Health Reform Timeline


Overview of current issues, what’s right and what’s wrong with current law and some very important reference links

OECD Health Data 2014 - Of the 34 OECD (“industrialized”) countries, USA outcomes exceed only the Czech Republic, Poland, Estonia, Slovak Republic, Hungary, Turkey and Mexico. Total health expenditure is by far the highest.

OECD Health Data 2015 - We spend 2.5 times as much per capita as the average of all OECD per capita spending and 40% more than the next most expensive country.

Compare Your Country: Various Health Expenditures of OECD Nations - Guess who’s at the very very top by large margins in almost every category? USA USA USA!!

PNHP: The Facts On How Much Single Payer Would Cost

#cureALL - 7 minute video outlining the case for Single Payer

Physicians For A National Health Program

National Nurses United

Single Payer Action

Single Payer Now

Labor for Single Payer


Stat News: Drug Makers and Insurers Eye An Alliance on Prices - This would be a truly evil development. Wouldn’t happen with Single Payer.


Commonwealth Fund: How High is America’s Health Care Cost Burden? - “Health care costs are unaffordable for 25% of privately insured working-age people. 53% of privately insured people with low incomes have unaffordable health care costs.” 33% of households with incomes above 4 X the Federal Poverty Line found their deductibles impossible to afford. In 2009, this is what our politicians told us was ‘realistic.’ Unacceptable. Wouldn’t happen with Single Payer.


Bloomberg: UnitedHealth May Quit Obamacare In Blow to Health Law - Designed by and for the insurance industry, and yet they are starting to walk.


NYTimes: Many Say High Deductibles Make Their Health Law Insurance All But Useless


NYTimes: Obamacare Not as Egalitarian as it Appears - Another problem that Single Payer would solve.


Common Dreams: Report From Annual Single-Payer Strategy Conference


NYTimes: Why Consumers Often Err in Choosing Health Plans - Wouldn’t happen with Single Payer.


NYTimes: We Mapped the Uninsured. You’ll Notice a Pattern.

Bloomberg: Obamacare Premiums Climb, But Insurers Struggle for Profit - PNHP: “Higher premiums, greater cost-sharing, narrower networks - the behavior of the private insurers is not changing in spite of the promise of higher value and lower costs through the ACA Marketplaces. The ACA exchanges are a creeping failure that is growing worse.”


Woodrow Wilson School of Public and International Affairs and Princeton University: Rising Morbidity and Mortality In Midlife Among White non-Hispanic Americans - Fig. 1 in this report says it all. Midlife deaths among the study group from alcohol/drug overdoses and suicide has skyrocketed since 1999. Midlife deaths among US Hispanics and among 6 other countries with Single-Payer has been steadily dropping. What could be the cause?

PNHP: “The authors suggest that the decline in economic security that began in the early 1970s may be an important factor. Not only have wages stagnated, but retirement security has diminished with a shift from defined benefit to defined contribution pension plans. Lack of higher education has been especially associated with this phenomenon of higher mid-life morbidity and mortality.

A single payer system would help by improving access to preventive health, mental health, and drug treatment services. But we need to do more. We need public policies that distribute the gains in productivity to the workers rather than to the rentiers, plus tax policies that reduce the injustices of income and wealth inequality. We need to ensure adequate education opportunities for all, including industrial arts and training for the service industries, along with assurances of adequate incomes in those fields. In general, we need policies that serve the social good.

To do that we need political leaders who are dedicated to the health and welfare of the people and who would enact policies to ensure that. We need to displace our current political leaders who have dedicated themselves to supporting the military-industrial complex (through more warfare), the medical-industrial complex (through prioritizing support of insurers and pharmaceutical firms above the interests of patients), and the rentiers of Wall Street who are redistributing wealth from the masses to the magnates.

Black Agenda Report puts it a bit more succinctly.

The two largest segments of the Rethug party are 1. Old white people and 2. Tea Partiers (basically the subject of this article). Both segments are dying out. But the Democraps need someone to oppose on election day, just to make it look good. I wonder where that leads.

Salt Lake Tribune: End of Arches Points to Single-Payer - A very short editorial that consolidates many of the reasons why the only rational answer for universal, affordable health care is Single-Payer.


CMS: 2016 Marketplace Affordability Snapshot - CMS celebrates an increase rate for health insurance premiums which is 5% greater than the increase in the consumer price index (CPI-U) increases for medical care services and commodities, and a 7.5% increase over CPI-U for all items.


NYTimes: Thousands Who Didn’t File Tax Returns May Lose Health Care Subsidies - IRS form 8962 with 15 pages of instructions. Don’t file it and you will have to refund all tax credits from the previous year and lose them in the future. A stiff price to pay for folks who even have problems with form 1040A. Wouldn’t happen with Single Payer.


Health Care News: Fareed Zakaria: Health IT Is No Magic Bullet - “There's absolutely no question that when we look at the ability to provide good healthcare at an affordable price, lower levels of massive inequality in healthcare outcomes or provision, a single government payer and multiple private providers is the answer. It's absolutely clear that is the only way you can achieve that goal.”


NYTimes: Insurance Dropouts Present Challenge for Health Law - Wouldn’t happen with Single Payer - Everybody In, Nobody Out.


Washington Post: Financial Health Shaky at Many Obamacare Insurance Co-ops - Bet you didn’t even know these existed. Neither did I until I read this article. This was supposed to be the crumb thrown to progressives after the R&D pols reneged on their promises for a Public Option, which was first said to be the ‘realistic’ alternative to Single Payer. Lie on top of Lie. Once implemented, the pols then changed several ‘rules’ that were actually in the law: 1. Government grants of $10 Million suddenly became government loans which had to be serviced; 2. The the ‘loans’ were reduced to $2.4 Million; 3. Then the co-ops were prevented from advertising (that’s why we didn’t know about them); 4. Finally HHS has increased the amounts that the co-ops have to set aside for reserves. Good bye Co-ops, hello more control for private insurance companies. The whole law has been a corporate farce from the beginning.


Health Affairs: Medicare Advantage: The Healthy Go In and the Sick Go Out and New England Journal of Medicine - Medicare Advantage is a rip-off of the consumer and the taxpayers. The plans look good for new, mostly healthy enrollees because it is heavily subsidized by the taxpayer (thanks to bribes, aka political contributions, paid from insurance companies to politicians) but as soon as enrollees age and begin to need real services, the costs go up and the patients leave. For Medicare Advantage insurance companies it’s a win-win. Wouldn’t happen with Single Payer, because there wouldn’t be a Medicare Advantage, or health insurance companies for that matter.


CNN Money: Bernie Sanders’ Plan for Prescription Drug Prices


NYTimes: Valeant’s Drug Price Strategy Enriches It, But Infuriates Patients and Lawmakers - The root cause of the drug price scandals is the backroom deal negotiated between BigPharma and the Obama administration in the run up to the passage of Obamacare, which specifically prevents Medicare from negotiating drug prices. Under that deal, Medicare has to pay whatever the drug companies charge.


HedgeClippers: Hedge Funds Attack American Health Care - Wouldn’t happen with Single Payer - the monopsony power of Medicare would have the power to negotiate rational drug prices and facilitate needed research.


OECD Report: Fiscal Sustainability of Health Systems - The OECD is the economic organizations of the 34 “first world” or industrialized countries. This particular study finds that: “The United States currently spends a share of its GDP on health care which would seem unthinkable and horrifying to policy makers in any other country.” The US is the only country of the 34 that does not have some form of Single Payer or government subsidized universal health care safety-net system. The most radical plan for the US would be to continue the current insurance company centric health care system. If left uncontrolled, this current system will bankrupt most individuals, companies and county, state and national governments. For further comment on this study, see the comments of Physicians For a National Health Plan.


Kaiser Family Foundation: Employer Family Health Premiums Rise 4%, Extending Decade-Long Trend of Moderate Increases - Here’s yet another lipstick-on-a-pig article designed to cherry-pick the stats. Sometimes the hilarity of these things really gets to me. Sure, for employees of very large firms, the family premiums are rising but not all that fast. But what about deductibles? Take a look at the chart. For the past 5 years, inflation has been flat, worker earnings are flat, premiums are increasing and deductibles have skyrocketed. OINK OINK. Wouldn’t happen with Single-Payer, which doesn’t have premiums or deductibles or co-pays or ‘condition not covered’ or limited networks, etc. It’s paid for with a progressive tax, meaning people who are accustomed to drinking $7,000 bottles of wine would have to pay a little more. Boo Hoo.


Common Dreams: A Consummate Douchebag Illustrates Why Profit-Driven Healthcare is a Broken Model and NYTimes - When the Democraps negotiated Obamacare, one of their decisions was to give Big Pharma the right to do just what this human piece of shit is doing now: set the price of a drug arbitrarily high, with no price negotiation with Medicare allowed, and no sort of anti-trust enforcement, and prevent the production of generics. Now people who need this drug will pay the price or die. This wouldn’t happen with a Single Payer system that gives the government a monopsony and forces drug companies to negotiate all drug prices - like they do it in every other OECD country.

NYTimes: Trapped in the System: A Sick Doctor’s Story - A great narration by a doctor who is also a patient...a captive patient. As usual, Times readers ‘get it’ in the comments section. I always sort by ‘Readers’ Picks.’ People from Canada can’t understand why we do this. But the best comment is about France. I have to quote it, it’s so good:

The opposite of this is the health care system in France. Adam Gopnik wrote movingly of his experience when he son became acutely ill while the family was living in Paris. They went first to the local clinic, were promptly sent to a local hospital, and ended up at the top level trauma center where his son was admitted and successfully treated. Gopnik suddenly realized, when it was all over -- nowhere in the 2-day ordeal was he even asked for identification or insurance. No bills were presented, no credit check, no promissory notes. Nothing. The entire focus of the health care system was to treat his son's condition and make him better -- nothing more, nothing less.

That, friends, is a health care system. The United States does not have a health care system -- it has a "system" that is basically large corporate institutions each trying to extract as much money as possible from the sick people who come in contact with them. We are just basically warm-blooded ATM machines. The mystery is why Americans don't feel empowered to ask for better.

I had the same basic experience in France years ago for a much less serious condition. When I asked for the bill, they at first gave me an incredulous look, and then started chuckling and said, “Oh, you’re from America!”


US Census Bureau: Good News!! 33 Million Americans Still Have No Health Insurance - The richest country in the world still cannot supply universal health care. Even though every other industrialized country in the world does, the Dems and Move-On told us that was not ‘realistic.’ It’s not ‘realistic’ only if the plan from the start was to put the essentially unregulated insurance companies totally in charge.


MPR News: At Community Clinics, Underinsured Replace Uninsured - Also known as health care apartheid...wouldn’t happen with Single Payer.


Kaiser Health News: Medicare Yet to Save Money on Heralded ACOs - One of the ways that Obamacare was supposed to achieve budget neutrality was the ‘streamlining’ that ACOs were going to bring. Hasn’t happened, not going to happen. The way to save $592 Billion per year - enough to cover everyone - is to switch to Single Payer.


Bernie Sanders On His Prescription Drug Affordability Act of 2015 - The Bill itself.


Health Affairs: Health Savings Accounts: Growth Concentrated Among High-Income Households and Large Employers and NYTimes - Using actual tax records, this study shows 4 X as many high-income households have funded HSAs as low-income households. So again we have a highly regressive tax structure benefitting mainly the rich, who can then use the funds for retirement expenses after age 65. It’s a tax policy designed to benefit only the healthy and wealthy. Wouldn’t happen with Single Payer.


Kaiser Health News: Health Care Injustice for California’s High-Needs Children - Wouldn’t happen with Single Payer.


Politifact: Bernie Sanders Repeats Flawed Claim About US Health Care Spending - But if he had slightly re-worded the statement, it would have been exactly correct: The US spends two and one half times as much per capita on health care as the average health care spending of all of OECD nations, and 40% more than the next highest spending country - Switzerland.


ProPublica: Insurance Lobby That Fought Hillarycare and Obamacare Now Has Sturdy Bridges to Democrats - The revolving door continues. Once a government official supposedly looking out for American citizens, now a corporate executive tasked with maximizing profits at the expense of those same citizens - and then back again. Shameful! But just one more example of how corporate America and the two parties are merging into one large indistinguishable control organization. Again, no-difference. The two parties become more identical every day, with only cable-fluff to paper over the obvious. They represent only the ultra-rich at everyone else’s expense.


NYTimes: Tax Filing Problems Could Jeopardize Health Law Aid for 1.8 M - 40% of the 4.5 million people who received tax credits in 2014 are in jeopardy of not only loosing their benefits for 2016, but also of having to pay IRS fines because of complicated filing rules. We now have a financing system requiring IRS rules that can threaten individuals with loss of their health care. That’s wrong. And it would not happen with Single Payer - once in a lifetime simple registration, financed by individuals’ ability to pay, overhead reduced from 20%+ to 3% with enough savings every year to pay for everyone’s health care, everybody in, nobody out, no exceptions.


AMA Journal of Ethics: Poll Medicine in the Marketplace - Preliminary results: 98% favor Single Payer.


PNHP: Why “Skin In The Game” is Both Wrong and Counterproductive


Harper’s Magazine: Wrong Prescription? The Failed Promise of the ACA - Great article! Ranks right up there with Bitter Pill. Many great points here; one is that instead of being the ‘stepping stone to Single Payer,’ the frustration level is so hight that it could push back the general acceptability of Single Payer for decades. For most Americans, ‘health reform’ is now a dirty word.


CNN Money: Anthem to Acquire Cigna, Leaving Only 3 Big Insurance Companies - This follows right on the heels of the Aetna-Humana merger 2 weeks age. As Robert Reich has already stated, either we get Single Payer or we’ll have one big monopoly insurance company. That does not fit within the definition of “free market.”


Medicare Resources: Priceless Safety Net Reaches Golden Anniversary - ....but there’s an existential threat

Carleton University: Medicare Part D Pays Needlessly High Brand Name Drug Prices Compared With VA and Other OECD Countries - Part of ACA included provisions that prevented Medicare from using its monopsony power to negotiate with Big Pharma. As a result Medicare Part D participants pay some of the highest prices in the US and the world.

Kaiser Health News: Good News, Bad News in Medicare Trustees Report - The corporate Democrat and corporate Republican assault on Medicare continues. High income individuals will see their Medicare Part B premiums rise - some by as much as 50% - next year. The alternative would have been to fund the increased costs of medical care in the US for seniors from general revenues, where much of it comes from already. The result? More of those with high incomes will shift from Part B to either Part C (Medicare Advantage and Here and Here) or the individual market place - slowly starving public Medicare and eventually moving everyone into the clutches of private insurance companies. Part C seems very desirable to seniors right now, but once this plan is completed, there will be no limit on how much the insurance companies can charge or how little care they will provide. The one-payer, and thus strong cost negotiating feature of current Medicare, which has been successfully holding down costs for seniors will no longer exist.


NYTimes: Labor and Employers Join in Opposition to ACA Cadillac Tax - The tax is not calculated on the amount of benefits. It is based on the cost of the plan. As costs are increasing rapidly, more and more plans fall under the additional tax. Those with specific health problems will have to pay considerably more. The alternatives for employers are plans that cost less and offer little in the way of protection. This is all part of the general problem with kludging together a law that allowed a few more people to get insurance - not necessarily additional health care, but kept insurance companies in charge (while transferring $$ billions directly from the US Treasury into the insurance company coffers). The solution is simple.


NYTimes: Beware the Fine Print In Your Health Insurance Policy


NYTimes: Head of Obama’s ACA Rollout Takes the Revolving Door to Lobby for Insurers - Former United Health Group exec moves in to take her place. What this is about is the privatization of Medicare. All of these people are working hard to fund private Medicare Advantage (Medicare C) with $Millions in overpayments and Here and Here, courtesy of the taxpayers, which allows insurance companies to increase profits and offer these private plans to the public at way below costs. They are slowly bleeding public Medicare (A & B) dry. Guess what happens to costs and services for enrollees as soon as private insurance companies control the entire program.


Duke Univ. Journal of Health Politics, Policy and Law: Point-Counterpoint: ACA vs Medicare For All - Just read the first paragraph of the Abstract, which says it all. PNHP: “You do not compromise clearly superior policy to conform with the dysfunctional politics, but rather you change the politics in order to support optimal policy.” Or in the words of Joe Hill: “Don’t Mourn...Organize!”


Robert Reich: The Choice Ahead: A Private Health Insurance Monopoly or Single Payer


NYTimes: Health Insurance Companies Seek Big Rate Increases for 2016


Truthdig: The Fight Over Obamacare Was a Giant Political Charade - It’s not about protecting sick people. It’s about protecting health insurance markets, hospitals, pharmaceuticals, and medical corporations. It is a direct transfer of hundreds of $ billions directly from the US Treasury to corporate coffers in exchange for profit-based “managed care.”

Among the losers are Americans who remain dependent on their employers for health insurance and those who have bought plans from the ACA’s exchanges but pay through the nose for minimal coverage. Even plans available to those who used to be denied them because of pre-existing conditions are expensive and the deductibles extremely high.

Most unfortunate of all are the nearly 13 percent of Americans who remain uninsured.”

None of this would be happening with Single Payer paid for with a progressive tax; Everybody In, Nobody Out. No narrow networks. No premiums, deductibles, co-pays, conditions not covered, etc. Elimination of the 20-30% profit skimmed of the top by the insurance companies and replaced by the 3% overhead of Medicare.


ProPublica: A Pharma Payment A Day Keeps Docs’ Finances Okay

Sojourners: ‘It’s the Prices, Stupid’: An Interview With Health Policy Expert Gerard Anderson - Anderson is a professor of health policy and management and professor of international health at the Johns Hopkins University Bloomberg School Public Health, and professor of medicine at the Johns Hopkins University School of Medicine.


Sojourners: What are some of the most important causes for why the U.S. is paying a lot more than other wealthy countries [in the OECD] for health care without getting improved results?

Anderson: A higher health-care cost is pretty much because of what I call, “It’s prices, stupid.” We just pay approximately twice as much for each good and service that we utilize in the U.S. vis-a-vis other industrial countries. In fact, for a hospital visit it’s about three times more than other industrialized countries for a similar visit — in a shorter period of time that you’re in the hospital, we still spend about three times more. So it seems to be that we just pay more for identical services compared to other industrialized countries.

Sojourners: Why?

Anderson: Because, in most other countries they have a single purchaser, which is a very tough negotiator, whereas in the United States we have so many different purchasers that nobody has a lot of power.

Sojourners: If you didn’t have to think about political realities at all, what health-care policies would you suggest the U.S. adopt?

Anderson:  Basically, that everybody has the same health care and access to the same health care.

Sojourners: Through a single-payer system?

Anderson:  Well, that’s the payment side. And then access to the same delivery system as well.

Sojourners: So, both single-payer and a standardized quality of care?

Anderson:  Correct.

WHO: Cuba Is First Country to Eliminate Transmission of HIV and Syphilis From Mother to Fetus - Their success is attributed in part to “an equitable, accessible and universal health system in which maternal and child health programs are integrated with programs for HIV and sexually transmitted infections.” In other words: They were able to accomplish this result because they have Single Payer. Why don’t we?

Washington Post: Towers Watson Merges With London-Based Consulting Firm in $18 Billion Deal - This is but one example of the current wave of mergers going on in the health care industry. More mergers equal fewer competitors, less competition, higher prices and degraded services for sick people. In addition, this one is taking a huge US firm overseas where it’s tax rate will go down from 34% (paid to the US Treasury) to 25% (paid to the UK). “Many independent analysts believe that this is just the start, and that the business is at an inflection point, with the total market likely to grow significantly within five to seven years.” Translation: more US businesses are pushing their employees into health exchanges which is what Towers Watson specializes in. Bottom line: The longer we wait to establish a Single Payer system, the richer the C-level employees and Boards of Directors will become, the poorer we’ll become by having to either forgo health care that we need or spend a lot more for it, and the worse the overall US health care delivery system will become. Obviously all this goes away with Single Payer. There are no exchanges. Everybody’s in automatically, nobody’s out. Single Payer is financed by progressive taxes, not taxpayer subsidies.


New England Journal of Medicine: The Elusive Right to Health Care Under US Law - “Is there a right to health care in the United States? No U.S. Supreme Court decision has ever interpreted the Constitution as guaranteeing a right to health care for all Americans. The Constitution does not contain the words “health,” “health care,” “medical care,” or “medicine.” But if we look deeper, a more nuanced picture emerges. The Court has found rights to privacy, to bodily integrity, and to refuse medical care within the vague right to “due process” contained in the Constitution. The Court has also constructed a right to decide to terminate a pregnancy, although it has also ruled that the government has no obligation to subsidize the exercise of this right. When this line of cases is considered together, it would appear that the U.S. Constitution provides scant affirmative obligation to provide health care.

Despite the absence of a universal right to health care in the Constitution, Congress and the Supreme Court have incrementally crafted an incomplete web of health care rights during the past 50 years. In prisons and emergency rooms across the country, physicians and medical institutions have for decades been required to provide medical care. In a 1976 landmark decision in Estelle v. Gamble, for example, the Supreme Court found a right to adequate medical care for prisoners grounded in the Eighth Amendment of the Constitution.


It is notable that all three of these litigation efforts against the ACA — the 2012 ruling on the individual mandate, the 2014 ruling in Hobby Lobby, and the forthcoming ruling on subsidies for exchange participants — arise from the devolved structures of American health governance; none of the three issues would be valid constitutional or statutory objections to a taxpayer-financed single-payer system. As the Court ruled in Hobby Lobby, religious objections to general taxation used to finance national imperatives are not protected as strongly as the specific claim of Hobby Lobby against the regulatory mandate of the ACA. Perhaps paradoxically, under the Court framework, a completely single-payer system is more constitutionally sound than the ACA statutory design, which aims to preserve a private institutional role in the health care system.”

PNHP: Subsidies Upheld, But Health Needs Still Unmet


Commonwealth Fund: How Insurers Competed In ACA’s First Year - 1. By ‘cost sharing’ meaning raising premiums, co-pays, deductibles, and exclusion of coverage (aka condition not covered), and 2. narrowing doctor and hospital networks - so basically finding ways to prevent sick people from getting the care they need. From the OECD data at the top of this page, we know that the US has one of the poorest health care systems in the world in terms of outcomes at by far the highest costs and rising. A July, 2013 shows that because of insurance company bureaucracy and overhead, we could save $592 Billion per year by switching to Single Payer, cover everyone and still have enough left over to pay down the national debt and Here and Here. By staying with ACA, 30 million people still won’t have health insurance and at least another 30 million will be under-insured, a fact they will only realize when they need advanced care. Yet so-called ‘business experts’ keep telling us that increase competition always leads to better quality service at reduced cost to the consumer. That is not happening. None of this would be happening with Single Payer.


HuffPo: Robert Reich: Medicare Isn’t the Problem, It’s the Solution - But here’s why a public option would not be a viable interim measure.


Journal of General Internal Medicine: Illegal Immigrants Prolong The Life of Medicare Trust Fund and PNHP - Yep you read that right. In 2011, they paid in $3.5 Billion more than they used. “Unauthorized immigrants are mostly working age, have high rates of labor force participation, and hence contribute substantial payroll taxes. Medicare outlays for unauthorized immigrants are low because they are ineligible for Medicare benefits.”


Health Affairs: Medicare Advantage Members’ Expected Out-of-Pocket Spending For Inpatient and Skilled Nursing - Many members of Medicare Advantage plans have zero premium policies. For many of these members, when needed, inpatient or skilled nursing needs will be unaffordable because of high deductible and co-pays. This would never happen with Single Payer since with SP, there would be no premiums, co-pays or deductibles. All services would be paid through a progressive income tax. For the country as a whole and for individuals, the increased taxes would be more than offset by the savings over current insurance costs.


Public Citizen: Three Burning Questions About the Leaked TPP Transparency Annex and its Implications for US Health Care - Bottom line: If Fast Track/TPP passes, pharmaceutical and medical device corporations will be able to control markets and prices at home and abroad. The implications are horrendous. This bill has already passed the Senate. It comes before the full House in a couple of days. If you haven’t contacted your Representative, you should do so. One quick call is all that is necessary.


Health Affairs: Extreme Markup: The Fifty US Hospitals With the Highest Charge-To-Cost Ratios - 49 of the 50 are for-profit hospitals. Single Payer calls for the conversion of for-profit health care delivery of all types to be converted to non-profit. This is a prime example of why.


NYTimes: In Vermont, Frustrations Mount Over Affordable Care Act - This article is simply stating the obvious, and it’s not just Vermont. Just one more piece of evidence that ACA is NOT a ‘bridge to Single Payer.’ The frustration is nationwide, with the result that for most Americans, “health reform” is now a dirty word. The Republicans/Democrats and their health insurance, Big Pharma corporate backers have scored a huge victory over proponents for Single Payer. Corporations will be in control of our health care for decades.

Miami Herald: Florida House Rejects Senate Health Insurance Expansion Plan But Florida Legislators Benefit From Heavily Taxpayer Subsidized Health Insurance


HHS: March Effectuated Enrollment Consistent With Department’s 2015 Goal - It was my goal to run a 6 min. mile. However it took me 8 min. So naturally, I changed my goal...and boom! my run was consistent with my goal.

PNHP Response: ““Effectuated” enrollment in the ACA exchange plans is an evasive term to obscure the fact that 13 percent of those enrolled for 2015 had already dropped out by the end of the first quarter. Also, when they decided that previous anticipated levels of enrollment were unrealistic, they set a lower goal which they now report that were able to meet. Surprise!

They do concede that exchange plan enrollment is inherently unstable, as with “other well-functioning insurance markets,” they state. Not only do large numbers of eligible individuals fail to attempt to enroll, but changing circumstances and eligibility cause attrition in enrollment, especially for those who find that they are unable to pay their share of the premium.

If we really want everyone insured, this clearly is not the way to do it. “Well functioning insurance markets” that leave tens of millions uninsured is not a standard that we should accept. Enrollment should be automatic for everyone, for life. Single payer is what we need.”


Bloomberg: Top Cancer Specialist Leads the Attack on Astronomical Drug Prices

NYTimes: Seeking Rate Increases, Insurers Use Guesswork - Seeking increases between 25-75%. Wouldn’t happen with Single Payer because insurance companies and insurance premiums, co-pays, deductibles, conditions not covered, etc etc would not exist.


Health Affairs: The Post-Launch Problem: The Affordable Care Act’s Persistently High Administrative Costs - $273.6 Billion through 2022 which will be transferred directly from the US Treasury to private insurance company coffers, which have a built in 20% overhead as opposed to traditional Medicare which has only 3% overhead, as explained in this article.

WSJ: Blue Cross, Blue Shield: Illegal Cartel?

Politico: New York State Assembly Passes Single Payer


Commonwealth Fund Biennial Health Insurance Survey: The Problem of Underinsurance and How Rising Deductibles Will Make It Worse - Wouldn’t happen with Single Payer - there are no deductibles, premiums, copays, service not covered, not to mention tiny networks associated with Single Payer.


Milliman: 2015 Milliman Medical Index - Synopsis: In 2015, the cost of healthcare for a typical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan is $24,671 according to the Milliman Medical Index (MMI), climbing 6.3% in 2015. The U.S. median annual household income in 2015 is approximately $53,800. The amount will almost certainly surpass $25,000 in 2016. Costs for the typical family have more than doubled over the last decade. Prescription drug costs spiked significantly, growing by 13.6% from 2014 to 2015. The total employee cost (payroll deductions plus out-of-pocket expenses) increased by approximately 43% from 2010 to 2015, while employer costs increased by 32%. Based on these numbers one has to conclude that more and more people will be unable to afford health insurance and health care in the future.


International Foundation of Employee Benefit Plans: Survey of Impact of ACA on Employer Sponsored Health Plans - Results: The majority of employees in America continue to have employer sponsored health plans. Because of the ‘Cadillac’ provision in ACA, employers are taking measures to stay below the premium threshold that would trigger the associated excise tax. In order to do that they are forced to sign up for plans with very high out-of-pocket costs. Result: price of health care goes up, networks get more narrow, many employees are priced out of coverage. Wouldn’t happen with Single Payer because insurance companies would play no part and there would be only one monopsony purchaser for all health care services.


Families USA: Forgoing Health Care Because of High Out-Of-Pocket Expense - Wouldn’t happen with Single Payer.

Bloomberg Health Care Blog: Blue Cross Executive Warns of Higher Premiums in 2016 - Even though ACA proponents said it would never happen, adverse selection is alive and well.


Politico: Nurse Confessions: Don’t Get Sick in July - And don’t be poor.


Center For Public Integrity: Court Case Shows How Health Insurers Rip Off You and Your Employer


Health Affairs Blog: The TPP: A Threat to Global Health


Vocal-NY: Hedge Fund Managers Cash In On Predatory Drug Pricing and Hedge Clippers and PNHP - Hedge fund managers that almost went to jail for insider trading, but Obama/Eric Holder/Loretta Lynch said they broke no laws. They charge as much as $1,125 per tablet or $94,500 for a course of lifesaving treatment. Another benefit of ACA.


Washington Post: Almost Half of Obamacare Exchanges Face Financial Struggles - States that actually did get their exchanges up and running are facing maintenance cost increases. These costs are passed to the insurers, who in turn pass them on to the consumer, plus the 20% overhead that Obamacare entitles them to charge. And if the Whore Court rules in favor of Burwell at the end of June, these exchanges will become all the more important as they will be the only ones left that will allow consumers to get the premium subsidies. Wouldn’t happen with Single Payer because with Medicare for All there would be no exchanges and no insurance companies. Will we ever learn?


NYTimes: Insurers Flout Rule Covering Birth Control, Study Finds - Once again insurance companies stand between people and their doctors. Wouldn’t happen with Single Payer, because insurance companies would have no role.


WSJ: Pharmaceutical Companies Buy Rivals’ Drugs, Then Jack Up Prices - ...sometimes by as much as 525%...and charging over $1,000 per tablet. It is the appropriate function of government to regulate such activities, but PPACA gave away all of that control. Because the government would be a monopsony purchaser, this wouldn’t happen with Single Payer.


ABC News: Teva Offers to Buy Mylan for $40 Billion - If this gets past regulators, it will be the end of cheap generics. Big PHarma got a front row seat during the negotiations for Obamacare. Now their investment is paying off big time. See yesterday’s entry - this wouldn’t happen with Single Payer since there would be no advantage for either company.


Boston Globe: Attorney General Investigates Rising Price for Drug That Reverses Overdoses - Another example of outrageous drug pricing by Big Pharma. The more essential a drug is to patient survival, and the more one or a few companies can control its production, the higher the drug companies raise the price. It’s called price gouging. A proper role for government would be to curtail such activity. Under a Single Payer system, the government would be the monopsony (only) purchaser, so it could exert the proper control. Just another example of a situation that wouldn’t happen with Single Payer.


Healthcare-NOW: If The Fire Department Were Run Like Healthcare - You gotta watch this 40 second video.


Huff Po: Why The Private Health Insurance Industry Has to Go


CMS: Moving Medicare Advantage and Part D Forward - Comment: The march towards Medicare privatization continues, aided by both Dems and Rethugs. Instead of increasing the Medicare Advantage (private plan Medicare) payment rates by 1.05% as previously mandated, CMS decided - in response to heavy lobbying by AHIP, the medical insurance companies’ lobbying arm; the same people who literally wrote the rules for Obamacare and then delivered it to Max Baucus to pass - to increase the rate by 3.25%, courtesy of US taxpayers.

This is how the private insurance corporations can offer their version of Medicare, with greater benefits and lower out-of-pockets at below market rates. If you don’t believe they are below market, compare the cost of a Medicare Advantage plan to a similar private plan offered in the non-Medicare market.

The object of this game for the insurance corporations is two-fold: 1. Make more money now by retaining most of the increased reimbursements (not passing it on to providers), and 2. make more money later by pricing Medicare Advantage so low that enough people will move into it so that regular Medicare essentially ceases to exist. So in the future look for all of the ‘Happy Healthy’ to move into Medicare Advantage and the truly sick, poor and disabled will be forced to stay in regular Medicare, with ever lessening benefits. PNHP Comments.


Harvard Med. School/CUNY - ACA Has Not Cut Insurance Companies’ Overhead - In fact it’s actually increased since now they are allowed to include most overhead under “quality improvement” and “community benefit,” and then charge an additional 20% on top of that. In a nutshell: for every dollar you pay in premium, 20 cents goes to pay the salaries of people whose only job is to deny you the health care you need.


Healthcare-NOW: Insurance Companies Still Find Ways Not to Cover Pre-Existing Conditions


Health Affairs: Reflections On the 20th Anniversary of Taiwan’s Single-Payer National Health Insurance System


PNHP: Health Law’s Complexity Invites Attack, Even As It Fails To Cure the Ailment - “King v. Burwell threatens to add more than 8 million people to the ranks of the tens of millions who are currently uninsured, leading to 8,000 ‘excess deaths’ annually linked to lack of insurance.”

ProPublica: Behind Supreme Court’s Obamacare Case, A Secret Society’s Hidden Hand - See also New Yorker: Money Unlimited - How Chief Justice Roberts Orchestrated the Citizens United Decision.

Center for American Progress: The Great Cost Shift: Why Workers Do Not Feel the Health Care Spending Slowdown


H&R Block: 52% of Those Receiving Tax Credits for ACA Premiums Will Face an Average $530 Tax Repayment Charge - PNHP: “Under a single payer system, there is no premium to be paid and thus no need for subsidies based on income. It is much simpler and even more equitable to fund the entire system through progressive taxes.”


International Journal of Health Service: A Five Year Assessment of the Affordable Health Care Act - Abstract excerpt: “This article compares the goals and claims of the ACA with its actual experience in the areas of access, costs, affordability, and quality of care. Based on the evidence, one has to conclude that containment of health care costs is nowhere in sight, that more than 37 million Americans will still be uninsured when the ACA is fully implemented in 2019, that many more millions will be underinsured, and that profiteering will still dominate the culture of U.S. health care. More fundamental reform will be needed. The country still needs to confront the challenge that our for-profit health insurance industry, together with enormous bureaucratic waste and widespread investor ownership throughout our market-based system, are themselves barriers to health care reform.” Full Report. The PPACA is one of the most complex and convoluted laws ever passed - which insured all forms of market gaming. It is past time to scrap it and replace it with the much more simple concept: Improved Medicare for All.

Bloomberg: Out of Pocket, Out of Control


NYTimes: Insured But Not Covered - And check the comments. Click on ‘Reader’s Picks.’

NYTimes: Health Law Case Poses Conundrum for Republicans - They sue to destroy the law and then demand to know what Obama’s going to do about their destruction. Silly. But long time followers of this web site will remember that a recurring theme has been that all of the ‘advantages’ of Obamacare are only there so that politicians of both corporate parties can reap campaign contributions for slowly removing them all.


Copernicus: How Obamacare is Unsustainable and Why We Need a Single-Payer Solution for All Americans


The Hill: New Poll Finds Majority Still Supports Single-Payer


Commonwealth Fund: Over 60 Million Americans Still Face Medical Related Financial Difficulties


New England Journal of Medicine: Medicare at 50 - Origins and Evolution - Or What We Need to Do to Improve It and Make It Universal. Here’s what.


60 Minutes: What Obamacare Doesn’t Do - Cost Control. A great summarization of the cost of health care in the US. But Stephen Brill never talks about the cure, which of course is Single Payer. Brill wrote a similar article for Time magazine “Bitter Pill” about how hospital corporations, Big Pharma are blatantly ripping off sick Americans. The sicker, the more they are cheated, and nothing about this has changed with the implementation of Obamacare.

BioMed Central: $375 Billion Wasted Every Year On Billing and Health Insurance Related Paperwork and Here - Over $1 Trillion every 3 years - enough to cover all that are uninsured today plus upgrade coverage for all that are under-insured, with no increase in overall US health care spending.


PNHP: What Happened in Vermont - A detailed look at what Gov. Shumlin was trying to do, why it was not really single-payer (it was a public-private hybrid), and how the insurance companies mobilized in the background to undermine the effort. No state program can achieve single payer because even in the best case it would still have to compete with Medicare, Medicaid and the VA’s Tricare programs - and federal law prohibits the states from outlawing private insurance plans entirely. Vermont’s attempt veered even further away from the single payer concept - mainly because Shumlin appointed an insurance industry insider to head the board that was to come up with detailed implementation plans. It went downhill from there. But the important point to remember is: It was not single payer, and without the economies of scale that national single payer affords, state plans are severely hampered.


ProPublica: How To Investigate Health Professionals - A state by state guide


ProPublica: When Medical Debts Become an Impossible Burden - Without Single Payer in the USA, regardless of health insurance, we are all just one major illness away from homelessness. Can we really be called a ‘civilized society?’


William J. Clinton Presidential Library: Recently Released Documents: Hillary Clinton’s 1994 Statements On Health Care Reform - “I believe that by the year 2000 we will have a single payer system. I don’t think it’s — I don’t even think it’s a close call politically. I think the momentum for a single payer system will sweep the country. And regardless of the referendum outcome in California, it will be such a huge popular issue in the sense of populist issue that even if it’s not successful the first time, it will eventually be. So for those who think that building on the existing public-private system with an employer mandate is radical, I think they are extremely short-sighted, but that is their choice.” More docs (search engine available):


Natl. Bureau of Economic Research: Can Health Insurance Competition Work? - Me: It’s always amazing to me how many hoops biased observers will jump through to try to ‘prove’ that something is true which is not. PNHP comment: “This technical paper is not worth reading. It was apparently written with the intent of proving that private Medicare Advantage plans show that health insurance competition works. Numerous assumptions were made while largely ignoring the gaming of insurers through favorable risk selection and upcoding for risk adjustment. With all of the authors’ efforts to prove the efficiencies of managed competition through private Medicare Advantage plans, they still showed that this program resulted in “an even larger net cost to taxpayers.”

We need to lay managed competition to rest. Single payer, now.”

Upton Sinclair: “It is impossible to get a man to understand something, when his salary depends on his not understanding it.”


Portside: Why Did Swiss Voters Reject Single-Payer Health Care? - This is a long article that must be read completely in order to understand the dynamics of the current Swiss system vs. that in the US. But basically the reasons are that

1. the Swiss system of health care today is far superior to Obamacare; insurance companies are forbidden from making a profit on medically necessary care - what we call the ‘Cadillac’ plan and there are no ’networks’ all doctors and hospitals are ‘in the plan';

  1. 2.this referendum comes up annually for the Swiss and more and more (though not yet the majority) of Swiss voters are steadily voting for Single Payer and

  2. 3.the insurance industry in Switzerland, like that in the US, is becoming more and more powerful and doing a better job of controlling the propaganda. Bottom line: It’s eventually going to happen there and it’s eventually going to happen here.


NYTimes: As Medicaid Rolls Swell, Cuts in Payments to Doctors Threaten Access to Care - "The Affordable Care Act provided a big increase in Medicaid payments for primary care in 2013 and 2014. But the increase expires on Thursday — just weeks after the Obama administration told the Supreme Court that doctors and other providers had no legal right to challenge the adequacy of payments they received from Medicaid.”

Doctors will now see their fees for primary care cut by 43%. Result? Fewer and fewer doctors are going to accept new Medicaid patients. Doctors that stay in the program are therefore going to see proportionally more and more Medicaid patients, squeezing out time they would normally devote to non-Medicaid patients - the beginning of a death spiral.

This is what ‘the lesser of two evils’ and ‘don’t let the perfect be the enemy of the good’ got us. This is what ACA, MoveOn and the Democratic party called ‘realistic.’ 

Exactly what this web site has been pointing out since Feb. 2009.

Wouldn’t happen with Single Payer.


ProPublica: Nonprofit Hospitals Seize Patient Wages - ...which causes them to loose their homes. “We will be paying them off until we die.” Wouldn’t happen with Single Payer.


NYTimes: US Healthcare Lags Worldwide For Those Over 65 - But “It’s definitely a better picture than when we look at the US population generally...” and Americans generally arrive at 65 sicker than people of other countries.


Health Affairs: Two Theologies Have Blocked Medicare-For-All - Synopsis: Actually two myths. ‘Managed Care’ and ‘Competition.’ They have now both been tried and failed. Time to get past the myths and implement Single Payer.

CFPB: Consumer Advisory: 7 Ways to Keep Medical Debt in Check - Actually there is no way to do that, but it’s worth noting that 52% of all collection accounts are for medical debt, “far outpacing all other types of debt.” Single Payer would make all of this moot.


NYTimes: The Health-Cost Slowdown Isn’t Just About the Economy - A totally bogus article, but check the comments. Sort by “Reader’s Picks.” The author doesn’t get it. The people do.


ProPublica: Using an Exchange Health Care Plan? Check the Fine Print. They’re Changing.


The Hill: Tom Harkin, Co-Author of ACA Says “We Blew It” - “We had the power to do it in a way that would have simplified healthcare, made it more efficient and made it less costly and we didn’t do it. Congress should have enacted single-payer right from the get-go or at least put a public option would have simplified a lot. We had the votes to do that and we blew it.” Exactly what this web site has advocated from the very start (2/15/09). Absolutely stupid and galling!


NYTimes: Underinsurance Remains Big Problem Under Obamacare - “In fact, it may be helping to spread it.” Duh!


NYTimes: Suit on Health Law Puts Focus on Funding - Since the ‘negotiations’ began on the ACA in 2009, this site has pointed out that the few benefits of this law were delayed until 2014 so that legislators could slowly whittle them away in return for more and more contribution money. This is the latest phase. Now the exchanges, which most lower and middle income families depend on to afford the skyrocketing total out-of-pocket costs, are under attack in the Kabuki theatre sometimes referred to as Congress. If this suit is successful, and there is every reason to believe that it will be, millions more Americans will be priced out of the market. Initially, the Dems called it universal and affordable health care. Then later they just called it expanded. Now it won’t even be that. Just more promises followed by bait-and-switch. Wouldn’t happen with Single Payer.


Gallup: Cost Still A Barrier Between Americans and their Doctors - Among other interesting findings: 34% of Americans with private health insurance reported putting off needed medical treatment in 2014, up from 25% in 2013. 57% without any health insurance reported putting off treatment. For those who reported putting off treatment, 22% rated the forgone treatment as ‘for a serious condition,’ the highest number ever recorded by this yearly survey. And yet we pay the highest total cost for health care of any country in the world, and we have a lower life expectancy and poorer overall outcomes than most of the other OECD countries.


Georgia Health News: Grady, Blue Cross At Impasse as Contract Expires - Grady, home to one of the nations best trauma centers, is now out-of-network for those with Wellpoint or Blue Cross, Blue Shield health insurance. So as they pay higher premiums and out-of-pockets and find that less is covered, they also have to hope they don’t get in a car wreck. Wouldn’t happen with Single Payer.


NYTimes: ACA Recasts Insurers as Obama Allies - ‘Recasts’? I think we’ve known all along who his, and the Democrats, friends are - same as the Rethugs without the histrionics.


NYTimes: Cost of Coverage Under ACA to Increase in 2015 - In some cases by as much as 20%. Obama and the Democrats put the insurance companies in charge and this is what happened. MoveOn helped them prevent the Public Option, after refusing to even hear about Single Payer. This is their version of “realistic.” Wouldn’t happen with Single Payer.


Washington Post: Who is Jonathan Gruber? and J Turley - He was Obama’s top advisor for ACA. Here he is at a conference stating that the passage of Obamacare relied on “the stupidity of the American voter” and that the “lack of transparency” during the process was “crucial.”


NYTimes: Providing Health Insurance Still A Struggle for Small Businesses - Wouldn’t happen with Single Payer.


JAMA: Medicare Advantage Plans Are Lying About Their Networks

Center for Public Integrity: Another Whistleblower Suit Alleges Medicare Advantage Fraud - More sham ‘treatments’ used to collect inflated fees. Part of a pattern of denying reimbursements for treatments and drugs and limiting choices for consumers and padding overpayments from the federal government and Here and Here and Here and Here and Here.


JAMA: Health Care Price Transparency and Economic Theory - “the much ballyhooed consumer-directed health care strategy so far has been more a cruel hoax than a smart and ethically defensible health policy.”


NYTimes: Unable to Meet the Deductible or the Doctor - It’s called health care apartheid and it wouldn’t happen with Single Payer.


Associated Press/Univ. of Chicago: Privately Insured in America: Opinions on Health Care Costs and Coverage - A significant and growing minority of Americans with health insurance, more than 16 million people, are concerned that they will not be able to afford their medicals bills, don’t go to the doctor when they are sick, have reduced their savings and retirement plans in order to pay medical bills. 1 in 4 with high deductible plans state that they have gone without food or have exhausted their savings due to health care costs. And we still have 30 million Americans without any health care coverage at all. Are we truly a civilized society when this is going on? Wouldn’t happen with a well designed Single Payer system.


NYTimes: US Finds Many Failures in Medicare Health Plans - Referring to Medicare Advantage


NYTimes: Walmart to End Health Coverage for 30,000 Part-Time Workers - Shameful! And a direct result of Obamacare. Most of these workers are already at poverty level incomes. For some, the exchanges will allow them to get sub-standard coverage at great cost to the average taxpayer. The rest will not be able to afford health coverage even after the subsidies. The Walton family is not only in the top 1%, they are in the top 0.01% wealthiest Americans. Single Payer, financed by steeply progressive tax on the wealthiest Americans is the only answer.


WSJ: Income Inequality and Rising Health Care Costs - We keep hearing that health care costs are rising modestly. Sometimes the contention made is that ACA is the cause of that, but there is no proof of that. What we don’t hear in the same paragraph is that wages are increasing even more modestly, so that health care continues to take a bigger and bigger percentage of take home pay, making it one of the drivers of income and wealth inequality. We all know the obvious fix.


NYTimes: Costs Go Up Fast When ER is In Network, But Doctor is Not


NYTimes: Report: For Many New Enrollees, Care is Hard to Find


Kaiser Health News: Underinsured Enrollees Flood Community Health Centers - As predicted, ‘Bronze Plans’ are essentially health care apartheid. People who only looked at monthly premiums chose plans that don’t protect them from any sort of medical costs. They are paying for nothing and not getting the health care they and their families need - and along with most of the rest of us, are one medical catastrophe away from homelessness. Meanwhile the community health centers that are trying to fill the gap as best they can are being used by the insurance companies as non-reimbursed providers of last resort. How long do you think that is going to last? Wouldn’t happen with Single Payer.


Reuters: HCA Will Face Class Action Over 2011 IPO - HCA originated under the leadership of ex-US Senate leader Bill Frist, paid a record $1.7 Billion Medicare fraud fine while under the leadership of now Florida governor Rick Scott, then taken private by Bain Capital/Mitt Romney and started routinely performing unnecessary cardiac procedures to bump up revenue so that it could maximize profits to the private owners during the IPO. A veritable Republican shyster hall of fame. This is just one more bad result of non-regulated capitalism. Wouldn’t happen with Single Payer. HR 676 John Conyers’ Expanded and Improved Medicare for All - with 62 co-sponsors - rids the health care system of private insurance and converts the health care delivery system to non-profit status.


NYTimes: After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn’t Even Know - Putting a lie to the theory that if a patient ‘has more skin in the game,’ he’ll be more careful in choosing among his options. Wouldn’t happen with Single Payer.


Univ. of South Carolina Study: Fortune 500 Employees Can Expect to Pay More For Health Insurance - Synopsis: As health insurance policy costs rise, even the biggest employers, that supposedly offered the ‘best of the best’ plans, are shifting more and more of the cost to their employees. PNHP response: “As if there were not enough problems already with excess deductibles, narrower provider networks, tiering of health care services and drugs, limiting dependent coverage, and other innovations that impair access and reduce costs, in the face of ever more increasing costs the employers are now raising employee contributions to the plans, shifting to consumer directed plans that place a greater financial burden on the employees, reducing eligibility for their employees, shifting retirees out of their plans, reducing hours for part-time employees in order to avoid ACA penalties, and limiting full-time employee hires while increasing part-time workers. And this is the best of the best!” Wouldn’t happen with Single Payer.


ProPublica: A New Way Insurers Are Shifting Costs to the Sick - The sicker you are and the more you need it, the more you pay for the same generic. After all, if you don’t ‘have skin in the game,’ you would never seek to control your behavior, right? Yet another failure of the ACA and another reason to replace insurance companies with Single Payer.


Annals of Internal Medicine: Comparative Effectiveness of Generic vs. Brand-Name Statins on Patient Outcomes - Summarized conclusions: Generics work. Generics are cheaper. If patients pay more for medications (‘have more skin in the game’), they will not take them and they will die. Therefore shifting costs to patients leads to more death.


Albuquerque Journal: US Squanders $150 Billion per Year on Hospital Bureaucracy

Dallas Morning News: Health Care Insurance Overhead is Costing Us Big Bucks

Portside: Dr. Paul Song’s Address to Labor Campaign for Single Payer - He refers to Gerald Friedman’s economic research showing that simply being able to negotiate drug prices would save America $600 Billion per year, enough to provide universal access to health care; and also the facts that current Medicare administrative overhead is 1.4% (compared to insurance industry average of around 25%) and could be lower if it were not for Medicare Advantage, which has cost taxpayers $280+ Billion in total overpayments (24.4% of all Medicare expenses), and $34 Billion in 2012 alone; and that Medicare is prevented by law from negotiating with BigPharma. “How come when Wellpoint negotiates lower prices, it is good business and the free market at work, but when Medicare tries it, it is government interference?!”


Brookings Institute: Why the Geographic Variation in Health Care Spending Can’t Tell Us Much About the Efficiency or Quality of our Health Care System - Kind of wonkish, but worth including in this archive because it directly challenges conclusions reached by the Dartmouth group upon which the ACOs are based. Essentially it says that variations in costs of health care across the country are mostly due to health related behaviors - smoking, poor eating habits, etc, not some streamlined set of procedures, or some easily eliminated wasteful health care delivery. ACOs don’t work. PPACA doesn’t work. We need Single Payer.


Health Affairs: Study: Bureaucracy Consumes One-Quarter of US Hospital Costs; Highest In The World - Two reasons: 1. the complexity of billing a multiplicity of insurers with varying payment rates, rules and documentation requirements; 2. the entrepreneurial imperative for hospitals to amass profits (or for non-profits, surpluses). Wouldn’t happen with Single Payer.


NYTimes: Medicare: Not Such a Budget-Buster Anymore

Kaiser Health News: Health Law Ups Taxes On Insurers With Big Pay Packages - So what happened is the health insurance companies upped top executive salaries (averaging $5.4 Million in 2013) by more than enough to cover the increase in their taxes. Who really paid more? You and I in the form of premium increases. Some of the executive pay numbers in this article are totally obscene. Wouldn’t happen with Single Payer.

Kaiser Health News: Insurers’ Take On ‘Patient Management’ - This is currently focused on end-of-life, but it’s going to become the norm for everyone if insurers have anything to say about it - and they are running the show right now. Remember all the people who used to say that Obamacare would control costs by making sure that insurers take no more than a 20% profit? But that’s really just a cost-plus scheme, which was originally the idea of the insurers anyway. Whatever they can get defined as a legitimate cost, they can tack an additional 20% on top of that. Your case manager will be calling very soon - even if you’re not sick. Wouldn’t happen with Single Payer.


Center for Public Integrity: How Medicare Advantage Overbills and Cheats the Taxpayers and CMS Medicare and Medicaid Research Review: Measuring Coding Intensity in the Medicare Advantage Program - To the tune of $160 Billion per year. See also entry of 6/4 and 4/3/14, 4/9/13.

PNHP Response: “The history of Medicare Advantage is that of a steady string of abuses. The program began with overpayments of about 14 percent over the cost of caring for Medicare patients in the traditional program. That overpayment was a deliberate ploy of Congress to give the private plans a competitive market advantage in an effort to privatize Medicare. The plans then selectively enrolled healthier, less expensive patients through deceptive marketing practices. When an effort to correct this favorable selection was made through risk adjustment using Hierarchical Condition Categories, the insurers then padded the diagnoses, as mentioned above. Further, since the Affordable Care Act included adjustments to correct the overpayments, the insurance industry heavily lobbied Congress and the Obama Administration to use three years of accounting gimmicks to reduce the impact of these adjustments. Cheat, cheat, cheat...These crooks will continue to cheat the American taxpayers. They will surely use other HCCs to upcode their patients, until that door is finally slammed shut. What then? The private insurers continually tout to their shareholders the importance of “innovation” in health care coverage. They will always be able to find new and more effective ways to cheat us.

One of the more important improvements in an Improved Medicare for All would be to get rid of these crooks once and for all. The sooner the better.”


Health Affairs: For-Profit Medicare Home Health Agencies’ Costs Appear Higher and Quality Lower Compared to Nonprofit Agencies - PNHP Response: “Markets, competition, investor ownership, and profits are touted incessantly as being key to higher quality and lower costs in health care, even though Noble laureate Kenneth Arrow showed us decades ago why markets do not work in health care. Previously studies of hospitals, HMOs, nursing homes, hospices, and dialysis centers have shown us that investor ownership is associated with lower quality and higher costs. We can now add Medicare home health agencies to that list wherein proprietary, for-profit investor ownership is detrimental.

H.R. 676, the Expanded & Improved Medicare For All Act, sponsored by Rep. John Conyers, Jr, is a single payer bill that includes provisions that would eliminate investor-owned, for-profit providers. Today’s article adds to the evidence as to why the leadership of Physicians for a National Health Program supports the elimination of passive investors and profit diversion from our health care system. Health systems must be designed to benefit patients, not market exploiters that sacrifice quality while draining resources from health care. The primary missions are different. One is to take care of patients and the other is to make money.”


NYTimes: Adventures in ‘Prior Authorization’ - Just one more set of unnecessary insurance company administrative nightmares. 20% of your insurance premiums go towards paying the salaries of people whose job is to deny you the health care you need. Wouldn’t happen with Single Payer.


Common Dreams: Don’t Panic, We Can Expand Social Security and Medicare


Aids Institute: Letter to Secretary of Health and Human Services From 300 Patient Advocacy Groups - Summary: Even with ACA, enrolled patients with pre-existing or chronic conditions are still being discriminated against and are facing insurmountable barriers to care. Some examples are: restrictive formularies - including removal of critical drugs from formularies without notice, inadequate provider networks, lack of access to specialists, high cost-sharing, high co-insurance on life-saving medications, utilization management policies such as prior authorization, step therapy and quantity limits. Bottom line: As long as insurance companies are involved, they will find any number of ways to cheat the system in order to maximize their profits. That’s only natural. The only solution is to remove insurance companies from the process. The only way to do that is with Single Payer.


CrossCut (Seattle indy): Glimmers of Healthcare Politics at Meeting of Western Docs - Kshama Sawant, after winning a $15 minimum wage for Seattle workers, turns her attention to health care. What did ACA achieve? Coverage of only about half of the previously uninsured, a shift to underinsurance policies with ultra-narrow networks that eliminate choice, costs (premiums, deductibles, co-pays) that erect financial barriers to adequate care, inadequate subsidies, insurance marketplaces that increase complexity and waste, inadequate cost containment policies. What would Single Payer achieve? Universal care, removal of financial barriers, dramatic reduction in administrative waste, coverage of all essential health care, free choice of doctors/hospitals, elimination of the interventions and excesses of insurance companies, infrastructure that would slow spending to sustainable levels, progressive taxpayer financing based on ability to pay.


New England Journal of Medicine: Money, Sex and Religion - The Supreme Court’s ACA Sequel - PNHP response: “Our incremental, fragmented, and incomplete health insurance system means that different Americans have different access to health care on the basis of their income, employment status, age, and sex. The decision in Hobby Lobby unravels only one more thread, perhaps, but it tugs on a quilt that is already inequitable and uneven. A central goal of the ACA was to repair some of this incremental fragmentation by universalizing certain basic health care entitlements. In ruling in favor of idiosyncratic religious claims over such universality, the Court has once again expressed its disagreement with this foundational health-policy goal.”


NYTimes: CEO Finds Lucrative Work at New York-Presbyterian - Very lucrative. And we wonder why the overall cost of health care in the US is out of control. A large portion of it goes to CEOs and the Board of Directors in the insurance-hospital-pharmaceutical industry.


AlterNet: At Some Point, Progressives Need to Break Up With the Democratic Party - Best article I’ve read in a very, very long time; pointing up issues that have been emphasized on this site since 2010. Progressives’ behavior around Democrats is exactly like that of abused around the abuser.


PNHP: Godzilla Has Risen: The Insurance Industry Under ACA


LA Times: Hobby Lobby Case Proves Necessity of Single Payer


NYTimes: Justices Rule in Favor of Hobby Lobby - Apparently corporations have religious rights, but employees don’t. This ruling is another bizarre and ridiculous legislation from the bench from our politicized Whore Court. 1. The majority opinion makes the implicit assumption that health insurance is some sort of gift to employees from the employer. It is no such thing, but rather a part of an overall compensation package. If the employer has some sort of crazy religious objection to birth control (and I’m not even going to get into the hypocrisy of then objecting to abortion), then the employer does not have to use birth control, but they have no right to control the private lives of the employees. 2. This is just a part of the slow dribble of the elimination of all of the benefits that Obamacare proponents originally touted - which I’ve been predicting since 2009. 3. This wouldn’t be happening with Single Payer - the only rational solution to obtaining universal, affordable health care and at the same time a means to significantly reduce the overall cost of health care in the US - while taking the burden of providing health insurance off the backs of employers.


AJC: Patients Find Fewer Doctors, Hospitals To Choose From - In this case, a matter of life and death. We could have done so much better, and we still can.

NYTimes: Dr. Arnold Relman, Outspoken Medical Editor of the New England Journal of Medicine, Dies at 91 - He won numerous journalism awards and was a loud critic of the ‘medical-industrial complex’ which is more interested in selling profitable products than in helping sick people and is the main cause of the soaring overall cost of medical care in the US. He advocated for one and only one solution during his entire career: Single Payer.


Commonwealth Fund: How The Performance of the US Health Care System Compares Internationally - Synopsis: 11 OECD nations were included in this study. The fully socialized (government owned and operated) system of the UK came in first. USA dead last because of lack of Access and lack of affordability (Equity).  The US was also last in Efficiency.


NYTimes: The Koch Cycle of Endless Cash


JAMA: The Moral Case for Affordable Coverage and How Obamacare Fails to Live Up To It - It’s not universal. It’s not affordable. The proper solution: Single Payer.


Center for Public Integrity: The Medicare Advantage Money Grab and Why Medicare Advantage Costs Taxpayers Billions More Than It Should


Washington Monthly: VA Care: Still the Best Care Anywhere - Short article (first in a series) that puts the current ‘VA scandal’ in perspective. The right wing media, along with MSM stenographers posing as journalists, are using the scandal in Phoenix, AZ as a way to discredit socialized medicine. The backlogs that are at the heart of the scandal could be fixed by Congress tomorrow, but their incentive is not to fix the problem, but rather to milk it for propaganda purposes. The fact is that all major veterans services are unanimous in their praise for the quality of VA health care. Recent surveys of newly discharged patients from VA hospitals rate their care four points higher than newly discharged patients from the private sector. 96% of the VA discharges state that they would turn to VA hospitals for future care needs.


NYTimes: Hospital Charges Surge For Common Ailments - Note that Medicare pays what Medicare pays no matter what the charge. What does this tell you about ‘Improved Medicare for All’, aka Single Payer?


AFLAC: American Workers At the Edge of A Financial Cliff


Medical Group Management Assoc: Statement on the Effect of ACA Exchange Implementation On Medical Group Practices - Deductibles and premiums on the rise. Networks becoming smaller. And now this: “Even though there hasn’t been a huge influx of patients into physician offices as many predicted, simple tasks such as obtaining patient insurance coverage information or finding specialists for in-network referrals have proven to be significant challenges.” “We are consistently denied 'out of network' approvals for the very sick who truly need to continue their care with providers who have worked with the patient for years.” The full report. Too bad Single Payer never got ‘a seat at the table.’ Too bad Obama and the Dems threw Public Option under the bus.


Bernie Sanders: Where Do We Go From Here?

LA Times: Obama ‘Adjusts’ ACA To Fund Insurance Companies If They Incur Losses - Making $ Billions of taxpayer funds available. That’s the definition of bailout.


Health Affairs: Paradigm Lost: Provider Concentration and the Failure of Market Theory - Instead of making health care more affordable, Obamacare has set up a framework that encourages consolidation and monopoly pricing. The opposite of that would be the monopsony system called Single Payer.


NYTimes: More Insured, But the Choices Are Narrowing - CEO of PreferredOne: “We have to break people away from the choice habit that everyone has...We’re all trying to break away from this fixation on open access and broad networks.” Most people only look at the monthly premium when picking an insurance policy. That strategy can lead to homelessness the moment they need to see a specialist or go to a hospital that is not ‘in-network.’ As far as this CEO is concerned, if you don’t like that choice you can always just go find a ditch to lay down and die in. Meanwhile, he’s enjoying his multi-million salary and benefits. Given that kind of income, he doesn’t have to worry about in- or out-of-network. It doesn’t have to be this way. Of course, when PPACA was just a bill, the Obama administration loved to talk about all of its cost containment measures.

Health Affairs: Vertical Integration: Hospital Ownership of Physician Practices Is Associated With Higher Prices and Spending - One intent of ACA was to reduce overall health care spending through the establishment of more efficient integrated systems called Accountable Care Organizations. Instead of reducing spending through greater efficiencies, this consolidation has had the opposite effect by increasing the market power of these organizations. A better approach would be the administered pricing of a Single Payer monopsony system, where patients are no longer victimized by anti-competitive market groups.


Baltimore Sun: Getting Serious About Single Payer - More doctors are getting on board by the day. This article refers to another included on this site from January 17 which is worth reviewing.


ProPublica: MIA In The War On Cancer: Where Are The Low Cost Treatments?


NYTimes: Acceleration Is Forecast for Spending on Health Care


Healthcare-NOW: Public Citizen Report: Single Payer Would be a Boon to the Economy - It would remove unfair burdens from companies that are now forced to provide health insurance for their employees.


Common Dreams: Majority of Med Students Want Single Payer - “The sad truth is that for many health insurance is an umbrella that melts in the rain—when you need it most, it isn’t there. One thing that's clear: the business of corporate medicine is doing very well under the ACA. Health insurer profits, stock value, and CEO salaries are all up. In fact, the entire law was written around preserving the gluttonous bottom lines in American health care. The ACA handed private insurers $500 billion in taxpayer subsidies to continue profiteering off illness in our country. Health insurers profit by avoiding the sick, collecting premiums, denying claims, and shifting more and more costs onto the patient.”

ProPublica: Medicaid Programs Drowning In Backlog


PNHP: Thomas Piketty: “Capital in the Twenty-First Century” - This is a good short summation of what is rapidly becoming a very seminal work. Without a progressive income tax and a progressive wealth tax, capitalism just doesn’t work. With such a tax, we can finance among other things, a health care system that provides basic health care to all - a basic human right.


NYTimes: Even Small Medical Advances Can Mean Big Jump in Bills - Even under Obamacare. A number of people have gotten insurance that couldn’t before, but with large premiums and deductibles. Some of the comments are more interesting than the article. Medicare is not allowed by law to negotiate over the cost of insulin. The ability to negotiate over the cost of pharmaceuticals is part of  ‘Improved’ Medicare for All. Notice how many comments include the statement about waiting until they are eligible for Medicare before getting the treatment they need.


PNHP: Medicare Advantage Scamming the Nation Again


Labor For Single Payer: Organizing Our Way Out Of Labor’s Healthcare Muddle - Democratic leaders who previously were allies of labor have been telling union representatives that they need to “regress to the mean.” But it’s a simple rule of math that if you reduce the factors that exceed the mean, the mean itself constantly adjusts downward. Prior to the concerted efforts by the right to attack unions of the 1980’s, improvements in union contracts had a trickle down effect on non-union benefits. After all, it is only because unions negotiated for health benefits in the first place that non-union workers came to expect them as well (not to mention the 40 hour week, 2 weeks paid vacation, child labor laws, etc). The landscape has changed drastically since then, and ACA has only made things worse for not only unions, but the entire middle class. “If organized labor settles for piecemeal changes and refuses to challenge the link between medical insurance and employment, it will miss the chance to connect with millions of poorly insured and uninsured workers who have no union. The only way to guarantee healthcare for every worker is to guarantee healthcare for all through a single-payer Medicare for All program.”


Forbes: ‘Double Jeopardy’ in American Health Insurance - Summary: It is exactly at the moment when the sick  in the US are most in need of therapy that their ‘tiered’ insurance costs go up. That’s when insurers impose higher ‘cost sharing’ on patients through techniques such as ever higher deductibles, large coinsurance requirements, and tiering of drugs and specialized services with even higher coinsurance requirements for the most expensive tiers. Insurance companies give lip service to sick people having more ‘skin in the game,’ but in reality this simply a profit maximizing strategy on their part - imposed on sick individuals exactly when they have no choice but to get these therapies/drugs no matter what the cost. Wouldn’t happen with Single Payer.


Popular Resistance: Tell Obama: ACA’s A Scam, We Need Medicare for All


Diane Rehm Show: Jimmy Carter Joins the Chorus Calling for Single Payer


Bloomberg: Obamacare Limits Choices Under Some Plans - Actually, all plans. Bought Platinum, got Bronze. Wouldn’t happen with Single Payer.


AP: Health Law Concerns For Cancer Centers - Pre-existing conditions may now be nominally covered, but the best doctors/treatment centers are probably not in any plan.


Kaiser Health News: Warning Opting Out of Your Network is Financially Risky


LA Times: Watch An Expert Teach A Smug US Senator About Canadian Health Care - And here’s the YouTube video.


PNHP: Senate Subcommittee Hearing On Healthcare Access and Cost: Single Payer Lessons For the US - A healthcare policy research analyst outlines 11 basic reasons why - based on empirical research, if the goal is universal affordable healthcare, SP far outperforms the current US approach.

Public Citizen: Testimony of International Experts Underscores Benefits of Single Payer

Unite Here: The Irony of Obamacare: Making Inequality Worse - Many more Americans will gain some form of health care, but with higher premiums, loss of hours, a shift to part-time work, and for many less comprehensive coverage, very limited networks. A Trillion dollars of US taxpayer money transferred directly into the hands of private insurance companies. When ACA first passed, their stock prices doubled. Top executives were paid half a billion in wages and stock options over the last 2 years. Fair competition has been strangled. 388 companies have announced that they would cut worker hours to avoid the law’s requirements. Wouldn’t happen with Single Payer.


NYTimes: When Health Costs Harm Your Credit - Wouldn’t happen with Single Payer.


AlterNet: Why I’m Naming The New Brain Lesion ‘Anthem Blue Cross’ After the Criminals That Denied Care - A great anecdotal argument for Single Payer.


Towers Watson: Employers Experiencing Smallest Increases in Health Costs in 15 Years - Yea! USA! USA! Guess who’s not experiencing smallest increases in health care costs in 15 years. Yep, Employees. The title of this article should be Progressive Deterioration In US Health Plans. Wouldn’t happen with Single Payer.


NYTimes: New Law’s Demands on Doctors Have Many Seeking Networks - Doctors remaining in private practice are turning Medicaid patients away. Most doctors are seeking the ‘security’ of becoming employed by large hospital corporations, which right now have very poor earnings. But left unsaid: These large corporate structures are consolidating at a rapid rate. Once the consolidation phase is complete, they will begin to squeeze all of their employees - doctors, nurses, etc and patients - in order to regain profitability. It’s not going to be pretty. Wouldn’t happen with Single Payer.


Yahoo: GOP Would Bar Poor From Health Care Altogether - But it’s not just the GOP. Remember when the Democrats said that Single Payer was “not realistic.” So they said they were going to support the Public Option. But at the very end of the ‘debate,’ they also dropped the Public Option, again because it was “not realistic.” So this is where “realistic” has gotten us. Rather than stand up for what they said they really believed in, they decided to calculate and compromise away all of the good. Guess they mis-calculated.


New England Journal of Medicine: The Calculus of Cures - Here’s an article in an esteemed journal that clearly illustrates how money interferes with science. The editor of NEJM is Jeffery Drazen, who has been cited by the FDA for making false claims about drugs (levalbuterol) in which he had a large financial interest and who has close ties to at least 20 drug firms from whom he has accepted sizable fees. The actual authors of this article are venture capitalists. Basically the article takes the position that drug trials are just too doggone expensive and who needs them anyway. What this has to do with Single Payer is that in that scenario, one purchaser would have the power to negotiate serious reductions in drug costs - something that is specifically forbidden by PPACA.


Bloomberg: Employers Turn to Private Health Exchanges to Cut Costs - About 1/3 of all employers will be eliminating their own health plans within the next 5 years and sending their employees to private exchanges. This will essentially be a voucher system, so the employer can control their health care expenditures. So more and more, employees will have to bear the additional costs either through higher premiums, further cost sharing (deductibles, co-pays, conditions not covered, etc). This is a continuation of the conversion of health plans from defined benefit to defined contribution plans from the employers’ point of view - and a move in the direction of the old pre-PPACA days. Just one more way that productivity gains are funneled to the large corporation employers. Wouldn’t happen with Single Payer.


Democracy-NOW: Job Killer? How Media Spin Got Obamacare Wrong And Why Single-Payer Could Cure Its Actual Flaws


Albany Herald: In SW Georgia, The Affordable Care Act Is Having Trouble Living Up To Its Name


NYTimes: How Wellpoint Will Profit From PPACA


PNHP: CEO: Bayer Designs Its Products for Rich People, Not Sick People - Be sure and read the ‘Comment’ at the very bottom of the article.


PNHP: Why We Do Not Want Investor Owned Health Care Institutions


NYTimes: Patients’ Cost Skyrocket; Specialists’ Incomes Soar


Journal of Oncology Practice: Why Oncologists Should Support Single-Payer National Health Insurance

Wisconsin State Journal: In Health Care, Need is Trumped by Profit


NYTimes: Ads Attacking Health Law Stagger Outspent Democrats - Koch Bros. see an opening. The Democrats are getting ready to pay a very high price for passing this insurance-centric, and very unpopular law. Now think how much different this scenario would have been if the Democrats had pushed really hard for Medicare for All, or even if they had just left the Public Option in the law. Maybe it wouldn’t have passed, and now they’d be in a position to say that they really tried to get the best possible law - Everybody In, Nobody Out - passed for the good of the people. Maybe it would have passed, who knows - in which case they’d be extremely popular. But they kept saying they had to do what was ‘realistic.’ Yeah, so how does ‘realistic’ feel now?


Albany NY Times Union: Single-Payer Activism Gets Boost From Obamacare

Real Clear Politics: Single-Payer Is Not Dead


NYTimes: Enrollees At Health Exchanges Face Struggle to Prove Coverage - Wouldn’t happen with Single Payer. Everybody In, Nobody Out.


MoJo: New Data Shows How Hospitals Rip You Off


Kaiser Family Foundation: Medical Debt Among People With Health Insurance


Counter Punch: The Left After the Failure of Obamacare


Health Affairs: Medicare’s Rollout vs. Obamacare Glitches Brew - The original Medicare rollout in 1966 cost $867 Million in today’s dollars, and that included the cost of processing 1966 medical bills in addition to the actual rollout. It saved $376 Million by displacing several smaller federal health assistance programs. The Obamacare rollout has cost at least $6 Billion. Most of that cost has been because it is a workaround designed to keep health insurers at the center of the health care system. Obamacare’s exchanges must coordinate thousands of different plans, with premiums, co-payments, deductibles and provider networks that vary county-by-county; Medicare offered a single, uniform plan. Medicare has an overhead of about 2%. Private plan overhead is, on average, at least 20%. Thus, a single payer plan that excluded private insurers could save hundreds of billions in transaction costs. The glitches and associated costs of the Obamacare rollout don’t come from government incompetence, but rather from political cowardice.

Health Reform 2013