Friday, July 25, 2014

Fwd: qotd: Kshama Sawant on single payer

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-------- Original Message --------
Subject: qotd: Kshama Sawant on single payer
Date: Fri, 25 Jul 2014 13:11:52 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Crosscut.com (Seattle)
July 23, 2014

Glimmers of healthcare politics at meeting of Western Washington docs

Tough talk from Kshama Sawant and others at annual gathering of Western
Washington Physicians for a National Health Program.

By Ted Van Dyk

Seattle City Council member Kshama Sawant also was critical of
Obamacare, arguing that the administration colluded with drug and
insurance companies in framing it. Sawant spoke longest and most avidly
at the meeting. She called on committed single-payer supporters to
follow the example of those who sought a $15 minimum wage in Seattle,
and bring tireless pressure to bear on Democratic officeholders in
particular. Sawant is a committed socialist who often referred to
"working class interests" and "corrupt corporations, banks, and hedge
fund operators."

Kshama Sawant (video at 4:45):

"Our discussion should be formulated not on the basis of whether or not
the ACA delivered something good. Maybe it did, but that's not the
point. The point is, what are we not getting from it, and why didn't we
win single payer health care? That's what I would like to focus on."

http://crosscut.com/2014/07/23/health-medicine/121125/western-wa-physicians-national-health-program/?page=single

****


Comment by Don McCanne

Socialist Kshama Sawant, a member of the Seattle City Council, came to
national attention by leading her fellow council members in passing a
$15/hour minimum wage for their city. Having shown that political
activism can still be effective, she has important advice for us in our
efforts to enact single payer reform.

Currently attention has been diverted from single payer, as most
progressives are celebrating the supposedly great successes in
implementation of the Affordable Care Act (ACA). Even the Republicans in
Congress who have voted several times to repeal ACA, are now suing
President Obama for not implementing it fast enough.

Those of us who continue to adamantly support single payer are facing
criticism for not joining the ACA bandwagon. This is where Sawant's
message is so important. Whether "ACA delivered something good" is not
the point. The point is, we have to inform the public on "what are we
not getting from it." And what we are not getting is most of the goals
of reform! The accomplishments are extremely modest compared to the
reform that we need.

What are we not getting from ACA that we would be getting from single payer?

* Truly universal coverage
* Dramatic reduction in administrative waste
* Removal of financial barriers to care
* Coverage of all essential health care services
* Free choice of hospitals and health care professionals
* Removal of the interventions and excesses of the private insurers
* Taxpayer financing based on ability to pay
* Infrastructure reform that would slow spending to sustainable levels

And what successes are the ACA supporters touting (though using
different rhetoric)?

* Coverage of only about half of the uninsured
* Shift to underinsurance products
* Guaranteed issue of these underinsurance products
* Deductibles that keep patients away from care by erecting financial
barriers
* Insurance subsidies that are inadequate
* Ultra-narrow networks that take away choice
* Insurance marketplaces that increase administrative complexity and waste
* Inadequate cost containment policies (except for perverse higher
deductibles)

Sawant delivers a very strong leftist message on social justice issues,
and includes in her comments the failures of the Democratic Party to
act. But this point on what we are not getting from ACA and why we need
single payer is not a leftist message. It is a call for all of us from
across the political spectrum who support single payer to take control
of the message. We can no longer allow ourselves to be a meek voice
silenced by those who, for noble and ignoble reasons, celebrate the
paltry successes of ACA.

Again, the something good that ACA did is not the point. The point is
what we are not getting from ACA and would be getting under a single
payer system. Let's drown out the message of the ACA supporters who
wimped out on real reform.

Thursday, July 24, 2014

Fwd: qotd: Arkansas - Poor people need to be taught how insurance works

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-------- Original Message --------
Subject: qotd: Arkansas - Poor people need to be taught how insurance works
Date: Thu, 24 Jul 2014 11:37:14 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Kaiser Health News
July 22, 2014
Arkansas Weighs Plan To Make Some Medicaid Enrollees Fund Savings Accounts
By Michelle Andrews

If all goes according to plan, next year many Arkansas Medicaid
beneficiaries will be required to make monthly contributions to
so-called Health Independence Accounts. Those that don't may have to pay
more of the cost of their medical services, and in some cases may be
refused services.

Supporters say it will help nudge beneficiaries toward becoming more
cost-conscious health care consumers. Patient advocates are skeptical,
pointing to studies showing that such financial "skin-in-the-game"
requirements discourage low-income people from getting care that they need.

Michigan and Indiana have already implemented health savings accounts
for their Medicaid programs, modeled after the accounts that are
increasingly popular in the private market. The funds, which may be
supplemented by the state, can be used to pay for services subject to
the plan deductible, for example, or to cover the cost of other medical
services.

The program particulars in each state differ. But both states – and the
Arkansas proposal -- require beneficiaries to make monthly contributions
into the accounts in order to reap certain benefits, such as avoiding
typical cost sharing for medical services. Funds in the accounts may
roll over from one year to the next, and participants may be able to use
them to cover their medical costs if they leave the Medicaid program.

"We believe in consumerism," says John Selig, director of the Arkansas
Department of Human Services. By requiring Medicaid beneficiaries to
make a monthly contribution to a Health Independence Account, "we think
they'll use care more appropriately and get a sense of how insurance works."

Under the health law, states can expand Medicaid coverage to adults with
incomes up to 138 percent of the federal poverty level (currently
$16,105 for an individual). So far, about half have done so. But some
conservatives have objected to the expansion of a government entitlement
program, preferring a private market approach that they say encourages
personal responsibility.

Arkansas and Iowa proposed and received approval from the federal
Department of Health and Human Services for premium assistance programs
that use federal funds to enroll the new Medicaid-eligible beneficiaries
in marketplace plans.

For 2015, Arkansas is proposing to expand its experiment by introducing
the Health Independence Accounts. Nearly all beneficiaries earning
between 50 and 138 percent of the poverty level ($5,835 to $16105 for an
individual) would have to participate through monthly contributions of
between $5 and $25, depending on their income, or face cost-sharing
requirements capped at 5 percent of income by Medicaid rules. In
addition, Medicaid enrollees with incomes over the poverty level could
be refused services if they don't make their monthly contribution and
don't make a copayment. (This year, those with incomes between 100 and
138 percent of poverty already have co-pays.)

Under the new program, any of the private option enrollees would be able
to avoid all cost sharing charges next year by making monthly
contributions to their HIA.

Each month that a beneficiary makes a payment to his or her account, the
state will contribute $15. Unused amounts will roll over from one year
to the next up to a maximum of $200, which can be used by the
beneficiary for health care costs if he or she leaves Medicaid for
private coverage.

Advocates say they're pleased that 175,000 Arkansans have gained
coverage under the Medicaid expansion. But the proposal for next year
gives them pause.

"There are concerns with adding cost sharing to those below the poverty
level," says Anna Strong, health care policy director at Arkansas
Advocates for Children and Families.

Those concerns are well founded, say experts. "This is something that
researchers have looked at a lot," says MaryBeth Musumeci, associate
director at the Kaiser Commission on Medicaid and the Uninsured.
"Overarchingly, premiums and cost sharing have been shown to discourage
or impede folks from getting needed care."

Some experts note that at least 40 states already charge premiums or
cost sharing for at least some beneficiaries. Beneficiaries have skin in
the game already, they say, and they question the value of these special
accounts that add a whole new layer of complexity for people who may not
ever have had insurance before.

"We're creating these incredibly complicated administrative structures,
and I don't think people will understand them," says Judith Solomon,
vice president for health policy at the Center on Budget and Policy
Priorities.

http://www.kaiserhealthnews.org/Stories/2014/July/22/Michelle-Andrews-on-Arkansas-plan-for-Medicaid-savings-accounts.aspx

****


Comment by Don McCanne

Arkansas is demonstrating to us the irrationality of basing reform on
ideological concepts divorced from health policy science. Let's look
closer at this proposal for "Health Independence Accounts," their
version of consumer directed health care for very low income
individuals, using the concept of health savings accounts.

* "Nearly all beneficiaries earning between 50 and 138 percent of the
poverty level ($5,835 to $16,105 for an individual) would have to
participate through monthly contributions of between $5 and $25."

* It seems to matter little that these individuals have no
discretionary income since they do not have enough revenues to meet
their basic needs, much less contribute to a savings account.

* If they are able to make their payments, then, according to this
article, cost sharing is eliminated. Wasn't a purpose of the savings
accounts to help pay for cost sharing?

* So what do they suggest is the purpose of the health savings
accounts? They "can be used by the beneficiary for health care costs if
he or she leaves Medicaid for private coverage." So this is a financing
plan for Medicaid that won't be used, but saved until after the person
leaves Medicaid? How does that help?

* For those with incomes between 100 and 138 percent of the federal
poverty level, failure to make a payment into the Health Independence
Account could result in being refused health care services. Is this
really a rational policy for trying to improve health care access for
these low income individuals?

No, it's not about improving health care access. According to John
Selig, director of the Arkansas Department of Human Services, "We
believe in consumerism. We think they'll use care more appropriately and
get a sense of how insurance works."

This is ideology that is totally divorced from health policy science.
Contrast that with ideology that is based on sound health policy science
that results in everyone receiving the health care that they need within
a system that is affordable for all. Of course, that would be a single
payer national health program.

This is sometimes presented as an ideological divide between the
"individual responsibility" and the "we're all in this together"
mindsets, but ideology cannot be divorced from policy science. Health
care should not simply be teaching poor people about how insurance
works. It should be about getting them the care that they need, when
they need it.

Wednesday, July 23, 2014

Fwd: qotd: Paradox of health care spending slowdown but higher financial burden for patients

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-------- Original Message --------
Subject: qotd: Paradox of health care spending slowdown but higher
financial burden for patients
Date: Wed, 23 Jul 2014 12:35:50 -0700
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>



Dobson/DaVanzo
Report prepared for the Federation of American Hospitals
July 23, 2014
Health Care Spending Slowdown: The Consumer Paradox
By Al Dobson, Ph.D., Gregory Berger, M.P.P., Kevin Reuter, Phap-Hoa Luu,
M.B.A. and Joan E. DaVanzo, Ph.D., M.S.W.

In recent reports we have outlined the continuing historic slowdown in
the growth rate of health care spending driven in large part by emerging
structural changes in the health care system. Recent evidence suggests
that the cost curve has continued to bend, with health care spending
declining in the first quarter of 2014. Despite this continuing trend in
health care spending growth, consumers are increasingly concerned that
they are ever-more financially burdened by spending on their own health
care.

This consumer perception is largely a factor of the "new normal" being
established through health insurance, which includes:

• Benefit plan designs, used by employers and insurers to shift greater
financial risk to consumers through higher out-of- pocket spending
(i.e., deductibles, co-payments, and co- insurance); and

• Health insurance premiums, which continue to rise faster than the
average person's income.

This trend of growth in out-of-pocket spending combined with increases
in health insurance premiums that outpace increases in wages is not
sustainable over the long term, and harms both patients and providers.

Key Findings

• In the first quarter of 2014, consumer spending on health care
declined by 1.4%, representing the largest decline in over 30 years

• Almost 60% of Americans think that health care costs have been growing
faster than usual in recent years, and more than 70% of consumers
attribute responsibility for their perceived high and rising costs to
health insurance companies

• Total premiums have increased substantially over the past decade, from
14.9% to 21.6% of median household income between 2003 and 20126

• Employee contributions to premiums and out-of-pocket spending have
risen 23% faster than employee costs since 2009 (32% in cumulative
growth vs. 26%)

• Cumulative growth in workers' contributions to premiums between 2002
and 2013 was 114%, approximately four times higher than growth in
workers' average income (31%)

• Deductibles for family coverage increased more than 75% from 2006 and
2013 (from $1,034 to $1,854), while enrollment in plans with a
deductible increased to 81% in 2013

• The percentage of workers enrolled in high-deductible plans ($1,000 or
more) has increased more than five times over the past decade, from 4%
in 2006 to 26% in 2014

• Overall, employees' premium contributions and out-of-pocket expenses
per capita have grown by 42% over the past five years, from $6,824 in
2009 to $9,695 in 2014

Payers and providers are both adjusting to a "new normal" in the
marketplace through a variety of multi-year strategies aimed at
improving quality, reducing costs, and minimizing financial risk within
the evolving regulatory framework. Additional interventions or blunt
policymaking, rather than allowing the market to respond to current
reform efforts, could interfere with the system.

Both payers (including employers) and providers have prepared multi-year
transition plans to adjust their business models, and require some level
of predictability and capital reserves. Major disruptions to the
operating environment for providers, payers and/or employers may
generate uncertainty, which ultimately could flow down to consumers in
the form of higher premium contributions and out-of-pocket spending.

http://fahpolicy.org/wp-content/uploads/2014/07/Dobson-DaVanzo-Federation-Cost-Sharing-Executive-Summary.pdf

Report:
http://fahpolicy.org/wp-content/uploads/2014/07/Dobson-DaVanzo-Federation-Cost-Sharing-Report.pdf

****


Comment by Don McCanne

This report describes the paradox of the "new normal" in which increases
in health care costs have been slowing as payer/employers and providers
adjust their business models to the marketplace, while the financial
burden for health care on patient/consumers continues to increase. As
this report states, "this trend of growth in out-of-pocket spending
combined with increases in health insurance premiums that outpace
increases in wages is not sustainable."

This study was sponsored by the Federation of American Hospitals - the
lobby organization for America's private, investor-owned hospitals. To
no surprise, they recommend that the marketplace be allowed to work its
magic, avoiding disruptions or policy changes that could interfere with
the system. They caution that such interference "could flow down to
consumers in the form of higher premium contributions and out-of-pocket
spending."

What? They have just shown us how the market they want to protect is
taking care of payer/employers and providers (including for-profit
hospitals) while creating financial burdens for patient/consumers
through "higher premium contributions and out-of-pocket spending."

They haven't gotten reform right, and they won't as long as we allow the
medical/industrial complex to remain in charge. Reform needs to be
centered around the patient, yet it is the patient who is being dumped
on. Single payer would fix that.