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Newsletter, What's Going On, October 27, 2010

October 26, 2010 

No health care falsehood should go unchallenged. Become a Health Care Lie-Swatter!  In this morning’s Birmingham News, for example, a letter writer disputed the assertion that there are 40 million uninsured in this country.  She believes the number is closer to 8 million, made up of (1) people with incomes over $50,000 who could get insurance if they want it, (2) young invincibles who don’t need it and (3) the rest, who could go on Medicaid if they wanted to.  That letter cries out for a reply, and one’s been sent, but too many errors like that are printed and never challenged.

Newspapers generally won’t print more than one letter a month from anyone.   So here’s what we’ll do.  If you see something in print that doesn’t seem right, fire off a response but let us know, so we won’t spend time on a duplicate effort.  If you wish, we’ll do some quick research, get you the facts you need for a solid letter.  Or if you prefer, we’ll compose a letter for you, send it along for you to submit to the paper as your own if you agree with its style and content.  If you see errors we’re not apt to know about, let us know. 

For the moment, we’re swatting lies…inaccurate information.  If you see opinion that cries out for response, go to it!  But that’s something different.

We can all be part of the next wave of health care reform!

Our first lie-swatter letter was published in the Birmingham News last Saturday.

As if it could read my mind, the New York Times had an article Sunday that began, “Republican candidates and deep-pocketed special interests are spreading so many distortions and outright lies about health care reform that it is little wonder if voters are anxious and confused.”

Just read...in my college's alumni publication...of its effort to form 'affinity groups'...attorneys, finance, public policy and LGBT groups...supporting alumni activities.  Seemed promising enough to the college that it's assigning an administrator to work (? full time) to advance the idea.   Might be an idea we can borrow from?

Interesting conversational threads on the OnePayerStates conference call last Friday. 

The phrase, Medicare for All, or related seems to have general public support in repeated surveys over the years.  Medicare for All is also said to receive a lot of physician support in published polls.  Yet physicians on the call report that in doctor’s lounges in hospitals, the word “Medicare” is almost a cussword, and that’s been my own experience, too.  There was discussion of why this might be so, and the conclusion that the greatest thing for single-payer would be to help Dr. Berwick revitalize Medicare.  Meanwhile, at least one speaker on the call no longer calls for improved Medicare.  He advocates publicly funded, privately delivered healthcare for everyone.

It’s beginning to look as if state single payer legislation is moving in several states.  Vermont leads the list.  California and Maine are prominently mentioned.  There are others.  It’s also clear that each state’s legislation will differ from everyone else’s in small or large ways.  Need to begin to consider what differences each of us will find tolerable, what the essential minimums are that each of us would insist on.   Copayments for example.  Alternatives to fee-for-service reimbursement.

Dr. Hsiao is expected to have his preliminary report ready for the people of Vermont on or before January 2, 2011.  The report will be open for public comment for fifteen days, after which Dr. Hsiao will prepare a final report for the Vermont legislature.  One of the candidates for Governor of Vermont is a strong single-payer advocate.

Despite pledges to leave employer-based health plans intact, benefits consultants say some firms are considering ending or reducing coverage for their workers, The Associated Press reports, adding: "That's just not going to happen, White House officials say." But an executive for the consulting firm Deloitte said, "What we are hearing in our meetings is, 'We don't want to be the first one to drop benefits, but we would be the fast second.' We are hearing that a lot."  "'My conclusion on all of this is that it is a huge roll of the dice,' said James Klein, president of the American Benefits Council, which represents big company benefits administrators. 'It could work out well and build on the employer-based system, or it could begin to dismantle the employer-based system.'" The White House denies the possibilities of such a trend taking off (Alonso-Zaldivar, 10/24).   Kaiser Daily Health Policy Report.  But James McGee (The Amazing Maze of US Health Care) reacts: “The warning bells are sounding!”  And it would not be pretty.

American Medical News: The Mental Health Parity and Addiction Equity Act hasn't made employers drop coverage as some feared it might. The full effects won't be felt until early 2011 as health plans begin their new enrollment years, but "[e]arly indications ... are that relatively few employers are dropping mental health coverage in response to the law's mandate, a concern of some of the bill's opponents." Kaiser Daily Health Policy Report.

It’s the Prices, Stupid! In a reprise of a seminal article written in 2003, Alec MacGillis writes  “… Democrats' effort to sell the law to the public may be undermined by what even some ardent supporters consider its biggest shortfall. The overhaul left virtually untouched one big element of our health-care dilemma: the price problem. Simply put, Americans pay much more for each bit of care -- tests, procedures, hospital stays, drugs, devices -- than people in other rich nations.” 

The growing cost of Medicare is the elephant in the room.  Everyone acknowledges it’s there; no one has a good idea of what to do about it.  Until now.  David Leonhardt, writing in the NY Times, describes a proposal in the current issue of Health Affairs:  Expensive new treatments get three years to prove that they work better than cheaper treatments, or their reimbursement rates would be cut to that of the cheaper treatments.  (The October issue of Health Affairs is primarily devoted to Comparative Effectiveness research.)  Peter Orszag weighs in supporting the proposal. 

Ever wonder how much doctors make an hour?  Here’s your answer.  

In the latest Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey, experts voice support for moving away from the current method of negotiating health care payments and toward all-payer rate setting, in which a government authority sets the rates, or an all-payer system of jointly negotiating rates for all payers. 

Will the Supreme Court rule the individual mandate to be unconstitutional?  By midnight, Oct 31, 2011?  INTRADE.COM says there’s a 16.9% chance that it will, and you can bet on it.  At that web site.  Really.  (Intrade is incorporated in Ireland).  Ezra Klein restates the strong case for considering the possibility. 

The New York Times has an article contrasting the insurance exchanges in Massachusetts and Utah, and mentioning new legislation establishing an exchange in California.  

The Joint Commission’s ambulatory accreditation program will begin surveying medical homes next July, using criteria it will publish by next March.  The National Committee for Quality Assurance already accredits medical homes. TransforMED, a wholly owned, for-profit subsidiary of the American Academy of Family Physicians, has 35 small and midsized practices that adhere to AAFP’s own accreditation criteria.  So when someone says they’re an “accredited medial home,” what do they mean? 

Health insurers are beginning to look at the cancer treatments provided by oncologists.  Treatment protocols that are the most highly profitable seem to be administered more frequently than they should be. 

The Hill's Healthwatch blog: "[P]rocedural motions that Republicans filed during the healthcare reform debate offer the best insights into which provisions of the law the party wants to repeal first, a top staffer for a senior House Republican told The Hill. ... If Republicans can get enough Democrats to support repealing specific provisions, that could make it politically difficult for Obama to exercise his veto power. And Democrats who have publicly spoken out against specific provisions, such as Medicare cost-cutting and long-term disability insurance, could be tarred as flip-floppers if they refuse to go along." Other provisions targeted for repeal include those paying for the Independent Payment Advisory Board, comparative effective research and prevention funding (Pecquet, 10/19).   Kaiser Daily Health Policy Report.  

Peter Orszag contends that changes in malpractice law could persuade doctors to practice evidence-based medicine.  His proposal has been challenged.  A more fleshed-out version of the idea was published last fall.  

The Massachusetts Medical Society has asked doctors what they think about health reform in its annual “Physician Workforce Survey” of 1,000 practicing physicians in the state. The results? Doctors picked single payer health reform over a public option, over high-deductible plans, over the Massachusetts health reform – in short, over every other option presented.  PNHP has details.  The study also confirmed that half of primary car practices in Massachusetts are closed to new patients, and in the practices that are open the average wait time is 29 days. 

The Boston Globe: "Half of primary care practices in Massachusetts are closed to new patients and wait times for appointments continue to be long, according to a new survey released today by a statewide physicians' association. ... When primary care patients do secure an appointment for a non-urgent matter, they have to wait to get in the door, the survey found. The average delay is 29 days to see a family medicine doctor, down from 44 days last year, and 53 days to see an internist, up from 44 days last year" (Cooney, 10/20). Kaiser Daily Health Policy Report. 

What healthcare is like in the Netherlands.  And Australia..  Denialism blog via Health Care For All-Colorado blog.  And Finland.  Matthew Yglesias.  

Mergers Between Hospitals And Insurers Expected To Increase   And all those doctors working for all those hospitals are going to wind up working for…who?   With what conflict of interest?   And why? 

THE PRE-EX PLANS PREPARE PITCHES- Facing dismal enrollment numbers, state Pre-Existing Condition Insurance Plans are gearing up to spend big on professional marketing campaigns. North Carolina filmed television commercials last week, featuring citizens who have already enrolled in their plan, testifying to how they have been helped. Wisconsin is about to begin soliciting contracts from professional marketing firms to help get the word out. "We're trying to identify who the influencers are, who has credibility, whether that's a parish nurse, a broker or somebody else," says Amie Goldman, CEO of Wisconsin's Health Insurance Risk Sharing Plan, who was in Washington Friday to meet with HHS on this and other issues related to PCIPs. Goldman notes that they have begun offering pro-rated deductibles to make the plan more attractive, something they do not do in their regular, state-level plan. 

--WHAT'S THE HOLD UP? Observers initially expected applicants to overwhelm these plans but state officials chalk the low numbers up to two main factors: affordability and the uninsured being a difficult population to reach. Premiums in the new federal plans are still financially out of reach for many. "I've had a number of complaints that they thought the plan was free," Vernita McMurtrey, executive director of the Missouri Health Insurance Pool, tells PULSE. The monthly premium in Missouri is as high as $972 a month; the program has only had about 140 enrollees since opening this summer. Second issue is finding the long-time uninsured, who are often unfamiliar with enrollment processes or even that the new program exists.  POLITICO Pulse. 

ARIO: FEDS CAN HANDLE EXCHANGES- OCIIO's Joel Ario pushed back against claims that the federal government does not have the necessary funds to administer health exchanges in states that decline to run their own. "We're ready to put up any federal exchanges that we need to," Ario, who directs OCIIO's Office of Health Insurance Exchanges, said at a Friday briefing moderated by the Alliance for Health Reform. He later added that the federal government "knows it's on the hook" for the responsibility. At the same time though, he insisted that the feds won't end up having much responsibility in the matter: Ario believes most will run their own exchanges. He noted that all but two applied for the initial round of exchange planning grants (although many clarified, in their applications, that their application did not indicate an intention to run an exchange). 

--LOOMING- Even if HHS does have adequate funding, there's still concern over whether the federal government, working from afar, would be able to successfully monitor and encourage the stability of an exchange. "I have some serious concerns about how the federal government can protect against adverse selection," where consumers decide to purchase outside the exchange, Timothy Jost, a strong reform supporter and law professor at Washington & Lee University, said at the same briefing. POLITICO Pulse 

State health insurance commissioners concluded their deliberations about Minimal Loss Ratios last week, with a surprisingly consumer-friendly conclusion.  Discussion of the deliberations

Carol Steckel, Alabama’s highly-regarded Medicaid Commissioner, will leave our state for Louisiana where she’ll become Executive Director for Health Care Reform.  She’ll start in her new position shortly after the election.  Dr. Bentley didn’t ask her to stay on. 

Dr. Alice Chenault, of Huntsville, authored a thought-provoking piece questioning whether health care is a right.   Pippa Abston adds: “It is an interesting piece-- ….  Then I started reading some of the substantial work done on the concept of human rights (non-medical).  The whole concept of "positive rights", which conservatives call entitlements and have included things like public education, and "negative rights", which conservatives like-- "freedom from" things like the right not to be imprisoned without due process-- is actually obsolete.  It turns out that every single thing we call a right is actually a complex mixture of positive and negative factors.  For example, the right not to be taxed without representation could be framed as a negative right-- but it requires positive duties from the government such as establishing polling places, paying legislators for their time, funding the IRS, etc.  The right not to be murdered requires provision of a police force, courts, prisons... There really is no "freedom from" right that does not require some sort of entitlement to accomplish it. 

The United States Preventive Services Task Force cancelled its meeting, scheduled for early November, at which it was to consider controversial PSA screening for prostate cancer.  Recall that this was the group that issued controversial recommendations last year covering mammograms for younger women.  Recall also that, under the new health law, a test must receive a strongly favorable rating from the task force in order to receive full insurance coverage.   Wall Street Journal Health Blog, cited by the Kaiser Daily Health Policy Report.  

Approximately 4.5 million college students nationwide receive health insurance coverage through so-called student health plans.  It is not clear whether that coverage is subject to regulation under the Affordable Care Act…or, for that matter, under any existing law.  The Wonkroom. 

The United States has now slipped to 49th in life expectancy.  Healthcare-NOW

Kevin Drum celebrated his birthday by publishing a photograph of the statement his family received after his delivery, in 1958.  Total hospital charges: $133.98. 

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Wednesday, October 27, 2010.  Lunch, (social gathering) Panera Bread, Airport Road, Huntsville.  Wednesday before each monthly meeting. 

Thursday, October 28, 8 PM CDT.  PNHP’s monthly activist phone call.  Please call me for the phone number and access code.  

Saturday, October 30, 2010.  Baylor University, Faith & Future of Healthcare Symposium.  Pippa Abston to participate. 

Monday, November 1, 2010  @ 5:30 PM.  North Alabama Healthcare for All Monthly Meeting —Huntsville/Madison County Public Library, 901 Monroe Street  (downtown).  The meeting is in Room AB, on the first floor. After you enter the library’s front door, turn right towards the auditorium. 

Are you ready for Leadership Training? New PNHP members - and longtime members who want to take the next step and get active - are invited to come to Denver the day before the Annual Meeting to participate in PNHP's popular crash course in health policy and politics starting on Friday, November 5, at 1:00 p.m. We look forward to working with you! Contact Matt Petty at matt@pnhp.org or 312-782-6006 to register. 

Please join PNHP in Denver for our Annual Meeting on Saturday, November 6, at the Sheraton Denver Downtown Hotel. The Annual Meeting is PNHP's most important, energizing and inspiring gathering of the year. This year's theme is "From PPACA to Single Payer: Next Steps for Single-Payer Activists in the Wake of the Obama Health Plan." Speakers will include Amy Goodman, PNHP co-founders Drs. David Himmelstein and Steffie Woolhandler, and more. A limited number of travel scholarships are available for medical students. 

Sunday, November 7 (probably),  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.

Healthcare-NOW National Strategy Conference.  When: Saturday, November 13th and Sunday, November 14th Where: William Way Community Center, 1315 Spruce St., Philadelphia, PA Time: Sat, 4pm to 9pm; 
Sun, 8am to 4pm
 Fee: $30 for Healthcare-NOW! Members and $50 for Healthcare-NOW! Non- Members  Go to our National Strategy Conference page to register and more information.  (10/25 New: Draft Agenda.) 

Thursday, November 18, 2010.  @5:30 PM.  Third Thursday happy hour (social gathering), at 801 Franklin (Huntsville). 

Saturday, November 20, 9 AM.  Pippa Abston’s home.  Vision 2011 Workshop to develop roadmap and plan of action for 2011 activities of NAHA, North Alabama Healthcare for All, the north Alabama Chapter of PNHP, Physicians for a National Health Program. 

Wednesday, December 1, 2010.
- B'nai Shalom Temple, Women's Group, anticipates about 30 people. Pippa Abston to present.

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