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 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 expenditure category? USA USA USA!!

PNHP: The Facts On How Much Single Payer Would Cost


Kaiser Family Foundation: Survey of Non-Group Health Insurance Enrollees, Wave 3 - PNHP: “One of the most important functions of health insurance is to provide financial security in the face on medical need. In spite of the Affordable Care Act, that security is deteriorating.”


Progressive Physician: What’s Wrong With Sanger-Katz’s Single Payer Analysis - A critique of the ridiculous “Worst Single Payer Study Ever.” Here’s the study we should all be focused on. See entry of 5/5. All of the ‘progressive’ critics that have come out of the woodwork critiquing single-payer (the “puppies and rainbows” brigade: Ezra Klein (Vox), Paul Krugman (NYTimes), Paul Starr (Princeton), Ken Thorpe (Emory)), were proponents of single payer before Bernie started to threaten Hillary. This debate is really not about single-payer. It’s about keeping the Democratic party base in line. Here’s a short video that debunks the faux-progressive line. Ken Thorpe is cherry-picking his numbers and uses statistical sleight of hand. Here’s a review of studies that have shown that single-payer reduces costs, and another. Here’s a more comprehensive run down of what’s right with Sanders’ over-all economic plans.


Boston Globe: How to Provide Medicare For All

Vice: More Americans Want Socialist Healthcare Than You Think


Gallup Poll: Majority of US Supports Fed-Funded Health Care System - 58% of US adults are in favor of repealing ACA and replacing it with Single-Payer, including 41% of Republicans and right-wing voters.

Philadelphia Inquirer: Single-Payer Essential to Controlling Health-Care Costs - By the former editor-in-chief of the Journal of the Canadian Medical Association, who moved to the US for personal reasons only to discover how superior the Canadian single-payer really is.


NYTimes: Sorry, We Don’t Take Obamacare - Remember when the Democrats said, “If you like your current policy, you can keep it.”? “Everybody in, Nobody Out”? Remember when all 65 members of the Congressional Progressive Caucus took a solemn oath never to vote for a health law that did not contain a Public Option, collected $400,000 in donations for taking that pledge, then broke the pledge and kept the money? Well all except for Dennis Kucinich. Although 20 million people previously without health care now have it, 33 million still don’t. And this article is about the 20 million. It’s a “two-tiered system” aka medical apartheid. Yes you can insure your children up to 26 years of age, but not if they live or go to school in another state. You can buy a plan that includes your favorite doctor or your most necessary medication, but if the plan removes either one in the middle of the year, you can’t change with it. Most of these 20 million people who now nominally have insurance are no better off financially than they were before the law. The article describes how regulators are trying, mostly in vein, to fix these problems. Why are we trying all kinds of kludges to a dysfunctional system when Single Payer would fix all of these issues?


The Hill: GOP Closing In On Obamacare Alternative, Lawmakers Say - Also buried in this article are some of the details for how the GOP plans to defund Medicare by making it a voucher system. See remarks under the Center for Public Integrity article of 5/9 below. Apparently they intend to conflate ‘the replacement for Obamacare’ into the destruction of Medicare.

NYTimes: Judge Backs House Challenge to a Key Part of Health Law - This will most likely be overturned on appeal, but the interesting part is: $130 Billion over 10 years transferred directly from the Treasury Dept. to health insurance company coffers. Staggering. Wouldn’t happen with Single Payer, which would save $500 Billion per year.


Change.Org: Worst Single Payer Study Ever - Prior to this election cycle, over 40 single-payer studies have been conducted by government agencies, actuarial firms and think thanks. Every one concluded that Single-Payer reduces costs while providing universal coverage. Every country with single-payer spends less on health care (by % of GDP, per-capital, and absolute, real dollars), and gets better outcomes. This new study pulls assumptions out of nowhere, and leaves out the largest sources of savings: reducing administrative overhead from 20% to 1% and the monopsony power of one payer to force hospitals and pharmaceuticals to reduce prices.


Portside: Urban Institute’s Attack on Single-Payer: Ridiculous Assumptions Yield Ridiculous Estimates - The more popular Bernie’s plan gets, the more entrenched, duopoly institutions try to create false narratives. This article shoots down another one.

Center for Public Integrity: Auditors: Feds Failed to Rein in Billions in Over-Tilling By Medicare Advantage - A great report by this fantastic watchdog group.

Synopsis: Medicare Advantage (MA) is the private insurance alternative to Medicare, introduced by Congress in an effort to starve out Medicare and replace it with a private voucher system. The Center for Medicare and Medicaid Services (CMS), driven by Congressional pressure, is complicit in allowing this to go on. MA reimbursements to insurance companies are about 14% higher than than Medicare reimbursements directly to providers for the same services.

On top of that, the insurance companies are gaming the system by ‘upcoding’ their services, reaping an extra $160 Billion annually. Because of all this, the insurance companies are able to offer these plans to retirees at a cost very much lower than the already low Medicare costs. This in turn is bleeding retirees away from Medicare and onto MA. Upcoming audits may result in the recovery of only about 3% of these overcharges from the insurance companies. Already almost 1/3 of Medicare enrollees, deceived by the temporary and artificially low costs, opt for MA, and that fraction is increasing steadily.

Look for Congress to start reducing funding for Medicare, based on reduced enrollments, which will reduce reimbursements to providers causing many of them to drop out. Once most of the enrollees are in MA, Congress can then enact its “premium support” plan - essentially vouchers. At that point, traditional Medicare will be dead.

Once everyone is on the voucher program, Congress can ratchet down the voucher amounts and insurance companies will be free to increase premiums, co-pays, deductibles, etc etc.

Despicable! Wouldn’t happen with Single Payer.


American Journal of Public Health: Moving Forward From the Affordable Care Act to a Single-Payer System - A milestone, detailed proposal for how to switch from the current system that still leaves out 33 million and underinsures another 36 million, saving $500 Billion/year in the process - signed by 2,231 doctors. The Summary; Background Fact Sheet.


Healthcare-NOW: Seth Meyers Explains Single Payer and Its Colorado Corollary - See entry of 4/22.

Health Affairs: Traditional Medicare Vs. Private Insurance: How Spending, Volume, and Price Change At Age 65 - In a nutshell: For people who move from private insurance to Medicare, the volume of services they use remains the same, but their spending and overall healthcare spending goes down - not exactly a bombshell. But moving the eligibility age from 65 to 67 as some neolibs have suggested, would increase national health care spending - mainly because of increased Medicaid spending, increases in ACA premium tax credits and cost-sharing subsidies resulting in tax revenue losses and greater overall outlays - again leaving the volume of services unchanged. From a national healthcare spending perspective, that’s moving in the wrong direction. And the corollary is: Moving the eligibility age down would decrease overall healthcare spending while leaving volume of services unchanged. You have to wonder when the light is finally going to come on.


Monthly Review: Obamacare: The Neoliberal Model Comes Home to Roost - Another interesting, but long scholarly article. But the last two paragraphs are eye-openers. Essentially: the collapse of Obamacare - which is the culmination of the oligopolistic, neoliberal model, where the top wealth strata of  society becomes fantastically rich and everyone else, including doctors, move successively lower - could ultimately become the catalyst for a drastic turn towards a more socialist democratic society overall.


Reuters: Ryan Wants to End Obamacare Cost Protections for Sick People - Republicans keep saying they want to repeal Obamacare. But what’s the replacement going to be and how will it contain the overall cost of health care in the US? Paul Ryan is beginning the reveal. Their idea is to move the responsibility for the care of the sickest people - those with ‘pre-existing conditions’ - to the states, much as the Clintons did with welfare. The top 10% of individuals in health care spending account for 65% of overall health care costs. Telling the states to cover 2/3 - about $2 Trillion per year - of the overall cost for health care in the US is not going to happen.

In the words of PNHP: “With a single payer system this problem disappears. Funding is based on ability to pay, through the tax system, and not on the basis of anticipated medical expenses. Everyone receives the care they need, regardless of their health status. The fragmented plans supported by the repeal and replace people cannot do that.”


Reuters: Health Insurer Centene’s Profits Beat Expectations as Medical Costs Fall - The insurer spent less on health care for sick people - they call it “loss.” They spent proportionally more on administrative overhead and profit. Wall Street considers this a good thing. That’s the upside-down logic that ACA has perpetuated.


Intercept: Health Care Industry Moves Swiftly to Stop Colorado’s “Single Payer” Ballot Measure - From the article: There are a couple of things wrong with this measure - it’s really not ‘single payer’ when a state does it because there are still other ‘payers’ in play: Medicare, etc., and this measure is financed by the workers, not by a steeply progressive income tax as it should be - but it’s a step in the right direction. What’s really interesting is how the insurance companies, who stand to lose a lot of business are trying to kill it. They are about to flood the media, not with an honest discussion of the details, but rather with completely false soundbites: “doubling our state budget”, “diminishing the accessibility and quality of care”, “creating an unaccountable, massive bureaucracy.” None of that is true - but it probably doesn’t matter. Voters are easily fooled by simple soundbites. And to top it off, the Koch Bros. are financing most of the media flood. This strategy has already worked in California and Oregon.


Kaiser Family Foundation: Is ACA Coverage Affordable for Low-Income Families? - Stating that ACA is good because it has allowed lots of people to gain health insurance is disingenuous at very best. The originally stated intent of the law was to make health care universal and affordable. It has done neither. CBO has found that half of the people (27 million) that were not covered before ACA are still not covered. The other half are greatly under-insured. In this study, low-income families respond that having insurance has not alleviated their financial struggles with respect to medical debt, and many can neither afford the total overall costs of coverage nor can they find appropriate providers within their narrow networks.


New England Journal of Medicine: The Virtues and Vices of Single Payer - “When we look at the entire patchwork of the American medical care system and our insurance system there’re still so many holes in it, there’s so much redundancy, and it’s so inefficient. And that’s why the single payer idea is going to resonate far beyond whatever the outcome of the 2016 election is. Because when you have a health insurance that leaves tens of millions uninsured, tens of millions underinsured, that is beset by administrative complexity and is governed too often by profit, there’s going to be an appetite for sweeping change. And whatever its political fortunes are, and I don’t think they’re particularly good, single payer is going to continue to speak to those who are disaffected by what’s going on in American medical care and are looking for something different, something better.”


Peterson-Kaiser Health Tracker: Payments for Cost Sharing Increasing Rapidly


Salt Lake Tribune: High Cost of Hepatitis Meds Makes Good Case for Universal Medicare - People across the nation are slowly beginning to wake up.


BCBS, Health of America Report: ACA Compliant Plans Have Been Subject to Adverse Selection - In a nutshell: Some, but by no means all, sicker people who could not afford health care before ACA, have been signing up for insurance, mostly because they are getting government subsidies (actually these subsidies are $Billions transferred directly from the US Treasury to insurance company coffers). This has driven up the overall cost of these plans. But what about the middle income, hard working families that do not qualify for these subsidies? Costs for their plans has skyrocketed, with no help from the ACA. Wouldn’t happen with Single Payer.


NYTimes: How to Stop the Bouncing Between Insurance Plans Under Obamacare - There’s no way to tweak this totally dysfunctional system. None of this would be necessary with Single Payer.


KQED: Pharmaceutical Companies Hiked Price For Aid-In-Dying Drug


Business In Savannah: Medicare for All Is Way Forward


Healthcare-NOW: Setting the Record Straight: Busting the Media Myths About the Sanders’ Plan

Health Affairs: Don’t Let the Talking Points Fool You, It’s All About the Risk Pool - A very Darwinian article. But think of it this way: If you’re healthy and you buy insurance, then you pay a little bit for the few that are really sick. If you don’t buy, then you’re a little better off...except if you all of a sudden get really sick. Oops! Then you’re screwed. But aside from all that, none of this would be a consideration with Single Payer.

ProMarket: “There Is Regulatory Capture But It Is By No Means Complete” - Wikipedia: “Regulatory capture is a form of political corruption that occurs when a regulatory agency, created to act in the public interest, instead advances the commercial or political concerns of special interest groups that dominate the industry or sector it is charged with regulating.[1] Regulatory capture is a form of government failure; it creates an opening for firms or political groups to behave in ways injurious to the public (e.g., producing negative externalities). The agencies are called "captured agencies".” Kenneth Arrow, youngest person ever to win the Nobel Prize in Economics, and one of the most influential economists of the 20th century discusses Single Payer Health Care. His conclusion: “It’s better than any other system.”


CNN: Full Transcript Hillary Clinton TV One Democratic Presidential Town Hall - About half way down a Teresa O’Donnell asks Hillary a question about the skyrocketing cost of health care. Just search on Teresa O’Donnell. From there you can see Hillary’s approach.

PNHP response:

Hillary Clinton says that one of her proposals is to bring health care costs down. This town hall exchange is significant because it reveals the depth, or lack thereof, as to how she might accomplish this.

She says that she would lower co-pays and deductibles. But the question was about high premiums, and the market is using higher deductibles and other cost sharing to lower premiums. Lowering deductibles will cause higher premiums, not lower.

She says that we need more non-profit insurers like Blue Cross and Blue Shield used to be. But if you compare premiums in California for for-profit Anthem Blue Cross and non-profit Blue Shield, they are the same. The non-profit insurers share the same inefficiencies and administrative excesses as the for-profits.

She says that she wants more competition in the exchanges so that less expensive plans will be available for diligent shoppers, but, again, lower premiums are possible only by reducing coverage - higher deductibles, less accessible narrower networks, etc.

Private plans competing in the marketplace is what we already had before the Affordable Care Act was passed. We merely continued the same system. Adding exchanges did very little except to enable the administration of subsidies and credits for lower-income individuals. For those not eligible for government subsidies and credits, nothing was done to control the very high costs of health care and the insurance products that pay for that care.

Unfortunately, Hillary’s proposal is more of the same. Perpetuate the fiction of lower prices through competition while manipulating the insurance products to have either lower premiums or poorer coverage. In fact, included in ACA is the excise tax (Cadillac tax) which is designed to prevent the marketing of full benefit plans. Making health care less affordable through greater out-of-pocket cost exposure is the exact opposite of where Clinton says she wants to take us. The problem is that the current financing infrastructure will not allow us to go there.

If we want affordable care for everyone, we need a single payer improved Medicare-for-all which will control costs and make the financing more equitable.”


International Journal of Health Services: “Cadillac Tax” On Health Benefits Will Hit the Middle Class the Hardest


HuffPo: Cherry-Picking Statistics to Bash Sanders’ Medicare-For-All Plan


Bloomberg: Bad Debt Is The Pain Hospitals Can’t Heal - Having health insurance is NOT the same as having health care when you need it. Advocates for Obamacare like to say that more people have health insurance, including those with pre-existing conditions - even though sign ups are much lower than predicted. But most of the ones that do sign up can barely afford the premiums. When deductibles, co-pays, procedures not covered, doctors or hospitals out of network, medications not covered, etc. are added on, they very often go bankrupt. Insurance policies can drop your doctor or hospital from your network, and can drop the medications you need from their formularies at any time - but when they do that, you cannot change policies until another year rolls around. Obamacare has amounted to a direct transfer of $Hundreds of Billions from the US Treasury to the coffers of private insurance corporations. It is not a step towards Single Payer.


Intercept: Wall Street Analyst Says Hillary Would Be the Best President for Healthcare Investors


Jacobin Mag: Meet the New Harry and Louise - Maybe you’ve heard on cable news that Bernie’s Single Payer plan is all “puppies and rainbows.” This is a very long article that meticulously dissects each of those recent opinion pieces and shows in detail why they are based on false assumptions, and in all cases were written by so-called experts who several years ago were actually proponents of Single Payer. Essentially those articles are not meant to inform. They are meant to control the Democratic party ‘base’ and keep Hillary on track.


HuffPo: Medicare’s History Belies Claim that Single Payer Would Disrupt Care - 11 months after the original Medicare law was signed, it went live. 99% of those eligible were signed up. The overhead for signup AND coverage for 6 months totaled $882 Million in today’s dollars. By contrast, just setting up the insurance exchanges under Obamacare cost more than $6 Billion. Also, Medicare eliminated several smaller federal health assistance programs, saving $383 Million in today’s dollars (so a net cost of $499 Million). Just like today, industry spokesmen all said there would be major disruptions in health care, and that doctors would not accept the program. None of that came to pass. And today, practically everyone who turns 65 - even those who rail against it - immediately signs up.

USA Today: Costs, Changes Led Obamacare Enrollment to Fall Short of Estimates - Sad. But in a small way funny. After CBO estimated that 21 million formerly uninsured people would sign up for health insurance under Obamacare, only 12.7 million people did so. Then Health and Human Resources Secretary Sylvia Burwell lowered her estimate to 10 million and immediately declared that sign ups exceeded estimates. Talk about spin. So after all of the turmoil surrounding the implementation of Obamacare, and after basically turning over the well-being of the American people to insurance companies, what was supposed to create affordable, universal health care has achieved neither of its goals and the best thing you can say about it is that a very marginal number of additional individuals are now covered.


NYTimes: Disparity in Life Spans of the Rich and Poor Is Growing - On top of everything else, now the rich are actually killing us. How much longer can we avoid calling this a class war?


Columbus Dispatch: InHealth Customers Mad About Late Notice Dropping OhioHealth - Health plans are free to change provider networks anytime during the year, but customers of those health plans are not free to change plans when they do. One more gotcha! with Obamacare. Wouldn’t happen with Single Payer.


PNHP: Review of Studies Showing How Much Single Payer Would Save Over Current System - Reviews by everybody from GAO, CBO to Economic Policy Institute and others all agree. It’s a no-brainer.


Philadelphia Inquirer: Single-Payer Health Plan Would Not Cost US More


Kaiser Health News: Licking Wounds, Insurers Accelerate Moves to Limit Health-Law Enrollment - Broker disincentives help insurance companies avoid the sickest.


New England Journal of Medicine: Effect of Removal of Planned Parenthood from the Texas Women’s Health Program - Result: Low-income Texas women are losing access to all forms of health care, family planning services and pregnancy prevention. Birth rates from unintended pregnancy in this group will now skyrocket, swamping Medicaid rolls. State expenditures for neonatal, early child and female health care will correspondingly skyrocket. Wouldn’t want to be a Texas taxpayer.


NYTimes: Drug Shortages Forcing Hard Decisions on Rationing Treatments

HuffPo: On Kenneth Thorpe’s Analysis of Senator Sanders’ Single-Payer Reform Plan


NPR: Insurers Are Refusing to Pay for Some Common Medications - Drug companies have all started doing what Martin Shkreli (and Here, Here) did: start raising the prices of all of their drugs to whatever they think they can charge. Then drug plans remove those drugs from their ‘formularies.’ Result: Sick people who think they have health/drug care can’t get the drugs they need. This is the result of the deal that Obama struck with BigPharma before Obamacare passed which allows them never to have to negotiate their drug prices. Thanks Democrats!


Kaiser Health News: Check the Fine Print. Some Work-Based Health Plans Exclude Outpatient Surgeries


PNHP: Myths Surrounding the Single Payer Debate

Truthdig: Finding a Cure for Bernie Sanders’ and Hillary Clinton’s Health Care Plans - By Margaret Flowers (Popular Resistance) and Jill Stein (Green Party). Remember that 58% of Americans favor Single Payer. 34% strongly favor. 81% of Democrats favor. Hillary’s approach, to tweak ACA around the edges until everyone gets coverage is clearly pie-in-the-sky. But Bernie’s plan also has issues. ACA is not a ‘step in the right direction’ because it has essentially turned the control of US health care over to the insurance companies. Bernie’s plan gives too much power to the states (which he modified in his latest release), and we’ve seen the results of that in the refusal of red states to expand Medicare under ACA.


Healthcare-NOW: Clinton Opposes Single Payer


Common Dreams: Sanders’ Medicare-For-All Plan Takes Aim at For-Profit Healthcare System - Saving $6 Trillion over the next 10 years and $592 Billion per year.


NYTimes: Even the Insured Can Face Crushing Medical Debt, Study Finds - Patient Protection and Affordable Care Act”...Seriously?


John Geyman MD: The Human Face of Obamacare: Promises vs Reality and What Comes Next - By one of the most well respected researchers in the field, Dr. Geyman starts with 50 patient and family stories, then looks at the major problems with Obamacare - out-of-control insurance costs, narrow networks making it impossible to find the right doctors/hospitals when needed and thus forcing patients to pay out-of-network costs, unacceptable levels of care, inability to keep favorite doctors or original plans, having ‘coverage’ that does not translate into having affordable care - to the point that it is no longer called by its original name “Patient Protection and Affordable Care Act” PPACA. Finally he looks at options for the future: 1) muddle through with what we’ve got, 2) Republican plans for repeal and replace with government ‘voucher’ programs, 3) Single Payer. There is really only one answer.


Urban Institute: How Much Do Marketplace and Other Non-group Enrollees Spend on Health Care Relative to Their Incomes? - What does it mean to be insured if you can’t afford care when you need it?


Common Dreams: On Medicare-For-All, Clinton Reminds Us That She’s Part of the Problem


Politifact: Sanders’ Claim That US Spends 3 X What Great Britain Does on Health Care: True


Kaiser Family Foundation: 58% of Americans Favor Medicare-For-All


NYTimes: Martin Shkreli’s Latest Plan to Sharply Raise Drug Price Prompts Outcry - Wouldn’t happen with Single Payer.


Mayo Clinic: Changes in Burnout and Satisfaction With Work-Life Balance in Physicians and the General US Working Population Between 2011 and 2014 - With the advent of Obamacare, the pressure to see more patients and to spend less time with each patient (turnover) has increased leading to increased burnout and depression. The solution is a well designed Single Payer system.


We Are Better Than This - How the Government Should Spend Our Money: Edward D. Kleinbard


NYTimes: Health Spending in US Topped $3 Trillion Last Year - Just as the past President of American Public Health Association predicted. Check out his speech, because no matter how the Times article spins it, we are right on track to waste $37 Trillion over the current decade, and eventually bankrupt not only the federal but also every state, local and corporate entity that provides employee health care and especially Retiree Health Benefits. There is only one way out of this mess.


ABC News: What to Know About ‘BernieCare,’ Sanders’ Health Overhaul - Good article, great comments - sort by ‘Best’.


NYTimes: Instability in Marketplaces Draws Concern on Both Sides of Health Law - Ok, so how bout we get rid of networks and let patients have free choice to pick any doctor/hospital they want. How bout we get rid of deductibles, co-pays, co-insurance, conditions not covered, premiums, gold-silver-bronze plans...and while we’re at it health insurance companies. Yep, that would be 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


Market Watch: Employees Pay 130% More for Health Care Than a Decade Ago


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):

Health Reform 2014