurance Premiums Crisis in Health Insurance: Paying More for...
September 07, 2005
73% of workers want a national health care system
Health care tops a growing list of worries By John Sweeney, President of AFL-CIO The Philadelphia Inquirer Sep. 5, 2005 Despite the “recovery,” economic dissatisfaction among working Americans is increasing. Nearly 60 percent are not happy with the country’s economic...
September 06, 2005
Is Regence BlueCross BlueShield selling retirement plans?
Regence BlueCross Blue Shield of Oregon Regence Health Savings Account Frequently Asked Questions For employers: Q: What are the advantages to the employer? A: Employer contributions to a health savings account are tax-deductible in year in which the contributions were...
September 02, 2005
Two American Disasters
The faces of disaster Editorial The Philadelphia Inquirer Aug. 31, 2005 The images were stunning: rooftop rescues, submerged casinos, a high-rise hotel bereft of windows, and the Superdome’s roof peeled back in places like a banana peel. As the floodwaters...
September 01, 2005
USA Today-KFF-Harvard Health Care Costs Survey
USA Today/Kaiser Family Foundation/Harvard School of Public Health September 1, 2005 Health Care Costs Survey Survey Findings Health care costs are more than a barrier to access to care, our findings show that medical bills create a significant challenge for...
August 31, 2005
CBO: The Price Sensitivity of Demand for Nongroup Health Insurance
The Price Sensitivity of Demand for Nongroup Health Insurance Congressional Budget Office August 2005 This paper examines the sensitivity of decisions to purchase insurance in the individual, or “nongroup,” insurance market to the price of that insurance-a central aspect of...
August 30, 2005
U.S. Census Bureau: 45.8 million uninsured
Income Stable, Poverty Rate Increases, Percentage of Americans without Health Insurance Unchanged U.S. Census Bureau August 30, 2005 The percentage of the nation’s population without health insurance coverage remained stable, at 15.7 percent in 2004. The number of people with...
August 29, 2005
Physicians returning to Canada
For the First Time, More Canadian Physicians Are Returning to the Country Than Leaving Canadian Institute for Health Information August 24, 2005 New statistics compiled by the Canadian Institute for Health Information (CIHI) show that for the first time since...
August 26, 2005
M. Gladwell on the moral-hazard myth
The Moral-Hazard Myth: The bad idea behind our failed health-care system By Malcolm Gladwell The New Yorker August 29, 2005 At the center of the Bush Administration’s plan to address the health-insurance mess are Health Savings Accounts, and Health Savings...
August 22, 2005
Aetna and the California Medical Association are off target
Cover Yourself! Op-Ed By Jack Lewin, M.D. and Ronald Williams (Dr. Lewin is CEO of the California Medical Association. Mr. Williams is president of Aetna.) Wall Street Journal August 19, 2005 With 45 million Americans uninsured, achieving universal access to...
August 18, 2005
Celebrate New York's victory, but get back to work!
N.Y. Council Backs Benefits Bill By Amy Joyce The Washington Post August 18, 2005 The New York City Council yesterday passed a measure requiring most stores that sell groceries to provide a set level of health care coverage for their...
August 17, 2005
Taking away choice
Pick and Lose By Jonathan Cohn The New Republic August 22, 2005 Has any word done more to cloak the modern conservative agenda than “choice”? …what conservatives in this country never mention is that giving us these new choices also...
August 16, 2005
UCLA study of California insurance a lesson for all
The State of Health Insurance in California: Findings from the 2003 California Health Interview Survey By E. Richard Brown, PhD, Shana Alex Lavarreda, MPP, Thomas Rice, PhD, Jennifer R. Kincheloe, PhD, MPH and Melissa S. Gatchell, MPH UCLA Center for...
August 15, 2005
Thorpe's NCHC report on the costs of comprehensive reform
A previous Quote of the Day provided a link to Prof. Kenneth Thorpe’s PowerPoint presentation of his study of the costs of four models of universal health care coverage. The National Coalition on Health Care has now released a formal...
August 12, 2005
Another report on medical debt
Seeing Red: Americans Driven into Debt by Medical Bills By Michelle M. Doty, Jennifer N. Edwards, and Alyssa L. Holmgren The Commonwealth Fund August 2005 ABSTRACT: New analysis of the 2003 Commonwealth Fund Biennial Health Insurance Survey reveals that an...
August 09, 2005
Alberta's Premier Klein supports better access for those willing to pay
Opening access to health care is a moral duty, says Klein By Ralph Klein, Premier of Alberta Calgary Herald July 30, 2005 Opinion Let me be blunt. We have unacceptable waiting lists in our publicly funded, rationed health-care system, and...
July 26, 2005
Immigrants use half as much health care as US-born residents
Health Care Expenditures of Immigrants in the United States: A Nationally Representative Analysis By Sarita A. Mohanty, MD, MPH, Steffie Woolhandler, MD, MPH, David U. Himmelstein, MD, Susmita Pati, MD, MPH, Olveen Carrasquillo, MD, MPH and David H. Bor, MD...
July 14, 2005
The inequity of the deductibility of employer-sponsored plans
Job-sponsored health plans may be targeted for taxation By Kevin G. Hall (Knight Ridder Newspapers) CentreDaily.com Jul. 13, 2005 For 60 years, American workers have received job-sponsored health-care benefits that are excluded from income and payroll taxes, but now they’re...
July 13, 2005
Brown and Kominski on single payer
The Uninsured in California: Single-Payer Health Care Project California July 13, 2005 Serious ailments afflict California’s health care system. The “single-payer” model is seen by many as one possible cure. Advocates say such a system would provide universal coverage at...
July 12, 2005
High prices contribute to high costs
Health Spending In The United States And The Rest Of The Industrialized World By Gerard F. Anderson, Peter S. Hussey, Bianca K. Frogner and Hugh R. Waters Health Affairs July/August 2005 Do Americans have access to a greater supply of...
July 08, 2005
The Public-Private Mix for Health
The Nuffield Trust The Public-Private Mix for Health Edited by Alan Maynard This book, written over 20 years after the publication of a similar collection of essays, examines again the complexities, frustrations and progress of healthcare systems in a leading...
July 06, 2005
Rick Mayes on the elusive quest for national health insurance
Book Review by Don McCanne The New England Journal of Medicine July 7, 2005 Universal Coverage: The Elusive Quest for National Health Insurance (Conversations in Medicine and Society.) By Rick Mayes. 207 pp. Ann Arbor, University of Michigan Press, 2004....
June 30, 2005
Bush & Congress agree on reform - "Patient Navigator"
Bush Signs ‘Patient Navigator’ Bill To Help People Make Medical Decisions Kaiser Daily Health Policy Report June 30, 2005 President Bush on Wednesday signed into law a bill that will establish a “patient navigator” system to help patients with chronic...
June 29, 2005
"Medicare Health Accounts"
Medicare Health Accounts: A New Policy Option to Help Adults Save for Health Care Expenses Not Covered by Medicare Findings from the Commonwealth Fund Survey of Older Adults By Sara R. Collins, Karen Davis, Sabrina K. H. How, and Alyssa...
June 27, 2005
Higher costs related to rising prevalence of chronic disease
The Rising Prevalence Of Treated Disease Effects On Private Health Insurance Spending To contain spending, the U.S. health care system needs to address rising rates of treated disease instead of requiring higher cost sharing from consumers By Kenneth E. Thorpe,...
June 22, 2005
Medi-Share: the Cadillac of uninsurance
Christian cost-sharing health insurance gaining subscribers By Bob Jones IV, with Joe Maxwell Church Central June 21, 2005The members of Medi-Share conduct a 24-hour, seven-day-a-week prayer chain for fellow members who have suffered sickness or injury serious enough to require...
June 21, 2005
Paul Starr, "End of the Private New Deal"
End of the Private New Deal As Republicans loudly threaten the public New Deal, the corporate version quietly slips away By Paul Starr The American Prospect Online Edition June 20, 2005The old corporate America that took responsibility for workers’ pensions...
June 20, 2005
Health care is "the most important domestic issue"
The New York Times/CBS News Poll June 10-15, 200515. If you had to say, which of these domestic issues do you think is MOST important right now — 1) the budget deficit, 2) health care, 3) education, 4) social security,...
June 17, 2005
Industry consulting firm on CDHPs
Consumer-Directed Health Plan Report - Early Evidence Is Promising By Vishal Agrawal, Tilman Ehrbeck, Kimberly O’Neill Packard, and Paul Mango McKinsey & Company June 2005To gain early insights into what is, arguably, the most important development in health insurance since...
June 16, 2005
Premium increases three times inflation is a victory?
CalPERS gives OK to HMO increase By Victoria Colliver San Francisco Chronicle June 16, 2005It’s a sign of the times when the state pension fund approves HMO rate increases roughly three times the rate of inflation and that’s considered a...
June 15, 2005
PNHP's response to the Canadian Supreme Court decision
PNHP Statement on the Canadian Supreme Court Decision on Private InsuranceOn June 9, 2005, the Supreme Court of Canada ruled that the Quebec government cannot ban private insurance that duplicates the coverage under Canada’s national health insurance system (known as...
June 14, 2005
Underinsurance is almost as bad as no insurance
Insured But Not Protected: How Many Adults Are Underinsured? The experiences of adults with inadequate coverage mirror those of their uninsured peers, especially among the chronically ill. By Cathy Schoen, Michelle M. Doty, Sara R. Collins, Alyssa L. Holmgren(Commonwealth Fund)...
June 13, 2005
Paul Krugman on single payer
One Nation, Uninsured By Paul Krugman The New York Times June 13, 2005Harry Truman tried to create a national health insurance system. Public opinion was initially on his side: Jill Quadagno’s book “One Nation, Uninsured” tells us that in 1945,...
June 10, 2005
RAND report on consumer-driven health plans
“Consumer-Driven” Health Plans: Implications for Health Care Quality and Cost By RAND California HealthCare Foundation June 2005Confronted with double-digit increases in health insurance costs and consumer dissatisfaction with managed care, employers are looking for new ways to contain health care...
B. Capell on RAND's conclusions on CDHPs
Beth Capell, Ph.D. on the RAND conclusions on CDHPs:Don:There is a rather substantial literature (about 12 inches deep on my desk) demonstrating that people with high out of pocket costs fail to seek necessary and appropriate care.To quote Health Access...
June 09, 2005
Canadian Supreme Court ruling a step toward two-tiered care
Top court strikes down Quebec private health-care law CBC News (Canada) June 9, 2005The Supreme Court of Canada ruled Thursday that the Quebec government cannot prevent people from paying for private insurance for health-care procedures covered under medicare.The plaintiffs in...
June 08, 2005
The uninsured drive up premiums for the insured
Paying a Premium: The Added Cost of Care for the Uninsured Families USA June 2005This study quantifies, for the first time, the dollar impact on private health insurance premiums when doctors and hospitals provide health care to uninsured people. In...
June 07, 2005
Targeting incremental reforms to states falls far short of goals
Variations In The Impact Of Health Coverage Expansion Proposals Across States By Sherry Glied and Douglas Gould Health Affairs June 7, 2005Abstract:Most estimates of the consequences of alternative health insurance proposals focus on national impact, but the extent of cross-state...
June 06, 2005
Insurers reviving reputation of limited benefit plans
Second look: High costs and insurer interest are reviving limited benefit medical plan reputation By Karen Lee Employee Benefit News May 2005In only a few short years, limited medical benefit plans have risen in perception from a status as low-selling...
June 03, 2005
Italians reject private health insurance
Health: Italians Pay for the Doctor, Not for Private Insurance Agenzia Giornalistica Italia (AGI) June 2, 2005Between 1991 and 2002 the trend towards private insurance among Italian families has been steadily growing but they still remain “under-insured” compared to the...