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Newsletter, "What's Going On", August 10, 2010

August 10, 2010


QUOTABLE - Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University, explains that the health reform law's 2,000+ pages should be a signal that the legislation isn't a federal takeover. If it was, it would have been two lines, he says: “You're all on Medicare. It starts in September.”


 “Canadian Physician Organization: Country’s Health System Need to be ‘Massively Transformed’” The Toronto Star: Canada's largest physician group released a report (last) Tuesday saying that Canada's health system needs to be changed to allow "universal access to prescription drugs and improved outpatient services." The Canadian Medical Association called for the changes because it says the system is insufficient to meet the needs of Canada's aging population. "According to the report, Canada's health care system is underperforming on several key measures, including timely access to services and ensuring accountability. That is despite the fact Canada is one of the highest spenders of health care compared to other industrialized countries with universal health care, the report points out." Many patients without employer health plans in Canada have large out-of-pocket expenses for prescription drugs and "hospitals are increasingly focusing only on patients who are acutely ill." The report also suggests using pay-for-performance funding to reward quality of care and a greater reliance on e-prescribing (Boyle and Yang, 8/3).  Kaiser Daily Health Report.


I do spend a good deal of time puzzling over how to increase our effectiveness, how we can increase awareness and support of measures that will make the same, high-quality, affordable health care available to everyone.  This week I found California One Care, a major coalition in that state that's behind their state single payer initiative.  Listen to a 10 minute video, starring Lily Tomlin, that outlines their strategy.


I ran into another interesting organization, the  Archimedes Movement in Oregon.  It was started by John Kitzhaber, a one-time practicing emergency room physician and two-time Governor who deserves great credit for pioneering an innovative health care system for the state.  Presently the organization is engaged in a campaign for state-based health care reform: adequately funded to support staff, with a sound, intelligent plan developed in thoughtful detail, augmented by communication with people at the grass roots and solicitation of input from citizens at grass roots.   The movement doesn't appear to be a coalition.


POLITICO Pulse: “EXCLUSIVE: GRUBER'S CASE FOR THE MANDATE - Writing at the Center for American Progress, MIT economist and Obama administration advisor Jonathan Gruber defends the besieged individual mandate: Removing the mandate and only keeping the market reforms and small business tax credit ‘would virtually wipe out those coverage gains and cause an enormous premium spike.’ PULSE had an early look at the paper that was to be released last week: http://bit.ly/bQnHTQ


Much of the opposition to the individual mandate turns about the unpopularity (or alleged illegality) of making people buy insurance.  There's another viewpoint…that the individual mandate should be opposed because it's simply bad policy, particularly in comparison to single-payer insurance but also in comparison with a number of other progressive alternatives.


Congressional Republicans are planning a death by a thousand cuts for health care reform, reports Jennifer Haberkorn: "Republicans have proposed a bill to deny funding to any part of the law. But a more likely scenario is to choke off funding for pieces of the legislation that they find particularly troublesome, such as the requirement to buy insurance, changes to Medicare and the provision most cited by House Minority Leader John Boehner of Ohio: the 'army of new IRS agents' to implement new requirements for business."  From the Wonkbook. And from Ezra Klein: The Conservative effort to undermine health-care reform.  Much more dangerous is the Republican strategy to refuse to appropriate the funds the bill needs. But Republicans are going to have to think hard about that one: If they set the precedent that one side can erode legislation they don't like by refusing to fund it, the same is going to happen to their eventual accomplishments. Policy stability will disappear, as it will become normal for the opposition party to defund the other side's legislation when they take power. This wouldn't be the first time Congress has made a disastrous move toward gridlock and dysfunction, but it would be the one that scares the business community the most, as it would effectively end their ability to plan for the future.  POLITICO Pulse chimes in: “Workroom's Igor Folksy warns that the Republican strategy of repealing health reform by starving funds does come with political risk: just think of what happened to Newt Gingrich with the 1995 government shut down. http://bit.ly/bwj9DO


The National Economic and Social Rights Initiative (NESRI) is publishing a series of fact sheets analyzing the Affordable Care Act from the perspective of immigrants, women, people of color, and rural communities. They find that the law’s failure to meet the key human rights standards of universality, equity, and accountability has concrete repercussions for already disadvantaged groups.  From Healthcare-NOW. The Commonwealth Fund published a study showing the specific benefits that women will experience from the law.  By way of contrast, read the reaction of the National Organization for Women to the bill’s passage. 


And more from POLITICO Pulse: “YET ANOTHER EMAIL TO SIGN UP FOR - The White House this week rolled out a ‘This week in health care’ newsletter, with its take on the week's health developments. http://bit.ly/aNFAoA


There were bullish predictions about the solvency of Medicare in the news this week.  Paul Krugman was impressed.  But there was skepticism about the bullish reports.


Starting this year, businesses with fewer than 25 workers and average wages of less than $50,000 will be eligible to receive a tax credit for the health insurance that they provide for their employees under terms of the new health care reform legislation.  In Alabama, 87.7% of its 57,800 small businesses will qualify.  From a study (.pdf) by the Small Business Majority and FamiliesUSA


Dr. William Hsaio, Professor in Harvard's School of Public Health, has been hired by the state of Vermont to prepare proposals for overhaul of the state's health care system.  He recently made his first report to the Vermont Health Care Reform Commission.  It's a detailed discussion of many of the challenges he faces.  Worth a thoughtful read.


The Washington Post: The administration recently invested more than $1 billion from the stimulus and the health-care law into the National Health Services Corps to beef up doctor recruitment (to serve in rural and underserved areas that have a scarcity of physicians.)   It's more money than the 40-year-old agency has ever had, said Rebecca Spitzgo, associate administrator for the Bureau of Clinician Recruitment and Service.  Nearly 5,000 recent medical school graduates accepted federal grants to pay off tuition and school loans averaging $150,000 per student. The awards come with contracts that obligate the young doctors to remain in what are typically rural areas for three to five years.


The Chicago Tribune: The wrong prescription: What the health care law cannot do.  Beginning, like the United States, with excellent intentions, each (Nordic) country's health care system evolved similarly. Initially, all care was covered.  But costs rose. The government covered fewer illnesses. Expensive treatments increased government spending. Physicians' hours were reduced: Danish physicians are limited to 37-hour work weeks; in France (ranked No. 1 by the WHO), the work week is 35 hours, about half of those worked by U.S. physicians. Taxes rose. Triple-digit waiting lists increased death rates, so protocols established penalties if patients were not treated within a prescribed number of days. Patients began buying private insurance for illnesses no longer covered by "universal care." The governments struggle with solvency. In France, the system faces bankruptcy. Being No. 1 has its price.  This is not an evolution that the U.S. can avoid: It is built into system dynamics. When the same set of circumstances produces the same unintended consequences in different countries, the inescapable conclusion is that we are dealing with an error-prone situation, not incompetent countries. There are things that health care laws cannot do, even in Nordic countries.  (From the Kaiser Family Foundation Daily Health Policy report.)


Ever wonder why the Health Insurance Industry supported passage of the new health care reform legislation, even while it was being vilified as the incarnation of all evil?


By now it's widely known that health insurance companies have been raising their rates on health insurance at a stunning pace.  Some small businesses have experienced as much as a doubling of premiums in the past year.  The Affordable Care Act changes things a little.  "Health insurance issuers will have to submit to the Secretary (of HHS) and the relevant State a justification for an unreasonable premium increase prior to the implementation of the increase and that information will be 'prominently' displayed on their Internet websites. The federal government will encourage states to conduct rate review by offering grants and states themselves can decide to block certain insurers with a poor history of rate increases from participating in the exchanges."  However, some states…including Alabama…lack the legal power to do anything about unreasonable premium increases other than to publicize them.


“President Obama’s Deficit Commission is all smoke and mirrors. Its members are making a big show of laboring over ‘painful’ choices and considering all options in their quest to bring down the deficit. But inside the Beltway everyone knows what’s going to happen: The commission will reduce the deficit on the backs of the old and the poor, through cuts to Social Security, Medicare, and Medicaid. Some opponents have taken to calling it the Cat Food Commission, since that’s what its victims will be forced to eat once the commission gets done slashing away at their modest entitlements.”  From Mother Jones.


McClatchy Newspapers: "With a wounded economy and high unemployment, more than 1,000 people came to a one-day free health clinic in the nation's capital Wednesday to get the basic care they can't afford or are otherwise denied because they have no insurance. More than three-quarters of those attending don't have insurance because they are recently unemployed, work for small businesses, earn hourly wages, or must work multiple part-time jobs with no insurance, said the event's medical director Dr. Bobby Kapur. According to the National Association of Free Clinics, about 83 percent of the patients who go to free clinics are employed but don't have health insurance. ... A team of about 1,000 volunteer doctors, nurses, and everyday folks made it a priority to ease the anxiety faced by patients…in addition to providing a range of other primary medical care to more than 1,000 uninsured individuals from the D.C. metro area" (Bridgeman, 8/4).   Kaiser Daily Health Policy Report.  More:


Deloitte Survey: One in Five Americans Skip Medical Care When Sick or Injured; Cost is a Major Factor


Bloomberg BusinessWeek: "In 2009 and 2010, as the economic collapse shuddered across the globe, oncologists in California noticed a troubling trend: Three patients who had had serious tumors under control for as long as eight years reappeared in the clinic with massive cancer regrowth which, in one case, required emergency surgery. In retrospect, this downturn in fortunes should have been predictable: The economic recession had forced the patients to discontinue a life-extending medication. ... And there have been other such cases, both at UCSF and around the nation, either of patients stopping medications altogether or rationing in the hopes of making precious supplies last longer" (Gardner, 8/4).  Kaiser Daily Health Policy Report.


Would you like to see a little one-minute video in which Rush Limbaugh contends that purchasing health care is like owning a beach house?


Nice little video…parody of the Beyonce "Single Ladies"…supporting "Single Payer"


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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. 


Sunday, September 5,  7PM CDT.  Healthcare-NOW monthly activist phone call. Please use this Dial-in Number 1-218-862-1300 and Conference Code 441086. To mute and unmute the line, please hit *4.

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