Democratic Underground Latest Greatest Lobby Journals Search Options Help Login
Google

PNHP on Massachusetts Program - (please stop holding up MA as some great example to follow)!

Printer-friendly format Printer-friendly format
Printer-friendly format Email this thread to a friend
Printer-friendly format Bookmark this thread
This topic is archived.
Home » Discuss » Archives » General Discussion: Presidential (Through Nov 2009) Donate to DU
 
debbierlus Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 02:21 PM
Original message
PNHP on Massachusetts Program - (please stop holding up MA as some great example to follow)!

http://www.pnhp.org/news/2009/march/masschusetts_health...

MASSACHUSETTS HAS been lauded for its healthcare reform, but the program is a failure. Created solely to achieve universal insurance coverage, the plan does not even begin to address the other essential components of a successful healthcare system.

What would such a system provide? The prestigious Institute of Medicine, part of the National Academy of Sciences, has defined five criteria for healthcare reform. Coverage should be: universal, not tied to a job, affordable for individuals and families, affordable for society, and it should provide access to high-quality care for everyone.

The states plan flunks on all counts.

First, it has not achieved universal healthcare, although the reform has been a boon to the private insurance industry. The state has more than 200,000 without coverage, and the count can only go up with rising unemployment.

Second, the reform does not address the problem of insurance being connected to jobs. For individuals, this means their insurance is not continuous if they change or lose jobs. For employers, especially small businesses, health insurance is an expense they can ill afford.

Third, the program is not affordable for many individuals and families. For middle-income people not qualifying for state-subsidized health insurance, costs are too high for even skimpy coverage. For an individual earning $31,213, the cheapest plan can cost $9,872 in premiums and out-of-pocket payments. Low-income residents, previously eligible for free care, have insurance policies requiring unaffordable copayments for office visits and medications.

Fourth, the costs of the reform for the state have been formidable. Spending for the Commonwealth Care subsidized program has doubled, from $630 million in 2007 to an estimated $1.3 billion for 2009, which is not sustainable.

Fifth, reform does not assure access to care. High-deductible plans that have additional out-of-pocket expenses can result in many people not using their insurance when they are sick. In my practice of child and adolescent psychiatry, a parent told me last week that she had a decrease in her job hours, could not afford the $30 copayment for treatment sessions for her adolescent, and decided to meet much less frequently.

In another case, a divorced mother stopped treatment for her son because the father had changed insurance, leaving them with an unaffordable deductible. And at Cambridge Health Alliance, doctors and nurses have cared for patients who, unable to afford the new copayments, were forced to interrupt care for HIV and even cancers that could be treated with chemotherapy.

Access to care is also affected by the uneven distribution of healthcare dollars between primary and specialty care, and between community hospitals and tertiary care hospitals. Partners HealthCare, which includes two major tertiary care hospitals in Boston, was able to negotiate a secret agreement with Blue Cross Blue Shield of Massachusetts to be paid 30 percent more for their services than other providers in the state, contributing to an increase in healthcare costs for Massachusetts, which are already the highest per person in the world. Agreements that tilt spending toward tertiary care threaten the viability of community hospitals and health centers that provide a safety net for the uninsured and underinsured.

There is, though, one US model of healthcare that meets the Institute of Medicine criteria: Medicare. Insuring everyone over 65, Medicare achieves universal coverage and access to care, is not tied to a job, and is affordable for individuals and the country. Medicare simplifies the administration of healthcare dollars, thereby saving money. We need to improve Medicare, and expand this program to include everyone.

A bill before Congress, the United States National Health Insurance Act, would provide more comprehensive coverage for all. The bill includes doctor, hospital, long-term, mental health, dental, and vision care, prescription drugs, and medical supplies, with no premiums, copayments, or deductibles.

People would be free to choose doctors and hospitals, and insurance would not be tied to a job. Costs would be controlled because health planning in a national health program can reestablish needed balance between primary/preventive care and high-tech tertiary care. A modest, progressive tax would replace what people currently pay out of pocket. This program would pay for itself by eliminating the wasteful administrative costs and profits of private insurance companies, and save $8 billion to $10 billion in Massachusetts alone.

We must let Congress know we want improved access to affordable healthcare for all, not more expensive private health insurance we cant afford to use when we are sick. Massachusetts healthcare reform fails on all five Institute of Medicine criteria. Congress should not make it a model for the nation.
Printer Friendly | Permalink |  | Top
debbierlus Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 02:27 PM
Response to Original message
1. I should add that this is a personal family issue, my sister lost her coverage
Edited on Sun Aug-23-09 02:27 PM by debbierlus
And, she can't afford to purchase health insurance through the 'affordable' group pool set up in Massachusetts.

1,400 dollars month BEFORE co-pays and deductibles.

16,800 dollars a year.

This is for a family of three - two relatively healthy adults & one healthy baby.

They are middle income.

Printer Friendly | Permalink |  | Top
 
valerief Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 02:27 PM
Response to Original message
2. Romney's (Robme's) gift to insurance companies, not to Massachusetts residents. nt
Printer Friendly | Permalink |  | Top
 
debbierlus Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 02:31 PM
Response to Reply #2
3. Yet, I see people on DU talk about how great the MA system is all the time

It isn't.

Government mandated private insurance without a true public option (and right now, there isn't a bill that actually meets the criteria for a real public option), it is a gift to the insurance companies and does NOT solve the health care crisis.

The fact that insurance profit has been the dictating force in the health care 'debate' is sickening.

The term level playing field makes me want to throw up. (Code for keeping the insurance companies competitive so they can make a profit - they use the term to confuse people - they associate it with fairness and competition that will benefit them, but if you look at the context, it ALWAYS means keeping the insurance profits in the game. Obama & all the major dems have used it and they ALL need to be called out on it).
Printer Friendly | Permalink |  | Top
 
valerief Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 02:48 PM
Response to Reply #3
7. The ones saying that must be Blue DUers. nt
Printer Friendly | Permalink |  | Top
 
IndianaGreen Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 02:53 PM
Response to Reply #7
8. Blue Dog DUers think Romney Care is fine!
Of course, all the Blue Dog DUers care about is their investment portfolios. Single Payer will take a bite out of the value of their stocks.
Printer Friendly | Permalink |  | Top
 
Davis_X_Machina Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 03:04 PM
Response to Reply #8
9. I suspect that they don't consider it fine...
Edited on Sun Aug-23-09 03:08 PM by Davis_X_Machina
...so much as preferable to the alternative, which was the status quo.

It's worth remembering that the legislature that passed 'Romneycare' was composed of 141 Democrats and 19 Republicans in the House and 35 Democrats, 5 Republicans in the Senate.

That's a whole lotta sellouts. If they're all Blue Dogs, then Massachusetts is worse off than Mississippi.
Printer Friendly | Permalink |  | Top
 
Hello_Kitty Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 05:29 PM
Response to Reply #3
18. I've asked MA DUers what they think of the system and it varies by individual
Edited on Sun Aug-23-09 05:33 PM by Hello_Kitty
Which is the problem with anecdotal evidence. But as a whole, while I wouldn't call it a failure, there are problems inherent in the system that will only get worse over time. And all those problems are a direct result of having a plan that is based on profit-driven private insurers.
Printer Friendly | Permalink |  | Top
 
Davis_X_Machina Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 02:31 PM
Response to Original message
4. The second sentence is what poker players call 'the tell'.
Making it unnecessary to the rest of the piece:

Created solely to achieve universal insurance coverage, the plan does not even begin to address the other essential components of a successful healthcare system.
.

This is the debating equivalent of announcing "I consider any ice-cream sundae that's not crunchy to be a failure, and my car is a lousy bookmark".

It's interesting, but the piece's premises dictate its conclusion. Frankly, since PHNP is a proponent of HR 676, I'd not expect them to do otherwise.

And since Massachusetts is moving away for fee-for-service and towards capitation payments as a basis for their system, they're ooching towards changes in the delivery system more radical than anything PNHP is proposing.

The answer's out there -- but no one answer is the answer, yet.
Printer Friendly | Permalink |  | Top
 
dkf Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 02:39 PM
Response to Reply #4
5. But isn't this what the Clinton/Edwards/Obama plans were about?
Have we been chasing the wrong goal?
Printer Friendly | Permalink |  | Top
 
Davis_X_Machina Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 02:44 PM
Response to Reply #5
6. Universal health care is a end....
Edited on Sun Aug-23-09 02:46 PM by Davis_X_Machina
...and all the models we argue about, whether single-payer, or a UK-style NHS (my favorite) or an insurance mandate with a public option, or an insurance mandate without an option, or Brad Delong's barefoot doctors are all just means to an end. There are others, and some as yet unthought-of.

I have a preference for some means over others, but my attachment is to the end.

Much unhappiness in life is caused by confusing wants with needs, and means with ends.

The PNHP piece confuses an end - health care delivery -- with a means -- the Massachusetts plan -- in its second sentence, and then procedes on that basis. It's fundamentally dishonest. Not in a lying-dishonest way, but dishonest.
Printer Friendly | Permalink |  | Top
 
John Q. Citizen Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 03:47 PM
Response to Reply #4
10. It won'r matter because MA is cutting benefits as costs raise. Covering everyone is easy if
resources are unlimited.

The problem with the single payer people is that single payer has worked everywhere it's been tried. It contains costs and it covers everyone. So you have to forgive them if they seem unwilling to search out free market based solutions, which so far haven't worked anywhere.

My bet, is if given another 1000 years or so, someone will come up with a way to do it free market style.

Printer Friendly | Permalink |  | Top
 
Davis_X_Machina Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 04:06 PM
Response to Reply #10
11. Single payer has perhaps worked everywhere it has been tried...
Edited on Sun Aug-23-09 04:08 PM by Davis_X_Machina
...but not every place where something is working is single-payer.

The Netherlands, Switzerland, Germany and France for starters do not have single-payer plans, nor do they have a UK-style NHS (my personal favorite), and manage somehow.

They may regulate the daylights out of their private insurers, or have mongrel quasi-governmental insurers (Comment dit-on 'Meddy Mae and Freddy Doc?'), or something else, but they a.) don't have single payer and b.) deliver the goods.

There's more than one way to get this done.

The problems in Massachusetts are a recession, a gutless legislature, despite 10-1 and 7-1 Democratic majorities, and the inevitable problems caused by going first, and going alone.

Printer Friendly | Permalink |  | Top
 
John Q. Citizen Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 04:34 PM
Response to Reply #11
12. If recession means benefits are cut then that's a fail. Market based solutions have been
Edited on Sun Aug-23-09 04:35 PM by John Q. Citizen
tried in Or, in WA in VT and TN and now MA and all have failed due to soaring costs.

But since it doesn't really matter that 20,000 Americans die year in and year out from treatable diseases, like i said, we will just have to keep experimenting, because damn it, saying a system has to control costs to be workable is just putting too big a burden on the free market, and it's totally like an ice cream sundae.

From your link- Thanks. Notice how PNHP have the best info? It's reliable and it's quality

1. In a single-payer national health insurance system, as demonstrated by Canada, Denmark, Norway, and Sweden, health insurance is publicly administered and most physicians are in private practice.
2. Great Britain and Spain are among the OECD countries with national health services, in which salaried physicians predominate and hospitals are publicly owned and operated.
3. Highly regulated, universal, multi-payer health insurance systems are illustrated by countries like Germany and France, which have universal health insurance via sickness funds. The sickness funds pay physicians and hospitals uniform rates that are negotiated annually (also known as an all-payer system).


None of these countries leave financing up to autonomous corporations. The "All Payers" regulate the hell out their companies and they have funding in place that guarantees everyone has access to quality timely health care.

The rest are two classes of single payer, one with private delivery and the other with public delivery.

None of these countries have anything even remotely resembling Romney Care.


Since we have a long history of people being able to choose their own care provider and most care providers are private, it makes sense to look at the single payer system, since it works to contain costs and provide universal coverage and it's closest to what we now have.

If congress passed an NHS today, i'd be glad, but they really need to quit fucking around with every new market based solution fad that comes down the pike. It's just a diversion.
Printer Friendly | Permalink |  | Top
 
Davis_X_Machina Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 04:47 PM
Response to Reply #12
13. Massachusetts wanted to do 'must-buy/must-issue' on the cheap....
....and without regulating anybody -- much. That's a political failure, not a failure in the model.

Query -- why with a 8-1 majority in the Great and General Court did the Democrats simply not go state-single-payer? Surely they had the votes?
Printer Friendly | Permalink |  | Top
 
John Q. Citizen Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 05:07 PM
Response to Reply #13
15. For one thing, Fed rules prohibit using fed dollars
Edited on Sun Aug-23-09 05:12 PM by John Q. Citizen
for single payer. Wellstone introduced a bill in the US Senate back in the 1990s to allow some states to do that as laboratories.

Also Romney was Gov.

The Dems in CA passed it twice in the legislature, but the Guv vetoed twice.

And let's face it. Dems aren't what they used to be. I know our current Dems wouldn't pass Social Security or Medicare or any number of social legislation that Dems used to. They are now by and large, corporate, and people can eat shit and die.


edited to add-

Look at the "so-called" "Public Option" in either the house or senate bill. It's worse than a joke, it's a very bad joke. It's structured to do absolutely nothing except fail.

That was in Obama's plan when he ran, but they won't even talk about it. The Dems like Dean who pretend to push a public Option still talk about it like it's akin to Medicare but it's a shriveled up little turd and they won't even talk about it.

That's why.

Printer Friendly | Permalink |  | Top
 
Davis_X_Machina Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 05:18 PM
Response to Reply #15
16. Why was Romney's proposal even given the time of day, though?
Edited on Sun Aug-23-09 05:22 PM by Davis_X_Machina
Is the Quisling caucus so big that they rammed through a bill to enhance the election prospects of a guy running for the White House from the wrong party?

I know that Harrington, Bulger, and Birmingham weren't/aren't exactly Pitt, Canning and Peel, but come on...

{ON EDIT} Maine did a limited public-option plan at around the same time, Dirigo Health. Was anything similar on offer?
Printer Friendly | Permalink |  | Top
 
John Q. Citizen Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 05:24 PM
Response to Reply #16
17. The insurance companies love it. And the insurance companies
spend a lot of money bribing legislators.

Dem are getting far more money now than Repos and Dems are in control.

Baucus is king of the whores.

And what he's pushing looks an awful like Romney care. I don't live in MA so I don't know the personalities.
Printer Friendly | Permalink |  | Top
 
debbierlus Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 06:10 PM
Response to Reply #11
20. I would be fine with Switzerland's model - make it illegal to turn a profit!

Fine with me.
Printer Friendly | Permalink |  | Top
 
depakid Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 04:53 PM
Response to Original message
14. More than a few Dems are as intellectually dishonest (and ideologically bankrupt) as Republicans
Edited on Sun Aug-23-09 04:53 PM by depakid
Trouble is- neither the administration or the party "leadership" seems to be capable of dealing effectively with them- much less holding them to account.
Printer Friendly | Permalink |  | Top
 
wroberts189 Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 06:00 PM
Response to Original message
19. thank you great post ..looking for this info nt
Printer Friendly | Permalink |  | Top
 
ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 06:18 PM
Response to Original message
21. Pnhp is always leaving out information to promote their distortion of a public option
Massachusetts health care isn't a failure, and everything Pnhp presents to suggest it is...

First, it has not achieved universal healthcare, although the reform has been a boon to the private insurance industry...

Second, the reform does not address the problem of insurance being connected to jobs...

Third, the program is not affordable for many individuals and families...

Fourth, the costs of the reform for the state have been formidable...

Fifth, reform does not assure access to care...

<...>

We must let Congress know we want improved access to affordable healthcare for all, not more expensive private health insurance we cant afford to use when we are sick. Massachusetts healthcare reform fails on all five Institute of Medicine criteria. Congress should not make it a model for the nation.

(emphasis added.)

...is attributable to the fact that Mass. has no public option, which would control costs, improve quality and expand coverage. This is why Pnhp's claim that Congress is trying to make Mass the model is completely misleading.

Printer Friendly | Permalink |  | Top
 
John Q. Citizen Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 06:45 PM
Response to Reply #21
22. Physicians for a National Health Plan know more about the Public Option than you do, ProSense.
Edited on Sun Aug-23-09 06:48 PM by John Q. Citizen
They actually read the bills that congress introduces.

Have you read any of the health care bills that you post on yet? Even one of them?

Printer Friendly | Permalink |  | Top
 
Honeycombe8 Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 09:01 PM
Response to Original message
23. But Medicare is in financial trouble.
So it is not "successful" in that sense of the word. It may have been the Part D (the Republicans' Rx coverage added) that drove it over the edge. I don't know.

Also, Medicare coverage isn't really "full" coverage. There is a big business selling Medicare supplemental policies. I and my other co-workers factor in the cost of Medicare supplemental policies, when trying to figure out expenses after retirement (or partial retirement).

OTOH, Medicare provides coverage to people WHO ARE GUARANTEED TO NEED LOTS OF HEALTH CARE, whereas coverage for all the public won't; there will be some groups that use it minimally or not at all.

So...I don't know. This is so confusing.
Printer Friendly | Permalink |  | Top
 
dflprincess Donating Member (1000+ posts) Send PM | Profile | Ignore Sun Aug-23-09 10:01 PM
Response to Reply #23
24. If the people using Medicare weren't happy with it we wouldn't see
so many of them worried about it being "messed with".

If we took the copays, deductibles and premiums we're all paying now to the private crooks and put them into a Medicare for All some of us might just break even on the expenses but everyone would be covered and the system would be solvent.
Printer Friendly | Permalink |  | Top
 
frazzled Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Aug-24-09 12:01 AM
Response to Original message
25. I'm not so sure the figures in the OP are correct
Read through this article, at the link, for an explanation. In the meantime, here are a few tables from it. Table 1 is the program for people earning up to 300% of the Federal Poverty level; Table 3 seems to be for everyone else who is not covered by an employer plan (small businesses, self-employed, etc.) Note that for this last table, the premiums listed are for an individual. It doesn't give the family premium cost.


Table 1. Commonwealth Care Plan Types by Copayments and Premium Contributions

Plan Type Household Income (as % of FPL) Enrollee Cost-Sharing Lowest Premium Available (7/1/08)

1 0%100% Copays only for Rx* $0 ($3 copayment for nonemergency visits to emergency room) $0
2A 100.1%150% Copays for Rx and all medical services $0
2B 150.1%200% Copays for Rx and all medical services $39
3 200.1%300% Copays for Rx and all medical services (lower premium, higher copays compared with Plan 4 200.1%250% FPL: $77; 250.1%300% FPL: $116
4 200.1%300% Copays for Rx and all medical services (higher premium, lower copays compared with Plan 3 (eliminated in July 2008)



Table 3. Commonwealth Choice Monthly Premium Ranges by Plan Level Plan

TypeMonthly Premium Range(August 2008)
Gold$337$551
Silver$269$415
Bronze$193$287
Young Adult Plan (with Rx)$158$196
Young Adult Plan (without Rx)$133$176

* These premium ranges represent the range in monthly premium costs among those plansavailable to a single 35-year-old living in the Boston area. For Young Adult Plans, the


https://www.mahealthconnector.org/portal/binary/com.epi...
Printer Friendly | Permalink |  | Top
 
John Q. Citizen Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Aug-24-09 01:20 AM
Response to Reply #25
26. I don't understand what you mean. Which figures in the
OP and which in your table are you saying aren't the same?

Printer Friendly | Permalink |  | Top
 
Hello_Kitty Donating Member (1000+ posts) Send PM | Profile | Ignore Mon Aug-24-09 02:47 PM
Response to Reply #25
27. The OP's sister's income is too high to qualify for those plans.
Printer Friendly | Permalink |  | Top
 
DU AdBot (1000+ posts) Click to send private message to this author Click to view 
this author's profile Click to add 
this author to your buddy list Click to add 
this author to your Ignore list Tue Sep 02nd 2014, 02:51 PM
Response to Original message
Advertisements [?]
 Top

Home » Discuss » Archives » General Discussion: Presidential (Through Nov 2009) Donate to DU

Powered by DCForum+ Version 1.1 Copyright 1997-2002 DCScripts.com
Software has been extensively modified by the DU administrators


Important Notices: By participating on this discussion board, visitors agree to abide by the rules outlined on our Rules page. Messages posted on the Democratic Underground Discussion Forums are the opinions of the individuals who post them, and do not necessarily represent the opinions of Democratic Underground, LLC.

Home  |  Discussion Forums  |  Journals |  Store  |  Donate

About DU  |  Contact Us  |  Privacy Policy

Got a message for Democratic Underground? Click here to send us a message.

© 2001 - 2011 Democratic Underground, LLC