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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 Me

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

Journal Archives

I Am A Republican … Can We Talk About A Single Payer System?

By David May, M.D.
American College of Cardiology Touch Blog, April 23, 2013

I am a Republican. For those who know me that is not a surprise. I live in a red state. I have never voted for a Democratic presidential candidate. I can field strip, clean and reassemble a Remington 12-gauge pump blindfolded. And on top of it, I think we should talk about having a single payer national health care plan. The reason is quite simple. In my view, we already have one; we just don’t take advantage of it.

Firstly, Medicare and the Center for Medicare and Medicaid Services (CMS) are de facto setting all of the rules now. They are a single payer system. When we go to lobby the Hill, we lobby Congress and CMS. Talking to Blue Cross, Aetna, Cigna and United Health care is essentially a waste of time. All the third party payers do is play off the Medicare rules to their advantage and profit. They have higher premiums, pay a somewhat higher benefit and have a significantly higher level of regulation which impedes the care of their customers. This is no longer consumer choice but effectively extortion, a less than hidden shake down in which the “choice” for a family of four is company A at $900 per month or company B at $1100 per month. The payers are simply taking advantage of the system, playing both ends against the middle.


Resolution Against the Confiscation of Customer Bank Accounts by “Systemically Important” Banks

Steal it and use it however you like.

All LD and county Democratic Party organizations should consider this resolution

Resolution Against the Confiscation of Customer Bank Accounts by “Systemically Important” Banks

WHEREAS the 2008 financial bailout has committed American taxpayers to permanent, blind support of an ungovernable, non-regulated, hyper-concentrated new financial system that exacerbates the behavior of bankers that caused the crash; and

WHEREAS Attorney General Eric Holder has publicly stated that he will not prosecute the clearly criminal behavior of large financial institutions because “it will have a negative impact on the national economy;” and

WHEREAS since the bailout these banks have become even larger and are still engaged in the same risky behavior as before; and

WHEREAS European austerity hawks have recently required Cyprus banks to confiscate money from the accounts of customers to essentially repay what are gambling debts of those banks; and

WHEREAS a joint paper by the U.S. Federal Deposit Insurance Corporation and the Bank of England dated Dec. 10, 2012 recommends the confiscation of customer deposits on the grounds that these institutions no longer have the resources to do a bailout which is expected to be even larger than that of 2008; and

WHEREAS Canada, New Zealand, Spain and other countries have proposed similar policies, indicating that this will be the default policy of the entire global financial elite; and

WHEREAS enabling legislation in the US has not yet been proposed or passed by Congress;

THEREFORE BE IT RESOLVED that _________ call on our Democratic representatives to not only refuse to make American bank depositors liable for the gambling debts of vastly overpaid financial operators, but to originate and pass legislation specifically forbidding this; and

THEREFORE BE IT FURTHER RESOLVED that _________ call on our Democratic representatives to reinstate financial regulation of large banks and investment firms; and

THEREFORE BE IT FURTHER RESOLVED that _________ direct our Democratic National Committee representatives put this issue on the agenda of the DNC; and

THEREFORE BE IT FINALLY RESOLVED that the ________ send copies of this resolution to the members of our Democratic Congressional delegation, Senate Majority Leader Harry Reid, House Minority Leader Nancy Pelosi and Attorney General Eric Holder.


Governments may push workers to health exchange


OLYMPIA, Wash. — In a move that would capitalize on provisions under President Barack Obama's health care law but could cost the federal government millions of dollars, Washington state lawmakers have found a creative way to pass a large chunk of their health care expenses along to Washington, D.C. – and analysts say others are likely to follow suit.

The plan threatens to affect the federal budget and the pocketbooks of some part-time workers, as it would push a group of employees out of their current health care plans and into an exchange developed under the Affordable Care Act.

Observers say the shift seems to run counter to the intent of the new health care law. Supporters, however, say it's a viable strategy for governments to pursue as they manage the insurance rules related to part-time staff.

Washington state appears to be the first major government to seriously explore the possibility of pushing workers into the exchange — but it probably won't be the last. Rick Johnson, who advises state and local governments on health care policy at the New York-based consulting firm Segal Company, said he expects it will be an option some governments will look at in the years to come.
"I can see that as one of the solutions out there," Johnson said.

A spokeswoman with the Department of Health and Human Services declined comment, and it's unclear whether the federal government accounted for this possible outcome.

While Democratic lawmakers have expressed concern about the Washington state plan this year, it is drawing growing interest among a bipartisan group of political leaders in the state. Democratic Gov. Jay Inslee, who supported the Obama health care law while in Congress, has reservations about the plan.
But the former congressman said federal rules don't dictate how employers and employees should handle insurance coverage and indicated that he may consider supporting the idea in the future.

"It's one of those ideas that's premature for us to launch this year, but I don't think we should take it off the table," Inslee said Tuesday.

The Washington state proposal has come before lawmakers as governments around the nation are formulating strategies to manage those who don't work 40 hours a week, since the federal law requires employers to provide coverage for those working at least 30 hours.

Virginia, for example, is requiring all part-time employees to work fewer than 30 hours, which will help the state avoid penalties for not providing health coverage. Florida, facing a potential $300 million penalty for not covering workers who have 30 to 39 hours a week, is moving to extend coverage to those employees.

Washington state is in a less common situation, since it already provides coverage for part-timers down to 20 hours a week

Medicare: one size really does fit all


Uwe E. Reinhardt, PhD, economics professor at Princeton: On this point, I'm very disappointed that we Americans couldn't even get the exchanges right. As Atul said, an exchange is really just like the personnel benefit department at General Motors. It's just an electronic market to buy health insurance. I could show you the Swiss or the German exchanges. We have now made a horrendous mess of these exchanges. It cost close to a billion dollars to implement the California exchange, and heaven knows what's happening in the other states. I was thinking if this generation of Americans had to plan the Normandy invasion, I think they would never have gotten there, or by the time they got there, the Russians would have been there. It is just unbelievable what an administrative nightmare the Affordable Care Act has become. Americans always tell me - I'm just an immigrant trying to learn about this country - they always tell me, oh, one size doesn't fit all. Well, tell that to McDonald's or to the Holiday Inn. In fact, Americans invented the idea that one size fits all, and built great industries on it - the auto companies, the food services, the hotels, the department stores - they're all one size fits all.

Ed Livingston, deputy editor of JAMA: You mentioned that companies like McDonald's and Holiday Inn have been very successful in building large industries with uniformities, but those are private industries. Is the problem that when the government tries to take on something this complex they just can't seem to get it done?

Uwe Reinhardt: Well, it's for the reason that Atul mentioned, that somehow we give enormous respect to regional variations, and, because we do, we make everything enormously complex. Imagine if you ran the U.S. Army that way. Soldiers from every state could pick their own rifles, and so on and so forth. Sometimes you have to do national things. I recently wrote a Health Affairs piece and said, every American is a dual citizen. He has citizenship in the state that they live in and citizens in America. And it really depends when you draft federal legislation, which citizenship do you make supreme.

Typically you find Democrats put American citizenship up on top. The idea being that a baby in Mississippi should have the same rights to access to health care as a baby in Massachusetts, because they are both Americans. I think more on the Republican side they would say, no, what happens to a Mississippi baby is up to the people down there, and you can do what you want to a Massachusetts baby up there in Massachusetts. Now, that's a different conception, neither right or wrong, but I'm saying on some issues we really, in my view, should have national policies because it would be much more easy to administer. After all, that's what we said in Medicare. We said no matter where the elderly live, they should have the same deal in health care, and we created Medicare. Has Medicare been that much of a disaster?

Comment by Don McCanne of PNHP: Hmmm.

"It is just unbelievable what an administrative nightmare the Affordable Care Act has become."

"...they always tell me, oh, one size doesn't fit all. Well, tell that to McDonald's or to the Holiday Inn."

"...but I'm saying on some issues we really, in my view, should have national policies because it would be much more easy to administer."

"We said no matter where the elderly live, they should have the same deal in health care, and we created Medicare. Has Medicare been that much of a disaster?"

So can we draw the conclusion that we should adopt the administrative simplicity of a national, one-size-fits-all Medicare that gives everyone the same deal in health care? Seems like a really good idea.

Wendell Potter: Medicare Advantage – or DISAdvantage?


If you’re being courted by a private insurance company to enroll in one of its Medicare Advantage plans, don’t sign on the bottom line until you’ve read a recent report by a researcher at the Center for Medicare and Medicaid Services (CMS). The real bottom line you need to understand is that the insurer might want to keep you enrolled only as long as you’re relatively healthy. When that changes, you just might find that you’re no longer considered a valued member and that the traditional Medicare program is a much better deal for you.

The study, published recently in the Medicare and Medicaid Research Review, confirmed what some who are familiar with the Medicare Advantage program, including me, have suspected: when people enrolled in MA plans become critically ill, many realize that the only way they will get coverage for the care they need – and at a facility of their choice – is to return to the traditional Medicare program.

Former health insurance industry exec Wendell Potter says he believes his mother Pearl, left, is alive today because she was disenrolled from a Medicare Advantage plan that would have failed to cover costs of care that Traditional Medicare covers.

It may come as a surprise, but one of the reasons the Medicare program costs taxpayers more than it should is that the federal government has for years been overpaying insurance companies to participate in the Medicare Advantage program. (Medicare Advantage plans – typically HMOs and PPOs – are private alternatives to traditional Medicare.) Congress created the program after private insurers insisted that not only could they meet the medical needs of senior citizens and the disabled more cost effectively than the government, they could do so and still make a profit.

Hospitals Profit From Surgical Errors, Study Finds


Hospitals make money from their own mistakes because insurers pay them for the longer stays and extra care that patients need to treat surgical complications that could have been prevented, a new study finds.

Changing the payment system, to stop rewarding poor care, may help to bring down surgical complication rates, the researchers say. If the system does not change, hospitals have little incentive to improve: in fact, some will wind up losing money if they take better care of patients.

The study and an editorial were published Tuesday in The Journal of the American Medical Association. The study authors are from the Boston Consulting Group, Harvard’s schools of medicine and public health, and Texas Health Resources, a large nonprofit hospital system.

The study is based on a detailed analysis of the records of 34,256 people who had surgery in 2010 at one of 12 hospitals run by Texas Health Resources. Of those patients, 1,820 had one or more complications that could have been prevented, like blood clots, pneumonia or infected incisions.

National Committee to Protect Social Security and Medicare statement on Obama's budget

The President's FY 2014 Budget and Its Effect on Seniors

On April 10, 2013, President Obama submitted his Fiscal Year (FY) 2014 budget to the Congress. This budget proposes a total spending level of $3.78 trillion in FY 2014 and calls for over $1 trillion in budget reductions that include some unacceptable proposals. This paper summarizes some of the key proposals affecting seniors in the President's FY 2014 budget. Additional information about Social Security and Medicare and Medicaid is available on the National Committee's website (www.ncpssm.org ) or by calling 1-800-966-1935.

Social Security

Unlike previous budgets, the President’s FY 2014 budget targets Social Security benefits as a means of reducing the deficit. Despite the fact that Social Security has the financial resources to pay all benefits through 2033, Social Security benefits are targeted in this budget for substantial cuts by adopting the “chained” consumer price index (CPI) for the purpose of calculating Social Security cost-of-living adjustments, or COLAs.

The Administration characterizes this switch as a technical adjustment. However, using the “chained” CPI will substantially reduce the Social Security benefits of current and future beneficiaries. The amount of the reduction is substantial. If it is adopted, a typical 65 year-old would see an immediate decrease of about $130 per year in Social Security benefits. At age 95, the same senior would face a 9.2 percent reduction—almost $1,400 per year.

While all beneficiaries will feel the impact of this change, its effect will be greatest on those who draw benefits at earlier ages (e.g., military retirees, disabled veterans and workers) and those who live the longest. These are often women who have outlived their other sources of income, have depleted their assets, and rely on Social Security as their only lifeline to financial stability.

Seniors and others receiving benefits recognize that the current COLA already undercounts the higher inflation they experience because they spend a disproportionate amount of their income on health care. A lower COLA will make it increasingly difficult for current and future generations to make ends meet.

Would this new “chained” CPI be more accurate? We do not think so. And despite words to the contrary, the White House also knows this new formula is not more accurate for seniors, which is why it has promised exemptions and benefit “bump-ups” to try and soften the impact. But it still leaves millions of seniors facing benefit cuts, breaking the promise President Obama made to protect America’s middle class families.

An especially problematic aspect of the “chained” CPI proposal in the President’s budget is that it disproportionately affects communities of color. African American retirees would be negatively affected by the cuts stemming from the “chained” CPI because they rely heavily on Social Security benefits for retirement income. And because, on average, they have shorter life expectancies than other Americans, they would benefit less than other Americans from the benefit bump-ups that are proposed for people who have been on the rolls for many years.

Clearly, it will be up to members of Congress to set fiscal priorities that actually represent the needs of the average citizens they were elected to represent. The vast majority of Americans, of all political parties, oppose cutting Social Security and Medicare to reduce the deficit. The National Committee calls on all members of Congress to reject the Administration’s proposals to cut seniors’ Social Security benefits.

The President’s budget includes a number of legislative proposals that, unlike the “chained” CPI, would strengthen the Social Security Administration’s (SSA) ability to administer the Social Security program. Among them are proposals to allow SSA to develop and test improvements to the disability insurance program, provide assured and adequate funding for program integrity activities, and extend the period of time during which individuals admitted to the U.S. on humanitarian grounds can receive Supplemental Security Income.

We are pleased to see that funding to restore the mailing of annual Social Security statements has been included in the President’s request. These statements provide workers with information about the Social Security program, including a benefit estimate as well as information about the amount of wages that have been reported to a worker’s Social Security earnings record. Provision of these statements to the 156 million workers who are supporting Social Security with their contributions is required by law.
SSA's Administrative Funding

With SSA's enormous workloads and challenges, the President is requesting $12.3 billion for SSA's FY 2014 appropriation for administrative funding, a seven percent increase over the 2012 enacted level. The President's budget request for SSA in FY 2014 exceeds the agency’s recommendation by $68 million, and establishes a new funding source, allowing a more dependable revenue stream for conducting Continuing Disability Reviews and Supplemental Security Income Redeterminations. The National Committee applauds this proposal, which will help to ensure that only those eligible for benefits receive them and which will achieve significant deficit reduction. However, if this new funding source is not approved, it is critical that the agency be funded adequately through existing funding sources to fulfill its service and stewardship responsibilities.


The National Committee opposes proposals in the President's budget which would shift additional costs to Medicare beneficiaries. Over half of Medicare beneficiaries had incomes below $22,500 per year in 2012, and they are already paying 27 percent of their average Social Security check for Part B and D cost-sharing in addition to paying for health services not covered by Medicare. Medicare beneficiaries with annual incomes over $85,000 for individuals and $170,000 for couples are paying higher income-related premiums. We do not share the Administration's view that people will make wiser choices about using health care services if they have to pay more of the cost. Rather, we agree with research which shows that these additional costs could lead many seniors to forego necessary care, which, in turn, could lead to more serious health conditions and higher costs.

The President’s budget includes the following four proposals which would increase costs for future beneficiaries.
1. The President's budget proposes to apply a $25 increase in the Part B deductible in 2017, 2019, and 2021 for new beneficiaries. This increase would be in addition to the current Medicare Part B deductible that beneficiaries pay which, along with general revenues, funds Part B physician and outpatient services. This proposal is estimated to save approximately $3.6 billion over 10 years.
2. The President's budget proposes a home health copayment for new beneficiaries beginning in 2017. A $100 copayment per home health episode would be applicable for episodes with five or more visits not preceded by a hospital or other inpatient post-acute care stay. This proposal is estimated to save approximately $730 million over 10 years.
3. The President's budget proposes a Part B Premium surcharge for new beneficiaries who purchase “so-called” near first-dollar Medigap coverage. The surcharge would be equivalent to about 15 percent of the average Medigap premium (or about 30 percent of the Part B premium) for new beneficiaries who purchase Medigap policies with particularly low cost-sharing requirements, starting in 2017. Many seniors of modest means depend on such Medigap plans to ensure they have predictable and lower out-of-pocket costs. Other Medigap plans would be exempt from this requirement while still providing beneficiaries options for protection against high out-of-pocket costs. This proposal is estimated to save approximately $2.9 billion over 10 years.
4. The President's budget proposes to further increase income-related premiums under Medicare Parts B and D. Beginning in 2017, the Administra¬tion proposes to restructure means-testing in Medicare Parts B and D by increasing the amount of income-related premiums, and maintaining the income thresholds associated with income-related premiums until 25 percent of beneficiaries under Parts B and D are subject to these premiums. A Kaiser Family Foundation study found that this proposal would affect individuals with incomes equivalent to $47,000 for an individual and $94,000 for a couple. This proposal is estimated to save approximately $50 billion over 10 years.
The President's budget includes numerous proposals to strengthen Medicare's financing and improve the quality of care provided to beneficiaries. We support many of these proposals, including:
• Building on provisions in the Affordable Care Act that will provide better care to Medicare beneficiaries and reform Medicare payments to physicians.
• Supporting initiatives to prevent, detect and recover improper payments, including fraud, waste and abuse.
• Allowing Medicare to receive the same rebates as Medicaid for brand name and generic drugs provided to beneficiaries who receive the Part D Low-Income Subsidy, beginning in 2014.
• Increasing manufacturer discounts for brand name drugs from 50 to 75 percent in 2015, effectively closing the coverage gap “donut hole” for brand name drugs in 2015, five years sooner than under current law.
• Promoting lower pharmaceutical costs by providing for faster development of generic versions of biologic drugs, and prohibiting "pay-for-delay" agreements between brand name and generic pharmaceutical companies that delay entry of generic drugs into the market.


The National Committee is pleased that the President’s budget does not make major structural changes to the Medicaid program. Medicaid pays for about 62 percent of all long-term services and supports and many older adults and people with disabilities depend on the program for their health care needs.
The President's budget maintains funding for the Qualified Individual program and extends the program through December 31, 2014. The QI program pays for Medicare Part B premiums for qualified beneficiaries with limited income. Specifically, the QI program provides States 100 percent federal funding to pay the Medicare Part B premiums of low-income beneficiaries with incomes between the 120 and 135 percent of the federal poverty level.

Administration for Community Living

The President's budget includes $2 billion for the Administration for Community Living, which administers the Older Americans Act programs, as well as other programs to support independent living for seniors.

Low-Income Home Energy Assistance Program (LIHEAP)

The President's budget includes $3 billion for the Low-Income Home Energy Assistance Program, which is a reduction from current funding. Many older adults, individuals with disabilities and low-income families receiving LIHEAP are struggling to meet basic needs, and should not have to choose between buying food and medicine or paying for home energy.

Government Relations and Policy, April, 2013

Judgment against Anthem for retaliating against a doctor who advocated for patients.

Private health insurance adds no value whatsoever and should be abolished.


In a rare case, a Los Angeles jury awarded $3.8 million in compensatory damages to a Porter Ranch doctor who contended insurance giant Anthem Blue Cross retaliated against him for being a strong patient advocate.

The jury ruled late Monday in favor of Jeffrey Nordella, 58, an urgent-care and family-practice doctor who alleged that Anthem barred him from its network in 2010, when he applied to be a preferred provider. The damages could climb higher Friday, when the 12-person panel reconvenes and considers punitive damages against Anthem, a unit of insurance giant WellPoint Inc.

The jury found that Anthem, the state's largest for-profit health insurer, violated Nordella's right to "fair procedure," and the company did so with "malice, oppression or fraud." That latter finding prompted the hearing Friday in Los Angeles County Superior Court to determine punitive damages.

This case comes as health insurers, in a bid to hold down costs, are increasingly dropping doctors and hospitals and promoting smaller networks. Insurers typically try to negotiate lower rates with the fewer providers left in the network, who get higher patient volume in return.

Comment by Don McCanne of PNUP: The intent of today's message is not so much to use this opportunity to once again bash one of the nation's largest private insurers (even if appropriate), but rather it is to demonstrate the perversity of one more example of placing the business interests of the insurer over the interests of patients.

Even though this court decision was in favor of a physician barred from Anthem Blue Cross's network of physician providers, it confirms the principle that private insurers should be improving patient access to health care rather than impairing it, as in this now all too common instance of limiting access by narrowing their networks of health care professionals and institutions.

Once again, this demonstrates the irrationality of imposing expensive, intrusive, private third party administrators between patients and their health care professionals.

In a universal, publicly financed and publicly administered health care system, such as a single payer national health program, the third party - the government - covers all reasonable health care services and products provided by any legitimate health care professional or institution, with enough oversight to prevent deviancies such as fraud or price gouging.

What pops up on the 1st page when you Google "House + budget + chained CPI"

From the Republican Campaign Committee


Well, I thought it very intriguing in that the budget really lays out kind of a shocking attack on seniors, if you will. And we haven't seen all the detail yet, and we'll look at it, but I'll tell you, when you're going after seniors the way he's already done on Obamacare, taking $700 billion out of Medicare to put into Obamacare, and now coming back at seniors again, I think you're crossing that line very quickly here in terms of denying access to seniors for health care in districts like mine, certainly, and around the country. I think he's going to have a lot of pushback from some of the major senior organizations on this and Republicans, as well.

From the Repuclican House leadership


House Republican leaders did give Obama credit for including something known as “chained CPI” in the spending plan, which would slow the rate of growth for Social Security benefits. They were on message in calling for Obama to help them enact policies they agree on, without coming to terms on a large-scale deficit busting package.

The usual suspects have naturally been hollering about this for weeks.

What chained CPI will do to each of the five income quintiles of SocSec beneficiaries

Here is what happens to SocSec beneficiaries quintile by quintile. The lowest quintile will get slightly increased benefits which will still leave them mired in poverty. That is to say real poverty, not the fake Census Bureau "poverty," which is calculated by figuring the cost of a minimal food basket (itself consisting of items not readily available in food deserts) and multiplying that number by three. It is a fantasy world in which rent, utilities and medication expenses don't exist.

The second and third quintiles will be driven INTO real poverty. The fourth quintile will have most of its discretionary income eliminated, staying slightly above real poverty The highest quintile will see serious cuts to discretionary income. As a result, businesses relying on this income will continue to disappear.

Our economy is still a depression economy. I get that the Repukes will not allow Obama to enact any kind of the stimulus spending that would help us make progress on the still deep post-crisis job deficit, but why in fucking hell would anyone sane propose trashing the stimulus spending done by retirees? Is the solution to permanent 8% unemployment supposed to be having grandma and grandpa pushing their grandkids of of jobs just to survive?
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