Blue Mass Group

Reality-based commentary on politics.

Medicare Part E (Everyone in, no one left out) is finally on the table

By

June 10, 2009

The United States Congress finally puts “single payer”–improved and expanded Medicare-for-All–health reform on the table at the HELP Subcommitee (Health, Education, Labor and Pensions) hearing. Click link to view hearing on C-SPAN http://www.c-span.org/Watch/Me…

The House HELP Subcmte. held a hearing examining the merits of a single-payer health care plan, which calls for a single insurance plan to pay for medical costs nationwide. A panel of health care experts, physicians and medical scholars testified in favor and opposition of the legislation. View at http://www.c-span.org/Watch/Me…

It should be up to the American people and NOT the lobbyists, not the big-money campaign contributors and not the advertisers as to what happens next on health reform; what do you think should happen?

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  1. Single payer is not ‘government health care’.  It’s ‘government insurance’.  “Government health care” would be the VA, not medicare.

  2. I know it’s incredibly important that our health care system be fixed, and I would be first in line to kick the insurance industry to the next galaxy.
    My concern is the red tape involved with a medicare type system. I have watched elderly friends driven to tears trying to reach Medicare customer service to resolve problems such as having another insurance company listed as their primary payer when they were no longer covered by that company. It takes months or longer to go through the process to take the old coverage off of your plan so Medicare will pay. In the meantime, claims are rejected, hours are spent on the phone talking to one representative after another, all of which don’t have a clue what your talking about even though you just spoke to them last week. I can’t even bear the thought of going through that, but then, the current system we have is pretty unbearable as well.
    Perhaps if there were no other coverages available to be secondary to, then that would cure one huge difficulty in dealing with a medicare type system.

    • Should be “all of whom” not “all of which”.
      Geez, does it really matter.

    • I recently started collecting Social Security retirement benefits. It was easy to apply for (on-line) and has worked like a charm, starting on time, coming via direct deposit like clockwork. I even changed banks, and the switch in direct deposit was handled by me in minutes on-line, and went into effect immediately. A dream.

      <

      p>In contrast, I have a former employer (I left there in 1980), from whom I am trying to collect my pension. I have been trying for at least 6 months, and I’m not much closer than nowhere. I finally, by writing an indignant letter to a senior executive, got someone to actually call me, instead of referring me to yet another 800 number to be ignored. The woman was very nice, but said I would have to be patient since my records were not computerized, and she would have to authorize a search of their physical archives. “It’s so old,” she said somewhere along the way. Duh. People who retire and want to collect pensions are usually young? This comes as a surprise to them? Were they hoping I wouldn’t ask?

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      p>Sorry, but all my experiences with government agencies (not just SS) have been far superior to their private equivalents.

      <

      p>When I have time, I’ll post a letter from a friend, who complains of the amount of useless paperwork required by the insurance companies that provide MassHealth. She says she has to do about an hour of paperwork for every hour of treatment she provides. Talk about inefficiency!

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      p>More anon.

      <

      p>Meanwhile, sign me up for a government-run insurance plan!

      <

      p>Any day!

    • than the grief people endure through private insurance — something much more than anecdotal.

      <

      p>And when you get that insurance and everything straightened away, a public option or single payer won’t throw you overboard as soon as you have the audacity to actually get sick!

      <

      p>All these complaints are very silly when you factor in just how bad HMOs are in this country. They do everything much worse than single payer ever would — and at least single payer (or  public option) is accountable to the public. If there are improvements to be made, voters can demand them. They could never, in a million years, do the same for an HMO. Single payer exists in most of the developed world; most of the developed world has vastly better health care than us. We’re not even remotely near the top 10. Our private system, which leaves 40-50 million uninsured a year, with another 100+ million having bad insurance, is a complete clusterfuck/FUBAR/failure.  

  3. Such as if I had to choose between a government bureaucrat and an insurance bureaucrat, I’d take the former in a heartbeat.  They are more accountable because if someone is having a problem they can complain to their congressman who will get on the horn and slap some people around.  The insurance industry would not be responsive to that; in fact influence works in the opposite direction with private insurance.

  4. I’ve always been a proponent of single-payer health care.  There’s little reasonable argument that it would be a better solution for the 40+ million people with no insurance at all than a new patchwork of partially subsidized private insurance.  I used to think the obvious merits of this reform would eventually overcome self-interested opposition from the insurance, drug and medical industries.

    <

    p>However, over 15 years removed from the Hillary Care debacle, I think it is pretty clear that I was wrong.

    <

    p>It seems clear to me now that will never be able to transition directly to single-payer.  We may be able to get a larger “public plan option” (Medicare Part B-2?) that is available to everyone.  This would be a great start that could lead to single-payer if done right.  

    <

    p>But (in addition to opposition from powerful corporate interests) I’ve come to realize that inertia plays a more important role than I would have thought.  There are simply too many people with real employer-sponsored insurance (low premium sharing) that the person is happy to keep.  Indeed, a recent Rasmussen poll showed that 70% of insured people rate their own health insurance coverage as good or excellent. Only 25% would support any reform proposal that required a change in their own coverage.
    (http://www.rasmussenreports.com/public_content/business/healthcare/june_2009/congressional_consensus_on_health_care_gets_mixed_reviews_from_public )

    <

    p>Most folks want the government to help cover almost everyone but they don’t want to replace the private insurance system that serves them reasonably well at relatively low direct cost to the employee.

    <

    p>It’s time, Anne, for you to aknowledge these realities too and consider an alternative approach to reform like a robust, highly-subsidized public plan option.

    • There have been some good articles in The New Yorker lately about how government plans in other countries have evolved slowly, and how that’s a good thing.

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      p>Medicare Part B is the poster child for the dangers of making a sudden switch to an all-new plan. Chaos and worse!

      <

      p>Let the government plan compete with private plans. If the efficiencies are there, as I expect they will be, people will gradually switch over. Employers will see the light of day (why pay for insurance when you don’t have to?), and the government plan will become the vehicle of choice. No need to foist it on people. And, probably dangerous to do so.

      <

      p>The Massachusetts experience shows that a patchwork quilt can work, however awkwardly at times. Despire numerous problems, I think nearly everyone agrees we’re better off than we were, even though there is lots of room for improvement.  

      • is if the insurance industry can’t outright stop the public option, they’re going to do everything possible to make it terrible. They’ve already pushed successfully to ensure that the public option pays doctors more than medicare — and thus costs more than medicare. Why should that be written in? What else will be written in? That they can’t charge less than private care? That it, unlike any other government program, must come in at or under budget every year? If the public plan isn’t a good plan and far more affordable than private options, it’ll be a massive failure — and a costly one at that. We’ve got to ensure that it reigns in costs, gives excellent care and that the private markets are the ones forced to compete on an even playing field — no longer allowed to refuse care or charge different rates based on preexisting conditions, etc.  

        • there are public options and there are public options. The question is where exactly did the progressive caucus draw the line in the sand. These are the folks we need to keep the pressure on. The other Dems will have to fall in line, because the public demands reform.

        • I have experience with Medicare from the doctors billing perspective. Medicare does not reimburse doctors for their services 100%. Recently a patient received a drug called avastin that cost the doctor 4K to procure. Medicare reimbursed the doctor 3K. The doctor makes up that loss form private insured patients.

          <

          p>In many cases Medicare denies doctors bills or claims automatically. Then the doctor must start the appeals process to receive payment ( payment again could be less than the services provided) and spend a lot of time and money trying to get a bill paid.

          <

          p>How is that reasonable? How could a system like that work? Medicare is a mess, be careful when touting a system like medicare, it is not working.

          • To learn more about how and why Medicare is not working as well as it could be, I suggest these posts from Maggie Mahar’s Health Beat blog for starters

            <

            p>

            http://www.healthbeatblog.org/…
            The Century Foundation Medicare Reform Working Group

            I am delighted to announce that The Century Foundation has created a working group to look at Medicare Reform.  I’ll be directing it. We’re going to do the work online, communicating with each other on a closed list-serve. In this way, we’ll be able to get a lot done without wasting time traveling to meetings. In the end, we’ll issue a report, and then we’ll get together and host a conference with keynote speakers and panels. (See our Press Release below for more information).

            We’ll be looking at many of the issues I have been discussing on this blog: how physicians are paid; the secretive panel, dominated by specialists, that sets fees; the need to reward providers for quality, not volume; over-paying for Medicare Advantage; overpaying for drugs; unwarranted regional variations in how much Medicare spends in different parts of the country; the need to squeeze the hazardous waste out of the system; the need for a comparative effectiveness institute that is truly insulated from Congress and lobbyists; the need to co-ordinate care; and the need for health IT.

            Our working group is comprised of professionals who understand these problems in depth, and we’ll be recommending how to address these issues. Many of the participants are very politically savvy, and I am hopeful that the people in this working group will be able to draw broad support from other physicians and public health experts. I believe that Congress is ready to act on Medicare Reform….

            And this

            Health Care Spending: The Basics

            JUST HOW MUCH DO PRIVATE INSURERS ADD TO THE NATION’S HEALTH CARE BILL?

            As a nation, we are spending well over $2 trillion a year on health care. This includes: all of the money that you and I pay out-of pocket to cover co-pays, deductibles and drugs; the dollars that you and I (and our employers) fork over for private insurance; the money Medicare, Medicaid and SCHIP lay out to reimburse doctors, hospitals and patients; the billions taxpayers chip in to fund veterans’ health programs, public hospitals, school programs, and health insurance for government employees as well as the money private charities contribute to health care.

            What exactly are we paying for? How much of that money is used to pay the CEOs of drug companies salaries that read like telephone numbers? How much do hospitals eat up?  How much is spent on insurance company ads? How much is used to provide healthcare for the poor?

            I’ve decided to do a series of posts spelling out exactly where the money goes. Today, I’m going to start with private insurance.

            Many people believe that if we just eliminated the private insurance industry, healthcare would become much more affordable. There is a general sense that the “administrative costs” of private insurance are siphoning off a sizable share of our health care dollars.

            There is some truth to that: because we  have  multiple insurers-not to mention so many solo practitioners, small hospitals, clinics, and individuals filing for reimbursement-the paperwork is enormous. If we had only one big insurance company that used just one set of forms we could simplify the paperwork greatly. People who want a “single payer” system, with the government paying all of the bills,  point out that the savings would be enormous.

            And we could cut costs even more if, instead of having tens of thousands of health care providers filing for separate reimbursements, doctors, hospitals and clinics joined together into, say, eight our ten large organizations like Kaiser Permanente, each with its own back office.  The doctors would be on salary, so rather than filing for payment for each service they performed, they would receive a monthly check for taking care of their patients, just as they do at Kaiser Permanent or the Mayo Clinic (where doctors are on salary).

            In other words, it is not only a fragmented multi-payer insurance industry that generates so much paperwork; on the other side of the transaction a fractured network of separate providers adds to a mind-boggling stack of paper. Unlike most other developed countries, we have turned healthcare into a  cottage industry. This gives us lots of choices: we can select from a Chinese menu of insurance plans and proviers. But it also means higher administrative costs. In this post I would like to focus first on just on how much our huge private insurance industry is costing us. (In a later post, we’ll look at the price we pay for a fee-for-service system of independent providers.)…
             

    • We may be able to get a larger “public plan option” (Medicare Part B-2?) that is available to everyone.

      <

      p>Apparently, so does President Obama…

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      p>

      A Town Hall, and a Health Care Model, in Green Bay
      So what we’re working on is the creation of something called the Health Insurance Exchange, which would allow you to one-stop shop for a health care plan, compare benefits and prices, choose the plan that’s best for you.  If you’re happy with your plan, you keep it.  None of these plans, though, would be able to deny coverage on the basis of pre-existing conditions.[ ]
      Every plan should include an affordable, basic benefits package.  And if you can’t afford one of these plans, we should provide assistance to make sure that you can. [ ] ]  I also strongly believe that one of the options in the Exchange should be a public insurance option. [ ]  And the reason is not because we want a government takeover of health care — I’ve already said if you’ve got a private plan that works for you, that’s great.  But we want some competition.  If the private insurance companies have to compete with a public option, it’ll keep them honest and it’ll help keep their prices down.  

      <

      p>And to add to the beauty of this proposal is to fund it by “…rooting out fraud, waste and abuse in both the Medicare & Medicaid system”… and by “….scaling back on how much the highest income American’s can deduct on their taxes”.

      <

      p>This is terrific!

    • We’re actually on the same page, I believe!  You see, AnnEM long ago “acknowledged these realities…” that you refer to and she set to work alongside other activists seeking to build a broader progressive movement for health reform. Case in point, see comments page on BMG including this post http://vps28478.inmotionhosting.com/~bluema24/s…

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      p>For an update on the national reform scene, below are 2 items from EQUAL, a national listserve run by a PhD MPH in health policy out in California. BMG readers might find it a useful resource; EQUAL=Equitable, Quality, Universal, Affordable health care and can join the EQUAL listserve by sending a blank email to: join-equal@list.equalhealth.info

      <

      p>

      On Fri, Jun 12, 2009 at 2:49 AM, Flavio Casoy wrote to EQUAL listserve:

         I disagree with Nick’s (and Claudia’s) political calculation that we must “Hold out for Single Payer”.  I fully agree that Single Payer (SP) is better the a public option.  I would also say that a National Health Service, where both the financing AND delivery are fully public, is better than SP.

         1.
         This health care fight has a dual nature.  One goal is to reform the health care system so that we foster health equity in the country.  The other goal lies in the political situation in Washington.  Last november’s victory was a very positive, very exciting, and very hopeful defeat of the most reactionary, most cynical, and most destructive elements of the right wing.  Their defeat ushered not only the first African American President in our nation’s history, but also a myriad of opportunities to advance a broad progressive agenda that includes healthcare reform in addition to protecting collective bargaining rights, immigration reform, educaiton funding, energy policy, peace, etc.  I think both SP and public option folks can agree that it is senseless to be single-issue minded when it comes to health, given all the social determinants of illness.

         Importantly, with our victory last november we actually created a path to winning a SP system.  While we fought for SP in the dark Bush years, we knew that there was NO way to muster veto-proof support for HR676.  Now, we dont have to.  We can actually see a political path to winning SP.  However, that path is not immediate.  I cite Ellen’s posting on the House of Representatives Math.  We need 218 votes to pass anything in the House, and there are only 206 non-blue dog democrats.  To pass anything in this session, we need at least 12 Blue Dogs or Republicans.  We know we cannot win these for HR676 or HR1200.  In fact, HR676 has 78 sponsors right now…140 short of the necessary 218.

         What will absolutely close the door to SP is a right-wing come back in the midterm elections.  If we loose ground in 2010, SP will be ever more difficult to win that it is now.  Like it or not, this is how our democracy works.  So, Nick, it’s not just winning for the sake of winning.  I am a strong SP supporter, but I believe that our success in winning SP depends on Obama remaining strong and getting stronger.  A defeat for the President and the public option folks is not only a defeat for THEM, it’s a major defeat for US because it puts us on terrible footing for the coming elections.  Furthermore, if we lose on this health care fight, it will be much harder for us to win on tons of other issues that, for our patients, are equally important: immigration reform, education funding, incarceration policy, food policy, affirmative action, occupational safety, environmental safety, reproductive choice, marriage equality, judicial appointments, NLRB appointments, the role of science in policy formulation, etc.

         What is critical now is for all progressive health care activists, SP and non-SP, to come together and fight to get the most advanced demand we can right now and consolidate/expand the victory of last november.  If we don’t do this together, we will all lose.

         2.
         Older SP activists will remember that they too were once called sell-outs for willing to compromise on a national health service and fight “only” for SP.  In fact, as recently as 2005-2006, activists were fighting for HR3000, the “Josephine Butler United States Health Service Act” introduced by Rep Barbara Lee (D-CA).  The act “Establishes the United States Health Service as an independent executive branch entity to provide health care and supplemental health services to all individuals within the United States.”
         Now if we are committed to, as Nick says, “remedying the systemic defects that cause their patients to suffer and die”, than clearly we should be working for HR3000, and not the inferior HR676, which would allow the continuation of the patchwork of for-profit hospitals, dialysis centers, off-site surgi-centers, for-profit imaging, physician self-referrals, non-negotiating with device- and pharmaceutical-manufactureres, and so on.  If we are serious towards creating health equity in this country, we all know we have to go way beyond HR676.  So 15 years ago, why did SP folks “sell out” and react against their more dogmatic friends who were fighting for a solution they were convinced could never win in America?  Is it because they stopped caring?  Or maybe because they desired a political victory more than real reform for their patients?  Why abandon what they know, as evidence shows, works for something more politically feasible?  I think the answer is because politics exist and it matters.  I reject the notion that HR676 supporters care less, or “get it less”, than HR3000 supporters.

         We make the most advanced demand when we can, fight to win it, and in the process build a movement that can make even more advanced demands in the future.  In the aftermath of the Obama victory, there is a huge opportunity to grow our movement, win a robust public option, win single payer, and, yes, win beyond!

         Yours,
         Flavio Casoy, MD
         flavio.casoy@gmail.com

      reply from Ann E Malone to EQUAL listerve

      Dear health justice allies,

      I agree with the dual nature assessment and related political calculation put forth by Flavio; there’s health policy on the one hand and the harsh realities of U.S. politics on the other. The nexus of policy and politics is where “reform” happens. Or not.  We must work for campaign finance reform and other ways to create a better system of politics as an integral part of our fight for healthcare justice.

      We activists do not have to give up our passion for advocating and educating the public and lawmakers-and their staff-about the wisdom and justice of improved Medicare-for-All/ SP reform while we simulataneously link arms with those fighting for “a Medicare-like” public option in order to create a stronger progressive reform movement in this short window of opportunity.

      Those of us who’ve been at this for many years–I’m at 20+ years, ever since my sister developed schizophrenia and the hc system pretty much trampled her and our entire family, then bearing witness to many hc injustices as a nurse for 15+ years–we are called to be the human links between coalitions such as HC-Now (SP) and HCAN (Medicare-like public option alongside strict new regs) in order to build the strongest possible progressive reform movement between now and October 2009.  Four months. Without a groundswell reform movement that is largely united we will not be broad, deep nor strong enough to defeat the Insurance Co’s, big PhARMA, medical supply Co’s and their lackeys.

      The national AFL-CIO is in HCAN and the California Nurses/NNOC is a member of AFL-CIO, correct? Cal Nurses/NNOC is one of the most visible leadership groups spiriting the charge for meaningful reform and they’re in both coal
      itions already, right?

      I respectfully ask individual members, and those in leadership positions of Cal Nurses/NNOC and other groups that also straddle the two major health reform coalitions, to take action and forge links of human and political solidarity across coalitions. Finding a way to come together in solidarity united against our common opponents is essential. This current phase of ongoing healthcare reform is short and we have a real opportunity to make huge strides that will help millions, if we can come together and stay together for the long haul. Thank you for considering this urgent request.  Sincerely, Ann

      —
      Ann Eldridge Malone, RN, Alliance to Defend Health Care “Working together for health justice for all”
      web: http://www.DefendHealth.org
      mobile: 617-784-6367

      • I had not seen these or the other BMG post where you rightly argue that “finding a way to come together in solidarity united against our common opponents is essential.”

        <

        p>We are mostly on the same page, for sure.

        <

        p>Our remaining difference, it seems, is on the wisdom of vigourous advocacy for single-payer given the admittedly “short window of opportunity.”  I do think now is the time (for political reasons and in the interest of national reform that includes a public plan option) to call a temporary halt in advocacy for single-payer and go “all in” on backing the Obama/Kennedy approach to reform.

        <

        p>But that’s a pretty small tactical difference given that we seem to agree that now it is essential to “forge links of human and political solidarity across coalitions” abd, most importantly, that “Without a groundswell reform movement that is largely united we will not be broad, deep nor strong enough to defeat the Insurance Co’s, big PhARMA, medical supply Co’s and their lackeys.”

        <

        p>Together we struggle…

        • I do believe that educating and advocating for “SP” creates the political space for a stronger Medicare-like public insurance option to be included in final the national reform bill of 2009

  5. It’s clear that Obama and the liberals in Congress and everyone at BMG want Medicare to be the ONLY health care system available.  You crave centralized control of the supply and delivery of health care in US.

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    p>Is this preferable to having CHOICE?  Why not have just one brand of toothpaste?  Or one type of PC?  Or one car manufacturer?  Or one TV channel?

    <

    p>Want lower prices?  Competitive choices will lower prices.  When in the history of man has a government monopoly delivered the best product at the lowest price?

    <

    p>Has anyone read gp2b3a’s comment? How is a 75% Medicare reimbursement feasible in the long run? In an effort to reduce cost, the government will begin to restrict medical care.  Is this what we want?

    <

    p>Not me.  I’m happy with my Harvard plan.

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