Wednesday, July 31, 2013

Doctors Increasingly Ignore Evidence In Treating Back Pain

More From Shots - Health News HealthLast Person To Get Smallpox Dedicated His Life To Ending PolioHealthA Bit Of Thought Makes Finding Out Medical Risks Less ScaryHealth CareParents Grapple With Explaining Cancer To ChildrenHealth CareWill Obamacare Mean Fewer Jobs? Depends On Whom You Ask

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Tuesday, July 30, 2013

Canvassers For Health Coverage Find Few Takers In Boca Raton

More From Shots - Health News HealthDoctors Increasingly Ignore Evidence In Treating Back PainHealth CareCanvassers For Health Coverage Find Few Takers In Boca RatonHealthPanel Urges Lung Cancer Screening For Millions Of AmericansHealthBoys With Autism Or ADHD More Prone To Overuse Video Games

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Montana's State-Run Free Clinic Sees Early Success

fromMTPR

Listen to the Story 4 min 37 sec Playlist Download Transcript   Enlarge image i

Montana opened the first government-run medical clinic for state employees last fall. A year later, the state says the clinic is already saving money.

Dan Boyce for NPR

Montana opened the first government-run medical clinic for state employees last fall. A year later, the state says the clinic is already saving money.

Dan Boyce for NPR

A year ago, Montana opened the nation's first clinic for free primary healthcare services to its state government employees. The Helena, Mont., clinic was pitched as a way to improve overall employee health, but the idea has faced its fair share of political opposition.

A year later, the state says the clinic is already saving money.

Pamela Weitz, a 61-year-old state library technician, was skeptical about the place at first.

"I thought it was just the goofiest idea, but you know, it's really good," she says. In the last year, she's been there for checkups, blood tests and flu shots. She doesn't have to go; she still has her normal health insurance provided by the state. But at the clinic, she has no co-pays, no deductibles. It's free.

That's the case for the Helena area's 11,000 state workers and their dependents. With an appointment, patients wait just a couple minutes to see a doctor. Visitation is more than 75 percent higher than initial estimates.

"For goodness sakes, of course the employees and the retirees like it, it's free," says Republican State Sen. Dave Lewis.

He wonders what that free price tag is actually costing the state government as well as the wider Helena community.

"If they're taking money out of the hospital's pocket, the hospital's raising the price on other things to offset that," Lewis says.

He and others faulted then-Gov. Brian Schweitzer for moving ahead with the clinic last year without approval of the state legislature, although it was not needed.

Now, Lewis is a retired state employee himself. He says, personally, he does like going there, too.

"They're wonderful people, they do a great job, but as a legislator, I wonder how in the heck we can pay for it very long," Lewis says.

Lower Costs For Employees And Montana

The state contracts with a private company to run the facility and pays for everything � wages of the staff, total costs of all the visits. Those are all new expenses, and they all come from the budget for state employee healthcare.

Even so, division manager Russ Hill says it's actually costing the state $1,500,000 less for healthcare than before the clinic opened.

"Because there's no markup, our cost per visit is lower than in a private fee-for-service environment," Hill says.

Physicians are paid by the hour, not by the number of procedures they prescribe like many in the private sector. The state is able to buy supplies at lower prices.

“ Because there's no markup, our cost per visit is lower than in a private fee-for-service environment.- Russ Hill of the Montana Health Center Bottom line: a patient's visit to the employee health clinic costs the state about half what it would cost if that patient went to a private doctor. And because it's free to patients, hundreds of people have come in who had not seen a doctor for at least two years. Hill says the facility is catching a lot, including 600 people who have diabetes, 1,300 people with high cholesterol, 1,600 people with high blood pressure and 2,600 patients diagnosed as obese. Treating these conditions early could avoid heart attacks, amputations, or other expensive hospital visits down the line, saving the state more money. Clinic operations director and physician's assistant Jimmie Barnwell says this model feels more rewarding to him. "Having those barriers of time and money taken out of the way are a big part [of what gets] people to come into the clinic. But then, when they come into the clinic, they get a lot of face time with the nurses and the doctors," Barnwell says. That personal attention has proved valuable for library technician Pamela Weitz. A mammogram late last year found a lump. "That doctor called me like three or four times, and I had like three letters from the clinic reminding me, 'You can't let this go, you've got to follow up on it,' " she says. Two more mammograms and an ultrasound later, doctors think it's just a calcium deposit, but they want her to keep watching it and come in for another mammogram in October. Weitz says they've had that same persistence with her other health issues like her high blood pressure. She feels the clinic really cares about her. "Yeah, they've been very good, very good," she says. Montana recently opened a second state employee health clinic in Billings, the state's largest city. Others are in the works. Share Facebook Twitter Google+ Email Comment More From Health Care Health CarePfizer Announces It's Splitting Up Its Drug BusinessHealth CareMontana's State-Run Free Clinic Sees Early SuccessHealth CareCanvassers For Health Coverage Find Few Takers In Boca RatonHealthPanel Urges Lung Cancer Screening For Millions Of Americans

More From Health Care

Comments

Panel Urges Lung Cancer Screening For Millions Of Americans

More From Shots - Health News Health CareCanvassers For Health Coverage Find Few Takers In Boca RatonHealthPanel Urges Lung Cancer Screening For Millions Of AmericansHealthBoys With Autism Or ADHD More Prone To Overuse Video GamesHealthHow To Find A Path Off The Dreaded Diet Plateau

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Panel Urges Lung Cancer Screening For Millions Of Americans

More From Shots - Health News Health CareCanvassers For Health Coverage Find Few Takers In Boca RatonHealthPanel Urges Lung Cancer Screening For Millions Of AmericansHealthBoys With Autism Or ADHD More Prone To Overuse Video GamesHealthHow To Find A Path Off The Dreaded Diet Plateau

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Tuesday, July 23, 2013

State Laws Limiting Abortion May Face Challenges On 20-Week Limit

More From Shots - Health News HealthA Scientist Debunks The 'Magic' Of Vitamins And SupplementsHealthPolio Eradication Suffers A Setback As Somali Outbreak WorsensHealthNote To Teen Boy With Blowgun: It's Exhale, Not InhaleHealthTVs Pose A Danger To Kids, But Not The Way You Might Think

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

State Laws Limiting Abortion May Face Challenges On 20-Week Limit

More From Shots - Health News HealthPolio Eradication Suffers A Setback As Somali Outbreak WorsensHealthNote To Teen Boy With Blowgun: It's Exhale, Not InhaleHealthTVs Pose A Danger To Kids, But Not The Way You Might ThinkHealthState Laws Limiting Abortion May Face Challenges On 20-Week Limit

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Saturday, July 20, 2013

White House Muddles Obamacare Messaging — Again

More From Shots - Health News HealthPolio Eradication Suffers A Setback As Somali Outbreak WorsensHealthHPV Vaccination Might Help Reduce Risk Of Throat CancersHealthTiny Rat Cocktail Parties Shed Light On Why Smokers DrinkHealthDoctors' Questions About Guns Spark A Constitutional Fight

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Wednesday, July 17, 2013

Costlier Insurance For Smokers May Not Come With Quitting Help

More From Shots - Health News GoverningWeight Loss Is Worth Gold In DubaiHealthA Warm Winter Helped Fuel West Nile Outbreak In DallasHealthSickle Cell Anemia Is On The Rise WorldwideHealthCerner Fights For Share In Electronic Medical Records Boom

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Friday, July 12, 2013

Messy Rollout Of Health Law Echoes Medicare Drug Expansion

More From Shots - Health News HealthMessy Rollout Of Health Law Echoes Medicare Drug ExpansionHealthFailure To Communicate Between Doctors And Men About PSA TestHealthFor Youths, Fewer Homicides But Still Many DeathsHealthAfter FDA Approval, Drugmakers Often Miss Study Mark

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Will A Health Insurer Sponsor The Next 'Jackass' Movie?

More From Planet Money BusinessWill A Health Insurer Sponsor The Next 'Jackass' Movie?EconomyWhere The Jobs Are (And Where They Aren't), In 1 GraphPlanet MoneyBanks, Borrowed Money And BailoutsPlanet MoneyEpisode 471: The Eddie Murphy Rule

More From Planet Money

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Thursday, July 11, 2013

Catholics Split Again On Coverage For Birth Control

More From Shots - Health News Health CareGOP Says, Why Not Delay That Health Care Law, Like, Forever?HealthBros Get Wasted; Girls Get Tipsy: Why Boozy Talk MattersHealthMastermind Of 'Body Stealing' Scheme DiesHealthRich With Water But Little To Drink In Tajikistan

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

How Oregon Is Getting 'Frequent Fliers' Out Of The ER

More From Shots - Health News Health CareGOP Says, Why Not Delay That Health Care Law, Like, Forever?HealthBros Get Wasted; Girls Get Tipsy: Why Boozy Talk MattersHealthMastermind Of 'Body Stealing' Scheme DiesHealthRich With Water But Little To Drink In Tajikistan

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Catholics Split Again On Coverage For Birth Control

More From Shots - Health News Health CareGOP Says, Why Not Delay That Health Care Law, Like, Forever?HealthBros Get Wasted; Girls Get Tipsy: Why Boozy Talk MattersHealthMastermind Of 'Body Stealing' Scheme DiesHealthRich With Water But Little To Drink In Tajikistan

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Tuesday, July 9, 2013

Insurance Pitch To Young Adults Started In Fenway Park

More From Shots - Health News HealthTreating The 'Body And Soul' In A Russian TB PrisonHealthYouths At Risk Of Violence Say They Need Guns For ProtectionHealth CareInsurance Pitch To Young Adults Started In Fenway ParkHealthFinding Simple Tests For Brain Disorders Turns Out To Be Complex

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Saturday, July 6, 2013

Anthony Weiner’s single-payer plan is progressive, but not single-payer

Advocates for a single-payer health care plan see plenty of reasons to like Anthony Weiner’s proposed overhaul of the city’s health system. They just think it’s mislabeled.

“Well as I understand his proposal, it’s not what I would call a single-payer proposal, but it has some useful elements,” said David Himmelstein, a professor of public health at Hunter College, and a co-founder of Physicians for a National Health Program.

Weiner has made health care the key component of his mayoral campaign so far, pledging to implement a single-payer plan like the one he loudly argued for during the national debate over health care back in 2009.

Back then, Weiner seemed motivated primarily by a desire for national publicity, actually delivering a message on health care that served him well politically but was at odds with the president’s agendaand that of more serious Democratic advocates of universal health care in Congress. 

While Weiner clearly sees a political opportunity in health care reform now as well, he is at least advocating something that, as mayor, he’d theoretically have a chance of putting into practice.

“Single-payer health care is on the ballot,” Weiner proclaimed in the subject line of a fund-raising email last month, a few days after Weiner devoted his first big policy speech to his health care plan, at an event his campaign dubbed “Big Thought Thursday.”

A subsequent email to a list of Hillary Clinton’s 2008 alumni asked, “Will you help Anthony stand up for single-payer health care?“

Weiner’s basic idea is to convene a task force of city department heads and nonprofit leaders to design an overhaul of the city’s health care system, in order to consolidate the nearly $16 billion the city spends each year on health care into a single system overseen by a deputy mayor for health care innovation. 

“We should make New York City the single-payer laboratory for the rest of the country,” he said at his policy speech.

By his own admission, the plan is a rough sketch, with details to be filled in by the task force. 

But the crux of the idea is that municipal workers and retirees could be united under a single health insurance plan, overseen by the city, which could also cover undocumented immigrants not covered by President Obama’s new health reforms, with an eye toward one day opening the city’s plan to all New Yorkers.

That’s something advocates of universal health care would certainly regard as progress, even if it’s not anything they’d recognize as single-payer.

“Single-payer really means there’s just one payer left in the health care system,” said Himmelstein. “You can’t really do that as the mayor of New York, because Medicare would still exist and private employers, private plans would still exist, so there would still be multiple payers. But I think having a large public plan that encompasses a large piece of the market makes a lot of sense.”

Asked by WNYC’s Brian Lehrer on July 3 whether the plan could accurately be billed as single-payer, Weiner responded by talking generally about the inefficiencies in the current model, and then said, “I guess the best way to look at this is, this is for city workers, for the uninsured, for retirees, this would be Medicare for all New Yorkers who are eligible. But I’m also going to try to expand this to cover the undocumented who are not going to be covered under Obamacare who are going to cost us a great deal of money if we don’t cover them.”

Health care reformers say the potential benefits of Weiner’s plan are great, with the possibility of expanding coverage to more New Yorkers, while reducing the profit-making role of insurance companies and utilizing the city’s leverage to reduce rates and drive down premiums.

“His thinking on health coverage is certainly in the right place,” said Assemblyman Dick Gottfried, who has repeatedly sponsored bills in Albany to create a statewide single-payer system (and who has not endorsed anyone for mayor). “And part of that thinking is the notion that a publicly run plan with as broad a base as possible can do a much better job than relying on insurance companies as a middle man.”

But the potential implementation could be difficult.

Himmelstein said insurance companies would “fight tooth and nail to stop this from happening,” since any talk of containing costs is essentially “cost-containment from their hide.”

Weiner has been dismissive of that kind of opposition.

In his speech, Weiner said the city could leverage its power within the existing private insurance structure, or that it could wholly control the plan, or a hybrid option, with the city contracting an insurance company for administrative costs, like Medicare and Medicaid do. But he made clear that he wasn’t at all concerned with preserving their profits in the current system.

“It’s not my burden as the mayor of the city of New York to protect that,” he said. “My burden as the mayor of the city of New York is to get reasonable costs for high-quality care.” The first line of his fund-raising email touting single-payer read as follows: “If you are a health insurance executive, you may want to stop reading right here.”

He has also struck a combative posture with regard to municipal unions, who he has suggested should pay 10 percent of their own premiums (25 percent for smokers). Weiner has framed the contributions as way of reducing costs and saving the city money that might then be put toward new union contracts that include raises. But the unions, which are some of the most politically powerful in the city, might prefer the raises without the new system, or the added contributions.

“The experience of doing this in other contexts has been challenging because the employees are not always happy to move into whatever plan the city might set up,” said Dr. Sherry Glied, a professor at Columbia’s Mailman School of Public Health and a former Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services under President Obama.

(Himmelstein and Gottfried both suggested Weiner’s fixed-rate contribution was less desirable than a system that spreads the costs, since Weiner’s proposal would extract roughly the same contribution payment from, say, a highly paid CUNY chancellor as it would an administrative assistant or bus driver, who earns significantly less.)

Asked about the need for state or federal support, Weiner, referring to his proposed task force, said “there is no one who is sitting at that table who really needs to get a go-ahead from the state or federal government.”

But any attempts to extend his proposals beyond municipal workers, toward a more robust public plan that would be open to all New York City residents�something more akin to a single-payer system or a public option�would have to navigate a thicket of state and federal regulations.

Covering the undocumented population also presents its own set of problems, since undocumented immigrants are expressly barred from receiving any of the federal subsidies that generally apply to other low-income populations.

Medicaid and Medicare are largely covered by state and federal requirements, with Maryland as the only state that currently enjoys a federal waiver to negotiate its own rates (a waiver the state is fighting to preserve). 

“I think if there’s going to be a single-payer system, given the way that health care is regulated in our country, it will have to be at a state level at the least, or at the federal level,” said Glied, who suggested the city’s efforts might be better focused on enrolling the uninsured in the national reforms set to take effect next year. “It would just be very difficult to manage it, given the governance structure of health insurance and health care delivery, at a city level.”

PNHP note: For additional commentary on Weiner’s proposal, see Leonard Rodberg’s blog posting titled “Should we support Anthony Weiner�s �single-payer� plan?“

Anthony Weiner’s single-payer plan is progressive, but not single-payer

Advocates for a single-payer health care plan see plenty of reasons to like Anthony Weiner’s proposed overhaul of the city’s health system. They just think it’s mislabeled.

“Well as I understand his proposal, it’s not what I would call a single-payer proposal, but it has some useful elements,” said David Himmelstein, a professor of public health at Hunter College, and a co-founder of Physicians for a National Health Program.

Weiner has made health care the key component of his mayoral campaign so far, pledging to implement a single-payer plan like the one he loudly argued for during the national debate over health care back in 2009.

Back then, Weiner seemed motivated primarily by a desire for national publicity, actually delivering a message on health care that served him well politically but was at odds with the president’s agendaand that of more serious Democratic advocates of universal health care in Congress. 

While Weiner clearly sees a political opportunity in health care reform now as well, he is at least advocating something that, as mayor, he’d theoretically have a chance of putting into practice.

“Single-payer health care is on the ballot,” Weiner proclaimed in the subject line of a fund-raising email last month, a few days after Weiner devoted his first big policy speech to his health care plan, at an event his campaign dubbed “Big Thought Thursday.”

A subsequent email to a list of Hillary Clinton’s 2008 alumni asked, “Will you help Anthony stand up for single-payer health care?“

Weiner’s basic idea is to convene a task force of city department heads and nonprofit leaders to design an overhaul of the city’s health care system, in order to consolidate the nearly $16 billion the city spends each year on health care into a single system overseen by a deputy mayor for health care innovation. 

“We should make New York City the single-payer laboratory for the rest of the country,” he said at his policy speech.

By his own admission, the plan is a rough sketch, with details to be filled in by the task force. 

But the crux of the idea is that municipal workers and retirees could be united under a single health insurance plan, overseen by the city, which could also cover undocumented immigrants not covered by President Obama’s new health reforms, with an eye toward one day opening the city’s plan to all New Yorkers.

That’s something advocates of universal health care would certainly regard as progress, even if it’s not anything they’d recognize as single-payer.

“Single-payer really means there’s just one payer left in the health care system,” said Himmelstein. “You can’t really do that as the mayor of New York, because Medicare would still exist and private employers, private plans would still exist, so there would still be multiple payers. But I think having a large public plan that encompasses a large piece of the market makes a lot of sense.”

Asked by WNYC’s Brian Lehrer on July 3 whether the plan could accurately be billed as single-payer, Weiner responded by talking generally about the inefficiencies in the current model, and then said, “I guess the best way to look at this is, this is for city workers, for the uninsured, for retirees, this would be Medicare for all New Yorkers who are eligible. But I’m also going to try to expand this to cover the undocumented who are not going to be covered under Obamacare who are going to cost us a great deal of money if we don’t cover them.”

Health care reformers say the potential benefits of Weiner’s plan are great, with the possibility of expanding coverage to more New Yorkers, while reducing the profit-making role of insurance companies and utilizing the city’s leverage to reduce rates and drive down premiums.

“His thinking on health coverage is certainly in the right place,” said Assemblyman Dick Gottfried, who has repeatedly sponsored bills in Albany to create a statewide single-payer system (and who has not endorsed anyone for mayor). “And part of that thinking is the notion that a publicly run plan with as broad a base as possible can do a much better job than relying on insurance companies as a middle man.”

But the potential implementation could be difficult.

Himmelstein said insurance companies would “fight tooth and nail to stop this from happening,” since any talk of containing costs is essentially “cost-containment from their hide.”

Weiner has been dismissive of that kind of opposition.

In his speech, Weiner said the city could leverage its power within the existing private insurance structure, or that it could wholly control the plan, or a hybrid option, with the city contracting an insurance company for administrative costs, like Medicare and Medicaid do. But he made clear that he wasn’t at all concerned with preserving their profits in the current system.

“It’s not my burden as the mayor of the city of New York to protect that,” he said. “My burden as the mayor of the city of New York is to get reasonable costs for high-quality care.” The first line of his fund-raising email touting single-payer read as follows: “If you are a health insurance executive, you may want to stop reading right here.”

He has also struck a combative posture with regard to municipal unions, who he has suggested should pay 10 percent of their own premiums (25 percent for smokers). Weiner has framed the contributions as way of reducing costs and saving the city money that might then be put toward new union contracts that include raises. But the unions, which are some of the most politically powerful in the city, might prefer the raises without the new system, or the added contributions.

“The experience of doing this in other contexts has been challenging because the employees are not always happy to move into whatever plan the city might set up,” said Dr. Sherry Glied, a professor at Columbia’s Mailman School of Public Health and a former Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services under President Obama.

(Himmelstein and Gottfried both suggested Weiner’s fixed-rate contribution was less desirable than a system that spreads the costs, since Weiner’s proposal would extract roughly the same contribution payment from, say, a highly paid CUNY chancellor as it would an administrative assistant or bus driver, who earns significantly less.)

Asked about the need for state or federal support, Weiner, referring to his proposed task force, said “there is no one who is sitting at that table who really needs to get a go-ahead from the state or federal government.”

But any attempts to extend his proposals beyond municipal workers, toward a more robust public plan that would be open to all New York City residents�something more akin to a single-payer system or a public option�would have to navigate a thicket of state and federal regulations.

Covering the undocumented population also presents its own set of problems, since undocumented immigrants are expressly barred from receiving any of the federal subsidies that generally apply to other low-income populations.

Medicaid and Medicare are largely covered by state and federal requirements, with Maryland as the only state that currently enjoys a federal waiver to negotiate its own rates (a waiver the state is fighting to preserve). 

“I think if there’s going to be a single-payer system, given the way that health care is regulated in our country, it will have to be at a state level at the least, or at the federal level,” said Glied, who suggested the city’s efforts might be better focused on enrolling the uninsured in the national reforms set to take effect next year. “It would just be very difficult to manage it, given the governance structure of health insurance and health care delivery, at a city level.”

PNHP note: For additional commentary on Weiner’s proposal, see Leonard Rodberg’s blog posting titled “Should we support Anthony Weiner�s �single-payer� plan?“

Thursday, July 4, 2013

Delay For Insurance Mandate Pleases Businesses

More From Shots - Health News HealthScientists Grow A Simple, Human Liver In A Petri DishHealthA Surge In Painkiller Overdoses Among WomenHealthDelay For Insurance Mandate Pleases Businesses HealthHow To Make Disease Prevention An Easier Sell

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.

Wednesday, July 3, 2013

Canadians pay taxes for universal healthcare, and now they’re richer than us

I�ve been watching with some dismay the wrestling match going on between the governor and the Maine Legislature over the opportunity offered by the federal Affordable Care Act to expand our MaineCare program.

Proponents of expansion of MaineCare make their argument on both moral and economic grounds. Such expansion would provide health care coverage for almost 70,000 low-income Mainers who will otherwise receive no assistance from the ACA. More coverage would result in better management of our burgeoning level of chronic illness as our population ages. That will drive down the use of expensive crisis-oriented emergency services as well as the illness-inducing stress produced by out-of-control health care bills in low-income patients already afflicted by poor health.

Since 100 percent of the costs of the proposed expansion would be borne by the federal government for at least the first three years of the program (gradually reduced to 90 percent by 2020), MaineCare expansion under the ACA would also provide significant economic benefits to Maine in the form of federal dollars and the jobs they will create in every county in the state. According to a new study released last week by the Maine Center for Economic Policy and Maine Equal Justice Partners, if MaineCare were expanded under the terms of the ACA it would stimulate more than $350 million in economic activity, lead to the creation of 3,100 new jobs, and result in the generation of up to $18 million in state and local taxes.

Since the Legislature has now refused to override the governor�s veto of the expansion, those federal dollars (including those originating from Maine taxpayers) and their associated benefits will go to other states that accept the deal.

Some opponents of expansion claim that they don�t trust the feds to keep their word (even though it�s now written into law) and that we won�t be able to get rid of the extra costs should they renege on their commitment. Others are simply philosophically opposed to bigger government. It seems as though some are opposing MaineCare expansion simply out of spite.

This fight could be avoided, and is just a symptom of a more fundamental underlying disease � the way we pay for health care in the U.S. Our insurance-based system requires that we slice and dice our population into �risk categories.�

This phenomenon was made worse by PL 90, the �pro-competition� health insurance reform law passed by the Republican legislature in 2011. Now we�re seeing older, rural Mainers pitted against younger, urban ones. This type of discrimination is the very basis of the insurance business.

Many conservatives still characterize Medicaid as �welfare,� and many think of it as such. Presumably other types of health care coverage have been �earned� (think veterans and the military, highly paid executives, union members and congressional staff). We resent our tax dollars going to �freeloaders.� Until the slicing and dicing is ended, the finger pointing, blame shifting and their attendant political wars will continue.

In sharp contrast, our Canadian neighbors feel much differently. Asked if they resent their tax dollars being spent to provide health care to those who can�t afford it on their own, they say they can�t think of a better way to spend them. �Isn�t that what democracy is all about?� I�ve heard Canadian physicians say, �Our universal health care is the highest expression of Canadians caring for each other.�

Here in Maine, the response tends to be much different. Canadians seem to think health care is a human right. We don�t � yet.

If everybody was in the same health care system in the U.S., as is the norm in most wealthy nations, we would be having a much different and more civil conversation than what we are now witnessing in Augusta. No other wealthy country relies on the exorbitantly expensive and divisive practice of insurance underwriting to finance their health care system. They finance their publicly administered systems through broad-based taxes or a simplified system of tax-like, highly regulated premiums. Participation is mandatory and universal.

Taxation gets a bad rap in the U.S. and consequently is politically radioactive. Yet it is the most efficient, most enforceable and fairest way to finance a universal health care system.

In her excellent New Yorker essay called �Tax Time,� Jill LePore points out that taxes are what we pay for civilized society, for modernity and for prosperity. Taxes insure domestic tranquility, provide for the common defense, promote the general welfare, and take some of the edge off of extreme poverty. Taxes protect property and the environment, make business possible and pay for roads, schools, bridges, police, teachers, doctors, nursing homes and medicine.

Oliver Wendell Holmes once said, �Taxes are what we pay for a civilized society.� The wealthy pay more because they have benefited more.

Canada�s tax-financed health care system covers everybody, gets better results, costs about two-thirds of what ours does and is far more popular than ours with both their public and their politicians. There is no opposition to it in the Canadian Parliament.

What�s not to like about that?

Oh yes, and the average Canadian is now wealthier than the average American. Their far more efficient and effective tax-based health care system is part of the reason.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.

To Make Hearing Aids Affordable, Firm Turns On Bluetooth

More From Shots - Health News HealthOne Man's Quest To Make Medical Technology Affordable To AllHealthCuring Drug-Resistant Tuberculosis In Kids Takes CreativityHealthFederal Rule Extends Subsidies For College StudentsHealthSavory And Sweet: A Taste For Infertility

More From Shots - Health News

Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

Please enable Javascript to view the comments powered by Disqus.