Category Archives: legislation

Medicare for All Act of 2019

Yesterday, Sen. Bernie Sanders introduced the Medicare for All Act for 2019, along with 19 co-sponsors in the Senate.

This bill mostly follows the previous bill he introduced in 2017, yet it has one notable addition. The new bill is summarized as follows:

*  Eligibility: Covers everyone residing in the U.S.
*  Benefits: Covers medically-necessary services including primary and preventive care, mental health care, reproductive care (bans the Hyde Amendment), vision and dental care, and prescription drugs. This bill also provides home- and community-based long-term services and supports, which were not covered in the 2017 Medicare for All Act.
*  Patient Choice: Provides full choice of any participating doctor or hospital. Providers may not dual-practice within and outside the Medicare system.
*  Patient Costs: Provides first-dollar coverage without premiums, deductibles or co-pays for medical services, and prohibits balance billing. Co-pays for some brand-name prescription drugs.
*  Cost Controls: Prohibits duplicate coverage. Drug prices negotiated with manufacturers.
*  Timeline: Provides for a four-year transition. In year one, improves Medicare by adding dental, vision and hearing benefits and lowering out-of-pocket costs for Parts A & B; also lowers eligibility age to 55 and allows anyone to buy into the Medicare program. In year two, lowers eligibility to 45, and to 35 in year three.
According to the Physicians for a National Health Plan (PNHP), this bill can be improved by:
* Funding hospitals through global budgets, with separate funding for capital projects: A “global budget” is a lump sum paid to hospitals and similar institutions to cover operating expenses, eliminating wasteful per-patient billing. Global budgets could not be used for capital projects like expansion or modernization (which would be funded separately), advertising, profit, or bonuses. Global budgeting minimizes hospitals’ incentives to avoid (or seek out) particular patients or services, inflate volumes, or up-code. Funding capital projects separately, in turn, allows us to ensure that new hospitals and facilities are built where they are needed, not simply where profits are highest. They also allow us to control long term cost growth.
* Ending “value-based” payment systems and other pay-for-performance schemes: This bill continues current flawed Medicare payment methods, including alternative payment models (including Accountable Care Organizations) established under the ACA, and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Studies show these payment programs fail to improve quality or reduce costs, while penalizing hospitals and doctors that care for the poorest and sickest patients.
* Establishing a national long-term care program: This bill includes home- and community-based long-term services and supports, a laudable improvement from the 2017 bill. However, institutional long-term care coverage for seniors and people with disabilities will continue to be covered under state-based Medicaid plans, complete with a maintenance of effort provision. PNHP recommends that Sen. Sanders include institutional long-term care in the national Medicare program, as it is in Rep. Pramila Jayapal’s single-payer bill, H.R. 1384.
* Banning investor-owned health facilities: For-profit health care facilities and agencies provide lower-quality care at higher costs than nonprofits, resulting in worse outcomes and higher costs compared to not-for-profit providers. Medicare for All should provide a path for the orderly conversion of investor-owned, for-profit health-care providers to not-for-profit status.
* Fully covering all medications, without co-payment: Sen. Sanders’ bill excludes cost-sharing for health care services. However, it does require small patient co-pays (up to $200 annually) on certain non-preventive prescription drugs. Research shows that co-pays of any kind discourage patients from seeking needed medical care, increasing sickness and long-term costs. Experience in other nations prove that they are not needed for cost control.
Any other legislation such as strengthening the ACA, or half-measures for Medicare such as
buy-ins or public options, or leaving private, employer-based insurance alone, will not solve the
problems we are having, which stem from the financing of health care, and not the providing of
health care.

Medicare for All Legislation Introduced

Yesterday, as reported by Dr. Adam Gaffney, President of the Physicians for a National Health Program (PNHP), Rep. Pramila Jayapal (D-Wash.) and more than 100 co-sponsors in the House of Representatives, introduced the Medicare for All Act of 2019.

In keeping with earlier posts on the subject, and to further convince not only the skeptics, but the opponents of Medicare for All, here is what is in the act, according to Dr. Gaffney’s letter:

What’s in the Medicare for All Act?

Coverage

  • Covers all medically necessary care, including hospitalization and doctor visits; dental, vision, and hearing care; mental health services; reproductive care, including abortion; long-term care services and supports; ambulatory services; and prescription drugs.
  • Covers all U.S. residents. Coverage is portable and lifelong.

Choice

  • Provides free choice of doctor or hospital.

Cost

  • Eliminates all patient cost-sharing such as co-pays, premiums, and deductibles.

Budgeting and Efficiency

  • Pays institutions such as hospitals and nursing homes via lump sum global operating budgets to provide covered items and services.
  • Funds capital expenditures such as expansions and renovations with a separate budget.
  • Pays individual providers on a fee-for-service basis that does not include “value-based” payment adjustments. Providers cannot use fees for profit, marketing, or bonuses.
  • Establishes a national drug formulary that promotes the use of generics. HHS will negotiate prices for drugs, supplies, and equipment on an annual basis.
  • Allows the override of drug patents when drug firms demand extortionate prices (a key recommendation from PNHP’s 2018 Pharma Proposal).

Health Equity

  • Provides regional funding for rural and urban areas that are medically underserved.
  • Preserves the benefits provided by the Dept. of Veteran Affairs and the Indian Health Service.
  • Overrides the Hyde Amendment that bans federal funding of abortion.

Transition to Medicare for All

  • Implements Medicare for All over a two-year transition period.
  • In the first year, current Medicare enrollees can utilize expanded benefits such as dental and vision care. After year one, the plan automatically enrolls everyone ages 0-18 and 55 and older, and also offers a Medicare Transition buy-in plan through the Federal and State exchanges during this time.
  • Allocates one percent of budget for the first five years to assistance for workers displaced by the elimination of private health insurance.

There are other similar legislation already introduced, especially the one introduced by Sen. Bernie Sanders, as well as several faux Medicare for All plans that are really Medicare for Some.

Sen. Sanders’ bill calls for a four-year transition period, so the difference is not that important. What is important is that both bills will transform healthcare as we know it and finally get this nation to do what other nations already are doing.

As reported today by Dr. Don McCanne, the legislation was written with the help of a broad swath of lobbyists and special interest groups, if perhaps not the kind associated with typical health policy legislation on Capitol Hill.

Among these groups, as written in The Intercept yesterday by Ryan Grim (not making that up, folks), are the following: nurses, doctors, disability rights activists, and advocates for the elderly, as well as public interest organizations such as Public Citizen and the Center for Popular Democracy.

According to Mr. Grim (don’t laugh, that’s really his name), along with Consortium for Citizens with Disabilities, the main groups involved in drafting the legislation were National Nurses United, a major nurses union that has long been on the forefront of the fight for single payer; Physicians for a National Health Program; the Center for Popular Democracy, which organizes poor and marginalized communities; Public Citizen; and Social Security Works, which represents more than a million progressive seniors who support expanding the Medicare coverage they have to the rest of the population.

Mr. Grim called these groups “special interests” and said that the insurance and pharmaceutical industries had no part in the drafting of this legislation, to which Dr. McCanne gave an affirmative comment, because they are “when that interest is for the all of the people and their health, but we need to keep out the “usual suspects.

It is sad that some choose to call those organizations who fight for people as “special interests”, yet, have no problem when those interests are insurance companies, pharmaceutical companies, large hospital systems, Wall Street, investors, and shareholders in the medical-industrial complex.

Eventually, we will get there. Unfortunately, many of us may not live to see it, or be able to take advantage of it for only a short time before the opposition party repeals it, or we pass on.

Texas Passes Telehealth Law

Texas has passed a telehealth law, joining other states. This ties in with yesterday’s infographic.

Here are the details:

https://www.linkedin.com/pulse/lone-star-joins-rest-nation-texas-passes-new-law-ferrante?trk=v-feed&lipi=urn%3Ali%3Apage%3Ad_flagship3_feed%3B7SI2NNb46r4tG3kR22C5Ew%3D%3D

Despicable!

“Capital is reckless of the health or length of life of the laborer, unless under compulsion from society.”

Karl Marx

“Our policy is to create a national health service in order to ensure that everybody in the country irrespective of means, age, sex or occupation shall have equal opportunities to benefit from the best and most up-to-date medical and allied services available.”

Winston Churchill

 

Here we have two quotes dealing with the same subject. The first quote is from the father of Scientific Socialism, i.e., Marxism and Communism, and the second quote is from the wartime Prime Minister of Great Britain, who was a staunch anti-Communist.

But what transpired today in Washington, is far from the view of Marx, or the view of Churchill. In other words, it is DESPICABLE!

Never before in the history of the United States, has the government of the people, by the people, and for the people ever taken away something the government gave them in the first place.

Not even the enactment of the 18th Amendment outlawing the sale and production of alcohol, stoops to the level of total disregard for the health and welfare of the American people. Alcohol was never something the government had to give to people, they produced it themselves. Our founding fathers were brewers and distillers of alcoholic beverages.

But the vote this afternoon represents a step towards a society this nation has not seen in many decades. You hear that Republicans want to take the country back. The obvious place they want to take us to is the 19th century, when no one had health care, there was no Medicare or Medicaid, or Social Security, Unemployment Insurance, and Workers’ Comp.

There are specific reasons for this, which I will discuss.

First, pure and simple, it is greed. They want the money dedicated for health care and the other medical plans for a huge tax cut for their wealthy friends.

Second, the health insurance companies can now get to pick and choose who they want to cover, what they will cover, and what they will charge you if you have a serious pre-existing condition or a life-threatening disease. We know this as adverse selection.

Third, they don’t believe in giving “entitlements” to anyone except the military and the wealthy.

Fourth, their libertarian, puritanical, Calvinism teaches them that the poor are undeserving of the benefits that money brings, so let them die, and who cares if they are poor, it is a sign of a moral failing.

Another quote from Churchill says that you can always trust the Americans to do the right thing after they have tried everything else.

Well, after today, we have tried everything else. We have given employers the right to offer health insurance to their employees, we have allowed private insurance companies to sell policies to individuals, and we have created separate health care plans for children, the elderly, the military and their families, members of Congress, and the poor.

But for all the reasons I have given above, and many more, this nation refuses to enact single payer health care, the only thing we haven’t tried, and the one form of universal health care every other Western nation provides its citizens.

One fellow blogger last year during the Democratic Primary, said that while he liked Bernie Sanders, he knew that the health insurance companies were not going to scrape their businesses and start from scratch.

But maybe they should. It is because the capitalist profit motive is at the heart of what, in the words of Walter Cronkite, our health care system really is. “America’s health care system is neither healthy, caring, nor a system.” Too many are profiting from other people’s misery, and driving many into poverty. This is the richest nation on Earth, and this is how we treat our fellow citizens.

It is strange that the Conservative Party of Great Britain believes in single payer, but the American Republican Party does not. The truth is, they are no longer the Republican Party but the Republican Libertarian Party.

Once upon a time, members of their right-wing decried the nation’s drift towards “Creeping Socialism.” With this vote, and with executive orders flowing from 1600 every day, we are witnessing “Creeping Fascism.’ The new Secretary of Labor comes from the fast food industry where workers were mistreated, and still are in some places.

Worker’s rights are being eroded with new overtime rules, wages are stagnant, unemployment is still too high despite what the government says.

One other reason for enacting single payer is that doing so will free employers from having to provide it to their employees, and workers over forty will not have to face losing their jobs and careers they spent their lives in.

We, as a nation, must decide; either we take away health care for millions of Americans, or we make sure everyone has it. There can be no half-measures. Many pundits have said the AHCA (Zombie Health Care Bill) will not pass the Senate, but that is what they said about the House of Representatives.

I hope the Senate will defeat this, but if they don’t, the only option left is single payer.

One More Thing on Health Reform

Could not ignore Joe Paduda’s first post this morning, which is also covered on the Health Wonk Review blog.

He lays out in great detail who would be affected by passage of this zombie legislation, and who would come out ahead,

It’s enough to make you sick, that such people exist who will take away health care from the very people who put them in office, and don’t care that many of them will die because they can no longer get health care.

Comedian Jimmy Kimmel went on his show the other night and confessed to the entire country about his newborn son’s heart disease. What was the response from the Nazi right? Attacks.

Why do these people continue to vote against their own economic interests? There are many reasons for this. The first one is simply, they don’t believe Democrats. And why? Because for far too long, Democrats have engaged in Identity Politics, and have ignored the heartland.

Second, the Democrats have generally avoided campaigning in, or developing their local or state parties in those states most likely to vote Republican, but would benefit from Democratic policies in education, job creation, health care, etc.

Third, Republicans have done a great job of convincing people of an “us versus them” mentality. Republicans sound like “us”, act like “us”, enjoy the same activities as “us”, where “they” do not. You hear the words, “elite”, or “elitist” thrown around, as was done yesterday in response to Kimmel’s plea by an alt-rightist.

Forth, Republicans know how to frame an argument by using simple words and phrases, where Democrats go into long, drawn out lectures on policy. They talk to Americans as if every American has a college degree in political science or sociology. Yex, polls do so that many Americans agree with Democratic policies, but we know that polls are not always accurate.

The last election proved that.

Lastly, the Democrats have been late to the party as to what is happening to working people, both blue collar and white collar workers. In fact, the Republicans know all too well what is happening, as they are responsible for the prolongation of their misery, and will do nothing to stop what is about to happen when jobs are replaced by automation.

Universal Basic Income (UBI)? Not from this crowd of neo-fascist, libertaritards. (Take that, Rush Limbaugh!) Want some more Oxycodone?

As we are witnessing day by day, the US is going backwards. All the way back to the 19th century, the very century the GOP is most comfortable with, because that is when they had complete control of the entire government, and their friends in industry were getting richer and richer, and there were no government programs or laws protecting workers and the poor.

So if this zombie health care law gets passed, look out…there will be more zombies where that came from.

The Zombie Apocalypse and Other Matters

For sometime now, your humble author has subscribed to a health care blog called Health Wonk Review.

Some of their posts are usually out of the scope of this blog, so I very rarely write about these issues, and many times, there are posts from Joe Paduda on subjects I’ve already read, or commented on, so to write about it would be redundant.

But in light of my post yesterday, in which I said, based upon Joe’s post, that the AHCA (Zombie Health Care Bill) was dead, here is the link to today’s Health Wonk Review. I cannot do any more justice to the discussion, so I will let it speak for itself.

Be frightened, be very frightened.

ARAWC Strikes Again: Opt-out Rolls On

“Just when I thought I was out… they pull me back in.”

Michael Corleone, Godfather, Part III

Source: https://www.pinterest.com/Mamzeltt/famous-movie-quotes/

When Michael confronts Connie and Neri in the kitchen of his townhouse, he warns them to never give an order to kill someone again (in this case, it was Joey Zaza), and goes on to state that when he thought he had left the mob lifestyle, they pull him back.

Thus, is the case with opt-out, as I discussed in my last post on the subject.

Kristen Beckman, in today’s Business Insurance, reminds us that opt-out, like the Mob, is pulling us back into the conversation.

As I reported last time, a bill in Arkansas, Senate Bill 653, pending in that state’s legislature’s Insurance & Commerce Committee since the beginning of March, proposes an alternative to the state system.

Ms. Beckman quotes Fred C. Bosse (not Fred C. Dobbs), the southwest region vice president of the American Insurance Association (AIA), who said that the bill is an attempt to keep the workers comp opt-out conversation going.

Mr. Bosse said that the AIA takes these bills seriously (good for them) and engages legislators to dissuade progress of such legislation the AIA believes could create an unequal benefit system for employees. (They haven’t drunk the Kool-Aid either)

Arkansas’ bill is the only legislation currently under consideration, but a state Rep in Florida, Cord Byrd (there’s a name for you), a Republican (it figures) from Jacksonville Beach, promoted legislation last year, but never filed it.

South Carolina and Tennessee, where bills were previously introduced within the past two years has gone nowhere.

And once again ARAWC rears its ugly head. For those of you unfamiliar with ARAWC, or the Association for Responsible Alternatives to Workers’ Compensation, it is a right-wing lobbying and legislation writing group based in Reston, Virginia. (see several other posts on ARAWC on this blog)

A statement ARAWC sent to BI said that these bills are beginning to pop up organically to model benefits that companies have seen from Texas’ non-subscription model. (Organically? That’s like saying mushroom clouds organically popped up over Hiroshima and Nagasaki)

Here’s a laugh for you, straight from the ARAWC statement:

Outcomes and benefits for injured workers have improved, employers are more competitive when costs are contained and taxpayers are well served by market-driven solutions,” They further said, “We recognize that each state is different and that the discussions at the state level will involve varied opinions.”

Of course, we cannot really know if injured workers are benefitting, or just being denied their rights, and it seems that opt-out is only to help employers and taxpayers get out of their responsibility to those who sustain serious injuries while employed.

In another post, the notion that Texas’ system could serve as a model for other states was outlined in a report by the Texas Public Policy Foundation (don’t you just love the names of these reactionary groups?)

Bill Minick, president of PartnerSource, praised the report, according to Ms. Beckman, and said that competition has driven down insurance premium rates and improved benefits for Texas workers. (That’s what he says, but is any of it true, I wonder? I doubt it.)

ARAWC has listed a laundry list of benefits they say responsible alternative comp laws could provide:

  • Better wage replacement
  • Reduced overall employer costs
  • Faster return to work
  • Fewer claims disputes (yeah, because they would be denied)
  • Faster claim payouts
  • Faster closure (well, when you deny claims, they can be closed faster, duh!)

It is good to know that the AIA is critical of the report, and that in their opinion, it is unworkable to allow employers to adopt a separate, but unequal system of employee benefits.

And as we have seen with the defeat of the AHCA, leaving a government-sponsored program up to market-driven forces is a recipe for disaster that should not be repeated in workers’ comp, no matter what flavor the Kool-Aid comes in.