Friday, October 31, 2014

Fwd: qotd: Insurance shopping without health insurance literacy

_______________________________________________
Quote-of-the-day mailing list
Quote-of-the-day@mccanne.org
https://pairlist2.pair.net/mailman/listinfo/quote-of-the-day

-------- Forwarded Message --------
Return-Path: quote-of-the-day-bounces@mccanne.org
Received: from two.pairlist.net ([216.92.1.93]) by mx.perfora.net
(mxeueus003) with ESMTPS (Nemesis) id 0Le3XG-1YR2Wu0qzc-00pxNQ for
<gebser@mousecar.com>; Fri, 31 Oct 2014 20:18:44 +0100
Received: from two.pairlist.net (localhost [IPv6:::1]) by
two.pairlist.net (Postfix) with ESMTP id A9503680DE; Fri, 31 Oct 2014
15:18:28 -0400 (EDT)
X-Original-To: quote-of-the-day@lists2.mccanne.org
Delivered-To: quote-of-the-day@two.pairlist.net
Received: from tanha.pair.com (tanha.pair.com [209.68.5.144]) by
two.pairlist.net (Postfix) with SMTP id AE261680D0 for
<quote-of-the-day@lists2.mccanne.org>; Fri, 31 Oct 2014 15:18:02 -0400 (EDT)
Received: (qmail 13969 invoked by uid 3187); 31 Oct 2014 19:18:02 -0000
Delivered-To: mccanne-mccanne:org-quote-of-the-day@mccanne.org
Received: (qmail 13966 invoked from network); 31 Oct 2014 19:18:02 -0000
Received: from mailwash46.pair.com (66.39.2.46) by tanha.pair.com with
SMTP; 31 Oct 2014 19:18:02 -0000
Received: from localhost (localhost [127.0.0.1]) by mailwash46.pair.com
(Postfix) with SMTP id 8389FEBF9F for <quote-of-the-day@mccanne.org>;
Fri, 31 Oct 2014 15:18:02 -0400 (EDT)
X-Virus-Check-By: mailwash46.pair.com
Received: from mail-qc0-f181.google.com (mail-qc0-f181.google.com
[209.85.216.181]) by mailwash46.pair.com (Postfix) with ESMTP id
71790EBF9C for <quote-of-the-day@mccanne.org>; Fri, 31 Oct 2014 15:18:02
-0400 (EDT)
Received: by mail-qc0-f181.google.com with SMTP id w7so6363885qcr.40
for <quote-of-the-day@mccanne.org>; Fri, 31 Oct 2014 12:18:02 -0700 (PDT)
X-Google-DKIM-Signature: v=1; a=rsa-sha256; c=relaxed/relaxed;
d=1e100.net; s=20130820;
h=x-gm-message-state:mime-version:sender:date:message-id:subject:from
:to:content-type; bh=/Ytf6Wd56je08sJbXnszA8PX4tXxzeKfQuyLgvmYE5g=;
b=evBCAA68mGnu42W5JQ93ewNJThd1uDZySwRwhpKyTpkU+hXLcT3cLyBlZriDjt6SBF
DbHGw7nUNkleB/QgPgbRrPC7hWlBP2JYCmlBiTGxUGVh7PVxYePH5seTJTQGnJcXcr7L
8LdRowMAdQlfcUcW21JdinfKmuIJyBYLHewllPqTnxBr+DztAoDRpTXSeeqwgmh/D/+M
zTXHAVmTYBR2o5Csi0v4ydomSPNu2O3ktK8NV+gTrkIr2Q0K5r50EQlPit1jYPHCVvkG
1WNOHeljbBBag4drqWk5bkNlnr3W586WEPoJnHcFb8oQk0AW8boiLO3f4gmzX+FVJOXR QV+g==
X-Gm-Message-State:
ALoCoQkn+JSlbKGRGiU66Czah5bXl3Wv9EidsqUQq/sDNSgVsfyYcT5m5ceFoE+OiB75pvPHiMoB
MIME-Version: 1.0
X-Received: by 10.140.92.37 with SMTP id
a34mr33345815qge.103.1414783080248; Fri, 31 Oct 2014 12:18:00 -0700 (PDT)
Received: by 10.140.92.82 with HTTP; Fri, 31 Oct 2014 12:18:00 -0700 (PDT)
Date: Fri, 31 Oct 2014 12:18:00 -0700
X-Google-Sender-Auth: GKzqVEqHVGx0U5xA5Ha6alwsTOs
Message-ID:
<CACPk_ansBG8uqY4m3+p4rNN_zVg1hV99FVve+0aaehU4JWCSOA@mail.gmail.com>
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>
X-Mailman-Approved-At: Fri, 31 Oct 2014 15:18:27 -0400
Subject: qotd: Insurance shopping without health insurance literacy
X-BeenThere: quote-of-the-day@mccanne.org
X-Mailman-Version: 2.1.18-1
Precedence: list
List-Id: Current items on health care policy <quote-of-the-day.mccanne.org>
List-Unsubscribe:
<https://pairlist2.pair.net/mailman/options/quote-of-the-day>,
<mailto:quote-of-the-day-request@mccanne.org?subject=unsubscribe>
List-Post: <mailto:quote-of-the-day@mccanne.org>
List-Help: <mailto:quote-of-the-day-request@mccanne.org?subject=help>
List-Subscribe:
<https://pairlist2.pair.net/mailman/listinfo/quote-of-the-day>,
<mailto:quote-of-the-day-request@mccanne.org?subject=subscribe>
Content-Type: multipart/mixed;
boundary="===============2064298249154034655=="
Errors-To: quote-of-the-day-bounces@mccanne.org
Sender: "Quote-of-the-day" <quote-of-the-day-bounces@mccanne.org>
Envelope-To: <gebser@mousecar.com>
X-UI-Filterresults:
notjunk:1;V01:K0:CNBExlnE3AA=:YDWCMSx7my11cubCO4HGMLMl5J
jFOj1u8Wysbpawy6dK3UFmx6c30IqzEzQQGLUw9B98ABE7UwPCDd5wHR7/WrsPemS0aq1MtqW L56YwuyVc8PFc2D5KbcCF8pxiN7WshZmiNZ/04XvUeymw9r2qFaUNzRhY1XOW7y0B23dvYoce
DDqBjUEf5VHCOShTUqMRsbfUZRMvhA8u6xaha+VcHFt36V+RSogoRuUrlxZBhvAqyIX4ZtKi9 Xb1EeF/puk2ASXsZmb0mgrOSVEY2i5fBGIUxoNQ1W9uWHQsUI6/rwvGu17eT0I4mUOzILals9
eZtv0Pj2OVlBq/ruWARbmW1ICW60lsmLLfZqAjK82nMugp7gLCFqBQY2p5RC29FEFx8mO9fzZ 52FSPSybOWiZh2q7BFiyDZRp5FxF8S/2bSASVh5LfyDIpVF0XvJvWFLph7c9Kb1IfJd+L5YEy
fz9iKeVHzUVWSrizMecoMZkYIHEqMzzjUBMIF2Drb9oLGKFhY3myp00VvHusuVzwENwK4Sb5r cR1siYK2OU9zPdaH1AZvueqyLOK3Rup//DYK3yp6g6mwFixlpM8Oj2vlQnZNT0iegwI8qv5QM
NTjH2yyLrggj9xE5myZ9R7gqTKgAdXkIFeQLZQpOT5BXi3tqAfYG+DQvj87lJAKoXfvpx6QkF ttH9XOOLFiBEtkAta9rNMk+aHl9PsYtLfwsLhle23x2WpigVfbYOvN1cyCs+PWgdY9LUQlVwx
IgYvPQ6wpfI0o0NtfF7EOVafAxQg5zi86c6+yimb6An6mk12YdfAYaP2xHDwlJmuHq2eenx1N qvFxlGdDNmSRAABJKPf7lZ+ar+6T7DYtLadXt7IbGR7Ldd9QMlyneVlErNmwmf/hh6ooJGjmV
fuUE9LwyrT6KYoEHNqGEDTbgfZKMm1Vkp2UNValjKFToyKd1+BKPdA+W7hIUXtHZpyv3KeKGJ /KV28bJW93Lj3EhvtvuzIa3eGBMbQdWx35wNSFXBHEQ1uAUio+/JLl/4Xw7Z7A8GTM4a3odAz
ix35jOlObGkwBp10C8Bz50YU2vtCJMzgu9fX1jJgdvAZI14skDdtjzaRU7rVPUmPSifa690Qf pASmeKltk7X7KKc5QsnvlO5YUopsw3QSpbxz2fbUm8G1ltcYKr2TPjxwINu45u2nsCs21olA+
85v5kT59NZ1NA2NvMqkBQBLvFK5D0hmV74UtnBjfBDYfxb3LeHJiK3TNVEN4PMUOmZjhErM+C P1wyY2abrD1tCPqIiI83/vpKKFt4QNK8wX0bCy8S//5OcztVAtIbek6M=



American Institutes for Research
October 2014
A Little Knowledge Is a Risky Thing: Wide Gap in What People Think They
Know About Health Insurance and What They Actually Know
By Kathryn A. Paez and Coretta J. Mallery

Health insurance is among the most complicated and costly products that
consumers buy. Lacking health insurance-related knowledge and skills —
or health insurance literacy — puts people at risk of choosing an
insurance product that could fail to provide needed benefits or protect
them financially.

More than half of all people surveyed were moderately or very confident
in their ability to choose and use a health plan that is best for their
family, but their actual knowledge was less.

Because many people believe they know more than they do about health
insurance, they may not fully understand their options before committing
to a particular health plan for an entire year, or they may have an
unpleasant surprise when they use health care services and end up owing
a larger amount out of pocket than expected.

Understanding Plan Type and Calculating Cost Sharing

When comparing and selecting health plans, 61 percent of people said
they were moderately or very confident that they could choose the best
health plan for themselves. Only 23 percent could identify
characteristics of a preferred provider organization (PPO) — for
example, "you may have to pay a percentage of the bill."

Three out of four people said they were moderately or very confident
that they have the knowledge to use health insurance. However, only 20
percent could accurately calculate how much they would pay for a visit
to an in-network doctor when presented with a cost-sharing scenario that
included a copayment, deductible and coinsurance.

Skills Differ by Age, Care Use, Race, Income, Education

Generally younger people were less health-insurance literate — for
example, people aged 22 to 34 got an average of 55 percent of knowledge
and skills items correct.

Likewise, people who use health care less frequently had more difficulties.

Health insurance knowledge and skills also varied greatly by race, with
blacks and Hispanics on average having less knowledge about health
insurance.

Knowledge and skills also decreased with income and education.

Implications

Choosing and using a health insurance plan can be daunting, especially
for people with little experience with the health care system and health
insurance. According to the 2013 AIR Health Insurance Literacy Survey,
many Americans are unprepared to make informed choices when selecting
and using health plans — especially younger people, minorities, people
with lower incomes and those with less education.

At the same time, health insurance and benefit structures are becoming
even more complex. As mentioned previously, consumers likely don't need
to know the exact differences between an HMO and PPO, but they do need
to consider important health plan characteristics — such as patient cost
sharing, which hospitals and doctors are in network, and the rules for
out-of-network coverage — when choosing a plan.

Without efforts to increase health insurance knowledge and skills, many
insured people will remain at risk of forgoing needed care if they don't
understand how their health insurance works or how to estimate
out-of-pocket costs.

At a minimum, counseling efforts could stress that once people are
enrolled, they should contact their health plan member services
department to get questions answered.

http://aircpce.org/wp-content/uploads/2014/10/11801-451-05_Issue_Brief_102014.pdf

****


Comment by Don McCanne

Great. The insurance exchanges established by the Affordable Care Act
have created a shoppers paradise for health insurance. People can choose
from different premiums, different plans, at different levels of
coverage, with different benefits, and different cost-sharing
deductibles, co-payments and coinsurance, with different networks of
physicians and hospitals, and different rules on out-of-network
coverage, not to mention different insurance structures such as PPOs,
HMOs, EPOs, and ACOs, whatever they are.

How many times have you heard physicians, nurses, health policy wonks,
and knowledgeable others say that they have trouble figuring out their
own insurance plans. Most end up waiting until they receive their
Explanation of Benefits to find out just what was covered. How on earth
can we ever expect people with little prior exposure to the intricacies
of health insurance to be able to shop intelligently for plans offered
in the exchanges? We can't.

The tragedy is that poor choices in plan selection can have major
impacts on both the physical and financial well being of the health plan
purchasers. But when you think about it, virtually every plan offered
has significant deficiencies, especially in limiting access through
narrow networks and in increasing risk of financial hardship through
excessive cost sharing. The subsidies may help some, but they are
inadequate for most. Not only are the choices difficult to make, they
are mostly all bad choices.

Those concerned about lack of "health insurance literacy" - an almost
universal phenomenon - suggest that the solution is to increase
transparency in the exchanges. But the authors of this report suggest
that we need much more. Health insurance shoppers need additional
training to "increase health insurance knowledge and skills." Is that
the answer?

What we want is a system wherein whenever we need health care, we go get
it. Period. What we have is a conglomeration created by private and
public intermediaries that make it difficult to decide where you can go
when you need health care and how to pay for it ex-ante (premiums) and
ex-post (cost sharing). And we end up paying much more for all of the
administrative excesses that these intermediaries have created.

Do we want to make it all go away so that each of us can simply get the
health care that we need? Easy - single payer.

Tuesday, October 28, 2014

Fwd: qotd: Vermont is giving up on single payer

_______________________________________________
Quote-of-the-day mailing list
Quote-of-the-day@mccanne.org
https://pairlist2.pair.net/mailman/listinfo/quote-of-the-day

-------- Forwarded Message --------
Return-Path: quote-of-the-day-bounces@mccanne.org
Received: from two.pairlist.net ([216.92.1.93]) by mx.perfora.net
(mxeueus001) with ESMTPS (Nemesis) id 0Lvj90-1YARkL2HS0-017OJt for
<gebser@mousecar.com>; Tue, 28 Oct 2014 21:12:25 +0100
Received: from two.pairlist.net (localhost [IPv6:::1]) by
two.pairlist.net (Postfix) with ESMTP id 646E0680FB; Tue, 28 Oct 2014
16:12:11 -0400 (EDT)
X-Original-To: quote-of-the-day@lists2.mccanne.org
Delivered-To: quote-of-the-day@two.pairlist.net
Received: from tanha.pair.com (tanha.pair.com [209.68.5.144]) by
two.pairlist.net (Postfix) with SMTP id BB97A6741F for
<quote-of-the-day@lists2.mccanne.org>; Tue, 28 Oct 2014 16:11:39 -0400 (EDT)
Received: (qmail 40078 invoked by uid 3187); 28 Oct 2014 20:11:39 -0000
Delivered-To: mccanne-mccanne:org-quote-of-the-day@mccanne.org
Received: (qmail 40074 invoked from network); 28 Oct 2014 20:11:39 -0000
Received: from mailwash46.pair.com (66.39.2.46) by tanha.pair.com with
SMTP; 28 Oct 2014 20:11:39 -0000
Received: from localhost (localhost [127.0.0.1]) by mailwash46.pair.com
(Postfix) with SMTP id 7CC4CEBFC7 for <quote-of-the-day@mccanne.org>;
Tue, 28 Oct 2014 16:11:39 -0400 (EDT)
X-Virus-Check-By: mailwash46.pair.com
Received: from mail-qg0-f48.google.com (mail-qg0-f48.google.com
[209.85.192.48]) by mailwash46.pair.com (Postfix) with ESMTP id
69322EBFBA for <quote-of-the-day@mccanne.org>; Tue, 28 Oct 2014 16:11:39
-0400 (EDT)
Received: by mail-qg0-f48.google.com with SMTP id q108so1167715qgd.21
for <quote-of-the-day@mccanne.org>; Tue, 28 Oct 2014 13:11:39 -0700 (PDT)
X-Google-DKIM-Signature: v=1; a=rsa-sha256; c=relaxed/relaxed;
d=1e100.net; s=20130820;
h=x-gm-message-state:mime-version:sender:date:message-id:subject:from
:to:content-type; bh=6lAFfSbEeirbXyL6Q6DEzIirNsKD8aA9wCbn6zStEkU=;
b=DBGXANxn4cRw+aoXqvwDMmrGMimp8ls56fo/njGZs1ioBNPI1MtkP5Nkj3gHv1GB1Y
c+WiA2jF/sm1qGX4wIRdP9Fj/NLaS7A5ByFR+Q5LTPy4rhxf9mEzPwrcHcerbkM6fPeW
QmST5oO91bGZ/GERdOiLXphrppv9pedU7HiBaQx8dK9keMMD1Zo+F6WZY/TWXrWF7iE9
CcCD2pH0zF5apoMRIF/mbPEJtB4xBWw774yLT2Y3yhJxOuUftoRxROe+QqLTvbSF3LpR
NxI7PrB2UTtrJU7THevYjQAO6mNbmbKNKPedHsSjYZ6UobzHrEYuqXdVkGtf3bWs6loF 2uLw==
X-Gm-Message-State:
ALoCoQlCW88jv1GvuvX4EfVj/ePCrbYFaBS5VdeStZyoEjVygVfJXuvqWQdRJi284JbayuLitLiR
MIME-Version: 1.0
X-Received: by 10.140.94.246 with SMTP id
g109mr8132500qge.77.1414527099015; Tue, 28 Oct 2014 13:11:39 -0700 (PDT)
Received: by 10.140.92.82 with HTTP; Tue, 28 Oct 2014 13:11:38 -0700 (PDT)
Date: Tue, 28 Oct 2014 13:11:38 -0700
X-Google-Sender-Auth: 9ODww9thKGoVY8gthdiWdDHacbc
Message-ID:
<CACPk_akfuRuoZ7rPWNtus9C0gjZJt0SzhTjwxGE9j-872OkzwA@mail.gmail.com>
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>
X-Mailman-Approved-At: Tue, 28 Oct 2014 16:12:09 -0400
Subject: qotd: Vermont is giving up on single payer
X-BeenThere: quote-of-the-day@mccanne.org
X-Mailman-Version: 2.1.18-1
Precedence: list
List-Id: Current items on health care policy <quote-of-the-day.mccanne.org>
List-Unsubscribe:
<https://pairlist2.pair.net/mailman/options/quote-of-the-day>,
<mailto:quote-of-the-day-request@mccanne.org?subject=unsubscribe>
List-Post: <mailto:quote-of-the-day@mccanne.org>
List-Help: <mailto:quote-of-the-day-request@mccanne.org?subject=help>
List-Subscribe:
<https://pairlist2.pair.net/mailman/listinfo/quote-of-the-day>,
<mailto:quote-of-the-day-request@mccanne.org?subject=subscribe>
Content-Type: multipart/mixed;
boundary="===============1466044126467985883=="
Errors-To: quote-of-the-day-bounces@mccanne.org
Sender: "Quote-of-the-day" <quote-of-the-day-bounces@mccanne.org>
Envelope-To: <gebser@mousecar.com>
X-UI-Filterresults:
notjunk:1;V01:K0:JZsRrlQU4SE=:+kPgX5P32eY8S1zfP7GPfirJLm
/u78+CLVR2K2hasjfiP2ValNw6jAMzzMxtleyTKewICJoOgz+6HZ+SgDiG7BmLw1k2wea/So6 bQz+UUzw29L4TA1fwq2FZZ925U6z7kU4o+eqpSjLQnCFKptKokyWe4xsvP4hGEwEDDRxnvrVK
/6Lv0rmt+8R9DWJIzSLz0nByJSgkBTL1Dn55GIq6t/E9QNR2ZvAnvFmUUPgT1KLSFASyd6C3o GocvetIgXuwrO3k6X6Pq7ZrPFSNui9uyXP0PS8roZPwA/E/vOPYGA73RC1NIHTdqHegJAiihV
VBO0nrTX3NBemZqtRvTryhgIkxJMG8pSL388HrQdKTkwnYZoCHIFi+s7sy1XPiiuW9q8fRn63 AsHg2eG5b70f3QFcsp7J9tEWMV7IF9zfINgHi3660Q0B+hNZhqI2VtImva2vSXaQdWu11GgGr
m+PpkkfMl+7fN107Au2HrYyayX5OjkJ9CdveI5raRXWTBYRvHfKhpth99m4RmlXExq7SbJ/Qt kF1scjebd66nxy4r0Qn1OlK2Wvx0ZlVRaydM9df8JVnGFWh699mPCofAEM0Uo27cGBsTweC4g
EyTHQfvgHiMyBO7Yd47LhNOb4+XiE2uXEvdgN9G+IqQfqz9GJ19SMFBlT4jNXgOej5HfHggkh YsgwwNNKUhC1+eewXfJNxznQzovMEN96Z4Bp9Sx/sfYnJcKt23h3Reii7352/64AUiiZLH2HT
LOGH0xYCWIY8FAhuHgHiQqflBtXGw9FeVH+QxhBTmKfyF3kbuSfSGF/cJGH1ctLI21TDoiDiH dmo5Hos/E4XRMb0aciqEAmrKnuOdbGllFoHnqPZzcbFZGyo8lGKHFDFiUucXgVkiZK74K0RrU
4ylcI2ErcS3CCPFpns/KG7AVT31JuPej+LL01bo4dO39S1uJ2KrM4i5658U/Wsv6EiS5ozbFz ohztcthMrVFv30A66AyZc9JAxV3R2A9bBV/YOY0Zeto3elkqK0Ho6mRpWsxeXpKXAoq9QJKvY
PxdjitQU779C0Of6weraWQL/U4uX8cxGMKOTk6z9visN86ZYTBwZ3ltT3odfjYvomRxiuFS0n NtPTTwe9ThpyCHCdU2A/kPzoiNqbuOyAfHc/SzSc93ZfX384Jy8gQfyoXnO4CFQKhdJpSQ2RR
7e75kGebrPuocWsOQQbVu6JcECP8hlq+fKgzlABtzJa8TIChgrYdCsIzyTH397VbchzNrIP+d QOLbEoLHb4Dkm1hQ4lgCdSwKo7pkxNfIn4iNb4F5XHXggnWj1XtUkP6o=



VTDigger
October 26, 2014
Correction: State No Longer Looking to Administer Medicare
By Anne Galloway

Two recent stories about the relationship between Medicare and Green
Mountain Care, the state's planned universal publicly financed health
care program – often called single-payer – were inaccurate. The stories
were based on statutes on the Legislature's website that had not been
updated.

Section (e) of chapter 18, Public Private Universal Health Care System,
in Title 33, Human Services, still states online that, "The Agency shall
seek permission from the Centers for Medicare and Medicaid Services to
be the administrator for the Medicare program in Vermont. If the Agency
is unsuccessful in obtaining such permission, Green Mountain Care shall
be the secondary payer with respect to any health service that may be
covered in whole or in part by Title XVIII of the Social Security Act
(Medicare)."

Act 144, which was enacted in 2014, repeals that section, though the
statutes have not been updated online.

Section (f) of the same chapter now reads, "Green Mountain Care shall be
the payer of last resort with respect to any health service that may be
covered in whole or in part by any other health benefit plan, including
Medicare, private health insurance, retiree health benefits, or federal
health benefit plans offered by the military, or to federal employees."

State officials have said they are no longer seeking to administer
Medicare as part of Green Mountain Care, and the law reflects that change.

It is currently unknown what Green Mountain Care will cover or what
private supplemental health insurance policies will be offered once the
program is in place.

Gov. Peter Shumlin has said there is no reason to expect that currently
available supplemental coverage options for Medicare would change if the
state moves forward with a single-payer health care system.

http://vtdigger.org/2014/10/26/correction-state-longer-looking-administer-medicare/

****

Vermont Act 144
An act relating to miscellaneous amendments to health care laws.

Sec. 1 Principles for Health Care Financing

(3) As provided in 33 V.S.A. § 1827, Green Mountain Care shall be
the payer of last resort for Vermont residents who continue to receive
health care through plans provided by an employer, by another state, by
a foreign government, or as a retirement benefit.

Sec. 2 Vermont Health Benefit Exchange

(4) To the extent permitted by the U.S. Department of Health and
Human Services, the Vermont Health Benefit Exchange shall permit
qualified employers to purchase qualified health benefit plans through
the Exchange website, through navigators, by telephone, or directly from
a health insurer under contract with the Vermont Health Benefit Exchange.

Sec. 6 Administration; Enrollment

(e) [Repealed.]

(f) Green Mountain Care shall be the payer of last resort with
respect to any health service that may be covered in whole or in part by
any other health benefit plan, including Medicare, private health
insurance, retiree health benefits, or federal health benefit plans
offered by the military, or to federal employees.

Governor signed bill: May 27, 2014

http://www.leg.state.vt.us/docs/2014/Bills/H-0596/ACT0144%20As%20Enacted.pdf

Green Mountain Care
http://www.greenmountaincare.org/vermont-health-insurance-plans

Vermont Health Connect
http://info.healthconnect.vermont.gov/healthplans

****

VPR
September 12, 2014
Shumlin Won't Pursue Single Payer If It Doesn't Help Economy
By Bob Kinzel

Act 48, the law that put Vermont on the path to a single-payer health
care system, was passed in 2011. It called on the governor to unveil a
single-payer financing plan in January of 2013.

That didn't happen because Shumlin said he needed more time to develop a
plan. Shumlin said he would be ready to release his proposal in January
of this year.

But Shumlin missed this deadline as well. He now says he'll unveil his
plan at the start of the Legislative session in January.

Shumlin says there's no point pursing a single-payer option if the
effort will hurt the state's business community.

"If we come up with a financing plan that doesn't grow jobs, economic
opportunity, and make Vermont more prosperous, trust me, we're not going
to do it," said Shumlin.

http://digital.vpr.net/post/shumlin-wont-pursue-single-payer-if-it-doesnt-help-economy

****


Comment by Don McCanne

Many consider Vermont to be the trailblazer for a state single payer
program, serving as a model for other states to enact single payer
reform. Vermont does have lessons for the rest of us. Let's see what
they are so far.

Green Mountain Care is Vermont's program for Medicaid and for Dr.
Dynasaur (Vermont's Medicaid program for children and pregnant women).
Most participants are now required to enroll in PC Plus - a Medicaid
primary care managed care program. Vermont Health Connect is Vermont's
health insurance exchange (marketplace) under the Affordable Care Act
through which individuals and small businesses can purchase insurance.
Many Vermonters still have access to other programs such as Medicare,
employer-sponsored health plans, retiree plans, and federal employee
programs such as FEHBP and Tricare. So far this is not really much
different than programs in other states - certainly far from single payer.

What about Medicare? Vermont has given up on attempting to become the
administrator of Medicare, much less rolling Medicare funds into a
universal single payer program. Gov. Peter Shumlin has even stated that
"there is no reason to expect that currently available supplemental
coverage options for Medicare would change." Thus apparently they are
continuing even the private Medigap supplements and private Medicare
Advantage plans.

What about Green Mountain Care - the Medicaid program that was to be the
single payer for Vermont? A few months ago legislation was signed by
Gov. Shumlin that stated, "Green Mountain Care shall be the payer of
last resort with respect to any health service that may be covered in
whole or in part by any other health benefit plan, including Medicare,
private health insurance, retiree health benefits, or federal health
benefit plans offered by the military, or to federal employees."
Further, "Green Mountain Care shall be the payer of last resort for
Vermont residents who continue to receive health care through plans
provided by an employer, by another state, by a foreign government, or
as a retirement benefit." At this point in time, that does not look like
a program that is being remodeled to fulfill the role of a single payer.

The original Vermont legislation called on Gov. Shumlin to unveil a
single payer financing plan in January, 2013. He missed that deadline
and again missed the next one in January, 2014. He now says that he
intends to release a plan in three months. We will have to wait to see
what that proposal is, but at this late stage he is saying, "trust me,
we're not going to do it," if the effort will hurt the business
community. That seems quite tenuous for having worked on it a couple of
years.

Many still talk about the enabling ACA waiver that Vermont will obtain
in 2017, but the ACA section 1332 waiver applies only to the subsidies
and some specific requirements of ACA. Even combined with Sec. 1115
Medicaid waivers and waivers for Medicare demonstration programs,
especially considering the ERISA barriers, we simply do not have enough
leeway for states to independently establish their own bona fide single
payer systems.

The point is that we must have comprehensive federal legislation if we
wish to establish state-level single payer systems. We need need the
federal funds currently used in other federal health programs such as
Medicare and Medicaid, and we need relief from federal statues and
regulations such as ERISA. It would be far better to simply enact a
national single payer program, but those who wish to pursue a state
model must still advocate for comprehensive federal legislation.

Regardless, we can have single payer if we all work together to create
the momentum for federal legislation, state and/or national, but none of
us will see single payer if we each confine our activities to our
respective states. Many have called for a cooperative effort. This is it!

Friday, October 24, 2014

Fwd: qotd: Improving trust in the profession

_______________________________________________
Quote-of-the-day mailing list
Quote-of-the-day@mccanne.org
https://pairlist2.pair.net/mailman/listinfo/quote-of-the-day

-------- Forwarded Message --------
Return-Path: quote-of-the-day-bounces@mccanne.org
Received: from two.pairlist.net ([216.92.1.93]) by mx.perfora.net
(mxeueus001) with ESMTPS (Nemesis) id 0LopET-1YIkIM3mf5-00gg1N for
<gebser@mousecar.com>; Fri, 24 Oct 2014 21:31:14 +0200
Received: from two.pairlist.net (localhost [IPv6:::1]) by
two.pairlist.net (Postfix) with ESMTP id 6F7586811B; Fri, 24 Oct 2014
15:30:47 -0400 (EDT)
X-Original-To: quote-of-the-day@lists2.mccanne.org
Delivered-To: quote-of-the-day@two.pairlist.net
Received: from tanha.pair.com (tanha.pair.com [209.68.5.144]) by
two.pairlist.net (Postfix) with SMTP id 4F50268112 for
<quote-of-the-day@lists2.mccanne.org>; Fri, 24 Oct 2014 15:30:18 -0400 (EDT)
Received: (qmail 26271 invoked by uid 3187); 24 Oct 2014 19:30:18 -0000
Delivered-To: mccanne-mccanne:org-quote-of-the-day@mccanne.org
Received: (qmail 26268 invoked from network); 24 Oct 2014 19:30:18 -0000
Received: from mailwash46.pair.com (66.39.2.46) by tanha.pair.com with
SMTP; 24 Oct 2014 19:30:18 -0000
Received: from localhost (localhost [127.0.0.1]) by mailwash46.pair.com
(Postfix) with SMTP id 22439EBF9A for <quote-of-the-day@mccanne.org>;
Fri, 24 Oct 2014 15:30:18 -0400 (EDT)
X-Virus-Check-By: mailwash46.pair.com
Received: from mail-qc0-f180.google.com (mail-qc0-f180.google.com
[209.85.216.180]) by mailwash46.pair.com (Postfix) with ESMTP id
0E46AEBF97 for <quote-of-the-day@mccanne.org>; Fri, 24 Oct 2014 15:30:18
-0400 (EDT)
Received: by mail-qc0-f180.google.com with SMTP id x3so1255305qcv.25
for <quote-of-the-day@mccanne.org>; Fri, 24 Oct 2014 12:30:17 -0700 (PDT)
X-Google-DKIM-Signature: v=1; a=rsa-sha256; c=relaxed/relaxed;
d=1e100.net; s=20130820;
h=x-gm-message-state:mime-version:sender:date:message-id:subject:from
:to:content-type; bh=aQHuYa46N/o7TxOeH0ooQkQjdouVXnNyiaTNHjgD1VY=;
b=H5IpzkBsFxO/i4BH9er3jeOHBlJIJVuIuH4P4hhJC9eSl3To32sYAx7FSNJ37/vHzV
vhq6EbNS4uiLzBZcLc10gV3oLplpwseHbgnCKCJiG0w8A2DUK3TYFRu18Wb3RE16zafY
UGmKAgiwhKxmZCa7c0+AX3aG4Ntnd8YHgQNzeO5mNOLLtMtrlrhRcbEDZhZTUadEVn8j
Cy1DDNr7U0EJkO4nOcJ1MAiKVkQabPK1hZXYYK1ciT4UT4uRt46W0uNcgVSRuT229l2K
CCHObBfaUOldXN+0OnKHywplXkEn1TeJtEBWofFdE79jb+R11GJtU2RG2jBLcbrzRiX3 5Htg==
X-Gm-Message-State:
ALoCoQkj1wr94K9Pa9E4FRv860U14fR9MeEXmOjQ3fCYyQJDndtfL06H/DvEogOM3T2+FVdHFZw7
MIME-Version: 1.0
X-Received: by 10.140.91.201 with SMTP id
z67mr8710911qgd.5.1414179017649; Fri, 24 Oct 2014 12:30:17 -0700 (PDT)
Received: by 10.140.27.182 with HTTP; Fri, 24 Oct 2014 12:30:17 -0700 (PDT)
Date: Fri, 24 Oct 2014 12:30:17 -0700
X-Google-Sender-Auth: VPpd7C2XHGIYvl5SIeUhvfzDN74
Message-ID:
<CACPk_a=_nP0fcwng527+Z-bTp9MDkw+2FaiuVxCbEU1RsrhqyA@mail.gmail.com>
From: Don McCanne <don@mccanne.org>
To: Quote-of-the-Day <quote-of-the-day@mccanne.org>
X-Mailman-Approved-At: Fri, 24 Oct 2014 15:30:45 -0400
Subject: qotd: Improving trust in the profession
X-BeenThere: quote-of-the-day@mccanne.org
X-Mailman-Version: 2.1.18-1
Precedence: list
List-Id: Current items on health care policy <quote-of-the-day.mccanne.org>
List-Unsubscribe:
<https://pairlist2.pair.net/mailman/options/quote-of-the-day>,
<mailto:quote-of-the-day-request@mccanne.org?subject=unsubscribe>
List-Post: <mailto:quote-of-the-day@mccanne.org>
List-Help: <mailto:quote-of-the-day-request@mccanne.org?subject=help>
List-Subscribe:
<https://pairlist2.pair.net/mailman/listinfo/quote-of-the-day>,
<mailto:quote-of-the-day-request@mccanne.org?subject=subscribe>
Content-Type: multipart/mixed;
boundary="===============2691052823672228403=="
Errors-To: quote-of-the-day-bounces@mccanne.org
Sender: "Quote-of-the-day" <quote-of-the-day-bounces@mccanne.org>
Envelope-To: <gebser@mousecar.com>
X-UI-Filterresults:
notjunk:1;V01:K0:NoWm9InDKKo=:s5PwQVlze45ipYpLLW6nlk3bDe
H0/orGe0nOwYQJy1D6YZSSZVd0hWnMN3mQ13k0woh7HcHcId/AHlvIKPp+qGYZa4U3SQLVc02 toKObTBZCknWr1l9gtm9JAwfvNx4Nur7mr7mB1gpkuciyBAHxZa2hW0cWqAlVKh3PMTKnqtFH
7J12WF+XMK6WRqiafAQOCY5DL+ZVrUzlJFmCOh4SkGh0WrNtAsg//uJ3dfqSfJkHuNk3/99ky 4on8XLpFQzPbcazI578l/5FjTpGi8+jIESd1t5o6erSxC7cWRD8FObVu7EYHI8R4+0CG+HtF1
ArJdhFfdpsderbY5Mz+JDio/Q3MwQVZOFjMPA2MT6s01KJucGA4ktIfpYMO6/YcCBr/uRrfE4 ODRjMaQ5lEw9dE86KPHzY8zgR93/B8QF8yEQA3D0xnWUNUX10fsm6U6OpByG4NDBusK3h79zS
nTnQWcgUQgGs3ldAqH0MtMgz8HmZByXtOkd7QJyeZ9uDt1KQk0i0Q08z6sv6fQSrL19iUOrPa MLGKu1IGe2jQVUfftx3Zwfj0kxkqKvuC5zqRdvtd/wliwh41ePdVV7H2/ZlTCNVGIVmUHArYY
oRcLJzxYOCRBCYpHu8V9NU3RZ3zcSH0gA6JqCGUibcRIjpdYFiaTYnCkxtGaj6cZ/9S0m7juL uKaDgd5doU8f6wEdSFTsyTbcsdybsfGnHe/SOd5dsTwvuFPDc6Cm4o+n24T79ATuv0K1GX4Hr
WU6rcTxT7/97PZJP+JzTXEPClTcJJHo2zh4C/svjRRYMi5VFuNWj30TWjbcs4rghjVo/F52z0 iFV53/YKvysSSckMAoGdAEkYCkpFIt7DqPGSy68bpA/w42ZV0JGnt4xFQvRXbnfMcE2pqHd4t
8+HFAnRAPrV31LWf9m1L9WdfboNDRuB7L+8A/3Mz9KKI4GTC6TylipLkzNzzpbASEv2UlEiG7 hZLs5r0kk4/ELvLfNPVWubk+blBi10hCdgc1/8xXgqfAjmU0G6oCro0S9zk6g+uFvLdZCLtFl
sRd3qWPbMnbsbKQ8oXYmoTxrd2h0ciy3Ci6vQ+xGi2+5nUaekGs2dVo5ikIXvOVgLxWzZh33f +kFmexCvP6nMBQjH8AruhPk1gX2lDjXirKjRhvy4OWytwgZ2PUfzM8TqwUyTouzvu692kByIP
PuVjtH+TeZfSd+wHCBNTLKjRSNt919/GneLnam6zdPL+PdlQrZHF9qKIVuHJIP3CllxeTvck3 /3Y8U1MGmVJe9jrRolmRyUi8hkhjfCkAUwj8rRIqEF1nT91Me4Fou6ac=



The New England Journal of Medicine
October 23, 2014
Public Trust in Physicians — U.S. Medicine in International Perspective
By Robert J. Blendon, Sc.D., John M. Benson, M.A., and Joachim O. Hero,
M.P.H.

One emerging question is what role the medical profession and its
leaders will play in shaping future national health care policies that
affect decision making about patient care.

Research suggests that for physicians to play a substantial role in such
decision making, there has to be a relatively high level of public trust
in the profession's views and leadership. But an examination of U.S.
public-opinion data over time and of recent comparative data on public
trust in physicians as a group in 29 industrialized countries raises a
note of caution about physicians' potential role and influence with the
U.S. public.

In a project supported by the Robert Wood Johnson Foundation and the
National Institute of Mental Health, we reviewed historical polling data
on public trust in U.S. physicians and medical leaders from 1966 through
2014, as well as a 29-country survey conducted from March 2011 through
April 2013 as part of the International Social Survey Programme (ISSP),
a cross-national collaboration among universities and independent
research institutions.

In 1966, nearly three fourths (73%) of Americans said they had great
confidence in the leaders of the medical profession. In 2012, only 34%
expressed this view. But simultaneously, trust in physicians' integrity
has remained high. More than two thirds of the public (69%) rate the
honesty and ethical standards of physicians as a group as "very high" or
"high" (Gallup 2013).

Today, public confidence in the U.S. health care system is low, with
only 23% expressing a great deal or quite a lot of confidence in the
system. We believe that the medical profession and its leaders are seen
as a contributing factor.

This phenomenon does not affect physicians in many other countries.
Indeed, the level of public trust in physicians as a group in the United
States ranks near the bottom of trust levels in the 29 industrialized
countries surveyed by the ISSP. Yet closer examination of these
comparisons reveals findings similar to those of previous U.S. surveys:
individual patients' satisfaction with the medical care they received
during their most recent physician visit does not reflect the decline in
overall trust. Rather, the United States ranks high on this measure of
satisfaction. Indeed, the United States is unique among the surveyed
countries in that it ranks near the bottom in the public's trust in the
country's physicians but near the top in patients' satisfaction with
their own medical treatment.

Part of the difference may be related to the lack of a universal health
care system in the United States. However, the countries near the top of
the international trust rankings and those near the bottom have varied
coverage systems, so the absence of a universal system seems unlikely to
be the dominant factor.

The United States also differs from most other countries in that U.S.
adults from low-income families (defined as families with incomes in the
lowest third in each country, which meant having an annual income of
less than $30,000 in the United States) are significantly less trusting
of physicians and less satisfied with their own medical care than adults
not from low-income families.

In drawing lessons from these international comparisons, it's important
to recognize that the structures in which physicians can influence
health policy vary among countries. We believe that the U.S. political
process, with its extensive media coverage, tends to make physician
advocacy seem more contentious than it seems in many other countries.
Moreover, the U.S. medical profession, unlike many of its counterparts,
does not share in the management of the health system with government
officials but instead must exert its influence from outside government
through various private medical organizations. Moreover, in terms of
health policy recommendations, the U.S. medical profession is split
among multiple specialty organizations, which may endorse competing
policies.

Nevertheless, because the United States is such an outlier, with high
patient satisfaction and low overall trust, we believe that the American
public's trust in physicians as a group can be increased if the medical
profession and its leaders deliberately take visible stands favoring
policies that would improve the nation's health and health care, even if
doing so might be disadvantageous to some physicians. In particular,
polls show that Americans see high costs as the most important problem
with the U.S. health care system, and nearly two thirds of the public
(65%) believes these costs are a very serious problem for the country.
To regain public trust, we believe that physician groups will have to
take firm positions on the best way to solve this problem. In addition,
to improve trust among low-income Americans, physician leaders could
become more visibly associated with efforts to improve the health and
financial and care arrangements for low-income people. If the medical
profession and its leaders cannot raise the level of public trust,
they're likely to find that many policy decisions affecting patient care
will be made by others, without consideration of their perspective.

http://www.nejm.org/doi/full/10.1056/NEJMp1407373

****


Comment by Don McCanne

Another unique feature of the U.S. health care system that sets us apart
from other nations: "You just can't trust doctors nowadays, but my
doctor is really good." What can we make of this?

In general, individuals are relatively satisfied with their personal
care. Low-income individuals are less satisfied, but that is likely
related to the deficient financing of their care and the consequences of
that - a characteristic of our fragmented, dysfunctional system of
financing health care. But, overall, our system is capable of ensuring
patient contentment.

It is the confidence in physician leadership that has deteriorated. The
authors of this article suggest some possible explanations, but it is
more likely that the image of the profession at large has changed from
that of the dedicated personal physician steeped in the Hippocratic
tradition, to that of the high-tech, entrepreneurial agent of the
medical-industrial complex. Combine that perspective with the very high
costs of health care today - costly care which physicians orchestrate -
and it is no wonder that the public is no longer as trusting of the
profession. Only "my doctor" is immune to this.

When you look at the role that the AMA had in the enactment of the
Affordable Care Act, it is evident that they were not there to represent
patients; they were there alongside the other elements of the
medical-industrial complex - especially the insurance, pharmaceutical
and hospital industries - to be sure that they got their own share of
the action. The only patient advocates present were the consumer
organizations that chose the default option of "political feasibility,"
becoming "strange bedfellows" of the private insurance industry.

There are many dedicated individual physicians and other health care
professionals who clearly place patients first. They are well
represented in organizations such as Physicians for a National Health
Program. They are also well represented in the AMA and the various
specialty organizations, but, as a collective voice, they are
ineffective in communicating the tradition of caring; rather they
passively communicate the acceptance of the medical-industrial complex -
a very sterile advocacy position.

Let's indulge in a fantasy. Let's imagine that our professional
organizations all joined together in a clarion call for comprehensive,
affordable, high-quality care for absolutely everyone - including those
low-income individuals who distrust the profession today. Single payer
would bring us such quality that is truly affordable.

With a voice unified in support of the patient, what do you think would
then happen to the level of confidence that the public has in the
medical profession? Physicians would once again relish respect as a
noble profession advocating for their patients. As an aside, it would
also mean that they would have a very pleasant work environment and be
adequately compensated for their efforts. If the system works for
patients, it will work for physicians.