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Mon Mar 31, 2014, 03:46 AM

The Single Payer Movement Expands

PA is lucky to have a Repubican who is not merely someone who broke with his caucus on the issue, but is an active persuader. Still looking for someone like that in WA, but no luck so far.

http://readersupportednews.org/opinion2/277-75/22840-the-single-payer-movement-expands

The biggest winners under a single payer system in Pennsylvania would be employers, said Friedman. Employer-provided insurance currently costs about 13 percent of payroll in Pennsylvania, he noted.

David Steil, president emeritus of HealthCare4AllPA, the nonprofit organization advocating for a single payer system in Pennsylvania, and a business owner, agrees with Friedman’s assessment of the benefits to employers. “Businesses shouldn’t be in healthcare,” he said.

But Steil doesn’t take quite as negative a view of the impact a single payer system would have on insurance companies as Friedman does. Steil, a former Republican house representative in Pennsylvania, said insurers would more likely have to change the way they do business.

There are many services that wouldn’t be covered under a single payer plan, like elective plastic surgeries or private rooms, home health visits and ambulance services. Insurers, Steil said, could move to providing supplemental coverage for these kinds of services.

“I think they will have to look at changing their business model, but they won’t go out of business,” he said.

12 replies, 2401 views

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Arrow 12 replies Author Time Post
Reply The Single Payer Movement Expands (Original post)
eridani Mar 2014 OP
Fred Sanders Mar 2014 #1
xchrom Mar 2014 #2
Victor_c3 Mar 2014 #3
Fortinbras Armstrong Mar 2014 #4
Laelth Mar 2014 #5
Victor_c3 Mar 2014 #6
kentauros Apr 2014 #11
ProSense Mar 2014 #7
rhett o rick Mar 2014 #8
eridani Mar 2014 #9
IronLionZion Mar 2014 #10
ljm2002 Apr 2014 #12

Response to eridani (Original post)

Mon Mar 31, 2014, 05:26 AM

1. In Canada insurers provide supplemental copayment (20% is normal), insurance to cover dental,

semi-private, chiropractic, physio, eye care etc., all at a fraction of the cost of employer based health provided insurance to private for profit companies.....single payer.....the insurance company underwriters still make money, just a whole lot less and have no control over actual health. Health care decisions are between the doctor and patient within regulated parameters by boards consisting of doctors and health care experts, all transparently made. No one is tied to their employer for their health care.

Makes too much sense for America.

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Response to eridani (Original post)

Mon Mar 31, 2014, 05:44 AM

2. du rec.

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Response to eridani (Original post)

Mon Mar 31, 2014, 06:02 AM

3. I've been saying that for a long long long time

If you want a health insurance solution that will help business, then disconnect health insurance from employment for everyone.

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Response to Victor_c3 (Reply #3)

Mon Mar 31, 2014, 07:06 AM

4. I was discussing this with a libertarian I know

And he was coming up with the most bizarre set of objections to single payer. He claimed that most Americans who don't have health insurance could afford it, but choose to go without it. I offered the counterexample of his own daughter, who lost her job and her health insurance, and simply cannot afford to pay for it herself.

He tried to claim that having government bureaucrats making healthcare decisions is A Bad Thing, to which I responded, "Is having healthcare insurance company bureaucrats doing it any improvement?" I reminded him that he had told me that some years ago, he was having simultaneous disputes with the IRS and with Cigna, and he had also told me that the people at the IRS were friendly and genuinely tried to help him (he had got some bad advice from another libertarian, and the IRS did not allow a claim on his return) and the people he dealt with at Cigna tried to stonewall him.

He finally gave me his real objection: He didn't want the government involved in running his healthcare. He admitted that he was prepared to pay considerably more out of his own pocket so this would not happen. He had no response to my rebuttal that he also insisted that I pay more out of my pocket because of his fear of the Big, Bad Government Hiding Under His Bed.

I don't think he likes what I had to say.

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Response to Fortinbras Armstrong (Reply #4)

Mon Mar 31, 2014, 07:50 AM

5. Well done. n/t

-Laelth

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Response to Fortinbras Armstrong (Reply #4)

Mon Mar 31, 2014, 07:53 AM

6. Yup, some people just don't get the difference between government and business

Basically simplifying what you said, government's purpose is to serve people and the purpose of a business is to make profit.

Now for the rhetorical question:

With that in mind what sort of organization would people ultimately prefer to have running their healthcare?

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Response to Fortinbras Armstrong (Reply #4)

Tue Apr 1, 2014, 12:06 AM

11. Contradiction is strong with that one.

So, he admits that the people at the IRS (the big, bad government) were friendly and genuinely wanted to help, while the people at the private company wanted to do anything but help, and he sides with the private, 100% unhelpful system, in order to avoid the government healthcare system.

He trusts the government agency of the IRS, but not a government-run healthcare system. Seems to me that the IRS is a helluva lot more complex than the ACA, and yet still can't be trusted? Well, it's his money. And I'm sure Cigna will be more than happy to take far more from him than the ACA would

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Response to eridani (Original post)

Mon Mar 31, 2014, 08:18 AM

7. Great news, and evidence

Even as the Affordable Care Act is in its nascent stages, some states are already looking toward 2017 when they can request waivers to opt out of the healthcare exchanges. And a small, but persistent, movement has popped up toward a single payer system as an alternative to participating in the exchanges.

<...>

Robin Lunge, Vermont’s director of healthcare reform, said that Vermont’s goal is to move the issue of healthcare completely away from the employer. Vermont’s single payer system, she said, would be similar to the one state employees are already on. It would be financed through an employer and individual tax as well as the premium tax credits and subsidies provided through the exchanges.

<...>

The state’s Medicare, Medicaid and Veteran’s Administration programs would continue to operate as usual under a plan similar to Vermont’s. In Vermont’s potential single payer system, the system would act as a supplement to government insurance and cover everyone who is uninsured or part of the current state health exchanges.

... that Obamacare is providing the impetus.

Vermont single payer move has been fully funded by Obamacare.

Lessons from Vermont's Health Care Reform

By Laura K. Grubb, M.D.
The New England Journal of Medicine, April 4, 2013

In May 2011, Vermont Governor Peter Shumlin signed legislation to implement Green Mountain Care (GMC), a single-payer, publicly financed, universal health care system. Vermont's reform law passed 15 months after the historic federal Affordable Care Act (ACA) became law. In passing reforms, Vermont took matters into its own hands and is well ahead of most other states in its efforts to implement federal and state health care reforms by 2014. The Supreme Court decision last June to uphold most of the ACA left many states scrambling, since they had postponed reforms pending the judgment. Although Vermont is a small state, its reform efforts provide valuable lessons for other states in implementing ACA reforms.

<...>

Finally, Vermont policymakers are maximizing federal financing and have projected cost savings. In January 2013, the state released a 156-page financing plan for its single-payer arrangement; the plan outlines federal financing sources and the anticipated generation of savings. Vermont has been awarded more than $250 million in federal funding for its state exchange — the fifth-highest amount among the states, although Vermont has the country's second-smallest state population. “We feel strongly that the exchange is not the answer to all of Vermont's health care problems,” Shumlin remarked, explaining that “the exchange is helpful to Vermont to bring us federal dollars to achieve our single-payer goal.”3 In fact, state exchange development will be 100% federally funded.4

- more -

http://www.pnhp.org/news/2013/april/lessons-from-vermonts-health-care-reform

For everyone who has a problem with ACA--
http://www.democraticunderground.com/10024747402

The OP piece also mentions the VA and drug pricing.

Obamacare improved the Medicaid drug rebate program, which is one of the best.

Issue Brief - Medicare Drug Negotiation and Rebates

<...>

Best Price. A third argument is that it makes sense for Medicare to receive the best price available for prescription drugs, just like Medicaid and the VA. In Medicaid, the drug manufacturer provides the federal government discounts for drugs, which are shared with the states. The discount is either the minimum drug amount or an amount based on the best price paid by private drug purchasers, whichever is less. Current law requires drug companies to charge Medicaid 23 percent less than the average price they receive for the sale of a drug to retail pharmacies. Drug companies also must provide another discount if a drug’s price rises faster than the rate of inflation (Thomas and Pear, 2013)...Medicaid rebates, if applied to Part D, would save the federal government money. According to a 2011 study conducted by the Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services, Medicaid rebates were three times greater than the discounts negotiated by Part D for 100 brand name drugs. In 68 of these drugs, Medicaid rebates were twice as high as rebates granted by the drug companies for Medicare drugs (OIG HHS, 2011; Hulsey, 2013). Similarly, a 2008 study of drug pricing information by the U.S. House Committee on Oversight and Government Reform found that Part D paid, on average, 30 percent more for drugs than Medicaid (Hulsey, 2013).

- more -

http://www.ncpssm.org/PublicPolicy/Medicare/Documents/ArticleID/1138/Issue-Brief-Medicare-Drug-Negotiation-and-Rebates


The ACA increased the Medicaid rebate percentage.
http://www.medicaid.gov/AffordableCareAct/Timeline/Timeline.html

Medicaid Drug Rebate Program

<...>

The Medicaid Drug Rebate Program is a partnership between CMS, State Medicaid Agencies, and participating drug manufacturers that helps to offset the Federal and State costs of most outpatient prescription drugs dispensed to Medicaid patients. Approximately 600 drug manufacturers currently participate in this program. All fifty States and the District of Columbia cover prescription drugs under the Medicaid Drug Rebate Program, which is authorized by Section 1927 of the Social Security Act.

The program requires a drug manufacturer to enter into, and have in effect, a national rebate agreement with the Secretary of the Department of Health and Human Services (HHS) in exchange for State Medicaid coverage of most of the manufacturer’s drugs. When a manufacturers markets a new drug and electronically lists it with the FDA, they must also submit the drug to the Drug Data Reporting (DDR) system. This ensures that states are aware of the newly marketed drug. In addition, Section II(g) of the Rebate Agreement explains that labelers are responsible for notifying states of a new drug’s coverage. Labelers are required to report all covered outpatient drugs under their labeler code to the Medicaid Drug Rebate Program. They may not be selective in reporting their NDC's to the program. Manufacturers are then responsible for paying a rebate on those drugs each time that they are dispensed to Medicaid patients. These rebates are paid by drug manufacturers on a quarterly basis and are shared between the States and the Federal government to offset the overall cost of prescription drugs under the Medicaid Program.

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Prescription-Drugs/Medicaid-Drug-Rebate-Program.html

The reality is the massive expansion of Medicaid, a single payer system, along with the option for states to replace their exchanges with a single payer system will speed the arrival of single payer in this country.

When Vermont's system is up and running, I expect the dominoes to fall, finally.

A Brief History: Universal Health Care Efforts in the US
http://www.democraticunderground.com/10024755799

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Response to eridani (Original post)

Mon Mar 31, 2014, 03:14 PM

8. k&r thanks for posting. nm

 

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Response to eridani (Original post)

Mon Mar 31, 2014, 11:00 PM

9. If it happens at all, it will happen at the state level

So get involved in your state ASAP.

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Response to eridani (Original post)

Mon Mar 31, 2014, 11:38 PM

10. It really is the pro-business plan.

and many large US companies have publicly endorsed it.

Imagine that, businesses for socialism!

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Response to eridani (Original post)

Tue Apr 1, 2014, 12:44 AM

12. That is really good!

I have wondered, ever since the health care debate started, why on earth more business people were not demanding single payer as an obvious solution to the crisis? What CEO in his or her right mind would want their company engaged in health care administration if that is not the business they are in? What CEO cannot recognize that being relieved of that burden would make them more competitive in the global market? What the hell do these people get paid for, anyway?

/rant

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