March 15, 2016

US Physician Practices Spend More Than $15.4 Billion Annually To Report Quality Measures

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Comment by Don McCanne of PNHP: Quality measures in health care have proven to be burdensome, consuming excess resources in both time and money. This study quantifies those costs.

Not only do these quality games waste resources, they have become a significant contributor to physician burnout.

Wouldn’t it be far better to devote these extra resources to improving access to actual health care for the uninsured and underinsured who are now being all too often left out? It would be automatic under a single payer Medicare for all program.

March 15, 2016

How Liberals Tried to Kill the Dream of Single-Payer

Incrementalism only works if you have a vision and long-tern goals.

https://newrepublic.com/article/131251/liberals-tried-kill-dream-single-payer

Let’s first admit the obvious: The political terrain for transformational health care reform is currently quite adverse. A single-payer bill would encounter colossal resistance from, for instance, the health insurance lobby, which is understandably in no great rush to be legislated off the face of the planet (nor does the pharmaceutical industry look forward to long-avoided price negotiations with the government). It’s also true that a Democratic sweep of both houses of Congress is unlikely in the coming election. And Democrats are, in any event, divided on the issue, as this primary election demonstrates.

To proceed, however, from an admission of these facts to an acceptance that the cause should be abandoned is to concede the contest before the first shot has been fired. This is something the Democratic Party has excelled at—with disastrous consequences—for decades. Conservatives, in contrast, have been far more willing to adopt ambitious, long-range political goals, even when contemporaneous political forces are arrayed against them.

As Daniel Stedman Jones describes in his Masters of the Universe: Hayek, Friedman, and the Birth of Neoliberal Politics, the articulation of an initially unpopular, highly ambitious, anti-New Deal “neoliberal” program—outlined and promoted in the decades following World War II by economists like Friedrich Hayek and Milton Friedman and associated think tanks—took decades to “bear fruit.” But when political and economic circumstances changed in the 1970s, conservatives had an ambitious program ready to launch, and the right-wing revolutions of Ronald Reagan and Margaret Thatcher could begin in earnest.

The liberal retreat on single-payer is in line with a long history of centrist Democratic thinking that haplessly confuses rearguard action with political vision. Passing a federal single-payer bill would, no doubt, necessitate key electoral victories, a powerful campaign at the governmental level, and a formidable grassroots struggle. Useful initial steps in this direction might include the election of a president determined to pass single-payer, the restoration of single-payer to the platform of the Democratic Party, and vigorous support for such reform by pundits and scholars in high places. That none of these things may wind up happening is a cause of the alleged political “impossibility” of single-payer—not its result.

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Second, proposals for “Medicare-for-all” usually call for the elimination of cost sharing, which is to say no copayments, deductibles, and co-insurance. I’d argue that this is an essential aspect of real universal health care (with some notable exceptions, such payments are absent from the systems of Canada and the United Kingdom). The harms of such payments are all too real: As a result of out-of-pocket exposure, an analysis of survey findings published by the Commonwealth Fund last year put the number of underinsured Americans—the insured who lack sufficient coverage against the cost of medical care—at 31 million in 2014. Though discarding such out-of-pocket payments might sound like a pricey proposition, to the extent that these monies are already being spent, their elimination would be a wash, with no net effect on overall national health expenditures. But again, as is the case with the uninsured, insofar as some individuals and families are avoiding health care because of out-of-pocket payments, the elimination of these financial barriers would result in some real increases in health care utilization.

March 13, 2016

The “Cadillac Tax” on Health Benefits in the United States Will Hit the Middle Class Hardest

Comment by Don McCanne of PNHP: The “Cadillac tax” is an excise tax on premiums of more expensive employer-sponsored health plans. It was included in the Affordable Care Act partly as a revenue source to help pay for ACA, partly to offset the tax subsidies for employer-sponsored insurance that were more generous for higher income individuals, and partly to reduce the incentive to purchase more insurance than necessary under the theory that making patients more sensitive to health care costs will prevent spending on supposedly excessive health care services (certainly a contentious point).

Because of the high costs of health care, we do need funding mechanisms that result in a transfer to those less able to pay. The Cadillac tax is a problem because, instead of disproportionately assessing the very wealthy, it impacts primarily working families. Not only is the tax unfair, the health plans will likely have their benefits reduced in an effort to escape the taxes.

In a PNHP press release (link above), Steffie Woolhandler, one of the co-authors of the report, stated, “Taxpayers should be paying directly for health care through Medicare-for-All, not indirectly through tax subsidies to private insurance. However, removing the tax subsidies – as Obamacare will do – without setting Medicare-for-All in place is a step backwards. It’s shameful that economists have provided cover for this tax that will hit middle-class families and largely spare the wealthy.”

The Cadillac tax is just one more example of the flawed policy patches required simply because the architects of reform decided to build on our current dysfunctional, fragmented financing system instead of replacing it with a more efficient, effective and equitable single payer Medicare-for-all program. That doesn’t mean that we have to live with our highly flawed system. We can still change it.

My comment: Do you know what they call "Cadillac plans" in other developed countries? Just plain old "health care."

March 8, 2016

Medicaid and CHIP premiums decrease access to health care

Well, like, duuuhhhh!!

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Comment by Don McCanne of PNHP: Most individuals are relatively sensitive to the health insurance premiums they pay. This particular analysis of multiple studies shows that the rate of low-income children enrolling in the Medicaid or CHIP programs declines as the premium increases. Since an important objective is to try to ensure that all low-income children have insurance coverage, charging premiums for the government programs is an unwise policy as it results in the opposite outcome.

In fact, health insurance premiums are a deterrent to enrollment for all populations. A goal of health reform was to have everyone covered (though that was abandoned when it was acknowledged that the Affordable Care Act model could not accomplish this). Thus we still have 29 million people who remain uninsured without much of a prospect that we can significantly decrease the numbers simply because of the administrative complexity of the ACA model. Many of these 29 million people are disqualified for the public programs or cannot afford even subsidized premiums and thus will remain uninsured.

A single payer system is not funded through insurance premiums but rather is funded through equitable taxes based on the ability to pay. Taxes are automatic. An individual does not have the option of not paying them, unlike the option of declining to pay insurance premiums, thus forgoing coverage. True, some people fail to pay their taxes. Although that might cause problems with the IRS, it does not result in the revocation of the right to enjoy the fruits of government funded services. If we funded an improved Medicare for All program through the tax system, nobody would lose his or her coverage for non-payment. Health care coverage would always be there for everyone.

We should be supporting effective policies that would bring health care to all of us rather than being distracted by peripheral issues such as protecting the the interests of the inefficient private insurers. Switching from insurance premiums paid to private plans to equitable taxes to fund a more efficient public insurance program is exactly the type of public policy that we should be considering if we really do want everyone to have health care.

March 6, 2016

Cherry-picking Statistics to Bash Sanders’ Medicare-for-All Plan

Comment by Don McCanne of PNHP: An Improved Medicare for All system would provide for everyone all necessary health care, and it would be funded with progressive taxes that are fair and affordable for each of us. Using one tentative set of tax policies as an example of how the system could be funded does not change this basic truth.

Selected numbers associated with Bernie Sanders’ loosely sketched out Medicare for All proposal have been used to attack the fundamental concept of single payer with no acknowledgement that eventual legislation would ferret out any numbers or assumptions that might be slightly off (though that's in dispute) and then carefully tune them to get the financing right.

One example, using the widely circulated set of numbers, indicates that some lower income individuals might end up paying more than they do now, though the extent and intensity of the deficits have been exaggerated, as the analysis by Steffie Woolhandler and David Himmelstein shows.

The point is that tax policies are quite malleable, with many potential sources and variable rates. They can be adjusted to ensure that taxes would be equitable for all.

Under the tentative Sanders numbers, about 1.2 million lower-income individuals might be slightly worse off financially, but at least they would be insured. Compare that to the 2.9 million adults who are in the ACA coverage gap who remain uninsured - a far worse problem than facing a modest financial imbalance. It would be far easier to adjust the taxes under a single payer system than it would be to fill in the coverage gap resulting from the complex administrative infrastructure created by ACA.

Those who continue to bash the Medicare for All concept based on tentative numbers and then conclude that we should stick with the Affordable Care Act are being disingenuous.

The Medicare for All model only needs fine tuning to meet the goal of health care for all, whereas merely patching the irreparably flawed ACA infrastructure will always leave us short of the goal. We need the right infrastructure, and then we can get them numbers right.

March 3, 2016

Health Care ‘Retailization’ Is Coming

Comment by Don McCanne of PNHP: Yesterday, at the annual meeting of the Federation of American Hospitals, Acting CMS Administrator Andy Slavitt asked the for-profit hospitals to join CMS’s ongoing push for the "retailization" of health care.

Retailization? Providers should imagine negotiating with cash paying consumers. They should strive for “further price and billing transparency in health care — just like in other consumer markets.”

Could there be a more explicit advocacy of consumer-driven health care - placing the patient-consumer in charge of health care spending? It fits with CMS’s efforts to privatize Medicare by over-paying the private Medicare Advantage plans, with overtures to convert Medicare to a premium support (voucher) market of private plans.

Politics? This is coming from an administration headed by a Democrat - a neoliberal administration that has been mislabeled as progressive - and supported by a presidential candidate who rejects Medicare for All and wants to build on Obamacare with its high deductible private health plans that place the patient-consumer in charge.

Retailization. Watch out, here it comes!