From wmjwj at wmjwj.org Mon Oct 3 14:33:29 2011 From: wmjwj at wmjwj.org (WMass Jobs with Justice) Date: Mon, 3 Oct 2011 14:33:29 -0400 Subject: [Health Care Action] Verizon leafleting this week Message-ID: <061701cc81fa$f4873310$dd959930$@org> Will you Be There to leaflet about Verizon and corporate greed on Wednesday October 5 & Saturday October 8? We leaflet regularly at the door at 360 Russell St, Hadley , 1123 Riverdale St, West Springfield , 1420 Boston Rd, Springfield , & 555 Hubbard Ave, Pittsfield . This week's schedule: Wednesday, noon to 2pm, at the Hadley store: Please let Ryan Quinn know you are coming: rep at geouaw.org, 413-545-0705. Graduate Employees Organization/UAW 2324 has adopted this shift. Wednesday, 5 to 7pm, at the Hadley store: Please let Jon Weissman know you are coming: jon at wmjwj.org, 413-827-0301. Wednesday, 5 to 7pm, at the Springfield store: Please let Kathy Collins know you are coming: kathy7157 at hotmail.com, 413-734-0863. Wednesday, 5 to 7pm, at the West Springfield store: Please let Patrick Burke know you are coming: patrick at wmjwj.org, 413-454-5692. Saturday, Noon to 2pm, at the Hadley store: Please let Jon Weissman know you are coming: jon at wmjwj.org, 413-827-0301. Saturday, 11am to 1pm, at the Pittsfield store: Please let Brian Morrison know you are coming: brian.morrison at state.ma.us, 413-281-3223. Berkshire Central Labor Council has adopted this shift. Saturday, Noon to 2pm,, at the Springfield store: Please let Kathy Collins know you are coming: kathy7157 at hotmail.com, 413-734-0863. Saturday, Noon to 2pm, at the West Springfield store: Please let Patrick Burke know you are coming: patrick at wmjwj.org, 413-454-5692. Join us! Please wear your organization's apparel and/or a red shirt, as the strikers did. Western Mass. Jobs with Justice will provide leaflets. It is important to point out that we are leafleting not picketing! Since the workers are not currently on strike, a picket would not be lawful. Instead, we are passing out flyers in front of Verizon stores and to customers of other stores nearby. If it looks like rain, we will make the decision to call it off by 9am and let you know by email. We can send the email to your cell phone as a text message if you send your number and name of carrier to wmjwj at wmjwj.org. You can call the "store captains" listed above to be sure, but it's better if you tell us in advance that you're coming and we'll call you. When we call off a leafleting shift, the captains will be there at the beginning to tell anyone who did not get the message, but we'll only wait 15 minutes. If this email was forwarded or copied to you, be sure to keep up-to-date on workers' rights campaigns by subscribing to the Workers' Rights List. To subscribe, send a blank email to workersrights-subscribe at lists.prometheuslabor.com or go to http://lists.wmjwj.org/mailman/listinfo/workersrights. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Jon Weissman, Coordinator Western Mass Jobs with Justice 640 Page Blvd #101 Springfield MA 01104 (413) 827-0301 Founded in 1987, Jobs with Justice's mission is to improve working people's standard of living, fight for job security, and protect workers' right to organize. We believe workers' rights are human rights and to be successful, we have to be part of a larger campaign for economic and social justice. To that end, "J with J" has created a national coalition and a network of local coalitions that connect labor, community, student, and faith-based organizations and activists on workplace and community social justice campaigns. Western Mass JwJ - founded June 5, 1993 - is now a coalition of almost 70 organizations. Let's keep in touch - please check out our mailing lists at http://wmjwj.org/our-lists. -------------- next part -------------- An HTML attachment was scrubbed... URL: From don at mccanne.org Mon Oct 3 15:44:26 2011 From: don at mccanne.org (Don McCanne) Date: Mon, 3 Oct 2011 12:44:26 -0700 Subject: [Health Care Action] qotd: Private Medicare plans shockingly game risk adjustment Message-ID: The National Bureau of Economic Research NBER Digest OnLine September 2011 The Consequences of Risk Adjustment in the Medicare Advantage Program Since the 1980s, people eligible for Medicare have been able to choose between the regular fee-for-service plan, under which the federal government pays a set fee to health care providers for each service provided, and Medicare Advantage (MA), whereby the government pays private health plans a fee for each individual they enroll. Almost one quarter of Medicare beneficiaries are currently enrolled in Medicare Advantage plans. Paying the same amount for every person enrolled in a health plan encourages plans to enroll low-cost people and to avoid high-cost ones. Because of this, the federal government historically overpaid for MA enrollees relative to their costs in traditional Medicare. So, in 2004 the Medicare program began to adjust its payments to private plans for enrollees health status. As a result, a plan would, for example, receive a higher "risk-adjusted" payment for a recipient with diabetes or heart disease than for an otherwise identical person without these conditions. In "How Does Risk Selection Respond to Risk Adjustment? Evidence for the Medicare Advantage Program" (NBER Working Paper No. 16977), Jason Brown, Mark Duggan, Ilyana Kuziemko, and William Wollston study individual-level data for 55,000 people in the Medicare Current Beneficiary Survey (MCBS) from the period 1994 to 2006. Prior to risk adjustment, insurers simply had an incentive to enroll individuals with low costs. After risk adjustment, insurers instead had an incentive to enroll individuals with low costs conditional on their medical conditions. The main reason for this is that the risk adjustment formula pays the plans the average cost of the average person in a particular risk category. The authors demonstrate that, because individuals with less costly cases of diabetes and other health conditions enrolled in MA plans after the move to risk adjustment, overpayments to these plans actually increased. The risk adjustment formula that is used also explains only 11 percent of an individual's fee-for-service costs in the year after risk is assessed. The formula systematically over-predicts costs for those with below average costs, and systematically under-predicts costs for those with above average costs. The authors find that individuals who are more expensive than the average person to insure are less likely to enroll in Medicare Advantage plans. So on balance, the government ends up paying the average cost for people who, had they stayed in fee-for-service Medicare, would have cost the government much less. Before risk-adjustment began in 2004, switching from fee-for-service Medicare to Medicare Advantage increased average individual Medicare spending by $1,800. The authors calculate that using risk adjustment formulas on the population that enrolled before 2004 would have reduced Medicare Advantage overpayments by more than $800 a person. But when the reimbursement formula changed, so did the pattern of enrollment in Medicare Advantage plans. After 2004, switching from fee-for-service to Medicare Advantage increased Medicare spending by approximately $3,000 per person. Thus the shift to risk adjustment actually increased Medicare spending. Although Medicare Advantage plans did enroll people with higher "risk scores" after risk adjustment was instituted, those people still tended to be significantly below the average cost in their risk category. Furthermore, both before and after risk adjustment, MA enrollees in poor health expressed greater dissatisfaction with their medical care relative to their counterparts in traditional Medicare. This pattern suggests that MA plans invest more resources in their relatively healthy enrollees, perhaps to differentially retain them. Thus the authors conclude that the Medicare Advantage program both increased total Medicare spending and transferred Medicare resources from the relatively sick to the relatively healthy, and that risk-adjustment was not able to address either of these problems. http://www.nber.org/digest/sep11/w16977.html And... NBER Working Paper No. 16977 April 2011 How does Risk Selection Respond to Risk Adjustment? Evidence from the Medicare Advantage Program By Jason Brown, Mark Duggan, Ilyana Kuziemko, William Woolston We close by returning to the potential distributional consequences of our results. Regardless of how the surplus described above is split, the MA program appears to expand the cost of Medicare while also transferring relative expenditures from the FFS population toward the financing of care for the MA population. As those switching into MA have, throughout the sample period, lower baseline costs and better self-reported health than do those remaining in FFS, the MA program transfers Medicare expenditure to those who likely have less need for it. Moreover, as we show in Section 7, the gradient of satisfaction with one's health care is a more positive function of self-reported health for MA enrollees than FFS enrollees, consistent with MA plans treating their healthier (and thus more profitable) enrollees better so as to differentially retain them. Indeed, exit rates out of MA plans are differentially higher among those in poor health. Therefore, the MA program appears not only to transfer aggregate Medicare expenditures from the relatively higher-cost FFS population to the relatively lower-cost MA population, but it seems to effect a similar transfer within the MA population. These results suggest that governments may wish to take special care in "contracting out" social insurance. Imperfect pricing - whereby the government overpays a private firm relative to the cost and quality of in-house production - is, of course, a potential concern every time governments contract with a private party and has received great attention in the literature (see, for example, Hart et al. 1997). In the case of, say, paving a road, the consequences of imperfect pricing would seem limited to whatever amount the government overpaid. With social insurance programs, however, imperfect pricing can induce private firms to cream-skim, exacerbating the utility consequences of the underlying inequality the program was initially intended to mitigate. At least in the case of Medicare, we find little evidence that risk adjustment has solved this problem. http://www.nber.org/papers/w16977 Comment: Never underestimate the ability of the private insurance industry to stick it to us. This shocking study on risk adjustment in the Medicare Advantage program should have been a front page story across the nation. It shows us how the private insurers have used risk adjustment - designed to correct their cheating through favorable selection - to further reap their own rewards by upending the adjustments so that they steal even more funds from us! How could this be? Some history. Congress was sold on the concept that private insurers could provide higher quality at lower costs than could the traditional, government-run Medicare program. The Medicare + Choice program was established to do this. Even though the plans were able to selectively enroll healthier, lower-cost patients (favorable selection), the concept still was a failure and plans began withdrawing from the markets. They could not fulfill their promise of lower costs for comparable care. The conservatives would not give up. It was essential that a robust market for private Medicare plans be established as an initial step toward privatizing the entire Medicare program (a concept still very much alive in the Paul Ryan proposal which was approved in the House of Representatives). They were successful in passing legislation that gave private Medicare plans (now Medicare Advantage) a new life by paying them about 13 percent more per beneficiary than it costs to provide care for them in the traditional fee-for-service program. As is that weren't enough, the plans continued to selectively enroll healthier, less expensive patients, further expanding their margins. To counter this, risk adjustment was applied to the payment rates. If the plans' beneficiaries were healthier than average, they would be paid less. If they were subject to adverse selection - enrolling a greater portion of sicker patients - they would be paid more. Enter this study. Although it is 55 pages of a very heavy read, seriously testing your math skills, the conclusions can be gleaned from the summary and excerpts above. The plans continued to favorably select their patients, not only by enrolling the healthy, but even more by selecting fairly healthy patients that had just a touch of illness that would allow the insurers to move them into intensified diagnostic groups that increased their payments much more than the level of illness would warrant. The authors explain that firms have been able to decrease "extensive-margin" selection and increase "intensive-margin" selection. These terms might be obscure to us, but what isn't obscure is that this chicanery on the part of the insurers allowed them to escape the risk adjustments that would have reduced their overpayments from $1,800 to $800 per beneficiary (still an overpayment), and replace it with a $3,000 per person overpayment! The authors conclude that "governments may wish to take special care in 'contracting out' social insurance." They are far too kind. We need to throw the damn crooks out, fix our traditional Medicare program, and then provide it for everyone. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From acswift at comcast.net Tue Oct 4 15:14:55 2011 From: acswift at comcast.net (Alice Swift) Date: Tue, 4 Oct 2011 15:14:55 -0400 Subject: [Health Care Action] Only 5 Days to Wait for the Great Grill and Bake! In-Reply-To: <1714505717.24349.1317754251382.JavaMail.root@sz0009a.westchester.pa.mail.comcast.net> References: <1714505717.24349.1317754251382.JavaMail.root@sz0009a.westchester.pa.mail.comcast.net> Message-ID: ---------- Forwarded message ---------- From: Mass-Care Announce Date: Tue, Oct 4, 2011 at 2:50 PM Subject: Only 5 Days to Wait for the Great Grill and Bake! To: Mass-Care Announce Hello Single Payer Supporters - we will be doing a 5 day countdown for this Sunday's barbecue fundraiser! Set at the beautiful Larz Anderson Park in Brookline, more than eight contestants will work their culinary magic in two separate competitions - for the most mouth-watering grilled appetizer, and the most delectable baked goods. Prizes will be awarded by a star-studded Judges Panel, and will consist of gifts supplied by the Boston Common Coffee Company, Flour Bakery, Ula Cafe, and more! We are asking attendees to contribute $35 towards making health care a right ($10 for under age 18), and you will get to taste the competitors? dishes. Low-income attendees are more than welcome to join us at a discounted rate! WHERE AND WHEN: Sunday, October 9, 11:30AM - 2:00PM Larz Anderson Park, Brookline (click here for directions) Tickets: $35 ($10 for under age 18) JUDGES PANEL: - Jay Murray, Executive Chef, Grill 23 & Bar - Jamie Eldridge, Senator, Middlesex and Worcester - Mohamed Maenaoui, Personal Chef and former Executive Chef, The Barking Crab GRILLING COMPETITORS: - Benjamin Day, Executive Director, Mass-Care - Jennifer Doe, Workers Rights Organizer, Massachusetts Jobs with Justice - Mike Fiske, Owner, Fiske & Company - Robert Hall, Waiter, Grill 23 & Bar BAKING COMPETITORS: - Olivia Alford, Research Assistant at the Education Development Center and former Mass-Care intern. - Reverend Judy Deutsch, retired Unitarian Universalist minister - Denise Zwahlen, Physician Assistant, Codman Square Health Center - Margaret Reeve Panahi, Family Nurse Practitioner, graduate of Madeleine Kamman School for Culinary Arts _______________________________________________ Mass-Care: The Massachusetts Campaign for Single Payer Health Care 33 Harrison Ave - 5th floor Boston, MA 02111 Ph: 617-723-7001 Fx: 617-723-7002 Em: info at masscare.org -------------- next part -------------- An HTML attachment was scrubbed... URL: From don at mccanne.org Tue Oct 4 16:09:23 2011 From: don at mccanne.org (Don McCanne) Date: Tue, 4 Oct 2011 13:09:23 -0700 Subject: [Health Care Action] qotd: Medicaid/CHIP patients are shoved out of the office faster Message-ID: The National Bureau of Economic Research NBER Digest OnLine October 2011 The Effects of Public Health Insurance Expansions In the United States, public health insurance programs cover over 90 million individuals. Changes in the scope of these programs, such as the Medicaid expansions under the recently passed Patient Protection and Affordable Care Act, or in the generosity of these programs, may affect physician behavior. In "The Doctor Might See You Now: the Supply Side Effects of Public Health Insurance Expansions" (NBER Working Paper No. 17070), Craig Garthwaite finds that after the 1990s implementation of the State Children's Health Insurance Program (SCHIP) - a partnership between federal and state governments intended to increase insurance coverage for low-income Americans under the age of 19 - more physicians participated in the program, but their total number of hours spent with patients declined as a result of shorter office visits. Garthwaite finds that there were fewer visits that lasted more than 10 minutes after this public program expansion. The evidence on shorter office visits is consistent with economic models of physician behavior in a system with both public and private payers. The negative effects of reductions in physician labor supply, such those observed in this study, may be particularly important for Medicaid patients because they are covered by a program that is increasingly not accepted by physicians. http://www.nber.org/digest/oct11/w17070.html Comment: Most of us who support a single payer national health program do so primarily because it would provide high quality, comprehensive care for everyone. Although the Affordable Care Act will not cover everyone, much of the expansion in coverage that it does accomplish is through increased eligibility for the Medicaid and CHIP programs, chronically underfunded welfare programs. This study demonstrates that such an approach does result in a system with at least two tiers, the lower tier patients facing shorter visits and a decline in access to participating physicians. There is already enough money in our health care system to provide a single level of comprehensive, high quality care for everyone. We should reject the concept of a separate, underfunded, lower tier program for low-income individuals and families, with a higher tier of great care for the rest of us (though the Affordable Care Act certainly doesn't ensure that either). -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From don at mccanne.org Wed Oct 5 15:20:16 2011 From: don at mccanne.org (Don McCanne) Date: Wed, 5 Oct 2011 12:20:16 -0700 Subject: [Health Care Action] qotd: Most large health plans fall short on quality Message-ID: Consumer Reports Health.org October 4, 2011 New rankings make choosing health insurance easier By Steven Findlay When it comes to health insurance, a familiar name and lots of members don?t guarantee quality or customer satisfaction, according to new rankings of health-insurance plans from the National Committee for Quality Assurance that we published today. Our analysis of the NCQA rankings found that the five largest national insurers?Aetna, Cigna, Humana, Kaiser Permanente, and United Healthcare, plus the mostly state-based Blue Cross Blue Shield plans?account for about 75 percent of the 390 ranked private plans, but only 36 percent of the top 50. Biggest isn?t best. United is the nation?s largest health-insurance company, but none of its private plans rank among the top 100, and most occupy the bottom half. http://news.consumerreports.org/health/2011/10/new-rankings-make-choosing-health-insurance-easier.html NCQA Health Plan Report Card http://reportcard.ncqa.org/plan/external/plansearch.aspx Comment: The big health insurers that are dominating most of the markets fall short on NCQA quality standards, except for Kaiser Permanente. No surprise. What is surprising is that we continue to tolerate this mediocrity merely because an improved Medicare for all is not politically feasible. How about changing the politics? -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From acswift at comcast.net Wed Oct 5 16:51:34 2011 From: acswift at comcast.net (Alice Swift) Date: Wed, 5 Oct 2011 16:51:34 -0400 Subject: [Health Care Action] Fwd: Rep. Smizik and Dr. Recht Join BBQ & Bakeoff Judges Panel for this Sunday! In-Reply-To: <1941509423.75314.1317847315335.JavaMail.root@sz0009a.westchester.pa.mail.comcast.net> References: <1941509423.75314.1317847315335.JavaMail.root@sz0009a.westchester.pa.mail.comcast.net> Message-ID: ---------- Forwarded message ---------- From: Mass-Care Announce Date: Wed, Oct 5, 2011 at 4:41 PM Subject: Rep. Smizik and Dr. Recht Join BBQ & Bakeoff Judges Panel for this Sunday! To: Mass-Care Announce Hello Single Payer Supporters - Representative Frank Smizik and Dr. James Recht, chair of Massachusetts PNHP, have joined the judges panel for this Sunday's Barbecue and Bakeoff for Health Care Justice!! There is now a flyer for the event available on Mass-Care's web-site, along with an updated list of sponsors and participants. Please print out the flyer, and distribute copies to your friends and colleagues, or bring along a significant other! http://masscare.org/barbeque-and-bake-off-for-health-care-justice/ *WHERE AND WHEN* Sunday, October 9, 11:30AM - 2:00PM Larz Anderson Park, Brookline Tickets: $35 ($10 for under age 18) _______________________________________________ Mass-Care: The Massachusetts Campaign for Single Payer Health Care 33 Harrison Ave - 5th floor Boston, MA 02111 Ph: 617-723-7001 Fx: 617-723-7002 Em: info at masscare.org -- acswift at comcast.net Alice C. Swift Amherst, MA 01002 -------------- next part -------------- An HTML attachment was scrubbed... URL: From don at mccanne.org Thu Oct 6 10:15:36 2011 From: don at mccanne.org (Don McCanne) Date: Thu, 6 Oct 2011 07:15:36 -0700 Subject: [Health Care Action] qotd: Undocumented immigrants under the Affordable Care Act Message-ID: Health Affairs October 2011 Undocumented Immigrants, Left Out Of Health Reform, Likely To Continue To Grow As Share Of The Uninsured By Stephen Zuckerman, Timothy A. Waidmann and Emily Lawton The increase in undocumented immigration between 1999 and 2007 contributed to an increase in the number of uninsured people in the United States. During this period, the number of undocumented immigrants increased from an estimated 8.5 million to 11.8 million, leading to an estimated additional 1.8 million uninsured. These uninsured and undocumented immigrants were estimated to represent 27 percent of the overall increase of 6.9 million uninsured people during this period. Undocumented immigrants accounted for one in seven of the uninsured in 2007, up from one in eight in 1999. These undocumented immigrants will not be eligible for public insurance or any type of private coverage obtained through exchanges under the Affordable Care Act of 2010. As a result, members of this group will eventually constitute a larger percentage of the uninsured population, unless other policy actions are taken to provide for their coverage, or their immigration status is changed. http://content.healthaffairs.org/content/30/10/1997.abstract Comment: Under a properly designed single payer national health program, the financing of the health care system and the delivery of care are totally separated. Everyone contributes funds to the system based on ability to pay, including undocumented immigrants. Everyone who needs health care receives health care, including undocumented immigrants. During the national dialogue on health care reform, a vociferous component of our society opposed including health insurance coverage for undocumented immigrants, and Congress complied with their wishes. The reason often given was that they were "illegals" (an unfortunate pejorative term). They committed the crime of coming to this country illegally, so they shouldn't receive the benefit of health care, so the argument goes. But is denying health care to those who commit crimes really our national policy? Hardly. Individuals who commit crimes severe enough to result in imprisonment are automatically granted health care. Anyone who shows up at an emergency room in need of urgent care is given that care, regardless of immigration status. >From a practical standpoint, in a microsimulation study that we did as part of the California Health Care Options Project, we showed that, under a single payer model, providing comprehensive care for absolutely everyone, including undocumented immigrants, would actually reduce our total health care spending. All immigrants, documented or not, would participate like everyone else - paying into the system and receiving care when needed. Regardless of all this, what should be the overriding principle is the concept of social justice, specifically health care justice. No person in the community should be singled out for any reason whatsoever to be excluded from gaining access to the practitioners of the healing arts. A just society would guarantee that access for everyone, regardless of ability to pay or immigration status. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From wmjwj at wmjwj.org Thu Oct 6 10:44:58 2011 From: wmjwj at wmjwj.org (WMass Jobs with Justice) Date: Thu, 6 Oct 2011 10:44:58 -0400 Subject: [Health Care Action] Verizon leafleting Saturday 10/8 Message-ID: <004001cc8436$86a7dc30$93f79490$@org> Dear Workers' Rights Activists, Please let the Store Captains below know you are coming to leaflet about Verizon and corporate greed on Saturday October 8! And please sign the Message of Solidarity . The CWA and IBEW have asked me to convey to you their gratitude for joining this fight! Our pressure on Verizon has helped at the bargaining table. And our Verizon Street Heat committee meets Friday October 7, 9:30-10:30am, at IBEW Local 2324, 281 Cottage St, Springfield . We leaflet regularly at the door at 360 Russell St, Hadley , 1123 Riverdale St, West Springfield , 1420 Boston Rd, Springfield , & 555 Hubbard Ave, Pittsfield . This Saturday's schedule, October 8: Noon to 2pm, at the Hadley store: Please let Jon Weissman know you are coming: jon at wmjwj.org, 413-827-0301. 11am to 1pm, at the Pittsfield store: Please let Brian Morrison know you are coming: brian.morrison at state.ma.us, 413-281-3223. Berkshire Central Labor Council has adopted this shift. Noon to 2pm,, at the Springfield store: Please let Kathy Collins know you are coming: kathy7157 at hotmail.com, 413-734-0863. Noon to 2pm, at the West Springfield store: Please let Patrick Burke know you are coming: patrick at wmjwj.org, 413-454-5692. Join us! Please wear your organization's apparel and/or a red shirt/jacket, as the strikers did. Western Mass. Jobs with Justice will provide leaflets. It is important to point out that we are leafleting not picketing! Since the workers are not currently on strike, a picket would not be lawful. Instead, we are passing out flyers in front of Verizon stores and to customers of other stores nearby. If it looks like rain, we will make the decision to call it off by 9am and let you know by email. If we know you are coming, we can send the email to your cell phone as a text message if you send your phone number and name of carrier to wmjwj at wmjwj.org. You can call the Store Captains listed above to be sure, but it's better if you tell us in advance that you're coming and we'll call you. When we call off a leafleting shift, the captains will be there at the beginning to tell anyone who did not get the message, but we'll only wait 15 minutes. If this email was forwarded or copied to you, be sure to keep up-to-date on workers' rights campaigns by subscribing to the Workers' Rights List. To subscribe, send a blank email to workersrights-subscribe at lists.prometheuslabor.com or go to http://lists.wmjwj.org/mailman/listinfo/workersrights. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Jon Weissman, Coordinator Western Mass Jobs with Justice 640 Page Blvd #101 Springfield MA 01104 (413) 827-0301 Founded in 1987, Jobs with Justice's mission is to improve working people's standard of living, fight for job security, and protect workers' right to organize. We believe workers' rights are human rights and to be successful, we have to be part of a larger campaign for economic and social justice. To that end, "J with J" has created a national coalition and a network of local coalitions that connect labor, community, student, and faith-based organizations and activists on workplace and community social justice campaigns. Western Mass JwJ - founded June 5, 1993 - is now a coalition of almost 70 organizations. Let's keep in touch - please check out our mailing lists at http://wmjwj.org/our-lists. -------------- next part -------------- An HTML attachment was scrubbed... URL: From acswift at comcast.net Thu Oct 6 15:48:22 2011 From: acswift at comcast.net (Alice Swift) Date: Thu, 6 Oct 2011 15:48:22 -0400 Subject: [Health Care Action] Fwd: Growing Physician Support for Single Payer & 3 Day Count-Down to BBQ Fundraiser! In-Reply-To: <904212294.115140.1317930184599.JavaMail.root@sz0009a.westchester.pa.mail.comcast.net> References: <904212294.115140.1317930184599.JavaMail.root@sz0009a.westchester.pa.mail.comcast.net> Message-ID: ---------- Forwarded message ---------- From: Mass-Care Announce Date: Thu, Oct 6, 2011 at 3:43 PM Subject: Growing Physician Support for Single Payer & 3 Day Count-Down to BBQ Fundraiser! To: Mass-Care Announce Hello Single Payer Supporters - Along with the 3 day count-down until this Sunday's BBQ and Bakeoff fundraiser, we wanted to pass on some exciting news. Last year for the first time, the Massachusetts Medical Society included a question about national health reform in its annual survey of practicing physicians. The results were striking: doctors could choose only one reform model out of 4 options, and more respondents picked single payer (34%) than any other option! Close behind was a public option (32% of doctors), and using Massachusetts health reform as a model for the nation came in last (14%). This year, support for single payer grew even further: 41% of docs picked single payer, followed by 23% who would prioritize a public option. Only 17% preferred the recently enacted Affordable Care Act. Let's keep building support for single payer in Massachusetts: join us in three days, this Sunday, for a Barbecue and Bakeoff for Health Care Justice! Details are on Mass-Care's web-site here: http://masscare.org/barbeque-**and-bake-off-for-health-care-**justice/ ______________________________**_________________ Mass-Care: The Massachusetts Campaign for Single Payer Health Care 33 Harrison Ave - 5th floor Boston, MA 02111 Ph: 617-723-7001 Fx: 617-723-7002 Em: info at masscare.org -------------- next part -------------- An HTML attachment was scrubbed... URL: From don at mccanne.org Fri Oct 7 10:41:36 2011 From: don at mccanne.org (Don McCanne) Date: Fri, 7 Oct 2011 07:41:36 -0700 Subject: [Health Care Action] qotd: IOM's disturbing report on "essential health benefits" Message-ID: Institute of Medicine October 6, 2011 Essential Health Benefits: Balancing Coverage and Cost Abstract The principle intent of the Patient Protection and Affordable Care Act (ACA) is to enable previously uninsured Americans to obtain health insurance. To accomplish this, in part, subsidized plans will be offered to low- and moderate-income individuals and small employers through health insurance exchanges. Plans qualified to be offered through exchanges must at minimum include "essential health benefits" (EHB). The ACA is not very specific on the definition of EHB except that such benefits shall include at least ten enumerated general categories and that the scope of the EHB shall be equal to the scope of benefits provided under a typical employer plan. The ACA requires the Secretary of the Department of Health and Human Services to define the essential health benefits. The Institute of Medicine (IOM) was asked by the Secretary to make recommendations on the methods for determining and updating the essential health benefits. Notably, the request was to focus on criteria and policy foundations for the determination of the EHB, not to develop the list of benefits. The IOM formed a committee of volunteers with varied perspectives and professional backgrounds; the committee held four face-to-face meetings and numerous conference calls. Broad public input was obtained. In two open workshops, the committee heard from more than 50 witnesses, and 345 comments were received in response to questions posted on the web. The consensus report then underwent rigorous external review in accordance with procedures established by the Report Review Committee of the National Research Council. As the committee examined its charge, it saw two main questions for the Secretary: (1) how to determine the initial EHB package and (2) how to update the EHB package. Defining the initial EHB package. In considering how to determine the initial EHB package, the committee was struck by two compelling facts: (1) if the purpose of ACA was to provide access to health insurance coverage, that coverage had to be affordable; and (2) the more expansive the benefit package was, the more it was likely to cost and the less affordable it would be. How to balance the competing goals of comprehensiveness of coverage and affordability was key. The committee concluded that it was best to begin simply by defining the EHB package as reflecting the scope and design of packages offered by small employers today, modified to include the ten required categories. This package would then be assessed by criteria and a defined cost target recommended by the committee. The committee considered how four policy domains - economics, ethics, population-based health, and evidence-based practice - could guide the Secretary in determining the EHB package in general. From these policy foundations, the committee recommends: criteria to guide the aggregate EHB package; criteria to guide specific EHB inclusions and exclusions; and criteria to guide methods for defining and updating the EHB. To ensure affordability and protect the intent of the ACA, the committee concluded that costs must be considered both in the determination of the initial EHB package and in its updating. Thus, the cost of the initial EHB package resulting from the previous steps should be compared to a premium target defined by the committee as what small employers would have paid, on average, in 2014. Committee members believe that absent a premium target, there would be no capacity to acknowledge the realities of limited resources and the ongoing need for affordability of the package. The EHB package should be modified as necessary to meet this estimated premium, including using a structured public deliberative process. In addition, the committee recommends that states operating their own exchanges be able to design a variant of the EHB package if certain standards are met. Updating the EHB package. Both medical science and our understanding of how best to design insurance products will change over time. Thus, the committee recommends creating a framework and infrastructure for collecting data and analyzing implementation of the initial EHB; a National Benefits Advisory Council is recommended to give the Secretary advice on the research plan and on updates to the EHB package. The committee believes that the EHB package should become more fully evidence-based, specific, and value-based over time. In addition, as with the initial package, costs must be taken into account such that any service added to the package should be offset by savings, through either medical management or the elimination of inappropriate or outmoded services. Finally, the committee noted that even with the use of a premium target, the affordability of the EHB package is threatened by rising medical costs in the United States overall and recommends that the Secretary, in collaboration with others, develop a strategy to reduce health care spending growth across all sectors. http://iom.edu/Reports/2011/Essential-Health-Benefits-Balancing-Coverage-and-Cost.aspx And from the IOM Report Brief: One way to think about the EHB package is to compare HHS?s task to going grocery shopping. One option is to go shopping, fill up your cart with the groceries you want, and then find out what it costs. The other option is to walk into store with a firm idea of what you can spend and to fill the cart carefully, with only enough food to fit within your budget. The committee recommends that HHS take the latter approach to developing the EHB package and to keep in mind what small employers and their employees can afford. Employers who offer insurance packages make such choices now. http://iom.edu/~/media/Files/Report%20Files/2011/Essential-Health-Benefits-Balancing-Coverage-and-Cost/essentialhealthbenefitsreportbrief.pdf Comment: From the start of the reform process it was understood that defining which essential benefits should be covered by the exchange plans would be controversial. What is no surprise is that, just as the process of writing the Affordable Care Act (ACA) was guided by the private insurance industry, this recommendation for establishing a process for determining essential benefits has the private insurance industry's fingerprints all over it. When ACA was developed, the large group employer health plans were functioning fairly well, so it was decided to include policies that would encourage the continuation of these plans. It was the market of small group and individual plans that was not functioning well. Benefits were quite skimpy, and underwriting practices prevented many from obtaining coverage in this market. Thus it was decided to establish state health insurance exchanges in which a market of better regulated and more standardized insurance products would be available. When the Institute of Medicine tried to balance the essential health benefits package (EHB) with affordability what did they choose? They decided that affordability must come first, and then benefits selected to match the affordable premiums. Wait a minute! What is being made affordable? Health care or health plans? Skimpy benefits equate with unaffordable health care since much of health care has to be paid out-of-pocket simply because it is not part of the benefit package. By establishing the current benefits of existing small group plans as the standard essential benefits in the plans offered by the exchanges, the IOM has made a deliberate choice of making private health insurance products affordable at the cost of making health care itself unaffordable for those purchasing their plans in the exchanges. This is precisely what the private insurance industry wanted when it came to defining the essential health benefit packages. By making the austere small business packages the new standard, the insurers could keep their premiums low enough to ensure that they still had a market for their products. The insurers could care less what happens to patients when they actually need care, as long as their own market is protected. It isn't the insurers' problem now since they have the prestigious Institute of Medicine telling the nation that we can't have more than skimpy, spartan health care unless we are willing and able to pay for it out-of-pocket. Since most middle-income families can't, they'll just have to do without. (Single payer systems do not cut benefits. They control spending through administrative efficiencies, global budgeting, price negotiations, elimination of coverage for detrimental services, and by planning and separate budgeting of capital expenditures.) -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From acswift at comcast.net Fri Oct 7 19:48:40 2011 From: acswift at comcast.net (Alice Swift) Date: Fri, 7 Oct 2011 19:48:40 -0400 Subject: [Health Care Action] Mass-Care Fwd: Two Days to Wait Until the Great Grill and Bake! Message-ID: ---------- Forwarded message ---------- From: Mass-Care Announce Date: Fri, Oct 7, 2011 at 7:34 PM Subject: Two Days to Wait Until the Great Grill and Bake! To: Mass-Care Announce Hello Everyone - After several days of truly fall weather, the forecast for this Sunday at Larz Anderson Park calls for 84 DEGREES AND SUNSHINE! We're so glad to have a piece of summer in the middle of October, and hope you can all join us at our Barbecue and Bakeoff for Health Care Justice, from 11:30AM to 2PM in Brookline. Feel free to bring friends and family, significant and insignificant others, for a great time and some wonderful food. Details are on our web-site here: http://masscare.org/barbeque-**and-bake-off-for-health-care-**justice/ ______________________________**_________________ Mass-Care: The Massachusetts Campaign for Single Payer Health Care 33 Harrison Ave - 5th floor Boston, MA 02111 Ph: 617-723-7001 Fx: 617-723-7002 Em: info at masscare.org -------------- next part -------------- An HTML attachment was scrubbed... URL: From don at mccanne.org Mon Oct 10 11:16:56 2011 From: don at mccanne.org (Don McCanne) Date: Mon, 10 Oct 2011 08:16:56 -0700 Subject: [Health Care Action] qotd: Corporate control of drug pricing and distribution Message-ID: Los Angeles Times October 7, 2011 Walgreen battle over drug prices will limit consumer choice By David Lazarus Beginning Jan. 1, Walgreens will no longer fill prescriptions for Anthem Blue Cross members, meaning that they'll have to switch to another drugstore if they want their insurance to keep covering their meds. In this case, though, it's not the insurance giant calling the shots. Instead, it's Anthem's pharmacy benefit manager, a St. Louis company called Express Scripts Inc. The dispute between Walgreens and Express Scripts highlights how consumers can find their healthcare choices limited by the money-minded business decisions of big corporations. (Express Scripts) is spending about $29 billion to acquire rival Medco Health Solutions Inc. If the deal passes regulatory muster, it would give Express Scripts control over about a third of the market for pharmacy benefits. Nearly 4 billion prescriptions are dispensed in the U.S. annually. Obviously steps should be taken to keep medical costs down. Both Express Scripts and Walgreen say that's what they're trying to do. But it's hard not to think all we're really seeing here is two large, profit-hungry corporate behemoths fighting over as much of our healthcare dollars as they can get their hands on. Inevitably, prices will go up for consumers and choices will be further limited. http://www.latimes.com/business/la-fi-lazarus-20111007,0,2128189,full.column Comment: Congress turned the Medicare prescription business over to private pharmacy benefit managers under the fiction that they would increase choices and reduce costs. What did we get? Reduced choices in drugs covered, reduced choices in pharmacies, and prices much higher than the government obtains for the Medicaid and the VA drug programs. It's only going to get worse, unless we finally decide that we're ready to take over the financing of health care in America by establishing our own public insurance program. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From don at mccanne.org Tue Oct 11 10:07:48 2011 From: don at mccanne.org (Don McCanne) Date: Tue, 11 Oct 2011 07:07:48 -0700 Subject: [Health Care Action] qotd: Preventing the implosion of the Los Angeles County safety-net Message-ID: Los Angeles Times October 9, 2011 L.A. County expands no-cost healthcare By Anna Gorman In one of the largest expansions of health coverage to the uninsured, Los Angeles County is enrolling hundreds of thousands of residents in a publicly funded treatment program and setting the stage for the national healthcare overhaul. The county hopes to register as many as 550,000 patients and is assigning them to medical clinics for services at no cost to them. Under President Obama's controversial healthcare overhaul, millions more uninsured Californians will be eligible for Medicaid ? the healthcare program for the poor ? beginning in 2014. Even as the debate over the law continues in Washington, California is starting that expansion now and using federal dollars to do so. Altogether, the state expects to receive $2.3 billion to expand and modernize its Medicaid program, known as Medi-Cal, now available only to certain low-income residents. In L.A. County, the stakes are high. In 2014, the newly insured county residents will be able to seek treatment wherever they want. To keep them with the county, health leaders recognize that they must make the system one of choice rather than of last resort. Otherwise, the only patients left will be illegal immigrants and others still ineligible for public coverage. "Our survival depends on it," said Mitchell Katz, director of the county Department of Health Services. Unless the healthcare system improves, he said, "if people have choice, they won't choose us and the system will implode." Health workers began signing patients up for a program called Healthy Way L.A. in July and so far have enrolled 24,000, many of whom are receiving services. County residents are eligible if they are between the ages of 19 and 64, citizens or permanent residents of five years and earn less than 133% of the federal poverty level (about $14,500 for an individual and $29,700 for a family of four). The coverage is not insurance and cannot be used outside of L.A. County, but it does give patients the ability to receive free primary and specialty care, mental health services, chronic disease management, medication and emergency treatment. Most of the enrollment is being done when patients go to the county's network of hospitals and clinics. Over the next two years, the county will pay half the cost for Healthy Way L.A. ? or about $300 million ? and the federal government will pay the other half. By 2014, when the patients become eligible for Medi-Cal, the federal government will pick up the entire tab, which will help bolster the financially strapped county's health system. http://www.latimes.com/health/la-me-health-reform-la-20111010,0,4242519.story Comment: This admirable effort in Los Angeles County to include more uninsured adults in its health services programs demonstrates some of the complexities that arise in trying to coordinate health care financing and health care delivery under our current dysfunctional, fragmented system that is being expanded by the Affordable Care Act (ACA). Traditionally, the county has been the health care provider of last resort. If we had a financing system that covered everyone, there would be no need to support separate financing of a welfare program for low-income individuals, though there would still be a need to be sure that adequate facilities were available in areas with high rates of poverty that might not attract private health care providers. Between this need to ensure adequate capacity in underserved areas, and the anticipation that there will still be tens of millions of uninsured individuals, forward thinking county health administrators are wise to try to work within the current system, with the anticipated changes under the Affordable Care Act, to be sure that care will be available for these underserved populations. The efforts in Los Angeles County can serve as a model for other counties throughout the nation, though the task is difficult because of the budget constraints that states and counties now face. So how is Los Angeles County going to finance the safety-net in an unstable environment during the health reform transition? The first phase is to expand the safety-net to cover uninsured low-income adults. This is not an insurance program, but it relies on a contribution of federal funds that would pay about half of the expansion in clinic services for this population. Thus it expands the traditional role of the county as the provider of last resort, with the addition of much needed federal funds. By providing these patients with a primary care medical home now, the transition to a program financed completely by the expansion of Medicaid will be much smoother. But then what? The 100 percent federal financing of the Medicaid program applies only to the expansion of coverage for these newly enrolled low-income adults, and it is only temporary, designed as an enticement to states to roll out their Medicaid expansions under ACA. States are already facing severe fiscal problems in trying to finance their Medicaid programs, so what will they do when the extra federal subsidies end for these state programs with greatly expanded enrollments? This policy nightmare was created by our politicians who decided above all to protect the markets for the private insurance industry catering to all of the population sectors that are above poverty levels. For those in poverty, they decided to use chum money to get the states to expand their Medicaid programs, but then revert to the chronic underfunding that characterizes this program, but which would now be compounded by expanded enrollment. What would have happened had our legislators instead enacted a single payer national health program? Full federal funding would have been provided for these low-income individuals on an equal basis as with everyone else. Income would play no role in a person's ability to clear the financial barriers to health care. The safety-net facilities provided by the counties would be fully funded by the program. Because of a lack of interest by the private health care sector in serving regions with high poverty levels, it is likely that the counties would continue as administrators of these institutions, but they would do so knowing that adequate federal funding would always be there through the single payer national health program. Think of how much easier the task would be, under a single payer system, for Mitchell Katz, the director of the Los Angeles County Department of Health Services, to prevent the implosion of the county administered health facilities, which we will need regardless of whatever financing system we end up with. But then, Mitchell Katz isn't looking for a way to make his job easier; he is looking for a way to be sure that health care will always be there for everyone who needs it. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From wmjwj at wmjwj.org Tue Oct 11 12:47:45 2011 From: wmjwj at wmjwj.org (WMass Jobs with Justice) Date: Tue, 11 Oct 2011 12:47:45 -0400 Subject: [Health Care Action] Verizon leafleting this week Message-ID: <007101cc8835$80b68030$82238090$@org> Dear Workers' Rights Activists, Please let the Store Captains listed below know you are coming to leaflet about Verizon and corporate greed this week! Note that we are no longer doing the Wednesday 5-7pm shift. We would like to start up more midday shifts. And our Verizon Street Heat committee meets Friday October 14, 9:30-11am, at IBEW Local 2324, 281 Cottage St, Springfield . And please sign the Message of Solidarity . We leaflet regularly at the door at 360 Russell St, Hadley , 1123 Riverdale St, West Springfield , 1420 Boston Rd, Springfield , & 555 Hubbard Ave, Pittsfield . This week's schedule: Wednesday, Noon to 2pm, at the Hadley store: Please let Ryan Quinn know you are coming: rep at geouaw.org, 413-545-0705. Graduate Employees Organization/UAW 2324 has adopted this shift. Saturday, Noon to 2pm, at the Hadley store: Please let Jon Weissman know you are coming: jon at wmjwj.org, 413-827-0301. Saturday, 11am to 1pm, at the Pittsfield store: Please let Brian Morrison know you are coming: brian.morrison at state.ma.us, 413-281-3223. Berkshire Central Labor Council has adopted this shift. Saturday, Noon to 2pm,, at the Springfield store: Please let Kathy Collins know you are coming: kathy7157 at hotmail.com, 413-734-0863. Saturday, Noon to 2pm, at the West Springfield store: Please let Patrick Burke know you are coming: patrick at wmjwj.org, 413-454-5692. Join us! Please wear your organization's apparel and/or a red shirt/jacket, as the strikers did. Western Mass. Jobs with Justice will provide leaflets. It is important to point out that we are leafleting not picketing! Since the workers are not currently on strike, a picket would not be lawful. Instead, we are passing out flyers in front of Verizon stores and to customers of other stores nearby. If it looks like rain, we will make the decision to call it off by 9am and let you know by email. If we know you are coming, we can send the email to your cell phone as a text message if you send your phone number and name of carrier to wmjwj at wmjwj.org. You can call the Store Captains listed above to be sure, but it's better if you tell us in advance that you're coming and we'll call you. When we call off a planned leafleting shift, the captains will be there at the beginning to tell anyone who did not get the message, but we'll only wait 15 minutes. If this email was forwarded or copied to you, be sure to keep up-to-date on workers' rights campaigns by subscribing to the Workers' Rights List. To subscribe, send a blank email to workersrights-subscribe at lists.prometheuslabor.com or go to http://lists.wmjwj.org/mailman/listinfo/workersrights. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Jon Weissman, Coordinator Western Mass Jobs with Justice 640 Page Blvd #101 Springfield MA 01104 (413) 827-0301 Founded in 1987, Jobs with Justice's mission is to improve working people's standard of living, fight for job security, and protect workers' right to organize. We believe workers' rights are human rights and to be successful, we have to be part of a larger campaign for economic and social justice. To that end, "J with J" has created a national coalition and a network of local coalitions that connect labor, community, student, and faith-based organizations and activists on workplace and community social justice campaigns. Western Mass JwJ - founded June 5, 1993 - is now a coalition of almost 70 organizations. Let's keep in touch - please check out our mailing lists at http://wmjwj.org/our-lists. -------------- next part -------------- An HTML attachment was scrubbed... URL: From acswift at comcast.net Tue Oct 11 18:38:18 2011 From: acswift at comcast.net (Alice Swift) Date: Tue, 11 Oct 2011 18:38:18 -0400 Subject: [Health Care Action] Join Mass-Care to Ask Legislators for Spare Change to Pay for Child Deliveries In-Reply-To: <932055124.274399.1318364095601.JavaMail.root@sz0009a.westchester.pa.mail.comcast.net> References: <932055124.274399.1318364095601.JavaMail.root@sz0009a.westchester.pa.mail.comcast.net> Message-ID: ---------- Forwarded message ---------- From: Mass-Care Announce Date: Tue, Oct 11, 2011 at 4:14 PM Subject: Join Mass-Care to Ask Legislators for Spare Change to Pay for Child Deliveries To: Mass-Care Announce Hello Single Payer Supporters - *Mass-Care is asking for your help next Tuesday, October 18 at the State House in Boston, from 10AM to noon, to ask legislators to address a truly horrifying situation facing students in Massachusetts. Please email info at masscare.org if you are able to help on Tuesday.* Students must have insurance coverage to enroll in a college or university program in our state, but unlike everyone else in the state who is required to purchase health care, student are banned from receiving state subsidies no matter how low income they are. While the most fortunate students in the state can enroll in their parents' family health plans, 27% are either too old or their parents are uninsured, and must purchase their college's 'student health insurance plan' (or SHIP). In the past few years, colleges and universities across the state have been offering worse and worse coverage through their SHIPs, introducing high levels of 'co-insurance' for even in-network care at "preferred" providers. Co-insurance means that students must pay 15%, 20%, sometimes even 35% of the total cost of care. For overnight stays at hospitals, surgeries, or other expensive forms of care, this can quickly reach into the thousands of dollars. For students with very low or no disposable income, this is essentially being uninsured. Katie Lazdowski, a graduate student at the University of Massachusetts at Amherst, *gave birth this past week, and only recently found out that UMass had added a 15% coinsurance fee for most medical services, including maternity care - all of which had been covered with no extra charges previously*. She commented "I had anticipated that the delivery and associated bills related to my delivery process would be covered. Now they say I am expected to pay 15%? This could result in a bill between $1,500 and $3,000. As a doctoral student, my teaching assistantship stipend does not provide enough money to live on, and now I am extremely fearful of how I will make ends meet come October when I am expected to deliver. My husband now has to work three part-time jobs, which still don?t allow us to save $3000 in three months." We have reports of other students with chronic illnesses, or who recently suffered car accidents, and will face similarly unaffordable costs to receive much needed care. *HOW WE ARE TAKING ACTION ON OCTOBER 18* Mass-Care along with a coalition of other health care advocacy and student organizations has asked the Division of Health Care Finance and Policy (DHCFP) to investigate the legality of coinsurance for students. We believe the state's regulations of student health plans do not allow such unaffordable cost sharing. *On October 18 from 10AM to noon, we will visit every Representative and Senator at the State House and ask them to contribute some spare change to help pay for Katie's delivery, and for the life-saving care that other students will not be able to afford so long as colleges and universities are allowed to impose co-insurance on student health plans. *We will also legislators to write letters of support to the DHCFP, urging the Commissioner to intervene immediately on behalf of students. Please email info at masscare.org to help on October 18! Thank you all for your support. _______________________________________________ Mass-Care: The Massachusetts Campaign for Single Payer Health Care 33 Harrison Ave - 5th floor Boston, MA 02111 Ph: 617-723-7001 Fx: 617-723-7002 Em: info at masscare.org -------------- next part -------------- An HTML attachment was scrubbed... URL: From don at mccanne.org Wed Oct 12 12:16:21 2011 From: don at mccanne.org (Don McCanne) Date: Wed, 12 Oct 2011 09:16:21 -0700 Subject: [Health Care Action] qotd: Orrin Hatch on Obama and single payer Message-ID: Vitals October 11, 2011 Orrin Hatch Forecasts Obamacare Will Morph To Single Payer Health Care US Senator from Utah, Orrin Hatch, spoke at Heritage Foundation about what he envisions happening to ObamaCare and the health care system if President Obama will be reelected for another term. ?If President Obama is reelected within a year or two he?ll throw his hands in the air and say, ?it?s not working, we got to go to a single payer system.? 40 second video: http://spotlight.vitals.com/2011/10/orrin-hatch-forecasts-obamacare-will-morph-to-single-payer-health-care/ Comment: Don't we wish. Sen. Hatch's comment does demonstrate, once again, that even the conservatives understand the compelling advantages of single payer, in spite of their ideological opposition. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From don at mccanne.org Thu Oct 13 09:31:50 2011 From: don at mccanne.org (Don McCanne) Date: Thu, 13 Oct 2011 06:31:50 -0700 Subject: [Health Care Action] qotd: Reinhardt and McCanne on Goodman's claim that free health care causes disparities Message-ID: National Center for Policy Analysis October 12, 2011 Why Are There Disparities In Health Care? Because It?s Free. By John Goodman (Excerpts) The latest issue of Health Affairs is devoted to racial and ethnic disparities in the consumption of health care. Naturally, they found some. Why are they there? Let?s consider another necessity: food. Suppose you get a Double Quarter Pounder with cheese and a large order of fries, my favorite fast food indulgence when I put all considerations about healthy eating aside. Do you think your burger would have less cheese if you were a black customer? Would your fries be less crispy if you were Hispanic? Would the meat be less juicy if you earned a poverty level wage? The answer to these questions is obvious. Just about anybody in America can have the same fast food dinner anyone else in America is having ? usually with very little inconvenience. If there is any disparity in this market, it is due solely to individual preference and choice. So what makes health care different? I am happy to report that increasingly, it isn?t different. MinuteClinics, RediClinics and other walk-in establishments around the country offer standardized services that are comparable to the market for cheeseburgers and fries. In fact, almost one of every five people who got a flu shot last year got it at a supermarket or a drugstore. At a walk-in clinic, your flu shot costs the same as my flu shot. Your allergy prescription is just as inexpensive and just as accessible as mine. If there is any difference between us it is solely due to differences in needs and preferences. Nothing more. **** Without looking at any empirical data, economic theory alone predicts that if minimum wage laws and other labor market restrictions create a labor surplus, the black unemployment rate will be greater than the white unemployment rate. If policies that promote first-dollar coverage create a shortage of medical care, economic theory alone would predict that unmet needs will be greater among black patients than among whites. If the demand for medical care exceeds the supply, for example, providers can discriminate based on racial, ethnic or sexual preferences and not pay a price for doing so. For the entire article: http://healthblog.ncpa.org/why-are-there-disparities-in-health-care-because-its-free/ Comments on the Goodman blog: Don McCanne says: There are a great number of complex variables that result in disparities in health care, and efforts should be made to reduce the impact of all of them. Perhaps the easiest measure would be to reduce financial barriers that result in disparities by providing first dollar coverage for everyone. Central planning would also be important to ensure adequate health care facilities in low-income regions ? areas that do not tend to be attractive to private providers of health care services. Perhaps the biggest challenge would be to reverse trickle-up economics so that every household can maintain a decent standard of living, as much as is humanly possible. And... Uwe Reinhardt says: I think John is on to something here. If white and non-white Americans get the same Big Macs in the free market place, they would get the same CABG?s in a free market place. I am assuming here that anyone who can afford to pay for a Big Mac can also afford to pay for a CABG out of pocket. Lest someone on this blog ? e.g., Don McCanne ? argues that it isn?t so in the real world, let me tell you that I am an economist and thus entitled to make assumptions. Our whole profession depends on it. Uwe And... John Goodman responds to Uwe Reinhardt: I thought economists were supposed to be able to think abstractly. Do I have to walk through every single medical service and show there is an alternative to nonprice rationing in each case? It appears so. Okay, let?s take CABGs. One way to allocate them is to make them free and deter access with various forms of nonprice rationing. This is how other countries do it, and it appears to be really bad if you are poor or if you are a racial or ethnic minority. The other way is to empower patients, make them legitimate consumers and invite providers to compete for their patronage. What I call the casualty model of insurance and what others call reference pricing or value based purchasing gives the patient purchasing power, but leaves the market free to determine prices and realize the benefits of competition. QED And... John Goodman responds to Don McCanne: First dollar coverage is not the solution. It is the problem. Most people in most countries have first dollar coverage and it does not guarantee access to care. In fact, it impedes access to care. http://healthblog.ncpa.org/why-are-there-disparities-in-health-care-because-its-free/#comments Comment: John Goodman promotes himself as being the "Father of Health Savings Accounts." He has been very influential in spreading the concept that we must "empower patients, make them legitimate consumers and invite providers to compete for their patronage." This concept has gained traction as we see more health care costs being shifted to patients, especially in the form of higher deductibles for accessing care, and higher premiums so that health consumers will shop for only the insurance that they need. This exchange on his blog is important because it reveals that this approach is based on ideology under the guise of "economic theory" rather than being based on "empirical data" and health policy science. As Goodman states, "Without looking at any empirical data, economic theory alone predicts..." He then is free to advance his ideology based on his version of economic theory. Uwe Reinhardt shows that he has Goodman's number when he states, "... let me tell you that I am an economist and thus entitled to make assumptions. Our whole profession depends on it." Although policy wonks might find some humor in this exchange (I did), we are jolted back into reality when we realize the implications of Goodman's manipulation of economic theory. Disparities in health care produce horrendous health care injustices for the victims. One of the more effective methods of reducing disparities, confirmed by empirical data, is to eliminate financial barriers to care through first dollar coverage. Yet Goodman insists that first dollar coverage "impedes access to care." The basis for that statement seems to be that it does not fit with his own economic theory of consumer empowerment through bearing the costs of health care. The tragedy of all of this is that perverse, ideology-based economic theory permeates the Affordable Care Act and has an omnipresence in ongoing political manipulations of our public programs designed to provide health and financial security, especially with the current attack on Medicare, and the continual dismissal of single payer even though it has been proven to be one of the most efficient and effective models of financing health care for everyone. This is not to say that we don't have our own ideology. Ours is one of health care justice - providing needed health care for everyone - but we do use empirical health policy science to back up our recommendations. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From don at mccanne.org Fri Oct 14 07:57:40 2011 From: don at mccanne.org (Don McCanne) Date: Fri, 14 Oct 2011 04:57:40 -0700 Subject: [Health Care Action] qotd: URGENT: Sign letter of protest over IOM's skimpy health plan prescription Message-ID: FOR ACTION TODAY A recent Quote of the Day message expressed alarm at the fact that the Institute of Medicine is recommending a grossly inadequate, skimpy, spartan standard for the package of benefits to be offered by health plans in the state insurance exchanges being established under the Affordable Care Act: http://www.pnhp.org/news/2011/october/ioms-disturbing-report-on-essential-health-benefits Following is a letter asking the Obama administration to reject this recommendation. Though only selected names will be used in publicizing this letter, we encourage everyone who concurs with the views expressed to sign it, using this link: http://www.pnhp.org/iom-letter/index.php?UID=1348 President Obama: Reject the Institute of Medicine's skimpy health plan prescription We protest the Institute of Medicine?s (IOM) recommendation that cost rather than medical need be the basis for defining the ?essential benefits? that insurance policies must cover when the federal health reform law takes effect in 2014. If adopted by the Department of Health and Human Services, this recommendation will sacrifice many lives and cause much suffering. We call on Secretary Sebelius and President Obama to reject them. The IOM proposal would base the required coverage on the benefits typical of plans currently offered by small businesses ? enshrining these skimpy plans as the new standard. These bare-bones policies come with a long list of uncovered services and saddle enrollees with unaffordable co-payments and deductibles. Already, millions of underinsured Americans forgo essential care: adults with heart attacks delay seeking emergency care; children forgo needed primary and specialty care; patients fail to fill prescriptions for lifesaving medications; and serious illness often leads to financial catastrophe. The inadequate coverage the IOM recommends would shift costs from corporate and government payers onto families already burdened by illness. Yet this strategy will not lower costs. Delaying care frequently creates even higher costs. Steadily rising co-payments and deductibles over the past two decades have failed to stem skyrocketing medical inflation. And nations that assure comprehensive coverage ? with out-of-pocket costs a fraction of those in the United States ? have experienced both slower cost growth and greater health gains than our country. Our patients urgently need what people in these other nations already enjoy: universal and comprehensive coverage in a nonprofit system that prioritizes human need over corporate profit. The IOM committee was riddled with conflicts of interest, many members having amassed personal wealth and career success through their involvement with health insurers and other for-profit health care firms. Its recommendations were lauded by insurance industry leaders who have sought to undermine real health reform at every turn. As the Lancet noted on its Dec. 5, 2009, cover: ?Corporate influence renders the U.S. government incapable of making policy on the basis of evidence and the public interest.? Sadly, the committee?s damaging recommendations suggest that this corporate bug has also infected the IOM. http://www.pnhp.org/iom-letter/index.php?UID=1348 -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From don at mccanne.org Mon Oct 17 13:14:08 2011 From: don at mccanne.org (Don McCanne) Date: Mon, 17 Oct 2011 10:14:08 -0700 Subject: [Health Care Action] qotd: The fundamental flaw with the IOM recommendation on benefits Message-ID: Institute of Medicine Essential Health Benefits: Balancing Coverage and Costs (2011) "The committee concludes that the EHB (Essential Health Benefits) should be defined as a package that will fall under a predefined cost target rather than building a package and then finding out what it would cost." (Section 4, page 7) http://books.nap.edu/openbook.php?record_id=13234&page=85 Comment: When the Institute of Medicine (IOM) released its recommendations on the method for determining essential health benefits for the private plans to be offered in the state insurance exchanges called for in the Accountable Care Act, advocates of comprehensive health care for everyone were quite disappointed, to say the least. When looking through this 300 page report for an explanation as to why they recommended such intolerably skimpy benefits, the one sentence above stands out. By predefining a specific cost target and then defining a benefit package to fit those costs, the committee explicitly has recommended that the new standard for health insurance in America should be a defined contribution rather than a defined benefit. This concept, which is permeating our public and private social programs, has been one of the most destructive to our unifying stance of social solidarity. Many have seen their pensions based on defined benefits being converted into individual plans in which contributions are defined but benefits are no longer guaranteed, being dependent on the variables of investment returns and, more importantly, the gamble that you won't outlive your personal account. (Of course, the annuity industry is quite willing to take a major portion of your account in exchange for guaranteeing you less generous payments for the remainder of your life.) The privatization health care schemes, such as the proposed voucher program for Medicare, also would provide a defined contribution to be used to purchase a skimpier, ill-defined benefit package, unless the individual contributes more personal funds that many simply do not have. The IOM recommendation for the exchange plans does the same. The standard defined contribution would be subsidies provided toward the price of a skimpy plan with inadequate benefits. If the individual wants a plan with adequate defined benefits, an additional personal contribution to the premium would be required to buy up to a better plan, again with the questionable assumption that the person has the funds. The media keep reporting that participants in Occupy Wall Street and similar demonstrations throughout the nation don't seem to know what they want. That is blatantly untrue. They want our economy to work not only for the top 1 percent, but for the other 99 percent of us as well. Taking away our defined benefits and substituting an inadequate contribution is precisely the the type of activity that has left middle-income Americans behind. Let's take a stand. Let's immediately let President Obama and Secretary Sebelius know that we won't tolerate this injustice. Then let's expand the protests into a national movement that returns America to the people. We may have to have a dialogue with the Tea Party people as to just what that means. It doesn't mean abandoning government, but rather it means taking control of our government so it works for the benefit of all of us - a defined benefit, if you'll permit. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From don at mccanne.org Tue Oct 18 11:54:24 2011 From: don at mccanne.org (Don McCanne) Date: Tue, 18 Oct 2011 08:54:24 -0700 Subject: [Health Care Action] qotd: The value of $100,000 drugs Message-ID: Bloomberg Businessweek October 14, 2011 UK medical group rejects new skin cancer treatment By Maria Cheng An independent British medical watchdog says the first treatment proven to help people with the deadliest form of skin cancer is too expensive to be used by the U.K.'s health care system, a recommendation critics called a potential death sentence. The drug, Bristol-Meyers Squibb's Yervoy, has offered some hope to people with advanced skin cancers, though a recent study showed it only worked in a small segment of patients studied, and they lived just four months longer than patients given older medications. The National Institute for Clinical Excellence, or NICE, advised Friday that at a cost of 80,000 pounds ($126,600) Yervoy "could not be considered a cost-effective use" of health funds. A final decision is expected next month after a public consultation. In the U.K., most medicines are paid for by the government, as long as they're recommended by the cost-efficiency watchdog. The agency commonly rejects expensive drugs, including recently advising against new treatments for prostate cancer, breast cancer, and multiple sclerosis, though patients and doctors are increasingly protesting the decisions. The government usually adopts NICE's recommendations, meaning doctors in the government-funded health service cannot prescribe Yervoy without NICE's approval. In its decision, NICE said it was not convinced by the evidence, saying the data for Yervoy, which works by stimulating the immune system to fight cancer, did not compare it to older drugs used to treat melanoma. NICE also said the trial was too short to know how long the drug's effects would last and raised concerns about the drug's side effects, including diarrhea, rash, fatigue and nausea, which they said could affect a patient's quality of life. "We need to be sure that new treatments provide sufficient benefits to justify the significant cost (the health care system) is being asked to pay," said Sir Andrew Dillon, NICE's chief executive, in a statement. Patient groups and charities slammed the decision, labeling it a "death sentence" for people with advanced skin cancer. http://www.businessweek.com/ap/financialnews/D9QC77O00.htm And... The Wall Street Journal October 14, 2011 U.K. Agency Rejects Bristol-Myers Skin Cancer Drug By Jonathan D. Rockoff and Sten Stovall Yervoy is expected to be a blockbuster for Bristol, with more than $1 billion in yearly sales. The therapy was approved in the U.S. in March and in Europe in July. It had $95 million in sales during the second quarter. Bristol CEO Lamberto Andreotti recently said the company was "very happy with the results so far" from the drug's uptake. "The price of Yervoy reflects the value of Yervoy," Mr. Andreotti added, at the Pharmaceutical Strategic Alliances conference in New York last month. http://online.wsj.com/article/SB10001424052970204002304576630891235750606.html And... National Institute for Health and Clinical Excellence (NICE) October 12, 2011 Melanoma (stage III or IV) - ipilimumab: appraisal consultation document Key conclusion Ipilimumab is not recommended for the treatment of advanced (unresectable or metastatic) malignant melanoma in people who have received prior therapy. The Committee was satisfied that ipilimumab meets the criteria for being a life-extending, end-of-life treatment and that the trial evidence presented for this consideration was robust. The Committee acknowledged that few advances had been made in the treatment of advanced melanoma in recent years and ipilimumab could be considered a significant innovation for a disease with a high unmet clinical need. Despite the combined value of these factors the Committee considered that the magnitude of additional weight that would need to be assigned to the QALY gains (quality-adjusted life years) for people with advanced (unresectable or metastatic) melanoma would be too great for ipilimumab to be considered a cost-effective use of NHS resources. http://guidance.nice.org.uk/TA/WaveCRS2/48/Consultation/DraftGuidance Comment: Should a $126,000 drug (Yervoy, ipilimumab) that produced only a very minimal benefit in a small segment of patients studied, yet caused significant side affects, be included in program that we finance? Is there no limit as to what we should add to coverage when our national health expenditures are already challenging individual, business and government budgets? When the CEO of the manufacturer of this drug says, "The price of Yervoy reflects the value of Yervoy," we should take a serious look at what constitutes value. That's precisely what NICE did. Their fairly detailed report should be read before endorsing "anything goes" health care. There is a limit. When we are picking up the tab, either through taxes for government programs or through premiums for private plans, we should be very concerned about how are funds are being spent. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From wmjwj at wmjwj.org Tue Oct 18 18:00:20 2011 From: wmjwj at wmjwj.org (WMass Jobs with Justice) Date: Tue, 18 Oct 2011 18:00:20 -0400 Subject: [Health Care Action] Verizon leafleting this week Message-ID: <020e01cc8de1$556f7e70$004e7b50$@org> Dear Workers' Rights Activists, Please let the Store Captains listed below know you are coming to leaflet about Verizon and corporate greed this week! Schedule below. Note that we are no longer doing the Wednesday 5-7pm shift. We would like to start up more midday shifts. Available? And our Verizon Street Heat committee meets Friday October 21, 9:30-11am, at IBEW Local 2324, 281 Cottage St, Springfield . And please sign the online Message of Solidarity . We leaflet regularly at the door at 360 Russell St, Hadley , 1123 Riverdale St, West Springfield , 1420 Boston Rd, Springfield , & 555 Hubbard Ave, Pittsfield . This week's schedule: Wednesday, Noon to 2pm, at the Hadley store: Please let Ryan Quinn know you are coming: rep at geouaw.org, 413-545-0705. Graduate Employees Organization/UAW 2324 has adopted this shift. Saturday, Noon to 2pm, at the Hadley store: Please let Jon Weissman know you are coming: jon at wmjwj.org, 413-827-0301. Saturday, 11am to 1pm, at the Pittsfield store: Please let Brian Morrison know you are coming: brian.morrison at state.ma.us, 413-281-3223. Berkshire Central Labor Council has adopted this shift. Saturday, Noon to 2pm,, at the Springfield store: Please let Kathy Collins know you are coming: kathy7157 at hotmail.com, 413-734-0863. Saturday, Noon to 2pm, at the West Springfield store: Please let Patrick Burke know you are coming: patrick at wmjwj.org, 413-454-5692. Join us! Please wear your organization's apparel and/or a red shirt/jacket, as the strikers did. Western Mass. Jobs with Justice will provide leaflets. It is important to point out that we are leafleting not picketing! Since the workers are not currently on strike, a picket would not be lawful. Instead, we are passing out flyers in front of Verizon stores and to customers of other stores nearby. If it looks like rain, we will make the decision to call it off by 9am and let you know by email. If we know you are coming, we can send the email to your cell phone as a text message if you send your phone number and name of carrier to wmjwj at wmjwj.org. You can call the Store Captains listed above to be sure, but it's better if you tell us in advance that you're coming and we'll call you. When we call off a planned leafleting shift, the captains will be there at the beginning to tell anyone who did not get the message, but we'll only wait 15 minutes. If this email was forwarded or copied to you, be sure to keep up-to-date on workers' rights campaigns by subscribing to the Workers' Rights List. To subscribe, send a blank email to workersrights-subscribe at lists.prometheuslabor.com or go to http://lists.wmjwj.org/mailman/listinfo/workersrights. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Jon Weissman, Coordinator Western Mass Jobs with Justice 640 Page Blvd #101 Springfield MA 01104 (413) 827-0301 Founded in 1987, Jobs with Justice's mission is to improve working people's standard of living, fight for job security, and protect workers' right to organize. We believe workers' rights are human rights and to be successful, we have to be part of a larger campaign for economic and social justice. To that end, "J with J" has created a national coalition and a network of local coalitions that connect labor, community, student, and faith-based organizations and activists on workplace and community social justice campaigns. Western Mass JwJ - founded June 5, 1993 - is now a coalition of almost 70 organizations. Let's keep in touch - please check out our mailing lists at http://wmjwj.org/our-lists. -------------- next part -------------- An HTML attachment was scrubbed... URL: From don at mccanne.org Wed Oct 19 07:35:14 2011 From: don at mccanne.org (Don McCanne) Date: Wed, 19 Oct 2011 04:35:14 -0700 Subject: [Health Care Action] qotd: Disarray of our health care workforce Message-ID: Health Resources and Services Administration (HRSA) National Center for Health Workforce Analysis For at least a decade, the United States has experienced worsening workforce shortages in the health professions. Analysts now are projecting a nationwide shortage of almost 100,000 physicians, as many as one million nurses, and 250,000 public health professionals by 2020. Due to the high cost of health insurance and increasingly pervasive staffing shortfalls in the health professions, at least 50 million Americans lack access to the most basic care. A third are children. http://bhpr.hrsa.gov/healthworkforce/ And... Bipartisan Policy Center October 18, 2011 The Complexities of National Health Care Workforce Planning Authored by a team from Deloitte Center for Health Solutions Background Establishing future workforce requirements is an inherently imprecise activity. Health care is a complex environment with many uncertainties affecting workforce supply and demand. Characterized by multiple stakeholders at the national, state and local levels and within professional, educational and other jurisdictions, the interdependencies between the groups that make up the health care sector are complicated. Moreover, efficient and effective workforce planning and deployment is inextricably linked to changes in demand for services, clinical technologies that facilitate diagnosis and treatment, payments that influence provider behaviors, workforce policies that frame licensing and scope of practice, as well as the overall structure of the system especially as it is impacted by the recently-passed Patient Protection and Affordable Care Act of 2010. Section Five of the Patient Protection and Affordable Health Care Act of 2010 emphasizes the need for strategies to increase workforce supply and capabilities, develop workforce diversity, and strengthen professional areas where supply is weak. These strategies are necessary to plan for a supply of professionals that is able to meet the changing demands of the health care system. Looking Ahead: Workforce Innovations in the U.S. National Health Workforce Commission: A 15-member committee (as yet unfunded) appointed by the General Accountability Office, the National Health Care Workforce Commission is required to review health care workforce supply and demand and make recommendations regarding national priorities and policy. Other areas of focus will involve review of the implementation of state health workforce development grants program and workforce development actions including career pathways, policies and practices regarding recruitment, retention and training of the health care workforce. Findings The U.S. health care industry is capital intense, highly regulated and labor intensive. These three factors complicate efforts to radically and/or quickly change its workforce composition. Health care consumes 17 percent of the U.S. gross domestic product (GDP), and the U.S. consistently spends more on health care per capita than other developed countries. As widely noted, health care costs exceed $9,000 per capita and will increase at six percent annually for the next decade. Innovative approaches to educating and training the health care workforce are imperative to effectively manage increased demand for services while reducing costs and improving quality. Traditional supply-demand analyses for the health care industry workforce fall short in addressing both objectives. Fragmented and inconsistent data collection, variance in methodological assumptions and rigor, mistrust between professional groups and wide differences in regulatory and educational context contribute to an incomplete understanding of workforce supply and demand. To ensure an adequate, effective workforce in the U.S. health care system, a fresh approach is critical. The National Health Workforce Commission as well as the National Center for Health Workforce Analysis are integral to the transformation of the US health care system. These bodies must lead in the creation of a solid methodological foundation upon which workforce shortages, demand and regulatory oversight must be constructed. http://www.bipartisanpolicy.org/sites/default/files/Workforce%20Study.pdf Comment: Health care consumes 17 percent of the U.S. gross domestic product, yet our health care workforce is in a terrible state of disarray. The fragmentation of our health care system makes it virtually impossible for the private sector to plan and coordinate the development of our health care workforce. This is exactly the type of need that requires government action and oversight. Yet the 15 member National Health Workforce Commission remains unfunded. Occupy Wall Street? Maybe it's time to Occupy Congress! -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From wmjwj at wmjwj.org Wed Oct 19 09:12:51 2011 From: wmjwj at wmjwj.org (WMass Jobs with Justice) Date: Wed, 19 Oct 2011 09:12:51 -0400 Subject: [Health Care Action] Verizon leafleting this week Message-ID: <016701cc8e60$d186f8b0$7494ea10$@org> Rain is expected at noon today and we are cancelling the Hadley store visit. Can you sign up for Saturday? From: WMass Jobs with Justice [mailto:wmjwj at wmjwj.org] Sent: Tuesday, October 18, 2011 6:00 PM Dear Workers' Rights Activists, Please let the Store Captains listed below know you are coming to leaflet about Verizon and corporate greed this week! Schedule below. Note that we are no longer doing the Wednesday 5-7pm shift. We would like to start up more midday shifts. Available? And our Verizon Street Heat committee meets Friday October 21, 9:30-11am, at IBEW Local 2324, 281 Cottage St, Springfield . And please sign the online Message of Solidarity . We leaflet regularly at the door at 360 Russell St, Hadley , 1123 Riverdale St, West Springfield , 1420 Boston Rd, Springfield , & 555 Hubbard Ave, Pittsfield . This week's schedule: Wednesday, Noon to 2pm, at the Hadley store: Please let Ryan Quinn know you are coming: rep at geouaw.org, 413-545-0705. Graduate Employees Organization/UAW 2324 has adopted this shift. Saturday, Noon to 2pm, at the Hadley store: Please let Jon Weissman know you are coming: jon at wmjwj.org, 413-827-0301. Saturday, 11am to 1pm, at the Pittsfield store: Please let Brian Morrison know you are coming: brian.morrison at state.ma.us, 413-281-3223. Berkshire Central Labor Council has adopted this shift. Saturday, Noon to 2pm,, at the Springfield store: Please let Kathy Collins know you are coming: kathy7157 at hotmail.com, 413-734-0863. Saturday, Noon to 2pm, at the West Springfield store: Please let Patrick Burke know you are coming: patrick at wmjwj.org, 413-454-5692. Join us! Please wear your organization's apparel and/or a red shirt/jacket, as the strikers did. Western Mass. Jobs with Justice will provide leaflets. It is important to point out that we are leafleting not picketing! Since the workers are not currently on strike, a picket would not be lawful. Instead, we are passing out flyers in front of Verizon stores and to customers of other stores nearby. If it looks like rain, we will make the decision to call it off by 9am and let you know by email. If we know you are coming, we can send the email to your cell phone as a text message if you send your phone number and name of carrier to wmjwj at wmjwj.org. You can call the Store Captains listed above to be sure, but it's better if you tell us in advance that you're coming and we'll call you. When we call off a planned leafleting shift, the captains will be there at the beginning to tell anyone who did not get the message, but we'll only wait 15 minutes. If this email was forwarded or copied to you, be sure to keep up-to-date on workers' rights campaigns by subscribing to the Workers' Rights List. To subscribe, send a blank email to workersrights-subscribe at lists.prometheuslabor.com or go to http://lists.wmjwj.org/mailman/listinfo/workersrights. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Jon Weissman, Coordinator Western Mass Jobs with Justice 640 Page Blvd #101 Springfield MA 01104 (413) 827-0301 Founded in 1987, Jobs with Justice's mission is to improve working people's standard of living, fight for job security, and protect workers' right to organize. We believe workers' rights are human rights and to be successful, we have to be part of a larger campaign for economic and social justice. To that end, "J with J" has created a national coalition and a network of local coalitions that connect labor, community, student, and faith-based organizations and activists on workplace and community social justice campaigns. Western Mass JwJ - founded June 5, 1993 - is now a coalition of almost 70 organizations. Let's keep in touch - please check out our mailing lists at http://wmjwj.org/our-lists. -------------- next part -------------- An HTML attachment was scrubbed... URL: From don at mccanne.org Thu Oct 20 10:21:52 2011 From: don at mccanne.org (Don McCanne) Date: Thu, 20 Oct 2011 07:21:52 -0700 Subject: [Health Care Action] qotd: Ratings plummet for Medicare drug plans serving low-income patients Message-ID: Avalere Health October 19, 2011 Lower Income Seniors See Star Ratings Drop in Available Medicare Prescription Drug Plans in 2012 According to a new Avalere Health analysis of the Centers for Medicare and Medicaid Services' (CMS) landscape file of the 2012 Medicare market, a high number of prescription drug plans (PDPs) eligible for auto-assignment of low income subsidy (LIS)-eligible beneficiaries will see a drop in their star ratings from 2011 to 2012. In 2012, 52 percent of LIS-eligible plans are rated 2 stars compared to only 3 percent in 2011. In 2011, 83 percent were rated 3 stars and 14 percent were rated 4-5 stars. In 2012, 43 percent are rated 3 stars, and only 5 percent are rated 4-5 stars. Avalere Health attributes this precipitous decline in star ratings to the new rating system established by CMS for 2012. The new system places a greater emphasis on clinical outcome measures like medication adherence. Previous year ratings emphasized more process-oriented measures such as how long a person was kept on hold when calling a plan for assistance. Moreover, unlike the Medicare Advantage program, which rewards plans with higher payments for achieving higher ratings, there is no payment incentive in Medicare Part D. http://www.avalerehealth.net/wm/show.php?c=&id=890 Comment: We can only speculate as to why there was a very dramatic decline in the star ratings earned by Medicare prescription drug plans serving low income subsidy (LIS)-eligible individuals. Was it because the plans simply don't care about this low income population as long as they get their business? Was it because there is no financial reward for Part D plans receiving higher star ratings? Was it because of the change in the measurements of a new rating system? If so, that would confirm the findings of other studies that have shown that when efforts are made to improve results on measured processes or outcomes ("teach to the test"), then less attention is paid to those processes and outcomes which are not measured. Suddenly adding in measurements of neglected processes and outcomes would certainly cause star ratings to plummet. Regardless of the explanation, we pay far more for the private sector to manage these plans, while our choices in products and providers are restricted, and value is diminished by the diversion of funds to these intrusive intermediaries that provide worthless services. They really do care only about their investors and not about us. It's time to replace them and the rest of the wasteful intermediaries with our own publicly-administered, improved Medicare for all. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From don at mccanne.org Fri Oct 21 07:52:00 2011 From: don at mccanne.org (Don McCanne) Date: Fri, 21 Oct 2011 04:52:00 -0700 Subject: [Health Care Action] qotd: Wal-Mart squeezes employee health benefits Message-ID: The New York Times October 20, 2011 Wal-Mart Cuts Some Health Care Benefits By Steven Greenhouse and Reed Abelson After trying to mollify its critics in recent years by offering better health care benefits to its employees, Wal-Mart is substantially rolling back coverage for part-time workers and significantly raising premiums for many full-time staff. Citing rising costs, Wal-Mart, the nation?s largest private employer, told its employees this week that all future part-time employees who work less than 24 hours a week on average will no longer qualify for any of the company?s health insurance plans. In addition, any new employees who average 24 hours to 33 hours a week will no longer be able to include a spouse as part of their health care plan, although children can still be covered. Wal-Mart also significantly reduced the amount of money it contributes to the savings accounts workers can use to pay for medical bills that are not covered under their plan. Last year, the company put $1,000 into accounts for families but it will cut the amount by half for next year to just $500. Barbara Collins, a sales associate at the Wal-Mart in Placerville, Calif., said that the premiums for the H.M.O. plan for herself and her 5-year-old son would rise to $18 every two weeks from $10. Her big concern, she said, was that her deductible would jump to $5,000 a year, from $1,000 ? a daunting amount considering she earns $19,000 a year. Dan Schlademan, director of Making Change at Walmart, a union-backed campaign, condemned the changes. ?No wonder people are protesting in the streets,? he said. ?This is another example of corporations putting profits ahead of what?s good for everyday Americans. It?s outrageous and damaging to many hard-working families that the biggest corporation in America is increasing health care costs for many employees by 40 percent.? http://www.nytimes.com/2011/10/21/business/wal-mart-cuts-some-health-care-benefits.html?_r=1&hp=&pagewanted=all And... Forbes September 21, 2011 The Richest People in America #6 Christy Walton $24.5B #9 Jim Walton $21.1B #10 Alice Walton $20.9B #11 S. Robson Walton $20.5B http://www.forbes.com/forbes-400/#p_2_s_arank_All%20industries_All%20states_All%20categories_ And... Social Security Online October 21, 2011 Wage Statistics for 2010 By definition, 50 percent of wage earners had net compensation less than or equal to the median wage, which is estimated to be $26,363.55 for 2010. http://www.ssa.gov/cgi-bin/netcomp.cgi?year=2010 Comment: A fundamental principle in the Affordable Care Act is that we would continue to rely very heavily on employer sponsored plans for the majority of health care coverage in America. How is that working? Wal-Mart, the nation's largest private employer, is increasing the insurance deductible to $5,000 for an employee earning $19,000 per year. Yet look at her employers. Four members of the Walton family are amongst the eleven wealthiest individuals in America, each worth over $20 billion. (Compare that with the Koch brothers, who own Congress, each worth $25 billion.) This is in a nation with a median wage of $26,364. Relying on employers to do the right thing no longer cuts it. Not only do they fail to pay enough, they can no longer be relied upon to see that their employees and their families receive adequate health benefits. It's time to enact an improved Medicare for all, even if we have to "Occupy Congress" to accomplish that. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From acswift at comcast.net Fri Oct 21 12:03:23 2011 From: acswift at comcast.net (Alice Swift) Date: Fri, 21 Oct 2011 12:03:23 -0400 Subject: [Health Care Action] Fwd: Healthcare for the 99%: Sun 10/23 speak-out, Wed 10/26 march In-Reply-To: <2020606545.646687.1319211038165.JavaMail.root@sz0009a.westchester.pa.mail.comcast.net> References: <76325779u.862595.laurie@pnhpnymetro.org> <2020606545.646687.1319211038165.JavaMail.root@sz0009a.westchester.pa.mail.comcast.net> Message-ID: ---------- Forwarded message ---------- From: Benjamin Day Date: Fri, Oct 21, 2011 at 11:30 AM Subject: Fwd: Healthcare for the 99%: Sun 10/23 speak-out, Wed 10/26 march -------- Original Message -------- Subject: Healthcare for the 99%: Sun 10/23 speak-out, Wed 10/26 march Date: Thu, 20 Oct 2011 22:27:31 -0400 (EDT) From: Laurie Wen, PNHP-NY Metro To: director at masscare.org Having trouble reading this email? View it in your browser. Dear Single Payer Supporters, Thank you for the outpouring of support for *Healthcare for the 99% *(formerly *Doctors for the 99%*.) PNHP-NY Metro has been actively working in solidarity with the Occupy Wall Street movement, which defends human needs against corporate greed. Collaborating with the National Physicians Alliance, Healthcare-NOW! NYC and other groups, in the last two weeks we have organized speak-outs, solidarity marches, and on-site volunteer health care. Board member Dr. Mary O'Brien speaks at last Saturday's speak-out rally for Healthcare for the 99%. Visit our new blog to see more photos, get updated info, and find more ways for health professionals to support OWS. To those who have volunteered to join the medical presence team: we will be in touch soon as we finalize our work structure and figure out ways to make the most of your contribution. If you'd like to receive additional action alerts regarding OWS support work (up to several a week), please contact organizing at pnhpnymetro.org *UPCOMING EVENTS:* - * Sunday, October 23 @ 4:00 PM *Our second* teach-in/speak-out @ *Zuccotti Park, the site of OWS. Meet at the red cube sculpture across the street, followed by * Healthcare for the 99% Working Group meeting** @ 5:30 PM. ** * Meet near the big red sticks (Cedar and Broadway). - *Wednesday, October 26 March against the Health Insurance Industry * - *@ 4:00 PM Open Speak-out*, Zuccotti Park - *@ 4:30 PM Protest *at Empire Blue Cross Blue Shield/Wellpoint, across from Zuccotti Park - *@ 5:30 PM March *to WellCare, 110 Fifth Ave at 16th St. - *@ 6:00 PM March *to St. Vincent's Hospital, 12th St at 7th Ave. * * please wear your white coats or scrubs!* *Doctors support Occupy Wall Street because we want our patients to be healthy.* We support OWS because the private health insurance industry exemplifies the central complaint of the OWS movement: unchecked corporate greed threatens human needs. We support OWS because economic and social inequalities make our patients sick. We support OWS because we?re tired of being ashamed when we have to treat our patients differently based on the types of insurance they have and what kinds of treatments they can ?afford.? We support OWS because we believe in facts and evidence, and facts and evidence show us that a profit-driven health insurance industry is unhealthy for everyone except for CEOs and stockholders of those companies. We support OWS because most of our legislators, held hostage by corporate money, consistently refuse to pass health policies that save lives and money, like single payer legislations. We support OWS because the health care economy?like the overall economy?has more than sufficient resources to take care of everyone, but everyone is not taken care of due to the unfair siphoning of resources by profit-driven corporations. We support OWS because we took the oath to do no harm, and our corrupt political and economic systems are doing all of us harm. We support OWS because we are hopeful that we can change our society. *Join us.** *Click here to become a member/renew your membership. * *Help us continue this important work: * * Sincerely, Laurie Wen Executive Director PNHP-NY Metro 220 Fifth Avenue, 2nd Floor New York, New York 10001 This email was sent to: director at masscare.org Unsubscribe | Subscribe| Forward to a Friend powered by MailerMailer -------------- next part -------------- An HTML attachment was scrubbed... URL: From don at mccanne.org Mon Oct 24 11:58:08 2011 From: don at mccanne.org (Don McCanne) Date: Mon, 24 Oct 2011 08:58:08 -0700 Subject: [Health Care Action] qotd: OECD/WHO report on the Swiss health system Message-ID: NOTE: The Swiss have a universal, highly regulated system of social insurance based on nonprofit private insurance plans. Many consider their system to be superior to ours and one that ours might eventually emulate. Though this message is long, you should save it if you don't have time to read it now. It explains why an "ideal" system based on private health plans is not such a great idea after all. Organization for Economic Cooperation and Development (OECD) OECD Reviews of Health Systems: Switzerland 2011 October 18, 2011 OECD, World Health Organization Chapter 2 - Health Insurance (Excerpts) In 1996, Switzerland implemented the Health Insurance Law (LAMal), which sought to achieve three main objectives: strengthening solidarity in the Swiss health system, containing health spending, and guaranteeing high-quality coverage. 2.1 General trends in the Swiss health insurance market The Swiss health insurance market relies on regulated competition based on a set of key principles: health insurers cannot make profits on contracts for mandatory health insurance, consumers have free choice of insurer, and insurers are compelled to accept any applicant. The benefit basket covered by health insurance is defined at national level for all insurees and health insurers must offer the same premium to all enrollees with the same health insurance contract provided they are in the same age category and same region. Health insurers can propose optional health insurance contracts which provide lower premiums in exchange for higher deductibles or "managed care" contracts. Insurers can also offer "bonus" contracts, where insurees receive premium reductions if they do not claim any reimbursement from their insurance fund. # Swiss health insurance offers comprehensive coverage of health care In principle, all medical treatments and diagnostics prescribed by doctors and dispensed by licensed professionals are covered, unless they are explicitly excluded from the benefit basket. Mandatory health insurance also covers the costs of medical care provided to patients receiving long-term care in institutions or at home. After paying a deductible, patients contribute to the cost of care through coinsurance rates - usually 10% of costs - up to an annual ceiling. "Rationing" has not been part of the political agenda. The level of user charges, however, is one of the highest in the OECD. # Consumers can choose between different options for health insurance plans Ordinary contracts offer the highest level of financial protection against health care spending but also have the highest level of premiums. Other forms of health insurance contracts offer lower premiums with either higher deductibles or restrictions in the choice of doctor or hospital. The take-up of ordinary plans has been continuously declining, first to the benefit of high-deductible health plans. However, since 2004, the popularity of plans with restricted choice of provider has increased dramatically, with the share of insurees choosing such plans (36.9%) now higher than ordinary plans (35.2%), high-deductible plans (27.9%) and bonus plans (0.1%). # Consumer choice has increased at cantonal level, in spite of market concentration nationally # Private supplementary health insurance covers one third of the population 2.2 The 1996 Health Insurance Law has strengthened solidarity, but health financing inequalities remain # Switzerland has reached universal coverage Health insurers have been required to refuse payment for health care bills presented by negligent defaulters (366,000) until they have fully recovered unpaid premiums and related interests. In March 2010, the parliament revised the law with the objective of protecting people facing serious financial problems for paying premiums. # Health insurance premiums vary widely across and within cantons These intra-cantonal premium differences persist because of insurers' risk-selection activities and also because relatively few insurees switch insurers from year to year, although this number has been rising recently. # Public subsidies help some individuals and families pay health insurance premiums By nature, non-income related premiums are very regressive. In 2008, premiums accounted for 11.8% of household income for the lowest income quartile and 3.4% for the highest income quartile. The LAMal requires premium reductions of at least 50% for children and young adults in training in low and middle income households, but lets cantonal authorities define the thresholds used to define "low and middle income." Sixteen cantons fix a maximum percentage of households' income to be spent on premiums and subsidise any additional amounts. While this limits the households' effective burden, premium payments remain regressive. It is worth noting that achieving horizontal equity in health financing is not an explicit policy goal in providing premium subsidies in Switzerland. Furthermore, subsidies do not address health financing inequities resulting in out-of-pocket expenditure, such as copayments and deductibles which are independent of household incomes. # Swiss patients face relatively high out-of-pocket payments for health care Per capita out-of-pocket payments in Switzerland are significantly higher than in all other OECD countries: they are 60% higher than the United States and almost three times as high as the OECD average. # Out-of-pocket payments are usually regressive and thus the least equitable means to finance health care. The fact that an increasing number of consumers are opting for high-deductible plans is very likely to increase user charges for "essential care" and weaken the solidarity of the health insurance system. # Contributions to the financing of health spending are inequitable # Financing health care is a high burden for low-income families There is some indication that people forego health services due to high out-of-pocket expenditure, and that this is related to socio-economic status. 2.3 Competition in health insurance markets does not deliver all its promises # Switching rates are still low, though increasing in the recent period # Fragmentation increases administrative costs and premiums Multiple fund systems, especially with small pools, often coincide with relatively higher administrative costs. Moreover, a risk equalisation mechanism also creates additional administrative costs. Switzerland has relatively higher administrative costs for both social and private health insurance. Those accounted for respectively 5.9% and 17.0% of total health insurance costs. # Health insurers mainly compete on risk-selection Van de Ven et al. (2007) listed possible strategies for insurers to select good risks despite their obligation to accept any applicant. The list includes: * Marketing through targeted advertisements aimed at the healthier. * Selective contracting with providers (i.e., in managed care contracts) likely to attract the healthier who are more willing to accept limited provider choice. * Designing complementary insurance benefits packages and setting premiums such that low-risk individuals are attracted. * Exclusively offering contracts with high deductibles, which will offset higher risk individuals. * Establishing insurance conglomerates to channel new enrollees to specific contracts depending on their health risks; this strategy most often works due to the huge number of different contracts on offer, limiting the consumer's ability to be fully informed. * Identifying high risks via a health status declaration for those seeking complementary insurance. * Delaying reimbursements for chronically ill persons in order to make them leave the insurance. * Terminating insurance activity in areas with any high-cost patients. Many of these strategies are indeed manageable options for Swiss health insurers. The extent to which they really use them is not easy to determine. # Managed care plans have taken off since 2006 but insurers only modestly "manage care" The extent to which current managed care networks increase quality and efficiency in health care delivery is not well known. By nature, the impact of managed care is difficult to assess and disentangle from risk-selection, since these specific forms of contracts are known to attract people with good health risk profiles. Thus, age and gender adjusted comparisons of health care spending of managed care policy holders and other insurees are not sufficient to estimate savings achieved through managed care. # The inclusion of another risk factor into the risk-equalisation formula is a good step but may not be enough Initially, the risk equalisation mechanism was based on two simple risk factors only: age and gender. A new and third risk factor - hospitalisation beyond three days in the previous year - has been included in the risk equalisation formula and will be applied from January 2012 onwards. While this new factor will not fully avoid risk selection, it will now also be profitable for insurers to invest in product innovation, i.e. further develop managed care contracts. (Single payer) The high levels of fragmentation in a country with a small population raises questions about a single health insurer. In theory, a single insurer could pool risks more effectively. In light of risk equalisation mechanisms that are imperfect as long as there remain incentives for risk selection, a single insurer might in principle better ensure health financing equity across the population and strong purchasing, in addition to a tendency for lower administrative costs. Moreover, it provides incentives to focus more on prevention. A single insurer system thus has some important advantages. However, it has also its drawbacks, since it eliminates consumer choice, may inhibit innovation in insurance products or risk under-provision and rationing care when negotiated prices are too low. Shifting from a multiple insurer system to a single insurer system is with no doubt a tremendous challenge, although Korea demonstrated that a step-wise merging into a single fund is possible. However, this is likely to be particularly difficult for Switzerland, which has a very long history of multiple insurers for over 100 years, a strong preference for choice, and as a reflection of its federalism, an attachment to cantonal organisation. Moreover, there are considerable transaction costs to consider, not least the question about where to place all staff from the current health insurers. Any such reform option thus needs to be critically assessed as to its overall financial implications, its practical implementation as well as political feasibility. In fact, the option of a single insurer in Switzerland has already been rejected several times so far by the population, although a new initiative was launched in 2011. OECD Reviews of Health Systems: Switzerland 2011 (160 pages): http://www.oecdbookshop.org/oecd/display.asp?sf1=identifiers&st1=9789264120907 Comment: It is not clear why so many in the U.S. are enamored of the Swiss health insurance system when this OECD/WHO report confirms that it is highly inefficient and fragmented, with profound administrative waste, inequitably funded, with regressive financing and with wide variations in premiums, has the highest out-of-pocket costs, has an increasing prevalence of managed care intrusions, and is controlled by a private insurance industry that has learned how to game risk selection at significant cost to those on the losing end. There is one bit of good news buried in this report. A single payer system would correct these deficiencies. Although the report mentions the drawbacks of eliminating consumer choice and inhibiting innovation in insurance products, these are actually advantages. The loss in consumer choice is the loss in the ability to choose from a large market of private health plans which often take away provider choice. Eliminating the plans returns choice of providers to the patient. Innovations in insurance products are designed to benefit the private insurers by gaming the system to the detriment of the patients. That's innovation that they can do without. The report also cautions that a single payer could "risk under-provision and rationing care when negotiated prices are too low." This is a criticism of single payer systems that does have some merit, but it ignores the fact that this risk is even greater in privately insured managed care models. All systems face capacity and access problems, but the public stewards of a single payer system are in a position to act in the public interest, whereas private insurers use tools to deliberately obstruct access in order to reduce spending. Public single payer stewards are much more capable than private insurers of using capacity refinement and queue management to reduce the risk of under-provision (rationing) of care. It is true that conservative fiscal hawks, when they are in control, continually threaten excessive budget constraints, but the behavior in the private sector is much worse as ever more of the costs are shifted to those with greater health care needs, creating a formidable financial barrier to care. Our U.S. system of inhumanely rationing care by ability to pay is far worse than systems that struggle with capacity and queues because of budgetary limitations, especially when you consider that we already have by far the largest per capita health care spending of all nations. The important take-home point is that an "ideal" social insurance program based on the mandatory purchase of highly regulated, nonprofit private health plans, such as that in Switzerland, is far from ideal in that it fails to prevent the flaws inherent in the private insurance model - including segmentation and fragmentation, costly administrative excesses and inefficiency, inequitable regressive financing, excessive premium variation, shifting of costs (risks) to patients in order to protect insurance plans, and, perhaps most fundamentally, rejecting a public service model in favor of a private business model that intrudes in the relationship of patients and their health care professionals and institutions by gaming the system for the primary purpose of achieving success as a business, while relegating serving patients to a secondary role. In 2007, even though the Swiss understood the advantages of a single payer system, they rejected it in a ballot measure. The predominant reason was that 70 percent of the Swiss were not willing to trade their private insurance plans, which were perceived to be functioning fairly well except for high premiums, for a public program for everyone that they feared would be like their existing health welfare program for the poor, which most believed was plagued by bureaucratic inefficiency and cost overruns. They feared that they would be worse off in such a public program. In their campaign against the single payer proposal, the organization representing Switzerland?s private health insurers, sant?suisse, deliberately mislead the public by modeling the single payer proposal as a welfare program that would be funded primarily by middle-income citizens, creating this widely held misperception that resulted in the measure's defeat. The Swiss voters will get another chance with a new initiative launched this year. The question is, when will we get our chance? -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From wmjwj at wmjwj.org Tue Oct 25 10:23:39 2011 From: wmjwj at wmjwj.org (WMass Jobs with Justice) Date: Tue, 25 Oct 2011 10:23:39 -0400 Subject: [Health Care Action] Verizon leafleting this week Message-ID: <043d01cc9321$b1994ec0$14cbec40$@org> Dear Workers' Rights Activists, Please let the Store Captains listed below know you are coming to leaflet about Verizon and corporate greed this week! See schedule below. Note that we are no longer doing the Wednesday 5-7pm shift. We would like to start up more midday shifts. Available? And our Verizon Street Heat committee meets Friday October 28, 9:30-10:30am, at IBEW Local 2324, 281 Cottage St, Springfield . And please sign the online Message of Solidarity . We leaflet regularly at the door at 360 Russell St, Hadley , 1123 Riverdale St, West Springfield , 1420 Boston Rd, Springfield , & 555 Hubbard Ave, Pittsfield . This week's schedule: Wednesday, Noon to 2pm, at the Hadley store: Please let Ryan Quinn know you are coming: rep at geouaw.org, 413-545-0705. Graduate Employees Organization/UAW 2324 has adopted this shift. Saturday, Noon to 2pm, at the Hadley store: Please let Jon Weissman know you are coming: jon at wmjwj.org, 413-827-0301. Saturday, 11am to 1pm, at the Pittsfield store: Please let Brian Morrison know you are coming: brian.morrison at state.ma.us, 413-281-3223. Berkshire Central Labor Council has adopted this shift. Saturday, Noon to 2pm,, at the Springfield store: Please let Kathy Collins know you are coming: kathy7157 at hotmail.com, 413-734-0863. Saturday, Noon to 2pm, at the West Springfield store: Please let Patrick Burke know you are coming: patrick at wmjwj.org, 413-454-5692. Join us! Please wear your organization's apparel and/or a red shirt/jacket, as the strikers did. Western Mass. Jobs with Justice will provide leaflets. It is important to point out that we are leafleting not picketing! Since the workers are not currently on strike, a picket would not be lawful. Instead, we are passing out flyers in front of Verizon stores and to customers of other stores nearby. If it looks like rain, we will make the decision to call it off by 9am and let you know by email. If we know you are coming, we can send the email to your cell phone as a text message if you send your phone number and name of carrier to wmjwj at wmjwj.org. You can call the Store Captains listed above to be sure, but it's better if you tell us in advance that you're coming and we'll call you. When we call off a planned leafleting shift, the captains will be there at the beginning to tell anyone who did not get the message, but we'll only wait 15 minutes. If this email was forwarded or copied to you, be sure to keep up-to-date on workers' rights campaigns by subscribing to the Workers' Rights List. To subscribe, send a blank email to workersrights-subscribe at lists.prometheuslabor.com or go to http://lists.wmjwj.org/mailman/listinfo/workersrights. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Jon Weissman, Coordinator Western Mass Jobs with Justice 640 Page Blvd #101 Springfield MA 01104 (413) 827-0301 Founded in 1987, Jobs with Justice's mission is to improve working people's standard of living, fight for job security, and protect workers' right to organize. We believe workers' rights are human rights and to be successful, we have to be part of a larger campaign for economic and social justice. To that end, "J with J" has created a national coalition and a network of local coalitions that connect labor, community, student, and faith-based organizations and activists on workplace and community social justice campaigns. Western Mass JwJ - founded June 5, 1993 - is now a coalition of almost 70 organizations. Let's keep in touch - please check out our mailing lists at http://wmjwj.org/our-lists. -------------- next part -------------- An HTML attachment was scrubbed... URL: From acswift at comcast.net Tue Oct 25 13:22:51 2011 From: acswift at comcast.net (Alice Swift) Date: Tue, 25 Oct 2011 13:22:51 -0400 Subject: [Health Care Action] Mass-Care Releases Comprehensive New Report on Mass. Health Reform In-Reply-To: <957299881.778769.1319562501119.JavaMail.root@sz0009a.westchester.pa.mail.comcast.net> References: <957299881.778769.1319562501119.JavaMail.root@sz0009a.westchester.pa.mail.comcast.net> Message-ID: This report has 33 pages with lots of charts, plus an extensive bibliography. I urge you to download the entire report even if you just skim it. Alice ---------- Forwarded message ---------- From: Mass-Care Announce Date: Tue, Oct 25, 2011 at 1:08 PM Subject: Mass-Care Releases Comprehensive New Report on Mass. Health Reform To: Mass-Care Announce Hello Single Payer Supporters - Mass-Care and Massachusetts PNHP today released a comprehensive new report on the outcomes of the Massachusetts Health Reform law, as well as analysis of 5 years of media coverage of the law. The results will surprise many: while Massachusetts reform has had some important beneficial impacts, covering about half of the uninsured and modestly improving access to care, these gains have come at a price: - Claims that health reform was a "shared responsibility" are disingenuous: rising costs after health reform have been disproportionately shouldered by lower-middle class families, letting the wealthy off the hook. - Small businesses have been particularly hard hit by health reform: quality health care coverage for small business employees all but disappeared in the years following health reform, and reform led to premiums for small employers rising more rapidly than in other states (7 percent faster for individuals and 14 percent faster for families). - Health reform accelerated the growth of administration in the Massachusetts health care system, by adding additional complexity to an already expensive and fragmented system. - Underinsurance has increased rapidly after health reform, with high-deductible plans tripling between 2006 and 2008. - Health reform and subsequent policy decisions have led to a financial crisis for the state's safety net hospitals and health clinics, which provide care for low-income and minority communities, despite growing demand for safety net care. Most of the newly insured previously had access to the state's safety net program for the uninsured (called the Free Care Pool), and certain income groups actually had better access to care when they were uninsured than under Commonwealth Care coverage. Although Massachusetts reform was largely paid for by federal taxpayers, the remaining costs were still high and unsustainable for the state, which has led the state to gradually roll back the Commonwealth Care program (by disenrolled thousands of documented immigrants, increasing the share beneficiaries who are forced to pay premiums, raising co-payments, imposing limited networks, and other strategies that shift costs on to low-income families). Furthermore, the state has regularly increased the share of income it claims residents can afford to spend on health care premiums, in an attempt to continue mandating people to purchase insurance. Lastly, the report uncovered a pattern of widespread media bias in coverage of the Massachusetts health reform law. Most media sources cite only the lowest estimates of the uninsured in Massachusetts, although these have been demonstrated as inaccurate. It is also common for the media to perpetuate inaccurate myths about uninsured residents' use of emergency rooms, and to project savings from health reform that never materialized: even as half of the uninsured gained some form of insurance coverage, emergency room use and preventable or avoidable emergency room use continued to rise. Health reform has also failed to significantly reduce the share of families facing medical debt or facing health-related bankruptcy. You can download the report in its entirety here: http://masscare.org/massachusetts-health-reform-in-practice/ _______________________________________________ Mass-Care: The Massachusetts Campaign for Single Payer Health Care 33 Harrison Ave - 5th floor Boston, MA 02111 Ph: 617-723-7001 Fx: 617-723-7002 Em: info at masscare.org -------------- next part -------------- An HTML attachment was scrubbed... URL: From don at mccanne.org Tue Oct 25 15:08:18 2011 From: don at mccanne.org (Don McCanne) Date: Tue, 25 Oct 2011 12:08:18 -0700 Subject: [Health Care Action] qotd: The fundamental flaws in the Massachusetts (and ACA) model Message-ID: Mass-Care Massachusetts Physicians for a National Health Program October 2011 The Massachusetts Model of Health Reform in Practice The reform has not addressed the health care crisis that most Massachusetts residents face, and that renders our entire health care system increasingly unaffordable. Health care costs ? which are straining employer and household budgets, edging out all other spending priorities by the state and municipalities ? have increased at even more rapid rates following reform. Administrative waste in the system has grown as a consequence of introducing new payers into an already bureaucratic health care system. Cost shifting under employer-sponsored insurance, particularly for small business employees, has accelerated. Reform has not achieved universal coverage, despite the mandate, largely because the state has been unable to ensure that truly affordable plans are available. Reform has not reduced the burden of medical bills or medical bankruptcy on Massachusetts' families. The demand for safety net services by the uninsured and underinsured has remained high, and has begun to grow, while reform and subsequent state policy has created a financial crisis for safety net providers serving low-income and minority communities in the state. Reform has not been able to significantly slow the rising use of emergency departments for care. Most concerning, the modest gains achieved by the reform have come at a high cost ? even after the state has successfully shifted many of these costs on to federal taxpayers. The costs of the reform are widely acknowledged to be unsustainable and the state has been forced to restrict benefits and shift costs to residents, employers, and federal taxpayers as a consequence. This may help explain the declining support for reform noted in recent years. Moreover, the costs of the reform have not been born equitably, with low and middle income individuals bearing a disproportionate share of the costs. The Massachusetts reform has not addressed the fundamental deficiencies in the health care system. The reform contained no proven or robust cost-control measures and thus the state has had to struggle to afford expanded coverage in the face of unsustainable cost increases. The Massachusetts reform introduced new programs and rules to an already complex blend of public and private insurers, leaving the state with increasing administrative complexity ? and increasing costs. There is every reason to believe that the recently passed national reform law based on the Massachusetts reform (The Affordable Care Act) will result in similar mixed outcomes. Our hope is for an equitably financed health care system that serves all Americans in a cost-effective way, without requiring cost-sharing that prohibits needed care. A Massachusetts-style reform will not achieve these goals. http://masscare.org/wp-content/uploads/2011/10/masshealthreforminpracticefinal.pdf Comment: The Massachusetts plan has been successful only in nominally increasing the numbers of individuals insured, but at a trade-off of making almost everything else worse, including the insurance coverage itself. The federal Affordable Care Act (ACA) used the Massachusetts model, and experience with the implementation to date indicates that we can expect the same or similar fundamental deficiencies, making unaffordable under-insurance the new national standard. In a PNHP press release, Dr. Rachel Nardin, assistant professor of neurology at Harvard Medical School and co-author of this study, stated, "The Massachusetts reform built on a complex blend of public and private insurers, adding to the administrative complexity and cost of the system. To achieve cost-effective, high-quality and truly universal care, we need a single-payer system." To better understand why the Massachusetts/ACA model can't work, it would be worthwhile to read the full 46 page report, accessible at the link above. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From don at mccanne.org Wed Oct 26 16:40:59 2011 From: don at mccanne.org (Don McCanne) Date: Wed, 26 Oct 2011 13:40:59 -0700 Subject: [Health Care Action] qotd: Curing the economy: health consumer spending Message-ID: The New York Times October 25, 2011 It?s Consumer Spending, Stupid By James Livingston AS an economic historian who has been studying American capitalism for 35 years, I?m going to let you in on the best-kept secret of the last century: private investment ? that is, using business profits to increase productivity and output ? doesn?t actually drive economic growth. Consumer debt and government spending do. Private investment isn?t even necessary to promote growth. This is, to put it mildly, a controversial claim. Economists will tell you that private business investment causes growth because it pays for the new plant or equipment that creates jobs, improves labor productivity and increases workers? incomes. As a result, you?ll hear politicians insisting that more incentives for private investors ? lower taxes on corporate profits ? will lead to faster and better-balanced growth. The general public seems to agree. According to a New York Times/CBS News poll in May, a majority of Americans believe that increased corporate taxes ?would discourage American companies from creating jobs.? But history shows that this is wrong. Between 1900 and 2000, real gross domestic product per capita (the output of goods and services per person) grew more than 600 percent. Meanwhile, net business investment declined 70 percent as a share of G.D.P. What?s more, in 1900 almost all investment came from the private sector ? from companies, not from government ? whereas in 2000, most investment was either from government spending (out of tax revenues) or ?residential investment,? which means consumer spending on housing, rather than business expenditure on plants, equipment and labor. In other words, over the course of the last century, net business investment atrophied while G.D.P. per capita increased spectacularly. And the source of that growth? Increased consumer spending, coupled with and amplified by government outlays. The architects of the Reagan revolution tried to reverse these trends as a cure for the stagflation of the 1970s, but couldn?t. In fact, private or business investment kept declining in the ?80s and after. Peter G. Peterson, a former commerce secretary, complained that real growth after 1982 ? after President Ronald Reagan cut corporate tax rates ? coincided with ?by far the weakest net investment effort in our postwar history.? President George W. Bush?s tax cuts had similar effects between 2001 and 2007: real growth in the absence of new investment. According to the Organization for Economic Cooperation and Development, retained corporate earnings that remain uninvested are now close to 8 percent of G.D.P., a staggering sum in view of the unemployment crisis we face. So corporate profits do not drive economic growth ? they?re just restless sums of surplus capital, ready to flood speculative markets at home and abroad. In the 1920s, they inflated the stock market bubble, and then caused the Great Crash. Since the Reagan revolution, these superfluous profits have fed corporate mergers and takeovers, driven the dot-com craze, financed the ?shadow banking? system of hedge funds and securitized investment vehicles, fueled monetary meltdowns in every hemisphere and inflated the housing bubble. Why, then, do so many Americans support cutting taxes on corporate profits while insisting that thrift is the cure for what ails the rest of us, as individuals and a nation? Why have the 99 percent looked to the 1 percent for leadership when it comes to our economic future? A big part of the problem is that we doubt the moral worth of consumer culture. Like the abstemious ant who scolds the feckless grasshopper as winter approaches, we think that saving is the right thing to do. Even as we shop with abandon, we feel that if only we could contain our unruly desires, we?d be committing ourselves to a better future. But we?re wrong. Consumer spending is not only the key to economic recovery in the short term; it?s also necessary for balanced growth in the long term. If our goal is to repair our damaged economy, we should bank on consumer culture ? and that entails a redistribution of income away from profits toward wages, enabled by tax policy and enforced by government spending. (The increased trade deficit that might result should not deter us, since a large portion of manufactured imports come from American-owned multinational corporations that operate overseas.) We don?t need the traders and the C.E.O.?s and the analysts ? the 1 percent ? to collect and manage our savings. Instead, we consumers need to save less and spend more in the name of a better future. We don?t need to silence the ant, but we?d better start listening to the grasshopper. (James Livingston, a professor of history at Rutgers, is the author of ?Against Thrift: Why Consumer Culture Is Good for the Economy, the Environment and Your Soul.?) http://www.nytimes.com/2011/10/26/opinion/its-consumer-spending-stupid.html Comment: According to Professor James Livingston, the key to economic recovery is to use tax policy and government spending to redistribute income away from profits and toward wages so that it can be spent on products and services. So what does this have to do with health care? Our current national policies have moved us in the wrong direction. The tax burden in the United States is one of the lowest of OECD nations. We are told that taxes need to be reduced further to enhance profits that can then be reinvested in our economy. Yet those profits are not being directed to consumer spending. Instead this surplus capital has been used in financial markets to wreak havoc on our economy. The billionaires scoop up more funds while the consumers have even less income to spend. What we need is an infusion of more funds into the economy - spending on real products and services, not on destructive financial instruments. Health care is one of the most, if not the most, valuable sectors of our economy. Spending on health care is one of the better things that we can do. Yet our current policies are directed to shifting more of the costs to individuals with health care needs, with the result that there will be a decrease in health care purchasing simply because the health care consumer doesn't have enough money. Cutting back on spending in Medicare and Medicaid, and shifting to the new standard of unaffordable private underinsurance plans called for in the Affordable Care Act will deprive this important, beneficial sector of our economy of much needed consumer/government funds. It has long been recognized that health care financing must be progressive if we are going to provide essential care for everyone. The retained corporate earnings and other stashes of wealth are crying out to be tapped to be moved back into our economy, whether it's for health care or for the multitude of other essential needs that should be met in a well functioning society. For the health care sector of our economy, we need equitable tax policies and government spending. An improved Medicare for all would work just fine. It would be good for our economy, and good for the health of each and everyone of us. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From don at mccanne.org Thu Oct 27 08:42:46 2011 From: don at mccanne.org (Don McCanne) Date: Thu, 27 Oct 2011 05:42:46 -0700 Subject: [Health Care Action] qotd: "Family penalty" built into reform Message-ID: The Hill October 27, 2011 Healthcare reform penalizes married couples, says report By Julian Pecquet The report concludes that fewer than 2 million couples ? out of 60 million nationwide ? are projected to benefit from the insurance subsidies, while ?almost half of the beneficiaries of the tax credit will be unmarried individuals without dependent children.? One reason is that subsidies, which start in 2014, are tied to the federal poverty level, which does not increase proportionally along with household size. Another problem is a snafu in the law that The Hill first reported back in July. The law offers insurance subsidies for workers if their employer doesn?t provide affordable coverage, but proposed regulations released in August peg that affordability to individual, not family, coverage. As a result, a worker?s spouse and children would not have access to subsidies if that worker were offered affordable coverage ? even if the worker could not afford the family coverage offered by the employer. The American Academy of Pediatrics is spearheading a sign-on letter to the Centers for Medicare and Medicaid Services (CMS) that decries a ?family penalty? that will ?negatively impact the opportunity to access quality health insurance for significant numbers of children.? http://thehill.com/homenews/house/190105-healthcare-reform-penalizes-married-couples-says-report Comment: This is yet one more example of the fundamental strategic flaw of trying to design reform to fit a fragmented system of private health plans and public programs. Instead of a complex set of rules which are designed to protect the insurance industry, it would have been so much easier and much more efficient to design reform around the patient instead by simply declaring that everyone is covered by a single comprehensive program that is equitably funded. We can still do that. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From calendar at wmjwj.org Thu Oct 27 19:20:53 2011 From: calendar at wmjwj.org (=?us-ascii?Q?Workers'_Rights_Calendar?=) Date: Thu, 27 Oct 2011 19:20:53 -0400 Subject: [Health Care Action] OCCUPY SPRINGFIELD 10/29 + Message-ID: <02b901cc94ff$135412b0$39fc3810$@org> Saturday October 29 OCCUPY SPRINGFIELD 12-6 pm, Court Square. Rally 12-5pm. General Assembly 5-6pm. Needs donations of food, beverages, and supplies for posters and signs. SOME OTHER OCCUPY EVENTS: Check out the Robin Hood promo video calling for Merry Bands across the globe to join Occupy Wall Street's call for a #RobinHood March on Saturday October 29th . Occupy UMass: NATIONAL SCHOOL WALKOUT: Friday October 28, Noon-3pm. Meet at W.E.B. Dubois Library, march throughout campus. Info: Ben Taylor, bftaylor at student.umass.edu. Occupy Northampton: every day. General assembly Tuesday-Thursday 8pm, Friday-Monday 4pm. Protesting on Main Street every day 5-8pm. Saturday October 29: 11am to 1pm at Pulaski Park. Go to: http://www.occupynorthampton.com/ Email: sethn91184 at yahoo.com Occupy Amherst: Wednesdays 5pm & Sundays 12pm, on the Town Common. Email: occupyamherst at gmail.com. Go to: http://www.occupyamherst.com Occupy Greenfield: on the Greenfield Common every Monday 5-6pm. Info: Joe Kurland & Peggy Davis, yosl at ganeydn.com. Occupy Oakland: GENERAL STRIKE Wednesday November 2: http://www.occupyoakland.org/2011/10/general-strike-mass-day-of-action/. Two-term Iraq (4 years) vet, Scot Olsen, was shot in the head with a rubber projectile at Occupy Oakland. He was knocked unconscious and when a crowd rushed to help him, the police threw a flash bomb at the group. Olsen remains unconscious and is in critical condition with his brain swelling, expanding. http://www.youtube.com/watch?v=z0bNx6kYAdI http://www.youtube.com/watch?v=xWXm3cd5S-o More at http://www.occupytogether.org/. -------------- next part -------------- An HTML attachment was scrubbed... URL: From don at mccanne.org Fri Oct 28 10:56:31 2011 From: don at mccanne.org (Don McCanne) Date: Fri, 28 Oct 2011 07:56:31 -0700 Subject: [Health Care Action] qotd: Obama administration approves virtual destruction of Medicaid Message-ID: Los Angeles Times October 28, 2011 California gets OK for large cuts to Medi-Cal By Anna Gorman The Obama administration will allow California to cut hundreds of millions of dollars from Medi-Cal, a move doctors and experts say will make it harder for the poor to get medical treatment. California plans to reduce rates by 10% to many providers, including physicians, dentists, clinics, pharmacies and most nursing homes, the Centers for Medicare and Medicaid Services announced Thursday. Cindy Mann, deputy administrator of the Centers for Medicare and Medicaid Services, told reporters the action gives California the flexibility it had requested to address its budget shortfall. "We know that the reductions that are being approved today will have significant impact on affected providers, and we regret the very difficult budget circumstances that have led to their implementation," she said. California, which already spends less per beneficiary than any other state, has led the way in aggressively slashing its programs. Now the government's decision to allow California to move forward with its plans sets a precedent for other states seeking to reduce their Medicaid bills. The California Medical Assn. expressed frustration over the new cuts, saying that physicians could receive as little as $11 a visit. Doctors will have no choice but to stop seeing Medi-Cal patients, said CEO Dustin Corcoran. "You can't pay the bills at these rates," he said. "They are unconscionably low." Federal healthcare reform, which includes a massive expansion of Medicaid, also could be seriously hampered by this new round of cuts, Corcoran said. "They built federal healthcare reform on the foundation of Medi-Cal, and they just destroyed that foundation," he said. "We have a hard time seeing how healthcare reform has a chance of being successful in the state of California after these cuts are implemented." http://www.latimes.com/news/local/la-me-medicaid-20111028,0,4273464.story Comment: One of the most important components of the Affordable Care Act is the expansion of Medicaid coverage for uninsured, low-income individuals. Does the Obama administration seriously believe that this will be an effective step toward bringing affordable health care to everyone? Look at what they just approved for California. The state already spends less per Medicaid (Medi-Cal) beneficiary than any other state, yet the Obama administration has approved another 10 percent reduction. Just wait until the budget cutters in other states get wind of this! Theoretically, drastic payment reductions are met by further ratcheting down overhead expenses. At $11 per office visit, only a fraction of expenses can be covered, no matter how stringent the budgeting. In essence, the government is asking providers to help finance Medicaid through their own personal charity. Trying to cover 7.6 million Medi-Cal patients in the state by depending on provider charity is asking more than the system can bear. Two quotes above need to be repeated. Cindy Mann, deputy administrator of the Centers for Medicare and Medicaid Services: "We know that the reductions that are being approved today will have significant impact on affected providers." Dustin Corcoran, CEO of the California Medical Association: "They built federal healthcare reform on the foundation of Medi-Cal, and they just destroyed that foundation." And the other major component of the Affordable Care Act? A mandate for individuals to purchase inadequate coverage by paying unaffordable premiums. The Obama administration officials and their co-conspirators in Congress could not have been serious about bringing us real reform. If they were, we would have an improved Medicare covering everyone. Physicians for a National Health Program and the American Public Health Association are currently holding their national meetings in Washington, D.C. We need to go to Freedom Plaza and join the Occupy Movement. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day From don at mccanne.org Mon Oct 31 17:11:28 2011 From: don at mccanne.org (Don McCanne) Date: Mon, 31 Oct 2011 14:11:28 -0700 Subject: [Health Care Action] qotd: Insurers obliterate distinction between health plans and stop-loss insurance Message-ID: Business Insurance October 30, 2011 Self-funded health plans under attack in New Jersey By Joanne Wojcik In an Oct. 25 letter to Thomas Considine, commissioner of the New Jersey Department of Banking and Insurance, the Self-Insurance Institute of America Inc. asked the department to rescind a bulletin it issued this month that alleges stop-loss insurers are ?cherry-picking? employer groups with good claims experience. The Oct. 3 bulletin alleges that the insurers, which write excess coverage for self-funded group benefit plans, are ?selectively marketing coverage to small employers on the basis of health history of that employer's employees, and denying coverage to employers based on employee health status. The result of this selective underwriting is to "cherry-pick' groups less likely to incur claims, leaving the groups more likely to incur claims to the state's guaranteed-issue insured market. This, in turn, drives premiums up for small employers purchasing insured plans.? Because stop-loss insurance is excluded from the state's definition of a health benefit plan, it is not subject to the same regulations as fully insured health coverage, the bulletin states. Therefore, the department has invoked New Jersey's unfair trade practice law, asserting that ?the selective marketing and underwriting described herein constitutes an unfair trade practice.? Simpsonville, S.C.-based SIIA asserts that the department's contention is ?inflammatory and without merit. Stop-loss insurance is a completely different product than commercial health insurance, so it is misguided to conclude that "unfair competition' exists,? SIIA said in its letter. The Employee Retirement Income Security Act's ?regulatory exemption for self-insured (self-funded) plans is a persistent thorn in the side of state insurance regulators,? according to a September statement by Timothy Stoltzfus Jost, a law professor from Washington and Lee University School of Law in Lexington, Va., to the NAIC's ERISA (B) Subgroup. ?This may be acceptable for large employer groups, which have the bargaining power and expertise to protect their employees. But when small-employer packages purchase "self-insured' packages from insurers, including stop-loss coverage with very low attachment points and administrative services, they are essentially purchasing conventional health insurance, except that it is free from state regulation,? Mr. Jost said. Moreover, he said ?insurers have always had an incentive to market "self-insurance' to healthy groups, and small businesses with healthy enrollees have always had an incentive to purchase it. The Affordable Care Act, however, increases these incentives...Insurers understand this and are very actively marketing "self-insured' products to small groups.? http://www.businessinsurance.com/article/20111030/NEWS05/310309989?tags=%7C74%7C305%7C339 Comment: For smaller employers who want to self-insure their health benefit programs, stop-loss insurance is an imperative. A very large medical bill for one employee or family member could bankrupt a small business. This need to protect against large losses has created a thriving market in self-insured packages from insurers, which escape health plan regulation, yet are beginning to look more like conventional health insurance with extremely high deductibles. These plans not only provide stop loss coverage at a "low attachment point," they are now providing administrative services for the employers' self-insured plans, paying employees' medical expenses using the employers' funds. The attachment point - the level at which losses begin to be covered by the insurer - may be $40,000. That is a very low level for a stop-loss plan. Some conventional health plans have deductibles of $50,000. That blurs the distinction between a high deductible in a health insurance plan and a low attachment point in a stop-loss plan. What is happening is obvious. The insurers are selling these "self-insured packages" as stop-loss plans, avoiding the regulatory oversight for health plans. Yet they actually function as health plans with very high deductibles. Why does it matter? The insurers can avoid new regulations that prohibit medical underwriting. They are able to cherry pick - limiting the sale of these plans only to businesses with healthy employees, shifting the costs of higher risk employee pools to other programs with guaranteed issue. As Timothy Stoltzfus Jost states, "insurers have always had an incentive to market 'self-insurance' to healthy groups, and small businesses with healthy enrollees have always had an incentive to purchase it. The Affordable Care Act, however, increases these incentives...Insurers understand this and are very actively marketing 'self-insured' products to small groups." The private insurers have an absolute moral obligation to enhance value for their investors, and they must always make every effort to do so. The fault lies not with the private insurers themselves but with a financing model that is dependent on insurers. We need to change the model, switching to a single public insurer. -------------- next part -------------- An HTML attachment was scrubbed... URL: -------------- next part -------------- _______________________________________________ Quote-of-the-day mailing list Quote-of-the-day at mccanne.org http://two.pairlist.net/mailman/listinfo/quote-of-the-day