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Newsletter, "What's going On...", August 3, 2010

August 3, 2010


U.S. Sen. Bernard Sanders, I-Vt., pledged to personally take Vermont’s case for a statewide single-payer health care system to President Obama if the Legislature authorizes it next year. 

Sanders, speaking at a health care rally at the Hetty Green Park in downtown Bellows Falls Vt. on Saturday afternoon, said that he and other members of Congress would also introduce legislation that would roll back to 2014 the current 2017 restriction for states to apply for a waiver in order to implement their own systems. He said Democratic Reps. Dennis Kucinich of Ohio and John Conyers of Michigan would be co-sponsoring the legislation with him. 

But Sanders said that if Vermont opts for a single-payer system, as most of the Democratic candidates for governor have pledged to enact, he will take the state’s case directly to President Obama.  From the Rutland Herald, courtesy of Don McCanne.


California Single-Payer Update:  SB810, a state single-payer proposal, passed the Health Committee of the California Assembly on June 29th.  It ill be heard in the Appropriations Committee tomorrow, August 4th, and will pass.  It then goes to the floor of the Assembly, where its supporters outnumber opponents.  It then goes to Gov. Schwarzenegger who has vetoed similar legislation on two occasions in previous years.  So single-payer activists are working very hard to get pro-single-payer candidates elected or re-elected to their Senate and Assembly, and as Governor.


If you use Charter.net as your internet service provider, you most probably didn’t get last week’s newsletter.  A number of the newsletters came back, all from Charter, all labeled as SPAM.  We’ve done what we’re told to do to get the spam blocker to unblock us, and this week’s newsletter will tell if we succeeded.  You can get to last week’s newsletter from our web site, www.HealthCareForEveryone-Alabama.org“Our Newsletters” at the top of the page.  Touch those words with your cursor and you’ll have access both to the current newsletter and to recent archives.  Probably worth doing…it was one of the better newsletters, I think.  But then I’m biased.


Kaestner and Kahn’s study of data from the Medicare Current Beneficiary Study is cited in an article in the Healthcare Economist, titled Medicare Part D’s Effect on Drug Use, Other Medical Services, and Health.  When Medicare D came into effect, there was a 63% increase in number of prescriptions annually from seniors.  However, “… the authors find that Part D has no effect on health in terms of either functional status or self-reported health.”  From the Cavalcade of Risk.


The Boston Globe: Despite being home to the largest number of doctors per person in the country, finding a primary care physician has been getting more difficult for Massachusetts residents since 2006, according a report released by the state. "Last year 60 percent of family-medicine doctors' offices were accepting new patients, down from 70 percent in 2007, the first full year after the state mandated near-universal health insurance coverage. Last year only 44 percent of internal medicine practices were accepting new patients, down from 66 percent in 2005. The figures come from data analyzed by the Division of Health Care Finance and Policy" (Cooney, 7/26).  From Kaiser Daily Health Policy report. 


Ezra Klein, in a post on the Difficulty of Dying Well, said: “As Atul Gawande writes in a difficult but important article, our system is not set up for it:


“In 2008, the national Coping with Cancer project published a study showing that terminally ill cancer patients who were put on a mechanical ventilator, given electrical defibrillation or chest compressions, or admitted, near death, to intensive care had a substantially worse quality of life in their last week than those who received no such interventions. And, six months after their death, their caregivers were three times as likely to suffer major depression. Spending one’s final days in an I.C.U. because of terminal illness is for most people a kind of failure. You lie on a ventilator, your every organ shutting down, your mind teetering on delirium and permanently beyond realizing that you will never leave this borrowed, fluorescent place. The end comes with no chance for you to have said goodbye or “It’s O.K.” or “I’m sorry” or “I love you.”


“People have concerns besides simply prolonging their lives. Surveys of patients with terminal illness find that their top priorities include, in addition to avoiding suffering, being with family, having the touch of others, being mentally aware, and not becoming a burden to others. Our system of technological medical care has utterly failed to meet these needs, and the cost of this failure is measured in far more than dollars. The hard question we face, then, is not how we can afford this system’s expense. It is how we can build a health-care system that will actually help dying patients achieve what’s most important to them at the end of their lives.


Klein continued, “I want to talk about death panels here, and the difficulty we had in even assuring that doctors are paid for having a conversation with patients about end-of-life options, but I don't want to recast this as a political argument. The problem is, as with many things in medicine, a question that is terrifyingly intimate also has enormous public policy implications, as the last year of life is incredibly expensive, and it's paid for by Medicare, which means it's paid for by taxpayers. This is a difficult enough conversation to have without tossing politics and economics into the mix, but they're present whether we want them there or not. And so we've responded by ignoring the question, shouting it down when it comes up, and paying whatever's necessary to avoid a discussion we don't know how to have. That's not just a bad solution for taxpayers, of course. As Gawande says, it's a bad solution for patients, their families and their doctors.”


The Washington Post: New census data reveal big differences among states in the rate of uninsured people under age 65. Massachusetts has the lowest rate, 7.8 percent, and Texas the highest, 26.8 percent. (Alabama, at 14%, was about in the middle)  "The statistics are for 2007 and show health insurance coverage by state and for each of the country's roughly 3,140 counties. The numbers do not include the impact on millions of people who lost their jobs and health insurance after the recession began in December 2007."


Kaiser Health News editor Lexie Verdon writes: "The percentage of people who view the new health bill unfavorably dropped 6 points to 35 percent in the past month, but that has not translated into a significant increase of supporters, according to the July tracking poll from the Kaiser Family Foundation. The poll in graphic form.  Overall support remained stable since the June survey, with about half the public expressing a favorable view of the overhaul, the poll found" (Verdon, 7/29). Read entire article.  However, there are skeptics who note that Kaiser polling generally shows more support for the bill than do other polls.


Health insurers have started to back down "on their decision to pull out of the child-only coverage market after the Obama administration addressed their concerns about the potential damage to their bottom lines," The Hill reports. "The Department of Health and Human Services (HHS) on Tuesday clarified regulations mandating that insurance plans agree to cover sick children. HHS made it clear that plans are free to set up specific enrollment periods for their insurance plans if allowed under state laws. ... Health plans had raised concerns that without the enrollment periods, parents could wait until their children get sick before seeking coverage, making it impossible for insurers to stay profitable." Blue Cross Blue Shield of Florida quickly announced it would resume sale of children's policies. Karen Ignagni, president and CEO of America's Health Insurance Plans applauded the clarification (Pecquet, 7/29).   Kaiser Daily Health Policy Report.


Several Senate Republican leaders are now pushing a new, partial health-overhaul repeal bill that targets a Medicare cost-cutting panel, The Hill reports. The panel, the Independent Payment Advisory Board, would make cost-cutting recommendations whenever spending exceeds set benchmarks. Congress would have to adopt them, or come up with its own plan. "The Republican critics -- Sens. John Cornyn (Texas), Jon Kyl (Ariz.), Orrin Hatch (Utah), Pat Roberts (Kan.) and Tom Coburn (Okla.) -- argue that "unelected, unaccountable bureaucrats" shouldn't be granted such significant powers over the healthcare of seniors" (Lillis, 7/28).  The bill has no chance obtaining majority support in the Senate, nor of surviving a Presidential veto.


However: Power is concentrating in boards and the executive because Congress wants it to, writes Matthew Dickinson: "The idea that members of Congress would prefer to incur the political costs involved in balancing the budget or cutting Medicare themselves rather than farming these decisions out to an independent commission is, in my view, dubious...Indeed, rather than a power grab, the creation of independent commissions or boards to tackle tough issues is a time-honored method by both Congress and presidents to avoid having to tackle those issues themselves."  From Wonkbook.


On the 45th anniversary of Medicare, Reps. Dennis Kucinich and John Conyers and Sen. Bernie Sanders released a letter to the single payer community pledging to continue the fight for Medicare for All.  Dr. Quentin Young, National Coordinator of Physicians for a National Health Program, had a beautifully written piece in Huffington Post.   Check out the cute 30-second YouTube video of Andy Griffith promoting Medicare.  It’s running on CNN, the Weather Channel, Lifetime and Hallmark…all channels that seniors watch a good bit. Ezra Klein wished Medicare a happy 45th birthday, and noted that in 20 more years it will be eligible for Medicare, itself.  And the Republican National Committee wishes Medicare happy birthday, despite the party's record opposing it.  There’s also a cute 4-minute YouTube piece of seniors dancing and singing “Don’t Cut My Medicare” to the tune of “Stop In The Name of Love”, on the streets of NYC, originally from Dr. Andy Coates.


POLITICO Pulse (Monday morning): BREAKING - CMS will release a new report this morning saying that reforms in the Democratic health care law "will generate billions of dollars in savings for Medicare and strengthen the care Medicare beneficiaries receive." PULSE obtained an early copy. Get it here: http://politi.co/a4wXqq


On the heels of last week's New York Times piece on insurers paring back benefits, a new survey of 459 employers by Fidelity's Benefits Consulting group finds 84 percent taking a close look at their benefits in light of health reform with 20 percent considering no longer offering insurance. http://bit.ly/d4IDwA


Peter Van Vranken: A MUST READ - The nation's biggest insurers -- not happy with provisions of the four-month-old health care reform law that would force many of them to spend more of the money they collect in premiums for their policyholders' medical care -- are pressuring regulators to disregard what members of Congress intended when they wrote the law, so that they can keep raking in huge profits for their Wall Street owners. - Health Insurers Leaning on State Insurance Commissioners to "Reform" Reform Huffington Post by Wendell Potter (Our favorite former Health Insurance public relations executive)


The Centers for Medicare and Medicaid Services will cut hospital reimbursement by 2.9%. The move affects 3,500 acute care hospitals, which will see a .4% decline, about $440 million, in the next year. The American Hospital Association says this will hurt not only clinical care, but it will affect hospitals as employers, too. (Modern Healthcare, Health Leaders Media)  But, the silver lining is that cuts and other aspects of health care reform will save $8 billion in Medicare expenditures this year and $575 billion over the next decade. That's enough to run the program for 12 more years, pushing off the program's expected insolvency from 2017 to 2029. (San Francisco Chronicle)  From the ACP Internist blog. 


The new health reform law, the Affordable Care Act, bodes well for as many as 30 million women -- a number that includes 15 million women who are uninsured, according to a new report issued by the Commonwealth Fund, a private health research firm in New York City.  This new report is the first in a series that will look at how health care reform will affect specific populations.  While women as a group are just as likely as men to be uninsured, they are more likely to have medical debt, bill problems, and have trouble getting insurance," Karen Davis, the Commonwealth Fund president, said during a telephone conference. "This report brings good news to all women who will now be more likely to get the care they need with a reduced risk of incurring the unaffordable medical bills that have affected so many Americans."


In a post titled, “The Unfortunate Success of Sarah Palin's ‘Death Panel’ Lie,” Paul Waldman quotes from a very recent Kaiser Foundation poll: “On the other hand, large shares of seniors mistakenly believe the law includes provisions that cut some previously universal Medicare benefits and creates “death panels.” Half of seniors (50%) say the law will cut benefits that were previously provided to all people on Medicare, and more than a third (36%) incorrectly believe the law will “allow a government panel to make decisions about end-of-life care for people on Medicare.” 


Elective abortions will be prohibited and people with pre-existing conditions will be able to get comprehensive benefits without paying any more than healthy people, under new federal regulations for high-risk health insurance pools released Thursday by the Obama administration.  From the Kaiser Health News.


Houston.  We’ve got a problem.  The co-chair of the President’s Commission on Fiscal Responsibility and Reform (the Deficit Reduction Commission) has suggested that federal spending should be capped at 21% of GDP, the historical level for the years 1970-2009.   It’s now about 24%. Our income from taxes was about 18% of GDP before the recession; it’s about 15% now.  Matt Miller thinks the deficit commission's proposed 21% of GDP spending limit is too small: "As a matter of math, if you run the government at a smaller level than did Ronald Reagan (22% of GDP) while accommodating the massive increase in the number of seniors on our health and pension programs, you have to decimate the rest of the budget. That's especially the case when you consider that health costs in the Reagan era were around 10 percent of GDP, while they're now 17 percent, headed toward 20." From the Wonkbook. Adopting a 21% of GDP target would require cuts in Medicare and Social Security that no Democrat could tolerate.  But bringing the budget into balance with increased revenue would require tax hikes that no Republican (and no Democrat seeking reelection) can tolerate.


More: The Center for Budget and Policy Priorities points out that making a 21% spending limit is irrational because of new costs in recent years that include a doubling of the national debt (with doubled interest cost), the cost of two wars, the costs of Medicare part D and of new healthcare reform legislation, newly recognized need for homeland security and a host of others.  Congress created the programs that we Americans asked for; now we have to pay for them. 


Yet something here doesn’t compute.  The Commission has 18 people with excellent credentials as leaders and thinkers…albeit overall with a strong conservative bias…who have been working very hard for many months to come up with politically acceptable, fiscally responsible recommendations.  Hardly seems like probable behavior of people engaged in a self-evident futile cause.


 “I used to have a doctor,” she said, matter-of-factly, “but when I got laid off six months ago I lost my insurance.” Ms. C. shifted in her chair while I took notes during our first medical visit. “So I didn’t do anything about my knee, but when it got so painful that I couldn’t walk, I had to go to the emergency room.”  Then she gave a wan smile. “Cost me $400 to learn that I just have arthritis and that I need to take Tylenol.”  From Danielle Ofri, blog post and New York Times


And if you thought the current reform legislation had brought us into a period of relative tranquility, try this article that contains this paragraph: “The reform act has not brought us to the Promised Land. By bringing us access without capacity, fierce restrictions coupled with vague language and loopholes, mandates coupled with fines low enough to become the cheap way out, strong new ideas that are only pilots, and tough commissions and task forces that have no teeth, the reform act delivers us into a period of maximum melee, in which the needs and desires of hospitals, doctors, citizens, politicians, insurers, drug companies, device manufacturers and hundreds to thousands of niche industries within the sector get pitted nakedly against one another.”  There’s more good writing, satisfying to the hardcore cynic.


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Thursday, August 26, 8 PM CDT.  PNHP’s monthly activist phone call.  Please call me for the phone number and access code.  

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