Health Reform Timeline


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

#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


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.


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.


NBC Morning Joe: Dr. Nancy Snyderman: Best Fix for Affordable Care? Single Payer


MedPage Today: 10 Questions: Eric Matteson, MD


NYTimes: With Health Law Cemented, GOP Debates Next Move - Both parties plod towards mediocrity while striving never to risk corporate insurance company contributions. But wait...what’s that I see...sort the comments by “Reader Picks” and read the first one. It’s a one-liner.

Washington Post: Hospice Firms Draining Billions From Medicare - When we talk about Single Payer as Improved Medicare for All, this is what we mean by ‘Improved.’ Medicare’s rules need to be changed to remove the financial incentive for admitting non-terminal patients to hospice.


NYTimes: The Economics of A Kinder and Gentler Health Care - The esteemed Uwe Reinhardt posits that we are moving towards a tiered health care system. care apartheid. I prefer to believe that the citizens of the US will eventually see this path and will reject it.


NYTimes: Chairman NY State Assembly Health Committee: Single Payer for New York


NYTimes: Health Care’s Road to Ruin - A really good short article. This author has been writing a year long series on the outrageous costs of health care in the US. Read the article and then... Let the people speak: Here are two of the comments that got the most votes (the bold type is mine):


Spirit Lake, IA

NYT Pick

As a 40 year practicing family physician and member of Physicians for a National Health Plan, I believe the best and only answer is improved "Medicare for all." At some point there will be sufficient disgust among enough in the electorate to force politicians to act. Of, maybe there will be a progressive groundswell that displaces the current office holders who are dependents of the insurance, pharmaceutical, and medical device industries. An improved Medicare for all, financed through progressive taxation, offers the best chance to care in the most rational way for all US citizens. Moving in that direction is truly hard. Just what is it that the million and multi-million dollar executives of insurance companies and CEOs of hospital organizations do, that justifies those dollars diverted from sick and even healthy people? They, and the medical industry executives will fight hard. Only a true popular demand can lead in the right direction.

386 likes as of 12/23 at 6:00 AM.


Cambridge, MA

Rosenthal writes, "But the nation is fundamentally handicapped in its quest for cheaper health care: All other developed countries rely on a large degree of direct government intervention, negotiation or rate-setting to achieve lower-priced medical treatment for all citizens. That is not politically acceptable here."

This is a true statement, but it ignores the fact that politics is social condition that could be changed. As long as we feel defeated before we start we will remain defeated.

"Politics" is us and "we" can change. We have to change. We are deliberately dooming most Americans to inferior health care at an exorbitant cost and continuing to shut out a large part of our population almost entirely. No other advanced economy and civilized country does this.

The Affordable Care Act is needlessly complicated and cumbersome. Already some Democrats, including Nancy Pelosi, are saying that we/they should have fought for a single payer system. But the politicians and the press did not express outrage when Senator Baucus laughed and refused single payer advocates a seat at the table. When you give up the fight before you begin and let the insurance companies write the rules then, in the short run, the insurance companies will thrive and everyone else is scrambling.

We're cowards before the gods of corporate America. We, the people, can do better. We don't have to have the most expensive care in the world with indifferent outcomes for our people.

Get mad. Fix it.

276 likes as of 12/23 at 6:00 AM.


Kaiser Family Foundation: The Impact of the Coverage Gap in States Not Expanding Medicaid by Race and Ethnicity - An additional 5 million not covered. So a total of 35 to 40 million in the US with no form of health insurance in the first year of full implementation of ACA. Some people are proposing additional ‘fixes’ to a totally flawed Rube Goldberg system. We know what the solution is: Everybody In, Nobody Out.


Seattle Times: Expanded Medicaid’s Fine Print Holds Surprise: ‘Payback’ From Estate After Death - Medicaid has always had the ‘right’ to collect for medical expenses used by beneficiaries from their estate after death. With Obamacare’s expanded Medicaid, a lot more people are going to qualify and thus be subject to this ‘payback.’ Another odd and unnecessary complication from the new law. Again: Wouldn’t happen with Single Payer.


UCLA School of Public Health: Study Shows US Ranks Near Bottom In Health Care Spending Efficiency - This follows up on a study with the same results by the American Public Health Association earlier this year and the World Health Organization’s 2000 study showing the US to be 37th among OECD countries in terms of overall outcomes. Also see The Commonwealth Fund study which rated the US health care system a score of 65 out of a possible 100. All of the OECD countries that have better efficiency of health care delivery and better overall outcomes use some form of Single Payer. An American Journey of Public Health study indicates that for every 10 million people without health insurance, approximately 10,000 will die due to that fact. So even after Obamacare, 50,000 to 100,000 people per year will die due to lack of health care. The next time someone tells you the US has the best health care system in the world, remember these studies.


Kaiser Family Foundation: Medicare Patients’ Access to Physicians: A Synthesis of the Evidence - Laying to rest (one hopes once and for all) that doctors are leaving the Medicare system in droves. They are not.


ABC News: Colin Powell Pitches Single-Payer Health Care in US - People from both sides of the political spectrum are starting to realize how ridiculous the current system is and how much common sense Single Payer makes. Single Payer is getting legs. And I want you to think back over the last 4-5 years about all of the people, public and private, that told you that Single Payer was “not realistic.” Never listen to those people again.


ProPublica:’s Mysterious New Number: ‘834’


Bloomberg: Nobody Should Get Rich Off Obamacare - Who does? Insurance companies.


NYTimes: As Hospital Prices Soar, A Stitch Tops $500


NYTimes: Medicaid Growth Could Aggravate Doctor Shortage - As more doctors opt out of Medicaid, the pool of providers shrinks. The number of patients clamoring to see the few doctors still in the program overwhelm their practices and push out the patients with better coverage. So more doctors refuse to see new Medicaid patients. A point this site has been making since 4/26/10.


WSJ: Doctors: New Health Care Plans Raise Red Flags - All of a sudden doctors are worried that ACA will cut reimbursements and prevent sick people from receiving appropriate care. But strangely none of them advocate for the obvious solution. Maybe we live in Bizarro World?


NYTimes: The Single-Payer Alternative - Yet another short, well argued article by another scholar, this time from UMass, supporting Single Payer. We’re already paying more in overhead to insurance companies than it would take to implement Improved Medicare for All. The only conclusion I can draw is that we are a nation of idiots.


Common Dreams: 21 Ways the Canadian Health Care System is Better than Obamacare - 21. Check them out.

HuffPo: Single-Payer Advocates: It Hurts to Say I Told You So


Counter Punch: Open Letter to MoveOn

The Nation: Inequality is Killing Americans


NYTimes: Perks Ease The Way in Health Plans for Lawmakers

Single Payer Action: Single Payer vs. Obamacare - Giving more money to the corporations that influenced this legislation is not moving us toward a more equitable system of health care delivery. Down the road with ACA all we see is more privatization of this system. If you can’t pay, you die. That’s not right.


Counter Punch: The Obamacare Disaster - I find it interesting to read all of the sources who say they were the first ones pointing out in 2009 that this was not a ‘government takeover of healthcare’ but rather turning healthcare over to the insurance companies - which should now be clear to everyone. Faithful readers of this site know who was the first to point that out ;-). And please don’t ever forget that it was MoveOn who swayed the Progressive Caucus from their ‘pledge’ to never ever ever vote for a health care bill that did not contain a Public Option...Cute...and when Dennis Kucinich was the last hold out, MoveOn picketed his main office until he relented...and then repaid him by gerrymandering him out of office. And of course the Progressive Caucus raised over $400,000 in ‘little people’ contributions, but when they reneged on their own pledge, they kept the money. The only one to offer to return the money? DK. But really, you know what this is all about...the neo-liberals join with the right wingnuts to “prove” that liberal solutions just don’t least that’s what you voted for.


Frontline: Obama’s Deal

AHIP: Statement on Consumers Keeping Their Current Coverage - AHIP is the lobbying group for the health insurance industry. They wrote PPACA and then made sure Sen. Baucus got it passed. PNHP response: “Although the spinmeisters are busy trying to discredit the President and his administration for the false promise of allowing you to keep your insurance, and for the rollout of the exchange website before it was ready, this noise is a distraction from the real problem here. The Affordable Care Act is an irreparably flawed model of financing health care, and no amount of patching is going to fix it. It is and always will be an unstable, expensive and inequitable model of financing health care.

You know what is stable? Medicare. And it is less expensive and more equitable. Yes, it needs continual oversight and refinements, but it has the support of the public. If it were our only health care financing program, in an improved single payer version, virtually all of us would be demanding to keep the insurance that we would then have - an Improved Medicare for All.”


Health Affairs: Access, Affordability, And Insurance Complexity: US Ranks Lowest of 10 Countries

ProPublica: Coming In January: Obamacare Rate Shock Part Two


ProPublica: Loyal Obama Supporters, Canceled by Obamacare

Kaiser Health News: Popular Provision of Obamacare Causing Sticker Shock


British Medical Journal: Non-Publication of Large Randomized Clinical Trials - Many studies which show that commercial drugs are not effective, or worse are detrimental just don’t get published. Thus, the scientific method goes out the window.

LATimes: Anthem Blue Cross Sued Over Policy Cancellations


NYTimes: When Insurers Drop Policies - Three Stories - Ed Shultz said this wouldn’t happen.


NYTimes: The President Wants You to Get Rich on Obamacare - “It’s not the government takeover of health care. It’s the privatization of health care.”


Forbes: Despite Glitches, Obamacare Profit Windfall To Insurers Well Underway


Roosevelt Institute: What Kind of Problem is the ACA Rollout for Liberalism? - An insightful, short, but deep discussion of what the real problem is behind the IT fiasco and the ACA itself. In short, it’s that instead of going for by far the simplest and most easily implemented solution to insure universal, affordable health care - Improved Medicare for All, aka Single Payer - the politicians created a kludge allowing states to interfere with the implementation and so that insurance companies, along with their 30% overhead had to be dragged along. The ACA is a neo-liberal solution, when what was needed was the older New Deal form of liberalism. This is reflected both in the horrible difficulties encountered during the IT roll out, as well as in the 20,000 page law itself. This is one that you really should take the 20 minutes necessary to read and understand.


Washington Monthly: The Restive Single Payer Tribe - A very short article by a Democrat sycophant indicating that the light is dawning in their heads that PPACA may have been a big mistake. Maybe they should have listened to true progressives when they had a chance. PNHP Response: “It is fair to say that Ed Kilgore represents the views of neoliberals who have taken control of the Democratic Party and moved it to the right. What is striking about his message is that the intensive political attacks on Obamacare by the conservatives are assisting single payer advocates who are busy exposing its profound policy deficiencies. With their noise, and our reasoned policy prescriptions, middle America may be ready to move to single payer much sooner than expected.”


NYTimes: Out of Network, Not by Choice, and Facing Huge Health Bills - This is a really great article that goes into some detail to explain some of the gaping holes in ACA. You think you have a fully comprehensive health plan, but still get faced with $Millions in bills by out-of-network providers, and you have no control over this. “And while the Affordable Care Act generally caps what consumers must spend out of pocket when using providers within their plan’s network, it doesn’t protect consumers from large bills from outside providers. Those providers may be free to charge the consumer for the balance of the bill that the insurer did not pay, known as “balance billing.”... Still, there’s nothing in the law that stops health care providers from billing consumers for the balance, which is what often happens — and exactly what the D’Andrea family experienced. “This is not an issue that the Affordable Care Act fixes,” said Timothy S. Jost, a professor at the Washington and Lee University School of Law and expert on health care laws. “It is conceivable that the problem gets worse for some people if the Affordable Care Act encourages narrower networks, which some people think it might do.” As always, none of this would be happening with Single-Payer.


Truthdig: Amy Goodman: Single-Payer Prescription for What Ails Obamacare


HuffPo: Jon Stewart Grills Kathleen Sebelius On Obamacare, Single-Payer - KATHLEEN SEBELIUS: You’re more likely to live sicker and die younger without insurance.

JON STEWART: Exactly. Which is why I don’t understand the idea of staying with a market-based solution for a problem where people can’t be smart consumers. There are too many externalities in health care, that I honestly don’t understand why businesses wouldn’t jump at the chance to decouple health insurance from their responsibility, and why the government wouldn’t jump at the chance to create a single-payer system that simplifies this whole gobbledygook and creates the program that I think America deserves. I don’t get it. [Wild applause and shouts from the audience.]

Democracy-NOW: Is Obamacare Enough? Without Single-Payer, Patchwork US Healthcare Leaves Millions Uninsured


Single Payer Action: Single Payer Bernie Sanders and Ted Cruz


NYTimes: Millions of Poor Are Left Uncovered by Health Law


Mercer: Employers Hold The Line on Health Benefit Cost - And pass it on to employees. With Single Payer, employers wouldn’t even be involved in their employees’ health care.


Counter Punch: Ralph Nader: People Want Single-Payer Now - Senator Talk-A-Thon has accidentally brought this into focus.


Bill Moyers: Some People Are Making Big Bucks Sabotaging Obamacare - Fundraising groups that mostly fund their own salaries like the Tea Party Express; and health insurance brokers who want to limit their competition. The more they can confuse Americans, the more money they stand to gain. Sick.


WashPo: Canadians Don’t Understand Ted Cruz’s Health-Care Battle - Leaders of large corporations in Canada expound on the absurd American view of health care. Canada’s single payer system is more efficient (lower cost per person), effective (everyone is covered) with higher quality (better overall outcomes).


NYTimes: Lower Health Insurance Premiums in Exchanges Comes At Cost of Fewer Choices - And in some cases, no choices. “Having an insurance card does not guarantee access.” And to think, back in 2009 Ed Schultz told me “If you like the plan you have now, you can keep it.”

Common Dreams: US Health Care: Weaponized Greed


PNHP: Stronger Medicine Than Obamacare Needed to end Uninsured Crisis

NYTimes: Reaping Profits After Assisting on Health Law

J Turley: Vitter Moves to Block Congressional Exemption From Obamacare...Dems Move to Raise 2007 Prostitution Scandal - Difference?


National Nurses United: Healthcare Workers in 13 Countries Join Global Day of Action for a Healthy Economy


LATimes: Insurers Limiting Doctors, Hospitals in Exchange Markets - The doctor can’t see you now. And yet you’ll still hear pro-insurance folks tell you how limited your choices are and how long you’ll have to wait to see the doctor in Canada - and how much better we have it in the US. Wouldn’t happen with Single Payer.


New England Journal of Medicine: The Public and the Conflict Over Future Medicare Spending - There is a huge gap in the actual performance of the Medicare system and the public’s understanding of that performance. Many believe it is much less efficient than private health insurance. In fact Medicare’s overhead is 3%. That of private insurance companies is 20-30%. 63% of those polled thought Medicare regularly withholds treatments to save money. Just a few of the many misconceptions held by a majority of Americans.


NYTimes: Unions’ Misgivings on Health Law Burst Into View - See entry of 8/4. Many union members stand to lose their extremely good health care benefits because of PPACA. This was a clearly foreseeable consequence when the bill was being negotiated. Once again unions, who have been staunch Democrat supporters and are thus taken for granted, take it on the chin from the Dems. They’re getting all mad, but as long as they keep endorsing Dem candidates nothing will change.


The Hill: Bernie Sanders: A Single-Payer System Makes Economic Sense - PNHP: “Although the nation is distracted with the implementation of the Affordable Care Act, the single payer concept is not going to go away. Soon the nation will understand why.”

LATimes: Health Law’s Ailments Can Be Cured By Single-Payer System


Reuters: Time Warner to Move US Retirees to Healthcare Exchanges - Neat and clean. Get those liabilities off the books and make it sound like they’re performing a humanitarian service.


Labor Notes: Longshormen’s Union Quits AFL-CIO - This 60,000 member union, based mainly on the west coast has resigned from the AFL-CIO partially because of the PPACA, which will tax union health plans under the “Cadillac provision.”


MoJo: CBO: Medicare Costs Are Down - Going back to 1980. While all the overall cost of health care has been steadily climbing. It’s not Obamcare. It’s not the recession. This article and the underlying study can’t draw a conclusion as to why. Could it be that Medicare is just a very efficient system, as it has been found to be in every other industrialized nation?


AlterNet: Is The Affordable Care Act Actually Affordable?


The Hill: Obamacare Architects Reap Windfall As Washington Lobbyists - PNHP comment: “We need lobbyists, that is lobbyists such as Craig Holman of Public Citizen. But what about administration officials, lawmakers and congressional staffers who helped to create a profoundly wasteful health care financing system that falls tragically short of reform goals, and then left government employment to accept windfalls as private lobbyists representing clients who must deal with Obamacare? As Holman says, it raises questions about the bill's integrity.”


US Dept. of Health and Human Services: Access to Physicians’ Services For Medicare Beneficiaries - Next time you hear someone say that doctors are opting out of Medicare, here’s the proof that’s not true. 90% of doctors take new Medicare patients and that number has remained steady for at least the past 5 years.


McClatchy: Job-Based Health Insurance Costs Rise in 2013

New Jersey Star-Ledger: Tackling Our Uncontrolled Health Care Expenditures


AMA News: Insurers Seek Limited Insurance Exchange Plan Networks - One has to read between the lines on this one. The ACA law has a clause that allows “any willing provider” to participate in plans offered on the state exchanges. The insurance companies don’t like that because it means that you can still go to your regular doctor, even if he/she is not in-network for the state exchange plan you select, if he/she is willing to accept the reimbursement rates offered by that plan. This works against the insurers’ ability to squeeze more profit from the backs of just a few doctors willing to join their network. If patients are allowed to see other doctors, it means that the ‘squeezed’ doctors cannot necessarily expect the number of patients they see to increase in return for taking lower rates of reimbursement. Insurance greed on top of insurance greed. Wouldn’t happen with Single Payer.


NYTimes: A Limit On Consumer Costs Is Delayed In Health Care Law

NYTimes: New Law and Rising Costs Create A Surge of Supersizing Hospitals


Las Vegas Sun: Sen. Reid Says Obamacare Just a Step Toward Eventual Single-Payer System - Lots of interesting stuff here. With this public forum, Reid has gone beyond just saying that employer-sponsored plans must end. He has now taken the giant step of implying that the insurance based system should be eliminated. Also, it should be noted that Obamacare is NOT a step towards Single-Payer, in fact it’s a step in the other direction by giving the insurance and pharmaceutical companies far greater market power than they had before. Nevertheless, it’s a major step when the Senate Majority Leader says that we must eventually adopt Single-Payer.


WashPo: Do You Understand Health Insurance? Most People Don’t. - Only 14% of people surveyed answered all 4 simple questions correctly. When buying health insurance, most people look only at premiums and don’t realize they are under-insured until they get sick and need it. Wouldn’t happen with Single Payer.

National Nurses United: Advocating For Single-Payer


CA Health Line: More Doctors Are Quitting Medicare. Is Obamacare Really to Blame? - More doctors are leaving Medicare. That is a true statement as far as it goes. But it’s also true that many more doctors are coming into the program than are leaving. Lesson: Take anything you hear on CNN or the other 3-letter-networks, with a big fat grain of salt.


NYTimes: Health Care Law Raises Pressure on Public Unions - Up to now, unions have been somewhat successful in maintaining the actuarial value of their health care plans, when compared to the non-union employer sponsored health plans. But now comes Obamacare with its “Cadillac tax” which provides municipalities with all the excuse they need to force their employees to accept the high-deductible, low actuarial value underinsurance plans - with their worse outcomes and greater financial hardship. And what’s worse, most Democrats who voted for Obamacare actually saw this one coming. But they chose to take care of their big insurance corporate donors rather than their constituents. Once again, this wouldn’t be happening if we adopted the least expensive, most efficient health care system - one that puts big and small businesses on a level playing field with their global competitors, has better outcomes, and is truly universal and affordable - at half the price.


Univ. of Massachusetts Study: ‘Medicare For All’ Would Cover Everyone, Save $592 Billion Per Year - “With enough left over to pay down the national debt.” The presentation. Summarized in Beckers Hospital Review.

Bloomberg: eHealth Moves In For The Kill - ACA again proves to be the most expensive alternative possible. On top of the 30% administrative cost of private plans (Medicare is less than 3%), now broker’s fees will be added on top of the monthly premium costs as consumers shop on the state exchanges.


NPR: Montana’s State-Run Free Health Clinic Sees Early Success and Here - This is actually a form of socialized medicine, not single-payer. The state owns the facilities and pays the doctors and staff by the hour. It’s a hit with patients, doctors - and even state Republican politicians. Interesting short read. PNHP Comment at bottom.

HuffPo: Fulfilling the Promise of Medicare


Charlotte Observer: Let’s Celebrate Medicare

American Medical News: WellPoint/Employer Collusion Will Cost Employee/Patients Additional Out-of-Pocket - This borders on illegal price fixing, but whatever, it’s just another way to pass more of the cost on to the employee/patient. Just one more health insurer outrageous maneuver that would not happen under Single Payer.


Center for Public Integrity: ObamaCare Oversight Among Health Watchdog Cuts - The state exchanges will not be audited, or protected from hackers. “Three years from now we’ll be saying, ‘how could we not have predicted this mess?’”


Public Citizen: What the Prince of Cambridge Can Teach the US About the Benefits of Single Payer - Interesting comparative stats regarding medical costs per capita, as a % of GDP, out-of-pocket, and mortality rates between the US and the UK, which uses the Single Payer model.

Healthcare-NOW: NYC Labor Council Endorses HR 676


Boston Globe: Medicare’s Disguised Form of Rationing - A great article that explains a lot about how Medicare works. It’s well worth the read. But if you don’t have time, here’s my synopsis: Medicare is hiring for-profit vendors called “recovery audit contractors” who only get paid if they overturn a medical decision - a clear conflict of interest. In this case, it’s making the hospitals admit seriously ill patients as out-patients instead of in-patients. This shifts the payment from the hospital (Medicare Part A) to the doctor (Medicare Part B), which lowers the cost to Medicare, but increases the cost to the patient. So if the ER admits a seriously ill patient and the recovery audit contractor ‘finds’ that the admission should really have been as an out-patient, the hospital doesn’t get paid at all. Outrageous. When we say Single Payer = Improved Medicare for All, this is just one example of where the ‘Improved’ part comes in. “The latest fad in the ideology of using commercial incentives and intermediaries to contain costs goes under the name of consumer-directed care. The idea is to combine tax-favored “health savings accounts” with high-deductible health insurance plans and to rely on the consumer’s capacity to shop around for the most suitable plan. But as the system becomes ever-more convoluted, the idea of consumers having the knowledge or market power to intelligently navigate it is laughable.”

WSJ: Both Republican and Democrat Senators Agree: ObamaCare’s Definition of Full-Time Job Needs Revising - The definition of full time work in PPACA is 30 hours. This is causing severe pain to a large segment of American workers as their employers reduce their hours to 29 per week so they don’t have to provide health care. The Senators are proposing a the obvious ‘fix,’ and surely it needs to be done and hopefully it will. But take a step back. This is a kludge on top of a kludge. And with PPACA, we keep doing these ‘fixes.’ If we had Single Payer, none of this kludging would be necessary. Everybody In, Nobody Out, No Exceptions.


Health Care Not Wealth Care: TIAA-CREF Shareholders Meeting Hears Calls to Divest From Unethical Health Insurers - The idea is catching on among fund managers that, based on repeated findings of unethical behavior by regulatory bodies and the courts, funds that purport to invest only in high quality companies should begin to think of divestiture from health insurers. “The divestiture group says the private companies should be replaced by a single-payer, improved-Medicare-for-all system, which would provide excellent coverage to all by taking the private health insurance companies out of the equation and putting the needs of patients before profit.”

NYTimes: House Votes to Delay Two Requirements of Health Care Overhaul - Long time readers of this site will remember that I’ve been saying since May, 2009 that the reason for the delays in these ‘requirements’ and ‘benefits’ is so that the lobbyists and the politicians can continue their $ymbiotic relationship while they slowly take away all the goodies. Here’s just the latest example.


Health Research Services: An Examination of Pay-For-Performance and Here - This much advertised aspect of PPACA, in the final analysis, just doesn’t work as promised.


WSJ: Union Letter: Obamacare Will ‘Destroy The Very Health and Wellbeing’ of Workers - Three major US unions, including the Teamsters, have finally woken up to what this web site has been saying all along. The promise that “if you like the plan you have, you can keep it” was a lie all along - spouted by talking heads like Ed Shultz, Rachel Maddow, Air America and MSNBC - when their corporate owners were telling them to 'sell this program.' This is just one more case where the rewards of worker productivity are going right into the pockets of the 1%, leaving working people out in the cold. The good news is that these unions have woken up and they aren’t taking it anymore. The letter they wrote to Obama, Pelosi, and Reid is well worth the read - unions are totally pissed. The Democratic party has always taken the union vote for granted. That may not be the case anymore. PNHP remarks.


Health Services Research: Increased Risk of Death Among Uninsured Neonates - Just another in a long list of poor outcomes in the US that could be resolved with Single Payer - Everybody In Nobody Out.


NYTimes: Diagnosis - Insufficient Outrage - At what point does perverse healthcare become a crime? When it is not done under Medicare. By a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice.


Portside: Obamacare Bends For Big Business


Kaiser Health News: Turning to the Web to Help Pay Medical Bills - Truly pathetic. An anecdote about someone with probably the best health care coverage available, still has to pan handle on the internet to pay tens of thousands in out-of-pocket expenses - just in order not to leave his wife with a life time of debt due to his illness. And now on top of the overhead at health insurance companies, this person also has to bear the overhead involved for a company that specializes in setting up web sites for people in just this predicament. I don’t get it. Are Americans just not paying attention or do we all just love financial abuse?


WashPo: This Georgia Hospital Shows Why Rejecting Medicaid Isn’t Easy - PPACA + Supreme Court decision = Grady, a hospital that serves 600,000 patients per year, trains 1/4 of Ga. physicians, and provides medical care to more uninsured patients than any other hospital in the state, may effectively have to close many of its services.

Centers for Medicare and Medicaid Services (CMS): Guidance on Hardship Exemption Criteria - For those with financial hardship and the greatest need for the security of health care coverage, instead of establishing ways to bring them under the health care umbrella, we leave them unprotected against greater financial hardship and greater barriers to health care access.


Swiss Broadcasting Corporation: Swiss Voters Back Single-Payer Health Care


NYTimes: Healing the Overwhelmed Physician


Charlotte Observer: Single Payer Is The Needed Cure


Harvard Health Affairs: The Uninsured After Full Implementation of PPACA: A Demographic and Geographic Analysis - Who will remain uninsured? About 30 million people, mostly white, working age, very low income and/or unemployed. Why are we doing this to ourselves when we could have a system that costs half as much and insures everyone? Because our government is a wholly owned subsidiary of corporate Amerika.


PNHP: Medical Debt: A Curable Affliction Health Reform Won’t Fix


Campaign for America’s Future: The Obamacare Scorecard - More data showing the US has by far the highest cost (per capita, as a % of GDP, per household, and in absolute dollars) and the lowest life expectancy of any OECD country. At best Obamacare will slow the future growth of costs, but no one is contending that it will lower costs. In 2008, 45 million Americans were uninsured. This study cites the Urban Institute’s number of 18 million uninsured after Ocare is fully implemented, but the CBO has estimated 31 million. So somewhere between 5 and 9% of Americans will gain some sort of health insurance under Ocare. Article’s conclusion: “While the law does some good things, it will only marginally improve upon a fundamentally broken system.”

What’s so ironic about this article is that CAF (Think Progress), during the negotiations of PPACA, was one of the original sources along with HCAN, MoveOn, PDA, Planned Parenthood, NARAL, etc pushing the notion that Single Payer was not “realistic” or “politically feasible.” Then later they all went meekly along when Obama traded the Public Option for unlimited campaign cash for his re-election. What, have they now seen the light? I’ll believe it when I see them in the street fighting for Single Payer. But of course that day will never come.


Harvard Health Affairs Study: Immigrants Contributed A Net Positive $115 Billion to Medicare Between 2002-09  and NYTimes - Who knew?

NYTimes: A Simpler, Better Solution


LATimes: Insurers Limit Doctors, Hospitals In State-Run Exchange Plans - Proponents of PPACA publicly rejoiced when premiums on the CA exchange came in lower than feared. What they didn’t mention was the lack of choice, the tight networks and exclusions/limits of doctor and hospital choices. Because of this cost-cutting effort on the part of insurance companies in the exchange, “private companies are pursuing similar changes to shave costs. More employers have been adopting these narrower networks and the government's overhaul of the individual insurance market is accelerating the trend.” It’s becoming the new ‘standard.’ Choice? Nope. Thanks PPACA! Medicare does not limit patients to any network. Doctors can opt out of Medicare, but very few do. With an Improved Medicare For All, this issue would not exist. The insurance-company-centric method of health care delivery to sick people that is becoming institutionalized in the US by PPACA is shameful and a travesty. Any effort short of complete replacement is a waste of time.

NYTimes: States Policies on Health Care Exclude Poorest - Over half the people that currently do not have health insurance live in states that have opted out of Medicaid expansion. The most vocally fundamentalist Christian states continue to show the least concern for the poor. PPACA could just as easily have been written in such a way that these people could have received subsidies through the state exchanges rather than through Medicaid. Of course the root problem is that instead of passing a simple law that expanded Medicare to everyone (which the Dems said was not ‘realistic’), they felt they had to keep the insurance companies on the take, which required one of the most convoluted laws in history. This is the inevitable result.


WashPo: Health Care Tops All Industries for Highest Median CEO Pay - $11.1 Million. And what is it again that CEOs do for the betterment of society? I can never remember that one.


SacBee: Loophole in Health Care Law Could Stick Doctors With the Tab - One more effect of the control the insurance companies had during the creation and passage of this law. They are protected, while the physician and patient get the shaft.


NYTimes: Overruns Forcing Lower Payments to Some Providers In Stopgap Health Program - Less than half the predicted number of people signed up, but overall costs have already exceeded both White House estimate and the $5 Billion provided by Congress. The Pre-Existing Condition Insurance Plan was only open to those who had no insurance for 6 months. Since most people with pre-existing conditions have insurance with an exception rider for their pre-existing condition, they were therefore not eligible. However on 1/1/2014, whether in the plan or not, they will all seek new health care plans through the state exchanges. Healthy/young people will either keep the plans they already have at work or will not buy health insurance and pay the small penalty. I’ll leave it as an exercise for the reader to figure out what this adverse selection is going to do to costs/premiums for the state exchange plans - the very plans that proponents of the law originally claimed would be the one thing that would hold down the cost of health insurance. Remember none of this would be happening under Single Payer.

McClatchy: 62% of Deep South Public Favors Medicaid Expansion, But Republican Lawmakers Don’t


CBO: Estimate of Net Budgetary Impact of ACA’s Health Insurance Coverage Provisions Not Changed - When ACA is fully implemented, there will still be 31 million uninsured Americans, roughly the same as when the Clintons first tried reform.


International Journal of Health Services: Medicare Overpayments to Private Plans, 1985-2012: Shifting Seniors to Private Plans has Already Cost Medicare $282.6 Billion - PNHP response: Now we know that the private Medicare plans have been overpaid $282 billion in taxpayer funds. The Obama administration has continued to add to the overpayments by expanding eligibility for extra quality award payments to which the plans were not entitled, and by using a bookkeeping gimmick for suspended SGR adjustments. Congress and the administration, in using our taxpayer funds to reward this unprincipled industry, should pay a political price for their misdeeds.


NYTimes: Hospital Billing Varies Wildly, US Data Shows


Politico: Bernie Sanders: Primary Physician Shortage Calls For Intervention


NYTimes: Half of US Adults Lacked Adequate Health Care During 2012


Aetna Investor Relations: Q1 2013 Earnings Conference Call - “Margin over Membership” They plan to limit membership to the healthiest people and cut their provider network by 1/4 to 1/2 in order to use only providers who will accept lower reimbursement rates. That’s great for the investors, but horrible for sick people. It’s no way to run a health care system and it would not happen with Single Payer.

Georgia Health News: State Hospital Officials Muted on Medicaid Expansion - An example of what happens in a red state when the Republicans in control, in a childish attempt to ‘make Obama fail,’ refuse to expand Medicaid. In Georgia’s case, because of a supposed $4.5 Billion cost over 15 years, the governor refuses $20 Billion in federal aid. Small hospitals have to close their doors. Big hospitals that handle indigent emergencies lose even more money.


Hartford Courant: UnitedHealth Group CEO Takes Pay Cut Down to $34.7 Million - Plus $7 Million in stock.

Common Dreams: ‘Obamacare’ Failures Beg the Questions that Single-Payer Answers


Fox News (yech!) “Debate”: Single Payer vs Unregulated Private Care - John Stossel hosts a debate which includes a rep from PNHP. PNHP clearly has the superior argument even though Stossel goes out of his way to make sure the panel member favoring private sector gets all the advantages including the last word. Finally Stossel has to shut it down because the PNHP panelist is making all the points. Interesting and funny.

Journal of General Internal Medicine/PNHP: Insured But Unable to Afford Health Care


WashPo: Governments May Push Workers Out of Employer Health Care and Into Exchanges - forcing them to work 30 hours or less. And the private sector is poised to follow suit. Remember when proponents of PPACA used to say: “If you like the health care you have now, you can keep it.”? That was a great big lie.

Common Dreams: Beyond Obamacare: How A Single-Payer System Can Save US Health Care

Aflac: American Workers On An Uphill Road With Consumer-Driven Health Care - “Consumer-Driven” = High Deductible. The Affordable Care Act is slowly becoming unaffordable.

Main points of the study:

- Nearly three-quarters (72 percent) of the workforce have not heard of the phrase “consumer driven health care”;

- More than half (54 percent) of workers would prefer not to have greater control over their insurance options because they don’t have the time or knowledge to effectively manage it;

- 62 percent of workers believe the medical costs they will be responsible for will increase, while only 23 percent are saving money for potential increases;

  1. -75 percent of workers said they think their employer would educate them about changes to their health care coverage as a result of reform, but only 13 percent of employers said educating employees about health care reform was important to their organization.


American College of Cardiology: I Am A Republican...Can We Talk Single-Payer?


Bloomberg Businessweek: The Reason Health Care is So Expensive: Insurance Companies - Stanford University MBA professor talks about administrative waste. “The thing ... that no serious policy proposal attempts to fix—the arrangement that accounts for much of the difference between health spending in the U.S. and other places—is the enormous administrative overhead costs that come from lodging health-care reimbursement in the hands of insurance companies that have no incentive to perform their role efficiently as payment intermediaries.”


PNHP: Obama Admin. Intervenes to Give $71.5 Billion To Overpaid, For-Profit Medicare Advantage Plans


HuffPo: Big Pharma Pockets $711 Billion in Profits Robbing Seniors, Taxpayers - Remember the deal Obama cut with the drug companies to get them on board for PPACA?


PNHP: Advice for Stephen Colbert when Interviewing Pres. Clinton - A quick thumb-nail synopsis of why we need Single Payer - good reference article.


WashPo: Cancer Clinics Turning Away Thousands of Medicare Patients. Blame the Sequester. - Dems = Rethugs = NO DIFFERENCE


NYTimes: Health Law Provision for Small Business Is Delayed - Regular readers are by now sick of hearing me say that the whole reason for delaying all the goodies of PPACA was so that politicians and lobbyists could prolong and maximize their $ymbiotic relationship while they slowly and systematically dismantle those goodies. Proponents of this law, before its passage, were quick to say that its main cost control mechanism was going to be the exchanges. Now we see how that’s working out for all of us.


Salt Lake Tribune: Last Chance: If ACA Fails, Single Payer Is Next - If?


Reuters: Some Healthcare Costs May Rise When Obamacare Implemented - Sounds innocuous enough doesn’t it? This is the MSM candy-coating what is going to be a very bitter pill. Towards the end of the article, it starts to reveal some of the hard facts. For instance, it keeps saying how the state exchanges are going to save money for beneficiaries. But here’s the catch: You’re only eligible for the exchange if you don’t have insurance now because you can’t afford it - and many states have opted out of even that.  Bottom line for you and me: premiums are going up by 1/3 to 1/2 - and that doesn’t count co-pays, deductibles, and other out-of-pockets. Medical apartheid coming soon to America. People are going to continue to go bankrupt, loose their homes and die because of  lack of adequate health care. This situation is outrageous. We are the only industrialized country in the world that permits it.

Truth Out: Occupy Strike Debt Kicks Off Second Debt Buy-Up With March for Universal Care


Penn. Patriot-News: Single Payer Health Care, The Only Viable Solution - “When President Obama arrived on the scene, America’s health care system was in need of repair just like our economy was in need of help. Unfortunately, in both instances, the Obama administration in collaboration with both parties called upon corporate America to fix the problems that they (corporate America) had largely created. Not unexpectedly, their solutions served corporate America’s interests rather than that of most Americans and at the end of the day we will find that our healthcare system problems will remain unsolved.”

Change.Org: Yet Another Example of Workers Feeling the ‘Fruits’ Of PPACA


PNHP: The Cost Curve is Bending, But Not For All of Us - Note: There are two graphs in this article. If you can’t read the entire article, then just take a quick glance at the graphs.

NYTimes: Tight Deadlines and Lagging Funds Bedevil Obama Health Care Law - This site has maintained for over 3 years that the reason for delaying all of the “goodies” in PPACA was so that lawmakers and lobbyists could amplify their symbiotic relationship while they systematically eviscerated the benefits. This article is just the latest proof of that theory. How about we pass a simple law that says “the new minimum age for Medicare is 0 (zero)?”


NYTimes: Obama Admin. Encourages States to Expand Medicaid With Private Insurance - The Democrats urging a Rethuglican solution. Nothing new about that I suppose.


eHealth: Premiums to Rise 47% in 2014 For Comprehensive Benefits and LATimes - And eHealth is the cheapest health plan of all, and this does not include other out-of-pocket expenses such as deductibles, co-pays, etc. Ah, the ‘magic of the market.’ Can you imagine what it will do to your budget to add 50% to your current premiums next year? Amazing. It will be interesting to hear how the proponents of PPACA rationalize this one. And it will be interesting to see how the current estimate of the CBO, that 30 million people will go without insurance, holds up under this pressure. The next shoe to drop will be the advent of ‘scaled down’ plans that will seem cheaper when only premiums are considered, but will actually cost more if the beneficiary actually has a serious illness - medical apartheid. Again: Improved Medicare for All, aka Single Payer holds costs down by negotiating through monopsony pricing. Every other OECD nation does it this way, paying half of what we do and getting much better medical outcomes.

Forum for Health Economics and Policy: Price Shopping in Consumer-Directed Health Plans - We keep hearing that consumers in high deductible plans will be price conscious and shop for the best ‘deals’ in health care, thus bringing down the overall cost of health care. This study shows they aren’t and it doesn’t work. We are wasting our time looking for solutions prescribed by the 1% that don’t work, and we need to transition to a system that has been shown to be more efficient in every industrialized country in the world.


Center for Economic and Policy Research: State Savings with an Efficient Medicare Prescription Drug Benefit - Americans pay up to $7 Billion per year more for drugs because Medicare doesn’t negotiate with drug companies - part of the cost Obama paid to get them to sign on to PPACA.


Politico: Experts Debate Single Payer Solution vs. All Other Approaches - And guess who won that debate. This is essentially a follow up to Steven Brill’s excellent Time article of 2/20, see below. PNHP response: “Steven Brill provided such a convincing argument for using Medicare as a universal program to control health care spending that he now seems to be convincing himself that we should look beyond the current approach of dismissing single payer as impractical. As he says, single payer is "sort of the cleanest way to clean up the system."


Jonathan Turley: Is Private Health Care Squeezing the Life Out of Us?


Health Pocket: Only 2% of Health Plans Meet Minimum Essential Benefits Required Next Year - Translation: Your premiums are going North, ...Way North.

NYTimes: Worker’s Share of Health Costs Is Likely to Continue Rising


LATimes: Blue Shield and Aetna to Raise Rates Over State Objections - And yet proponents of Obamacare will tell you that it prevents this from happening.

The Nation: Strike the Debt Declares Healthcare Emergency: It’s A Matter of ‘Life or Debt’


PNHP: Medicare Part D Rife With Conflict of Interest - The OIG identifies huge conflicts of interest on the private committees creating the offerings for this program. Both Republicans and Democrats, including the Obama Admin., advocate for it by reasoning that any non-competitive offer by an insurance company (the result of all of the OIG identified conflicts of interest) would put them at a market disadvantage, as if Medicare recipients could easily make sense of the complexity of various benefits and the differences in their formulas of various policy offerings, and evaluate the various plans for drugs that they have not yet even been prescribed. The R’s and the D’s are both shamelessly touting the magic of the market, in order to benefit their corporate overlords.


Time: Bitter Pill: Why Medical Bills Are Killing Us - Literally. Only one word can describe what medical practice has come to in this country: Scandalous - especially with regard to big PHARMA, insurance companies and “non-profit” hospitals. PNHP response.

PNHP: Setting the Record Straight on Medicare Overhead - Response to yesterday’s Duke Univ. report. Medicare Part A and B have a 1% overhead. Medicare Advantage, the private option, has an overhead of 6%. For this and other reasons, primarily Medicare’s monopsony pricing, Improved Medicare for All would save hundreds of $ Billions over the next several decades.


Duke University: Thinking Clearly About Medicare Administrative Costs: Data Sources and Measurement - A very scholarly article showing that, despite what the insurance lobby likes to claim, administrative costs of Medicare are about 1% which includes all costs. It also shows administrative costs of Medicare Advantage and Medicare Part D are highly wasteful Bush Admin add-ons to the program that were advertised initially as an attempt to inject private sector, ‘market driven’ practices.


NYTimes: Some Employers Could Opt Out of Insurance Market, Raising Costs for Others - Not ‘Could,’ but ‘Will.’ PPACA is a very deeply flawed law. It is causing insurance to become less and less Affordable and thus less Universal - the two main goals that its proponents advertised during the ‘health care debate.’


Healthcare-NOW!: Rep. John Conyers Reintroduces National Single-Payer Health Care Bill and PNHP


NYTimes: Sharp Slowdown in US Health Care Costs Eases Deficit - Hey, I’m ‘fair and balanced’ so I couldn’t ignore this. This article is basically saying that the CBO’s estimates of ‘projected’ future growth are being reduced. “Health experts say they do not yet fully understand what is driving the lower spending trajectory.” ... “Part of the slowdown stems from “the recession and the loss of income and wealth” causing people to cut back on health care” ... “Even if slower growth persists, the cost of health care poses one of the greatest threats to the country’s fiscal health.” ... “Premature celebration never makes sense when it comes to health care” Clearly a mixed bag, but worth mentioning.

AMA: Doctor Integration Vital to Stronger Hospital Finances - First the Republicans will tell you that ‘the market should decide,’ a type of faith-based approach using the theory of a free market to attain the most efficient deployment of resources, at the lowest costs, with the highest returns and highest quality goods and services. But what they implement in reality is a consolidated, oligopoly that flies directly in the face of that theory. This article basically contends that doctors and hospitals make the most money when they combine forces to conspire to control costs and prices. What’s left out of this scenario? Sick people who can’t afford the inflated prices. Bottom line: for-profit delivery of health care is a broken idea.


The Hill: ACA Tax Hike You May Have Forgotten About


NYTimes: Health Care’s Trick Coin - Showing how health corporations have completely rigged the so-called ‘scientific process.’ So now when a medical professional says ‘there is or is not scientific evidence to support the effectiveness’ of some therapy, it’s not that he/she is lying, it just means that there essentially is no scientific process for them to rely on anymore. A sad state of affairs and this entry should probably be under Corporate Domination.


NYTimes: Federal Rule Limits Aid to Families Who Can’t Afford Employers’ Health Coverage - Last sentence in the article: “The Congressional Budget Office predicts that 30 million people will be uninsured in 2016 and that 6 million of them will pay penalties.” But that CBO estimate was made several months ago prior to this new rule. Look for the CBO to issue another higher estimate. Not affordable and not universal. And HuffPo


NYTimes: Carrots For Doctors - A good, reasoned argument against P4P turns into another voice for the ultimate solution: Single Payer. Remember: American now spends over twice as much for health care (per capita, and in absolute dollars) as every other OECD country and we get worse outcomes. See graph at top of page. We spent $2.85 Trillion in 2012. This will increase to $4.8 Trillion by 2019, or a total of $37 Trillion over the next decade. If we keep PPACA with no changes and do nothing more, we are on track to bankrupt every large corporation, local, state and federal government - and over 1/6 of Americans will still have no health insurance - not ‘universal’ and not ‘affordable.’ That would be the most radical plan - just do nothing more and wait - insanity. There is only one sane answer.


NYTimes: Fiscal Cliff Footnote: Big Gift to Drug Maker - “Supporters of the delay, primarily leaders of the Senate Finance Committee who have long benefited from Amgen’s political largess, said it was necessary to allow regulators to prepare properly for the pricing change.” And the beat goes on...


Buffalo News: Doctor Sees Shift to Single-Payer


Annals of Family Medicine: Life Disruptions Due to Out-of-Pocket Health Expenditures


Inter Press Service: US Health Worse Than Nearly All Other Industrialized Countries


NYTimes: Health Care and Pursuit of Profit Make A Poor Mix


Chicago Sun-Times: Why Not Good Health Care for All?


Reuters: Obama May Turn Medicare Reform Into Wider Health Debate - Towards the end: “Analysts say Obama could embrace the policies proposed in 2012 by Tanden's group, which contends that billions of dollars can be saved by expanding competitive bidding within Medicare, making costs and services more transparent, slimming down administrative costs and reforming medical education.” I’m afraid to get my hopes up.


Nation of Change: Our Deficit Debate’s “Sick Secret”

NYTimes: Despite New Health Law, Some See Sharp Rise in Premiums - More evidence that the law does not control costs.

Health Reform 2012