Quote of the Day

PNHP's Senior Health Policy Fellow Don McCanne, M.D. writes a daily health policy update, taking an excerpt or quote from a health care news story or analysis on the Internet and commenting on its significance to the single-payer health care reform movement. PNHP posts Dr. McCanne's listserv here; to subscribe to the listserv, please visit the Quote of the Day the mailing list website.

  • Posted on Monday, December 22, 2014
    Medicaid has traditionally underpaid physicians for their health care services. That has resulted in low participation rates, especially by specialists, which, in turn, threatens health care access for Medicaid patients. The Medicaid statute requires that states' Medicaid provider payments must be “sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population in the geographic area.” Failure of our government to enforce this equal-access provision will now be heard by the Supreme Court.

  • Posted on Friday, December 19, 2014
    Deb Richter is right. The criticisms of Vermont Gov. Peter Shumlin are not only misdirected, many of them are based on the notion that he had all of the tools at hand to establish a single payer system in Vermont, but that he then decided not to move forward in response to political pressure. We should look carefully at the facts and then decide what approach we should now take to advance the single payer cause.

  • Posted on Thursday, December 18, 2014
    During the health care reform debate there was considerable support for a “public option” - providing individuals an option of choosing a Medicare-like program, administered by the government, that would compete with the private health plans. During the legislative process it received much publicity, but it was eventually eliminated from consideration under pressure from the insurance industry that did not want any competition from the government. A vote on a single payer proposal also was promised by the Democratic leadership in the House, but eventually the opportunity for that vote was traded away in politics as usual.

  • Posted on Wednesday, December 17, 2014
    Gov. Shumlin has provided a very valuable lesson for all of us. He did almost everything possible on a state level to try to establish a single payer system within Vermont. He has established the fact that, beyond all doubt, a bona fide single payer system is impossible to enact and implement on a state level without comprehensive enabling federal legislation.

  • Posted on Tuesday, December 16, 2014
    This Avalere report reminds us that, at a given actuarial value of a health plan (average percent of the health care costs covered by the plan), there is a reciprocal relationship between the maximum out-of-pocket spending for which the insured is responsible and the deductible that must be met before the plan begins paying for health care.

  • Posted on Monday, December 15, 2014
    The dream of expanding Medicare to cover all of us has failed to materialize in a large part because of the nation’s obsession with marketplace concepts of health care financing. On the supply side, health care providers are responding to financial incentives that maximize their revenue. On the demand side, patient-consumers are responding to financial incentives that minimize their out-of-pocket spending.

  • Posted on Thursday, December 11, 2014
    During the health care reform process there seemed to be an attitude that we were already doing well in ensuring that the health care needs of children were being met. Employer-sponsored family coverage took care of middle- and upper-income children, Medicaid and SCHIP covered lower-income children, and community health centers and other safety-net institutions took care of children who were not covered by the other programs. The Affordable Care Act expanded assurances of coverage by providing income-based subsidies for plans offered through the exchanges. So what is the problem?

  • Posted on Wednesday, December 10, 2014
    One of the major features of the Affordable Care Act was to expand Medicaid to cover a greater number of low-income individuals. Although many states opted out of the expansion, nevertheless Medicaid enrollment increased in those states as well. Because of the expansion of state budgets required to cover the burgeoning Medicaid population, most states have moved most if not all of their Medicaid patients into Medicaid managed care plans.

  • Posted on Tuesday, December 9, 2014
    Both premiums for employer-sponsored health plans and employee out-of-pocket expenses for health care have continued to increase well in excess of employee income, in spite of a general slowing in health care spending. Employees “are paying more in premiums and deductibles as a share of their income than ever before,” and it is likely that there is no relief in site, in spite of the enactment of the Affordable Care Act.

  • Posted on Monday, December 8, 2014
    There are several factors contributing to the slowdown in health care spending, but one of the most important is insurance innovation that is impairing affordability and access. These innovations include “consumer empowerment” measures, such as ever-higher deductibles, shift from co-payments to higher coinsurance, establishment of higher-cost tiers, and narrower provider networks that impair access.

  • Posted on Friday, December 5, 2014
    Will everyone who is surprised that the the private insurers are changing the fine print on the plans offered through the exchanges please raise your hands. (Sorry, I can’t see your hands, just as most of those purchasing plans on the exchanges won’t see the fine print either.)

  • Posted on Thursday, December 4, 2014
    Specialty drugs are a problem for private insurers for two reasons. They are very expensive, and they are taken by individuals with serious high-cost disorders such as cancer, rheumatoid arthritis and multiple sclerosis. It is important to understand the insurers’ responses to their concerns.

  • Posted on Wednesday, December 3, 2014
    No comment.

  • Posted on Tuesday, December 2, 2014
    This short book by Amy Finkelstein, “Moral Hazard in Health Insurance,” provides an excellent update that can be used to better understand the application of the concept of moral hazard to the design of health care financing. But more must be said.

  • Posted on Monday, December 1, 2014
    Health care reform should have eliminated underinsurance, not create more of it. The private insurance industry will not fix this problem but only compound it as it strives to keep its premiums competitive.

  • Posted on Wednesday, November 26, 2014
    The character of a nation is determined by support of its social programs. Medicare and Social Security are two social insurance programs that are revered by U.S. citizens. Yet those programs, combined with other public social programs, leave us ranked only 23rd amongst OCED nations. It is our unique private social spending programs that move us from 23rd to 2nd place.

  • Posted on Tuesday, November 25, 2014
    We’ve heard similar stories many times before. The largest insurer in Georgia, WellPoint’s Blue Cross and Blue Shield of Georgia, has been unable or unwilling to negotiate a contract renewal with Grady Memorial Hospital, the home of one of the most prominent trauma centers in the nation.

  • Posted on Monday, November 24, 2014
    The Affordable Care Act included Senator Ted Kennedy’s Community Living Assistance Services and Supports Act (CLASS Act) which would have provided long-term care. Unfortunately the specifics of the CLASS Act proved to be unworkable and thus it has been suspended. But according to this new study, unless you are wealthy, you do not need long-term care insurance anyway. Most of us can simply spend down our assets and then Medicaid will take care of us.

  • Posted on Friday, November 21, 2014
    The experience of the homeless population under the Affordable Care Act (ACA) demonstrates both the benefits of reform under ACA and the flaws of ACA that call for replacement with a single payer system. ACA was better than nothing, but we can have so much more through enactment of a single payer system.

  • Posted on Thursday, November 20, 2014
    This international comparison of health care in older adults in eleven nations is the latest in the series sponsored by the Commonwealth Fund. For the United States, it is unique in that it compares only patients over 65 in our public Medicare program with older patients in other nations that already have universal health care systems.