What’s up with the single-payer health insurance plan Vermont?

Can one state take over its entire health insurance industry? We’ll find out in Vermont. Here are some links w/ more details

From The Rutland Herald:

MONTPELIER — Health care advocates and Democratic politicians on Thursday cheered a Supreme Court decision that preserves the foundation on which Gov. Peter Shumlin plans to build the nation’s first single-payer health care system.

While he vowed earlier this week to proceed with a publicly funded, universal system regardless of how the country’s highest court ruled on the Affordable Care Act (ACA), Shumlin said Thursday that the federal subsidies included in Obamacare will ease Vermont’s transition to single payer.


From Kaiser Health News:

KHN’s Marilyn Werber Serafini talks to Anya Rader Wallack, tapped to move Vermont toward a single payer health care system, who is confident the state would enact its own individual mandate requiring people to buy insurance if the Supreme Court strikes down the federal mandate. Still, finding the money to replace the lost federal subsidies won’t be easy. Wallack says, “We’ll have to cover [people] without adding new resources to the system or raising taxes at the state level. Both of those are difficult for a little state.”

Transcript here or see below:

While you’re at it, check out the Health Wonk Review’s two-part take on reform;

SCOTUS on health reform – the bloggers respond: Part 1 & Part 2.


Harvard video: The Supercommittee Collapse and America’s Healthcare Future

Harvard School of Public Health Panel

Mass. single-payer advocates take on limits of state health reform

Before you write off these folks, note that a recent survey of doctors by the Massachusetts Medical Society found that a growing number of doctors support the idea of a single-payer system. More than 40 percent, up from  34 percent last year. So do a lot of folks at Occupy Boston.

Massachusetts Health Reform in Practice and The Future of National Health Reform

OVERVIEW: While the Massachusetts health reform law of 2006, widely regarded as the model for the new federal health law, reduced the uninsured population in the state, it did so at the cost of rapidly rising underinsurance, increased health care premiums, and a financial crisis among the state’s safety-net hospitals and community health centers. And the financial burden of the reform has fallen disproportionately on lower-middle-class families.

Those are some of the findings in a new, exhaustively documented report on the outcomes of the Massachusetts reform law released by Mass-Care and Massachusetts Physicians for a National Health Program. The report draws on hundreds of sources, including academic studies, government statistics and scientific surveys, in the first compilation of its kind.


The Massachusetts Health Reform Law of 2006 expanded Medicaid coverage for the poor and made available publicly subsidized private health insurance for additional low-income residents of the state. It also mandated that all but the poorest uninsured residents either purchase private health insurance or pay a substantial fine (up to $1,212 in 2011). Smaller fines (up to $295 per employee) were also levied on employers who fail to offer insurance.

Four years after full implementation of the law, Massachusetts has not achieved universal coverage, although one-half to two-thirds of the previously uninsured now have some type of insurance policy. Most of the gains in coverage have come from expansions in publicly subsidized insurance. This largely represented a shift of patients from the state’s former Free Care Pool, which compensated hospitals and community health centers directly for care of the uninsured, to private insurance plans, which is a more costly way to provide care. The reform did not lead to a sustained increase in employer-sponsored coverage, but did slow declining employer coverage. Instead of dropping coverage, employers in Massachusetts have increased cost sharing, shifting costs on to employees, leading to rapidly rising underinsurance after health reform. The use of high-deductible plans more than tripled for residents with private insurance, and good insurance coverage at small businesses all but disappeared over a few short years after reform.

Reform has had a positive impact on access to care in the state, but this impact has affected a modest share of residents, and for some patients has been negative. For example, some low-income patients who previously received completely free care under the state’s prior free care program faced new co-payments and premiums after becoming insured, which impeded their access to care. Reform has not reduced the burden of medical bills and medical bankruptcy on Massachusetts’ families.

The growth of residents with insurance coverage has exacerbated a primary care shortage in Massachusetts by increasing wait times for appointments and decreasing the portion of physicians accepting new patients, creating access problems even for those with coverage. Reform did not reverse growing use of the state’s emergency departments for care, despite expectations that expanding insurance coverage would reroute patients through primary care offices. There is no evidence as of yet that expanding insurance coverage has had an impact on health outcomes or disparities in health outcomes. Reform has also created a financial crisis for safety net providers that specialize in care for low-income communities and the uninsured, by shifting resources away from safety net providers while patient demand for safety net care has actually increased.

The public cost of reform has been high, exceeding $800 million in fiscal 2009 for a state with a total budget of $32.5 billion.  However, federal taxpayers paid for the bulk of the law’s public expenses. The state has made a broad range of cuts to the original law in order to its keep costs down, cutting back coverage for over 30,000 documented immigrants, curtailing some benefits, increasing cost sharing, and increasing the share of enrollees required to pay premiums. Substantial funds from the federal stimulus bill were also used to sustain the reform law, but this was a short-term fix only.

Public payments account for only a portion of the reform law’s costs. A central premise of the law was that the state, employers, and individuals would all have to sacrifice financially to approach the goal of universal coverage. This premise of “shared responsibility” for the costs of the reform was in many ways disingenuous. Although employers, individuals, state and federal government have shared the burden of increased costs roughly equally, this overlooks the fact that governments pass on their spending to taxpayers, and employers pass on their costs to employees.  The actual burden of health reform was regressive, with increased spending after health reform falling disproportionately on lower-middle income residents.

The reform failed to “bend the cost curve” in Massachusetts because it contained no significant cost-control provisions. Health care costs in Massachusetts are higher than in any other state in the nation, and reform has been found to accelerate the rising costs of employer-sponsored health care. There is general agreement that the Massachusetts reform is itself not sustainable without effective cost control.

Massachusetts enjoyed favorable circumstances at the outset of reform, such as previously high levels of spending on health care for the poor, high personal incomes, and relatively low rates of uninsurance. Without controlling costs, national reform will run up against the same difficulties as Massachusetts: growth in public insurance coverage will prove unsustainable and will accompany the rapid erosion of private insurance benefits, while modest gains in access to care will be threatened in the short term by unsustainably high costs that are increasingly shifted on to patients.

While Massachusetts health reform has enjoyed support from a majority of residents in the state, that support has declined since national health reform instigated a broader debate over alternatives to the Massachusetts plan. Moreover, while residents support the Massachusetts reform law over no change at all, they have expressed increasing skepticism that the law is working for vulnerable communities, and more residents report that the law is hurting them than helping them.

We believe that the data in this report should give pause to those concerned with national health care reform. Although not without its successes, the Massachusetts reform has not addressed the fundamental deficiencies in the health care system – treating symptoms rather than causes – and even its modest successes are unsustainable for the state and Massachusetts residents.

New Yorker: How Mitt Romney came around to Massachusetts style health reform

Watching New Yorker writer Ryan Lizza on MSNBC on Wednesday night got us thinking – is this a repeat? Since we recently watched four innings of a rain-delay repeat of a Red Sox game before realizing
we had already seen it, we were suspect.

 Lizza struggled through his explanation of Health Reform 101 — we all do — without offering much news. The same can almost be said of his story on Mitt Romney’s role in the Mass plan in this week’s New Yorker.

One angle he did nail was – the approach embraced by Mitt and Obama is a Republicans idea. And contrary to the argument that this is a government takeover of health care, it’s actually an attempt at providing universal coverage while maintaining the private health insurance industry.

For government-run health care, see the UK. For government-run insurance, aka single payer, see Medicare
or Canada or Vermont. Find support for the latter approach at Mass Care or Physicians for a National Health Plan.

So, it you need to catch up and don’t want to dish out $5.99  or subscribe to The New Yorker,  just scroll down or click on the story in last week’s Globe, the first in a series On Romney and health and not yet behind a pay wall. We recycled the headline.

Maine senators join health reform lawsuit

 The Portland Press-Herald reports:

Snowe was concerned with the concept of government mandating an individual purchase of something, especially because she did not believe health insurance would be sufficiently affordable, her office has said.

Snowe and Sen. Charles Schumer, D-N.Y., tried to amend the reform to reduce the number of people subject to the mandate and allow Congress more flexibility to review the mandate altogether, but it failed in committee.

“The individual mandate has no place in a health care reform bill unless and until affordable health insurance is available for all Americans,” Snowe said in a release about the brief.

Photo by Var Resa

NHS: Maybe they fund fruit fly research too

Not to knock  my UK colleagues, but –would it be fair to say that maybe the headlines of some British newspapers are not the best source of information about England’s National Health Service?

 More demonizing of CMS nominee Donald  Berwick – who has said he “loves” the UK plan — in a column in today’s Globe, under the headline:” Dangerous to our health.”

 …(T)hose who have to live with the NHS and its “bottlenecks’’ don’t always find them so admirable. The British press has been reporting horror stories about the realities of government-run health care. Some recent headlines give a sense of the coverage:

“Overstretched maternity units mean mothers face a 100-mile journey to have baby.’’

“Hundreds of patients died needlessly at NHS hospital due to appalling care.’’

“Cash-strapped NHS trust introduces rationing for common children’s conditions.’’

“Standard of care in some wards ‘would shame a third world country.’ ’’

“Stafford Hospital caused ‘unimaginable suffering.’ ’’

No one can deny that America’s health care system is flawed in many ways. But when it comes to the standard that matters most — the quality of health care provided — our haphazard, expensive, insurance-based system towers above the NHS.

The comments are rolling in:

One reader says:

  Normally, a (Jeff) Jacoby column should be taken with a few tons of salt when it comes to facts. But this one really is flawed beyond belief. I have met many Brits during my travelsand, while they will complain about the NHS, I have never met any that thought it should be done away with. When I explained how our “free market” health system actually worked they tend to react with horror. When I tell them about Republican criticisms of the NHS in the United States they usually say they are ridiculus. General overall health in Britian, they tell me, is pretty good as a result. And no one fears denial of care based on ability to pay or bankruptcy because of illness.

As for the rather shocking headlines, I decided to check them out–one is from a blog (we all know the truth value of most political blogs), two are from the Daily Mail, a tabloid paper famous for supporting fascists before the war and at least one was based on tory party propoganda from the recent election. Two were from the Daily Telegraph, derisively known as the torygraph and connected with Rupbert Murdoch. One was from the Sunday Times (the Staffordshire Hospital story) which referred to the conditions at that hospital an “anamoly”, led to a clearing house of the management of that hospital and is leading to a review of accredidation of hospital managers.

 Another offers a conflicting view of the stats. The numbers indicate international rankings:

 Per capita costs, in dollars:
#1 US: 4361.
#16 UK: 1754.

Infant mortality, per 100,000 live births:
#26 UK: 5.01
#37 US: 6.37

Life expectancy: years, men–women
US: 77–81
UK: 77–82

Cancer deaths: per 100,000
#9 US: 321.9
#16 UK: 253.5

Poll results from the UK: preferences, percentages
Prefer the UK’s National Health Service: 89.9%
Prefer the US system: 10.1%

A quick ride in the Googlemobile presents a more mixed picture than does Mr Jacoby, who dwells on the UK system’s imperfections while ignoring ours. And one of his statistics seems disputable, if not actually wrong. Meanwhile, for all its problems, UK citizens overwhelmingly choose their system over ours. The huge number of MRI machines in this country are extraordinarily lucrative investments, costly to the system, duplicate facilities, and are of largely unproven utility in improving health care outcomes. Our increased performance of, and reliance on, diagnostic tests, too, may or may not reflect better care; it may reflect a dearth of primary care and an increased reliance on hospital emergency rooms.


Tipping point for health costs in Mass?

BHN is not a fan of the overused term “tipping point.”  But, it works here.

Let’s connect the dots. 

The Globe‘s reports on back room deals at Partners, the hospital giant that helps fuels the regions high health care costs high. The ever-looming high costs of care in Mass.  The state’s – and now the public’s –– stake in high health costs. The insurance industry attempt to raise some rates for small businesses by, in some cases, more than 30 percent.

 Tipping point?

 The state says no to high rates.  Insurers sue – and lose — but some start dropping high-cost hospitals. Partners — facing pressure for running thos high-costs hospitals — chips in $40 million for small businesses insurers.  And the state has a plan to cut waste by rewarding docs for who cure patients, not those who order lots of tests.

 BHN  was going to put all these pieces together. But the New York Time did it in yesterday’s staff editorial.

  When Massachusetts’s politicians designed their reform, they calculated that achieving near-universal coverage first would then give all participants in the health care system an incentive to help rein in costs. There are encouraging signs that that is starting to happen.