HCAO News

Single-Payer Activists Outline Possible 2016 Ballot Measure

While a legislative effort for single-payer does not have enough support to pass, particularly in the Senate, Sen. Michael Dembrow believes a ballot measure could bring universal healthcare to Oregonians before the end of the decade, using a template to be decided by a comprehensive study.

by Chris Gray
The Lund Report, May 5, 2015

Single-payer advocates came to the Capitol on Monday to air their passions on behalf of a bill that’s not going anywhere, but a pair of efforts on the horizon may bolster their ideas for replacing private health insurance with a single-payer health plan for everyone.

Charlie Swanson of Health Care of All Oregon told The Lund Report that his organization has submitted three potential ballot measures to the Secretary of State’s office, to put before the voters in 2016. His organization will decide later this month whether to begin collecting signatures.

“The most ideal time would be on the 2016 ballot, and that’d be great if that could happen,” said Sen. Michael Dembrow, D-Portland, Oregon’s longtime champion of single-payer health insurance. “We don’t want to go to the ballot until the organizers could guarantee us a million votes,” he added, reserving the possibility to delay the vote to 2018 or 2020.

Swanson explained that none of the ballot initiatives include details about how the system would actually work. One measure says that healthcare is a human right, and would require the state to guarantee healthcare to everyone. Another calls upon the Legislature to enact a universal healthcare system based on the outcome of House Bill 2828, which funds a comprehensive study.

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Health Care for Immigrants — Implications of Obama's Executive Action

Notably, however, the Obama administration has indicated that immigrants covered under the new policy will continue to be excluded from the ACA's exchanges and tax credits. Similarly, immigrants targeted by the executive action will for the most part remain ineligible for federally funded Medicaid, though some states do provide publicly funded health insurance for some classes of undocumented immigrants. To the extent that work permits lead to an increase in taxes paid by undocumented immigrants, ongoing exclusion of these immigrants from the programs supported by such taxes would be increasingly inequitable.

Benjamin D. Sommers, M.D., Ph.D

Benjamin D. Sommers, M.D., Ph.D

New England Journal of Medicine: Perspective
N Engl J Med 2015; 372:1187-1189March 26, 2015DOI: 10.1056/NEJMp1414949
by Benjamin D. Sommers, M.D., Ph.D., and Wendy E. Parmet, J.D.

On November 20, 2014, President Barack Obama announced his intention to grant millions of undocumented immigrants a reprieve from the threat of deportation, along with the possibility of legal employment in the United States. The announcement came shortly after midterm elections that saw Republicans take control of the Senate and bolster their majority in the House of Representatives, and it followed more than a year of congressional gridlock over the comprehensive immigration-reform bill passed by the Senate. The subsequent decision by a federal district judge in Texas to put President Obama's plan on hold has cast into doubt a policy that — if ultimately upheld — could have substantial effects on the health care system.

The cornerstone of the President's policy is a plan to allow up to 5 million undocumented immigrants (“covered immigrants”) to live and work in the United States. Modeled on the 2012 Deferred Action for Childhood Arrivals (DACA) program, which applied to young adults who arrived in the United States as children, the new policy will allow many more adults who have been here since 2010 to receive deferred-action status. The population affected by the policy is one that currently experiences major disparities in health care coverage and access. Immigrants are far more likely than native-born residents to be uninsured: among adults, an estimated 40% of legal permanent residents and 71% of undocumented immigrants are uninsured, as compared with 15% of U.S.-born citizens.1 Not surprisingly, health care utilization is far lower among immigrants than among citizens.

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Medicare at 50 — Origins and Evolution

Comments; 1) the author does not emphasize that Medicare in its current state is the most efficiently run insurance program in the country, 2) the author does not mention as cost-saving measures either the problems of malpractice reform or medical school debt, and 3) most relevant to HCAO, if there were a national single-payer health care system paid for by combination of income tax and VAT(ie ongoing sources of revenue), there would be no worry about depletion of the Medicare fund. 
Jerry Robbins MD, Newport

Medicare.jpeg

Health Policy Report, Mary Beth Hamel, M.D., M.P.H., Editor
David Blumenthal, M.D., M.P.P., Karen Davis, Ph.D., and Stuart Guterman, M.A.
N Engl J Med 2015
; 372:479-486January 29, 2015DOI: 10.1056/NEJMhpr1411701

Many Americans have never known a world without Medicare. For 50 years, it has been a reliable guarantor of the health and welfare of older and disabled Americans by paying their medical bills, ensuring their access to needed health care services, and protecting them from potentially crushing health expenses. However, as popular as Medicare has become, Congress created the program only after a long and deeply ideological struggle that still reverberates in continuing debates about its future. Nor was the Medicare program that was signed into law by President Lyndon B. Johnson on July 30, 1965, identical to the program we know today. As we mark the beginning of Medicare's 50th anniversary year, this first report in a two-part series recounts the history of this remarkable health care initiative and explains how it came to be, what it has accomplished, and how it has evolved over the past five decades. In the second report in the series, we will describe the ongoing challenges of the program and discuss proposals to address them.

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Part 2: Medicare at 50 — Moving Forward

David Blumenthal, M.D., M.P.P., Karen Davis, Ph.D., and Stuart Guterman, M.A.
N Engl J Med 2015; 372:671-677February 12, 2015DOI: 10.1056/NEJMhpr1414856

As Medicare enters its 50th year, this popular federal program faces profound challenges to its effectiveness and sustainability in future decades. In this report, we review these problems, building on the issues raised in our earlier article.1 We also review several options to strengthen the program and enhance its viability.

Critical Changes Facing Medicare
Rising Expenditures

Perhaps the most important challenge facing Medicare is the prospect of increasing expenditures, driven in large part by demographic trends. As the U.S. population ages, the number of people who are eligible for Medicare benefits will grow, from 52.3 million in 2013 to 81.8 million in 2030.2 From 2009 through 2013, Medicare spending per beneficiary increased at a historically low annual rate of 1.0% in nominal dollars and actually decreased in real terms (accounting for inflation). Over the next decade, slow growth in Medicare spending per beneficiary is expected to continue, but because of substantial increases in the number of beneficiaries, the growth in total program spending will outpace that in the overall economy (Figure 1 Figure 1Projected Annual Growth Rates for Total Medicare Spending, as Compared with the Gross Domestic Product (GDP) and Medicare Enrollment, 2013–2023.). Total Medicare spending is expected to increase from 3.0% of the nation's gross domestic product (GDP) in 2013 to 3.8% in 2030, and the program's share of the federal budget is expected to increase from 14.4% to 15.8%.3 These fiscal trends will create continuing pressure to reform the program.

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Report: Advocacy visits to Senators Beyer and Edwards

by David Ivan Piccioni, HCAO Eugene

At one of my visits Wednesday with Lee Beyer I told him my story which I had made into a letter to editor. It is bellow for reference:

Drug price disparities are unfair     
Register Guard 9/1/2014  (Labor Day)
I recently had a biopsy performed to check for liver damage due to hepatitis C. Medicaid excluded me from treatment because my liver looked good enough that they didn’t believe it will be the cause of my death.
Talking to the doctor, I learned that Medicaid wouldn’t pay to treat my condition because of the cost: $84,000.
He said I could take my prescription to Canada and buy the drugs there for $48,000. But that wasn’t what blew my mind; he also said for the price of a round-trip ticket to Iran or Saudi Arabia, or many African countries, I could buy the medication for a thousand dollars.
What? Who says America’s the land of the free? Free to be ripped of by dog-eat-dog capitalism.
I can’t figure out why pharmaceutical corporations are willing to bankrupt Americans while not doing the same to foreigners — after all, they only care about maximizing their profits.
Gilead, the company that currently owns the intellectual property for the medication, will eventually lose some of its loot to other chemists who will modify Sovaldi just enough so it still works but is novel enough to be patented.
Problems such as this are why the Affordable Care Act is far from what the Eugene group Health Care for All Oregon is advocating: single-payer or expanded Medicare for everyone.

I told Lee Beyer that our obstacles were the Insurance companies and the fact that we can't negotiate for prices with big pharma. He agreed about the Insurance, but said that negotiating with the drug companies is impossible because of a congressional clause which prohibits the gov't from bargaining with them. Some people think that the fact that drugs are cheaper in other countries means the big pharma companies are doing them a favor on the back of Americans who pay inflated prices. This is not so. Drug companies always get the most they can in any country. The fact that they negotiate fairly is credit to other countries' leaders and laws. It seems that if there are differences of 84 to 1 in American drug prices vs. say Saudi Arabia shows that this is one of the first problems to tackle: that congressional prohibition that inhibits fair business transactions and negotiating.

Also in a room full of people prompted by one of my questions, Chris Edwards disclosed that the Insurance companies have always offered him money. He said at first he turned it down, but then as he said "because I always vote against them I decided to take their money" "if they are dumb enough to give me money even though I vote against them, I'll take it". I am not mentioning this as an attack on senator Edwards, but I told him it was hard for me to believe the corporations would throw away money and really get nothing. And I told him health insurers are very powerful and they are not "dumb"; there might be strings invisible but real none the less.

Dave

Herb Rothschild Jr.: Support single-payer

RELOCATIONS
Posted Jan. 24, 2015 
Ashland Daily Tidings, Opinion

This year marks the 50th anniversary of the Voting Rights Act of 1965 and of the enactment of Medicare. Not long ago, a U.S. Supreme Court dominated by Republican appointees gutted the Voting Rights Act, and a Democratic president who never could have been elected without it took Medicare for Everyone off the table when he proposed his much ballyhooed health reform.

The American Medical Association tried to defeat Medicare. It cleverly labeled all such proposals “socialized medicine.” Medicare isn’t socialized medicine. The VA health care system is socialized medicine. Its hospitals are publicly owned, and VA staff are salaried employees paid with tax dollars. Medicare is only an insurance program.

So Medicare didn’t threaten the livelihood of physicians. Instead, it added huge numbers of paying clients to their patient base. The AMA had identified the wrong threat. The real threat emerged in the 1980s. It was the private insurance industry, not public insurance, that drastically interfered with the practice of medicine.

Private insurance plans forced most physicians to join groups like health maintenance organizations, hospital systems, and other large groupings — some of them corporations interested in profits, not health care. Often physicians couldn’t treat their patients without approval for payment from the patients’ insurance carriers, whose on-staff medical personnel could second-guess the attending physician. In more subtle but ever-present ways, the imposition of a corporate model has distorted the practice of medicine and diminished the satisfaction of practitioners.

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