Category Archives: Accessiblility

American College of Physicians Endorses Single Payer

For all you naysayers in the health care industry, whether you work for insurance companies, drug companies, or are consultants or analysts, the following posts from the Annals of Internal Medicine should convince you that you are on the wrong side of the issue, and that more and more physicians are coming around to the realization that single payer is necessary to improve the American health care system. The first article is authored by a panel, and the second by Woolhandler and Himmelstein.

I have been asking these questions, and many others like them for some time: What gives you the right to deny your fellow Americans universal health care? What right do you have to prevent them from getting lower cost medical care and lower cost drugs? What gives you the right to defend the profiteering in health care that has created a dysfunctional, broken, and wasteful system? The answer to these questions is the same – GREED. and your desire to protect your jobs. Well, according to these articles, you may be coming to the end of the line in that regard.

Here are the articles in full, thanks to Don McCanne:

Annals of Internal Medicine

January 21, 2020

Envisioning a Better U.S. Health Care System for All: A Call to Action by the American College of Physicians

By Robert Doherty, BA; Thomas G. Cooney, MD; Ryan D. Mire, MD; Lee S. Engel, MD; Jason M. Goldman, MD; for the Health and Public Policy Committee and Medical Practice and Quality Committee of the American College of Physicians

U.S. health care costs too much; leaves too many behind without affordable coverage; creates incentives that are misaligned with patients’ interests; undervalues primary care and public health; spends too much on administration at the expense of patient care; fails to invest and support public health approaches to reduce preventable injuries, deaths, diseases, and suffering; and fosters barriers to care for and discrimination against vulnerable individuals.

The ACP’s Vision of a Better Health Care System for All

The ACP believes the United States can, and must, do better and offers the following 10 vision statements for a better health care system for all.

1. The American College of Physicians envisions a health care system where everyone has coverage for and access to the care they need, at a cost they and the country can afford.

(Nine more vision statements listed.)

The accompanying policy papers offer specific recommendations, supporting rationales, and evidence on ways the United States can move to achieve ACP’s vision.

In “Envisioning a Better Health Care System for All: Coverage and Cost of Care” (1), ACP recommends transitioning to a system of universal coverage through either a single payer system, or a public choice to be offered along with regulated private insurance. Although each approach has advantages and disadvantages, either can achieve ACP’s vision of a health care system where everyone has coverage for and access to the care they need, at a cost they and the country can afford. The evidence suggests that publicly financed and administered plans have the potential to reduce administrative spending and associated burdens on patients and clinicians compared with private insurers. Other approaches were considered by ACP, including market-based approaches, yet ACP found they would fall short of achieving our vision of affordable coverage and access to care for all. The ACP asserts that under a single payer or public option model, payments to physicians and other health professionals, hospitals, and others delivering health care services must be sufficient to ensure access and not perpetuate existing inequities, including the undervaluation of primary and cognitive care.

The ACP proposes that costs be controlled by lowering excessive prices, increasing adoption of global budgets and all-payer rate setting, prioritizing spending and resources, increasing investment in primary care, reducing administrative costs, promoting high-value care, and incorporating comparative effectiveness and cost into clinical guidelines and coverage decisions.

In “Envisioning a Better Health Care System for All: Health Care Delivery and Payment Systems” (2), ACP calls for increasing payments for primary and cognitive care services, redefining the role of performance measures to focus on value to patients, eliminating “check-the-box” reporting of measures, and aligning payment incentives with better outcomes and lower costs. The position paper calls for eliminating unnecessary or inefficient administrative requirements, and redesigning health information technology to better meet the needs of clinicians and patients. The ACP concludes there is no one-size-fits-all approach to reforming delivery and payment systems, and a variety of innovative payment and delivery models should be considered, evaluated, and expanded.

In “Envisioning a Better Health Care System for All: Reducing Barriers to Care and Addressing Social Determinants of Health” (3), ACP calls for ending discrimination and disparities in access and care based on personal characteristics; correcting workforce shortages, including the undersupply of primary care physicians; and understanding and ameliorating social determinants of health. This position paper calls for increased efforts to address urgent public health threats, including injuries and deaths from firearms; environmental hazards; climate change; maternal mortality; substance use disorders; and the health risks associated with nicotine, tobacco use, and electronic nicotine delivery systems.

These are just a partial summary of the recommendations in the 3 position papers; considered together, they offer a comprehensive and interconnected set of policies to guide the way to a better a health care system for all. We urge readers of this call to action to review the 3 papers for a complete understanding of ACP’s recommendations and the evidence in support of them.

The ACP rejects the view that the status quo is acceptable, or that it is too politically difficult to achieve needed change. By articulating a new vision for health care, ACP is showing a willingness to try to achieve a better U.S. health care system for all. We urge others to join us.

https://annals.org/aim/fullarticle/2759528/envisioning-better-u-s-health-care-system-all-call-action

Better Is Possible: The American College of Physicians’ Vision for the U.S. Health Care System

21 January 2020 Vol: 172, Issue 2_Supplement

The following link provides full free access to nine papers in this special Annals of Internal Medicine/American College of Physicians Supplement on a bold new prescription for the U.S. health care system:

https://annals.org/aim/issue

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Annals of Internal Medicine

January 21, 2020

The American College of Physicians’ Endorsement of Single-Payer Reform: A Sea Change for the Medical Profession

By Steffie Woolhandler, MD, MPH; David U. Himmelstein, MD

For a century, most U.S. medical organizations opposed national health insurance. The endorsement by the American College of Physicians (ACP) of single-payer reform marks a sea change from this unfortunate tradition.

Canada’s generally positive experience is among the strands of evidence underpinning the ACP’s endorsement. A single-payer reform that reduced insurance overhead to 2% (the level for Canada and traditional Medicare) could save more than $200 billion annually. In addition, our multipayer system imposes complexity and expense on providers; the Cleveland Clinic has 210 000 000 different prices. Single-source payment could streamline reimbursement—for example, by replacing per patient hospital payment with global budgets and establishing uniform billing and documentation requirements. Hospitals and doctors could save billions on billing-related costs and repurpose those savings to expand care, making universal, first-dollar coverage affordable.

Achieving universal coverage would be costlier under the “public choice” model the ACP co-endorses along with single payer. Multipayer systems incorporating for-profit insurers have not gleaned large administrative savings. For-profit insurers’ overhead is high everywhere, and the persistence of multiple payers would hinder efforts to streamline providers’ billing-related work.

Moreover, real-world experience with 2 public choice models—Medicare’s Advantage program and the Consumer Oriented and Operated Plans (CO-OPs) under the Patient Protection and Affordable Care Act (ACA)—warns that in health insurance competition, public option good guys finish last.

Although no reform achieves perfection, evidence indicates that a well-structured single-payer reform might resolve our nation’s coverage and affordability problems, preserve the choices patients value, and allow doctors to focus on what matters most: caring for our patients.

https://annals.org/aim/fullarticle/2759531/american-college-physicians-endorsement-single-payer-reform-sea-change-medical

PNHP release:

https://pnhp.org/news/doctors-prescribe-medicare-for-all-single-payer-reform-endorsed-by-americas-largest-medical-specialty-society-and-recommended-in-open-letter-from-thousands-of-physicians/

Here is Don’s Comment:

Welcome to a bright new day in health care reform.

The American College of Physicians (ACP) is the largest physicians’ organization dedicated to patient care (the AMA has traditionally functioned primarily as a physicians’ guild). “ACP recommends transitioning to a system of universal coverage through either a single payer system, or a public choice to be offered along with regulated private insurance.”

ACP has proffered a large volume of material that presents a multitude of problems with our current expensive but underperforming health care system. They present many options for reform that have been under consideration, but, as mentioned, they single out two for their vision of a better U.S. health care system for all: 1) single payer, or 2) a “public choice” with regulated private insurance.

Included in the AIM supplement is an important paper by Steffie Woolhandler and David Himmelstein. They discuss the clear advantages of a Canadian-style single payer model, but they caution us about the deficiencies of the for-profit insurers that we have in the United States, and the failures of our experimentation with public choice models – CO-OPs and Medicare Advantage. (To understand better the problems with a private plan and public choice approach, you should read not only the full Woolhandler/Himmelstein paper at the link above, but also the voluminous material on this topic at pnhp.org.)

There is much more material in this AIM supplement, especially on delivery reform and addressing social determinants of health, but it is important to not get buried under the reams of material such that you might be distracted from the overriding imperative of ACP’s vision for reform – the pressing need to enact and implement the essential infrastructure on which we can build the rest of reform – a single payer national health program.

Still think you know better than the College of Physicians? You still think that physicians will not take Medicare for All because many don’t take traditional Medicare? You think that implementing Medicare for All/Single Payer will be destructive to medical care? Think again.

These physicians are more concerned with provide everyone with health care and not to make huge profits for themselves, insurance companies, drug companies, hospitals, investors, stockholders, and other stakeholders such as you and your employers. You are standing in the way.

Medicare for All and the Democratic Debates

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For those of you who did not watch the two nights Democratic debate, and those like me who did, one thing is clear. Medicare for All is very popular among the audiences who attended, judging by the applause garnered each time a candidate was asked about their plan for providing every American with health care.

On the first night, the moderator asked for a show of hands to the question as to who supported eliminating private insurance, only two candidates, Sen. Elizabeth Warren and New York mayor Bill de Blasio raised their hands.

The rest of the candidates on the first night supported keeping private insurance or giving people the choice of a public option, and de Blasio and former Congressman Beto O’Rourke sparring over the issue.

This is how some of the candidates responded to the issue:

“I’m with Bernie on Medicare for All,” said Elizabeth Warren

Amy Klobuchar said she preferred a “public option”, “I am just simply concerned about kicking half of America off of their health insurance in four years,”

Former Texas Rep. Beto O’Rourke allowed that the goal should be “guaranteed, high-quality, universal health care as quickly and surely as possible.” “Our plan says that if you’re uninsured, we enroll you in Medicare,” and called his plan Medicare for America.

On the second night, the same question about abolishing private insurance was asked, and again, only two raised their hands, Vermont Sen. Bernie Sanders and California Sen. Kamala Harris.

Former Vice President Joe Biden, who defended the ACA, said that Americans “need to have insurance that is covered, and that they can afford.”

Candidates Pete Buttigieg, mayor of South Bend, Ind., New York Sen. Kristen Gillibrand, and Colorado Sen. Michael Bennet all gave their views on universal coverage, noting the importance of a transition period, and suggesting that a public option would allow people to buy into Medicare.

While the rest of the candidates from both evenings’ debates were divided against their fellow candidates who supported Medicare for All, those who spoke up for it, Sanders, Warren, Harris and de Blasio, won over the audience in the hall. What remains to be seen is how their ideas are received in the primaries beginning early next year.

According to Bloomberg, (the publication, not the former New York mayor), Medicare for All enjoys broad support: 56% of Americans said they supported such a plan in a January survey by the Kaiser Family Foundation. However, when told Medicare for All would eliminate private health insurance, 37% said they favor it while 58% said they oppose the idea.

So, supporters of Medicare for All have their work cut out for them. They need to convince more Americans that sustaining the current system of private insurance, whether they get it from their employers, or they purchase it on their own, is a big part of the problem facing the US health care system.

Another point that is forgotten in the debate is the fact that what is being proposed is not a government takeover of health care, but rather a transition from a broken system to a government financed system of health care. Candidates who support this should explain the difference, and not be led into the trap set by debate moderators or interviews of calling Medicare for All, government-run health care.

It must be made clear that the providing of care will remain private, but that paying for it will not. Sanders’ stump speech line about going to any doctor sounds reminiscent of President Obama’s promise that you can keep your doctor under the ACA, but the reality was far from that.

But the takeaway from the debates indicates that the campaign will be a long and hard fought one, and that Democrats must be very clear what it is they actually want to do on health care, know how to pay for it, and sell it as the best solution to our dysfunctional health care system, or as author Marianne Williamson called it, a sickness system.

Because already, the Orangutan has pounced on one issue raised in the debate, the support by all candidates for providing medical care to undocumented immigrants. In today’s charged political climate where racism has raised its ugly head, and nationalism is on the march, such ideas can be disastrous, especially if rejected by swing voters and independents.

Time and the primaries will tell.

The Providers: A Film About Rural Health Care in America

Saturday evening, I came upon a documentary film in the Independent Lens series on PBS about the problems facing a part of rural America in providing health care to a poor, mostly elderly, and under-served population.

The film, The Providers, presented a very human face to the physician shortage, as well as the opioid epidemic in rural America, specifically by following three healthcare professionals at El Centro, a group of safety-net clinics that offer care to anyone who walks through the doors in northern New Mexico.

The providers in the film are Matt Probst, a Physician’s Assistant, Leslie Hayes, a Family Physician, and Chris Ruge, a Nurse Practitioner.

The first clinic shown is located in Las Vegas, New Mexico, a far cry from that other Las Vegas, many of you have gone to for conventions and gambling trips. The population of this Las Vegas is 13,201, and the per capita income is $15,481.

As the opening segment states, in 2016, 70,000 deaths in rural American could have been prevented with better access to health care.

Among some of the other points the documentary brings to mind are:

  • Hospital closures due to cuts to Medicaid
  • Failure to expand Medicaid, or repealing expansion Medicaid under the ACA

Chris Ruge, the Nurse Practitioner, is part of a program funded by insurance companies called ECHO Care™, which is an innovative program designed to improve access to primary and specialty care for patients with complex needs while also reducing the cost of care by utilizing a multidisciplinary team-based approach.  In New Mexico, the ECHO Care program expanded the capacity of primary care clinicians through:

  • The assembling, training and placement  of “Outpatient Intensivist Teams” (OIT) which dramatically improve care and reduce costs for the Medicaid beneficiaries served in this program.
  • Special teleECHO clinic designed to support the OITs as they care for patients with significant multi-morbidity, including mental health and substance abuse.

At some point, as the viewer will learn, the companies funding the program want to terminate it, but the CEO of the clinic wants to continue it, whether or not it makes a profit, as long as they break even, because she recognizes the benefits outweighs the cost and profitability.

In order to make sure that they can continue to provide health care to the community, both in Las Vegas, and in another town, they are recruiting from the local high school for students interested in careers in health care.

This was a very eye-opening film and should be watched by anyone who cares about health care and access to care for rural populations, and those who deal with patients suffering from substance abuse, either opioids or alcohol.

 

 

Trump Regime to Repeal ACA

From the Overnight News Desk:

Both CNN and The Washington Post reported yesterday that the Justice Department will back a full repeal of the Affordable Care Act (ACA), after a federal judge in Texas ruled the law unconstitutional in December.

If this repeal takes effect, millions of Americans will lose their healthcare. Those of you employed in the medical-industrial complex, and related industries, must face the fact, that if the Republicans succeed in their long-held promise to destroy healthcare for Americans who could never afford it before, or had limited coverage, there will be no other alternative left to provide healthcare than to have an Improved Medicare for All/Single Payer system.

There are those who believe that Medicaid for All is a better option, but given that many states that expanded Medicaid elected GOP governors and legislatures, or could in the future, Medicaid in those states could also be taken away from those who receive expanded coverage.

Many of you are employed by the very same insurance companies, pharmaceutical companies, device manufacturers, and other businesses that are allied with the healthcare system, and it is these companies that are gearing up to fight passage of any Medicare for All/Single Payer health care bill.

Do you really want your fellow Americans to die because they cannot generate huge profits for your employers and for Wall Street investors and shareholders?

if the Orangutan gets his way, that is what will happen. Also, our hospital ERs will once again be clogged with patients who need immediate medical attention, and the quality of health care will deteriorate even further.

The only logical solution is Medicare for All/Single Payer, because the only option left will be Medicare for All/Single Payer.

Health Insurance Costs Accelerating for Workers | HealthLeaders Media

This is a follow-up to my previous post, Health Care Costs Rising for Workers. My post then cited a Kaiser study; this article references the University of Minnesota’s State Health Access Data Assistance Center.

On Monday, I reported that there is an effort underway to discredit the move towards single payer by various groups, and even Howard Schultz, the outgoing Chairman of Starbucks said the following back in June:

“It concerns me that so many voices within the Democratic Party are going so far to the left. I say to myself, ‘How are we going to pay for these things,’ in terms of things like single payer [and] people espousing the fact that the government is going to give everyone a job. I don’t think that’s something realistic. I think we got to get away from these falsehoods and start talking about the truth and not false promises.”

So, if these two studies are accurate, and there is no way to prove they aren’t, then both Mr. Schultz and the various groups attempting to derail single payer, are only going to make things worse for workers, and for everyone else.

Oh, and by the way, there have been studies that indicated that we could afford single payer health care, especially a report sponsored by a Koch Brothers backed think tank, Mercatus.

So, consider the following from this Health Leaders article back in October of this year.

The average premium for employer-sponsored plans rose $267, or 4.4% between 2016 and 2017, which is twice the increase recorded between 2015 and 2016.

Source: Health Insurance Costs Accelerating for Workers | HealthLeaders Media

Employer Insurance Costs Growing Burden for Middle Class

The Commonwealth Fund today released a report that stated that the cost of employer-based insurance is a growing burden on middle-class families.

In 2017, more than half (56%) of people under age 65, about 152 million people, had insurance through an employer, either their own or a family member’s. In contrast, only 9 percent had a plan purchased on the individual market, including the marketplaces.

Here are the highlights from that brief:

Highlights

* After climbing modestly between 2011 and 2016, average premiums for employer health plans rose sharply in 2017. Annual single-person premiums climbed above $7,000 in eight states; family premiums were $20,000 or higher in seven states and D.C.

* Rising overall employer premiums increased the amount that workers and their families contribute. Average annual premium contributions for single-person plans ranged from $675 in Hawaii to $1,747 in Massachusetts; family plans ranged from $3,646 in Michigan to $6,533 in Delaware.

* Average employee premium contributions across single and family plans amounted to 6.9 percent of U.S. median income in 2017, up from 5.1 percent in 2008. In 11 states, premium contributions were 8 percent of median income or more, with a high of 10.2 percent in Louisiana.

* The average annual deductible for single-person policies rose to $1,808 in 2017, ranging from a low of $863 in Hawaii to a high of about $2,300 in Maine and New Hampshire. Average deductibles across single and family plans amounted to 4.8 percent of median income in 2017, up from 2.7 percent in 2008. In three states (Florida, Mississippi, and Tennessee), average deductibles comprised more than 6 percent of median income.

* Combined, average employee premium contributions and potential out-of-pocket spending to meet deductibles across single and family policies rose to $7,240 in 2017 and was $8,000 or more in eight states. Nationally, this potential spending amounted to 11.7 percent of median income in 2017, up from 7.8 percent a decade earlier. In Louisiana and Mississippi, these combined costs rose to 15 percent or more of median income.

Worker payments for employer coverage are growing faster than median income.

The average employee premium cost across single and family plans amounted to 6.9 percent of median income in 2017, up from 5.1 percent in 2008.

Average deductibles are also outpacing growth in median income.

In many states, even though costs are rising, people are not getting insurance that protects them more because deductibles are also increasing.

Still think that the free market works for health care? Guess again.

We are the only advanced nation that refuses to give its citizens universal health care like other similar nations do. This “growth” is unsustainable and will lead to single-payer health care.

 

National Health Care Spending In 2017: Growth Slows To Post–Great Recession Rates; Share Of GDP Stabilizes | Health Affairs

Yesterday, Health Affairs reported that spending on health care was slowing to post-Great Recession rates, and that its share of GDP stabilized. However, total nominal US health care spending increased 3.9 percent to $3.5 trillion in 2017, slowing from growth of 4.8 percent in 2016.

Yet, the authors stated that, “For a health sector that now accounts for nearly one-fifth of the US economy, future increases in health care expenditures will likely lead to policy decisions focused on affordability and sustainability.”

What are those policy decisions that will focus on affordability and sustainability? Single Payer, Medicare for All so that all Americans are covered, and receive all medical care they need without having to go into bankruptcy or to set up a “GoFund Me” account, or other similar application.

Just because the spending slowed to pre-Recession rates does not mean we are in the clear and all will be right with the health care world. As happens when we graph any statistics, there will always be a point in time when what looks like good news turns bad, and when bad news turns good. One day the market is up, the next it is down. That’s why they are depicted with lines instead of bars or circles or other graphic designs.

Source: National Health Care Spending In 2017: Growth Slows To Post–Great Recession Rates; Share Of GDP Stabilizes | Health Affairs