eridani
eridani's JournalThe One Where An Elderly White Couple Tries To Rap And Actually Pulls It Off
On Upworthy--
http://www.upworthy.com/the-one-where-an-elderly-white-couple-tries-to-rap-and-actually-pulls-it-off-bw1-1d?c=ufb1
When you hear people talking about "fixing Social Security" and saying that "it's broke" (hint: it's not!), just remember this little rhyme.
"The cap" means that if you make over $110,000 per year, you don't pay into Social Security for all those extra dollars. Because the rich don't get enough breaks, right? There wouldn't even be a question on its stability if we collected that money.
Who first said, “You can keep the insurance you have”?
By Don McCanne of PNHP
Considering our national health expenditures, our health care financing and delivery systems are a disaster. It is fully apparent that the Affordable Care Act will fall woefully short of what is needed, and even offset some of the minimal gains with changes that will make many of us worse off by passing more costs directly onto us when we become ill (higher deductibles and other cost sharing), and by further limiting our choices of physicians and hospitals (shifting to narrow provider networks).
At a time that it is imperative that we address policy issues to try to straighten up our system, we abandon reason and propel forward with politics as usual.
President Obama’s political enemies, well supported by the media - including editorialists - are now expressing shock, shock that he lied to us when he told us that we could keep the insurance we have, if we like it. He was not the author of this sound bite provided to him for political campaigning, so where did it come from?
Let’s go back five years, beginning before Sen. Obama was even the Democratic nominee for president, and look at some of our Quote of the Day messages beginning then:
Is "keeping the insurance you have" your choice?
http://www.pnhp.org/news/2008/february/is-keeping-the-insurance-you-have-your-choice
How many of you, under age 85, have the same health insurance plan that you had twenty years ago? None?
Why did you change?
What is the obvious conclusion? Health insurance coverage on a continual basis is practically non-existent in the private insurance market. In almost all of the instances listed, the insured individual was not granted the option of "keeping the insurance you have."
Most polls on health care reform continue to ask many of the same questions as they have over the past couple of decades, but there is one new question. The pollsters are now asking if you support reform that would allow you "to keep the insurance you have." For healthier individuals who believe that they have good insurance, this concept polls very well. In fact, the other questions in the polls are now tailored to reinforce this simple concept.
(Undated, but referenced in 2008)
Statement of Common Purpose
A choice of a private insurance plan, including keeping the insurance you have if you like it…
http://healthcareforamericanow.org/about-us/statement-of-common-purpose/
"Keeping the insurance you have" - Don't believe it!
http://www.pnhp.org/news/2008/july/keeping-the-insurance-you-have-dont-believe-it
Pause for a minute. Think back to the insurance you had twenty years ago. Remember? Now do you still have precisely that same coverage? Unless you are over 85 and have been in the traditional Medicare program for the past twenty years, it is highly likely that you do not.
So why do you no longer have the better coverage that you had twenty years ago? You may have changed jobs, likely more than once, and lost the coverage that your prior employer provided. Your employer may have changed plans because of ever-increasing insurance premiums. Frequently your insurer introduces plan innovations such as larger deductibles, a change from fixed-dollar co-payments to higher coinsurance percentages, tiering of your cost sharing for services and products, reduction in the benefits covered, dollar caps on payouts, and other innovations all designed to keep premiums competitive in a market of rapidly rising health care costs. You may have lost coverage when your age disqualified you from participating in your parents' plan. You may have found that health benefit programs have been declining as an incentive offered by new employers.
Your children may have lost coverage under the Children's Health Insurance Program when your income, though modest, disqualified your family from the program. Your union may not have been able to negotiate the continuation of the high-quality coverage that you previously held. Your employer may have reduced or eliminated the retirement coverage that you were promised but not guaranteed. Your employer may have filed for bankruptcy without setting aside the legacy costs of their pensions and retiree health benefit programs. You may have decided to start your own small business and found that you could not qualify for coverage because of your medical history, even if relatively benign, or maybe your small business margins are so narrow that you can't afford the premiums. You may have been covered previously by a small business owner whose entire group plan was cancelled at renewal because one employee developed diabetes, or another became HIV infected. Your COBRA coverage may have lapsed and you found that the individual insurance market offered you no realistic options. You may have retired before Medicare eligibility, only to find that premiums were truly unaffordable or coverage was not even available because of preexisting medical problems.
Will grandfathering save our current private plans?
http://www.pnhp.org/news/2010/june/will-grandfathering-save-our-current-private-plans
The opponents of reform, especially the Republicans in Congress, are making a big deal out of the fact that the Affordable Care Act breaks President Obama's promise that you will be able to keep the insurance plan you have. The Obama administration is countering by publicizing the new regulations that will allow plans in place on March 23, 2010 to be grandfathered, supposedly assuring that you will be able to keep your plan if you had it on that date.
Actually, this is a silly debate. As explained in my comment two years ago, except for those individuals on Medicare or other fiscally sound retiree programs, almost no one gets to keep the insurance he or she has. Rather than stabilizing existing coverage, the regulations that would grandfather plans make it less likely, in an environment of increasing health care costs, that existing plans would continue to be offered without significant changes.
In an effort to make the insurance plans more affordable, further adjustments in deductibles and coinsurance are almost inevitable, and the ever-changing insurance marketplace will surely result in changes in insurance companies selected. Insurance price shoppers, who are mostly healthy, will be much more sensitive to size of the premiums than they would be to cost sharing; this is precisely what has happened throughout the individual market. These pressures would accelerate the decline in grandfathered plans.
"Keeping the insurance you have" was only a slogan used to market the reform proposal. It wasn't a serious long term strategy. Instead of wasting time in another political dogfight - this time over grandfathering - we should move forward with supporting policies that will work for everyone - like a single payer national health program.
Comment, November 8, 2013:
“Liar!”
Is that the best lesson that we can learn from President Obama’s decision to accept the recommendation of his political advisers to use the sound bite, “You can keep the insurance you have, if that’s what you want”?
The fact that this is the framing of the current keep-the-insurance-you-have discourse demonstrates not only how acrimonious the Washington political environment has become, it also shows the ineptitude of the media. Not only do they buy this framing when there is a far more compelling message in this mess, they also serve as dupes, propagating the biting, counter-productive message of the Obama opponents.
Repeating my comment from 2010, “Instead of wasting time in another political dogfight… we should move forward with supporting policies that will work for everyone - like a single payer national health program.” That’s the lesson we should learn.
Reupblican Geraldo Rivera comes out in favor of single payer
Geraldo Rivera
November 1, 2013
Geraldo Rivera Radio, 11/1/2013 - at the 48:55 mark:
http://www.wabcradio.com/common/page.php?pt=Geraldo+Podcasts&id=512&is_corp=0
Comment by Don McCanne of PNHP: Geraldo Rivera was quite sincere when, on his radio show, he discussed briefly the serious flaws of Obamacare and then explicitly supported single payer - Medicare for everybody. This is from a Republican who also has a show (“Geraldo-at-Large”) on the Fox News Channel.
Recently, much of the media attention on single payer has been coming from conservatives who seem to be threatening us with the prospect of single payer as an inevitable outcome of expanded coverage through the Affordable Care Act. They may be correct, but not for the reasons they imply. Rather than ACA being a step closer to single payer, it moves in the direction of expansion of enrollment in private plans, whereas single payer would essentially eliminate private plans.
The real reason that ACA moves us closer to single payer is that the plans are further limiting our choices of physicians and hospitals, and they are shifting an unbearable amount of the costs to patients. Once a critical threshold of patients experience these abuses, the public will demand that everyone be covered with a public program like Medicare.
During our PNHP meeting in Boston last weekend, Fox News broadcast an attack on single pager (likely only coincidental that it was during our meeting). It represents what seems to be an orchestrated attempt to discredit single payer before it gains further traction. If you watch the 7 minute video at the following link, you may find disconcerting the fact that media professionals apparently believe that the intellect of the average American is so low that they would be swayed by their framing. Anyway, I report, you decide:
(Preview)
Play (Show link) ObamaCare rollout strikes blow to dream of single-payer? foxnewstest Can taxpayers thank their lucky stars?
On a more positive note, there are many Republicans, such as Geraldo Rivera, who do understand and support the single payer model. We need to expand our message beyond the progressive community by increasing our efforts to communicate with Republicans and with the business community.
Tomorrow, November 7, Geraldo Rivera is going to have as a guest on his program, PNHP co-founder David Himmelstein:
My comment: ACA allows state single payer in 2017. We need to get moving on this.
Obama completly insulated from feedback on potential ACA rollout problems
http://www.washingtonpost.com/opinions/dana-milbank-obama-is-bubble-wrapped/2013/11/05/8779997a-465b-11e3-a196-3544a03c2351_print.htmlIn one account of what even administration officials acknowledge is a debacle, the Wall Street Journal reported that Obama’s policy advisers were aware long ago that the president’s promise that “if you like your insurance plan, you will keep it” wouldn’t hold up. “White House policy advisers objected to the breadth of Mr. Obama’s ‘keep your plan’ promise,” the Journal reported, citing a former senior administration official. “They were overruled by political aides, the former official said. The White House said it was unaware of the objections.”
No, the Obamacare pratfall is not Obama’s Iraq: The magnitude is entirely different, and the problems — Web site malfunctions and a wave of policy cancellations — are fixable. But the decision-making is disturbingly similar: In both cases, insular administrations, staffed by loyalists and obsessed with secrecy, participated in group-think and let the president hear only what they thought he wanted to hear.
In a damning account of the Obamacare implementation, my Post colleagues Amy Goldstein and Juliet Eilperin described how Obama rejected pleas from outside experts and even some of his own advisers to bring in people with the expertise to handle the mammoth task; he instead left the project in the care of in-house loyalists. “Three and a half years later, such insularity — in that decision and others that would follow — has emerged as a central factor in the disastrous rollout,” Goldstein and Eilperin reported.
Their report is based in part on a prescient memo sent to the White House in May 2010 by Harvard professor David Cutler, an outside adviser on health-care reform. “I am concerned that the personnel and processes you have in place are not up to the task, and that health reform will be unsuccessful as a result,” he wrote. “My general view is that the early implementation efforts are far short of what it will take to implement reform successfully. .?.?. I do not believe the relevant members of the administration understand the president’s vision or have the capability to carry it out.”
Cutler identified many of the problems that would later plague the Obamacare rollout: The perception of secrecy, the lack of qualified personnel and the likelihood that “if you cannot find a way to work with hesitant states and insurers, reform will blow up.”
Instead, Obama followed a different governing philosophy: Dance with the one that brung ya. He figured that those who helped him enact the health-care law should be the ones to implement it.
Why we should stop saying "safety net"
From an email from Northwest Progressive Institute
Lastly, we suggest you avoid the metaphor of the safety net. Let's turn to George Lakoff's Little Blue Book again for an explanation:
The language of the safety net has certain disadvantages, which conservatives have taken advantage of in referring to it as a hammock. The mental images of the two ideas are similar, but there is a deeper connection that helps promote conservative opinions about social programs.
[Editor's note: It's tough to practice framing discipline - as we can see here, even Lakoff uses the word "programs", which, as we've just discussed, is also best avoided!]
The person falling into the safety net is passive; he or she is not holding up the net, others are. But the reality is that the person who needs Social Security, Medicare, or unemployment compensation has contributed to his or her own security through a lifetime of work. The safety net image leaves out that crucial fact, allowing the hammock image to make sense. You cannot hold up the hammock you are lying in. With both safety nets and hammocks, you depend on other forces. This allows conservatives to suggest that safety nets build dependency and take away the incentive to work.
The safety net metaphor has further metaphorical implications. One falls downward into a net, as far down as one can fall. Metaphorically, control is up, loss of control is down, falling is failing, and immoral is down. The implication is that people who rely on social programs [public services, George!] are failures who have lost control of their financial lives and are immoral in becoming dependent on others. In conservative religion, falling activates the idea of a fall from grace. All this fits into the conservative moral system for politics - that people are individually responsible for their financial state, that needing money indicates a lack of discipline and incentive, and that financial hardship indicates moral failure. The safety net metaphor buys right into this.
Instead of talking about a safety net or social safety net, you can talk about guaranteeing America's social contract or upholding the American ideal.
Social Security and Medicare are part of the American ideal. When a person works hard over a lifetime, whatever her job or pay is, she is making a valuable contribution to society. America's social contract says that if you work hard, participate in your community, and take care of your family, you should be able to retire and live between jobs with dignity.
This is why we have services like Social Security and Medicare: they manage the deferred pay that we earn as Americans so it's ready for us later on. To ensure the American ideal is upheld, we should be expanding our vital public services, not cutting them.
Why competition in health care sucks
--and why it should be a public good.
http://www.thelundreport.org/resource/is_competition_really_good_for_healthcare
The bronze and silver policies that most people will select under Obamacare have enormous deductibles so that people are discouraged from seeking routine medical care and from getting the companies to provide something in return for the premiums. And the companies will continue their efforts to avoid caring for the sickest patients and to deny coverage whenever possible. The “choice” in the “healthcare marketplace” is limited to policies of companies whose bottom line is not patient care, but profit. (The “not for profit” companies have the same bottom line as those that are “for profit”--they just have to call it something else.)
Is competition among drug companies a good thing? One would think that “ethical pharmaceuticals” would compete to offer the best products at the lowest prices. But like the health insurance business, the “competition” is only to see who can derive the maximum profit. We get the drugs that are most profitable and most easily marketed, not the drugs we need. And the price of the drugs is whatever the drug companies can get away with.
The business model of competition and profit seeking is even being foisted on doctors. “Pay for performance” is promoted as a way to get doctors to improve the care they provide. What an insult to the medical profession! Doctors don’t need a financial incentive to be motivated to provide quality care for their patients. When pay for performance has been put into effect, doctors and hospitals have shown that they know how to game the system, but there has been no evidence that pay for performance has actually improved patient outcomes.
If competition is so wonderful, why don’t we have competing police departments, fire departments and armed services? Clearly, the business model--competition and making a profit--is not always appropriate. The competitive model for healthcare is a terrible idea--inefficient, immoral, and colossally expensive. A recent study estimated that a single payer system would save $592 billion in administrative and pharmaceutical costs. Will we ever get a system whose bottom line is not making money, but caring for patients?
Report on Healthcare Now! (HCN) Strategy Conference 2013, Nashville, TN
http://hcao.org/home/2013/10/24/j79oidqxdedlgvawj8zoxgz2yl1wvwThe conference began with a plenary on the strategy in the south. The speaker talked about the need for a special strategy in the south due to the legacy of white supremacy, the plantation mentality (where whites feel oppressed by the government and the northern whites, and the blacks are oppressed by the whites), and the atmosphere of fear, distrust , and envy. They went on to talk about the particular challenges and opportunities that exist for organizing in the south.
Next, HCN’s Director of Organizing, Ben Day, highlighted some resources they’re putting together. They are publishing a Single Payer Activists Guide to Affordable Healthcare Act to help with education, media, and outreach during this time of transition. These Guides will be out soon. They are also planning to conduct Everybody Institutes, trainings they plan to conduct nationwide.
We then touched on Healthcare Justice in Tennessee. There wasn’t much there, but a good story about the women’s suffrage movement and how the last state to approve the amendment was Tennessee. The decisive legislator changed his vote to pro suffrage due to a letter from his mom saying something like “Dear Son, Be a good boy. Hoorah for suffrage! Your mother” It is a powerful story of the persuasive impact of finding an effective secondary target (in this case it was mom).
There was then a break out session on the Challenges and Solutions for State Single Payer Legislation. We spoke about two different strategies, one is passing a bill without funding and then following up to pass another with the funding mechanism, the other is passing a bill that contains the funding mechanism. We also talked about whether to include a laundry list of things covered by the law or to create a body to make those tough decisions. Finally we spoke about some obstacles such as ERISA and getting money from the federal government programs. Additionally, there were questions about the role and necessity of conducting studies.
Consolidated health care systems forbid you to see your regular doctor
For several hundred patients at the University of Pittsburgh Medical Center, it started with a certified letter informing them that they were no longer allowed to see their physicians. The reason? They were unlucky enough to have insurance called Community Blue, which is offered by a rival hospital system. Astoundingly, they were barred even if they could pay for the care themselves.
One patient, in the middle of treatment for lung cancer, said at a hearing before a State House of Representatives committee that she was prohibited from seeing her U.P.M.C. oncologist. Another, with the debilitating autoimmune disease scleroderma, said she was dismissed from the U.P.M.C. Arthritic and Autoimmune Center. A third, a five-year breast cancer survivor who needs follow-up care every six months, was cut off from the doctor who had been with her since she was first given her diagnosis.
Community Blue is sold by a company called Highmark. Like U.P.M.C., it is both a hospital system and an insurance provider, part of a growing trend toward vertical consolidation in the two industries. These and other companies insist that such consolidation streamlines the caregiving system and thus benefits the patient. But in the short term, they are waging a vicious war over patients--and as the experience in Pittsburgh shows, it?s often the patients who are losing.
Comment by Don McCanne of PNHP: Integrating health care is a great concept that theoretically should improve coordination of care, reduce duplication, provide incentives to meet quality and outcome targets, improve access to appropriate specialized care - in general, improving quality while reducing costs. That is the idea behind the Accountable Care Organizations established by the Affordable Care Act. How is it working out in the real world?
We've watched as insurers have consolidated. Although they tout that they are providing higher quality at lower costs through managed care, in fact they have used their oligopolistic leverage to limit patient access to their selected network providers. Although they contend that they are selecting the highest quality providers, in fact, they are excluding quality institutions such as academic medical centers and going with the cheapest contracts they can extract from the health care community.
In response, we are witnessing an explosion in consolidation of health care providers - hospitals and physician groups - often into single entities. Obviously this results in "must have" groups that in turn have leveraged their oligopolistic negotiating power in dealing with the insurers.
Not to be outdone, we are now seeing insurers and consolidated health care systems joining together to increase their control of markets, and thereby share in the spoils. When you see patients with lung cancer, breast cancer, and scleroderma being cut off from their care strictly on the basis of realignment of the health care business models, you can dismiss the concept that these changes are changes that are designed to benefit patients. The ugly competition that is taking place between Physician-hospital-insurer entities (Phi) is cutthroat and certainly not in the patients' best interests. (Phi seems to be an appropriate symbol for these entities since, in Lacanian psychoanalysis, it is the symbol for "the phallic function."
The Affordable Care Act very specifically was designed to keep control in the private sector. Private sector business models will always do what they are designed to do - anything to make more money. If we really do want a system designed to provide the best care possible with our available resources, we need to dismiss the private insurers and put our own public stewards in charge. They would have the responsibility of answering to us.
Breitbart: First Obamacare, Then a Single Payer System
Time for Satan to start looking through heating catalogs?
http://www.breitbart.com/Big-Government/2013/09/27/First-ObamaCare-Then-a-Single-Payer-System
The burden to find solutions will take congress to places that Republicans are very reluctant to go.
The German and other European systems accomplish lower costs and universal coverage by imposing tight controls on prices for services, drugs, and devices. Britain's National Health Service doesn?t bother with insurance companies and claims forms--by eliminating insurance company overhead it accomplishes much lower costs than even the German system.
Even before Obamacare, federal and state governments, through Medicare, Medicaid, and other programs, paid more than 50 percent of U.S. health care bills. That was more than the 9 percent of GDP, and the amount Britain spends to accomplish universal coverage ? without the additional $4,600 per person American businesses and individuals pony up.
Reducing U.S. doctors fees and drug and device prices down to German levels won't be easy or likely possible, but politicians, providers, and businesses still providing health insurance will need a solution--likely a scapegoat.
Enter the insurance companies that have been screwing down doctor's fees, hassling everyone with mindless paperwork, and paying executives like royalty.
The federal government could probably pay doctors, drug companies, and device manufactures pretty reasonably directly, and without the insurance company middlemen, through an American National Health Service.
(Peter Morici is an economist and professor at the Smith School of Business, University of Maryland, and a widely published columnist.)
Comment by Don McCanne of PNHP: Professor Peter Morici, an expert on international trade, is known for holding no punches. Here he suggests that Republican intransigence could lead us to an American National Health Service--true socialized medicine.
In the full article, available at the link above, he explains why Obamacare is unsatisfactory, likely with the intent of cajoling Republicans into working with Democrats to improve it. He seems to be using the prospect of a national health service as a threat to Republicans as to what could happen if they failed to cooperate. In doing so, he does present some very persuasive arguments for making the change.
Maybe he's serious. He does make private insurance companies the scapegoat. Get rid of them and then what options do we really have?
Insurers limiting doctors, hospitals in health insurance market
The doctor can't see you now.
To hold down premiums, major insurers in California have sharply limited the number of doctors and hospitals available to patients in the state's new health insurance market opening Oct. 1.
New data reveal the extent of those cuts in California, a crucial test bed for the federal healthcare law.
Consumers could see long wait times, a scarcity of specialists and loss of a longtime doctor.
"These narrow networks won't work because they cut off access for patients," said Dr. Richard Baker, executive director of the Urban Health Institute at Charles Drew University of Medicine and Science in Los Angeles.
To see the challenges awaiting some consumers, consider Woodland Hills-based insurer Health Net Inc.
Across Southern California the company has the lowest rates, with monthly premiums as much as $100 cheaper than the closest competitor in some cases. That will make it a popular choice among some of the 1.4 million Californians expected to purchase coverage in the state exchange next year.
But Health Net also has the fewest doctors, less than half what some other companies are offering in Southern California, according to a Times analysis of insurance data.
Comment by Don McCanne of PNHP: These new data on use of narrow provider networks in state insurance exchanges, using Los Angeles County as an example, are important because they show us the extent to which this concept is being applied. Narrow provider networks reduce health care spending by limiting patient access to low cost providers - taking away choice - and by impairing access though supply-side contractions, that is, rationing care by limiting the supply of covered health care providers.
Another table accompanying the Los Angeles Times article (available at the link above) lists premiums for typical policies issued by these insurers for the benchmark silver plans. When comparing premiums with the numbers of physicians in the network, there are several interesting observations. Health Net, with the fewest number of physicians in their network, has the lowest premiums - no surprise. Blue Shield, California's nonprofit Blues plan, has premiums on the lower end though it has a much larger number of physicians than does for-profit Anthem Blue Cross, yet their premiums are similar. The nonprofit seems to be more concerned about patient access whereas the for-profit seems to be concerned more about profits. However, Anthem's EPO (exclusive provider organization) offers a larger choice in providers but extracts a much larger premium for that coverage. Comparing Anthem's two products, it looks like if you want an accessible doctor, you're going to have to pay for that right. Considering that Kaiser is a closed, integrated health system, it does have a fairly decent number of physicians, but it also has the highest premiums. It is likely that Kaiser's premiums are not high because of the number of physicians, but rather they are high to prevent destabilization of their business model by allowing too many new enrollees which might strain their capacity.
Health Net's silver plan premiums are set far enough below the others such that they will be very attractive for shoppers in the insurance exchange. The bronze plans have even lower premiums and will also be attractive. Most shoppers will be relatively healthy and will select their plans based on the premium - not on the physician networks nor on the out-of-pocket costs they would face if major health problems were to develop. Some of these people will become ill or suffer significant injuries. At that time they will discover that their choices of providers are too limited, that access may be impaired because the physicians are too busy or because they are too far away, and that the out-of-pocket expenses to which they are exposed will cause financial hardships.
Leave policy decisions to private insurers and they will always select policies that will advance their business models as opposed to policies that would provide optimal access, quality and affordability for patients. Having cheap premiums is no solution when you can't get a doctor when you need one, and, when you finally do, you're left broke.
Single payer would have avoided all of this, and it still can.
My comment: Underinsurance is why health care bankruptcies are STILL 50% of all bankruptcies sever years after reform.
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