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eridani's Journal
eridani's Journal
March 28, 2013

CA hospital joint replacement center allows only 2 of its 8 orthopedists to practice there


When Robert Cantley needed both knees replaced in August, he was expecting to recover from the surgery at Washington Hospital's fancy, new $42.7 million Center for Joint Replacement.

According to hospital marketing brochures, the center offered "A Higher Level of Care" in a 20,000-square-foot space featuring 25 private patient rooms, a "breathtaking physical therapy space" and a beautifully landscaped therapy garden.

Instead, Cantley did his physical therapy sessions in a dimly lit hallway on the sixth floor of the main hospital in what he described as "a miserable set of circumstances."

Cantley's physician, Dr. John Jaureguito, who has been on the medical staff at Washington for 18 years, said the arrangement means his patients get "second-class" treatment. "Therapy is literally in the hallway," he said. "I've never come across anything like this before."

What Cantley and many other patients at the public hospital didn't know was that access to the new center, the only facility of its kind in the Bay Area, is restricted to just two orthopedic surgeons at the hospital -- the only ones on the Washington staff who met 24 criteria set by the hospital.

Comment by Don McCanne of PNHP: There are ten orthopedists on the staff of Washington Hospital in Fremont, California who perform joint-replacement surgery, but only two are allowed to use the hospital's state-of-the-art Center for Joint Replacement. The Center charges more than twice the average for California, while the two approved surgeons apparently have a policy of discouraging low-income residents, including Medi-Cal patients.

Perhaps the most appalling consequence is that the patients of the other eight orthopedists receive their post-op physical therapy in the hallway of the main hospital rather than in the new "breathtaking physical therapy space."

As a community hospital, serving the public, and with pressure from the state Department of Public Health and the Washington Township Health Care District, it is likely that this arrangement will be modified.

So what does this have to do with health care reform? We can ask ourselves if a single payer system that separately budgets capital improvements would have ever allocated funds for a state-of-the-art center serving only two prima donna surgeons and their affluent patients exclusively. Of course not. Attention surely would have been directed to a decision on whether or not it was even appropriate to establish a separate joint replacement pavilion. Likely the funds would have been better spent on improving or replacing existing surgical and physical therapy facilities.

Achieving the goal of health care justice for all will be made that much more difficult if our health care professionals and administrators fall below the ethical plane that we envision for the healing arts.
March 22, 2013

Plans for forgiveness of hospital debt


In an ideal world, collecting debts would be as simple as asking debtors to pay their obligations when they are able to. But in reality most businesses have found that they need to obtain other assurances, such as collateral or the option to shut off services to a delinquent payer. Otherwise it is too easy for debtors to claim hardship and walk away without paying.

On the other hand, many families and other debtors do experience genuine hardship. In those cases it can be compassionate and even efficient to at least partly forgive the debts of people who have fallen on hard times. Many economists see loan defaults as (sometimes) an efficiency-enhancing form of risk-sharing.

One approach would be for lenders to develop and disclose a ?forgiveness formula? that would clearly define ?hard times? and indicate precisely what kind of forgiveness is possible. The advantage of forgiveness formulas is that distressed borrowers can be certain where they stand with the lender and can readily evaluate whether they were treated "fairly".

Hospitals are also known to partly forgive medical debts incurred by the uninsured, while they make no accommodation for many others. Some states require hospitals to explain in writing how they go about discounting charges for hardship patients, but you might guess that hospitals worry that patients will game those calculations in order to pay less.

NYT Reader Response:by Don McCanne of PNHP
A forgiveness formula for hospitals?

Other nations have been successful in providing health care to everyone at a cost much below that of our dysfunctional system here in the United States. Their programs often have first dollar coverage; therefore medical debt is almost unheard of - certainly a minuscule fraction of what we have here.

Instead of establishing strategies for forgiveness in the future, wouldn't it be more logical to establish a health care financing system in which debt forgiveness would never need to be a consideration?
March 22, 2013

ACA health care plan requirements "too rich"?


"I think consumers can expect new health plans next year are going to be somewhere between 40% to 60% more expensive," said Bob Hurley, eHealth's senior vice president of carrier relations. "I think there is a fair amount of concern that the health plan requirements are too rich."

Comment by Don McCanne of PNHP: Many critics of the Affordable Care Act (ACA) say that the health plans to be offered in the proposed state insurance exchanges should be replaced with plans that have fewer regulatory requirements and that can be sold across state borders. They often cite the bargain prices of plans offered by eHealthInsurance as an example of how we could make health insurance more affordable for everyone. So what is eHealthInsurance offering?

By their own analysis, eHealthInsurance does not consider their plans to be comprehensive unless they offer the eight benefit categories listed in the article excerpt above. If those benefits are included, the premiums are 47 percent higher for both individual and family plans than the premiums for their cheapest plans. Note that these eight benefits are not the same as the ten benefit categories that are required as essential health benefits under ACA, so it is likely that the premiums under ACA will be even more than 47 percent higher than the cheap eHealthInsurance plans. This doesn't even take into consideration cost sharing such as the deductibles.

There is already concern that the benchmark silver plans under ACA, with an actuarial value of only 70 percent (patient pays 30 percent of costs, which might be partially offset by income-indexed subsidies), may leave patients vulnerable to excessive out-of-pocket costs. If the stripped down eHealthInsurance plans were allowed as replacements for exchange plans, it is inevitable that most enrollees would face financial hardship should they develop significant medical problems.

So what is the response of eHealthInsurance? eHealth senior vice president Robert Hurley says, "I think there is a fair amount of concern that the health plan requirements are too rich."

This exposes the highly touted low cost eHealthInsurance plans as the shoddy plans that they are. You might be nominally insured, but don't you dare get sick.
March 15, 2013

Legislators think voters are more conservative than they actually are

This is from a consultant's email list--I'm sure she won't mind my copying it, given that I spelled her name right. If you are interested in running for office or working on campaigns, do sign up.

As far as state legislators are concerned, all voters are conservatives.

OK, we’re being hyperbolic. But only a little bit, according to a recent survey that should have all progressive change-makers headed for the planning table - and maybe the budget spreadsheet - to revisit strategy decisions.

David Broockmany and Christopher Skovronz surveyed every candidate for state legislative office in the U.S. in 2012 (about 10,000 people). They got 1,907 responses from a wide variety of districts, candidate types (incumbent, challenger, etc.) and split about equally between Republicans and Democrats. They asked about the candidates’ own positions and what they thought their voters’ positions were on same sex marriage and universal health care. The researchers then matched up the candidates with district-level polling data on those same two issues.


Key findings:

•Conservative politicians overestimate support for conservative policy views among their constituents by over 20 percentage points on average.
•70% of liberal candidates underestimate support for liberal positions among their constituents.
•The democratic process - elections - does nothing to alter politicians’ misperceptions of the conservatism of their voters.
•In districts where supporters of same sex marriage and universal healthcare outnumber opponents by 2 to 1, liberal politicians appear to typically believe these policies enjoy only bare majority support while conservative politicians typically outright reject the notion that these policies command widespread support.

Yikes. So, now what?
At least these three things:

1) Even if you don’t work on state policy, this should be alarming.

46 US Senators and half of current members of the House used to be state legislators. There’s no reason to believe state legislators don’t take their biases and issue positions with them when they’re promoted from the state house to the US Capitol. If you care about progressive federal policy, you should care that state legislators across the ideological perspective dramatically underestimate the progressivity of their constituents.

2) Safe assumption: it’s not just marriage equality and universal health care. Your progressive priority is suffering, too.

The study doesn’t go further than to document state legislative candidates’ dramatic misperceptions of the opinions of their voters on these two progressive issues. The researchers chose those issues because, “(1) these issues are very highly salient in both national and state mass politics, (2) both national and state legislators are currently making high-stakes policy decisions on these issues that will affect tens of millions of Americans, and (3) these issues tap into two core ‘dimensions’ of contemporary American politics: degree of government economic redistribution and involvement in the case of universal healthcare, and social conservatism in the case of same-sex marriage.”

We think it’s safe to hazard a guess that a number of other progressive priorities, from climate change to education to tax reform, could be described the same way, so they likely suffer from the same conservative bias amongst candidates for state office.

3) The overestimation of the conservatism of the electorate matters. Progressive campaigners should work to fix it. Here are some ideas to get you started.

If candidates think their voters are more conservative than they really are, it follows that candidates will take more conservative positions on the stump and in office. At minimum, it’s a safe bet that the misperception prevents some state elected officials from being leaders on progressive issues.
So: what will you and your organization do to fix it?

Just a few of the things we’d love to work with you to try:

•Do in-district, in-depth, issue-specific polling for public release and use in private meetings with state legislative candidates and incumbents.
•Pick a district represented by a wobbly ally (or a sometimes opponent) and go deep in that district to mobilize supporters of your policy position (even if not your organization) to make a call or send an email.
•Test a campaign aimed at people who are likely to support a target incumbent (Republicans in a safe Republican district, for example) to mobilize them to make their opinions known on your issue to their state legislator. Note that this is different than asking them to vote differently; that’s not the point. The point is to correct a misperception.

Holler if you/your organization is game: [email protected] or 202.683.8465

If you’re interested in more reading on the study, some good resources:

The Atlantic: Are Americans as Conservative as Their Elected Officials Think?http://www.theatlantic.com/politics/archive/2013/03/are-americans-as-conservative-as-their-elected-officials-think/273669/

Washington Post Wonkblog: One study explains why it’s tough to pass liberal lawshttp://www.theatlantic.com/politics/archive/2013/03/are-americans-as-conservative-as-their-elected-officials-think/273669/

Englin Consulting, LLC
Shayna Englin <[email protected]>
2803 Mt. Vernon Avenue, Suite 719
Alexandria, VA 22301

March 13, 2013

Single-Payer Would Save PA $17 Billion Annually


Health Care for All PA, a statewide non-profit organization today released an economic impact study. The results prove that a single-payer health care plan will save families, businesses and tax payers $17 billion annually while at the same time providing comprehensive health care to all.

This study was done by University of Massachusetts – Amherst professor of economics Gerald Friedman, Ph.D. It compares the cost of the current for-profit health insurance model in Pennsylvania whereby provider choice is limited and health services are rationed by health insurance companies to that of a consumer-driven health care system which lets people have the freedom to choose their own doctors, hospitals and health care providers.

Some of the important advantages of a single-payer system are:

- Comprehensive coverage for every resident of Pennsylvania, including dental, vision and mental health services;

- Eliminates the need for hospitals to absorb the cost of care for the uninsured;

- Reduces bureaucracy for private physicians resulting in reduced administrative costs and improved compensation for private physicians;

- Reduces or eliminates health insurance over-costs for small business, allowing for more job creation, greater reinvestment of profits, and reduced workers’ compensation costs.

- Radically reduces the total cost of health care to levels more consistent with costs in the rest of the industrialized world.
March 10, 2013

Almost No Existing Individual Health Plans Meet New ACA Essential Health Benefit


Given that health insurance plans will have to meet new minimum coverage standards starting in 2014, HealthPocket examined the current marketplace of individual health plans to measure the market disruption that will occur as these plans are replaced by plans compliant with the new standards.

Our research took the Affordable Care Act's Essential Health Benefits as our starting point. The Essential Health Benefits are the minimum categories of health insurance coverage that every qualified health plan must have starting January 1, 2014. HealthPocket then examined 11,100 individual health plans across the United States to see how many plans had coverage in each of the Essential Health Benefit categories.

The data shows that there will be a near complete transformation of the individual and family health insurance market starting in 2014. Less than 2% of the existing health plans in the individual market today provide all the Essential Health Benefits required under the Affordable Care Act (ACA).

Implications for Health Insurance Premiums?

One of the questions raised by the results of this study is whether the coverage expansion required by the ACA will cause premiums to rise in 2014. Although the answer to that question is beyond the scope of this study, premiums could rise due to a combination of factors, including:

* The closing of the coverage gap as described in this study
* Guarantee issue provisions that will allow people with pre-existing
medical conditions to enroll in health plans
* ACA actuarial value requirements on the maximum out-of-pocket costs that
can be charged to beneficiaries

Comment by Don McCanne of PNHP: One of the problems that needed to be addressed by the Affordable Care Act (ACA) was the fact that health plans in the individual market have very skimpy benefits - benefit packages that were designed by private insurers who were attempting to keep their premiums competitive. This study confirms the extent of the inadequacies of these plans.

In response, ACA included a mechanism to require a minimum basic level of essential health benefits (EHB). The expansion of the benefits to be covered, along with guaranteed issue to those with preexisting disorders, and placing a maximum on out-of-pocket costs, will all result in significantly higher premiums for plans offered in the individual market. That is in spite of the fact that many will still find the benefits to be deficient, and will still face large out-of-pocket costs because of the low actuarial values of the plans that most people will select.

Even with subsidies, these plans will be expensive. And for those who do not qualify for subsidies? Maybe those potential purchasers would finally see the wisdom of establishing an equitable public system of financing health care through progressive taxes - a single payer national health program. They certainly aren't going to like what they are going to get under ACA.
March 5, 2013

Horror Care: How Private Health Care is Shortening Our Lives


the evidence for incompetence in the private sector is overwhelming. Data from the Congressional Budget Office (CBO) and the Center for Medicare and Medicaid Services (CMS) shows that since 1997 private insurance costs have risen much faster than Medicare costs. According to the Council for Affordable Health Insurance, medical administrative costs as a percentage of claims are about three times higher for private insurance than for Medicare. A study by researchers at Harvard Medical School and Public Citizen found that health care bureaucracy last year cost the United States $399.4 billion. The U.S. Institute of Medicine reports that the for-profit system wastes $750 billion a year on waste, fraud, and inefficiency. As a percent of GDP, we spend almost twice the OECD average.

When we look beyond industry malfeasance to the effects on human life, we find that Americans are paying the ultimate price. We now have a shorter life expectancy than almost all other developed countries. A National Research Council study placed the United States LAST among 17 high-income countries.

It wasn't always this way. Since 1960 there has been a close parallel between worsening life expectancy and increased health care costs as a percentage of GDP. Most disturbing is our growing infant mortality rate relative to other countries. A UNICEF study places the U.S. 22nd out of 24 OECD countries in "children's health and well-being."
March 3, 2013

When You're Cutting Social Security, 'Wealthy' Begins at $25K


Here's a proposal for Social Security that was on the New York Times' op-ed page Wednesday (2/20/13):

The top third of beneficiaries (by lifetime income) [would] receive no annual cost-of-living adjustment in retirement. The middle third would get half of today’s adjustment, and the bottom third would receive the same annual increase they do now. Such a reform…would reduce Social Security spending by more than a tenth over a decade and fix the program’s long-term financing.

Wealthy…or super-wealthy? This is part of Paul Ryan adviser Yuval Levin's attempt to find "common ground" on the entitlement issue: "Both sides should agree at least to spend less money on the wealthy." So who are these "wealthy" people who would be getting a benefit cut equal to the rate of inflation every year? According to the SSA, about 34 percent of people over 65 have family incomes of $50,000.

Now, you can argue about what "wealthy" is, but I think you would find pretty widespread agreement on what wealthy isn't: $50,000 a year. If you sent the New York Times an op-ed outlining your plan to balance the budget by raising taxes on "wealthy" people who make 50k a year or more, it would be put in the same pile that gets the submissions about Elvis's UFO diet. But when you're talking about cutting entitlements, if you want to call those people "wealthy," that's perfectly reasonable.

But wait! Those aren't the only people who are getting too much from the government and need to have their benefits cut–the middle third of the elderly are also "wealthy" and need their benefits cut–but by only half the rate of inflation per year. The ones making more than $50,000 must be the super-wealthy, the regular wealthy make…between $25,000 and $50,000, roughly.

For comparison purposes, the poverty line for a family of four is $23,350. Talk about a shrinking middle class!

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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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