Tag Archives: Single Payer Health System

Sanders: I’m ‘absolutely’ introducing single-payer healthcare bill

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Sanders: I’m ‘absolutely’ introducing single-payer healthcare bill

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Sen. Bernie Sanders (I-Vt.) said Sunday that he will “absolutely” introduce legislation on single-payer healthcare now that the Senate GOP’s bill to repeal ObamaCare has failed.

“Of course we are, we’re tweaking the final points of the bill and we’re figuring out how we can mount a national campaign to bring people together,” Sanders told Jake Tapper on CNN’s State of the Union.

Sanders promised to introduce a “Medicare for All” proposal once the debate over repealing ObamaCare ended. He is one of several progressive lawmakers who back the healthcare model that has divided Democratic lawmakers.

It’s unclear exactly when he will introduce the legislation. The Senate has two weeks remaining in sessions.

Sen. Steve Daines (R-Mont.) attached an amendment to one version of the ObamaCare repeal bill Wednesday that would have created a single-payer healthcare system in the U.S. Daines does not support a single-payer system but used the model as a political maneuver.

Sanders’s spokesman slammed the amendment as a “sham” at the time and said Sanders and other Democrats would refuse to vote on the measure.

The New California Health-Care Model

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Scheduled for Jul 26, 2017

This program is supported by Blue Shield of California Foundation.

With single-payer health care being debated in Sacramento while the repeal of the Affordable Care Act winds its way through Congress, California is setting itself apart from the rest on the nation.

What will this new California model look like, and how will it lift up the underserved populations who need the most care? Is a single-payer system viable for the Golden State? Join us for a discussion on an important and timely issue that affects everyone in all corners of California.

 

The Union That Roars: Nurses Aren’t Giving Up On California’s Single-Payer Push

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The Union That Roars: Nurses Aren’t Giving Up On California’s Single-Payer Push

To some, the California Nurses Association’s political tactics in pushing for a single-payer health system seemed a bit, well, extreme.

Never mind the raucous demonstrations it brought to the state Capitol in recent weeks, the “shame on you” chants in the hallways, the repeated unfurling of banners in the rotunda despite admonitions from law enforcement.

To further the nurses’ cause, the union’s executive director, RoseAnn DeMoro, tweeted out a picture of the iconic California grizzly bear being stabbed in the back with a knife emblazoned with the name of a powerful state lawmaker who stalled the single-payer bill sponsored by the union.

Before and after that tweet, the legislator — a Democrat — said he was besieged by death threats.

Meanwhile, the union’s public relations guy blasted a blogger for Mother Jones magazine — named after the famous union firebrand — for being insufficiently liberal in his single-payer coverage. “Maybe you can recommend the name of your magazine be changed … to Milton Friedman, which would better reflect your class sympathies,” communications director Chuck Idelson wrote acidly.

Dramatic and, to some, offensive, tactics are nothing new for this California union of about 100,000 registered nurses, which has made a name for itself in the state and nationally as a progressive and aggressive political powerhouse. Its reach has only broadened with the advent of social media. Leader DeMoro counts more than 29,000 Twitter followers, and CNA’s operation has a knack for mobilizing protesters and drawing crowds.

“The politicians are afraid of these angry intense grass-roots activists” mobilized by the union, said Mike Madrid, a Republican and principal at the public affairs firm Grassroots Lab, who believes the tactics could backfire. “Using fear and intimidation as a tactic in the legislature usually doesn’t get you too far.”

Others are impressed with the union’s drive and creativity, recalling how in 2005 CNA members taunted California’s then-governor, Arnold Schwarzenegger, trailing him wherever he went to protest his attempts to roll back hard-won nurse-to-patient requirements in hospitals. Activists dressed up as the Republican leader and staged theatrical protests at baseball games, rock concerts and even the San Francisco Ritz-Carlton.

In the single-payer fight, the union has shown it will go just as fervently after Democratic leaders in a heavily Democratic legislature. While the union isn’t responsible for everything freelance activists do in a campaign, the Assembly Democratic caucus has condemned the “bullying tactics” and violent rhetoric in the CNA-led effort.

Though not always admired for its approach, the CNA often gets results — or works up a sweat trying. It counts among its legislative successes the 1999 passage of the strict nurse-to-patient ratios, the nation’s first such mandate to bolster staffing in hospitals. It has fended off attempts to overturn that law, worked to protect employee pensions and pushed for campaign financing reform. And it lent its considerable political muscle to Bernie Sanders’ presidential campaign.

Historically, the nurses have had the upper hand in labor negotiations, says Joanne Spetz, director of the Health Workforce Research Center at UC-San Francisco. That’s partly because in some areas of California it represents most or all of the registered nurses, including many thousands who work for the managed-care giant Kaiser Permanente. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

Members of the California Nurses Association Board of Directors, Martha Kuhl (left) and Nancy Casazza, show their support for a 1994 state proposition to implement single-payer health care in California. (Courtesy of the California Nurses Association)

The union, founded in 1903, has always “punched above its weight,” said Thad Kousser, chair of the political science department at University of California-San Diego.

Sherry Bebitch Jeffe, a professor of public policy communication at the University of Southern California, agreed.

“I’m not sure we would be discussing single-payer if not by the push of the nurses’ association,” Jeffe said.

The union, which is affiliated with National Nurses United, makes no apologies for its approach, saying it is determined to hold lawmakers accountable. And it has no intention of backing off its campaign for a single-payer system in the state, an effort that would put the California government in charge of funding health care.

“We’re going to demand that the legislature legislate and move this bill,” said Michael Lighty, director of public policy at California Nurses Association/National Nurses United. The group on Tuesday plans to stage a “people’s assembly health committee” mock hearing in Sacramento.

Lighty said that the rallies reflect Californians’ desperation and fear about losing health coverage under Republican proposals to repeal Obamacare more than anything else.

Although Lighty said the union’s elected nurse leaders collectively decide on its actions, supporters and critics alike see DeMoro as setting the tone and agenda.

People focus on DeMoro because she “pushes the parameters of the politically possible” and that rubs “defenders of the status quo” the wrong way, Lighty said. DeMoro, on vacation, was unavailable for comment.

Former state senator Sheila Kuehl, who attempted several times to pass a single-payer bill, said the California Nurses Association has always been “very aggressive for the things they believed in.”

Former state senator Sheila Kuehl, who authored single-payer legislation in the 2000s, participates in a 2008 rally in San Francisco. (Courtesy of the California Nurses Association)

A smaller health consumer advocacy group persuaded Kuehl to carry the bill for the first time in 2003-04, Kuehl recalled, but the California Nurses Association brought more visibility and credibility when they joined her effort. Eventually, it became a co-sponsor.

“CNA, as fierce and progressive as they are, gave the idea a real boost,” said Kuehl, now a Los Angeles County supervisor.

Two of her bills passed through the legislature, but both were vetoed by then-Gov. Schwarzenegger.

Kuehl doesn’t buy the argument that the union’s in-your-face strategies may hurt their chances of passing single-payer later. Union members made nasty comments about Schwarzenegger at their rallies and that didn’t hurt the CNA’s reputation, she said.

Madrid, the Republican political consultant in Sacramento, says the CNA’s aggressive advocacy for a single-payer health system reflects the intense political polarization seen around the country right now — as well as conflicts among members of left-leaning causes.

More mainstream Democrats, including Assembly Speaker Anthony Rendon — the recipient of online death threats — say the legislature’s priority is to defend California against a GOP-proposed repeal of the Affordable Care Act and massive cuts to Medicaid, the state and federal health plan for the poor.

Rendon also said the single-payer bill, though approved by the state Senate, was “woefully incomplete” and needed to be recast. Among other problems, it carried a $400 billion annual price tag , according to an analysis by the state Senate Appropriations Committee.

But the CNA sees an opportunity for broader change and believes single-payer can move forward even as the state fights the Republican proposals in Washington.

If the single-payer bill stays idle in the legislature this year, the group vows to try again next year, making it a campaign issue in the 2018 elections.

“The best way to fight the GOP is to have an alternative,” Lighty said.

Why Market Competition Has Not Brought Down Health Care Costs

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http://www.realclearhealth.com/articles/2017/06/30/why_market_competition_has_not_brought_down_health_care_costs_110657.html?utm_source=morning-scan&utm_medium=email&utm_campaign=mailchimp-newsletter&utm_source=RC+Health+Morning+Scan&utm_campaign=f09272e5e1-MAILCHIMP_RSS_EMAIL_CAMPAIGN&utm_medium=email&utm_term=0_b4baf6b587-f09272e5e1-84752421

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It is easier than ever to buy stuff. You can purchase almost anything on Amazon with a click, and it is only slightly harder to find a place to stay in a foreign city on Airbnb.

So why can’t we pay for health care the same way?

My research into the economics of health care suggests we should be able to do just that, but only if we say goodbye to our current system of private insurance – and the heavy administrative burden that goes along with it. Republican efforts to repeal the Affordable Care Act (ACA) would take us in the wrong direction.

What makes health care so complicated

In a way, the reason buying health care is different than shopping for a garden gnome or short-term apartment seems obvious. Picking the right doctor, for example, involves a lot more anxiety and uncertainty and concerns matters of life and death.

But that’s not really the reason we can’t purchase health care the same way we buy an iPhone. In 1969, this would almost be true (for a rotary phone anyway). Back then, the bill for a birth in a New Jersey hospital looked a lot like the receipt you’d get for buying pretty much anything else: customer name, amount and a box to be checked for payment by check, charge or money order.

Today, paying for even the simplest office visit can become a nightmare, requiring insurance preauthorization, reimbursements adjusted for in-network or out-of-network copays and deductibles and the physician “tier” (or how your prospective doctor is evaluated for cost and quality by the insurance company).

Prescriptions require even more authorizations, while follow-up care necessitates coordinated review – and it goes without saying that many forms will have to be completed. And this doesn’t end when you arrive at the doctor’s office. A large chunk of any visit is spent with a beleaguered nurse, or even the physician, filling out a required checklist of insurance-mandated questions.

The growing complexity of health care finance explains why it’s becoming more and more expensive even though there has been little or no improvement in quality. Since 1971, the share of our national income spent on health care has doubled.

We can blame a significant part of the soaring cost of health care on the ever-increasing burden of administrative complexity, whose cost has climbed at a pace of more than 10 percent a year since 1971 and now consumes over 4 percent of GDP, up from less than 1 percent back then.

Lemons and cherries

So if the rising cost of administration is a primary force driving health care inflation, why don’t we do something about it?

That’s because administrative complexity and waste are no accident but rather are baked into our private health insurance system and made worse by continuing attempts to use competitive market processes to achieve social ends other than maximizing profit.

Paying a doctor was relatively simple in the 1960s. Most people had the same insurance policy, issued by Blue Cross and Blue Shield, which back then was a private company but operated like a non-profit under strict regulation.

But in hopes of controlling steadily rising costs, policymakers encouraged insurers besides Blue Cross to enter health insurance markets, beginning with the HMO Act of 1973. The proliferation of for-profit companies with competing plans raised billing costs for health care providers, which now had to submit claims to a multitude of different insurers, each with its own codes, forms and regulations.

Not only that, but insurers quickly discovered the dirty secret of health care finance: Sick people are expensive and make up most costs, while healthy people are profitable.

In other words, the vital lesson for an insurer looking to make money is to identify the few sick people and get them to go away (“lemon dropping”) and find the healthy majority and do things that attract them to your plan (“cherry picking”).

Insurers are happy to offer discounts on fitness club memberships to attract healthy people, for example. But they punish the sick with higher copays and deductibles, as well as increasingly restrictive and intrusive regulations on preauthorization.

Economists call it adverse selection. Regular people call it paperwork hell. Whatever the name, it’s the purpose of increasingly complicated insurance plans and reimbursement forms.

A failure to fix

The public and government authorities figured this out quickly, but too often the cures have been as bad as the disease.

We could, and I believe should, have abandoned the use of for-profit private insurance to adopt a simple single-payer system, in which a government agency would provide coverage to everyone in the U.S. Instead, in forging the ACA and in every other health reform enacted in the past 40 years, policymakers decided to work with private insurance while trying to fix some of its evils.

We adopted the “Patient’s Bill of Rights” around the turn of the century and created processes to allow patients and providers to appeal medical decisions made by insurers. State health commissioners now have considerable power to supervise insurers, while the ACA mandates certain essential benefits be provided in all insurance plans.

Yet each of these efforts to protect the sick from abuses inherent in the for-profit insurance system only added to the administrative burden, and the costs, on the entire industry.

Some perceived the problem as a lack of market competition so governments freed hospitals and other health care providers from regulations on prices and restrictions on mergers, advertising and other practices. Far from reducing administrative complexity or lowering prices, research has shown that deregulation made both problems worse by allowing the formation of networks of hospitals and providers who use advertising and other business and financial practices to **control markets and stifle competition.

Simply put, each attempt to fix a problem has led to more administration because we have kept intact the system of private health insurance – and for-profit medicine – that is at the root of at the dual problems of rising health care costs and growing complexity.

It’s time to take a step back

Clearly, our experiment in market-driven health care has gone awry.

Before we introduced competition and deregulation into health care, things were relatively simple, with most revenue going to providers. We could save a lot of money if we went backwards and adopted a single-payer system like Canada’s, where insurers do not engage in systematic preauthorization or utilization review and hospitals and pharmaceutical companies do not form monopolies to profit at the expense of the public.

Largely by reducing administrative costs within the insurance industry and to providers, a single-payer program could save enough money to provide health care to all Americans.

Compared with Canada’s single payer system, American doctors and hospitals have nearly twice as many administrative staff workers.

So whether the ACA remains in force or it’s replaced by something else, I believe we won’t be able to control health costs – and make health care affordable for all Americans – until we revamp the system with something like single payer.

 

 

 

 

San Francisco’s universal health care plan eyed as model for California

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San Francisco’s universal health care plan eyed as model for California

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Maria Consuelo believes she’s alive today because of a groundbreaking program this left-leaning city created a decade ago – one that guarantees health coverage to every one of its 864,000 residents.

It’s made San Francisco the only place in the country where truly universal health coverage exists, similar to what’s available in every other developed nation. Called Healthy San Francisco, it offers health care to those who can’t afford private insurance and are ineligible for other government health programs.

In Consuelo’s case, she visited a government-funded clinic in the fall of 2015 and told a doctor she had pain in her pelvis. Tests later showed cancer in her ovaries, leading to successful surgery to remove them in January 2016.

“This law really helped me,” Consuelo, a 55-year-old mother of five grown children, said while waiting to pick up some medication last week at San Francisco General Hospital. “If it could help others, that would be great.”

A similar thought is percolating in the mind of Lt. Gov. Gavin Newsom, a Democrat who helped implement the plan when he was San Francisco’s mayor.

Now, two years after he launched his campaign to succeed Gov. Jerry Brown, Newsom has been wondering: Would such a program work in every county in the Golden State?

His suggestion comes at a time when proposals for universal health care are receiving a surprising amount of attention. Last week, Sens. Ricardo Lara, D-Bell Gardens, and Toni Atkins, D-San Diego, unveiled details of their bill to create a single-payer system that would cover all California residents – just a few days after Vermont Sen. Bernie Sanders vowed to introduce a bill to launch a similar system nationwide.

Ironically, all of the universal health care buzz is coming after the GOP’s plan to replace the Affordable Care Act with a bare-bones substitute plan collapsed. The Congressional Budget Office had estimated that the Republican plan would have decreased the federal deficit by more than $300 billion, but increased the ranks of uninsured Americans by 24 million by 2026.

But Republicans in Congress are still vowing to chip away — if not replace — the law, commonly called “Obamacare,” which has insured five million Californians since 2014, bringing down the state’s uninsured rate from 17 percent to 7.1 percent in just three years.

Senate GOP Considers Taxing Employer Plans in Bill

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https://morningconsult.com/briefs/health-brief-senate-gop-considers-taxing-employer-plans-bill/

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Washington Brief

  • Senate Republicans are considering taxing employer health insurance plans, but haven’t decided whether to include such a provision in a draft health care bill to repeal and replace major parts of the Affordable Care Act being crafted this week. (The Wall Street Journal)
  • The California State Senate advanced a bill to adopt a single-payer health care system on Thursday, but the measure does not include a way to pay for the $400 billion tab. (The Los Angeles Times)
  • Freedom Partners and Americans for Prosperity, conservative groups affiliated with the Koch Brothers, is urging HHS Secretary Tom Price to take action on “Phase 2” work that would undo parts of the ACA through regulation ahead of Congress passing a bill.

Business Brief

  • Premiums for policies sold on the individual market in Pennsylvania next year are set to increase by 8.8 percent on average, but the state’s insurance commissioner warned that could jump to a 36.3 percent increase if the Trump administration does not enforce certain aspects of the Affordable Care Act. (Lancaster Online)
  • Hospital leaders are concerned that President Donald Trump’s decision to withdraw from the Paris climate agreement could hurt peoples’ health. (Axios)
  • Health insurers participating in models to improve care for beneficiaries enrolled in both Medicare and Medicaid originally struggled to find participants, but new data from the Centers for Medicare and Medicaid Services shows many have overcome that challenge. (Modern Healthcare)

States Where Single-Payer Health Care Could Work (If It Could Work Anywhere)

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https://www.bloomberg.com/view/articles/2017-05-30/states-where-single-payer-health-care-could-work-if-it-could-work-anywhere

Single-payer health care is the dream that just won’t die.

Eight years ago, when President Barack Obama came into office, there were folks on the left who hoped that somehow, his campaign concept of health-care-reform-by-mandate-and-subsidy could be transformed into a single-payer system like Britain’s or Canada’s. When it became clear that this wasn’t going to happen, they latched onto the idea of a “public option” that could, by out-awesoming all the private insurers, function as a backdoor route into a unified government system.

The public option vanished from the final bill, but the dream did not die. In 2014, as Obamacare finally rolled out, Vermont proposed building its own single-payer system, and hearts went a-flutter at the thought that plucky Vermont might show the rest of us how it’s done.

I predicted at the time that the plan would be too expensive, and therefore never go into effect. Eventually Vermont’s government confessed that it was too expensive, and would not go into effect. Vermont was not done with us, however, and in 2016, Vermont Senator Bernie Sanders kind-of-almost-came-close to winning the Democratic nomination on the slogan of “Medicare for All.” He lost to Hillary Clinton, and she lost to a candidate whose platform turns out to look more like “Medicaid for None.”

Hope springs eternal, however, and so do single-player plans. Their last run at the federal government having failed (along with a referendum in Colorado that voters rejected four to one), advocates are back at work in state legislatures. California and New York are both considering plans at the moment, and not just in the “Hmm, interesting. What’s for lunch?” sense. Say what you want about single-payer advocates, but say this too: You can’t stop them with much less than a Howitzer.

Of their plans, there are a few things to say. The first, and most obvious, is that none of them have solved the main obstacle to enacting single payer in the U.S.: the price tag.

California’s New Single-Payer Proposal Embraces Some Costly Old Ways

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http://khn.org/news/californias-new-single-payer-proposal-embraces-some-costly-old-ways/

Three of the dirtiest words in health care are “fee for service.”

For years, U.S. officials have sought to move Medicare away from paying doctors and hospitals for each task they perform, a costly approach that rewards the quantity of care over quality. State Medicaid programs and private insurers are pursuing similar changes.

Yet the $400 billion single-payer proposal that’s advancing in the California legislature would restore fee-for-service to its once-dominant perch in California.

A state Senate analysis released last week warned that fee-for-service and other provisions in the legislation would “strongly limit the state’s ability to control costs.” Cost containment will be key in persuading lawmakers and the public to support the increased taxes that would be necessary to finance this ambitious, universal health care system for 39 million Californians.

Several health experts expressed skepticism about the bill’s prospects in its current form.

“Single-payer has its pros and cons, but if it’s built on the foundation of fee-for-service it will be a disaster,” said Stephen Shortell, dean emeritus of the School of Public Health at the University of California-Berkeley. “It would be a huge step backwards in delivering health care.”

Paul Ginsburg, a health economist and professor at the University of Southern California, agreed and said the legislation reads like something out of the 1960s in terms of how it wants to reimburse providers.

“There’s broad consensus we ought to go from volume to value. This bill ignores all the signs pointing to progress and advocates a system that failed,” he said.

Backers of the Healthy California proposal are pushing for a vote in the Senate by Friday so the legislation can go to the state Assembly and remain in play for this year’s session.

The authors say that their single-payer proposal won’t rely entirely on old-fashioned fee-for-service and that there’s plenty of time for the bill to be amended. According to the authors, some of the criticism in the legislative analysis reflects a misreading of the bill: It would, they say, include some use of managed care.

The Bipartisan ‘Single Payer’ Solution: Medicare Advantage Premium Support For All

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http://healthaffairs.org/blog/2017/05/11/the-bipartisan-single-payer-solution-medicare-advantage-premium-support-for-all/

US national flag flying over Capitol Hill Building in Washington DC

In my last Health Affairs Blog post, I outlined a potentially bipartisan four-step plan to move past the American Health Care Act’s (AHCA’s) disastrous framework toward a more stable, less expensive health care system. For those seeking incremental, near-term solutions, I hope those recommendations provide helpful guidance.

But the AHCA’s reckless drive through the US House of Representatives has taught us something about the current status of health care politics and may have opened the window to more significant, ultimately more successful, reforms. To put it mildly, the public is essentially fed up with debating how to realign the fragmented elements of our Rube Goldbergian system. Its machinations are too complex, its politics too fickle, and its rent is too damn high for the care we are getting.

Where do we turn, then? More complexity? Cutting millions from coverage and shifting more costs to working families? With those options likely to be rejected, as conservative heavyweight Charles Krauthammer recently asserted, we may be heading “inexorably” toward a single-payer system. Poll after poll has in fact shown that a majority of Americans support such an approach. Most recently, an Economist/YouGov survey found that 60 percent of Americans support expanding Medicare to cover everyone, with only 23 percent opposed. If the AHCA defies odds and is enacted, this will only become exponentially truer as its impacts are felt.

But, you are quick to add, there are a variety of deep-seated concerns with a single-payer approach that have kept it out of mainstream political discourse so far. That’s undoubtedly true. They include: It will necessitate massive tax increases; it will cut reimbursement for services to unsustainably low rates; it will be lower quality than the employer-sponsored coverage most Americans currently have; it will consolidate power into the hands of a small number of bureaucrats; etc., etc.

My goal with this post is to demonstrate that a “unified” (punchline: It wouldn’t truly be single payer…), market-driven, federally regulated, privately delivered system need not possess any of these objectionable attributes. In fact, the parameters of such a system are all but staring us right in the face. I call it: Medicare Advantage Premium Support for All (MAPSA).

While any flavor of single payer may be the last thing that comes to mind when contemplating bipartisan initiatives, just as the far left and far right share some libertarian (and other) commonalities, we may have indeed finally come full circle in this tiresome, so-far-futile debate. By combining two shots of conservative orthodoxy with one overflowing progressive one, and stirring slowly, it is not at all far-fetched to envision an endgame cocktail for our health care system that covers everyone, decreases costs, and can pass Congress. Cheers.

California Senate Health Committee approves universal healthcare bill: 5 things to know

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http://www.beckershospitalreview.com/payer-issues/california-senate-health-committee-approves-universal-healthcare-bill-6-things-to-know.html

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A California single-payer healthcare bill is one step closer to passage after approval from the Senate Health Committee, according to a Los Angeles Times report.

Here are five things to know.

1. The bill in question, SB 562, would create a government-run healthcare plan, covering people living in America illegally and all other California residents, according to the report.

2. California would foot the bill for all medical expenses, according to the report. The measure, the report notes, states the program would be paid for by “broad-based revenue,” although exact details on how the program would be funded were not included.

3. Lawmakers had a few ideas on how to implement the single-payer system, including the use of EHRs and securing federal waivers to administer Medicaid and Medicare monies, according to the report.

4. Among the bill’s supporters are labor groups, such as the California Nurses Association, as well as consumer groups and the grassroots group Our Revolution, reports the Los Angeles Times. Opposing groups cited in the report include insurers, manufacturers and the California Chamber of Commerce.

5. One of the bill’s co-authors, Sen. Ricardo Lara, D-Bell Gardens, said a detailed financial study would be completed next month, according to the report.