April 30, 2016

Is ACA Coverage Affordable for Low-Income People? Perspectives from Individuals in Six Cities

Comment by Don McCanne of PNHP: This report of nine focus groups confirms that real people have found that the Affordable Care Act (ACA) often fails to provide access to affordable care.

Although the leading candidate for president has said that she wants to build on ACA, reducing premiums and deductibles pours yet more tax money into what is the most expensive and least efficient model of health care financing. The model cannot really be fixed if we want true value in health care. It needs to be replaced with a model that does work - a single payer national health program - Improved Medicare for All.

April 29, 2016

Ryan wants to end Obamacare cost protections for sick consumers

Comment by Don McCanne of PNHP: House Speaker Paul Ryan has promised to produce the Republican alternative to the Affordable car Act, likely before the Republican convention in July. In his comments at Georgetown University yesterday he discussed what would be the most important policy supposedly designed to control health care spending for the vast majority of Americans: Establish state level risk pools for the 10 percent of people with the greatest health care needs. Let's see what that means.

The top 10 percent of individuals in spending account for 65 percent of health care costs. By removing them from the standard insurance pools that means that the other 90 percent would have to pay insurance premiums that funded only 35 percent of total health care. Ryan says that this would lower insurance premiums through competition, but that is nonsense. Premiums would be much lower because two-thirds of health care costs are pulled out of the insurance plans in the marketplace. Surely most Americans would be happy with private insurance premiums that were one-third of what they would be if everyone were included. It would be a very popular program, and the Republicans would take credit for it.

But what about the 10 percent of people who account for two-thirds of our health care costs. Their premiums would have to be about 7 times what the premium would be if everyone were covered under a common risk pool, or about 20 times what everyone else is paying. As Paul Ryan says, they are “really kind of uninsurable.” So he proposes high-risk pools at the state level, with subsidized premiums. Expecting the states to subsidize two-thirds of our health care costs is a non-starter. Without massive increases in taxes, which are opposed by the Republicans anyway, the states would not be able to fund those pools.

We already have considerable experience with state high-risk pools. In recent decades, thirty-five states established such pools, and overall they were a spectacular failure. Also, the Affordable Care Act authorized temporary Pre-Existing Condition Insurance Plans (PCIP) which were also high-risk pools. These plans proved to be prohibitively expensive to administer, prohibitively expensive for consumers to purchase, and offered much less than optimal coverage, often with annual and lifetime limits, coverage gaps, and very high premiums and deductibles.

It is so obvious on the face of it. Most of us might be happy with our low premiums, but we would be very unhappy with the massive increases in regressive state taxes that would be enacted to pay for this. Vermont’s reform effort failed once the tax consequences were recognized, and that wasn’t even for high-risk pools.

As I wrote in a previous Quote of the Day, “With a single payer system this problem disappears. Funding is based on ability to pay, through the tax system, and not on the basis of anticipated medical expenses. Everyone receives the care they need, regardless of their health status. The fragmented plans supported by the repeal and replace people cannot do that.”

April 28, 2016

Medical loss ratios affect insurance company stock values.

Health insurer Centene's profit beats as medical costs fall

http://www.reuters.com/article/us-centene-results-idUSKCN0XN14E


Anthem Falls As Medicaid, Obamacare Results Pressure Margins

http://www.bloomberg.com/news/articles/2016-04-27/anthem-profit-beats-estimates-as-insurer-s-enrollment-increases



Comment by Don McCanne of PNHP: Today’s message is just a reminder of one of our problems that the Affordable Care Act (ACA) did not fix. A well-functioning health care financing system should be designed to obtain maximum value by spending our funds on health care and not wasting them on excessive administrative services and on profits that add no value to health care. Yet ACA perpetuates policies that turn these priorities upside down, to the pleasure of Wall Street.

Centene is reporting greater profits attributed to a lower percentage of revenues spent on health care compared to the year before - the medical loss ratio decreased from 89.9 percent to 88.7 percent. A comparable medical loss ratio for Medicare would be about 98 percent - only 2 percent is used for administrative services, and there are no profits. Spending less on patient care and retaining more for Centene’s own administrative services and for profits, Wall Street deems to be an improvement.

In contrast, the percent of revenues that Anthem spent on health care increased - the medical loss ratio increased from 80.2 percent to 81.8 percent. For insurers to spend more on health care is considered to be bad news on Wall Street, and thus they punished Anthem by bidding down the price of their shares.

Since these insurers are giving us the opposite of what we want, why are we leaving them in charge of our health care dollars? Let’s fix Medicare and expand it to cover everyone. Yes, we would have a very high medical loss ratio - with 98 percent of our Medicare tax revenues spent on patient care - but it would be a much better deal for all of us - except for the insurance executives and Wall Street rent-seekers.

April 26, 2016

Health Care Industry Moves Swiftly to Stop Colorado’s “Single Payer” Ballot Measure

https://theintercept.com/2016/04/22/colorad-single-payer/





Comment by Don McCanne of PNHP: Without additional enabling federal legislation, Colorado is not able to enact a bona fide single payer system. However, their ballot measure - Amendment 69, ColoradoCare - would improve efficiency, equity and coverage through the health care financing system in their state. Strong opposition is expected since ColoradoCare could be disruptive to some of the well-financed stakeholders, especially the private insurance industry.

The advocates of ColoradoCare are now seeking support for their effort (link above). It will be difficult to educate the public on the facts behind their reform proposal. Even when saturated with facts, the public often remains dubious because of the prevailing anti-government and anti-tax rhetoric. It is a massive project to convert the majority of the voters into passionate supporters of such a cause.

In the meantime, the opponents know that their task does not involve educating the public on the facts. They do not have to engage the other side in a information battle over the truth. They merely have to appeal to the passion of the voters. Simple rhetorical soundbites are usually enough to convince the voters that they do not have to waste their time studying some complicated government scheme in order to know how to vote on it. Just look at some of the rhetoric of the opposition group, Coloradans for Coloradans: “doubling the state budget,” “diminishing accessibility and quality,” and “creating an unaccountable, massive bureaucracy.” Who would support that? No need to try to find out the truth.

This is not just theoretical, as single payer activists supporting ballot measures in California and Oregon can attest to. In both cases, early polling was favorable, as it is now in Colorado. But closer to election time, intensive campaigns were launched by the opponents using simplistic sound bites and slogans, and the results were a disaster. California’s Proposition 186 lost by a 3 to 1 margin and Oregon’s Measure 23 lost by 4 to 1.

So what should we do? I have three suggestions.

1. Contribute to their effort in any way you can. (Today I made a donation through their website.)

2. If the effort should fail (and I hate to say that), then be sure that everyone understands that this was not a failure of single payer, especially since it is not even a bona fide single payer proposal. Rather it will have been a failure in mobilizing a social movement.

3. Above all, do not let up in the least in your advocacy for a single payer national health program - an improved Medicare for all. That is the ultimate goal, and it could be accomplished in a single step without having to first enact compromised systems in several states. Difficult? Of course. But, in spite of many attempts, how many states have enacted single payer? In this age of advanced communications, mobilizing a social movement on a national basis makes more sense than trying to do it in selected individual states.

April 24, 2016

Health insurance now costs $16,000 for average family

http://www.nbcnews.com/health/health-care/health-insurance-now-costs-16-000-average-family-f6C10960584

The average family’s health insurance now costs about $16,000, and workers pay more than a quarter of that, according to a new survey.

But health insurance premiums for job-based family coverage rose a relatively modest 4 percent, reflecting slowed health spending, according to a survey of about 2,000 employers released Tuesday by the Kaiser Family Foundation and the Health Research & Educational Trust. (KHN is an editorially independent program of the foundation.)

Nonetheless, workers are likely to feel an increased pinch from health care costs: More than a third have annual deductibles of at least $1,000 this year before their insurance kicks in, while wages continue to grow far more slowly than health insurance costs.

Premiums for the average family plan topped $16,000 for the first time, with workers paying on average $4,565 toward that cost, not counting copays and deductibles, the survey found.

The average cost of a single employee’s insurance premiums rose 5 percent, to $5,884, with workers paying an average of $999, the survey found. Workers’ wages increased 1.8 percent on average, while general inflation rose 1.1 percent. The survey was done between January and May of this year.

April 21, 2016

Does single payer/Medicare for All sound good now?

http://www.dailykos.com/stories/2016/4/17/1515199/-Does-single-payer-Medicare-for-All-sound-good-now

How do drug companies get away with this legalized theft? In addition to lobbying Congress, they brainwash Americans into the false belief that they are receiving some benefit for an overpriced product. The astounding amount of money they invest in advertising and marketing is probative. Yet, Americans live no longer than most in the industrialized world.

Ultimately, the only solution is a single payer/Medicare for All system where drug companies are regulated more strictly than utility companies. If they find that too restrictive, research and development can be relegated solely to public universities, and manufactured by the lowest bidder.

Drug companies’ sole desire is to make a profit. Humanity plays no role. Why, then, should anyone believe they will perform any better than a university? Why not pay professors a high salary to develop products based solely on science without the worry of advertising cost, exploitative executives, and shareholders?

A single payer system would give Americans the power to demand this.

April 16, 2016

The Virtues and Vices of Single-Payer Health Care

Comment by Don McCanne of PNHP: Although single payer advocates may be disappointed with Professor Oberlander’s conclusion that the best way forward now is to strengthen ACA and Medicare and to address underinsurance and the affordability of private coverage, we need to keep in mind that he has described the clear superiority of the single payer model, and that it still has widespread popular support. His pessimism is based on current political realities, which have been confirmed by over half a century of failure to advance comprehensive, universal single payer legislation.

Since single payer seems to be an imperative, why has it not been enacted? Oberlander writes, “Single-payer supporters have not articulated a convincing strategy for overcoming the formidable obstacles that stand in its way. Nor have they, despite substantial public support for single payer, succeeded in mobilizing a social movement that could potentially break down those barriers.”

He’s right, based purely on results to date. We have a lot of work to do.

My comment: Our biggest political problem is that most people do not get expensively sick. Many think they have perfectly good insurance, an opinion that is worth what their opinions on how good their fire extinguishers are--that is to say, not much. Only the 15% who account for 85% of health care costs in their demographic know otherwise.

April 14, 2016

News About Obamacare Has Been Bad Lately. How Bad?

Comment by Don McCanne of PNHP: Six years after the Affordable Care Act was signed into law we hear opinions ranging from what a phenomenal success it has been to what a miserable disaster it is. This brief excerpt from a discussion between two respected journalists who have followed the process closely, and who are well versed on the policy issues, provides us with a perspective on where we actually are on reform.

It is somewhat sobering. There have been some tradeoffs such as expanding nominally the numbers insured but with insurance products that further limit provider choice and shift more costs to the patients. Margot Sanger-Katz says that the health law “basically baked in all of the complexity and dysfunction of the pre-existing American health care system.”

Most of the system has remained about the same while the deficiencies introduced offset much of the gains. We are still left with tens of millions uninsured, tens of millions more who are underinsured, and costs that continue to increase in spite of the expansion of blunt financial barriers to beneficial health care services. Even employer-sponsored plans are beginning to deteriorate, especially because of higher deductibles and narrower networks.

Reed Abelson says that he is looking for “a market response — some real change in how care is delivered that is much less expensive or at least more effective.” Yet it has been confirmed over the last half century that markets do not work in controlling health care spending. Nothing in the Affordable Care Act will change that in spite of wishes that feeble policy measures such as ACA exchange competition, ACOs, shared shavings, bundling, wellness programs, meaningless rhetoric of quality over quantity, and other ACA concepts would revolutionize health care. The revolution is not happening.

So claims of phenomenal success or miserable disaster can be ignored since we really have not fundamentally changed the infrastructure of our system. But with that background, we actually have failed: We failed to enact an Improved Medicare for All which would have met our goals for reform. We can still do it, you know.

My comment: ACA has helped many, but we have to eventually get to single payer.

April 12, 2016

Highlights of Luntz Poll of American CEOs Shows Broad Support for Progressive Policies

FIX IT--Healthcare at the Tipping Point




Comment by Don McCanne of PNHP: This poll provides us with the reassuring (and not surprising) finding that CEOs of U.S. businesses “have empathy for their workers and society as a whole.” Regarding health care, they give the highest priority to “keeping health care costs low for American families.”

The poll was conducted by LuntzGlobal - the firm of Republican pollster and wordsmith Frank Luntz. It was commissioned by the Council of State Chambers to help state Chambers of Commerce get on message with the U.S. Chamber of Commerce. This is ominous.

In their new book, “American Amnesia,” Jacob Hacker and Paul Pierson describe how the U.S. Chamber of Commerce has been one of the most powerful organizations in suppressing the appropriate role of government in our mixed economy - an economy that functions best for the private sector when the government is doing what it does best though its services and regulations.

This poll does show that there is significant support for progressive policies amongst these empathetic business executives, including support for health care for American families. But what is really alarming is that the poll is not being used to advocate for the policies supported by these executives, rather it is being used “to help chambers of commerce overcome that empathy and continue to oppose legal policies strongly supported by both the American people and the business executives the chambers tell the press and public that they represent.” How nefarious.

American businesses would fare much better if we had a health care system that would ensure access and affordability for both their employees and their customers. Healthy employees and healthy customers who are not burdened by health care debt are key to business success. Businessman Richard Master has produced “FIX IT” - “a powerful new documentary that reaches across the political and ideological divide to expand support for major healthcare reform.” The documentary can be accessed for free at the link above.

So your homework assignment is to read “American Amnesia” and to view “FIX IT” if you have not yet done so. Doing one will get you a C- and doing both will qualify for a C+. For an A, you need to share these with as many individuals and organizations as possible. Not only will you receive an A, but finally our entire health care system will as well - and what greater reward could you ask?