The solution to the Obamacare mess is Medicare for All, period.
Prepared by our allies the folks at PNHP.org, the online resource of Physicians for a National Health Program
Op-Ed: Our Profit-Centered Private Medical Industry Is Cutting Back on Hospital Care
AlterNet [1] / By RoseAnn DeMoro [2]
December 24, 2013 |
With all the clamor over the website woes of the rollout of the Affordable Care Act finally ebbing, let’s hope the media can begin to notice some changes in the delivery of health care that will have more far-reaching consequences for health care quality and access long after the sign-up problems are a distant memory.
Despite the hysteria on the right, some components of the ACA are clearly welcome, especially the Medicaid expansion in those states where the governors are not standing with pitchforks in the door to block health coverage for the working poor.
Yet there’s plenty of trouble ahead, most evident with the cost shifting from insurers and providers to workers and families.
Many are now aware that the insurance plans offered through the exchanges are chock full of added out-of-pocket costs.
The cost problem extends well into the provider setting, as is now just being gleaned through some reporting on price gouging [3] by many big hospitals which jack up costs to patients through steeper co-pays, requiring cash up front before administering care, Medical Credit Scoring to determine if patients are a payment risk, and hounding patients for payment afterwards.
Less reported are the escalating problems on the care delivery side.
Let’s start with a new survey [4] out from Citi Research, via Reuters, which reports that “hospital inpatient admissions in November fell to their weakest level in more than a decade.”
Two big chains illustrate the trend. Henry Ford Health System in Detroit had a 6 percent drop the first seven months of this year, Modern Healthcare reported in August. California-based Kaiser Permanente has reduced its average daily census by 11 percent the past four years.
No one, of course, wants to be hospitalized. Sometimes you must be. A hospital is where you receive 24-hour nursing care, where they have the ability to quickly shift you to an operating room or intensive care floor if your condition suddenly deteriorates, and where they have the most specialized equipment.
But the hospital industry, increasingly dominated by giant corporations, either for-profit or acting like for-profits, are making higher profits elsewhere – in outpatient settings, especially surgery centers and boutique care centers, and investments, for example.
Hospitals overall, note NNU researchers at the Institute for Health and Socio-Economic Policy, have profit margins of 35 percent for elective outpatient services, compared to just 2 percent for inpatient care.
The bean counters and management consultants who, more than ever run the show, have far less financial interest in letting patients into the hospital or staying there.
Like those bad Halloween movies, the worst abuses long associated with managed care are back. Private health insurers, and hospital chains like Kaiser that are also insurers or hospitals that form their own integrated networks through the new Accountable Care Organizations (ACOs) have an economic incentive to restrict care.
For the past few months, registered nurses have been rallying and marching outside Kaiser Permanente facilities in Northern California protesting reductions in hospital services. These include broad cuts in hospital services that have sparked widespread opposition in Manteca, Ca. [5], and theclosure of pediatric services [6] in Hayward, Ca.
On a broader scale, Kaiser RNs are witnessing systemic practices aimed at setting up additional barriers to hospital care as fewer patients are admitted, held in “observation units” up to 24 hours and sent home, and pushed out the door prematurely to lesser-staffed, lesser-regulated sites or home.
In a 2012 Health Week presentation in Copenhagen, former Kaiser CEO George Halvorson said [7] that in the near future “for most people the home will be the primary site of care. In-home monitoring, EKGs, ultrasounds, blood and fluid diagnostic and patient communication tools will be increasingly sophisticated, effective and cheap.”
That will increase the burden on families, especially women.
As Patty Bellasalma, president of the California chapter of the National Association of Women (NOW) at a rally of nurses outside Kaiser’s Oakland headquarters, said [8]: “Forcing patients out of the hospital places a triple burden on women. We have to work, do most of the childcare and parent care and then when our family members are most ill and need hospitalization thaey will be sent home; leaving again us to manage it all.”
It also undervalues the professional care provided by registered nurses in the hospital setting. RNs have professional expertise that untrained family members do not, especially when called on to operated the “sophisticated” technology Halvorson boasts. They do not, for example, have the diagnostic skills to recognize problems in tube feeding, oxygen flow, proper care of a urinary catheter or colostomy, or how to respond to equipment alarms or power failures.
A gerontologist study in 2012 predicted an up to 15 percent likelihood of adverse events for home care patients in drug side effects, falls, and equipment malfunctions, and a huge increase in levels of stress and strain for the new home caregivers.
For the very sick patients who are able to still get into the hospital, the care delivery changes have other implications. Technology, promoted as both a way to reduce medical errors and cut costs (even as hospitals spend literally trillions of dollars on high tech systems) are too often used to displace, not enhance professional skill and routinize care.
One example is the rapid proliferation of electronic health records systems. While paper records and charting certainly have limitations, RNs and other caregivers have documented a number of problems with electronic health records systems [9] and the promise of savings are inflated. [10]
These include computerized delays in timely administration of medications, erroneous orders for drugs created by the software, hurdles in nurses’ ability to contact physicians and properly monitor patients, and other treatment delays. Further, many nurses find they end up spending more time with the computers than with patients.
At one Chicago hospital, a baby died [11] in 2011 after an automated machine prepared an intravenous solution containing a massive overdose of sodium chloride, more than 60 times the amount ordered by the physician.
In Northern California this summer and fall, several Sutter Health hospitals, where nurses have reported widespread breakdowns with their new Epic EHR system, has crashed for hours at a time [12], requiring RNs and doctors alike to effectively work blind without access to individual patient information, including patient histories and medication needs.
This latest wave of hospital and healthcare restructuring, of course, was wreaking havoc well before enactment of the ACA, but the ACA does provide a number of financial incentives encouraging the escalation of care delivery outside the hospital and the expanded use of EHRs inside.
Lives are in the balance. For RNs, the mandate to step up the role as patient advocates is clear. Our organization, National Nurses United, opposes the right-wing attack on the role of government or the calls to simply repeal or defund the ACA.
But we will never stop challenging a callous, profit-centered private health care industry and will continue to campaign for a more humane health care model as in an expanded, fully funded system of Medicare for all.
ABOUT THE AUTHOR
RoseAnn DeMoro is executive director of National Nurses United, and a presenter at the panel, “Vision for a New America. A Future Without Poverty,” which will be telecast on CSPAN at 6:30 p.m. EST January 17 and can also be viewed on this live stream, http://www.ustream.tv/visionforanewamerica. 
Links:
[1] http://alternet.org
[2] http://www.alternet.org/authors/roseann-demoro
[3] http://www.nytimes.com/2013/12/03/health/as-hospital-costs-soar-single-stitch-tops-500.html?hp&_r=2&
ADVENTURES IN THE ITALIAN NATIONAL HEALTH SERVICE
Cyrano’s Journal
Even confused, often corrupt, bumbling Italy has a much better healthcare service than America, and a much less savage capitalism.
I just returned from my national health doctor and the next door pharmacy. The doctor graciously dressed an inflamed, very deep cut on my right hand and gave me a prescription for an antibiotic to avoid infection. Total time, five minutes. Cost: zero.
An Italian health service card. That’s all you need. Italy ranks 2nd in the world in quality, right after France.
Then I went to the pharmacy where a beautiful pharmacist filled my National Health Service prescription. Total time: five minutes. Cost: euro 2.71, a little over $3.00, of patient participation which in my case will be reimbursed by a private journalist insurance.
I returned home after about 45 minutes in total, with the antibiotic and my hand well-dressed and re-bandaged and my spirits bolstered.
Now, I must go backwards a week to describe my accident that took me to the doctor and pharmacy today. Last week I had a tremendous fall in the semi-darkness in the parking lot of my usual supermarket. I stumbled over something and fell headlong among some cement blocks and other mysterious objects and woke up flat on my face with a brutal pain in my forehead.
The Italian National Health Service was instituted in 1978.
I finally managed to climb to my feet just as a lady stopped her car nearby, rushed toward me asking if I needed help and gave me a handful of Kleenex to wipe the blood off my forehead, at which point however I realized the blood was flowing from my hand. I supposed the wound came from a piece of broken glass; I was in a dark part of the parking lot where I shouldn’t have been in the first place in order to throw from a low wall to a trash bin a bag of trash from home that I had forgotten to dump in the proper place.
At that point I staggered into the supermarket where I know most of the employees. Several of them rushed toward me aghast. And what a sight I was! Dazed and covered in blood, the knob on my forehead already huge, and most likely a wild expression on my face. they rushed me into a room where the manager delicately washed my face and told me I had to get to a hospital. I adamantly refused that offer while the fish market manager began wrapping my hand with something and another person pressed an ice pack on the swelling and expanding bump on my forehead. As I gradually returned to the real world, I agreed that they could call a first aid ambulance which could then either medicate me on the spot or take me to an ER.
Meanwhile I staggered around the market, in my blood-stained head bandana and hand, still unaware of my damaged rib cage and right leg, stubbornly buying what I had come for, milk and bread, and especially the wine.
Within about five minutes the ambulance arrived just as I’d finished paying with a card at a check-out counter. The first aid people dressed in orange and black slickers rushed me and the wine out the door to the ambulance, sat me inside where a male nurse proceeded to medicate me. He cleaned and dressed my right hand, said I needed stitches—but maybe not—then wrapped a wide swath of gauze around my head so that I looked like a war bombing victim, while a second ambulance man continued to converse with me about this and that. I realized later his job was to make sure I didn’t have a concussion. While the nurse wrote up a long form with data from my national health card, the other continued talking and the female driver turned up the pop music and the service radio crackled and the people whose cars were blocked by the ambulance waited patiently and, to my surprise, uncomplaining. Total intervention time for the first-aid ambulance, I would guess, 45 minutes. Cost to me: zero.
[pullquote]World Health Organization‘s ranking, as the 2nd best in the world after France,[3] and according to the CIA World factbook, Italy has the world’s 10th highest life expectancy.[4] Thanks to its good healthcare system, the life expectancy at birth in Italy was 80.9 years in 2004, which is two years above the OECD average.[2](Wikipedia)[/pullquote]
After the nurse escorted me to me car and placed my shopping bag on a seat, reassured himself that I was in condition to drive, I went back into the supermarket to thank everyone and was met by waves and smiles and a left hand shake with the manager.
Now even though the Italian National Health Service might not be considered the best in Europe, today it is for me. Once back home this morning from doctor and pharmacy, I raced to the computer to record this experience. In Italy’s continual economic emergency the first places budgetary leaders look to make cuts are in the national health program and social security but it resists.
The National Health Services of Germany, France, Switzerland are considered among the best, though every European country offers excellent services, from Scandinavia to Malta, from Great Britain (despite recent cutbacks still among the best) to Russia and Bulgaria. The countries I have lived in, including Mexico and Argentina offer national health services, as do I’m certain all Latin American countries. The health service in Canada has long been considered among the best in the world. Rich Latin Americans even fly to Cuba for delicate heart surgery. The black hole in the world of national health services is the USA, reputedly the world’s richest country which spends proportionately much much more for far worse health protection than any other world country.
•
Italians as a rule are convinced that their national health service is the best, the elimination of which could literally cause a revolution. Most certainly no politician could ever be elected to any office in Italy based on a program of elimination of Italy’s single payer National Health Service. In fact, most political programs include protection and improvement of the national health service. The thing about a single payer (that is the state) health service is that once in place, it becomes the right it truly is and no people will ever willingly surrender that right.
Misinformed and ignorant people in the USA into whose DNA disastrous negative opinions about single payer national health services have been inculcated by crassly greedy and evil political leaders and pharmaceutical and insurance companies will raise the usual objections. But anyone who has lived a life in places where largely free health care is assured takes it for granted that the state guarantees the protection of the health of all its peoples.
Longtime Rome resident Gaither Stewart is TGP’s European correspondent. The author of many novels and essays, his latest is The Fifth Sun, with a plot spanning Italy and Mexico. The book was published by Punto Press.
Bernie Sanders Introduces Single Payer Bill: American Health Security Act of 2013
By Bernie Sanders
Summary of S. 1782, The American Health Security Act of 2013
The American Health Security Act of 2013 (S. 1782) provides every American with affordable and comprehensive health care services through the establishment of a national American Health Security Program (the Program) that requires each participating state to set up and administer a state single payer health program. The Program provides universal health care coverage for the comprehensive services required under S. 1782 and incorporates Medicare, Medicaid, the Children’s Health Insurance Program, the Federal Employees Health Benefits Program and TRICARE (the Department of Defense health care program), but maintains health care programs under the Veterans Affairs Administration. Private health insurance sold by for-profit companies could only exist to provide supplemental coverage.
The cornerstones of the Program will be fixed, annual, and global budgets, public accountability, measures of quality based on outcomes data designed by providers and patients, a national data-collection system with uniform reporting by all providers, and a progressive financing system. It will provide universal coverage, benefits emphasizing primary and preventive care, and free choice of providers. Inpatient services, long term care, a broad range of services for mental illness and substance abuse, and care coordination services will also be covered.
A seven-member national board (the Board) appointed by the President will establish a national health budget specifying the total federal and state expenditures to be made for covered health care services. The Board will work together with similar boards in each of the fifty states and the District of Columbia to administer the Program.
A Quality Council will develop and disseminate practice guidelines based on outcomes research and will profile health care professionals’ patterns of practice to identify outliers. It will also develop standards of quality, performance measures, and medical review criteria and develop minimum competence criteria. A new Office of Primary Care and Prevention Research will be created within the Office of the Director of the National Institutes of Health (NIH).
The Program is designed to provide patient-centered care supported through adequate reimbursement for professionals, a wealth of evidence-based information, peer support, and financial incentives for better patient outcomes. The Program seeks to ensure medical decisions are made by patients and their health care providers.
The Program amends the tax code to create the American Health Security Trust Fund and appropriates to the Fund specified tax revenues, current health program receipts, and tax credits and subsidies under the Affordable Care Act. While the final structure of the financing component is still under consideration and is subject to change, the tax revenues in the draft include a new health care income tax, an employer payroll tax, a surcharge on high income individuals, and a tax on securities transactions.
The federal government would collect and distribute all funds to the states for the operation of the state programs to pay for the covered services. Budget increases would be limited to the rate of growth of the gross domestic product. Each state’s budget for administrative expenses would be capped at three percent.
Each state would have the choice to administer its own program or have the federal Board administer it. The state program could negotiate with providers and consult with its advisory boards to allocate funds. The state program could also contract with private companies to provide administrative functions, as Medicare currently does through its administrative regions. State programs could negotiate with providers to pay outpatient facilities and individual practitioners on a capitated, salaried, or other prospective basis or on a fee-for service basis according to a rate schedule. Rates would be designed to incentivize primary and preventive care while maintaining a global budget, bringing provider, patients, and all stakeholders to the table to best determine value and reimbursement.
Finally, the Program also relieves businesses from the heavy administrative burdens of providing health care coverage, puts all businesses on an even playing field in terms of healthcare coverage, and increases the competitiveness of American companies in the global marketplace. Every other industrialized nation has been able to use the power of a public authority to provide universal health care. The American Health Security Act of 2013 seeks to do just that for all Americans and their
ABOUT THE AUTHOR
Bernie Sanders is the independent U.S. Senator from Vermont. He is the longest serving independent member of Congress in American history. He is a member of the Senate’s Budget, Veterans, Environment, Energy, and H.E.L.P. (Health, Education, Labor, and Pensions) committees.
Reprinted from healthcare-now.org
21 Ways the Canadian Health Care System is Better than Obamacare
Time for a Repeal
by RALPH NADER
Dear America:
Costly complexity is baked into Obamacare. No health insurance system is without problems but Canadian style single-payer full Medicare for all is simple, affordable, comprehensive and universal.
In the early 1960s, President Lyndon Johnson enrolled 20 million elderly Americans into Medicare in six months. There were no websites. They did it with index cards!
Below please find 21 Ways the Canadian Health Care System is Better than Obamacare.
Repeal Obamacare and replace it with the much more efficient single-payer, everybody in, nobody out, free choice of doctor and hospital.
Love,
Canada
Obama on the spot. He made his bed with his betrayals.
Number 21:
In Canada, everyone is covered automatically at birth – everybody in, nobody out.
In the United States, under Obamacare, 31 million Americans will still be uninsured by 2023 and millions more will remain underinsured.
Number 20:
In Canada, the health system is designed to put people, not profits, first.
In the United States, Obamacare will do little to curb insurance industry profits and will actually enhance insurance industry profits.
Number 19:
In Canada, coverage is not tied to a job or dependent on your income – rich and poor are in the same system, the best guaranty of quality.
In the United States, under Obamacare, much still depends on your job or income. Lose your job or lose your income, and you might lose your existing health insurance or have to settle for lesser coverage.
Number 18:
In Canada, health care coverage stays with you for your entire life.
In the United States, under Obamacare, for tens of millions of Americans, health care coverage stays with you for as long as you can afford your share.
Number 17:
In Canada, you can freely choose your doctors and hospitals and keep them. There are no lists of “in-network” vendors and no extra hidden charges for going “out of network.”
In the United States, under Obamacare, the in-network list of places where you can get treated is shrinking – thus restricting freedom of choice – and if you want to go out of network, you pay for it.
Number 16:
In Canada, the health care system is funded by income, sales and corporate taxes that, combined, are much lower than what Americans pay in premiums.
In the United States, under Obamacare, for thousands of Americans, it’s pay or die – if you can’t pay, you die. That’s why many thousands will still die every year under Obamacare from lack of health insurance to get diagnosed and treated in time.
Lots of ignorant and misguided people, including hard-core Obots, continue to support the law.
Number 15:
In Canada, there are no complex hospital or doctor bills. In fact, usually you don’t even see a bill.
In the United States, under Obamacare, hospital and doctor bills will still be terribly complex, making it impossible to discover the many costly overcharges.
Number 14:
In Canada, costs are controlled. Canada pays 10 percent of its GDP for its health care system, covering everyone.
In the United States, under Obamacare, costs continue to skyrocket. The U.S. currently pays 18 percent of its GDP and still doesn’t cover tens of millions of people.
Number 13:
In Canada, it is unheard of for anyone to go bankrupt due to health care costs.
In the United States, under Obamacare, health care driven bankruptcy will continue to plague Americans.
Number 12:
In Canada, simplicity leads to major savings in administrative costs and overhead.
The stupid and dishonest right-wingers badmouth Obamacare for all the wrong reasons. Among the most imbecilic accusations is that Obamacare is a socialist program. We wish.
In the United States, under Obamacare, complexity will lead to ratcheting up administrative costs and overhead.
Number 11:
In Canada, when you go to a doctor or hospital the first thing they ask you is: “What’s wrong?”
In the United States, the first thing they ask you is: “What kind of insurance do you have?”
Number 10:
In Canada, the government negotiates drug prices so they are more affordable.
In the United States, under Obamacare, Congress made it specifically illegal for the government to negotiate drug prices for volume purchases, so they remain unaffordable.
Number 9:
In Canada, the government health care funds are not profitably diverted to the top one percent.
In the United States, under Obamacare, health care funds will continue to flow to the top. In 2012, CEOs at six of the largest insurance companies in the U.S. received a total of $83.3 million in pay, plus benefits.
Number 8:
In Canada, there are no necessary co-pays or deductibles.
In the United States, under Obamacare, the deductibles and co-pays will continue to be unaffordable for many millions of Americans.
Number 7:
In Canada, the health care system contributes to social solidarity and national pride.
In the United States, Obamacare is divisive, with rich and poor in different systems and tens of millions left out or with sorely limited benefits.
Number 6:
In Canada, delays in health care are not due to the cost of insurance.
In the United States, under Obamacare, patients without health insurance or who are underinsured will continue to delay or forgo care and put their lives at risk.
Number 5:
In Canada, nobody dies due to lack of health insurance.
In the United States, under Obamacare, many thousands will continue to die every year due to lack of health insurance.
Number 4:
In Canada, an increasing majority supports their health care system, which costs half as much, per person, as in the United States. And in Canada, everyone is covered.
In the United States, a majority – many for different reasons – oppose Obamacare.
Number 3:
In Canada, the tax payments to fund the health care system are progressive – the lowest 20 percent pays 6 percent of income into the system while the highest 20 percent pays 8 percent.
In the United States, under Obamacare, the poor pay a larger share of their income for health care than the affluent.
Number 2:
In Canada, the administration of the system is simple. You get a health care card when you are born. And you swipe it when you go to a doctor or hospital. End of story.
In the United States, Obamacare’s 2,500 pages plus regulations (the Canadian Medicare Bill was 13 pages) is so complex that then Speaker of the House Nancy Pelosi said before passage “we have to pass the bill so that you can find out what is in it.”
Number 1:
In Canada, the majority of citizens love their health care system.
In the United States, the majority of citizens, physicians, and nurses prefer the Canadian type system – single-payer, free choice of doctor and hospital , everybody in, nobody out.
For more information see Single Payer Action at www.singlepayeraction.org.
Ralph Nader is a consumer advocate, lawyer and author of Only the Super-Rich Can Save Us! He is a contributor to Hopeless: Barack Obama and the Politics of Illusion, published by AK Press. Hopeless is also available in a Kindle edition.