There has also been concern about the problem of patent ‘ever greening’ — that the TPP will impose low patent standards ‘likely to lead to a proliferation of secondary patents being granted … preventing fair competition for long periods’. This would be an undesirable outcome, creating excessive opportunities for the extension of monopoly protections.
In Maryland it was Johns Hopkins that wrote the policies of Trans Pacific Trade Pact in health care and the structures being implemented by neo-liberals and neo-cons in the Maryland Assembly with Governor O'Malley. It is the Hopkins private non-profit Maryland Health Care for All that pushed Affordable Care Act to deregulate and consolidate the health industry preparing for TPP. Below you see Hopkins' associate Beilenson building the structure that will capture most Marylanders not able to access health care and it is the model of third world clinic care. Above you see the term 'evergreening' meaning privatization and profiteering in TPP trade policies that create the conditions of dismantling public health. Below you see Johns Hopkins and their use of the term as the name of the so-called private non-profits that will manage the masses not able to access health care in Maryland. The very institutions guilty of making the US health system the worst in the world are now writing policy to take the US health system third world.
At Evergreen Health we put your health first.
Evergreen Health is a new health insurance company in Maryland created to give you a better health care experience.
We were founded by local doctors who imagined a health care system that puts a patient’s health first – not corporate profits. Evergreen Health offers quality, affordable health insurance plans for individuals and families in Maryland. We also offer group plans for employees of your business who work in Maryland.
The reason Beilenson thinks Evergreen is well-positioned is that if Affordable Care Act is implemented more and more people will be forced into these non-profit plans. Evergreen will be the health structure people are forced to as Medicare, Medicaid, and people's corporate plans disappear. As with evergreening in TPP-----it will move the American people to a third world platform of health care. Beilenson is Johns Hopkins and Johns Hopkins is third world health care. Baltimore doesn't have citizens dying 30 years too early because of good policy!
OH WELL------IT'S ONLY THE POOR! WELL, IN THIRD WORLD NATIONS DOCTORS, LAWYERS, AND INDIAN CHIEFS ARE POOR.
Why do we need a private non-profit co-op to bring prices down when Medicare and Medicaid does just that? As Beilenson knows------he is there to replace these Federal programs and will not have to meet any Federal guidelines of care-----they are staged to downgrade a public health structure in Medicare that has served wonderfully for decades. All we need to keep Medicare is to stop the health industry fraud by institutions like Johns Hopkins.
OH, LET'S CREATE PRIVATE NON-PROFITS TO TAKE OVER PUBLIC HEALTH PROGRAMS LIKE MEDICARE AND MEDICAID THAT ALREADY WORK TO KEEP PRICES DOWN---- if 1/2 of entitlement spending wasn't lost to corporate fraud.
In the land of neo-liberalism/neo-cons, ending all Federal agencies that come with public protections is a must in order to allow global corporations to do anything they want in the US and to American citizens.
Evergreen faces challenges in delivering health insurance
Small businesses may be the future of health insurance co-op in MarylandOctober 29, 2013|By Meredith Cohn, The Baltimore Sun
Four weeks since it began selling health insurance on the state's new marketplace for the uninsured, Evergreen Health Cooperative Inc. has signed up only five people.
That's a long way from the nonprofit health insurance provider's first-year goal of 15,000 people, so Evergreen is already shifting focus.
Technical problems making it difficult for people to register for the state exchange culminated last week for Evergreen when its plans disappeared from the exchange offerings. The plans were restored after a short time.
Statewide, more than 3,100 people have signed up for health coverage on the exchange, according to the latest numbers released by the Maryland Health Connection. There are about 800,000 uninsured Marylanders.
Evergreen isn't waiting for the exchange to start working properly. For now, the co-op has switched focus from individuals buying its insurance on the exchange to small businesses buying plans directly from Evergreen, said Dr. Peter Beilenson, the former city health commissioner who started it. (The state's small-business exchange has been delayed until Jan. 1.)
"We obviously were predicating most of our business on the exchange market, which is not bearing fruit right now," Beilenson said. "That was a problem for us in two ways: financially in terms of generating enough members and for our mission. We did this for the middle class who would qualify for subsidies."
But the co-op was new and nimble enough to switch "almost overnight to small businesses," he said. "We think it will provide us with enough members to get through until the exchange is running smoothly."
Evergreen's small group rates were approved Oct. 25, so no group has enrolled yet, but the prices are below average and attracting attention from businesses and brokers, Beilenson said. The co-op will depend on enrollment to survive — members' premiums will pay to run the co-op and cover startup costs. Any profits would be returned to the plans.
The co-op's small-group rates are at the lower end of the spectrum, with an average premium of about $368 per insured, according to data from the Maryland Insurance Administration.
The lower rates may reflect Evergreen's model. The co-op employs its own doctors, who work in one of four centers for a salary rather than fee-for-service. The idea is to focus on prevention while managing multiple chronic conditions and staving off costly emergency visits and hospital stays.
Evergreen also offers a traditional plan using a network of doctors.
It's cost that matters most to small businesses, and a competitive premium will serve Evergreen well, said Karen Davis, a professor in the Johns Hopkins University's department of health policy and management. There is a "fair amount of evidence" that shows Evergreen's patient-centered model cuts costs, she said.
But insurance tends to be dominated by large insurance companies, so it remains unclear whether Evergreen and co-ops in other states can slice off enough business.
"The major challenge is size and scale," Davis said. "But the advantage Evergreen has is that its model of care is more effective. … I think they're in a better position than most of the co-ops."
Nationwide, 24 co-ops received federal funding as part of the Affordable Care Act. Evergreen got $65 million in federal loans, but all but about $13 million will go to a required reserve fund
Others wanted to start co-ops in Maryland, seeing the potential to compete with traditional insurance companies and bring down prices. One was MedChi, the state medical society, which planned to start a co-op largely on the Eastern Shore but was stymied when Congress cut startup funding.
"We're very supportive of the idea of co-ops and think they can work really well," said Gene Ransom, MedChi's CEO. "I don't think they have an easy task ahead. We are rooting for Evergreen because more competition is good for the marketplace."
Beilenson said Evergreen has made other adjustments to survive. It has hired some staff from the insurance industry to serve as a balance with those employees who know more about public health. It has raised $5 million in startup money from private foundations and another $1 million from other private sources for marketing, including a new TV ad (federal law prohibits explicit marketing with government money).
"I think we're well-positioned," Beilenson said. "We think we know what we're doing. And we think we have a really good product."
One of the elements in Affordable Care Act is the connection of generic drugs to Medicare. Obama and neo-liberals in Congress told the American people that because massive health industry fraud of our Medicare Trust occurred over these few decades they would have to reduce our health benefits to cover the money stolen. In the case of health care this means Medicare and Medicaid enrollees limited to what medications they can access. Common drugs will no longer be available to 80% of Americans because of this ACA clause pushing people to generic drugs only. IT SAVES MONEY AND LOWERS THE NATIONAL DEBT! As the statement at the top shows this ACA policy corresponds to the TPP health policies making generic drugs less common and harder to get. Neo-liberals and neo-cons are sending people to generics at the same time they are pushing TPP limiting access to generics. It's the same policy as pushing NAFTA and global markets knowing it will cause massive unemployment and poverty at the same time ending Welfare as a safety net-----creating the deepest poverty in US history. These are all Republican policies written for wealth and profit being installed by Clinton neo-liberals. Republican voters who are shouting against lost US Constitutional rights and dismantling of Rule of Law------lost access to health care need to remember these are all Republican policies. Don't vote Republican to fix this-----rebuild the Democratic Party at the national, state, and local level.
Below you see from what the Affordable Care Act is modeled......third world clinic care. Baltimore has had this system in place for a few decades but the model is being expanded because of the huge number of citizens falling into poverty. Only 1/2 of taxpayer money sent for social services are spent on the people meant to be served.....the rest has been funneled to Johns Hopkins and/or University of Maryland as profit. This is why the poor in Baltimore have life spans equal to third world countries. Neo-liberalism = third world poverty so 90% of Americans will be pushed into this system. Below you see a neo-liberal solution to our exploding health care costs fueled by health industry fraud and profiteering------third world clinic care and using college students to replace the public sector health care and social services employees. Health care outcomes in the US are at second and third world levels because of the dismantling of public health systems. College students are not prepared to be the backbone of public/social services-----they need practical experience of working with public professionals. Making volunteers and students the backbone of public health is a third world structure.
The US is now on par with countries like Hungary and Slovenia because Reagan/Clinton neo-liberalism dismantles all first world structures the protect and serve the public and all taxpayer money is looted in corporate fraud and subsidy. Simply rebuilding these oversight and accountability structures returns the US to first world status.
DEMAND EXPANDED AND IMPROVED MEDICARE FOR ALL IN YOUR STATE TO KEEP OUR FEDERAL MEDICARE PROGRAM STRONG AND EVERYONE COVERED! PUBLIC HEALTH IS WHAT KEEPS COSTS DOWN. WE SIMPLY NEED TO REBUILD OVERSIGHT TO ELIMINATE 1/2 OF HEALTH SPENDING AS FRAUD.
Doctor and Patient What We Can Learn From Third-World Health Care
By PAULINE W. CHEN, M.D. July 26, 2012 12:01 amJuly 26, 2012 11:16 pm New York Times
The young doctor had just returned from a month working in a country in Africa, familiar to the rest of us only through pictures of its impoverished population and news reports of recurring natural disasters and political upheavals. “You must feel exhausted but great,” a senior colleague commented. “You went in there and you really helped those people.”
Doctor and PatientDr. Pauline Chen on medical care.
But my younger colleague felt neither exhausted nor relieved to be back home, she confided when the older doctor had left the room. She had cared for dozens of patients with abscesses and broken bones, tumors and arrow wounds, relying on nothing more than a single rickety X-ray machine, a handful of battered surgical instruments and the aid of one well-connected local nurse.
“We could get so much done with so little over there,” she said. “It’s like we’re not doing something right over here.”
Put another way, the American health care system has become the great international paradox, spending more but getting less.
With all the most advanced technology and equipment, spending far more on health care than any other nation — a whopping $2.6 trillion annually, or over 17 percent of our gross domestic product — the United States consistently underperforms on some of the most important health indicators. Our infant mortality rates, for example, are worse than those in countries like Hungary, Cuba and Slovenia. Our life expectancy rates are not much better; in global rankings, we sit within spitting distance of Cuba, Chile and Libya.
This quality conundrum dogs us, even as our best and brightest have tried to imagine a more cost-efficient system. Some have pursued the carrot-and-stick route, linking quality measures to reimbursement. Others have attempted to reduce quality to its most basic parts, creating checklists and to-do lists. And still others have rearranged networks of hospitals, clinics, physician practices and payments, conjuring up a breathtaking array of combinations, permutations and bundles of care in order to create more cost-efficient systems.
But, according to an essay published this summer in The Stanford Social Innovation Review, we might have saved ourselves the huge effort, the expenses and the disappointments of only marginally successful initiatives, if we had first looked to countries traditionally viewed as needing our aid and learned from their successes in facing challenges similar to our own.
In the essay, Rebecca D. Onie, a founder and the chief executive of Health Leads, a domestic health care organization; Dr. Paul Farmer, a founder of Partners in Health, a Boston-based medical nonprofit group; and Dr. Heidi Behforouz, medical and executive director of the Prevention and Access to Care and Treatment project, a community-based health care initiative in the United States that is part of Partners in Health, argue eloquently for “reverse innovation.” They contend that for decades, several nongovernmental and nonprofit medical organizations have delivered high-quality care in some of the most challenging circumstances possible. Applying the solutions these medical organizations have already discovered could allow us to bypass or at least foreshorten what has become an interminable trial-and-error search for the answers to our country’s health care woes.
Their own organizations offer several models of success. For nearly three decades, Partners in Health, for example, has delivered consistently high-quality care to more than 2.5 million people in a dozen countries like Haiti, Rwanda and Peru, places with widespread poverty, scarce numbers of providers and no health care infrastructure. But they have managed to achieve, among other successes, the highest rate of cure of multidrug-resistant tuberculosis in the world and better rates of adherence to treatment regimens and follow-up than in much of the United States.
The key to their success is an unabashed disregard for some of our most cherished assumptions about what constitutes good care. Instead of providing antibiotics, CT scans and high-tech interventions, Partners in Health considers basic necessities like food and housing as critical components of the group’s medical work. Instead of asking patients to travel miles to the only clinic and see only the doctor or nurse, they train cadres of community health workers who can monitor, administer and advise in the heart of local villages and in people’s homes.
Applied to organizations in the United States, this approach has proved startlingly effective, as the Prevention and Access to Care and Treatment, or PACT, program has demonstrated. PACT targets some of the poorest and sickest patients with H.I.V. and other chronic illnesses in the greater Boston area. Just like Partners in Health, PACT relies extensively on community health workers who are trained in tasks like helping patients take their medications and make it to clinic appointments as well as reviewing their pantries and teaching them to prepare healthy meals. Applying these broad definitions of care, PACT has significantly decreased the number of emergency room visits and life-threatening opportunistic infections, cut hospitalization rates by 60 percent and yielded a 16 percent savings for Medicaid.
Health Leads has stretched these definitions even further, giving the terms “provider” and “care” a millennial twist. Each year, Health Leads trains a selected group of technology-savvy and tenacious college students to staff “resource desks” in primary care and prenatal clinics in cities like New York, Baltimore, Boston and Chicago. With these Health Leads volunteers in place, doctors can, for example, “prescribe” housing assistance for a family whose child’s severe asthma has been exacerbated by a cockroach infestation, healthy foods and nutrition resources for a man suffering from obesity, or transportation to a drugstore for an elderly woman who needs diabetes medications. At the resource desk, a Health Leads volunteer then “fills” these prescriptions by finding the best solutions for the problems at hand, whether that means tracking down the appropriate agency, navigating complicated online application processes or providing support as the patient makes the calls. In clinics where a single social worker may be responsible for as many as 25,000 patients, Health Leads volunteers have more than doubled the services provided.
The successes of PACT and Health Leads are no secret. But what does remain mysterious as our health care system threatens to implode is why more of us haven’t done the same and rushed to apply the lessons learned and proved elsewhere.
“We keep trying to reinvent the wheel,” Ms. Onie observed. “The humbling reality is that we are trying to recreate innovations that have been robustly developed in the developing world.”
In other words, we have yet to deploy what could prove to be the most powerful weapon in the fight to contain costs and improve the quality of health care: our own humility.
$200- 400 BILLION DOLLARS EVERY YEAR ARE LOST TO MEDICARE AND MEDICAID TO HEALTH INDUSTRY FRAUD. THAT IS WHERE THE HUMILITY NEEDS TO BE FELT!
People must understand the neo-liberal jargon---- when they say they work for the middle-class they see the middle-class in the US as people earning $250,000 as a family. They see Medicare and making it last longer for those 10% of people. Needless to say the working and current middle-class are the only ones having paid payroll taxes into this Medicare Trust so the very people that should be getting full benefit are the ones being pushed out with the ACA. That 'donut hole' will do no one any good if you cannot access or afford the kinds of PHARMA you need. I already have friends having bad health effects because of being forced to use a generic that does not work for a chronic condition.
THIS IS SERIOUS FOLKS. THE SAME PEOPLE TRYING TO KILL PUBLIC HEALTH WORLD-WIDE WITH TRANS PACIFIC TRADE PACT ARE WRITING THESE HEALTH POLICIES.
Remember, the answer is not to vote Republican because the Affordable Care Act is Republican policy. The solution is getting rid of neo-liberals in the Democratic Party. Do you hear your labor and justice leaders shouting out against neo-liberals?
In Maryland, Brown, Gansler, and Mizeur all supported these policies----while Cindy Walsh did not.
THE KING AND QUEEN OF NEO-LIBERALISM, BILL AND HILLARY CLINTON TAKING THE US FROM FIRST WORLD STATUS TO THIRD WORLD STATUS.
Which tier will your family fall? In the US almost 70% of Americans are at poverty line meaning they will fall into the lowest 2 tiers. Don't forget that TPP will keep generic drug availability at a minimum and when they do come available they will be very outdated. That's what the masses get say the neo-liberals and neo-cons. Someone has to replace the trillions of dollars in health industry fraud from our Medicare and Medicaid programs....
ACA 5-Tier Drug List
For Individual PPO and Small Group HMO, POS, and PPO plans (including Marketplace/QHP plans) with ACA-compliant coverage becoming effective on or after January 1, 2014
Most covered prescription drugs will be categorized into one of five tiers. The cost of drugs varies widely, even though several different medications may be used to treat the same condition. What you pay for the prescription depends upon what tier the drug is listed in. Health First offers many benefit plans that can vary in coverage for each tier. Details about your specific benefit for each tier are included in the Health First Summary of Benefits.
•Tier 1 — Preferred Generic Drugs •
Tier 2 — Non-Preferred Generic Drugs •
Tier 3 — Preferred Brand Name Drugs and some generics
•Tier 4 — Non-Preferred Brand Name Drugs and some generics (limited to a 30-day supply)
•Tier 5 — Specialty Drugs (limited to a 30-day supply, must obtain from Health First Family Pharmacy)
Generic drugs are prescription drugs that are identified by their chemical name. When the patent has expired on a brand name drug, the FDA permits new manufacturers to create an equivalent of the brand name drug and make it available to the public. Generally, more than one manufacturer will create generic versions, although often the same pharmaceutical firm that produces the brand name drug also makes the generic version. This prompts competitive pricing of the generic version and usually results in a less expensive drug. The Drug List is subject to change In order to continue to offer a safe and cost effective selection of prescription drugs, Health First periodically makes changes to the Drug List. These changes may include removing medications, adding restrictions, and/or covering a drug at a higher tier. The following list represents some of the most common scenarios in which changes to drug coverage will occur: •Throughout the year, new medications are approved by the FDA. It is the policy of Health First that new drugs will be excluded for 6 months from the date of FDA approval, during which time the Health First Pharmacy and Therapeutics Committee can review the drug for safety and efficacy. •The Drug List may change when a medication is withdrawn from the market due to safety reasons or if it becomes available over-the-counter (OTC). At the time that a medication on the Health First Drug List becomes available OTC, it may be excluded from coverage from that point forward. •When a brand-name prescription drug loses its patent and the equivalent generic form is added to the Drug List, the brand-name drug may be moved to the highest non-specialty drug tier, which is generally Tier 4 or removed from the formulary.