Category Archives: Single Payer

Models: Here We Go Again

My readers will remember that I have been critical of CMS’ multitude of models for health care payments and such from my articles, Models, Models, Have We Got Models!, Illogical!, or Regulation Strangulation.

So it comes as no surprise that CMS is unveiling another model for a voluntary bundled payment program.

The unveiling was reported today in FierceHealthcare. com. Called the Bundled Payments for Care Improvement (BCPI) Advanced model, it is the first model launched by CMS under the current political regime now occupying the White House.

As I have always maintained, the more models, the more complex, confusing and dysfunctional the health care system gets in the US. But it seems CMS never learns, and until the American people stand up to the medical-industrial complex and demand single-payer, damned the torpedoes to their profits and bottom-lines, the better our health care system will get.

Today, someone posted an article about single-payer on LinkedIn and most of the folks who responded did so with negative views about single-payer that indicated that they had drunk the kool-aid fed to them by the medical-industrial complex and their political allies.

They made the claim that countries that have single-payer have seen a decline in care, and that people hate it. So I asked the question, if it is so bad, why aren’t they adopting our system? It is because theirs works.

They don’t have too many models and regulations, and they get great quality of care. Yes, there are problems and they are not perfect systems, but nothing ever is. The truth is we are still the only Western country without single-payer, and CMS’ models are one reason why.

Here is the link to the article.

Advertisements

Gallup Poll Says Americans Equally Divided on Single-Payer

Don McCanne, former President of the Physicians for a National Health Plan posted a New York Times article that said that Americans are equally divided over support for single-payer versus private insurance.

The article also said that support for single-payer edged up 10-points from last year, and closed  a 27-point gap since 2010.

This year’s survey, conducted Nov. 2-8, indicated that 48% preferred the private health insurance system and 47% preferred the government-run system.

Here is the breakdown by party:

Favor government-run system
22%  Republicans/Leaners
67%  Democrats/Leaners

Favor system based on private insurance
76%  Republicans/Leaners
29%  Democrats/Leaners

When asked if they had an opinion on “Medicare for All”, the majority said they did not have enough information.
17%  Favor
21%  Oppose
61%  Don’t know enough to say

While private insurance is still favored, if only by a percentage point, time will tell as the GOP’s tax plan takes effect and wipes out the middle class, whether that poll changes in the direction of single-payer.

No Paradox

Sometimes, the solution to a problem is staring you right in the face, but you refuse to see it because you are blinded by your perceptions, your beliefs, or the distortions others have placed in your mind by lies and falsehoods spread about the real benefits of the solution, or the downsides.

Case in point, the question of single-payer health care in the US. The health insurance industry and their lobbyists and defenders in Congress have done a great job poisoning the minds of many Americans against the idea of single-payer, whether on ideological or economic grounds.

Yet, many of these same Americans are getting some form of government-sponsored health care, either Medicare, Medicaid, Tricare, or health care through the Veterans Administration. So, it was striking that before the enactment of the ACA, many Tea Party protesters shouted or carried signs that read, “Keep your hands off of MY Medicare!”

What they did not know or realize, was that it wasn’t THEIR Medicare, but the government’s Medicare. They were ones receiving the benefits.

So, it struck me this morning when I read an article by Tom Lynch of the Lynch Ryan blog, Workers’ Comp Insider.com.

The article, The American Health Care Paradox: A Lot Of Money For Poor Results, compares the US health care system with the health care systems of the OECD nations (Organization for Economic Cooperation and Development).

The OECD has 35 members, of which the US is one, and was formed in Paris in 1961. They promote policies that will improve the economic and social well-being of people around the world. It also performs annual comparative analyses of issues affecting its members.

Health care is one such issue, as is life expectancy, infant mortality, obesity, and death rates from cancer, among other health care-related topics.

But regarding health care, as Tom reports, on a per capita basis, we spend 41% more on health care than our wealthy nation peers in the OECD, and 81% more than the entire OECD average.

The following graph indicates amount of public versus private funding of health care among the OECD nations, as well as the OECD average. The light blue bars indicate private funding; the dark blue bars indicate public funding.

OECD Health Care Funding — 2015

According to Tom, while our public funding (Medicare, Medicaid, etc.) is comparable to many of the other countries in the OECD, private funding in the US is more than 100% greater tham Switzerland, and 300% greater than the OECD average.

Life expectancy:            US: 78.8 years (76.3 men, 81.2 women)
UK: 81 years (79.2 men; 82.8 women)
Japan: 83.9 years (80.8 men; 87.1 women)

Infant mortality:          US: 6.1% (per 1000 live births) 45% higher than UK at 4.2%, and 265%                                                higher than Japan’s at 2.3%.

Obesity and overweight rate is exceeded only by New Zealand. Finally, the rate of death from cancer per 100,000 people is 188, Mexico’s is 115, Japan’s is 177. But we lead the world in smoking cessation (whoopee!). So, I guess we can all breathe easier now than the rest of the world, especially the third world where so many start smoking at a very young age.

Into this discussion, Tom throws the current Republican tax plan, which he rightly says will throw 13 million people off of health care, and see $25 billion cut from Medicare.

Tom says that fixing health care will take time and a lot more money, and he is skeptical that the GOP tax scam will do that.

Duh! Of course it won’t. That’s the whole point of the tax scam and the umpteenth attempts to scuttle the ACA. They don’t believe in health care as a right for all Americans. It is in their DNA as Libertarian Conservatives. They are not Republicans, at least not like the two Republican presidents who tried to get health care passed, Theodore Roosevelt and Richard Nixon.

No, they want the money for their fat cat donors. They even said so publicly and bragged about it. And if all those votes to repeal and replace ACA didn’t convince you that they are fundamentally opposed to any government-sponsored health care, except their own, then you are blind.

The solution is staring you in the face on the above chart, Every other OECD member nation spends more publicly for health care than we do privately, and we are getting bad outcomes. Why is that? It is because health care is not like other consumer goods, and therefore should not be funded or marketed by private companies.

It is long past the time we should follow suit and do what every other OECD country has done, create a single-payer, improved Medicare for All system and stop fooling ourselves that the private market works. It does not, and the proof is in the metrics on cost, life expectancy, infant mortality, obesity and cancer deaths, etc.

Executive (Dis)order

The signing this morning of an executive order by the Orangutan will have, in the opinion of some of the bloggers and politicians, spell disaster for the nation’s health care system.

It will, if carried into action, likely siphon healthy people from the Affordable Care Act-compliant market, continuing a pattern of regulatory actions under the Trump administration that have undermined the ACA.

The rationale for such a move that has been given is that since Congress has not been able to repeal and replace the ACA, an executive order will, piece by piece.

Coupled with the recent budget move to eliminate the CHIP program for children’s health (New York State faces dire consequences if Congress does not act on CHIP), and cut backs to Medicare and Medicaid, the intent here is to privatize health care for some, and eliminate it for others, and to get government out of health care providing altogether.

There are provisions in this order for greater competition, short-term coverage, and lower premiums with less coverage. Why this is better is beyond me, unless the Orangutan is seeking to destroy health care so that single-payer will be the only option.

Cutting healthy people out of the ACA means leaving sick people to struggle with a health care law that many say needs to be fixed, not repealed and replaced. But because the Tea Party ranted and raved before it was enacted, and the Orangutan and the GOP campaigned on getting rid of it, they had no choice but to sabotage it if they could not do so through legislation.

I predict that we will soon see the total collapse of our health care system thanks to this stupid, overreaching, and ill-advised Executive Order. I even read today that the Vice President had to remind the Orangutan to sign the darn thing, something that almost slipped what is left of his so-called mind.

Welcome to Crackerbox Palace.

The End of the World Is Near (The Health Care World, That Is)

Fellow blogger, Joe Paduda, brilliantly summed up the current GOP attempt to blow up the nation’s health care system in today’s post.

Rather, than repeat and comment on what he wrote, I am letting you read the post here.

Then there is a great graphic on what the Cassidy-Graham bill will mean for states, and from a brief look at it, I can say that they are playing favorites with some, but not all of the states of the former Confederacy, and sticking it to those states in the North (and West like California) who they have disdain for.

Because of it’s dire impact on the health care system, it should actually be called the Butch Cassidy and the Sundance Kid bill, because like those two 19th century bandits, they are going to rob us blind. How do you say “We are taking back your health care” in Spanish?

But, in actuality, it is just another way of giving a tax break to the wealthy at the expense of everyone else.

If this bill passes, and the Orangutan signs it, the end of the world in health care would soon follow. The only option then would be single-payer, and it would be ironic and even cruel if that was the GOP’s game plan all along. Wreck the health care system so that single-payer is the only option left, and if that fails, they drop the whole thing and move on.

We shall see next week, as there are two Senators who may hold the future of health care in their hands, Collins of Maine and Murkowski of Alaska.

The “Curse” of For-Profit Health Care

Recently, Vermont Senator Bernie Sanders introduced a Medicare for All bill into the U.S. Senate, and many Democratic Senators signed on as co-sponsors of the bill.

Earlier yesterday morning, on his way to a photo-op in Naples, Florida to see the damage from Hurricane Irma (why didn’t he go to the Keys), the Orangeman tweeted that Senator Sanders’ bill would visit a curse on the U.S.

This from a man who said that he preferred the Canadian system, and told the Australian Prime Minister to his face, and the cameras, that they had a better health care system than the US.

What are we to make of someone who likes other countries health care systems as long as it is not our system? What do we do when the elected leaders of this country are dead set against providing the best health care system to their constituents, and in fact, are determined to take away what little health care they already have?

I find it rather odd, and callous that the Orangutan calls Sen. Sanders’ plan a curse, when millions of Americans are cursed everyday with not having any health care, or minimal care at best.

No, what is a curse are families going broke paying for medical care, individuals forgoing needed care because it costs too much, doctors and nurses burned out because they are overworked, underpaid (in some cases), and trying to work in a broken, bureaucratic, sclerotic, and byzantine system.

The American “health care” system is the curse. The cure, or rather the silver bullet for this vampiric monster, is single-payer. Maybe Sen. Sanders’ bill won’t pass this time, with this Congress and this President, but it or something like it should in the future.

Our curse as a nation is in our slavish devotion to making everything conform to the will and whim of the free market. We have seen that the free market is great for the production and selling of goods and services, but health care is not a consumer good. It is a right of every man, woman, and child.

The Canadians, the Australians, the British, and many other nations are not so slavishly devoted to the free market as we are when it comes to providing health care to all their citizens, and they cannot be called “Socialist” or “Communist” in any way, shape, or form.

Only because of the greed of a few insurance companies, Wall Street players and their investor clients, as well as very wealthy Libertarian brothers from the energy sector do we continue to be cursed with the worse system for providing health care.

Finally, the ultimate curse this nation has is the individual who said single-payer would be a curse. And like Dracula, only the light of day will stop him.

Single Payer Supported by Majority of Physicians

A shout-out to Dr. Don McCanne for posting the following article from Merritt Hawkins.

Merritt Hawkins
August 14, 2017
Survey: 42% of Physicians Strongly Support a Single Payer Healthcare System, 35% are Strongly Opposed
By Phillip Miller
A plurality of physicians strongly support a single payer healthcare system, according to a new survey by Merritt Hawkins.
The survey of 1,033 physicians indicates that 42 percent strongly support a single payer health care system while 14 percent are somewhat supportive. Over one-third (35 percent) strongly oppose a single payer system while six percent are somewhat against it. The remaining three percent neither support nor oppose single payer.
The results contrast with a national survey of physicians Merritt Hawkins conducted in 2008, which indicated that 58 percent of physicians opposed single payer at that time while 42 percent supported it.
In Merritt Hawkins’ experience, there are four reasons why a growing number of physicians are in favor of single payer. First, they are seeking clarity and stability. The fits and starts of health reform and the growing complexity of our current hybrid system are a daily strain on most doctors. Many of them believe that a single payer healthcare system will reduce the distractions and allow them to focus on what they have paid a high price to do: care for patients.
Second, it’s a generational issue. The various surveys that Merritt Hawkins has conducted for The Physicians Foundation in the past show that younger doctors are more accepting of Obamacare, ACOs, EHR, and change in general than are older physicians As the new generation of physicians comes up, there is less resistance among doctors to single payer.
Third, there is a feeling of resignation rather than enthusiasm among some physicians about single payer. These physicians believe we are drifting toward single payer and would just as soon get it over with. The 14% of physicians surveyed who said they “somewhat” support single payer are probably in this group.
Fourth, there is a philosophical change among physicians that I think the public and political leaders on both sides of the aisle now share, which is that we should make an effort to cover as many people as possible.
However, while single payer has gained acceptance among some physicians, it remains strongly opposed by over one third and strongly or somewhat opposed by over 40 percent. It is still a polarizing issue among physicians and is likely to remain so for the foreseeable future.
So, if a majority of physicians support single payer, and they are the ones we should listen to when it comes to taking care of our health, and if a growing majority of Americans are coming around to this idea, then the only ones standing in the way are our politicians.
POTUS, the Secretary of Health and Human Services, Mitch McConnell, Paul Ryan, Rand Paul, and the medical-industrial complex of insurance companies, drug companies, and medical device manufacturers are all opposed and are preventing this nation from joining the rest of the developed world in providing health care to ALL its citizens.
And there is one more obstacle in our way: Wall Street investors and their clients who are funding insurance and medical companies, engaging in adverse selection and determining who lives and who dies. Who gets covered and who goes into bankruptcy.
They need to removed from the equation.