Speaking at a recent conference, Mark Bertolini, CEO and Chairman of Aetna Insurance, announced that the end is near for profit driven health insurance companies. “The system doesn’t work, it’s broke today. The end of insurance companies, the way we’ve run the business in the past, is here.”
In highlighting the reasons for his bold statement, Bertolini called out the ban on medical underwriting propounded by the Affordable Care Act, which Bertolini believes has made the traditional health insurance business model untenable in the long term, while also giving an ‘honorable mention’ to the MLR requirements.
Underwriting is the process of separating out the healthy from those more likely to be ill and then offering coverage to the good risks while passing on the bad ones.
And yet Bertolini, who leads one of the nation’s largest health insurance companies and is a man known for his honesty and willingness to do the right thing, was not raging against government interference nor suggesting that the Affordable Care Act has destroyed his business as it leads America down the road to healthcare disaster. Indeed, Mark offers a considerable measure of praise for Obamacare saying, “For most of what has already been implemented, it has been a pretty good thing.”
If you are a single-payer advocate—and it is no secret that I fall within this category—you are likely pumping your fist in the air at this news. After all, when the CEO of one of the nation’s largest health care insurers waves the white flag, it’s got to be a good thing for those who wish to usher in the era of universal coverage.
To you single-payer supporters who are enjoying Bertolini’s perceived capitulation, I would simply say, “chill out.”
While I have long argued that the for-profit health insurance model no longer works, and that some form of a single-payer system is—whether you like it or not— inevitable, the simple fact is that we are no more ready to make single-payer a success in America then we are capable of sustaining the existing for-profit model.
Because our healthcare cost issues are going to be as damaging and deadly to a single-payer approach as they have been to the for-profit business model.
Yes, there is ample reason to believe that the conversion to a single-payer system will go some distance in solving some cost issues. Right now, the for-profit model sucks about $400 billion a year out of our health care dollars to pay for administrative costs —costs that largely disappear in a public system where administrative costs run dramatically lower. That’s a lot of money that could be better spent on providing actual care to those in need.
However, the few state-based experiments in making government-sponsored health care available to everyone have revealed problems—such as over-usage of the medical system when it is made available without co-pay or deductible—that can quickly eat up these savings, putting us right back in the soup when it comes to making this alternate approach to health care work out.
The notion of creating a “Medicare For All” health care system in America has been on the table ever since Medicare first came into being in 1965. And for just as many years, the battle has raged over whether making such a system available to all Americans would be akin to a capitulation to socialism in a nation that prides itself on its free-market principles or, conversely, a humane and moral step forward for our society.
Polls have long shown that when the idea of a “Medicare For All” is suggested, or some other variation of a national health insurance system is put to the public, the results tend to be favorable. However, when the wording of such a poll includes the words ‘socialized medicine’ or suggesting an increase in taxes to pay for the same, the results tend to be very different.
For advocates of a universal care system, the driving factor tends to be the underlying belief that health care should be a basic right for all humanity . For the more pragmatic supporters, the belief is that what we’ve currently got just isn’t working so why not try a different way?
Those who oppose a universal or single-payer approach, appear to believe that the practical matters are the greatest concern while some object based on deep ideological concerns. The practical fear is the perceived inevitability of rationing in medicine, and the wait times to receive medical care that come when the system is opened to all, based on our lack of adequate funds to pay for the increased services or the limited availably of sufficient medical personnel to meet the demand.
Whichever side draws your support, if the war over the Affordable Care Act has taught us anything it is that there is likely to be more than enough legislators to block an effort to extend Medicare to all Americans, or some other variation of a single-payer system, for the foreseeable future. However, if the for-profit insurance companies find it no longer worth their while to stay in the business, which is my own expectation and a notion that appears to be shared by Mr. Bertolli of Aetna, a single-payer system may be thrust upon our politicians when government is the only entity large enough to take on the financial responsibility of our health care system.
However it happens, and I very much believe it will, we had better be prepared—and we are not.
If single-payer is in our future, whether on a state-by-state basis or a system operated by the federal government, it would be best to set it up before we are forced into it by failed private insurance companies. That means that devising a workable program with political support from all sides is far preferable to waking up one day to find that this is the only option available to us.
To do this, supporters of the single-payer model are going to have to offer up something more than their good intentions to both politicians and citizens who oppose this approach. Supporters are going to have to offer the solutions designed to control what are now out-of-control health care costs without putting patients in jeopardy of death due to rationing or causing folks undue waiting times to deal with a medical problem.
And this all has to be done in a way that does not increase the cost of health care to taxpayers and promises to lower costs over time.
That’s a tall order to be sure. But it not only can be done- it is being done.
It also means that single-payer supporters cannot pretend that the experiments in variations of universal care in states like Maine, Minnesota and Tennessee did not fail. They did. By the same token, opponents of universal care cannot just point to these failures as the reason we should not be striving to achieve a far better health care system than the one we’ve got.
Failure does not mean that these efforts could not have succeeded had they been better planned and executed or that what we’ve learned from these failures can’t be used to do a better job in the future. The point of experimentation is not to give up when something doesn’t work—the point is to learn from the failure and devise approaches that will accomplish the goal while avoiding the mistakes that made earlier experiments go wrong.
In the coming days, you’ll find a discussion here on how we can go about reducing these costs in a way that will give opponents of universal care—and the politicians who represent their point of view—permission to support what is an important and noble goal. As a “warm-up”, take a look at a piece I published some weeks ago, relaying the story of Grand Junction, Colorado. This reveals what is possible when cost issues are tackled on the local level—which is precisely where the problem must be solved.
Now, if you are so engrossed in your ideology that you cannot deal with the idea that a government based payer system— or some combination of government and private industry— cannot come forward with a solution to our problem, these articles are not going to be for you. On the other side of the coin, if you are so convinced that there is no room for private industry in a healthcare system where government is the primary payor for care because profit is, somehow, the mortal enemy of quality healthcare for all, then you too will be equally disappointed.
However, if you are interested in bringing forth a new, uniquely American model for our health care system, there may be some ideas that might ring true or, at the least, spark a non-partisan, non-ideologically based discussion.
More to come.
Link to original article from Forbes
Healthcare for All/Single Payer -
I live in a state that has refused to accept Medicaid Expansion funds. The latest reports are proof that Texas, the largest state opting out, will cut off its nose to spite its face: we could collect $100 billion in federal funds over the next 10 years if we agreed to expand Medicaid eligibility. While hospitals in other states will see a drop in uncompensated care, Texas hospitals will continue to provide $5.5 billion annually to the uninsured.
It’s a little difficult to understand why politicians in our state—and others like ours–would reject the opportunity...
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A study of hospital administrative costs in eight nations published in the September issue of Health Affairs finds that hospital bureaucracy consumed 25.3 percent of hospital budgets in the U.S. in 2011, far more than in other nations.
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Don Berwick is making a vital point about the need for progressives to expand the discussion about healthcare reform.
Democratic and Republican strategists, and the candidates who let campaign consultants frame their range of opinion, are still engaging in picayune debates about the strengths and weaknesses of the Affordable Care Act.
But Berwick, who for seventeen months headed the Medicare and Medicaid programs under President Obama, isn’t getting lost in the political weeds. He’s blazing a trail in the direction of what ultimately must be done—pushing at the constraints of the conversation...
John Nichols | The Nation 14 Sep 2014 Hits:1103 HCA Articles
This week, U.S. experts from the Center for Reproductive Rights (CRR) and SisterSong Women of Color Reproductive Justice Collective will testify before the United Nations' Committee to End Racial Discrimination in Geneva, sharing a report that describes the experiences of American women of color and immigrant women who pay with their health and even their lives for the race and gender discrimination that tirelessly persists in our health system.
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Editorial Board | Star Tribune 15 Jun 2014 Hits:791 HCA Articles
Oregonians can take a critical step toward comprehensive health care for everyone in the state. That first step is the HB 3260 study of health care financing options.
In 2013, the Oregon House Health Care Committee unanimously approved the study, the legislative passed the measure with bipartisan support, and the governor signed it into law.
Why is this HB 3260 study critical?
The study authorizes the Oregon Health Authority (OHA) to study four options to finance comprehensive, universal health care in Oregon. When the study is complete, the OHA will submit its report...
Samuel Metz, MD 14 May 2014 Hits:705 HCA Articles
Twenty years ago this week, Rwanda's genocide began. Over the course of 100 days, more than 1 million people would be murdered, and after the violence ended, the country—including its health care system—was left in ruins. Cholera outbreaks were rampant, HIV was widespread and people no longer trusted the few doctors who remained in the country because of their ties (suspected or legitimate) to the genocidal regime, the Atlantic reports.
In just two decades, however, according to a new study published in The Lancet, Rwanda has gone from one of the world's most health care-deprived countries to a stand-out example...
Rachel Nuwer | Smithsonianmag.com 11 Apr 2014 Hits:840 HCA Articles
When the giant kapok and nawa trees that tower over the Queen's Medical Center in downtown Honolulu were planted more than a century ago, Hawaii faced a health crisis.
Many on the islands, including the queen who founded the hospital in 1859, feared that native Hawaiians, devastated by smallpox, measles and other illnesses brought by foreigners, were in danger of dying off completely.
Today, the people who walk under these trees are some of the healthiest in America.
Hawaiians live longer than their counterparts on the mainland. They die less frequently from common...
Noam Levey | Los Angeles Times 11 Apr 2014 Hits:745 HCA Articles
Sovaldi, a new hepatitis C treatment, can cure up to 90 percent of patients within three months. There's just one problem: The drug costs $1,000 a day. That price tag has thrown the biotechnology world into turmoil, as lawmakers and insurance companies complain that Sovaldi's maker is trying to milk desperate patients.
Doctors are understandably finding it hard to pass over a drug that is so effective. As a result, Sovaldi's manufacturer, Gilead Sciences (GILD), is raking in the dough, while its shares have soared 53 percent over the last year....
Kim Peterson | CBS News 11 Apr 2014 Hits:797 HCA Articles
Canadians don’t drop dead or delay care due to the lack of health insurance. However in America, thousands will continue to face death according to Harvard researchers. About 25 million people will still not have insurance under Obamacare. Those that do, have seen their rates rise and contrary to the promise that “you can keep your existing plans” bullshit, working people with existing coverage and the poor will see rates not only increase, but will continue to pay a greater share of their income for health care than the wealthy...
Steven Maiken | Daily Sundial 16 Feb 2014 Hits:1232 HCA Articles
Lawmakers have begun looking at how to finance a single-payer health care system that Gov. Peter Shumlin hopes will be his crowning achievement.
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But Sen. Peter Galbraith, a Democrat from Windham County, says the governor’s date is too late. He’s...
Staff | Times Argus 20 Jan 2014 Hits:754 HCA Articles
A government-run health care system in Maine would provide universal coverage to residents, cut down on administrative costs and free businesses from the complexities of providing insurance for their employees, supporters of a single-payer model said Thursday.
Advocates of a single-payer system have long been trying to implement the model in Maine with little success, but said they are hopeful that the steps Vermont officials have recently made to spearhead the effort there can help make it a reality in Maine.
"Our current health care system is complicated, is inefficient, unfair and...
Associated Press | Maine Sun Journal 20 Jan 2014 Hits:701 HCA Articles
As the rollout of Obamacare clunks forward, activists who opposed the law from the beginning say it is time to seize the moment, to tear down the current health-care edifice and start anew, especially now as frustration with the law’s implementation is reaching a peak.
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David Freedlander | Daily Beast 10 Dec 2013 Hits:2753 HCA Articles
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Salvatore Aversa | Truth Out 08 Dec 2013 Hits:2207 HCA Articles
Former CMS administrator Don Berwick is running for Governor in Massachusetts. He has an uphill battle in the ever growing primary for the Democratic nominee. Yet his controversial tenure in DC, his pursuit of the Corner Office in the state that birthed RomneyCare (a state that is home to some of the best medical research institutions in the world), and his devoted following on the left — all grant extra weight to his comments on healthcare.
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Josh Archambault | Forbes 08 Dec 2013 Hits:994 HCA Articles
It's no secret that the rollout for Healthcare.gov has been somewhat of a bumpy road. Technical glitches have caused delays for folks looking to obtain insurance, and frustrated those working hard to provide coverage options for all Americans for the first time in this nation's history. While the kinks get repaired, much of the criticism has been beyond comprehension. Is it okay to highlight website problems? Yes. Is it okay to push the president to get these tech issues resolved quickly? Absolutely. But when did having website problems become the...
Rev. Al Sharpton | Huffington Post 18 Nov 2013 Hits:941 HCA Articles
In my recent column in The Hill titled Obama's health care Katrina I took President Obama to task -- proudly -- for spending years telling Americans they would keep their insurance policies when he knew millions of Americans could not. I called for a solution to help these people and I called on progressives including myself to lead the fight to help them. And now, even more, it is time to do what really needs to be done and fight like hell for a public option, for Medicare for all,...
Brent Budowsky | Huffington Post 17 Nov 2013 Hits:1412 HCA Articles
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David Sirota TruthDig 17 Nov 2013 Hits:1345 HCA Articles
WASHINGTON — Defying a veto threat from President Obama, the House on Friday approved legislation that would allow health insurance companies to renew individual insurance policies and sell similar policies to new customers next year even if the coverage does not provide all the benefits and consumer protections required by the new health care law.
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Robert Pear and Ashley Parker 15 Nov 2013 Hits:829 HCA Articles
Holding signs demanding “Expand Medicaid Now,” about 60 people, including state legislators, medical professionals, clergy and health advocates gathered Thursday in Charlotte to ask the state’s Republican leaders to reverse their position and accept expansion of Medicaid benefits for the poor.
“Today I am making a 911 call to Gov. (Pat) McCrory and the North Carolina General Assembly,” said state Rep. Carla Cunningham, a Mecklenburg County Democrat.
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Karen Garloch | Charlotte Observer 01 Nov 2013 Hits:833 HCA Articles
As states open insurance marketplaces amid uncertainty about whether they're a solution for health care, Vermont is eyeing a bigger goal, one that more fully embraces a government-funded model.
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Dave Gram | The Huffington Post 27 Oct 2013 Hits:863 HCA Articles
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Seth Koenig | Bangor Daily News 15 Oct 2013 Hits:968 HCA Articles
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Rev. Jesse Jackson | Chicago Sun Times 08 Oct 2013 Hits:967 HCA Articles
Despite critics slamming "Obamacare" – the first major U.S. health-care reform passed in nearly 50 years – as "Canadian-style" health insurance, critics note that major differences between the two systems persist.
McGill University Professor of Political Science Antonia Maioni said the U.S. Patient Protection and Affordable Care Act, which went into effect earlier this week, is "not even close" to the Canadian system.
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CTVNews.ca Staff 06 Oct 2013 Hits:1070 HCA Articles
A sweeping national effort to extend health coverage to millions of Americans will leave out two-thirds of the poor blacks and single mothers and more than half of the low-wage workers who do not have insurance, the very kinds of people that the program was intended to help, according to an analysis of census data by The New York Times.
(Claretha Briscoe, left, of Hollandale, Miss., with family. She earns too much to qualify for Medicaid but not enough to get subsidies on the new health exchange./James Patterson for The New...
Sabrina Tavernise and Robert Gebeloff | The New York Times 03 Oct 2013 Hits:1106 HCA Articles
Donna Smith: “The fact remains that we all have bodies and we all will someday get sick or hurt; all of us will need some level of health care.”
Through all the rhetoric, the misinformation, the lack of information, the cheering and the nay-saying, and the threats and realities of government shutdowns that surrounds the Affordable Care Act (ACA), one thing remains certain: individuals will begin enrolling for health insurance at state exchanges starting on October 1, 2013. Whatever else people may think the ACA is or isn’t, it remains this country’s...
Joanne Boyer | Wisdom Voices 02 Oct 2013 Hits:1039 HCA Articles
Dr. Bill HonigmanCalifornia
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