Posts Tagged ‘DR.’

Sundance Documentary Focuses on America’s Broken Healthcare System

January 25th, 2012

Why does the United States still maintain a bloated, inefficient and outrageously expensive healthcare system? The new documentary, Escape Fire: The Fight to Rescue American Healthcare, which is premiering at this week’s Sundance Film Festival in Park City, Utah, examines the powerful forces driving America’s high medical costs, and how health providers are trying to find ways to save money by focusing on prevention. Below is a Democracy Now! interview with Dr. Steven Nissen, who appears in the film.

I haven’t yet seen Escape Fire – other than the trailer – but I’m hoping that the film goes beyond the usual Band-Aid solutions for cutting costs, and explores the need for systemic change, like implementing a national public health insurance program.

Escape Fire‘s premiere in Park City comes amid the sad irony surrounding the tragic death of Canadian freestyle skier and Olympic hopeful, Sarah Burke. Burke was killed in a training accident at the Park City Mountain resort. She was in a coma for several days before her death. But because the accident happened in the U.S., and not in Burke’s native Canada, her family is now saddled with over half a million dollars in medical bills. Healthcare advocate Wendell Potter wrote about the Burke tragedy in a poignant blog post, which includes information on where to send donations to the family.

Healthcare Reform 2.0 – Woolhandler and Himmelstein

December 13th, 2011

Healthcare Reform 2.0

By Steffie Woolhandler, MD, MPH and David Himmelstein, MD

CUNY School of Public Health, Social Research, Fall 2011

So while the American people want an expanded and improved Medicare for All — that is, a single-payer system — corporations dead-set against single-payer reform have come to dictate the agendas of both political parties. Hence, the only way to win national health insurance is to build a popular movement to counter corporate power.“healthcare-reform-2-0″-in-the-fall-2011-issue-of-social-research/

Healthcare Reform 2.0 (12 pages):


By Don McCanne, MD

This brief primer (9 short pages plus references) on Healthcare Reform 2.0 will provide little new information for those who have followed the research and educational efforts of the leadership of Physicians for a National Health Program. Nevertheless, it should be downloaded to be used as an advocacy piece to explain to others why Healthcare Reform 1.0 (Affordable Care Act) will remain a failure, and why we have to move on to Healthcare Reform 2.0 (expanded and improved Medicare for All). By distributing this, electronically or in hard copy, you can become a part of the popular movement to counter corporate power.

Re-posted with permission from

Don McCanne, MD: Preventing the implosion of the Los Angeles County safety-net

October 24th, 2011

L.A. County expands no-cost healthcare

By Anna Gorman

Los Angeles Times, October 9, 2011

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.,0,4242519.story


By Don McCanne, MD

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.

Re-posted with permission from

Don McCanne, MD: Consensus on the constitutionality of Medicare for all

October 12th, 2011

Some Common Ground for Legal Adversaries on Health Care

By Adam Liptak

The New York Times, September 29, 2011

The 2010 health care overhaul law has provoked an unprecedented clash between the federal government and 26 states, dividing them on fundamental questions about the very structure of the federal system. But the two sides share a surprising amount of common ground, too, starting with their agreement in briefs, filed on Wednesday, that the Supreme Court should resolve the clash in its current term.

Their briefs also reflect agreement on matters of substance. The two sides, along with the judges in the majority in the appeals court decision most likely to be reviewed by the justices, all said the dispute is about means rather than ends. There are other ways, they said, for Congress to achieve near-universal health coverage, some of them more expansive than what was enacted.

“Both sides agree that Congress has the constitutional power to enact a national health care system that raised taxes to support a single government agency that pays all medical bills, just like Medicare,” said Walter Dellinger, who served as acting solicitor general in the administration of President Bill Clinton and supports the law.

Randy E. Barnett, a lawyer for some of the plaintiffs who on Wednesday sought Supreme Court review, made essentially the same point. “What I’ve said from Day 1,” he said, “is that if Medicare is constitutional then Medicare-for-everyone is constitutional.”


By Don McCanne, MD

The Affordable Care Act represents the most expensive model of reform and yet falls short on universality and affordability, and now it is being challenged as a violation of the Constitution. Why are we defending it when the least expensive model that actually would accomplish our goals has been declared by all parties to be compliant with the Constitution?

Fast tracking the decision is great. Once the legal issues are dispensed with, we can look at the mess we have left, reject it, and move on to enacting an improved Medicare for all.

Additional comment from Merrill Goozner:

What’s interesting about rising insurance premiums is that they are way out of line with the rise in costs, which was only around 4% last year in nominal dollars, which in inflation-adjusted dollars would be just a 2% increase. Both Medicare total expenditures and insurance total expenditures rose (which, after adjusting for inflation was the same rate as economic growth; GDP rose 2.6% in 2010). It was one of the lowest increases in decades, as health care’s share of the economy did not increase for the first time in many years.

So why the hike in premiums. A Goldman Sachs analyst quoted in the WSJ story earlier this week attributed the outsized premium increases to insurance
companies padding their bottom lines.

I blogged on it here:

Re-posted with permission from