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eridani's Journal
eridani's Journal
November 27, 2013

People are Signing up in Droves for Obamacare, but not for Private Insurance

Is it this fact on the ground that will tip us toward single payer? I hope so!


Much of the news lately about the Affordable Care Act, also called Obamacare, has been about the troubled rollout of the web marketplace enrollment and the cancellation notices going out to a segment of the 5% of Americans who get coverage from the individual health insurance market. (Read this for an accurate explanation of what is going on with the cancellations. And this about President Obama’s announcement of a policy change that may allow some people to keep their cancelled policies for at least another year.) But there is another Obamacare story that has gotten much less attention: enrollment in Medicaid, which is being expanded in many states, is going like gangbusters.

Nine out of 10 new Obamacare enrollees have signed up for Medicaid, the Washington Post reports, compared to only “a trickle of sign-ups for private insurance.” Oregon, for instance, cut its uninsured “without signing up a single person for private health insurance.”

This is a potentially watershed development, because Medicaid is Obamacare’s only true public option: a program jointly administered and funded by federal and state governments. (Although many liberals had sought to have another public option added to compete directly with the private plans offered in the state marketplaces, that version of a public option never made it into the final law). But Medicaid, which even before the ACA was the largest insurance program in the United States with 62 million enrollees, is central to Obamacare’s goal of providing health insurance to nearly all Americans.

November 22, 2013

Insurers to pay doctors 30-40% less under exchange plans.


Doctors Complain They Will Be Paid Less By Exchange Plans

Many doctors are disturbed they will be paid less -- often a lot less -- to care for the millions of patients projected to buy coverage through the health law’s new insurance marketplaces.

“As it is, there is a shortage of primary care physicians in the country, and they don’t have enough time to see all the patients who are calling them,” said Peter Cunningham, a senior fellow at the nonpartisan Center for Studying Health System Change in Washington D.C.

If providers are paid less, “are [enrollees] going to have difficulty getting physicians to accept them as patients?”

Insurance officials acknowledge they have reduced rates in some plans, saying they are under enormous pressure to keep premiums affordable. They say physicians will make up for the lower pay by seeing more patients, since the plans tend to have smaller networks of doctors.

Comment by Don McCanne of PNHP: Insurers will be paying physicians less through their exchange plans than they do through their existing commercial plans. If the rates turn out to be typically 30 or 40 percent less, as this article suggests, they will have problems maintaining adequate provider networks. An insurance card is of little value if you cannot find physicians who will accept it.

As we said from the start, those designing health care reform were making a terrible mistake when they decided to make health insurance premiums affordable while largely ignoring health care costs.

Look what they did:

* They assigned very low actuarial values to the plans that most individuals will select, leaving 30 to 40 percent of health care costs to be paid by the patient, though some will receive inadequate subsidies.

* They designed plans with very high deductibles, causing the large percentage of patients who need less care to receive virtually no sickness or injury benefits from their plans.

* They reduced the size of their provider networks which will reduce spending by making care less accessible, especially specialized care.

* Now it appears that they will be reducing provider payments to levels that will be rejected by many physicians. Although employer-sponsored plans are moving in the same direction, it is likely that many physicians will limit their practices to these plans and cash-paying patients, while avoiding patients in the exchange plans and the chronically-underfunded Medicaid program.

* As part of the SGR fix, legislators are considering not allowing any inflationary increases in the Medicare program for the next ten years - keeping the payment rates flat. If so, physicians are apt to leave the Medicare program as payment rates approach that of Medicaid.

As we approach $3 trillion in health care spending, this is criminal! For that kind of spending, everyone could have high quality health care. Instead, we get a system that perpetuates disparities in health care while creating financial burdens for precisely those individuals who most need health care.

The entire health care system will not collapse, but this experiment will perform so miserably that most will consider it to be a failure. We don’t need to go back to the drawing boards. We merely need to enact a system that we already know will achieve our goals - an improved Medicare for all.
November 22, 2013

After 37-day delay, cancer patient gets insurance

Indicating that Obamacare will help people, but that we must move on to single payer.


While Smith’s insurance dilemma is resolved for now, she worries about others who haven’t even tried to get insurance or those who may be stuck like she was and unable to move forward.

“I have no idea why it took so long. Those of us who were stuck just entered some kind of black hole,” said Smith.

As executive director for a small nonprofit called Health Care for All Colorado, Smith advocates for a single-payer Medicare-style insurance for everyone.

While Smith supports Obamacare as an interim step toward universal coverage, her experience over the past six weeks has underscored the need for additional changes.

“Oh my goodness, do we need a simpler system,” Smith said. “The cost to administer this and the frustration everyone is experiencing…I can’t imagine when we get to January what people are going to experience. Some providers are going to have to absorb new patients. And other people will have to leave their providers just because of insurance.

“It could be so much simpler than this.”

November 19, 2013

37% of Americans avoided recommended care in 2013


■In 2013, more than one-third (37%) of U.S. adults went without recommended care, did not see a doctor when they were sick, or failed to fill prescriptions because of costs, compared with as few as 4 percent to 6 percent in the United Kingdom and Sweden.

■Roughly 40 percent of both insured and uninsured U.S. respondents spent $1,000 or more out-of-pocket during the year on medical care, not counting premiums. High deductibles and cost-sharing, along with no limits on out-of-pocket costs, may explain why even insured people in the U.S. struggled to afford needed health care, the researchers said.

■Nearly one-quarter (23%) of U.S. adults either had serious problems paying medical bills or were unable to pay them, compared with fewer than 13 percent of adults in the next-highest country, France, and 6 percent or fewer in the U.K., Sweden, and Norway.

■About one of three (32%) U.S. adults spent a lot of time dealing with insurance paperwork and disputes or were either denied payment for a claim or paid less than expected. Only 25 percent of adults in Switzerland, 19 percent in the Netherlands, and 17 percent in Germany—all countries with competitive health insurance markets—reported these problems. U.S. insurers spent $606 per person on administrative costs, more than twice the amount in the next-highest country. Such high costs result from a complex, fragmented insurance system, the researchers write.

■The vast majority (75%) of U.S. adults said their health system needs to undergo fundamental changes or be rebuilt completely.

■The U.S. spends $8,508 per person on health care. That is nearly $3,000 more per person than Norway, the second-highest spender.
November 15, 2013

So, do candidates behind on election night often make up 6000+ vote deficits?

Often (though 6000 is a much larger deficit than usual)--especially in all vote by mail states, where Democrats and progressive issues voters tend to vote later. Bullshit like requiring ballots to be received by election day can't change this, as the slow step is signature validation, not ballot tabulation. Watch for Repubs and conservatives to keep trying to implement this in order to cut down on the number of valid Democratic ballots.

Tuesday, November 15th, 2011--the incumbent has $200,00 to spend and lost anyway

Peter Maier falls behind challenger Sharon Peaslee in key Seattle school board race


Well-known University of Washington meteorologist Cliff Mass is among those who campaigned actively for Maier’s defeat. In a post published to his weather blog on October 22nd, Mass summarized the contest between the two as follows:

Peter is clearly the weakest of the board members and was the member who knew about the financial problems and kept quiet about it. Didn’t seem to care about math education. Rubber-stamper. I have known Sharon Peaslee for years. She has a real background in education, has kids in the schools, and has worked actively for improved math education. Sharon is strong-willed and will ask the hard questions. She is supported by The Stranger and most of the local Democratic organizations, as well as Seattle teachers. Peter has a huge financial war chest and is running a huge number of advertisements. Let’s hope that money doesn’t decide this race.

Tuesday, November 13, 2007

Simple majority takes the lead!

After days of a slow and steady increase in the Yes on SJR 4204 vote, the constitutional amendment to allow simple majorities to approve school levies is now passing statewide by a small margin - 50.2307% to 49.7693%, or 756,963 votes in favor to 750,011 against.


Late Voters Help Democrats Keep Control Of State Legislature

Democratic Congressman Rick Larsen has declared victory in the 2nd Congressional District. After yesterday's ballot count, Larsen now leads Republican challenger John Koster by more than 5,000 votes. Koster has not yet conceded the race. Koster had held a nearly 1,400 vote lead on Election night. But that soon evaporated as late voters favored Democrat Larsen. Democratic candidates for state Legislature also benefited from the late surge in Democratic voting. KUOW's Deborah Wang reports.

Kevin Haistings is a Seattle police officer and a Republican making his first run for elected office. He's challenging Democratic State Representative Roger Goodman in the 45th district on the Eastside. When the first results were posted on election night, Haistings was ahead by more than 600 votes. But by Friday of last week the Republican's lead had evaporated.

In 2011, I was the voter database manager for Democratic candidate for Tukwila City Council
Council Position No. 6. For those of you who know King County in WA, her Republican opponent was Louise Strander--as in the South Center shopping complex Strander Boulevard. Louise was ahead by 50 or so votes on election night, but as our campaign kept saying "Late voters are Kate voters."

Louise H. Strander 1348 47.72%
Kate Kruller 1462 51.75%
Write-in 15 0.53%
November 13, 2013

Survey: 81 Percent of Universities Say Sequester Has Directly Affected Research Activities


According to a new survey released Monday, 81 percent of responding universities said that the automatic federal spending cuts of budget sequestration have directly affected their research activities. More than half of universities said a decrease in new federal grant opportunities, and the shrinking value of existing grants, has prompted them to reduce research-related positions, and nearly a quarter of the institutions said they have laid off research employees as a result of the cuts.

“The survey shows that sequestration is already eroding America’s research capabilities at universities across the country,” the Association of American Universities, Association of Public and Land-grant Universities, and The Science Coalition announced in a written statement.

November 12, 2013

The One Where An Elderly White Couple Tries To Rap And Actually Pulls It Off

On Upworthy--


When you hear people talking about "fixing Social Security" and saying that "it's broke" (hint: it's not!), just remember this little rhyme.

"The cap" means that if you make over $110,000 per year, you don't pay into Social Security for all those extra dollars. Because the rich don't get enough breaks, right? There wouldn't even be a question on its stability if we collected that money.

November 9, 2013

Who first said, “You can keep the insurance you have”?

By Don McCanne of PNHP

Considering our national health expenditures, our health care financing and delivery systems are a disaster. It is fully apparent that the Affordable Care Act will fall woefully short of what is needed, and even offset some of the minimal gains with changes that will make many of us worse off by passing more costs directly onto us when we become ill (higher deductibles and other cost sharing), and by further limiting our choices of physicians and hospitals (shifting to narrow provider networks).

At a time that it is imperative that we address policy issues to try to straighten up our system, we abandon reason and propel forward with politics as usual.

President Obama’s political enemies, well supported by the media - including editorialists - are now expressing shock, shock that he lied to us when he told us that we could keep the insurance we have, if we like it. He was not the author of this sound bite provided to him for political campaigning, so where did it come from?

Let’s go back five years, beginning before Sen. Obama was even the Democratic nominee for president, and look at some of our Quote of the Day messages beginning then:

February 6, 2008
Is "keeping the insurance you have" your choice?

How many of you, under age 85, have the same health insurance plan that you had twenty years ago? None?

Why did you change?

What is the obvious conclusion? Health insurance coverage on a continual basis is practically non-existent in the private insurance market. In almost all of the instances listed, the insured individual was not granted the option of "keeping the insurance you have."

Most polls on health care reform continue to ask many of the same questions as they have over the past couple of decades, but there is one new question. The pollsters are now asking if you support reform that would allow you "to keep the insurance you have." For healthier individuals who believe that they have good insurance, this concept polls very well. In fact, the other questions in the polls are now tailored to reinforce this simple concept.

Health Care for America Now!
(Undated, but referenced in 2008)
Statement of Common Purpose

A choice of a private insurance plan, including keeping the insurance you have if you like it…


July 11, 2008
"Keeping the insurance you have" - Don't believe it!

Pause for a minute. Think back to the insurance you had twenty years ago. Remember? Now do you still have precisely that same coverage? Unless you are over 85 and have been in the traditional Medicare program for the past twenty years, it is highly likely that you do not.

So why do you no longer have the better coverage that you had twenty years ago? You may have changed jobs, likely more than once, and lost the coverage that your prior employer provided. Your employer may have changed plans because of ever-increasing insurance premiums. Frequently your insurer introduces plan innovations such as larger deductibles, a change from fixed-dollar co-payments to higher coinsurance percentages, tiering of your cost sharing for services and products, reduction in the benefits covered, dollar caps on payouts, and other innovations all designed to keep premiums competitive in a market of rapidly rising health care costs. You may have lost coverage when your age disqualified you from participating in your parents' plan. You may have found that health benefit programs have been declining as an incentive offered by new employers.

Your children may have lost coverage under the Children's Health Insurance Program when your income, though modest, disqualified your family from the program. Your union may not have been able to negotiate the continuation of the high-quality coverage that you previously held. Your employer may have reduced or eliminated the retirement coverage that you were promised but not guaranteed. Your employer may have filed for bankruptcy without setting aside the legacy costs of their pensions and retiree health benefit programs. You may have decided to start your own small business and found that you could not qualify for coverage because of your medical history, even if relatively benign, or maybe your small business margins are so narrow that you can't afford the premiums. You may have been covered previously by a small business owner whose entire group plan was cancelled at renewal because one employee developed diabetes, or another became HIV infected. Your COBRA coverage may have lapsed and you found that the individual insurance market offered you no realistic options. You may have retired before Medicare eligibility, only to find that premiums were truly unaffordable or coverage was not even available because of preexisting medical problems.

June 23, 2010
Will grandfathering save our current private plans?

The opponents of reform, especially the Republicans in Congress, are making a big deal out of the fact that the Affordable Care Act breaks President Obama's promise that you will be able to keep the insurance plan you have. The Obama administration is countering by publicizing the new regulations that will allow plans in place on March 23, 2010 to be grandfathered, supposedly assuring that you will be able to keep your plan if you had it on that date.

Actually, this is a silly debate. As explained in my comment two years ago, except for those individuals on Medicare or other fiscally sound retiree programs, almost no one gets to keep the insurance he or she has. Rather than stabilizing existing coverage, the regulations that would grandfather plans make it less likely, in an environment of increasing health care costs, that existing plans would continue to be offered without significant changes.

In an effort to make the insurance plans more affordable, further adjustments in deductibles and coinsurance are almost inevitable, and the ever-changing insurance marketplace will surely result in changes in insurance companies selected. Insurance price shoppers, who are mostly healthy, will be much more sensitive to size of the premiums than they would be to cost sharing; this is precisely what has happened throughout the individual market. These pressures would accelerate the decline in grandfathered plans.

"Keeping the insurance you have" was only a slogan used to market the reform proposal. It wasn't a serious long term strategy. Instead of wasting time in another political dogfight - this time over grandfathering - we should move forward with supporting policies that will work for everyone - like a single payer national health program.

Comment, November 8, 2013:

Is that the best lesson that we can learn from President Obama’s decision to accept the recommendation of his political advisers to use the sound bite, “You can keep the insurance you have, if that’s what you want”?

The fact that this is the framing of the current keep-the-insurance-you-have discourse demonstrates not only how acrimonious the Washington political environment has become, it also shows the ineptitude of the media. Not only do they buy this framing when there is a far more compelling message in this mess, they also serve as dupes, propagating the biting, counter-productive message of the Obama opponents.

Repeating my comment from 2010, “Instead of wasting time in another political dogfight… we should move forward with supporting policies that will work for everyone - like a single payer national health program.” That’s the lesson we should learn.

November 7, 2013

Reupblican Geraldo Rivera comes out in favor of single payer

Geraldo Rivera
November 1, 2013

“You know, it’s great that people get health care. I want everyone to have health care. I want single payer. I want Medicare for everybody. I want it to be like Sweden. I want it to be like the United Kingdom or Canada. I want everyone to have health care. This program (Obamacare), though, is deeply flawed, and I think part of the problem is we let the insurance industry write the legislation, and when the insurance industry, like they did for the prescription plan, Part B (D), when they write the legislation, they stack the deck so they’re the beneficiaries.

Geraldo Rivera Radio, 11/1/2013 - at the 48:55 mark:

Comment by Don McCanne of PNHP: Geraldo Rivera was quite sincere when, on his radio show, he discussed briefly the serious flaws of Obamacare and then explicitly supported single payer - Medicare for everybody. This is from a Republican who also has a show (“Geraldo-at-Large”) on the Fox News Channel.

Recently, much of the media attention on single payer has been coming from conservatives who seem to be threatening us with the prospect of single payer as an inevitable outcome of expanded coverage through the Affordable Care Act. They may be correct, but not for the reasons they imply. Rather than ACA being a step closer to single payer, it moves in the direction of expansion of enrollment in private plans, whereas single payer would essentially eliminate private plans.

The real reason that ACA moves us closer to single payer is that the plans are further limiting our choices of physicians and hospitals, and they are shifting an unbearable amount of the costs to patients. Once a critical threshold of patients experience these abuses, the public will demand that everyone be covered with a public program like Medicare.

During our PNHP meeting in Boston last weekend, Fox News broadcast an attack on single pager (likely only coincidental that it was during our meeting). It represents what seems to be an orchestrated attempt to discredit single payer before it gains further traction. If you watch the 7 minute video at the following link, you may find disconcerting the fact that media professionals apparently believe that the intellect of the average American is so low that they would be swayed by their framing. Anyway, I report, you decide:

Play (Show link) ObamaCare rollout strikes blow to dream of single-payer? foxnewstest Can taxpayers thank their lucky stars?

On a more positive note, there are many Republicans, such as Geraldo Rivera, who do understand and support the single payer model. We need to expand our message beyond the progressive community by increasing our efforts to communicate with Republicans and with the business community.

Tomorrow, November 7, Geraldo Rivera is going to have as a guest on his program, PNHP co-founder David Himmelstein:

My comment: ACA allows state single payer in 2017. We need to get moving on this.
November 7, 2013

Obama completly insulated from feedback on potential ACA rollout problems


In one account of what even administration officials acknowledge is a debacle, the Wall Street Journal reported that Obama’s policy advisers were aware long ago that the president’s promise that “if you like your insurance plan, you will keep it” wouldn’t hold up. “White House policy advisers objected to the breadth of Mr. Obama’s ‘keep your plan’ promise,” the Journal reported, citing a former senior administration official. “They were overruled by political aides, the former official said. The White House said it was unaware of the objections.”

No, the Obamacare pratfall is not Obama’s Iraq: The magnitude is entirely different, and the problems — Web site malfunctions and a wave of policy cancellations — are fixable. But the decision-making is disturbingly similar: In both cases, insular administrations, staffed by loyalists and obsessed with secrecy, participated in group-think and let the president hear only what they thought he wanted to hear.

In a damning account of the Obamacare implementation, my Post colleagues Amy Goldstein and Juliet Eilperin described how Obama rejected pleas from outside experts and even some of his own advisers to bring in people with the expertise to handle the mammoth task; he instead left the project in the care of in-house loyalists. “Three and a half years later, such insularity — in that decision and others that would follow — has emerged as a central factor in the disastrous rollout,” Goldstein and Eilperin reported.

Their report is based in part on a prescient memo sent to the White House in May 2010 by Harvard professor David Cutler, an outside adviser on health-care reform. “I am concerned that the personnel and processes you have in place are not up to the task, and that health reform will be unsuccessful as a result,” he wrote. “My general view is that the early implementation efforts are far short of what it will take to implement reform successfully. .?.?. I do not believe the relevant members of the administration understand the president’s vision or have the capability to carry it out.”

Cutler identified many of the problems that would later plague the Obamacare rollout: The perception of secrecy, the lack of qualified personnel and the likelihood that “if you cannot find a way to work with hesitant states and insurers, reform will blow up.”

Instead, Obama followed a different governing philosophy: Dance with the one that brung ya. He figured that those who helped him enact the health-care law should be the ones to implement it.

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: 51,907

About eridani

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