by RoseAnn DeMoro, writing for Common Dreams.

There’s a significant danger that a public option would not only fail to improve the ACA, it could undermine the movement for Medicare for All

With the collapse of the dismal Republican healthcare bill, some Democrats are reviving talk of a public option as the cure for the holes in the Affordable Care Act that opened the door for the GOP attack.

Some even project the public option as the path to real transformative reform, an improved and expanded Medicare for all. It’s not. The public option bears more in common with fool’s gold. It may look shiny, but it will still leave you broke.

And there’s a significant danger that a public option would not only fail to improve the ACA, it could undermine the movement for single payer, discrediting a fully publicly financed system that is not a feeble adjunct to the private insurance market.

Granted, the ACA did enact some important course corrections, especially the expansion of Medicaid, to a profit-focused healthcare system that had plummeted to 37th in World Health Organization rankings.

But ignoring the highly successful and popular model of a proven system, Medicare, the ACA architects instead opted for an alternative that left 28 million Americans uninsured and failed to reign in the price gouging practices of the private market.

The inevitable result was millions of newly insured people paying premiums for insurance they increasingly could not use because of ever-rising deductibles, co-pays and other out of pocket costs.

Enter the proposal for a public option, now again in vogue as the solution for driving down costs by offering competition for the private insurers. The public option, the argument goes, can offer less expensive coverage because it doesn’t have to divert massive sums for administrative costs, mainly profits, lush executive pay packages, claims denial paperwork, and marketing.

But in practice, the outcome would be far different. Medicare works in large part by including all the people it covers in one large risk pool so that healthier patients balance out sicker patients in costs that must be reimbursed to providers. But the public option would not have that protection. One of two scenarios is likely:

A. To actually compete, the public option has to employ the same cutthroat tactics private insurers employ to limit their costs.

Insurance companies reap profits by collecting premiums and restricting payments for care. They accomplish that goal by denying claims—data from California and Connecticut have shown insurers deny from one-fifth to one-fourth of all claims—or excluding patients likely to be sicker and in need of more costly care.

The ACA barred insurers from refusing to sell plans to people they used to summarily reject with even minor pre-existing conditions. But the insurers have decades of experience in gaming the system, such as the use of restrictive provider networks and drug formularies.

As Adam Gaffney and Danny McCormick wrote in The Lancet in April, in the massive New York market only one insurer, a consumer cooperative that ultimately collapsed financially, covered care at the city’s top cancer center. Another popular scam is charging their enrollees more for essential drugs for AIDS, cancer or other serious illnesses.

So the public option can engage in the same skullduggery to exclude sicker, more costly patients, or

B. The public option becomes the ACA escape valve by welcoming in the sickest people selected out by the private insurers, in effect another bailout for a failed private insurance market.

Noble, but fatal. Thus the public option has far higher operating costs than the private plans. To effectively compete, it must either greatly jack up its rates, eliminating it as a less expensive alternative, or endure the bankrupted fate of that consumer coop in New York.

To top it all off, the Congressional Budget Office in 2013 concluded that adding a public option would not even slice the number of uninsured, and could even encourage employers to dump workers they now cover into the ACA exchanges.

With millions still either uninsured or paying exorbitant costs for care, imagine promoting a publicly financed Medicare for all to a public that sees a public option that is just as unethical as the notorious private insurers, or a financial wreck that just went belly up.

In 1957, the Ford Motor Co. had the hot idea of a glitzy new car that would capture new market share. It was called the Edsel, which soon become a synonym for a flop. Nurses have a message to the public option purveyors. Stop trying to sell us an Edsel.

Original Post: https://www.commondreams.org/views/2017/07/20/public-option-doomed-start

The post The Public Option – Doomed From the Start appeared first on Healthy California Campaign.

By Jean Ross writing for Common Dreams.

With liberals across the land breathing a huge sigh of relief after the abrupt collapse of the Senate scheme to repeal and somewhat replace the Affordable Care Act, all is good again with healthcare in America. Right?

Well, there have been a few troubling signs if you can dig past all the news about Donald Trump’s latest tweets.

Americans are dying younger. A Bloomberg news report found that in 2015 the death rate rose slightly for the first time in 2015 since 1999 (though that has brought some cheer, , said Bloomberg, into some corporate boardrooms, who can revise down how much they’ll have to pay out in pension payments to retirees). https://www.bloomberg.com/news/articles/2017-08-08/americans-are-dying-younger-saving-corporations-billions

• Colon cancer mortality rates for white Americans under age 55 are climbing, as detailed in a study the Journal of the American Medical Association. https://www.washingtonpost.com/news/to-your-health/wp/2017/08/08/mortality-rates-are-rising-for-colon-cancer-but-only-for-white-americans/?utm_term=.d96b0ca141e6
• More than four in ten adults with health insurance struggle with the high cost of deductibles, according to a Kaiser Family Foundation survey. Nearly 30 percent had trouble paying medical bills, with 73 percent of those cutting back on spending on food, clothing or other basic items. Significant numbers skipped dental care, going to the doctor, getting a recommended medical test or treatment, or filling a prescription. https://www.kff.org/health-costs/poll-finding/data-note-americans-challenges-with-health-care-costs/
• Blue Cross and Blue Shield of Georgia informed enrollees that if they go to the emergency room with a health problem that insurance bean counters later decide was not an “emergency” the insurer will not pay their care, reported Michael Hiltzik of the Los Angeles Times. That’s right, patients will get stuck with the bill, after all how much could an ER visit cost? https://www.latimes.com/business/hiltzik/la-fi-hiltzik-insurance-er-20170602-story.html
• About 114 million Americans have no insurance coverage for dental care. Gum disease, the New York Times reported, increases the risk of heart disease, diabetes and lower baby birth weights. Dental emergencies in California alone rose by 50 percent from 2005 to 2011. https://mobile.nytimes.com/blogs/kristof/2017/05/23/our-teeth-are-making-us-sick/

But the news is not all bad. It’s a great time to be a healthcare chief executive. CEOs of the 70 largest U.S. health care companies have taken home a cumulative $9.8 billion since the enactment of the ACA. John Martin, former CEO of Gilead Sciences collected $863 million just by himself. https://www.axios.com/the-sky-high-pay-of-health-care-ceos-2442398819.html

If the name Gilead sounds vaguely familiar, here’s a refresher. They’re the people behind Sovaldi, the hepatitis C drug for which Gilead charges $1,000 a pill or $84,000 for a 12-week treatment course, an amount that is threatening to bankrupt public programs which now commonly ration the drug.

It’s also a banner time for creative new companies that profit off contracting health care services, like emergency care. The New York Times reports that more than 20 percent of ER visits result in much higher costs for patients who unexpectedly get a massive bill because their care was provided by doctors who are not part of their insurance “network.” https://www.nytimes.com/2017/07/24/upshot/the-company-behind-many-surprise-emergency-room-bills.html

Yes, but haven’t all the policy wonks assured us we have the best healthcare system in the world?

Not if you’re counting “amenable mortality,” which the Washington Post defines as deaths that “could have been avoided by timely and effective medical care.” By that score, according to University of Washington researchers, the U.S. ranked just 35th among 195 countries. https://www.washingtonpost.com/news/to-your-health/wp/2017/05/18/an-embarrassment-u-s-health-care-far-from-the-top-in-global-study

Of course, that’s an unfair comparison. All those other countries ahead of us actually prioritize healthcare as a public good, a societal benefit not to be mortgaged off to corporations that exploit their peoples’ health for profit.

What they all have is rational, coordinated national healthcare systems. Even if they have a role for private insurers, the government is still setting the rates and health benefits, and everyone, bar none, is guaranteed care. https://www.commondreams.org/views/2017/08/08/liberals-strike-back-against-single-payer

We could, of course, have such a system too; you just have to be 65 or older to get access to it. It’s called Medicare, and it remains one of the most popular reforms in U.S. history, far more beloved than those not so charming insurance companies whose principal mission is to collect your premiums and avoid paying anything out for your care.

We can, and should, all celebrate the defeat, for now, of call it McConnellcare or Ryancare or Trumpcare. But let’s not forget that the huge holes in Obamacare on access and out of pocket costs in particular have left tens of millions of people without care or hammered by the high cost.

There’s a reason 60 percent of Americans believe it is the government’s obligation to ensure health coverage for all. https://www.pewresearch.org/fact-tank/2017/06/23/public-support-for-single-payer-health-coverage-grows-driven-by-democrats/

And, there’s a straightforward way to accomplish that, building on 52 years of our successful Medicare experience – improve, strengthen Medicare, and lower the eligibility age to zero.

The Medicare for all movement is growing, climb on board.

Original Post: https://www.commondreams.org/views/2017/08/10/we-still-have-lot-work-do-healthcare

The post We Still Have A Lot of Work To Do On Healthcare appeared first on Healthy California Campaign.

Deborah Burger writing for the Eureka Times-Standard.

How long are we going to ask North Coast residents who have no health coverage or who struggle to pay inflated costs for medical care to wait for help?

A long time, apparently, in the view of North Coast Assemblyman Jim Wood and Assembly Speaker Anthony Rendon.

In Wood’s district, 24 percent of adults delayed filling prescriptions or getting medical services in 2014. One fifth of those adults were in only fair or poor health, according to the UCLA Center for Health Policy Research.

It will soon get worse. Insurance premiums are projected to jump on average 12.5 percent next year. But the worst hit will be across rural Northern California counties, many in Wood’s district, where increases could soar as high as 30 percent.

SB 562, now stalled in the Assembly, could provide relief. It would not only guarantee coverage for all currently uninsured Californians, it would also eliminate premiums, deductibles, co-pays that prompt far too many to self-ration the care they need.

After SB 562 passed the California Senate in June, Speaker Rendon unilaterally prevented the bill from moving forward.

Wood publicly backed Rendon (“I strongly believe health care is a right,” Times-Standard, Aug. 28, Page A4). The irony is that Wood is hardly an innocent bystander. Few Californians are in a better position to improve legislation he claims falls short.

Wood chairs the Assembly Health Committee, the first Assembly body that would hold hearings and consider changes Woods claims are required. No doubt the authors of SB 562 would welcome Wood’s willingness to work on potential improvements.

Instead, Wood now touts a “Select Committee” that is not a policy body and cannot pass legislation as an alternative to a real bill frozen in the Assembly that could end the health care emergency for so many in crisis.

Assemblyman Wood and Speaker Rendon should do the job they are elected to do. Hold hearings and make any fixes on actual legislation that immediately addresses an overwhelming public need.

And as with climate action, transportation and housing, and previous healthcare legislation, if further refinements to major programs are subsequently desired, they can be implemented through additional legislation.

Thousands of Californians, who have been campaigning for SB 562 for months, have made it clear they will not settle for the empty promises of a Select Committee that has no power and looks more like a cover for inaction.

That includes volunteers who knocked on the doors of 375 Eureka residents in mid-August, one-third of whom said they’d contact Wood to urge him to push the bill forward.

It also includes the California Democratic Party whose executive board, with over 300 members, voted unanimously August 27 to endorse SB 562.

For anyone who claims that health care is a right, it’s past time to move beyond rhetoric to action. For all of those in pain today, or who are one car accident, exposure to a deadly disease or one super storm away from calamity.

Deborah Burger is a registered nurse, co-president of the California Nurses Association, and a resident of Assemblyman Jim Wood’s district.

Original Post: https://www.times-standard.com/opinion/20170902/stalling-health-care-helps-no-one

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By Augie Lindmark, Vanessa Van Doren, Bryant Shuey, and Andy Hyatt – writing for STAT News.

Underneath a heap of hospital blankets, Stephen seemed small for a 7-year-old. His chest rose and fell rapidly, a frightening rhythm given his history of asthma. His parents stood nearby as veteran witnesses — Stephen had been admitted to a Cleveland safety net hospital for asthma four times already this year — but familiarity offers little comfort when your child struggles to breathe. When asked if their son used his asthma inhalers, they replied, “It depends. When we can afford them, he takes them. But when we can’t, it could be a few weeks.”

Stephen represents one of more than 430,000 hospitalizations each year due to asthma. At a cost of $56 billion annually, complications from asthma can be prevented with regular medications (inhalers), avoidance of triggers like dust and mold, and access to health care, which usually means access to health insurance. Stephen didn’t have the latter.

Of the diseases we are taught in medical school, a sudden worsening of asthma, known as an exacerbation, is a relatively common cause of illness in children and adults. To identify the cause of a disease, doctors are trained in the differential diagnosis. This bedrock of medical education encourages doctors — those in training, like us, as well as those with years of experience — to compile a list of causes that match a patient’s symptoms. In a way, the differential is half medicine, half Sherlock Holmes.

Chest pain, for example, might include differential diagnoses that range from heart attack to having eaten too many buffalo wings. Yet there’s a particular cause of illness — in Stephen’s case, a nonpulmonary culprit — that is unique to American health care: America’s private health insurance system.

Recent months provide ample context. As the latest Obamacare repeal efforts took the form of Graham-Cassidy 1.0 and 2.0, the GOP bill would have kicked 32 million Americans off their health insurance. Patients with preexisting conditions like asthma would have seen sharp increases in their health insurance premiums (in the case of metastatic cancer, to the tune of six digits), and Medicaid reimbursements to Planned Parenthood would have been banned, effectively barring millions of women from reproductive and preventive health care.

Both Republican and Democratic efforts have done little to change the fact that thousands of Americans die from lack of health coverage. America’s fragmented and inequitable health system is a sinking ship and recent fixes — often in the form of private health insurance industry bailouts or shutouts — are like placing tissue paper over the leaks in this doomed vessel.

No bacteria or viruses harm health more than policies that effectively prevent millions of individuals from access to affordable health insurance to pay for life-altering health care, including the recent ill-conceived executive order. As American health care maintains its appalling position as a leading cause of financial burden and bankruptcy, an equitable response is essential. That means creating a system in which access to health care is based on need, not the ability to pay. As future doctors, we are being trained to identify root causes of disease. That’s why we support Medicare for all.

Momentum toward an improved and expanded Medicare for all health system is at historic highs. The majority of American physicians now support single-payer health care, and 60 percent of Americans believe that the federal government has a responsibility to ensure health care for all citizens.

Last month, the Medicare for All Act was rolled out with fanfare as Sen. Bernie Sanders — joined by 16 co-sponsors — offered a blueprint for universal health care in America. Its sister bill in the House of Representatives, the Expanded and Improved Medicare For All Act, has 120 Democratic co-sponsors, making it the first single-payer bill in history to have a majority of Democratic support.

The overwhelmingly popular Medicare and Medicaid programs have saved millions of lives and offer strong, supportive health care to millions of Americans. Why not offer that to all Americans? As the life expectancy gap between rich and poor increases, the only path forward is to ensure that all Americans have affordable health care, regardless of socioeconomic background.

President Trump recently declared his desire to “stabilize markets” which, historically, has meant diverting funds to private insurers who have done an outstanding job of shrinking coverage and fattening corporate profits. Trump’s latest executive order, which eliminates select private insurance subsidies, will ironically dampen private profits at the expense of escalating premiums for the middle class.

Private insurance subsidies are Band-Aids on an already oozing wound, an inefficient private industry that prioritizes the depth of shareholder pockets over patient health. And while subsidies are short-term fixes inadequate for a long-term solution, removing them altogether, as has been the procedure in the latest GOP bills, would further limit patient access to affordable, comprehensive care. This worse-worst situation could be healed with an improved Medicare-for-all system that eliminates profit motives and preferentially places health above all else.

As medical students, we occupy a unique seat from which to view America’s health system. Our inexperience means we haven’t been indoctrinated into the damaging practices of the private health insurance industry. Our optimism tells us that the system can be changed. We entered medicine out of a desire to help people. But if we participate in a flawed health care system without advocating for structural and equitable change, we trend toward hypocrisy rather than Hippocrates.

Because Stephen’s parents couldn’t afford asthma medications, their son’s breaths were figuratively assigned a price tag. His family, like millions of Americans, is forced to make an impossible decision: pay for food and rent, or purchase medications and health insurance. Recent months have seen patients, students, and health professionals realize this crisis and mobilize toward a better alternative: Medicare for all. We advocate to practice in such a system, where every patient has health care. And where every patient can breathe freely.

Augie Lindmark, Vanessa Van Doren, Bryant Shuey, and Andy Hyatt are medical students the University of Minnesota, Case Western Reserve University, University of New Mexico, and Boston University, respectively, as well as board members of Physicians for a National Health Program, an organization that advocates for an improved and expanded Medicare for All health system.

Original Post: https://www.statnews.com/2017/10/25/medicare-health-insurance-asthma

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By Jessica Glenza, The Guardian.

In a major international intervention in the US debate, the former UN secretary general said the current system ‘ultimately functions to prioritize profit over care’

The former UN secretary general Ban Ki-moon called on Americans to pass universal health coverage at a speech in New York City on Tuesday, marking a dramatic intervention of world leaders into the US healthcare debate.

Ban called on the US to stop “powerful interests” from prioritizing “profit over care” as part of a global delegation pushing the US to adopt a publicly financed health system similar to those in other wealthy countries.

The US spends more on healthcare than any nation in the world, yet 28 million Americans still lack care.

“In the US, all too often only rich people get access to expensive life-saving treatments,” said Ban. “This is unjust and threatens everybody’s health when working- and middle-class people with communicable diseases cannot afford treatment for their infections.”

“Even routine preventive care is often prohibitively expensive,” said Ban. “As America is demonstrating, you simply cannot reach universal health coverage if your health system is dominated by private financing and ultimately functions to prioritize profit over care.”

Enacting universal health coverage would be a revolution in US healthcare. Currently, the US relies on a complex network of for-profit health insurers, government subsidies and limited public insurance programs to provide healthcare access to Americans.

Of the 25 richest countries in the world, the United States is the only one without universal health coverage. The political prospects of passing such a law remain remote with conservatives in power, yet calls for universal healthcare in the United States have grown louder since President Trump’s election as Republicans try to dismantle healthcare regulations.

Currently, about 28 million Americans have no health insurance. For people without insurance, an emergency room trip could easily be a financial disaster costing tens thousands of dollars.

In his speech, Ban highlighted that the gap in access to healthcare meant victims of the recent mass shootings at a Las Vegas concert and Texas church were left without affordable care.

“It simply breaks my heart to see victims of tragic mass shootings then be potentially bankrupted because they cannot afford the hospital and recovery bills,” said Ban. “This is one of the clearest indictments of America’s health system today.”

Ban spoke at an event called “Health for All: #WalkTogether” organized by The Elders, a group of global leaders working for human rights. The Elders was founded by Nelson Mandela and is chaired by Kofi Annan.

Gro Harlem Brundtland: ‘Denying health coverage for poor children for tax cuts for the rich is not what we would expect of a compassionate society.’ Photograph: Andrew Seng

Robert Yates, a political health economist and expert on universal health coverage at the international thinktank Chatham House, said the international community is increasingly hoping to help Americans achieve universal health coverage.

“We think this is the very first time that the global community has engaged so directly with the US healthcare debate,” he said. “The World Health Organization is thinking as well about how we can help here in the US.”

“I and my fellow Elders are fully aware that healthcare debates in the US somehow are different,” said Gro Harlem Brundtland, former director general of the World Health Organization. “They are fought with more tension and divisiveness than other places.”

Although Trump has called Sanders’ plan for universal healthcare in the US a “curse”, the US has already agreed to work toward that goal. One of the sustainable development goals adopted by the UN was an agreement to work toward universal healthcare by 2030, including in the US.

“President Trump seems intent on dismantling his predecessor’s reforms through excessive executive orders … denying health coverage for poor children for tax cuts for the rich is not what we would expect of a compassionate society, and hopefully the story will end there and it will not happen,” she said.

Original Post: https://www.theguardian.com/us-news/2017/nov/09/ban-ki-moon-us-universal-healthcare

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By Michael Lighty, Director of Public Policy, National Nurses United.

The announcement by the CEO’s from JP Morgan Chase, Amazon and Berkshire-Hathaway that they are forming a new healthcare company signals the symbolic end of the ACA-reform era. They recognize the inefficiencies and profiteering of the private insurance companies, who add no value to businesses dealing with healthcare. And should there be any doubt that the end of the ACA is nigh, there’s this from Trump: “We repealed the core of disastrous Obamacare. The individual mandate is now gone.”

Given the record of the CEO-in-chief who now occupies the White House, it’s doubtful we can expect improved healthcare, or lower costs, under his leadership, which should give us pause before putting CEOs in charge of our health.

If the ACA had fulfilled its promises, a new company by these CEOs would not be needed. The ACA sought to lower costs by forcing consumers to put more “skin in the game,” in Obama’s Budget Director Peter Orzag’s infamous phrase. Yes, patients are spending more, and in 2017 insurance premiums went up over 25% in many areas, deductibles have continued to climb to an average of $1440 for employees in large groups, and drug prices have skyrocketed for long-standing medications like Insulin and newer specialty drugs like Harvoni for Hepatitis C. High-deductible plans and a steady shift so workers pay more for insurance (on average 30% of premiums that are $18,000/year) has not lowered overall costs. Even worse, patients who have paid high premiums are not able to get care because they cannot afford the out-of-pockets costs their expensive insurance does not cover.

Into the breach come the heroic CEOs Bezos, Dimond and Buffett (BDB*). What do they offer? A company that can control costs. How will they do it? With technology, of course. Apparently we have come full circle: since the government regulatory program couldn’t enact effective cost control and utilize technology to save money, let’s have a corporation do so. But it is precisely the industry model that has created our dysfunctional, “money is the metric” approach to health. In the present healthcare industry, the war for revenue between insurers, drug companies, and hospital corporations, along with medical equipment manufacturers and other suppliers, has raised prices and created immense profits. Electronic Medical Records, and other technological innovations are supposed to anchor the new healthcare system. They are expensive, in fact more expensive than any savings they generate. The result of the ACA push to pay for “performance” has been to punish clinicians and hospitals with high-needs patients, no lowering of costs, and increased denials of care since there is an incentive to avoid rather than treat patients who will lower your “performance” score.

Somebody or some entity is going to make the decisions regarding the healthcare we get. Do we really believe CEO’s rather than clinicians should make those decisions? If the decisions are based on corporate bottom lines we can expect continued cost shifts to workers, deployment of labor-displacing technologies with unproven impacts on patient care quality, and fragmentation as each corporate castle fortifies its strategic market position: Aetna-CVS will go toe-toe-toe with BDB* as the Ascension hospital corporation (nation’s largest) pushes back, for example. Since less care equals greater profits, and more covered lives means greater revenue, we can see that money will likely remain the metric.

Those who control capital, like the richest guy in the world, investment banks and investors, favor capital-intensive approaches to social problems. Technology fits that bill. Yet, technology only serves the purposes for which it is designed: it is neither socially neutral nor a panacea. Nurses know, however, that human health cannot be reduced to an algorithm, subject as it is to the particularities of an individual’s family history, environment and most fundamentally, socio-economic status. Let’s hope the technologists and CEOs quickly learn from direct care RNs. Standardization of treatments whether through algorithms, protocols, or budget-mandates do not match the needs of individual patients.

Alternatively, the US could expand and improve the current program that puts clinicians in charge, is popular, and works at controlling costs: Medicare. With administrative costs as low as 5–6% compared to the 13% or higher for private insurance, Medicare is more efficient. The growth in Medicare spending, around 2.4% annually, is much less than growth in overall healthcare spending and far less than recent premium increases. Under Improved Medicare for All, benefits would be expanded to include those that ACA, Medicaid and CHIP provide, and Medicare will negotiate prescription drug prices. The biggest shortfalls in Medicare, the escalating privatization pushed by the insurance-financed politicians that have resulted in higher out of pocket costs for seniors, over payments to the private Medicare Advantage plans and the “donut hole” in the private the prescription drug benefit, would be eliminated through a robust Medicare for all plan, such as proposed nationally in Sen. Bernie Sanders S 1804 bill or the California single payer bill SB 562.

Moreover, traditional Medicare enables physicians to deliver the care their patients need without onerous “gate-keeping,” prior authorizations or narrow networks that insurers use to restrict access, limit choice of providers and undermine the clinical judgment of doctors and nurses. In fact, since older Americans tend to be the most intensive users of health services, expanding the pool by including everybody especially low-needs patients will make the program more sustainable.

Should patients, workers and employers be on the hook for the excessive compensation and enormous profits of the health insurance industry? In California between 2011–16, insurers made $27 billion in profits/net income. Why should we subsidize the failed business model of health insurers? (Employers get $342 billion each year in tax subsidies to lessen the cost to them of private health insurance.)

On this BDB is right — health insurance companies add no value, and the profits in healthcare are obscene. That recognition matters and can point the way toward real reform. The solution is not more of the same. We must contain prices in order to control costs. An industry approach cannot do that and also place patient care at the center of a reformed system.

The post Meet the New Boss, Same as the Old Boss appeared first on Healthy California Campaign.

Revelations Sunday by CNN that Aetna’s former Southern California medical director admitted under oath that he never looked at patient records when deciding whether to approve or deny care highlights a widespread abuse in the insurance industry that can have catastrophic consequences for patients, said the California Nurses Association/National Nurses United today

The case, which only came to light following litigation about a denial of care, is hardly an isolated incident, notes CNA.

Just last week CNA reported new data its researchers had uncovered that documented that 60 percent to 80 percent of health insurance denials are reversed by independent medical review by the California Department of Managed Health Care.

“California can end this behavior and protect our families and neighbors by changing to a system based on patient need, as proposed by SB 562 which would guarantee coverage for everyone and eliminate premiums, deductibles, and insurance denials. The Assembly should act on the bill now,” said CNA Co-President Deborah Burger, RN.

“Denials of care are increasingly common, with insurers creating a variety of pretexts which all amount to nothing more than the insurance company doesn’t want to pay for needed care, regardless of how much suffering it causes a patient,” said Burger.

In 2016 alone, the most recent year for which there is data:

• 60 percent of cases insurers denied as “not medically necessary” were either overturned by CDMCH independent medical review or ultimately reversed by the insurer.
• 80 percent of cases insurers denied as “experimental” or “investigational” were overturned or reversed by the insurer.
• 52 percent of cases where insurers refused to authorize payment for emergency or urgent care provided to a patient were overturned or reversed by the insurer.

Aetna is a prime example, says CNA. Of the cases that went to independent medical review in 2016, Aetna denials were upheld only 40 percent of the time.

“Everything about the case reported by CNN is a reminder why we need SB 562 – from the admission that Aetna’s former medical director to the case itself, in which a young patient was denied critical care, said Burger.

For years, California insurers were required to report total numbers of claims denials, until CNA researchers uncovered that data and published findings that from 2002 through 2010, the state’s largest insurance companies denied 26 percent of all claims. The state stopped publishing that data after it was widely reported in the media.

But while that data is no longer publicly reported, the independent medical review data is. The process is triggered after the insurer has denied a specific medical treatment, diagnostic test, or referral to a specialist, or a certain prescription medication.

In most cases, members must first file a grievance with their insurer and allow 30 days for it to be processed before filing for an independent medical review. Yet, grievance systems are rife with abuse, says CNA, such as failure to establish a grievance system, failure to respond to patients in a timely manner, and similar violations. For the largest insurers, those with more than 400,000 enrollees, 64 percent of violations with monetary penalties were related to the insurer’s improper grievance process.

“If anything, claims denials are actually under reported,” notes Burger. “It’s deliberately an arduous, burdensome process, buried in insurance fine print so that many patients are either unaware that they can appeal a care denial, or get so frustrated by the lengthy delay and bureaucracy that they stop fighting. That’s the disgraceful game that insurance companies play with people’s lives,” Burger said.

The post Dramatic Aetna Admission a Window Into Widespread Abuse of Patients in Insurance Claims Denials Say RNs appeared first on Healthy California Campaign.

I am a retired registered nurse who worked for 40 years in acute care hospitals. I watched all those years as our health care system morphed into the heath insurance for profit system now in place, which is a disgrace and denies health care access to millions of people, and which often results in death and/or needless stress and suffering.

I wish people understood that the California single payer health care bill now being discussed by many is not complete because the Assembly refuses to do the work of completing it. It is their job and why they were elected. The financing mechanism is their responsibility to study, discuss, and amend to include the needed finance piece. It was intended to work that way. This bill was never moved through one Assembly committee. Upon arriving in the California Assembly, after a positive vote in the California Senate, it was immediately shelved with the intention of killing it … on purpose. Why? Easy answer… follow the money. Look at who those corporate Assembly members obstructing this bill have as big donors. It is the health insurance industry, the pharmaceutical industry, and the entities who benefit from the dysfunctional status quo. I suggest everyone who keeps blaming the bill become educated about this rotten group of self-serving legislators. Stop regurgitating the disingenuous words of those same legislators who are the obstructionists and the recipients of many campaign donation dollars from those who oppose a single payer system.

Kathryn Donahue, R.N., McKinleyville

Source: Times-Standard – Letters »

The post Single payer health care’s opponents are beholden appeared first on Healthy California Campaign.

By Paul Y. Song, MD

As the sun begins to set on California’s two-year legislative session, it will officially signal the death of the Healthy California Act better known as SB562. After Assembly Speaker Anthony Rendon called SB562 “woefully incomplete” and banished it into legislative purgatory, it became quite obvious when none of its original co-sponsors or any other elected official emerged to fight on its behalf, that this would be its ultimate fate.

For all the “woefully incomplete” arguments made against 562 of it not having a funding mechanism, being dependent on federal waivers, and costing too much, Sacramento needs to explain its own hypocrisy. Why did the same assembly take up AB 1184 without providing any funding mechanism? Why did Sacramento rubber stamp Governor Brown’s fiscally irresponsible and grossly over-budget bullet train project and initiate construction without the guaranteed federal dollars and waivers that are desperately needed to complete it? How can Sacramento continue to call SB562 too expensive while ignoring the fact that our state already spends $368 Billion a year on healthcare of which 71 cents is already paid for by California taxpayers? And how can Sacramento continue to ignore and fail to address State Controller Betty Yee’s latest report of a $91.5 Billion unfunded healthcare retiree liability which increased $14 Billion from the year before, or our states’ $24 Billion annual school retiree healthcare liability?

Despite the empty talk by elected officials of being open to single payer, what was “woefully incomplete” in Sacramento was their political will. When the original Cap and Trade Bill (AB 398) died in the California Assembly, it was only through the sheer political will of the Governor, Speaker, and Senate Pro Temp to carry out a “gut and amend” which led to its ultimate passage. Sadly SB562 was not fortunate enough to be offered an honest legislative effort to address legitimate criticisms and concerns or be afforded a similar fate.

As bold as California has been on so many issues, Sacramento has failed to seize this opportunity to lead on real healthcare justice, and would like nothing more than for this movement to dissolve so they can get back to preserving the coporate status quo. They incorrectly assume that like prior single payer efforts, which fizzled without any political retribution from the electorate, that they can continue to ignore the will of their constituents and the harm and frustration many Californians face each day from our existing dysfunctional healthcare system. But, this healthcare movement is very different than before and is only growing stronger and at a far faster rate than insurance premiums.

While Sacramento sweeps SB562 under its legislative rug, it cannot hide from the following facts:

California’s Medicaid system, which currently covers roughly one-out-of-three Californians, remains extremely vulnerable to a heartless Congress hell bent on greatly reducing its Federal funding obligation.

Nearly 3 million Californians, including 250K kids remain uninsured.

With no insurance rate regulation, insurance premiums in CA have increased approximately 250% since 2002, while inflation has gone up 40% and wages for most Californians have remained stagnant. It is no wonder that the number of people who have difficulty paying their monthly premiums has increased from 27% to 37% in 2015 to 2017. Meanwhile, 53% of Californians worry they cannot pay their medical bill if they get sick, and 60% report that it is too difficult for them to afford healthcare in general.

For those who continually confuse universal coverage with actual access to care, they fail to grasp the prevlance of underinsurance. The number of people who report having difficulty with deductibles has increased from 34 to 43% during the last two years. And 44% of people with high deductible expenses will actually delay seeking care.

Coupled with the fact that 37% of people WITH insurance who had medical problems reported borrowing money from family and friends, 34% reported being unable to pay for food or rent, 63% used up all their savings, and 28% recently had a medical bill turned over to an agency, more Americans are afraid of paying for care than they are of getting seriously ill.

And for all the success of Covered California relative to the rest of the US, premiums will go up another 9% this year while 66,000 Californians will only have access to one plan and 216,000 will have access to just two. At the same time, 75% of all Covered California plans continue to have narrow networks.

While there is no perfect healthcare system, most agnostic experts agree that a single payer system, unlike our current system that continually increases cost while decreasing access to care, would indeed save money while increasing coverage and overall access.

As SB562 dies a cowardice death, rather than become dejected or disillusioned, activists should find great solace in what was accomplished. For the first time we had an unprecedented collection of new and lifelong activists of all ages, nationalities, religions, vocations, and socioeconomic groups, come together to demand something far better. This translated into advocacy, organizing, and canvassing in every single assembly district in California and has forever elevated single payer into the public consciousness. In the process, it has ultimately helped both statewide and federal efforts.

Recent attempts to have single payer removed from the California Democratic Party platform were soundly defeated, and due to an overwhelming groundswell of support created by SB562, Kamala Harris listened to the majority of her constituents and was emboldened to be the very first US Senator to co-sponsor Senator Bernie Sanders Medicare-for-all bill S.1804.

With a sustained majority of Americans supporting a single payer Medicare-for-all plan and 74% among Democrats, it has even become a litmus test in most democratic primaries. And in fact, a new Health Tracking Poll by the Kaiser Family Foundation now finds that three-quarters of voters say that a single government plan or Medicare-for-all should be considered, is very important, or the single most important factor in the upcoming election.

So rather than hide from it or view it as a political liability, more elected officials are boldly embracing it and more candidates are proudly running as Medicare-for-all candidates. For the very first time, we now have a Medicare-for-all congressional caucus with 72 members along with 123 co-sponsors of HR676 (the House Medicare-for-all bill), and one-third of Democratic senators who support S.1804 .

Still, many view corporate Democrats, not Republicans, as the real obstacle to making this a reality. Max Fine, who helped to create Medicare as a member of John F. Kennedy’s Medicare task force recalls how Democrats moved away from Ted Kennedy’s bill to cover all Americans with government health insurance towards a private insurance solution with absolutely no interest in Medicare-for-all. Fine went on to say “Single payer is the only answer and some day I believe the Republicans will leap ahead of Democrats and lead in its enactment, just as Bismarck in Germany and David Lloyd George and Churchill in the UK.” In fact, some Republicans have already begun to make the case for single payer and even question if our current profligate spending on health care is a conservative value.

For those in Sacramento and beyond who behave like climate change deniers when it comes to healthcare, it is simply getting harder for them to continue to justify a broken and unsustainable system.

But due to the obscene financial resources that are spent by the for-profit medical-industrial-complex (led by the pharmaceutical and insurance industries) to buy our elected officials, relentless organizing and electoral pressure is the only way we will ever break this vicious hold.

To my fellow activists, now is not the time to let up. If anything, we must utilize the organizing success created by SB562 to serve as an unbreakable foundation from which to continue to educate, advocate, mobilize, and eventually translate into undeniable political capital both in Sacramento and D.C.

And if our next Governor is truly commited to keeping California fifth largest economy golden, it would be wise to acknowledge the tremendous burden healthcare costs place on employers and employees alike. As businesses spend more and more on healthcare for their employees and less on wages, capital improvements, and R&D, their employees have begun to feel the brunt as well. In 2018, the average worker will contribute $4200 towards their employer sponsored plan. It is no wonder that Charlie Munger has referred to our “cockamamie” current system as the “tapeworm of American competitiveness”.

We must do everything to ensure that our next Governor’s previously stated commitment towards single payer is not “woefully incomplete”. And we must do everything we can to ensure that each of our state and congressional representatives (especially Democrats) come to support single payer as well.

And as the Centers for Medicare and Medicaid Services Administrator, Seema Verma, has repeatedly labeled single payer as “socialized medicine” and vowed to reject any state waivers for such a plan, it is one more reason for us to do everything we can to wake up and mobilize an apathetic electorate to end this presidential reign of horror.

The harm that countless Californians and Americans face each day at the hands of our broken and immoral system is sadly not going away and neither are we. Sacramento may be able to ignore it, but we simply cannot.

Like our nation’s evolution on marriage equality that had a dramatic sea change in less than a decade, a similar sea change is happening with regard to single payer. So keep up the fight and continue to make your voices heard while spreading the single payer gospel.

We are on the right side, the moral side, and ultimately the winning side.

For more information log on to www.pnhp.org

Original Post: https://medium.com/@paulysong/why-the-healthcare-justice-movement-is-just-getting-started-in-california-and-beyond-adbf6c8025cd

The post Why the Healthcare Justice Movement is Just Getting Started in California and Beyond. appeared first on Healthy California Campaign.