Friday, December 13, 2013

Promises To Fix Mental Health System Still Unfulfilled

More From Shots - Health News HealthFDA Warns Against Test Touted As Mammogram AlternativeHealthIf You Drank Like James Bond, You'd Be Shaken, TooHealthA Nasty Fever Called Chikungunya Hits Close To HomeHealthPromises To Fix Mental Health System Still Unfulfilled

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Thursday, December 12, 2013

A Rush To Reconcile Health Enrollment Data, By Hand

More From All Tech Considered Digital LifeWireless Companies, FCC Reach Deal On 'Unlocking' CellphonesDigital LifeTake A Look At The Top Tweeted Moments Of The YearTechnologyA Rush To Reconcile Health Enrollment Data, By HandBusinessAmid Cuts And Tax Hikes, Tech Companies Get Love in Ireland

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High Insurance Rates Anger Some Ski-Country Coloradans

More From Shots - Health News HealthIf You Drank Like James Bond, You'd Be Shaken, TooHealthWhy Meningitis That Hit Princeton Is Hard To Beat With VaccinesHealthScientists Turn To The Crowd In Quest For New AntibioticsHealthHigh Insurance Rates Anger Some Ski-Country Coloradans

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Colin Powell pitches single-payer health care in U.S.

Former Secretary of State Colin Powell has waded into the health care debate with a broad endorsement of the kind of universal health plan found in Europe, Canada and South Korea.

�I am not an expert in health care, or Obamacare, or the Affordable Care Act, or however you choose to describe it, but I do know this: I have benefited from that kind of universal health care in my 55 years of public life,� Powell said, according to the Puget Sound Business Journal, last week at an annual �survivors celebration breakfast� in Seattle for those who, like Powell, have battled prostate cancer. �And I don�t see why we can�t do what Europe is doing, what Canada is doing, what Korea is doing, what all these other places are doing.�

Europe, Canada and Korea all have a �single-payer� system, in which the government pays for the costs of health care.

Some Democrats who strongly advocated for, and failed to get, a single-payer system in the 2010 Affordable Care Act, still believe the current law doesn�t go far enough to reform the US health system.

A retired four-star general and former chairman of the Joint Chiefs of Staff, Powell told the audience about a woman named Anne, who as his firewood supplier, faced a healthcare scare of her own. Anne asked Powell to help pay for her healthcare bills, as her insurance didn�t cover an MRI she needed as a prerequisite to being treated for a growth in her brain. In addition, Powell�s wife Alma recently suffered from three aneurysms and an artery blockage. �After these two events, of Alma and Anne, I�ve been thinking, why is it like this?� said Powell.

�We are a wealthy enough country with the capacity to make sure that every one of our fellow citizens has access to quality health care,� Powell. �(Let�s show) the rest of the world what our democratic system is all about and how we take care of all of our citizens.�

Powell, who has taken heat from Republicans for twice endorsing President Obama�s election and reelection bids, said he hopes universal healthcare can one day become a reality in the U.S. �I think universal health care is one of the things we should really be focused on, and I hope that will happen,� said Powell. �Whether it�s Obamacare, or son of Obamacare, I don�t care. As long as we get it done.�

Friday, December 6, 2013

How to Revive the Fight for Single-Payer

Rep. Jim McDermott of Washington is optimistic that it will come�if we give states the tools to adopt it at their own pace.

When the media frenzy subsides and Republicans run out of scare stories, the country will be faced with the most important question about Obamacare: Can it deliver what it promised? Thanks to the Affordable Care Act, a new business model is rapidly emerging in the medical-industrial complex that, in theory, can dramatically reduce the inflated costs of healthcare while serving everyone�rich and poor, healthy and sick. But the reformed system will also still rely on the market competition of profit-making enterprises, including insurance companies. A lot of liberal Democrats, though they voted for Obama�s bill, remain skeptical.

�In the long arc of healthcare reform, I think [the ACA] will ultimately fail, because we are trying to put business-model methods into the healthcare system,� said Washington Representative Jim McDermott. �We�re not making refrigerators. We�re dealing with human beings, who are way more complicated than refrigerators on an assembly line.� I turned to the Seattle congressman for a candid assessment because he�s the third-ranking Democrat on the House Ways and Means Committee and has been an advocate of single-payer healthcare for decades. Plus, he�s a doctor.

The business transformation under way in healthcare involves the consolidation of hospitals, doctors and insurance companies in freestanding �integrated delivery systems��nonprofit and profit-seeking�that will have the operating scope and power to eliminate duplications and waste and hold down costs, especially the incomes of primary-care doctors. Major hospitals are buying up other hospitals and private practices, and they�re hiring younger doctors as salaried employees. An American Medical Association survey in 2012 found that a majority of doctors under 40 are employees, no longer independent practitioners.

�The medical-industrial complex is putting itself together so that the docs will be the least of our problem,� McDermott said. �They will simply be serfs working for the system.� The AMA�s market research reports that �hospitals focus on employing primary-care physicians in order to maintain a strong referral base for high-margin specialty service lines.� Big hospitals need a feeder system of salaried doctors, McDermott explained, to keep sending them patients in need of surgery or other expensive procedures.

�It�s possible hospital groups can reduce costs,� the congressman said, �but I look at the consolidations going on and ask myself, �Are we going to wind up with hospitals that are too big to fail? Are we going to have hospitals so powerful that we cannot not give them what they want?� It�s going to be the government against the medical-industrial complex, which is developing very rapidly. If the Little Sisters of Providence [his fanciful example] become a conglomerate and the government says you should close some of your hospitals, they will say, Who says?�

Despite these doubts�not to mention the Republican-promoted hysterical attacks on the ACA on other grounds�McDermott is actually optimistic. He expects stronger healthcare systems roughly resembling single-payer �to spring up like dandelions� around the country�led by progressive states that really want to make it work. �That�s probably going to happen in Vermont, Washington and Oregon,� he said. �California has tried twice to have a single-payer system and was defeated by the forces of money. Jerry Brown in California, maybe Cuomo in New York, maybe Kentucky. The governor in Oregon, John Kitzhaber, and our governor in Washington, Jay Inslee, all want it to happen.�

Having introduced a single-payer bill in Congress every year since 1993, McDermott is developing a different approach this time: a strategy designed to get around the hard-core resistance in so many states. �I now have a bill I�m going to drop in soon as a patch to the ACA,� he said. �What I�m trying to do is let the states that want it to go ahead, whether it�s Tennessee or Illinois. �Medicare for All� sounds wonderful, but the country is so diverse, you have to allow the delivery system to evolve where it can. You have to do it state by state.�

McDermott tried to sell this concept to the Obama administration and to Senator Max Baucus of Montana, chair of the Senate Finance Committee and one of the key Capitol Hill brokers in 2009�10 for what would become the ACA. No sale in either case. Instead, the president rejected the �public option� and made �bad deals� with hospitals, drug companies, the insurance industry and other players, McDermott said. Those interests agreed not to fight new rules on their behavior toward consumers, and in return Obama provided them with millions of new paying customers, subsidized by the government.

Under the ACA, hospital groups must sign a non-discrimination agreement, but as a practical matter they can still find ways to pick and choose which patients they will treat. The rules for Medicaid are set by each state, and enforcement varies widely among them. Typically, many private practices severely limit impoverished patients on Medicaid or refuse to serve any at all because that threatens their rate of return. Less obviously, some of the leading health conglomerates celebrated for their high quality and cost controls do the same. �When you dig down in all these great places like Mayo and the Cleveland Clinic, you see the same sort of thing,� McDermott said. �The Mayo doesn�t go out looking for Medicaid patients, and they don�t take just anyone who walks in the door.�

McDermott�s new legislation would break from the longstanding liberal assumption that the government must enact universal social programs that apply rules and benefits uniformly to all states at once. He figures that would allow the resistance to block single-payer for many years. So he wants to create a special deal for the limited number of states willing to uphold higher standards. State legislatures and governors can win approval to design and operate their own single-payer system, deciding how and where to spend the healthcare money the federal government already pumps into their state. (The Vermont Legislature has already approved, with the governor�s support, a move toward single-payer but can�t implement it until 2017, when it will need a federal waiver to do so.)

The congressman offered his hometown example, known as WWAMI�a five-state cooperative arrangement that includes Washington, Wyoming, Alaska, Montana and Idaho. The University of Washington has the only medical school in the Northwest border region, so the other states send their med students to Seattle and finance their education, in return for the students� commitment to come home to serve rural communities. This mutual support has functioned for forty years, despite red-blue differences. McDermott believes those five states could do a better job than distant DC of deploying and operating a first-class healthcare system.

To liberals who cry heresy, McDermott invokes Robert La Follette�s famous dictum that the states should be our �laboratory for democracy,� the best place to experiment and develop new solutions to public problems. Conservatives ought to like McDermott�s proposal because it disperses power closer to local decision-making. Liberals can embrace his approach as a practical way to break the stalemate on healthcare and open the way for basic solutions.

The congressman from Seattle thinks it may take a few more years of chaotic conflict before people understand the opportunity. But state governments�even in the neo-Confederate Republican Party�may start clamoring for this new approach once they begin to see the results.

�There are places where this could work,� McDermott said, �and once people see it work in Oregon or Washington, or maybe Kentucky, the people in Tennessee are going to say, �Why the hell don�t we have that? Are we not as good as the people in Oregon?� Then you�re going to get the governor of Tennessee to do an about-face.�

HealthCare.gov Now Allows Window Shopping, And A Do-Over

More From Shots - Health News HealthMedical Journal Goes To The DogsHealth CareWhite House Cites Pre-Existing Condition Case From Its Own RanksHealthFDA Expected To Approve New, Gentler Cure For Hepatitis CHealthHealthCare.gov Now Allows Window Shopping, And A Do-Over

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Wednesday, December 4, 2013

Rule Spells Out How Insurers Must Cover Mental Health Care

More From Shots - Health News HealthFertility Drugs, Not IVF, Are Top Cause Of Multiple BirthsHealthSecond Meningitis Outbreak Erupts In Southern CaliforniaHealthAdministration Says You Can Now Escape HealthCare.Gov 'Prison'HealthRule Spells Out How Insurers Must Cover Mental Health Care

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Tuesday, December 3, 2013

ACLU Sues, Claiming Catholic Hospitals Put Women At Risk

More From Shots - Health News HealthObama Launches HIV Cure Initiative, Ups Pledge For Global HealthHealthAlleged Perils Of Left-Handedness Don't Always Hold UpHealthAs Polio Spreads In Syria, Politics Thwarts Vaccination EffortsHealth CareACLU Sues, Claiming Catholic Hospitals Put Women At Risk

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Monday, December 2, 2013

Could A Tech Giant Build A Better Health Exchange? Maybe Not

More From All Tech Considered TechnologyCould A Tech Giant Build A Better Health Exchange? Maybe NotTechnologyGetting To Know Black Innovators, One Tweet At A TimeU.S.The Key Test For HealthCare.gov Is The Part You Can't SeeDigital LifeCould Video Games Be The Next Job Interview?

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Saturday, November 30, 2013

A New Worry Looms Online For The Affordable Care Act

Listen to the Story 3 min 16 sec Playlist Download Transcript   Enlarge image i

Insurance companies say they are finding numerous mistakes on a digital form that's essential for signing up through HealthCare.gov.

AP

Insurance companies say they are finding numerous mistakes on a digital form that's essential for signing up through HealthCare.gov.

AP

Saturday is the day the Obama administration promised it would have HealthCare.gov working smoothly for the majority of people who need to sign up for health insurance.

As the Obama administration scrambles to fix the glitch-plagued site, experts are beginning to worry about another problem that may further impair the rollout of the Affordable Care Act.

Health insurance companies say they're seeing numerous errors in a form that plays a vital part in the enrollment process. The problems are manageable so far, but many worry about what will happen if enrollment surges in the weeks to come.

The 834

It's safe to say that the vast majority of consumers have never heard of an 834 EDI transmission form, despite its crucial role in the process of signing up for health insurance. It's a kind of digital resume that tells an insurance company's computer everything it needs to know about an applicant, says Bob Laszewski, a health policy consultant.

"It contains all of the person's enrollment information, all the information that [an] insurance company needs to get this person entered as a policy holder," Laszewski says.

The 834 has been around for a long time. The architects of the Affordable Care Act intended for it to play a central role in the sign-up process, says Tim Jost, a professor of law at Washington and Lee University.

"The 834 information is information the insurers have to have to get people enrolled in coverage, which of course is the point of going through the marketplace," Jost says.

Multiple Mistakes Make Insurers' Jobs Harder

But health insurance companies say the 834s they are receiving from applicants on the federal and state exchanges have sometimes been riddled with errors, Laszewski says.

"Duplicate enrollments, people enrolling and unenrolling, inaccurate data about who's a child and who's a spouse, files just not being readable," he says.

Highmark Blue Cross Blue Shield of West Virginia has been steadily processing new customers ever since the launch of Obamacare this fall. But Highmark President Fred Earley says mistakes in the 834s are making the job harder.

"We've had some situations where the records don't track, or we've seen duplicates," Earley says. "We've had situations where we'll get a record to show that someone canceled coverage when we've never had a record to show they enrolled in the first place."

Earley says his firm has been dealing with the problems by calling up state and federal officials and correcting the mistakes. The exact cause of the problems is unclear. The Obama administration has been slowly making fixes, and officials say they're making progress. But Laszewski says the fixes are not fast enough.

"The error rates have been falling," he says. "HealthCare.gov has been making progress, but we're not to the point yet where people can trust that high-volume enrollment can occur and we won't have serious customer service problems."

Laszewski says the test will come over the next few weeks. People who want coverage to begin on Jan. 1 have until just before Christmas to sign up, and there's likely to be a surge of new applicants in the weeks to come.

"What happens if we start getting hundreds of thousands or millions of people signing up by the Dec. 23 deadline, and the insurance industry is receiving hundreds or thousands of these a day?" he says. "That's what everyone's worried about."

Share Facebook Twitter Google+ Email Comment More From Health Care Health CareWhite House Optimistic At Deadline To Fix ObamacareHealth Care3 Stories From HealthCare.gov UsersHealth CareHow Will We Know If HealthCare.gov Is Fixed?Health CareA New Worry Looms Online For The Affordable Care Act

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Wednesday, November 27, 2013

3 Ways Obamacare Is Changing How A Hospital Cares For Patients

More From Planet Money Planet MoneyEpisode 499: Richard Nixon, Kimchi And The First Clothing Factory In BangladeshHealth Care3 Ways Obamacare Is Changing How A Hospital Cares For PatientsPlanet MoneyHospital Puts Docs On the Spot To Lower CostsPlanet MoneyHere's Who Earns The Minimum Wage, In 3 Graphs

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3 Ways Obamacare Is Changing How A Hospital Cares For Patients

More From Planet Money Planet MoneyEpisode 499: Richard Nixon, Kimchi And The First Clothing Factory In BangladeshHealth Care3 Ways Obamacare Is Changing How A Hospital Cares For PatientsPlanet MoneyHospital Puts Docs On the Spot To Lower CostsPlanet MoneyHere's Who Earns The Minimum Wage, In 3 Graphs

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Tuesday, November 26, 2013

These Californians Greeted Canceled Health Plans With Smiles

More From Shots - Health News Health2009 Flu Pandemic Was 10 Times More Deadly Than Previously ThoughtHealthPart-Time Workers With Minimal Health Coverage Get New OptionsHealth CareThese Californians Greeted Canceled Health Plans With SmilesHealthEmergency Contraceptive Pill Might Be Ineffective For Obese

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Part-Time Workers With Minimal Health Coverage Get New Options

More From Shots - Health News Health2009 Flu Pandemic Was 10 Times More Deadly Than Previously ThoughtHealthPart-Time Workers With Minimal Health Coverage Get New OptionsHealth CareThese Californians Greeted Canceled Health Plans With SmilesHealthEmergency Contraceptive Pill Might Be Ineffective For Obese

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Part-Time Workers With Minimal Health Coverage Get New Options

More From Shots - Health News Health2009 Flu Pandemic Was 10 Times More Deadly Than Previously ThoughtHealthPart-Time Workers With Minimal Health Coverage Get New OptionsHealth CareThese Californians Greeted Canceled Health Plans With SmilesHealthEmergency Contraceptive Pill Might Be Ineffective For Obese

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Monday, November 25, 2013

Inequality Is (Literally) Killing America

Only a few miles separate the Baltimore neighborhoods of Roland Park and Upton Druid Heights. But residents of the two areas can measure the distance between them in years�twenty years, to be exact. That�s the difference in life expectancy between Roland Park, where people live to be 83 on average, and Upton Druid Heights, where they can expect to die at 63.

Underlying these gaps in life expectancy are vast economic disparities. Roland Park is an affluent neighborhood with an unemployment rate of 3.4 percent, and a median household income above $90,000. More than 17 percent of people in Upton Druid Heights are unemployed, and the median household income is just $13,388.

It�s no secret that this sort of economic inequality is increasing nationwide; the disparity between America�s richest and poorest is the widest it�s been since the Roaring Twenties. Less discussed are the gaps in life expectancy that have widened over the past twenty-five years between America�s counties, cities and neighborhoods. While the country as a whole has gotten richer and healthier, the poor have gotten poorer, the middle class has shrunk and Americans without high school diplomas have seen their life expectancy slide back to what it was in the 1950s. Economic inequalities manifest not in numbers, but in sick and dying bodies.

On Wednesday, Senator Bernie Sanders convened a hearing before the Primary Health and Aging subcommittee to examine the connections between material and physiological well-being, and the policy implications. With Congress fixed on historic reforms to the healthcare delivery system, the doctors and public health professionals who testified this morning made it clear that policies outside of the healthcare domain are equally vital for keeping people healthy�namely, those that target poverty and inequality.

�The lower people�s income, the earlier they die and the sicker they live,� testified Dr. Steven Woolf, who directs the Center on Society and Health at Virginia Commonwealth University. In America, people in the top 5 percent of the income gradient live about nine years longer than those in the bottom 10 percent. It isn�t just access to care that poor Americans lack: first, they are more likely to get sick. Poor Americans are at greater risk for virtually every major cause of death, including cancer, heart disease and diabetes. As Woolf put it, �Economic policy is not just economic policy�it�s health policy.�

Tracing health disparities back to their socioeconomic roots adds context to growing calls for pro-worker policies like raising the minimum wage and providing paid sick leave. Lisa Berkman, director of Harvard�s Center for Population and Development Studies, presented a range of evidence indicating that policies supporting men and women in the labor force�particularly low-wage and female workers�lead to better health for themselves and their families.

Continue reading…

Inequality Is (Literally) Killing America

Only a few miles separate the Baltimore neighborhoods of Roland Park and Upton Druid Heights. But residents of the two areas can measure the distance between them in years�twenty years, to be exact. That�s the difference in life expectancy between Roland Park, where people live to be 83 on average, and Upton Druid Heights, where they can expect to die at 63.

Underlying these gaps in life expectancy are vast economic disparities. Roland Park is an affluent neighborhood with an unemployment rate of 3.4 percent, and a median household income above $90,000. More than 17 percent of people in Upton Druid Heights are unemployed, and the median household income is just $13,388.

It�s no secret that this sort of economic inequality is increasing nationwide; the disparity between America�s richest and poorest is the widest it�s been since the Roaring Twenties. Less discussed are the gaps in life expectancy that have widened over the past twenty-five years between America�s counties, cities and neighborhoods. While the country as a whole has gotten richer and healthier, the poor have gotten poorer, the middle class has shrunk and Americans without high school diplomas have seen their life expectancy slide back to what it was in the 1950s. Economic inequalities manifest not in numbers, but in sick and dying bodies.

On Wednesday, Senator Bernie Sanders convened a hearing before the Primary Health and Aging subcommittee to examine the connections between material and physiological well-being, and the policy implications. With Congress fixed on historic reforms to the healthcare delivery system, the doctors and public health professionals who testified this morning made it clear that policies outside of the healthcare domain are equally vital for keeping people healthy�namely, those that target poverty and inequality.

�The lower people�s income, the earlier they die and the sicker they live,� testified Dr. Steven Woolf, who directs the Center on Society and Health at Virginia Commonwealth University. In America, people in the top 5 percent of the income gradient live about nine years longer than those in the bottom 10 percent. It isn�t just access to care that poor Americans lack: first, they are more likely to get sick. Poor Americans are at greater risk for virtually every major cause of death, including cancer, heart disease and diabetes. As Woolf put it, �Economic policy is not just economic policy�it�s health policy.�

Tracing health disparities back to their socioeconomic roots adds context to growing calls for pro-worker policies like raising the minimum wage and providing paid sick leave. Lisa Berkman, director of Harvard�s Center for Population and Development Studies, presented a range of evidence indicating that policies supporting men and women in the labor force�particularly low-wage and female workers�lead to better health for themselves and their families.

Continue reading…

21 Ways the Canadian Health Care System is Better than Obamacare

Dear America:

Costly complexity is baked into Obamacare. No health insurance system is without problems but Canadian style single-payer full Medicare for all is simple, affordable, comprehensive and universal.

In the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months. There were no websites. They did it with index cards!

Below please find 21 Ways the Canadian Health Care System is Better than Obamacare.

Repeal Obamacare and replace it with the much more efficient single-payer, everybody in, nobody out, free choice of doctor and hospital.

Love, Canada

Number 21:
In Canada, everyone is covered automatically at birth � everybody in, nobody out.

In the United States, under Obamacare, 31 million Americans will still be uninsured by 2023 and millions more will remain underinsured.

Number 20:
In Canada, the health system is designed to put people, not profits, first.

In the United States, Obamacare will do little to curb insurance industry profits and will actually enhance insurance industry profits.

Number 19:
In Canada, coverage is not tied to a job or dependent on your income � rich and poor are in the same system, the best guaranty of quality.

In the United States, under Obamacare, much still depends on your job or income. Lose your job or lose your income, and you might lose your existing health insurance or have to settle for lesser coverage.

Number 18:
In Canada, health care coverage stays with you for your entire life.

In the United States, under Obamacare, for tens of millions of Americans, health care coverage stays with you for as long as you can afford your share.

Number 17:
In Canada, you can freely choose your doctors and hospitals and keep them. There are no lists of �in-network� vendors and no extra hidden charges for going �out of network.�

In the United States, under Obamacare, the in-network list of places where you can get treated is shrinking � thus restricting freedom of choice � and if you want to go out of network, you pay for it.

Number 16:
In Canada, the health care system is funded by income, sales and corporate taxes that, combined, are much lower than what Americans pay in premiums.

In the United States, under Obamacare, for thousands of Americans, it�s pay or die � if you can�t pay, you die. That�s why many thousands will still die every year under Obamacare from lack of health insurance to get diagnosed and treated in time.

Number 15:
In Canada, there are no complex hospital or doctor bills. In fact, usually you don�t even see a bill.

In the United States, under Obamacare, hospital and doctor bills will still be terribly complex, making it impossible to discover the many costly overcharges.

Number 14:
In Canada, costs are controlled. Canada pays 10 percent of its GDP for its health care system, covering everyone.

In the United States, under Obamacare, costs continue to skyrocket. The U.S. currently pays 18 percent of its GDP and still doesn�t cover tens of millions of people.

Number 13:
In Canada, it is unheard of for anyone to go bankrupt due to health care costs.

In the United States, under Obamacare, health care driven bankruptcy will continue to plague Americans.

Number 12:
In Canada, simplicity leads to major savings in administrative costs and overhead.

In the United States, under Obamacare, complexity will lead to ratcheting up administrative costs and overhead.

Number 11:
In Canada, when you go to a doctor or hospital the first thing they ask you is: �What�s wrong?�

In the United States, the first thing they ask you is: �What kind of insurance do you have?�

Number 10:
In Canada, the government negotiates drug prices so they are more affordable.

In the United States, under Obamacare, Congress made it specifically illegal for the government to negotiate drug prices for volume purchases, so they remain unaffordable.

Number 9:
In Canada, the government health care funds are not profitably diverted to the top one percent.

In the United States, under Obamacare, health care funds will continue to flow to the top. In 2012, CEOs at six of the largest insurance companies in the U.S. received a total of $83.3 million in pay, plus benefits.

Number 8:
In Canada, there are no necessary co-pays or deductibles.

In the United States, under Obamacare, the deductibles and co-pays will continue to be unaffordable for many millions of Americans.

Number 7:
In Canada, the health care system contributes to social solidarity and national pride.

In the United States, Obamacare is divisive, with rich and poor in different systems and tens of millions left out or with sorely limited benefits.

Number 6:
In Canada, delays in health care are not due to the cost of insurance.

In the United States, under Obamacare, patients without health insurance or who are underinsured will continue to delay or forgo care and put their lives at risk.

Number 5:
In Canada, nobody dies due to lack of health insurance.

In the United States, under Obamacare, many thousands will continue to die every year due to lack of health insurance.

Number 4:
In Canada, an increasing majority supports their health care system, which costs half as much, per person, as in the United States. And in Canada, everyone is covered.

In the United States, a majority � many for different reasons � oppose Obamacare.

Number 3:
In Canada, the tax payments to fund the health care system are progressive � the lowest 20 percent pays 6 percent of income into the system while the highest 20 percent pays 8 percent.

In the United States, under Obamacare, the poor pay a larger share of their income for health care than the affluent.

Number 2:
In Canada, the administration of the system is simple. You get a health care card when you are born. And you swipe it when you go to a doctor or hospital. End of story.

In the United States, Obamacare�s 2,500 pages plus regulations (the Canadian Medicare Bill was 13 pages) is so complex that then Speaker of the House Nancy Pelosi said before passage �we have to pass the bill so that you can find out what is in it.�

Number 1:
In Canada, the majority of citizens love their health care system.

In the United States, the majority of citizens, physicians, and nurses prefer the Canadian type system � single-payer, free choice of doctor and hospital , everybody in, nobody out.

Mass. Gov. hopeful: Consider “single payer” care

From the AP –

Democratic candidate for governor Donald Berwick is pushing Massachusetts to take a second look at creating a truly universal health care system.

The former top Obama administration health care official said Thursday that the state should “seriously explore the possibility of a single payer system in Massachusetts” – a system which would effectively guarantee health coverage for all residents.

Massachusetts currently has the highest percentage of insured residents, but the system relies on a patchwork of private and subsidized care and falls short of universal coverage.

Many liberal Democrats have long said the best way to fix the health care system is to essentially offer Medicare to everyone, arguing that it would provide more coverage and is less cumbersome.

Berwick formerly headed the federal Centers for Medicare and Medicaid Services.

Saturday, November 16, 2013

New Medical Device Treats Epilepsy With A Well-Timed Zap

More From Shots - Health News HealthNew Medical Device Treats Epilepsy With A Well-Timed ZapHealthFor Many People, Lowering Blood Pressure Will Take A VillageHealthCan You Keep Your Old Health Plan? It May Depend On Where You Live HealthFederal Brain Science Project Aims To Restore Soldiers' Memory

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Making Moves In Food Delivery, Chess And Health Care

Listen to the Story 3 min 55 sec Playlist Download Transcript  

The online magazine Ozy covers people, places and trends on the horizon. Co-founder Carlos Watson joins All Things Considered regularly to tell us about the site's latest discoveries.

This week, Watson tells host Arun Rath about a delivery service that allows you to track your food in real time, a chess master who is making the board game sexy and his recent interview with President Bill Clinton.

The New And The Next Shaking Up The Food Delivery Model Enlarge image i Radius Images/Corbis Radius Images/Corbis

"A couple of young guys who were UC Berkeley grads � food obsessed � were finding that they couldn't get their favorite foods delivered. So, they starteda new service called Caviar, that for a flat fee is creating quite the Uber-like stir around San Francisco and now in Seattle and New York. ...

"They've got a lot of your basics, whether it's fish tacos or pulled pork sandwiches, but they also have some of the higher-end restaurants who in the past have been a little hesitant about delivery who have agreed to do it."

Read 'Caviar: Like Uber For Eaters' At Ozy.com

Sexy Moves In The World Of Chess Enlarge image i Courtesy of Ozy.com Courtesy of Ozy.com

"Chess is not always the sexiest sport. But the No. 1 chess player in the world is a young guy from Norway named Magnus Carlsen, who is becoming quite the sensation. He is not only a champion chess player but he is also a male model and that's a very different look from Bobby Fischer or Garry Kasparov, who were two other famous chess champions of the past. ... Guys like Kasparov and others are saying, 'I hope he does really well and puts chess back into the larger mainstream conversation.' "

Read 'Meet the New Ambassador of Chess' At Ozy.com

President Bill Clinton Talks Health Care With Ozy Youtube/YouTube

"He reminded us that when President George W. Bush rolled out the Medicare Part D plan that there also were a number of hiccups in the early days. So, that was his way of offering context to the current troubles with HealthCare.gov. And saying, be a little bit patient. While there may be a number of troubles in the first couple months with HealthCare.gov, they ultimately should be fixable and this won't have been the first time that we've had to smooth over some things in the early going."

Read 'Assessing the Healthcare Rollout' At Ozy.com

Share Facebook Twitter Google+ Email Comment More From The New And The Next Pop CultureMaking Moves In Food Delivery, Chess And Health CarePop CultureDigging Into The Truth About Messages, Images And Hard TimesPop CultureA Male Belly Dancer, Social Activism On Instagram, 'Thriller'Pop CultureA Teenage Music Phenom, Infographics, Motorcycles In Vietnam

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Friday, November 15, 2013

Obama Moves To Delay Cancellations Of Insurance Plans

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Thursday, November 14, 2013

Insurers Aren't Keen On Obama's Pledge To Extend Coverage

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Wednesday, November 13, 2013

'Holy Cow' And 'Kangaroo Court': Panel Grills HealthCare.gov Officials

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Tuesday, November 12, 2013

Self-Employed And With Lots Of Questions About Health Care

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Thursday, November 7, 2013

Obama Apologizes To Those Who Lost Health Plans

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How The Affordable Care Act Pays For Insurance Subsidies

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Wednesday, November 6, 2013

Single-payer healthcare vs. Obamacare

“Medicare for all” isn’t perfect, but it does what the ACA can’t: Guarantee better healthcare and a simpler system

From Salon –

Whenever scandal arises in Washington, D.C., the fight between the two parties typically ends up being a competition to identify a concise message in the chaos � or, as scientists might say, a signal in all the noise. This week confirms that truism, as glitches plagued the new Obamacare website and as insurance companies canceled policies for many customers on the individual market.

Amid the subsequent noise of congressional debate and cable TV outrage, Republicans argued that the signal is about government � more specifically, they claim the controversies validate their age-old assertions that government can�t do anything right. Democrats countered that the signal in the noise is about universal healthcare � Obamacare is a big undertaking, they argue, and so there will be bumps in the road as the program works to provide better health services to all Americans.

This back and forth is creating an even more confusing cacophony � and further obscuring the signal that neither the two parties nor their health industry financiers want to discuss. That signal is about the need for single-payer healthcare, otherwise known as Medicare for all.

One way to detect this signal is to consider the White House guest list.

In trying to show that he was successfully managing the Obamacare rollout, the president last week staged a high-profile White House meeting with private health insurance executives � aka Obamacare�s middlemen. The spectacle of a president begging these middlemen for help was a reminder that Obamacare did not limit the power of the insurance companies as a single-payer system would. The new law instead cemented the industry�s profit-extracting role in the larger health system � and it still leaves millions without insurance.

The second way to see this single-payer signal is to behold the Obamacare-related congressional hearings. During the proceedings, you�ve been hearing a lot about the insurance enrollment website that the government is paying millions to insurer UnitedHealth Group to build. But you�re not hearing much about actual health care. That�s because the insurance industry wrote the Affordable Care Act, meaning the new statute�s top priority isn�t delivering health services. Obamacare is primarily about getting the insurance industry more customers and government contracts, whether or not that actually improves health services.

Continue reading…

Tuesday, November 5, 2013

Insurance Cancellations: The Price Of Mending A Broken System?

More From Shots - Health News Health CareIn Colorado, A Couple Finds Relief In ObamacareHealthWondering If You Need A Strep Test? Crowdsourcing Might HelpHealthFor Many Workers, It's Time To Consider Insurance OptionsHealthInsurance Cancellations: The Price Of Mending A Broken System?

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Saturday, November 2, 2013

So You Found An Exchange Plan. But Can You Find A Provider?

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Thursday, October 31, 2013

For The Young And Healthy, Health Insurance Is A Hard Sell

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Wednesday, October 30, 2013

Victims Of Tainted Steroid Injections Still Struggling

More From Shots - Health News HealthOnline Advice Can Hurt Teens At Risk For Suicide, Self-HarmHealthNotices Canceling Health Insurance Leave Many On EdgeHealthThe Long List Of Health Apps Features Few Clear WinnersHealthWhy Insurers Cancel Policies, And What You Can Do About It

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Why Insurers Cancel Policies, And What You Can Do About It

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Notices Canceling Health Insurance Leave Many On Edge

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Tuesday, October 29, 2013

More Technical Issues For Obamacare, But Good News For Medicare

More From Shots - Health News HealthFor A Longer Life, You Might Try Mowing The LawnHealth CareInsurance Cancellations Elbow Out Website Woes At Health HearingHealthShort-Term Insurance Skirts Health Law To Cut CostsHealthHow A Wandering Brain Can Help People Cope With Pain

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Monday, October 28, 2013

More Technical Issues For Obamacare, But Good News For Medicare

More From Shots - Health News HealthUnlikely Multiple Sclerosis Pill On Track To Become BlockbusterHealth CareMore Technical Issues For Obamacare, But Good News For MedicareResearch NewsEeek, Snake! Your Brain Has A Special Corner Just For ThemHealthSome Health Screenings May Harm More Than Help

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Friday, October 25, 2013

Pennsylvania Governor Talks Up Plan To Expand Medicaid His Way

More From Shots - Health News BusinessFor Obamacare To Work, It's Not Just About The NumbersHealthPennsylvania Governor Talks Up Plan To Expand Medicaid His WayHealthWhat If Husbands Had A GPS To Help Wives With Breast Cancer?HealthWhy Engineers Want To Put B Vitamins In 3-D Printers

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Wednesday, October 23, 2013

FDA Asks Dog Owners For Help With Illnesses Linked To Jerky

More From Shots - Health News HealthA Toddler Remains HIV-Free, Raising Hope For Babies WorldwideHealthWhy Postponing Insurance Mandate Is No Easy Fix For ObamacareHealthFDA Asks Dog Owners For Help With Illnesses Linked To JerkyHealth CareStates' Refusal To Expand Medicaid May Leave Millions Uninsured

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Tuesday, October 22, 2013

The HealthCare.gov 'Tech Surge' Is Racing Against The Clock

More From All Tech Considered Digital LifeOnline Dating Is On The Rise (But There Are Still Haters)TechnologyThe HealthCare.gov 'Tech Surge' Is Racing Against The ClockScienceWhat's Creepy, Crawly And A Champion Of Neuroscience?BusinessCredit Cards Under Pressure To Police Online Expression

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Online Insurance Brokers Stymied Selling Obamacare Policies

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The HealthCare.gov 'Tech Surge' Is Racing Against The Clock

More From All Tech Considered Digital LifeOnline Dating Is On The Rise (But There Are Still Haters)TechnologyThe HealthCare.gov 'Tech Surge' Is Racing Against The ClockScienceWhat's Creepy, Crawly And A Champion Of Neuroscience?BusinessCredit Cards Under Pressure To Police Online Expression

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The HealthCare.gov 'Tech Surge' Is Racing Against The Clock

More From All Tech Considered Digital LifeOnline Dating Is On The Rise (But There Are Still Haters)TechnologyThe HealthCare.gov 'Tech Surge' Is Racing Against The ClockScienceWhat's Creepy, Crawly And A Champion Of Neuroscience?BusinessCredit Cards Under Pressure To Police Online Expression

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Monday, October 21, 2013

Obama: Health Care Site Is Troubled; Affordable Care Act Is Not

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If A Tech Company Had Built The Federal Health Care Website

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Wednesday, October 16, 2013

To Reduce Patient Falls, Hospitals Try Alarms, More Nurses

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Tuesday, October 15, 2013

Why A Medical Device Tax Became Part Of The Fiscal Fight

Listen to the Story 3 min 33 sec Playlist Download Transcript  

Among the bargaining chips in the budget crisis on Capitol Hill, there's the small but persistent issue of taxing medical device manufacturers.

The 2.3 percent sales tax covers everything from MRI machines to replacement hips and maybe even surgical gloves. The tax was imposed to help pay for the Affordable Care Act. It didn't attract much attention at first � at least, not outside the world of medical device manufacturers.

But they have waged a persistent campaign to undo the tax, and right now is the closest they have come to succeeding.

House Republicans have made repeated efforts to kill the tax, but Democrats had opposed any changes to the health care law.

Senate Finance Committee Chairman Max Baucus, D-Mont., last month dismissed changes in the medical devices tax. He told Politico that the industry had agreed to it when the bill was being written and "a deal's a deal."

But even Democrats have started softening that hard line.

Illinois Sen. Richard Durbin, the Senate's second-ranking Democrat, told CNN recently: "We can work out something, I believe, on the medical device tax � that was one of the proposals from the Republicans � as long as we replace the revenue."

Last week, a bipartisan compromise in the Senate included the idea of delaying the tax for two years.

Maine Republican Sen. Susan Collins spearheaded the proposal. She cited the lobbying campaign's work when she said the tax "will cause the loss of as many as 43,000 domestic jobs, according to industry estimates."

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Those estimates are crucial to the lobbying effort.

The CEO of one of the industry's giants, Medtronic, said last fall that the company likes to "focus on things we can control." Medtronic, which is based in Minnesota, did not respond to an interview request Tuesday.

But one of Minnesota's senators is a leader of the anti-tax campaign.

Democrat Amy Klobuchar gave industry advocates some advice this summer.

"I think that at the beginning of this battle, people didn't understand in Congress how many medical device manufacturers they had," she said. "I think just making the case at home and also back in Washington makes a difference."

And that is what the medical device industry has been doing, quietly but assiduously.

Cook Group, the largest privately owned maker of medical devices, boosted its lobbying outlays significantly in the past two years. It's also working with an industry consultant, Joe Hage, on a website called no2point3.com.

The website collects stories of anger and anguish from the small-business people who run a lot of the companies. It also has a petition to repeal with 11,000 signatures. It's all fueled by a LinkedIn group that Hage runs.

"The medical devices group is not in league with Washington lobbyists directly," Hage says, but he quickly adds: "We like to think that this effort complements their effort by giving them another bow in their quiver."

Still, it's hardly clear whether those efforts will move votes or whether the whole tax question will be just a pawn in the much larger debate over the budget and the debt limit.

Share Facebook Twitter Google+ Email Comment More From The Government Shutdown PoliticsShutdown Diary: Hope Turns Into Wall Street WarningPoliticsWhy A Medical Device Tax Became Part Of The Fiscal FightPoliticsOn Capitol Hill, A Flurry Of Activity But Still No Deal BusinessJPMorgan To Front Customers If Federal Shutdown Drags On

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Why A Medical Device Tax Became Part Of The Fiscal Fight

Listen to the Story 3 min 33 sec Playlist Download Transcript  

Among the bargaining chips in the budget crisis on Capitol Hill, there's the small but persistent issue of taxing medical device manufacturers.

The 2.3 percent sales tax covers everything from MRI machines to replacement hips and maybe even surgical gloves. The tax was imposed to help pay for the Affordable Care Act. It didn't attract much attention at first � at least, not outside the world of medical device manufacturers.

But they have waged a persistent campaign to undo the tax, and right now is the closest they have come to succeeding.

House Republicans have made repeated efforts to kill the tax, but Democrats had opposed any changes to the health care law.

Senate Finance Committee Chairman Max Baucus, D-Mont., last month dismissed changes in the medical devices tax. He told Politico that the industry had agreed to it when the bill was being written and "a deal's a deal."

But even Democrats have started softening that hard line.

Illinois Sen. Richard Durbin, the Senate's second-ranking Democrat, told CNN recently: "We can work out something, I believe, on the medical device tax � that was one of the proposals from the Republicans � as long as we replace the revenue."

Last week, a bipartisan compromise in the Senate included the idea of delaying the tax for two years.

Maine Republican Sen. Susan Collins spearheaded the proposal. She cited the lobbying campaign's work when she said the tax "will cause the loss of as many as 43,000 domestic jobs, according to industry estimates."

Related NPR Stories Shots - Health News How A Tax On Medical Devices United Political Rivals It's All Politics A Hint Of Bipartisanship On This Obamacare Tax? Shots - Health News Veterinarians Say Health Law's Device Tax Is Unfair To Pets

Those estimates are crucial to the lobbying effort.

The CEO of one of the industry's giants, Medtronic, said last fall that the company likes to "focus on things we can control." Medtronic, which is based in Minnesota, did not respond to an interview request Tuesday.

But one of Minnesota's senators is a leader of the anti-tax campaign.

Democrat Amy Klobuchar gave industry advocates some advice this summer.

"I think that at the beginning of this battle, people didn't understand in Congress how many medical device manufacturers they had," she said. "I think just making the case at home and also back in Washington makes a difference."

And that is what the medical device industry has been doing, quietly but assiduously.

Cook Group, the largest privately owned maker of medical devices, boosted its lobbying outlays significantly in the past two years. It's also working with an industry consultant, Joe Hage, on a website called no2point3.com.

The website collects stories of anger and anguish from the small-business people who run a lot of the companies. It also has a petition to repeal with 11,000 signatures. It's all fueled by a LinkedIn group that Hage runs.

"The medical devices group is not in league with Washington lobbyists directly," Hage says, but he quickly adds: "We like to think that this effort complements their effort by giving them another bow in their quiver."

Still, it's hardly clear whether those efforts will move votes or whether the whole tax question will be just a pawn in the much larger debate over the budget and the debt limit.

Share Facebook Twitter Google+ Email Comment More From The Government Shutdown PoliticsShutdown Diary: Hope Turns Into Wall Street WarningPoliticsWhy A Medical Device Tax Became Part Of The Fiscal FightPoliticsOn Capitol Hill, A Flurry Of Activity But Still No Deal BusinessJPMorgan To Front Customers If Federal Shutdown Drags On

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Why A Medical Device Tax Became Part Of The Fiscal Fight

Listen to the Story 3 min 33 sec Playlist Download Transcript  

Among the bargaining chips in the budget crisis on Capitol Hill, there's the small but persistent issue of taxing medical device manufacturers.

The 2.3 percent sales tax covers everything from MRI machines to replacement hips and maybe even surgical gloves. The tax was imposed to help pay for the Affordable Care Act. It didn't attract much attention at first � at least, not outside the world of medical device manufacturers.

But they have waged a persistent campaign to undo the tax, and right now is the closest they have come to succeeding.

House Republicans have made repeated efforts to kill the tax, but Democrats had opposed any changes to the health care law.

Senate Finance Committee Chairman Max Baucus, D-Mont., last month dismissed changes in the medical devices tax. He told Politico that the industry had agreed to it when the bill was being written and "a deal's a deal."

But even Democrats have started softening that hard line.

Illinois Sen. Richard Durbin, the Senate's second-ranking Democrat, told CNN recently: "We can work out something, I believe, on the medical device tax � that was one of the proposals from the Republicans � as long as we replace the revenue."

Last week, a bipartisan compromise in the Senate included the idea of delaying the tax for two years.

Maine Republican Sen. Susan Collins spearheaded the proposal. She cited the lobbying campaign's work when she said the tax "will cause the loss of as many as 43,000 domestic jobs, according to industry estimates."

Related NPR Stories Shots - Health News How A Tax On Medical Devices United Political Rivals It's All Politics A Hint Of Bipartisanship On This Obamacare Tax? Shots - Health News Veterinarians Say Health Law's Device Tax Is Unfair To Pets

Those estimates are crucial to the lobbying effort.

The CEO of one of the industry's giants, Medtronic, said last fall that the company likes to "focus on things we can control." Medtronic, which is based in Minnesota, did not respond to an interview request Tuesday.

But one of Minnesota's senators is a leader of the anti-tax campaign.

Democrat Amy Klobuchar gave industry advocates some advice this summer.

"I think that at the beginning of this battle, people didn't understand in Congress how many medical device manufacturers they had," she said. "I think just making the case at home and also back in Washington makes a difference."

And that is what the medical device industry has been doing, quietly but assiduously.

Cook Group, the largest privately owned maker of medical devices, boosted its lobbying outlays significantly in the past two years. It's also working with an industry consultant, Joe Hage, on a website called no2point3.com.

The website collects stories of anger and anguish from the small-business people who run a lot of the companies. It also has a petition to repeal with 11,000 signatures. It's all fueled by a LinkedIn group that Hage runs.

"The medical devices group is not in league with Washington lobbyists directly," Hage says, but he quickly adds: "We like to think that this effort complements their effort by giving them another bow in their quiver."

Still, it's hardly clear whether those efforts will move votes or whether the whole tax question will be just a pawn in the much larger debate over the budget and the debt limit.

Share Facebook Twitter Google+ Email Comment More From The Government Shutdown PoliticsShutdown Diary: Hope Turns Into Wall Street WarningPoliticsWhy A Medical Device Tax Became Part Of The Fiscal FightPoliticsOn Capitol Hill, A Flurry Of Activity But Still No Deal BusinessJPMorgan To Front Customers If Federal Shutdown Drags On

More From The Government Shutdown

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Friday, October 11, 2013

Single-Payer Prescription for What Ails Obamacare

�We apologize for the inconvenience. The Marketplace is currently undergoing regularly scheduled maintenance and will be back up Monday 10/7/3013.� You read it right, 3013. That was the message on the homepage of the New York state health insurance exchange website this past weekend.

Yes, the Affordable Care Act (ACA), popularly known as Obamacare, is going through difficult birth pains, as the marketplace websites went live only to crash. The government is not giving out numbers, but informed observers speculate that very few people have succeeded in signing up for any of the plans so far.

The ACA rollout occurred as Republicans shut down the government in their attempt to defund Obamacare. But their strategy backfired. Had there been no shutdown, all of the attention would have been on the disastrous rollout. The fundamental issue, at the core of the health-care dispute, is typically ignored and goes unreported: The for-profit health-insurance industry in the United States is profoundly inefficient and costly, and a sane and sustainable alternative exists�single-payer, otherwise known as expanded and improved Medicare for all. Just change the age of eligibility from 65 to zero.

�When Medicare was rolled out in 1966, it was rolled out in six months using index cards,� Dr. Steffie Woolhandler told me Monday. �So if you have a simple system, you do not have to have all this expense and all this complexity and work.� Woolhandler is professor of public health at CUNY-Hunter College and a primary-care physician. She is a visiting professor at Harvard Medical School and the co-founder of Physicians for a National Health Program, or PNHP. PNHP is an organization with 17,000 physicians as members, advocating for a single-payer health-care system in the U.S.

What is single-payer? Critics denounce it as �socialized medicine,� while ignoring that single-payer is already immensely popular in the U.S., as Medicare. A 2011 Harris poll found that Medicare enjoyed 88 percent support from American adults, followed closely by Social Security. Woolhandler explained that with a Medicare-for-all system, �you would get a card the day you�re born, and you�d keep it your entire life. It would entitle you to medical care, all needed medical care, without co-payments, without deductibles. And because it�s such a simple system, like Social Security, there would be very low administrative expenses. We would save about $400 billion [per year].� Dr. Woolhandler went on, rather than �thousands of different plans, tons of different co-payments, deductibles and restrictions�one single-payer plan, which is what we need for all Americans to give the Americans really the choice they want … not the choice between insurance company A or insurance company B. They want the choice of any doctor or hospital, like you get with traditional Medicare.�

Monthly premiums in most cases are expected to decrease with Obamacare�s health-exchange systems, which will enhance the transparency and ease of comparison for people shopping for a health-insurance policy. If and when the technical problems are eliminated from the online health insurance exchanges, and people can easily shop, there will likely be a huge number of people buying policies for the first time. The ACA offers important advances, which even single-payer advocates acknowledge: subsidies for low-income applicants will make insurance affordable for the first time. Medicaid expansion also will bring many poor people into the umbrella of coverage. Young people can stay on their parents� insurance until the age of 26. People with so-called pre-existing conditions can no longer be denied insurance.

While the ACA was deemed constitutional by the Supreme Court, the opinion gave states the option to opt out of the Medicaid expansion, which 26 states with Republican governors have done. A New York Times analysis of census data showed that up to 8 million poor people, mostly African-Americans and single mothers, and mostly in the Deep South, will be stranded without insurance, too poor to qualify for ACA subsidies, but stuck in a state that rejected Medicaid expansion.

So, while partisan bickering (between members of Congress who have among the best health and benefits packages in the U.S.) has shut down the government, the populace of the United States is still straitjacketed into a system of expensive, for-profit health insurance. We pay twice as much per capita as other industrialized countries, and have poorer health and lower life expectancy. The economic logic of single-payer is inescapable. Whether Obamacare is a pathway to get there is uncertain. As Dr. Woolhandler summed up, �It�s only a road to single-payer if we fight for single-payer.�

FAQ: How Obamacare Affects Employers And How They're Responding

This is one of several explainers to help consumers navigate their health insurance choices under the Affordable Care Act, or as some call it, Obamacare. Click here for answers to other common questions. Have a question we missed? Send it to health@npr.org. We may use it in a future on-air or online segment.

Do employers have to do anything different under the Affordable Care Act?

Not right away. The only thing required of employers at the start is that they notify workers that the new health insurance exchanges have opened. You may have received a letter from your employer to this effect � you probably don't need to do anything.

Starting in 2015, large employers with 50 or more workers have a responsibility � but no mandate � to offer employees health coverage. If they don't, they may face fines, but only if their workers go to health insurance exchanges and have earnings low enough to qualify for federal subsidies. Stores and restaurants � less likely to offer health insurance in the past � may be most affected. The coverage rule doesn't affect workers who put in less than 30 hours a week.

There are no responsibilities for small employers with fewer than 50 workers. If they want to buy coverage for their employees, the insurance exchanges represent a new option for them in terms of where to shop. Certain employers with fewer than 25 workers are eligible for federal tax credits. To qualify, the company has to cover at least half of the premium for all of its employees, and also have average wages of less than $50,000. For details on these tax credits, see this answer sheet from the IRS.

Will my employer cut back on my insurance coverage?

A number of employers have been overhauling the health benefits they offer employees, citing rising costs.

There are two themes to what they are doing. In trying to control their own spending, employers often are shifting health costs to employees. So the average annual deductible for an individual � what consumers pay before insurance kicks in � nearly doubled in the past seven years, from $584 in 2006 to $1,135 this year, according to the Kaiser Family Foundation.

But employers aren't just making workers pay more. They're trying to make them think more about health-related expenses and behavior.

Companies such as grocer Kroger Co. pay only a fixed amount for particular drugs or procedures, giving patients incentive to shop around for the best price. IBM started giving rebates to workers who adopt healthy lifestyles. Penalizing smokers with surcharges is one of the few discriminatory measures the health act allows.

What about part-time workers?

Nothing in the Affordable Care Act says that employers have to cover part-time workers. The law defines part time as someone who works less than 30 hours a week.

Some employers that have offered part-time workers minimal coverage, such as Trader Joe's and Home Depot, have dropped it on the grounds that those workers can now find coverage through the insurance exchanges. Most workers in this situation will be pleased with the outcome. They'll likely find better coverage than what they had for less money. Although depending on the situation, some people may see their premiums go up.

Are employers reducing their workforce as a result of the Affordable Care Act?

There have been reports of employers holding back on hiring in order to stay under the 50-employee threshold that triggers health insurance responsibilities. There also have been reports of employers cutting workers' hours to below 30 per week so that they don't count as full-time. While there is anecdotal evidence of both things happening, there's no evidence that those cases have added up to a broader drag on the economy as a whole.

Will my company stop offering coverage to my spouse and dependents?

Some companies, including UPS, have decided to stop covering working spouses if they have access to coverage at their own jobs. The health law does not require employers to cover spouses, but surveys show that only a minority of companies have implemented a "spousal exclusion."

However, employers increasingly offer incentives to get spouses off their plans. They may charge workers extra if a covered spouse has access to other insurance, or they may pay bonuses when spouses are not on the company policy.

The health law requires employers who offer coverage to employees to also offer coverage to dependent children, or pay a penalty.

See other Frequently Asked Questions on the Affordable Care Act:

Understanding The Health Insurance Mandate And Penalties For Going Uninsured All About Health Insurance Exchanges And How To Shop At Them A Young Adult's Guide To New Health Insurance Choices What Retirees And Seniors Need To Know About The Affordable Care Act Where Medicaid's Reach Has Expanded � And Where It Hasn't


Additional coverage from NPR Member Stations:

California (KQED, San Francisco) California (KPCC) California (KXJZ Capital Public Radio, Sacramento) Colorado (Colorado Public Radio) Massachusetts (WBUR, Boston) Minnesota (Minnesota Public Radio) Georgia (WABE, Atlanta) New York (WNYC) Oregon (Oregon Public Broadcasting) Pennsylvania (WHYY newsworks.org) Texas (KUHF) Texas (KUT, San Antonio)

This FAQ was produced through a collaboration between NPR and Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonpartisan health-care policy research organization. The Kaiser Family Foundation is not affiliated with Kaiser Permanente.

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