NOT DEAD YET

The California Senate passed a bill to create a single-payor health system, less than a week after a special election in Massachusetts cost Senate Democrats' the 60-vote majority they needed to pass federal health reform legislation.

Although Gov. Arnold Schwarzenegger has promised to veto the California bill, it could signal a change in the health reform debate, as proponents of health reform get frustrated with the national stage and move efforts to the states.

What happens to proposal now? The California Senate passed the bill by 22-14, with all but one Democrat and no Republicans voting for it. It now goes to the state Assembly, which has passed previous California single-payor bills, then to Gov. Schwarzenegger, who vetoed the previous bills. If passed, the bill would authorize $1million to establish a commission to decide how to pay for the system.

How does this relate to national health reform? Democratic State Sen. Mark Leno, the author of the bill, said voters came to dislike Congress' compromise health reform legislation. "Whatever comes out of Washington is much less certain, which only gives greater incentive for leadership coming from state legislators because somehow, some way, health care reform must be addressed," Mr. Leno told the Huffington Post.

What do Californians think? Mr. Leno points to past polls that have shown support for a state-run plan. A new poll by the Public Policy Institute of California finds that 74 percent of Californians believe the state is headed in the wrong direction. This could be interpreted as a call for radical change or anger at current legislators, the people who passed this bill.

What do opponents think? "What a bizarre place I work in," wrote Republican State Sen. Sam Aanestad, an oral surgeon, in the New American. Following the Massachusetts defeat, "Democrats who control the State Legislature in California revived their own universal healthcare bill. Didn't they get the message I did?"

How might other states react? With the prospect of the Congress' health reform bill failing, the health reform debate may now move to the states. Massachusetts has already enacted universal healthcare. Illinois, Oregon and Massachusetts have flirted with single-payor systems in state legislation and referendums, but all have failed so far.

Could it have a polarizing effect? There already is a wide gap between passionate proponents of a single-payor system, such as Physicians for a National Health Program, and opponents of government intervention in healthcare. Positions could harden if the federal health reform bill, which was supposed to bridge the divide, is not passed.

What exactly is a single-payor system? It involves creating a government-run or financed plan open to everyone. It may or may not be linked with elimination of private insurance and government-run health facilities. Canada and several European nations have various kinds of single-payor systems.

How would it affect physicians and hospitals? "I cannot support an under-funded program that would leave patients with far fewer options for care than they have today," Dr. Aanestad stated. The concerns are that a single-payor system could drive reimbursements down to Medicare levels and lead to waiting lines for certain services, as occurs in the Canadian system. Some U.S. physicians are already bailing out of Medicare, the U.S. single-payor system for the elderly, because it pays too little. But others argue that a single payor would be a boon for healthcare, providing a massive infusion of new paying patients and improving health status by detecting diseases earlier.

Could it reduce insurance premiums? Paul Krugman, a New York Times columnist who supports a single-payor system, has argued the arrangement could curb premium growth by eliminating the costs of insurer-middlemen and by extending coverage to healthy people who are less costly to the system.

Would it add to California's budget deficit? The state faces a $20 billion deficit. The California Legislative Analysts Office said the single-payer proposal would cost $200 billion, or more than $5,000 in new taxes for every Californian. But Sen. Leno argued that Californians already pay $200 billion for their healthcare through premiums and other funding. He said the system could be funded through a payroll tax, existing state and federal funding and increased efficiencies by eliminating the insurer-middleman.

Possible removal of anti trust exemption for insurance industry

Last night before President Obama's State of the Union Address, I heard a newscaster say that the Speaker of the House was considering giving up the massive health care reform bill in favor of pursuing passage of small, separate pieces of the larger reform agenda. As an example, she pointed to the anti trust exemption enjoyed by the insurance industry for several decades.

If this is accurate information, WE THE PEOPLE will be the beneficiaries. This small reform item is very large in the overall "big picture" because insurance companies will no longer be able to fix prices (both insurance policies and reimbursement to providers) and will have to act independently. This will lead to competition amongst the insurance companies for policy holders and provider contractors resulting in driving prices down while increasing access to more providers since the health insurance companies will no longer desire to exclude providers from their networks.

Contact your Senators and Representatives and let them know you want the anti trust exemption that protects the insurance industry REMOVED. We all can help accomplish Health Care Now by letting our elected officials know how we feel about the unfair advantage insurance companies have in the market place, and their abusive tactics towards policy holders and providers.

US Supreme Court legalizes prostitution.

The US Supreme Court has validated what I have been screaming about in this blog since August. The court's decision this morning allows unlimited corporation campaign contributions. The worst part is WE THE PEOPLE ARE PAYING FOR IT. Every time you pick up a prescription, every time you make a bank deposit, every time you put gas in your car or heat your home, every time you eat a piece of meat or drink a glass of milk, every time you make an insurance premium payment, you are paying for lobbyists to keep corporate america powerful and protected by the US Government.

Every legislator and elected executive at every level receives campaign contributions from corporations. After today's Supreme Court decision, politicians can receive unlimited funds from the highest bidder. Prostitution is now overtly LEGAL. Our purchases add to the corpus of $$$ available to buy politicians. It has come to a point that the only solution may be revolution.

We are engaged in two wars. Our our economy is NOT improving. The jobless rate continues to increase. The homeless rate continues to increase. Financial assistance to people suffering from international disasters (earthquakes) gets priority over help for our own homeless and jobless. NO HEALTHCARE REFORM. Insurance industry protected by anti trust exemption. Gutless Presidential leadership and worthless congressional leadership. And today the US Supreme Court decision to allow corporations to buy our politicians with unlimited campaign contributions. I doubt very seriously that our founding fathers had unlimited campaign contributions in mind when constructing our Constitution.

South of France is looking very good these days.

Real Health Care Reform NO longer possible

Neither the House or Senate bill provide REAL reform. Real reform would
require:

1) removal of the anti trust exemption for insurance companies

2) limits on policy pricing in exchange for up to 45,000,000 new customers

3) No refusal of insurance for pre existing conditions

4) No cancellation of policies when a policy holder contracts a
catastrophic illness

5) A public option to ensure competition that will drive health care
costs DOWN

Pretty simple and doesn't require 2000 pages of unnecessary language!

I was a staunch supporter of Obama and health care reform until Obama showed he has no balls and the congress showed they are worthless. I hope they all get replaced in their next election. Obama is the biggest political disappointment since I started to vote over 42 years ago.

Democrats Negotiate Healthcare Legislation, Plan to Submit for Cost Estimate Early Next Week

Written by Lindsey Dunn | January 14, 2010

More Key Congressional Democrats, along with Pres. Obama, held a nearly day-long session yesterday to negotiate a joint healthcare reform legislation package with the aim of submitting a final plan to the Congressional Budget Office early next week. Negotiations are expected to continue today.

In a joint statement, Pres. Obama, House Speaker Nancy Pelosi (D-Calif.) and Senate Majority Leader Harry Reid (D-Nev.) said the group had made "significant progress in bridging the remaining gaps between the two health insurance reform bills."

Key issues within the plan that continue to require debate, as outlined by the Washington Post and the Wall Street Journal include:

Value of subsidies provided to low-to-middle-income Americans to obtain coverage (Both the House and Senate bills contain provisions that would provide subsidies to Americans with incomes up to 400 percent of the federal poverty level, but the value of such subsidies is unclear);
Insurance plan value with which to begin "Cadillac" tax on high-cost health plans (The House bill would begin taxing on plans that are valued at or above $23,000 for a family, though the Washington Post report this may be increased to $25,000 after negotiations);
Structure of a mandate that would require employers to offer insurance coverage to employees (House bill currently requires employers with payrolls greater than $500,000to offer coverage, while the Senate bill would impose a penalty on employers with more than 50 employees that do not offer coverage);
Whether an insurance exchange would be run by states or the federal government (Both the House and Senate bills would offer exchanges for Americans that do not qualify for coverage through an employer or a public program); and
Overall funding for the bill (Both House and Senate bills offer slightly differing proposals for funding, including taxes on high-income Americans, taxes on high-cost health plans, taxes on medical devices, reductions in Medicare expenditure growth and annual fees for health insurance companies).
Although the kinks are still being worked out, current estimates place the cost of the legislation, which would extend healthcare coverage to 36 million Americans at approximately $900 billion.

CBO analysis is expected to take at least a week, making it unlikely that the bill would be pushed through both the House and Senate and on to Pres. Obama before his State of the Union address planned for early February, according to the Washington Post.

Republicans vow they will continue work to block the legislation. House Minority Leader Johan Boehner (R-Ohio) told fellow Republicans that they could still "beat the bill," according to the Washington Post.

Read the Washington Post's report on healthcare reform legislation.

Read the Wall Street Journal's report on healthcare reform legislation.

Senate Health Care Bill must be DEFEATED

Nation’s Largest RN Organization Says Healthcare Bill Cedes Too Much to Insurance Industry
By National Nurses United

December 21, 2009

The 150,000 member National Nurses United, the nation’s largest union and professional organization of registered nurses in the U.S., today criticized the healthcare bill now advancing in the U.S. Senate saying it is deeply flawed and grants too much power to the giant insurers.

“It is tragic to see the promise from Washington this year for genuine, comprehensive reform ground down to a seriously flawed bill that could actually exacerbate the healthcare crisis and financial insecurity for American families, and that cedes far too much additional power to the tyranny of a callous insurance industry,” said NNU co-president Karen Higgins, RN.

NNU Co-president Deborah Burger, RN challenged arguments of legislation proponents that the bill should still be passed because of expanded coverage, new regulations on insurers, and the hope that it will be improved in the House-Senate conference committee or future years.

“Those wishful statements ignore the reality that much of the expanded coverage is based on forced purchase of private insurance without effective controls on industry pricing practices or real competition and gaping loopholes in the insurance reforms,” said Burger.

Further, said NNU Co-president Jean Ross, RN, “the bill seems more likely to be eroded, not improved, in future years due to the unchecked influence of the healthcare industry lobbyists and the lessons of this year in which all the compromises have been made to the right.”

“Sadly, we have ended up with legislation that fails to meet the test of true healthcare reform, guaranteeing high quality, cost effective care for all Americans, and instead are further locking into place a system that entrenches the chokehold of the profit-making insurance giants on our health. If this bill passes, the industry will become more powerful and could be beyond the reach of reform for generations,” Higgins said.

NNU cited ten significant problems in the legislation, noting many of the same flaws also exist in the House version and are likely to remain in the bill that emerges from the House-Senate reconciliation process:

The individual mandate forcing all those without coverage to buy private insurance, with insufficient cost controls on skyrocketing premiums and other insurance costs.


No challenge to insurance company monopolies, especially in the top 94 metropolitan areas where one or two companies dominate, severely limiting choice and competition.


An affordability mirage. Congressional Budget Office estimates say a family of four with a household income of $54,000 would be expected to pay 17 percent of their income, $9,000, on healthcare exposing too many families to grave financial risk.


The excise tax on comprehensive insurance plans which will encourage employers to reduce benefits, shift more costs to employees, promote proliferation of high-deductible plans, and lead to more self-rationing of care and medical bankruptcies, especially as more plans are subject to the tax every year due to the lack of adequate price controls. A Towers-Perrin survey in September found 30 percent of employers said they would reduce employment if their health costs go up, 86 percent said they’d pass the higher costs to their employees.


Major loopholes in the insurance reforms that promise bans on exclusion for pre-existing conditions, and no cancellations for sickness. The loopholes include:



Provisions permitting insurers and companies to more than double charges to employees who fail “wellness” programs because they have diabetes, high blood pressure, high cholesterol readings, or other medical conditions.
Insurers are permitted to sell policies “across state lines”, exempting patient protections passed in other states. Insurers will thus set up in the least regulated states in a race to the bottom threatening public protections won by consumers in various states.
Insurers can charge four times more based on age plus more for certain conditions, and continue to use marketing techniques to cherry-pick healthier, less costly enrollees.
Insurers may continue to rescind policies for “fraud or intentional misrepresentation” – the main pretext insurance companies now use to cancel coverage.


Minimal oversight on insurance denials of care; a report by the California Nurses Association/NNOC in September found that six of California’s largest insurers have rejected more than one-fifth of all claims since 2002.


Inadequate limits on drug prices, especially after Senate rejection of an amendment, to protect a White House deal with pharmaceutical giants, allowing pharmacies and wholesalers to import lower-cost drugs.


New burdens for our public safety net. With a shortage of primary care physicians and a continuing fiscal crisis at the state and local level, public hospitals and clinics will be a dumping ground for those the private system doesn’t want.


Reduced reproductive rights for women.


No single standard of care. Our multi-tiered system remains with access to care still determined by ability to pay. Nothing changes in basic structure of the system; healthcare remains a privilege, not a right.
“Desperation to pass a bill, regardless of its flaws, has made the White House and Congress subject to the worst political extortion and new, crippling concessions every day,” Burger said.

“NNU and nurses will continue to work with the thousands of grassroots activists across the nation to campaign for the best reform, which would be to expand Medicare to cover everyone, the same type of system working more effectively in every other industrial country. The day of that reform will come,” said Ross.

United Health Care profits soar 155 percent on Medicare

United Health Care profits soar 155 percent on Medicare plans
By Jerry Mazza
Online Journal Associate Editor

Sep 25, 2009
United Health Care’s 155 percent profits on Medicare plans must be a company record, especially in a down economy, and an embarrassing fact, particularly as the concervatives on the Senate Finance Committee fight to preserve the present payment structure of United Health Care and its fellow private insurance companies.

Private insurance plans in Medicare cost up to 19 percent more than it would cost to care for the same people in the public Medicare program. But then, we know whose pockets the Republicans and Blue Dog Democrats are really stuffing.

And never mind, as the Medicare Rights Center points out, “Private plans came into the Medicare program with the claims that they could save taxpayers money.” Right and I’ve got a bridge in Brooklyn I can let you have for cheap. The fact is, “they [the Private Plans] cost between 12 percent and 19 percent more per person than the public Medicare program, amounting to $5 billion per year in over-fattened costs to taxpayers.”

I guess this must be the advantage in the Medicare Advantage plans, only it’s for United Health Care and friends not the USA and its taxpayers. In fact, as Families USA reported, “Overpayments to Medicare Advantage plans and those regional PPOs could easily cost more than $60 billion over the next 10 years . . .” Hey, piece of cake, right?

And as Families USA noted, “As part of the 2003 Medicare Modernization Act, Congress has substantially increased payments to Medicare Advantage plans. They’re overpaid in comparison to traditional Medicare.” Modernization, you understand, means privatization here, thanks to George Bush and now Barack Obama and Congress, God love them if she can.

For instance, in 2005, Medicare overpaid private plans by at least 7 percent per beneficiary. And you, Mr. and Mrs. Taxpayer, lost $2.7 billion in 2005 to private Medicare Advantage plans and their parent insurance companies. Then, in 2006, under a new payment formula [woo, woo], overpayments to plans were 11 percent per beneficiary (that is, after accounting for health care status). And now in 2009, up in the 19 percent range. Nothing like HMOs and PPOs saving us money.

See, they keep telling innocent seniors that they will suffer (even more) if they lose their Medicare Advantage plans. Don’t believe it, folks. Medicare Advantage plans can hurt people with Medicare. Two studies found that people could end up actually paying higher out-of-pocket costs in a private plan than in straight Medicare, or in one private plan over another. I mean, the minute you let those dogs in, they’re gonna bite you, not protect you.

A study by MedPac found that a share of Medicare private health plans have high cost-sharing for “nondiscretionary” services such as chemotherapy. Like say, looking at some of the costs for a 70-yer old male with advanced colon cancer, the study showed out-of-pocket charges of $7,100 for one plan, $6,500 for a second plan and $1,900 for a third plane. You’re rolling the dice for your life with all this razzle dazzle. So, buyer beware!

Another study, by the nonpartisan [could that be] Commonwealth Fund found that out-of-pocket costs for private health plan members vary widely not only by your plan benefit package but by your health status. The report says that costs for plan members in poor health are actually higher than public Medicare in 19 out of the 88 private Medicare Advantage (MA) plans looked at. “Despite the high payments, relative to fee-for-service [public Medicare] costs, that MA plans receive from Medicare to enrich enrollee benefits, these plans may not always be a good deal for sicker beneficiaries who use more health services.”

A little bit of backstory

Medicare, the federal health insurance program for people over the age of 65 and those with severe disabilities, contracts with private health insurance plans that compete with the public Medicare program for membership. So, you have a choice, and I would recommend staying away from the “Advantages.” You’re somewhat better off with the Medigap programs that simply fill in the holes, like co-pays, yearly deductibles, and allow you to go to whatever doctor you want to.

That said, according to the Kaiser Family foundation, here is a quick look at private plans in Medicare through 2006 . . .

“As the private market for health insurance has evolved, Medicare has been modified so that beneficiaries can elect to get their Medicare benefits through a qualified private plan rather than the traditional fee-for-service Medicare program. Authorized in 1982, the Medicare risk-contracting program provided for enrollment in health maintenance organizations (HMOs).

“In 1997, Congress expanded private plan authority to include preferred provider organizations (PPOs), provider-sponsored organizations (PSOs), and private fee-for-service (PFFS) plans as the Medicare risk-contracting program was absorbed into Medicare+Choice (M+C). The Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA) replaced M+C with the Medicare Advantage (MA) program in 2004, raising payment rates and making other changes in anticipation of the Medicare drug benefit in 2006.”

So you can see for yourself how the cats were let in the door under the guise of “modernization,” “improvement” and so on. Take note that the name changes for the private health plans went through as they contracted with Medicare. “Medicare risk-contracting program,” not so appetizing, became “Medicare+Choice,” tastier, to “Medicare Advantage.” Delicious! Now gimme some of that. I want my advantage.

Yeah, well, it’s time to put back the advantage where it belongs, in the hands of the folks with Medicare, not in the coffers of the fat cat insurance companies. Let Medicare plans compete if they want, say, even if we descend to a public option if or if . . . who knows . . . to rampant socialism . . . and a Single-Payer (America-Care as one writer proposed), if they dare. Yea! Though be prepared for some kind of goulash, with a little bit of this and little bit of that and a lot of it all for the private sector.

Jerry Mazza is a freelance writer living in New York City. Reach him at gvmaz@verizon.net. His new book, “State Of Shock: Poems from 9/11 on” is available at www.jerrymazza.com, Amazon or Barnesandnoble.com.

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