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Profile Information

Gender: Female
Hometown: Washington state
Home country: USA
Current location: Directly above the center of the earth
Member since: Sat Aug 16, 2003, 02:52 AM
Number of posts: 51,889

About Me

Major policy wonk interests: health care, Social Security/Medicare/Medicaid, election integrity

Journal Archives

Employer Wellness Programs Are a Great Idea—Right?


Actuarially driven discrimination can be as technologically sophisticated as it is socially regressive. Some programs rely on arbitrary formulas like the Body Mass Index (BMI)—a metric derived from height and weight used to bluntly assess obesity—instead of more holistic health examinations.

Insurers can’t be blamed for using BMI as a rough indicator of obesity-related risks within an insurance pool. But for an individual worker, such as the diabetic retiree with asthma who might exceed her target BMI but is not in a position to crash diet to achieve a “wellness” benchmark, how would making her doctor’s visits more costly make her healthier?

The very concept of “incentives” raises questions of medical efficacy. How would insurers even measure the long-term “success” of linking premium rates to a weight-loss program? As NPWF’s testimony pointed out, “There is scant—if any—empirical evidence that monetary rewards can result in sustained weight loss. Crucially, there is no independently evaluated research demonstrating that linking the cost of employer-sponsored insurance to certain biometrics has an impact on health outcomes.”

A possible side effect of biometric surveillance, the group argues, is anxiety: Arbitrary health assessments could lead to “more people refusing testing and treatments they need for fear employers and insurers will use the information against them,” and, while premium rates continue to inflate in general (worker contributions to insurance plans have jumped over 80 percent since 2005), the wellness gap could impose “higher health insurance costs for the consumers who can least afford to pay.”

One Payer States has a Facebook group


INTERSECTIONS: US has longest health care waiting times


It is a common mistake to associate universal or near-universal coverage with long waiting times for specialized care. ( Read the previous sentence again-- a mistake to associate universal coverage with long waits.) The UK has short waiting times for basic medical care and non-emergency access to services after hours. The UK also has improved waiting times to see a specialist and now ranks fourth on this dimension with the US ranking third. Patients in the Netherlands, Germany, France and Switzerland have rapid access to elective or non-emergency surgery compared with patients in the US.

Again, it is a mistake to associate universal care for all with delays in care, seeing a specialist or elective surgeries. If this goes against the propaganda one commonly hears in the US, such propaganda being paid for by US health insurers and Big Pharma, then read the above paragraph again. Now, it is true that Canada is having some wait times for specialized elective care--this is NOT a reflection of universal care (read the above paragraph again), it is a reflection of some issues unique to Canada that Canadians are addressing--just as the UK addressed waiting times to see a specialist and now ranks just behind the US.

If universal coverage was the cause of waits, then US Medicare patients would be looking at serious delays. US Medicare patients are not suffering, for many they are safe from predatory health insurers for the first time in their lives (except for privatized Medicare Advantage plan patients, who face restricted, choice, narrow networks while costing taxpayers more). What is often cited is Canadians wait for elective knee or hip replacements--in fact US patients wait also, often voluntarily putting off joint replacements for years on end--and remember that for 37% of US patients without good insurance the wait is infinite.

Establishment Dems Fight to Defeat 'Medicare-for-All' in Colorado


Highlighting the divisions in the Democratic party this election, Colorado's ballot measure for a universal, single-payer healthcare plan is facing unexpected resistance from the very same party that has been calling for such a healthcare plan since the 1990s.

"There is a disconnect between the powers that be and the people," said state senator Irene Aguilar, a former doctor and the chief architect of the statewide 'Medicare-for-all,' called ColoradoCare, in an interview with the Guardian. "The powers that be are incrementalists. There hasn't been a courage of conviction to try and deal with ."


Clinton's campaign is directly linked to Coloradans for Coloradans, the most prominent organization opposing ColoradoCare. Formed solely to defeat the measure, Coloradans for Coloradans is being funded by the very same consultant firm currently working for the Clinton super PAC Priorities USA, as Lee Fang reported in the Intercept.

While a stance for the ACA and against single payer is the least popular with the public, it is the most popular within a certain sector of the population: pharmaceutical and healthcare companies.

Indeed, in Colorado the "anti-single-payer effort is funded almost entirely by health care industry interests," Fang reported, "including $500,000 from Anthem Inc., the state’s largest health insurance provider; $40,000 from Cigna, another large health insurer that is current in talks to merge with Anthem; $75,000 from Davita, the dialysis company; $25,000 from Delta Dental, the largest dental insurer in the state; and $100,000 from SCL Health, the faith-based hospital chain."

Growing Support for a National Health Program and Health Care as a Human Right


This 2016 election season brings us three very different alternatives concerning future health care in this country: (1) continuation of the Affordable Care Act (ACA) with changes as necessary; (2) a Republican “plan” for health care; and (3) single-payer NHI. Despite some expansions of coverage, especially through Medicaid, the ACA has failed to make health care more affordable, has accelerated waste, bureaucracy and profiteering, and is unsustainable. Yet Hillary Clinton calls for expansion of the ACA to 100 percent coverage with no possible way of doing it by retaining some 1,300 private insurers. She also claims disingenuously that NHI will raise our taxes—without acknowledging that Gerald Friedman’s classic 2013 study found that 95 percent of Americans will pay less for insurance premiums, deductibles, co-payments, actual care and out-of-pocket payments, and that only the wealthiest five percent would pay more.6

Although no concrete plan has yet been advanced by the GOP, we can expect that it will repeal the ACA, then “replace” it with long discredited reliance on free markets in health care, consumer directed health care, health savings accounts, selling insurance across state lines, and high-risk pools.

Neither the ACA nor GOP options will make health care more affordable or accessible.

Single-payer NHI is the only alternative that will achieve universal coverage in an affordable and sustainable way. A strong case for it has been made elsewhere on economic, sociopolitical, and moral grounds.7 It will meet conservatives’ principles regardless of party affiliation, including efficiency, maximal choice, minimal waste, value, and everyone contributes in proportion to his or her income.8 Long an iconic guru of free-market economics, Kenneth J. Arrow has recently acknowledged that “a single-payer system is better than any other system,” as long as private practice is preserved (as it would be with NHI).9

We know that powerful forces are aligned against passage of NHI, including private insurers, Big PhRMA, medical device makers, and other members of the medical-industrial complex. They are empowered further by their hundreds of lobbyists and corporate money in our post-Citizens United world. As Bernie Sanders has observed: “the Koch brothers, as the second-wealthiest family in America with $82 billion in wealth, advocate destruction of federal programs that are critical to the financial and personal health of middle-class Americans.”10

Government Auditor Finds Billions in Improper Payments to Medicare Advantage Plans--

--Coupled with Inadequate Oversight by Federal Regulator


This week the General Accounting Office (GAO) issued a report entitled “Medicare Advantage: Fundamental Improvements Needed in CMS’s Effort to Recover Substantial Amounts of Improper Payments. The report states that the Centers for Medicare & Medicaid Services (CMS) estimates that about 9.5% of its annual payments to Medicare Advantage (MA) organizations were improper – totaling $14.1 billion in 2013 alone – “primarily stemming from unsupported diagnoses submitted by MA organizations.” This plan-initiated billing practice is commonly referred to as “upcoding” when an MA plan reports an enrollee as being more sick than they actually are in order to obtain a higher risk-adjusted payment from the Medicare program. The report also highlights the significant flaws in CMS’ current efforts to address and recoup such payments.

The Center is deeply troubled by these ongoing improper payments to MA plans and CMS’ lack of progress in recouping previous payments and deterring future misconduct. In an NPR story about the GAO report, “GAO Audit: Feds Failed To Rein In Medicare Advantage Overbilling” (May 9, 2016) the Center is quoted as stating: "We hope that policymakers who protect MA (Medicare Advantage) profit at all costs, while at the same time often proposing to shift more costs on to the majority of beneficiaries in traditional Medicare, take heed of this GAO report and ensure that the recommendations are implemented."

Kids need healthy mothers


The number of uninsured mothers fell from 7.5 million in 2013 to 5.9 million in 2014, as the uninsurance rate for mothers reached its lowest point since 1997. The largest declines in uninsurance were found among low- and moderate-income mothers who were targeted by the ACA’s Medicaid expansion and the introduction of subsidized Marketplace coverage, respectively.

Despite these gains in coverage, nearly one in six mothers remained uninsured in 2014, and these mothers were disproportionately young, low-income, Hispanic, noncitizens, less educated, not married, and living in the South. One particularly concerning finding is that about one in five mothers who were likely to have the greatest physical and mental health care needs—those who reported being in less than very good health or having moderate or severe psychological distress—were uninsured.

When asked about the reasons why they do not have health insurance or stopped having coverage, 41.5 percent of uninsured mothers in 2014 said it was because the cost was too high. The next most frequently reported reason was that coverage stopped after pregnancy (18.7 percent). In addition, some mothers identified their inability to get employer-based coverage as a reason for being uninsured, either because they or the person in their family with coverage lost or changed jobs (18.0 percent) or because their current employer does not offer coverage (7.3 percent). Over 5 percent said they had lost Medicaid or other coverage because of a new job or increase in income, and 18.6 percent reported not having coverage for other reasons, such as divorce, separation, or death of a spouse or parent, becoming ineligible because of age or leaving school, denial of coverage from an insurance company, or not needing coverage.

Comment by Don McCanne of PNHP:
Most would agree that having healthy mothers would be of benefit to their children. Suppose 5.9 million mothers were uninsured, wouldn’t it seem that we should enact health care reform that would address this problem? In fact, we did enact the Affordable Care Act, and between 2013 and 2014 the number dropped from 7.5 million to 5.9 million. Rather than celebrating the “success” of ACA reform, shouldn't we be advocating for reform that really does work for everyone?

Yesterday the Physicians' Proposal for Single-Payer Health Care Reform was released. Under that proposal the number of uninsured mothers would drop to zero. At the following link you can read and download the Proposal and its supporting documents, and provide your personal endorsement:


You don't want to trouble yourself by providing an endorsement? But Mother's Day is this weekend. Surely you'll reconsider, you know, for Mom.

Traditional Medicare Versus Private Insurance: How Spending, Volume, And Price Change--

--At Age Sixty-Five


To slow the growth of Medicare spending, some policy makers have advocated raising the Medicare eligibility age from the current sixty-five years to sixty-seven years. For the majority of affected adults, this would delay entry into Medicare and increase the time they are covered by private insurance. Despite its policy importance, little is known about how such a change would affect national health care spending, which is the sum of health care spending for all consumers and payers—including governments. We examined how spending differed between Medicare and private insurance using longitudinal data on imaging and procedures for a national cohort of individuals who switched from private insurance to Medicare at age sixty-five. Using a regression discontinuity design, we found that spending fell by $38.56 per beneficiary per quarter — or 32.4 percent — upon entry into Medicare at age sixty-five. In contrast, we found no changes in the volume of services at age sixty-five. For the previously insured, entry into Medicare led to a large drop in spending driven by lower provider prices, which may reflect Medicare’s purchasing power as a large insurer. These findings imply that increasing the Medicare eligibility age may raise national health care spending by replacing Medicare coverage with private insurance, which pays higher provider prices than Medicare does.

Comment by Don McCanne of PNHP: This study looked at the changes in spending and volume of services for individuals who, at age 65, transferred from private insurance to the traditional Medicare program. The authors showed that the volume of services remained the same, but spending went down, which reflects the lower provider prices that Medicare pays compared to private insurers.

One suggestion that has been made to “save Medicare” from future federal budget deficits would be to increase the eligibility age from 65 to 67. They showed that this would actually increase our national health expenditures without changing the volume of services, not exactly the health care cost containment that we are seeking.

Conservatives and neoliberals might think that the increase in spending would be worth it just to advance their ideological goal of relying less on government spending and more on the private sector. But a portion of the reduction in federal spending would be offset by increased Medicaid coverage for those eligible, and increased ACA premium tax credits and cost-sharing subsidies, resulting in tax revenue losses and greater outlays. Not a good deal at all.

Others have suggested that we should expand Medicare enrollment, perhaps by reducing the eligibility age in 5 year increments. Although it would be an extrapolation of this study, it is not unreasonable to assume that we could significantly reduce our expenditures without any change in the volume of services for those who otherwise would have been privately insured.

Or go all the way. Replace the private insurers with a Medicare for all program. Not only is Medicare a more efficient purchaser of health care services, the recovery of much of the profound administrative waste of our fragmented financing system would be enough to fully fund a health care system for all without increasing our national health expenditures from the current level.

Remember who the patient is. It is not the government budget. It is the people who need health care.
Establishing a well-designed single payer Medicare-for-all system would take care of the people, and the government budget would perk along just fine.

The Neoliberal Model Comes Home to Roost in the United States — If We Let It


Many countries have rejected the neoliberal model, and have instead constructed health systems based on the goal of “health care for all” (HCA). Such countries strive to provide universal access to care without tiers of differing benefit packages for rich and poor. For instance, Canada prohibits private insurance coverage for services provided by its national health program. Because Canada’s wealthy must participate in the publicly financed system, the presence of the entire population in a unitary system assures a high-quality national program. In Latin America, countries trying to advance the HCA model include Bolivia, Brazil, Cuba, Ecuador, Uruguay, and Venezuela. The inevitable failure of Obamacare may open a space, finally, for even the United States to pursue a national health program that does not follow the neoliberal model.

A Neoliberal’s Manifesto


If neoconservatives are liberals who took a critical look at liberalism and decided to become conservatives, we are liberals who took the same look and decided to retain our goals but to abandon some of our prejudices. We still believe in liberty and justice and a fair chance for all, in mercy for the afflicted and help for the down and out. But we no longer automatically favor unions and big government or oppose the military and big business. Indeed, in our search for solutions that work, we have come to distrust all automatic responses, liberal or conservative.

Comment by Don McCanne Of PNHP: The majority of Americans would like to see a high quality health care system that is affordable and accessible for everyone. We do not have that now. Why not?

Progressives/liberals generally recognize that costs and market dysfunctions require a major role of government in financing health care. Conservatives/libertarians believe that free markets can fulfill that role with the exception that those impoverished not by choice need private charity or the helping hand of government. But it is those in the middle - the moderates - who determine policy through the election process. So who are they?

They are both Republicans and Democrats. In health care, they support private financing, primarily through insurance, though they support public tax expenditures to help pay for the most common coverage - employer-sponsored plans. They also support Medicare for seniors and those with disabilities, and most support Medicaid for low-income individuals and families.

In fact, President Obama abandoned single payer in favor of the Heritage Foundation proposal, based on these principles, since it had broad bipartisan support - or so he thought, until the Republicans decided that a political defeat for Obama was more important than improving our health care system.

So what happened to these moderates? The Republicans have retreated toward the right where they would try to tolerate the conservative tea party faction. The moderate Democrats did not move to the left but instead also moved somewhat toward the right into the pro-market neoliberal niche. Following the groundwork laid by President Reagan, President Bill Clinton followed a neoliberal path in which "the era of big government is over" (State of the Union, 1996). The neoliberals then became the establishment force in the Democratic Party. President Obama, whether voluntarily or through political obstructionism, did not change the direction of the party. The likely next president has indicated that she will follow the neoliberal Clintonian path as well and not change direction in health care.

Today’s article describes how neoliberalism and its advocacy of using markets instead of the government to control the financing of health care has resulted in our overpriced and underperforming health care system, as if the neoliberals have failed to see the irony of a health care system that is already 60 percent funded through the tax system and that has failed to conform to free market dynamics.

Whatever labels are used, the majority of Americans support Medicare. If we already had an improved version of Medicare that included everyone, the support would be near unanimous. The neoliberals either need to take a reality check on their ideology, or they need to attend the next local tea party function and listen to the voices extolling the virtues of a society without a functioning government.

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


Issue Brief:

While people were grateful for coverage, unexpected bills, dealing with insurance companies, and facing known deductibles were sources of stress which made those with Marketplace coverage fearful to use the coverage they had. They were particularly frustrated by the out-of-pocket costs, which were unaffordable to many and wanted insurance that didn’t come with so many hidden costs.

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.
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