Stanley and Betty Sheinbaum explain what single payer means. All the health care premiums go into one pot and from that pot all health care providers including doctors, hospitals, even dentists are paid. Single payer California OneCare is the health care plan that makes sense.
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Many of us can lose our health insurance coverage if we change or lose jobs. For freelancers like actor David Clennon, the fear is even worse because his coverage depends on how much he earns in any given year. He’s been lucky so far, but if he had a bad year, he’d lose his coverage for himself and his family–a scary thought. The tragedy is that there are nearly seven million Californians who are already without coverage. Single payer, California OneCare would cover everybody, regardless of job status.
The plight of Michael Bell’s 92-year-old mother reminds us that while Medicare is good, it doesn’t go far enough in protecting our seniors from the escalating costs of prescription drugs, especially if they are in the “donut hole” and on their own. Single payer, California OneCare, not only provides prescription drug coverage for all, but it also means coverage for hearing aids, eye care, home health care, adult day care, hospice care and much more.
Tyrone Giordano, an actor, uses American Sign Language to explain that many people don’t have health insurance because their jobs don’t offer it or they can’t afford it. “That’s just not right,”
I have seen first hand how critical the healthcare crisis is. Unfortunately, mental illness runs in my family. Two of my relatives are on the antipsychotic drug, Zyprexa. This is truly a miracle drug, and it suppresses psychotic symptoms – completely, in some cases.
My older relative is on Medicare and a Medicare Supplement. She is in the “donut hole,” and now has to pay $430 for a month’s supply of the pills. My younger relative had a devestating mental breakdown when he was 18, and has been on Zyprexa ever since. Because he also suffers from anxiety, he takes two pills per night. He has done very well on Zyprexa, and is an honor student in college. He has been symptom-free for five years. However, now that he turned 23, he is no longer covered by the family’s insurance and must pay over $1,000 per month for his Zyprexa.
It doesn’t seem fair that people who suffer from mental illness and desperately need their medication in order to live a normal life are being discriminated against by insurance companies. Also, to charge $1,000 for a month’s supply of pills for any ailment strikes me as price gouging.
Sue Gunther
Dr. John Geyman, Professor Emeritus of Family Medicine at the University of Washington School of Medicine in Seattle writes in The Huffington Post that the new Patient Protection and Affordable Act of 2010 (PPACA) won’t do enough to tame exploding healthcare costs. His essay breaks down the flaws in the complicated law in bullet points that are easy to understand. For example PPACA has:
• No price controls. Wall Street has already factored in rapid expansion of markets for drugs, medical devices and other services in a system of expanded access. There is also a long line forming of providers of information technology and administrative services that will exploit the complex implementation of this law.
• No bulk purchasing. The PPACA has prohibited the government from negotiating the prices of prescription drugs and retains a ban on importation of drugs from Canada and other countries.
• Lack of control over perverse incentives that drive increased volume of services. These in turn are driven by retention of fee-for-service (FFS) reimbursement that encourages physicians and other providers to offer more services than are medically appropriate or necessary.
• No effective mechanism to rein in marginal or ineffective technologies. Coverage policies for new drugs and medical devices are still lax and not subject to rigorous evidence-based criteria for either efficacy or cost-effectiveness.
Click here to read the rest of Dr. Geyman’s article.
United States Still Ranks Last Among Developed Nations in Healthcare Performance
The Commonwealth Fund has just released its 2010 rankings of seven of the developed world’s healthcare systems, and once again, the United States came in dead last. The nonprofit, New York-based foundation studied seven countries – Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom and the United States – in terms of how each performed on a list of healthcare quality indicators. These indicators include access, patient safety, coordination, efficiency, equity, quality and life expectancy. Not surprisingly, the U.S. scored poorly on most of these measures, the main reason for this being the absence of a universal healthcare program like single-payer. All of the other countries studied have systems that cover everyone.
The U.S., the study said, performed poorly on indicators such as chronic care management, reduction of medical errors, accessibility to primary care doctors, health spending, administrative costs, use of information technology, and equality of access to coverage. In only things like preventive care (ie. advice on nutrition and exercise) and access to specialists did the U.S. do relatively well. Overall, the U.S. healthcare system ranked at the bottom of the list of countries.
What makes this study different from previous ones, is that The Commonwealth Fund interviewed patients as well as doctors in its survey. We are constantly told by politicians and the media that Americans are generally satisfied with the healthcare they receive, but that doesn’t take into account the fact that most people rarely use the coverage they have. The Commonwealth Fund’s study digs deeper and the dissatisfaction is revealed when people are using healthcare services more extensively. The Fund’s authors asserted:
It is difficult to disentangle the effects of health insurance coverage from the quality of care experiences reported by U.S. patients. Comprehensiveness of insurance and stability of coverage are likely to play a role in patients’ access to care and interactions with physicians. While the U.S. differs from the other countries in the survey because of the absence of universal health insurance coverage, we found that even insured Americans and higher-income Americans were more likely than their counterparts in other countries to report problems such as not getting recommended tests, treatments, or prescription drugs. This is undoubtedly a reflection of the lack of comprehensive health insurance coverage and the high out-of-pocket costs for care in the U.S., even among the insured and those with above-average incomes. Fragmented coverage and insurance instability undermine efforts in the U.S. to improve care coordination, including the sharing of information among providers. Patients in other countries, in addition, are more likely to have a regular physician and long-time continuity with the same physician.
The Fund’s authors noted that the recent reform legislation passed by Congress and signed into law by President Obama earlier this year should help with some of the problems insured and uninsured Americans are currently facing. However, the reforms won’t fully be implemented until 2014. In the meantime, millions of Americans will continue to go without needed care because they are adults with pre-existing conditions and/or cannot afford coverage.
Americans are still losing jobs and along with that, their healthcare coverage. And there are indications that the billions in federal aid the Obama administration has set aside to help the stranded before all the reforms kick in are inadequate.
But even with all the federal reforms in place, the U.S. will likely not have solved the problems of out-of-control costs, inefficiency and access. Those unresolved problems will still affect overall quality. And, according to the Health and Human Services’ Center for Medicaid and Medicare Services report, ten years from now, over 20 million Americans will still be uninsured.
The federal legislation doesn’t do enough to curtail runaway costs because it insufficiently addresses weak state oversight of premium increases, leaving Americans at the mercy of greedy insurance companies. The legislation still leaves in place the messy, for-profit, employer-based health insurance system with its confusing hodge-podge of plans, co-pays and deductibles. The other countries surveyed by the Commonwealth Fund cover all of their citizens more cheaply, and none has to deal with a bloated, self-serving and for-profit insurance industry. The U.S. must follow in their footsteps, and California can help lead the way by approving SB 810.
sylvia@californiaonecare.org
This essay is in response to the article, “Checkup” by Ryan Burns in The Journal (Humboldt County, CA):
Thank you, Ryan Burns, for “Checkup” on the new health care law. Oh, yes, it’s true: It IS “better than nuthin’.” But, wait! Doesn’t any one stop to wonder why we must settle for such a pittance when our economy, our health and often our very lives depend on finding a real solution to the healthcare crisis?
Yes, there are some very good features in the new legislation. Medi-Cal and Healthy Families in Humboldt County are rescued temporarily, and there will be some controls put on the mega-powered insurance companies that make life altering, financial judgments on our healthcare needs. Naughty insurance companies! They will have to pay fines now if they abrogate these new rules!
But guess what choices they’ll make when the fines they pay are cheaper than playing by the rules (giving you the health care you need)? Did anyone wonder why the stock values of the big insurance companies shot up when the legislation was passed? Did anyone wonder why they were so willing to get on board with the new law? Could it be the thousands and thousands of new customers who must soon buy health insurance?
Insurance companies will make even more money under this new deal. They will continue to raise rates across the nation and here in California, despite a new bill before our Senate that seeks to examine their rationale for rate hikes. And costs for health care will continue to spiral out of control.
The fact is, for-profit health insurance is the deal breaker. There is no feasible way to offer low-cost, effective, universal health care to the public with private insurance as a middleman. As much as 30% of every dollar we spend on insurance is eaten up by administrative costs, advertising, bonuses, mega-salaries, etc. Everything our governing bodies try to do to co-exist with this paradigm is nothing more than fingers in the dike. Because the insurance companies suck up the healthiest and wealthiest of the population, the burden of care and risk is borne by our government, which means, in case you have forgotten – US, the taxpayers.
We are already paying for health care for the poor and ill among us who are denied preventive care, and are driven to use emergency rooms for primary care. We are already paying through the state’s endless stop-gap programs that take up the slack created by Big Insurance hoarding all the no-risk clients.
There is only one rational solution. Everybody in, nobody out. We are all in this together. Together we can make it work by creating a single-payer model similar to systems adopted by many other developed nations, but tailored to our specific needs. There is currently a bill before our state legislature that would institute such a program. SB 810 (sponsored by Sen. Mark Leno) is NOT socialized medicine, but a gold-standard system. It offers full-choice, private delivery of care, public funding and stewardship.
SB 810 is fiscally sound, will control cost increases, is affordable for all, promotes better health, and will stimulate business by creating jobs, promoting productivity, and delivering the state from its financial meltdown. California can no longer afford NOT to adopt this kind of system. Check it out at http://californiaonecare.org and let’s join the rest of the civilized world that sees taking care of its citizens not as a means to obscene profits for some, but as a moral obligation to all.
Patty Harvey
Daniel Weintraub of the healthcare policy blog HealthyCal.org reports on SB 810’s success in advancing out of the state Assembly Health Committee:
The California Legislature is moving on two fronts when it comes to health care reform. On a bipartisan basis, lawmakers have passed two bills to create a high-risk pool that will expand access to health insurance for people who have been denied coverage due to pre-existing conditions. At the same time, though, the Democrats who control the Legislature are pushing forward with doomed legislation that would create a Canadian-style single payer health plan.
The Assembly Health Committee was the latest hurdle cleared by SB 810, by Sen. Mark Leno. The bill would do away with health insurance as we know it and gather the estimated $200 billion Californians spend now in premiums, co-pays and deductibles, plus government subsidies, and put all of that money into one health care plan managed by the government. A state commission would define benefits and any cost-sharing and then negotiate with doctors, hospitals, labs and drug companies to provide the care and services for everyone.
You can read the rest of the article here. Weintraub suggests that single-payer legislation in California faces long odds to passage. However, I don’t think the legislation is necessarily “doomed.” Twice, the state legislature approved a single-payer program. It can happen again with a strong grassroots movement. SB 810 can survive the inevitable political hurdles if ordinary Californians sweep into office this November political leaders who have the courage to fight for the only real solution to our healthcare crisis. What is doomed is the current, unsustainable, insurance-based model, which will eventually collapse under the weight of out-of-control costs and unbridled greed.
My son, who graduated from college a year ago in May, has been turned down for an individual health insurance policy by the same company that had insured him for years. He never had a claim beyond an occasional checkup. Johnny is 23, 6’ 2’’, athletic, slim, a non-smoker and doesn’t drink more than an occasional beer.
Because I’m involved in healthcare at my job, I’m aware of the darker side of the big health insurance companies. Daily, I face denials for necessary care, co-pays that prohibit a patient from receiving needed care, and delays in payment. We encounter people who have no insurance who desperately need care. Others have a high deductible that they aren’t aware of, and when their bill comes, they walk away from the charges. They have now received “free” medical care and satisfied their deductible. Walking away from the bill is not uncommon in any medical practice. When you, as a medical practice owner, are faced with losses such as these, your only alternative is to make a profit on those patients with “good” insurance that come for treatment. The system encourages over-treatment of those with “good” insurance. I truly believe that every healthcare provider would welcome a modest, but fair, payment for every patient that came through the doors. Obviously, the system is broken. ….but I’ve digressed from my topic!
I knew my son was going to be applying for individual coverage upon his graduation, so I advised him to have a checkup at his university. I didn’t want coverage delayed in any way, pending a medical exam. The physician “flagged” a lymph node that protruded from Johnny’s neck, something he’d had since birth and is completely benign. Johnny was denied coverage because of the doctor mentioning the lymph node.
The policy Johnny was applying for was a major medical policy and would have cost him about $50 a month. Instead, he was forced to rely on COBRA, which costs us – his parents – about $350 a month. Is it possible that his insurer did the math? I’d hate to think that the reviewers would be so devious, but I do know that employees are rewarded for actions that improve profitability.
Soon he will have to once again seek coverage, and he will have to answer “yes” when the question of whether he’d been denied by another insurance company comes up. Obama’s reforms will help us all, but they won’t control the health insurance industry. By 2014, no one will be turned down for health insurance. If the plan offered to you is six times the cost of that of a healthy person, I don’t think we’ve made progress. We absolutely need to challenge private insurance with Universal Healthcare.
Andrea Viel
