Today I will talk about more 'progressive' policies in the Affordable Care Act that have no intention of being anything other than a profit-maker for the health industry. First, I'd like people to think that if the US through Clinton, Obama and Bush are pushing the Trans Pacific Trade Pact that has world public health organizations declaring war against TPP-----because it dismantles world public health structures----do you really not see that Affordable Care Act is policy tied to TPP with a goal of ending public health structures in the US? REALLY? The quote below comes from an article at the end of this post from Doctors Without Borders.
'As all this suggests, the TPP’s draft IP Chapter confirms many of the concerns put forward by public health advocates prior to its release. The TPP is a surgical strike against public health. The text demands that signatory parties amend their laws in a manner that risks the health of their citizens and is ethically questionable. Médecins Sans Frontières has warned: ‘The leak of the secret text confirms that the US government continues to steamroll its trading partners in the face of steadfast opposition over terms that will severely restrict access to affordable medicines for millions of people’'.
Here is a friend in Maryland sharing what finding health insurance is really like----Blue Cross Blue Shield plan:
Remember that article I shared that had Maryland with the lowest premium offerings in the nation-----well, there is the rub. It's like advertising a great sale price for a Smart phone then being soaked trying to use it. This father/son is paying around $3,000 a year for insurance and getting no benefit up to $10,000. How many families can afford that much of a deductible? Certainly not 70% and growing of American citizens.
'I have B/C BS Private Parent/Child Coverage with $10,000 dollar deductibles for EACH of us and no Prescription Plan...$249+/mo'
Obama and Congressional neo-liberals told us the health insurance MANDATE was all about taking money paid for these premiums to help subsidize the poor needing insurance. Let's take a look at how that worked.
If you remember, it was the Republican voters fighting this individual mandate in courts and as we see below-----the mandate is a Republican health policy meant to transfer the public subsidy that was being given to allow people care in the health system----for example, a person without insurance was taken to the closest hospital, the hospital would treat that person, and be subsidize for the costs via Federal rebate. There was absolutely no problem with this process except that corporations wanted that Federal subsidy to go towards corporate profits. We needed to get people out of emergency rooms but all that was needed were more public clinics. Emergency rooms were overflowing because public clinics/hospitals were being closed. But the ACA is about ending public health ergo---super-sizing private health insurance industry.
THAT IS WHAT THE SUBSIDY WITH THIS INDIVIDUAL MANDATE DOES-----IT SUBSIDIZES THE HEALTH INSURANCE INDUSTRY WHILE CONTROLLING WHERE, WHEN, AND HOW THAT PERSON ACCESSES HEALTH CARE.
So, people who were uninsured and used to simply fit in with existing health systems are now marginalized out of ordinary care with the money going to corporations that restrict now what care that person gets profiting greatly from doing it. The bootstrap people who think everyone needs to pay their way need to see the same amount of money is going out-----it simply takes away people's freedom of choice and quality of care. NO MONEY SAVED FOLKS!
The other part of the individual mandate was that the system would bolster insurance coverage for the poor.......ie Medicaid for All. Raise your hand if you knew Republican states would not embrace Medicaid expansion since they plan to end Medicaid? Raise your hand if you know Medicaid was gutted of funding as ACA was being written. This is indeed what happened and with other mechanisms to move new revenue from this mandate to corporate profit-----almost none of the tens of millions of poor that was supposed to be helped with the mandate actually were.
ALMOST EVERY PROGRESSIVE ISSUE IN THE AFFORDABLE CARE ACT HAS BEEN LOST OR MADE IRRELEVANT.
Look below how the penalty for not complying rises to be the same as the amount a person would pay for a premium....there is no escape. As someone who was lucky in health----I never went to the hospital until I was 55 for a broken leg. That means I would have paid for this insurance premium for 3 decades while not needing it. I understand the idea of having it for health disasters---but the past structure of subsidized hospital treatment took care of that occasional disaster with the cost of paying taxes.
The mandate was purely geared towards corporate profit.
Individual Mandate
(“Individual Shared Responsibility”)Beginning in 2014, the Affordable Care Act includes a mandate for most individuals to have healthcare coverage or pay a penalty for noncompliance. Individuals will be required to maintain Minimum Essential Coverage(MEC)for themselves and their dependents. The individual mandate is now referred to in the latest regulations as “individual shared responsibility.
The penalty for not complying with individual shared responsibility is:2014: $95 per adult in the family plus $47.50 per child, up to a maximum of $285 or 1 percent of household income, whichever is higher2015: $325 per uninsured person or 2 percent of household income2016 and after: $695 per uninsured person or 2.5 percent of household income
This is a good summary of what the individual mandate includes....ask yourself-----why do we need something so complicated?
Health Care Affordability and the Individual Mandate
April 5, 2010 - by Donny Shaw Open Congress Blog
One of the most important and most controversial parts of the new health care law, the Patient Protection and Affordable Care Act as amendment by the reconciliation bill, is that it requires all U.S. residents to have insurance or pay a tax penalty. This is known as the “individual mandate,” and although it is a Republican idea that has a long history of bipartisanship, both conservatives and progressives have recently focused their criticisms of the law on it — progressives because it will be a boon for private insurers and conservatives because it is a strong use of federal government authority.
In reality, it’s quite nuanced. The idea of the law is that it will control costs and provide enough government assistance that insurance will be affordable for everyone and that the individual mandate penalty will not have to be used. It will give out billions in “affordability credits” and it includes an economic hardship exemption so that people who can’t reasonably afford insurance under the new law won’t have to pay the tax.
Here’s a detailed rundown of how the affordability and individual mandate provisions would work, including, to the extent possible, how much money people will be expected to pay for insurance under the new law.
Under the new health care law, affordability credit levels will be tied to the cost of the “second lowest cost silver plan” on a state exchange. What is a “silver plan?” Basically, the exchanges under the new law will mirror the one that currently exists in Massachusetts, which divides health care plans into three levels of benefits — bronze, silver and gold — each of which has its own range of costs and services — i.e. silver low, silver medium and silver high.
The new health care law would limit premium contributions for the second lowest cost silver plan to the following percentages of income once fully implemented (in 2019):
According to the CBO, the average tax credit for an individual or family under the bill would be $6,000 per year. Beyond that, it is impossible to put accurate tax credit numbers to the different income ranges because the prices of the second lowest cost silver plans in each exchange haven’t been set yet.
But, if the cost of health care in a state is similar to what it is in Massachusetts right now, the subsidies levels would look like this:
Now that we have an understanding on how the affordability credits work, we can look at the economic hardship exemption in the law, which would allow people that still can’t afford coverage to avoid paying the individual mandate tax penalty. First, here’s how it reads in the actual bill text:
‘(1) INDIVIDUALS WHO CANNOT AFFORD COVERAGE-
‘(A) IN GENERAL- Any applicable individual for any month if the applicable individual’s required contribution (determined on an annual basis) for coverage for the month exceeds 8 percent of such individual’s household income for the taxable year described in section 1412(b)(1)(B) of the Patient Protection and Affordable Care Act. For purposes of applying this subparagraph, the taxpayer’s household income shall be increased by any exclusion from gross income for any portion of the required contribution made through a salary reduction arrangement.
In other words, if the amount you would have to pay for the cheapest health care plan for the year is more than 8% of your annual income, you would be exempt from the tax penalty for not having coverage.
Since the tax credits are tied to premiums, this is really designed to keep people who earn above 400% of FPL and are ineligible for government assistance from having to pay any steep rate increases that may occur under the new law. If rates were the same as they are currently in Massachusetts, nobody would be exempt from the tax penalty from not having insurance. Rates would have to go up beyond that level for the hardship exemption to kick in for anyone. Here are a couple of scenarios:
This is the clue to why the mandate has nothing to do with using the young to subsidize the health care of the old or poor as we are told. The mandate was written by conservative Republican think tanks as 'personal responsibility' and a boon to corporate profit just as the auto insurance industry has become. Think about the tiered system and how Medicare as a Federal program will end with ACA. Think how over A TRILLION has been gutted from Medicare and Medicaid. Think how the structure of these plans with high-deductibles and co-pays that will hit the lower income families the most-----Medicaid being gutted of funding and made into a preventative clinic care. Does all that sound like policy written to help the old and poor access more health care? Of course not. The point of charging the young is to create huge profits for insurance corporations while they work hard to see that most people will not access care----especially the old and chronically ill.
THIS IS HOW YOU KNOW THE MANDATE WAS NEVER ABOUT FINDING FUNDS TO EXPAND HEALTH CARE COVERAGE.
The amount of money the Federal government sent to hospitals to subsidize uninsured care far exceeded what these costs for Medicaid insurance coverage will be.
Individual Mandate Was a Conservative Idea, WH Spokesman Reminds Reporters
June 28, 2012 - 6:09 AM By Susan Jones CNSNews
White House spokesman Jay Carney says the White House is awaiting the Supreme Court's decision on the Affordable Care Act just as everyone else is, and "we will be ready for the decision when in comes down."
And if the law's main funding mechanism -- the individual mandate -- is struck down? Well, that was a conservative idea anyway:
"Since you mentioned it, the mandate, the individual mandate, was a product of a conservative think tank," Carney told a reporter who brought up the topic.
"It was adopted by many leaders in the Republican Party in the '90s. It was adopted by and implemented by a Republican governor in Massachusetts. And while the President opposed it in the campaign, he -- in the process of crafting a health care reform bill in office -- was persuaded by experts in the field that it was the best and most efficient way to ensure that we can bring the largest number of people into and under coverage -- getting insurance coverage, and to allow for the -- to ensure that those with preexisting conditions get health care coverage."
Asked if Obama, in hindsight, still believes the mandate was the right way to go, Carney said, "He continues to believe that that was the most efficient and effective way to build on our private insurance system, to provide coverage to the most people in the most efficient way, and provide the benefits that I’ve described."
Carney said it seems that Republicans have made a "concerted decision" to abandon the individual mandate -- a "very mainstream conservative" idea -- once it was adopted by Democrats.
Carney insisted that "many, many legal scholars" have found the health care law to be constitutional -- and he stressed the "free" services that it bestows on American consumers.
"We await the Supreme Court decision, as does everyone, but while we do, we continue to implement the law. And I would note that thanks to the Affordable Care Act, 3.1 million more young adults who otherwise would have been uninsured have health insurance on their parent's plan, 5.3 million seniors with Medicare have saved $3.7 billion on their prescription drugs, and everyone on Medicare can get preventive services like mammograms for free -- again, because of the Affordable Care Act. And 54 million Americans with private insurance can now receive many preventive services without paying co-payments or deductibles."
Asked how the president will learn about the Supreme Court ruling, Carney said, "Well, we turn on televisions and radios and computers, and watch SCOTUS blog." He said the president will not receive advance word from a "airtight" Supreme Court.
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Below you see what the mandate revenue will subsidize rather than health access for the poor------it is a step to addressing this decades old SGR Medicare shortfall. This cap was placed to slow Medicare spending but it simply created the environment for health industry fraud to soar. Instead of allowing $138 billion flow freely into the health economy-----we watched as $200-400 billion in Medicare fraud each year took over. The reason that fraud is better than allowing the $138 billion to flow freely is that citizens get more care without the cap.....while with fraud, it goes right to corporate profits.
'This cap took $138 billion out of the Medicare disbursements.
According to Dr. Hoven, the costs associated with caring for seniors have risen 25 percent since 2001, but Medicare payments to doctors have not even increased 4 percent over the same time period'.
So, simply eliminating this SGR cap and rebuilding oversight and accountability in Medicare and health care in general would bring hundreds of billions of dollars back to health care economy. That's how twisted these policies are. Remember, the Medicare Trust has lost trillions of dollars to fraud and a new revenue source for Medicare will be needed-----ergo, the mandate will do for now.
You really cannot end SGR AND HAVE SYSTEMIC HEALTH INDUSRY FRAUD-- THAT IS WHY NEO-LIBERALS ARE PUTTING THIS OFF.
Docs disapprove of tying Medicare reform to ACA mandate
Author Kyle Murphy, PhD | Date March 24, 2014
A sizeable majority of physicians disagree with recent moves on Capitol Hill that ties the repeal of the Sustainable Growth Rate (SGR) to the delay of enforcing the individual mandate provision of the Affordable Care Act, according to a poll published by the American College of Physician Executives (ACPE). Of the 551 ACPE members surveyed, more than 80 percent (444/80.58%) responded no to the question of whether the SGR repeal and the ACA’s individual mandate should be linked as compared to one-fifth of that number responding in the affirmative (89/16.15%). The remaining 18 respondents remain unsure as to how the two provisions would affect each other.*
Editor’s note: The ACPE has issued a correction to its release, changing the number of respondents from 1081 to 551. “Repealing the outdated and ineffective SGR is not a partisan issue — it’s what’s best for health care,” ACPE President and CEO Peter Angood, MD, FRCS(C), FACS, FCCM, said in a public statement. “The poll results reflect the frustration many of our members feel after 17 years of short-term fixes. I believe we all feel strongly it’s time for a more permanent solution to our country’s Medicare funding challenges.” .........
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This is why we have ACA and not Expanded and Improved Medicare for All----
The Money Pit: Health Insurance Executives' Pay
Neil Wagner
Last year was a very good year for H. Edward Hanway. The CEO of Cigna made $14.6 million in 2009.(1) He retired on December 31. Here is some of what this money could have paid for, based on national averages:
The total compensation for the top four executives under Ms. Braly at Wellpoint totaled $20 million in 2009, meaning Wellpoint paid out $33 million just to its top five executives.
Hanway's compensation isn't at all atypical. Ronald Williams, Aetna's CEO made over $18 million in 2009.(2) And Angela Braly, the CEO of Wellpoint, made $13.1 million in 2009.(3) This was a 51% increase over Ms. Braly's 2008 compensation, and it came at a time when Wellpoint's subsidiary, Anthem Blue Cross, proposed premium increases of up to 39% for Californians.
Hundreds of Millions of Dollars For Salaries, Not Care And these are just the salaries of CEOs. Health insurance companies have many other highly compensated, top-level executives. At Wellpoint, at least three of them received compensation increases of up to 75% in 2009.(4) The total compensation for the top four executives under Ms. Braly at Wellpoint totaled $20 million in 2009,(5) meaning Wellpoint paid out $33 million just to its top five executives.
The ten largest health insurance companies insured roughly 118 million Americans in 2008.(6) Taking Wellpoint's compensation figures as typical suggests that these 10 companies paid over $300 million dollars to their executives in 2009. While this is only a crude estimate, it serves to define a ballpark figure for overall executive compensation: hundreds of millions of dollars, at minimum. This is all money paid for by health insurance premiums that buys little or no health care. Some might call it a money pit for health care dollars.
Executive compensation isn't the only reason health care costs are so high. Hospital procedures have grown more costly and doctor's fees have also risen. But it's hard to imagine a health care system without doctors or hospitals. A health care system without health insurance executives is not only possible, it existed well into the 20th century. And the first widespread health insurance companies were non-profits.
The current health care system is nothing more than an accident of history. Melissa Thomasson, an economic historian and professor at the University of Miami (Ohio), published an article in 2003 which details the development of the U.S. health care system from its infancy.(7) This article shows that the system in place today is not part of the natural order of the universe; it evolved through a series of historical accidents. There is nothing sacred about it.
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Given the mandate and expanded Medicaid -----will any of those funds actually get to people's care? Absolutely not. These global corporations are geared to suck the Medicare Trust dry and make sure Medicaid funds go to profit and not people. That's what a Wall Street profit-driven health system will do.
The subsidies being directed to help the working and middle-class buy private insurance could have simply been sent to rebuild our public clinics and hospitals for free care.
This article addresses the other loss from the ACA reform----small business plans that were to help workers employed by small businesses. There is no way these plans will come about-----these workers will simply be pushed into the state health system at a Medicaid or Bronze plan level.
CLINTON WALL STREET NEO-LIBERALS STRIKE AGAIN WITH A MIRROR IMAGE BANKING DEREGULATION FOR THE HEALTH INDUSTRY!
Investing 10/01/2013 @ 3:33PM
ObamaCare Enriches Only The Health Insurance Giants and Their Shareholders
So far in 2013 the value of the S& P health insurance index has gained 43%. Thats more than double the gains made in the broad stock market index, the S & P 500. The shares of CIGNA are up 63%, Wellpoint 47% and United Healthcare 28%. And if you go back to the early 2010 passage of ObamaCare, you will find that Obama’s sellout of the public interest has allowed the public companies the ability to raise their premiums, especially on small business, dramatically multiply their profits and send the value of their common stocks up by 200%-300%. This is bloody scandalous and should be a cause for concern even as the Republican opponents of the bill threaten the close-down of the government.
We warned you back on December4, 2009 in my blog ” The Horrendous Truth About Health Care Reform” that the Obama White House was handing a “ free ride for the health insurance industry” that would allow premium hikes of 8%-10% a year by CIGNA, Humana HUM -0.84%, Aetna AET -1.19%, UnitedHealth Group UNH -0.89% and Wellpoint, and as well a $500 billion taxpayer subsidy, a half trillion dollars without any requirement that the health insurers had to spend the subsidy on medical care. Several US Senators including Jay Rockefeller of West Virginia spoke to me openly of the outrageous sellout being foisted on the nation’s uninsured citizens.
At the time I wrote, Goldman Sachs research operation estimated that the 5 giants would increase profits by 10% a year from 2010 to 2019, sending their shares up an average of 59%. In truth, the shares of CIGNA and some others are up a multiple of several times since the contest was resolved by a very tight vote in early 2010. One startling reason for this amazing performance was that Obama took off the table “proposals to significantly reduce health care costs” as the giveaway in getting the bill through, according to Ron Susskind’s best-selling book ,”Confidence Men,” which I wrote about in a blog on September 24, 2011. ( “Obama’s Incoherent Policy-Making”) Some 3 years later, UnitedHealthCare Group(UNH) was rewarded by being added to the elite list of the Dow 30 industrials.
I understood belatedly that there would have been no Affordable Care Act of 2010 if the White House had not given into demands from the giant profit-making health insurance companies. Had he not done so, I am being assured that there would have been no bill passed, a priority goal that Obama promised in his 2008 Presidential campaign. How the profits have risen so impressively requires further investigation as the bill is meant to limit the profits earned to 20% of the revenues.
One of the other downsides to the supposed reform bill was the surprisingly unfair treatment of small business owners who faced even larger potential premiums for their employees. It has been the fear of these higher health costs that has resulted in the overwhelming trend toward hiring part-time employees whom the employers need not offer healthcare insurance.
So much for the reforms embedded in the mis-labeled Affordable Care Act of 2010. It may not die a bloody demise this month, but it is certain to be reformed itself, let’s hope for the benefit of the 300 million, not just the millions of lucky shareholders who may have understood the ramification of ObamaCare, which was to multiply the profits of five giant insurance companies, just as the major bank oligopoly was rewarded by the federal bailouts and Fed monetary policy.
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You know if a world-reknown and much beloved Doctors Without Borders bashes the US for TPP and its affects on public health-----that Obama and neo-liberals do not have any good news for the citizens of the US through the Affordable Care Act. The ACA is simply set to move the US to meet the standards that may come about in these TPP agreements.
Being tied to a mandated private insurance law at a time when US health institutions are growing as fast as possible to become global health systems WILL NOT END WELL!
TPP draft reveals surgical strike on public health
2 December 2013 Authors: Alexandra Phelan, Georgetown University, and Matthew Rimmer, ANU
On 13 November, WikiLeaks released a secret draft text of the Intellectual Property Chapter of the Trans-Pacific Partnership (TPP). The text reveals substantive proposals for expanded protection in respect of copyright, patent, trade mark and trade secrets law, and intellectual property enforcement. Across this, there is much cause for concern. In particular, the IP Chapter poses worrying challenges for patient care, access to medicines, and public health across the Pacific Rim. As WikiLeaks Editor-in-Chief Julian Assange warned, ‘[i]f you’re ill now or might one day be ill, the TPP has you in its crosshairs’.
With the drafting notes intact in the leaked TPP draft, the text reveals a fierce battle amongst the Pacific Rim nations over patent law, public health, and the objectives and the principles behind the TPP’s IP Chapter.
New Zealand, Canada, Singapore, Chile, Malaysia and Vietnam have proposed that the agreement should ‘support each Party’s right to protect public health, including by facilitating timely access to affordable medicines’. As an additional clause, New Zealand, Canada, Singapore, Chile and Malaysia have proposed the agreement should recognise that countries can ‘adopt measures necessary to protect public health and nutrition’.
The US and Japan opposed such recognition of the importance of public health in the agreement’s objectives, with Peru, Brunei Darussalam and Mexico withdrawing their names from the proposal to include public health in the TPP objectives. In contrast, Australia has reserved its position on the scope of the objectives — a disappointing stance given that Australian leaders have publicly emphasised the importance of public health measures, such as access to medicines and the plain packaging of tobacco products.
The TPP contains a raft of measures designed to boost the position of patent holders in the fields of pharmaceutical drugs, medicine and biotechnology.
The US has proposed a broad approach to patent law — demanding that plants, animals and medical procedures be subject to patent protection by Pacific Rim members. This could result, particularly for medical procedures, in greater patent litigation against doctors, surgeons and medical professionals.
In addition, the US has argued for extensions of the patent term in respect of pharmaceutical drugs, including extensions where there have been regulatory delays -- something which could result in skyrocketing healthcare prices. A review of pharmaceutical drug patents in Australia, for example, found that patent term extensions were exceedingly expensive in Australia.
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.
The US also argues for patent-registration linkages to marketing regimes. There has been significant debate over the protection of undisclosed data for regulatory purposes. The US has proposed 12 years for data exclusivity for biological medical products, though the text on this proposal was, unfortunately, not amongst the leaked material. The US has also controversially pushed for the cross-border seizure of infringing IP in transit. In light of past controversies with the seizure of Indian generic drugs, it is possible that such text could result in the interdiction of medicines in transit.
Given what is at stake, the TPP is a matter of life and death: it will affect access to life-saving medicines, drugs and treatments in developed and developing countries across the Pacific.
It is also very questionable whether the TPP’s IP Chapter fully embodies international understandings about the need for flexible public health measures, as reflected in the WTO through the Doha Declaration on the TRIPS Agreement and Public Health 2001 and the Decision of the General Council of 30 August 2003.
The US and its allies have proposed measures that would raise prices and reduce competition. This includes the Obama administration’s revocation of a 2007 agreement between the Bush administration and the Democrat-controlled Congress to give developing countries more flexible access to medicines through IP laws. In addition, the US has sought to limit the use of compulsory licensing, which would provide access to patented inventions in respect of medicines.
A group of five countries — Canada, Chile, Malaysia, New Zealand and Singapore — have put forward a counter-proposal to the US demands on medicines. Krista Cox of Knowledge Ecology International observed that the counter-proposal ‘preserves TRIPS flexibilities, and specifically takes into account important factors including the public interest, levels of development, and the potential for abuse of intellectual property rights by the right holders’.
Australia has been passive in the debate over access to medicines. Earlier this year, the Coalition party, then in opposition, opposed a bill that would have provided for the export of essential medicines to developing countries. It will be interesting to see what stance the now in-office Coalition government will take in the TPP on IP and drug pricing.
As all this suggests, the TPP’s draft IP Chapter confirms many of the concerns put forward by public health advocates prior to its release. The TPP is a surgical strike against public health. The text demands that signatory parties amend their laws in a manner that risks the health of their citizens and is ethically questionable. Médecins Sans Frontières has warned: ‘The leak of the secret text confirms that the US government continues to steamroll its trading partners in the face of steadfast opposition over terms that will severely restrict access to affordable medicines for millions of people’.
Obama may struggle, though, to obtain support for the TPP from the US Congress. Indeed, 151 House Democrats and 25 House Republicans have already signalled their opposition to granting Obama a fast-track authority for the TPP. And, on the 27 November, after much criticism at the Salt Lake City talks, the USTR announced that it will put forward new revised proposals on intellectual property and access to medicines in the TPP. It remains to be seen whether such proposals will remain unpalatable to the other Pacific Rim nations.
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Of course none of this is necessary as we fight for Expanded and Improved Medicare for All. Again, between the Federal funds being sent for Medicare and Medicaid, with all of the funds designated for subsidizing buying private insurance, and with rebuilding oversight and accountability throughout the health system-----
JUST USING THESE SOURCES WOULD GET ANY STATE WELL ON ITS WAY TO A FULLY FUNDED PUBLIC MEDICARE FOR ALL SYSTEM.
Obama and neo-liberals have sent hundreds of billions of dollars and more to build an insurance network that already exists in Medicare. They did that because that expect that private network to replace Medicare.......we can protect Medicare by adopting these public health systems in each state.
How to Fix Health Care Without the Mandate
June 27, 2012 by Healthcare-NOW!
Why truly affordable care means single-payer.
By Sarah van Gelder for Yes! –
What happens if the Supreme Court strikes down the “individual mandate” in the health care reform law?
Commentators ranging from former Labor Secretary Robert Reich to Forbes Magazine columnist Rick Ungar agree: Such a decision could open the door to single-payer health care—perhaps even make it inevitable.
This may be the best news about health care in years. Because ever since Republicans convinced the Obama administration to drop the “public option” in the Affordable Care Act, health reform has been in trouble. True, most Americans favor many of the provisions of Affordable Care Act. But the overall plan rests on forcing you and me to buy insurance from the same companies that have been driving up the costs of health care all along—the same companies that have been finding creative ways to avoid covering needed care, shifting costs on to patients, and endlessly increasing premiums and out-of-pocket expenses for all of us.
Forcing all Americans into a failed system is bad policy, and it’s not just President Obama’s opponents who say so.
What the Doctors Ordered
When the Supreme Court agreed to hear a challenge to the Affordable Care Act brought by 26 state attorneys general, one of the supporting briefs came from an unexpected source—a group of 50 doctors who believe that single-payer health care is the way to cover everyone and contain costs. As a model for a revamped health care system, they point to Medicare, which covers millions of seniors while devoting just 2 percent of expenditures to overhead (compared to as much as 16 percent for private insurers).
In spite of all the fear about government involvement in health care, Medicare is enormously popular; in a recent poll, two-thirds of Americans oppose changing Medicare to something more like private insurance. In the Medicare model, as in Canada’s single-payer system, health care providers are in private practice, but the government acts as insurer, covering everyone. The money for the program comes from payroll taxes.
This model is just one of a variety of ways that industrialized countries provide universal coverage; only the United States does not yet offer universal coverage at all, and the impact of our fragmented, privatized approach ripples throughout the economy and into the lives of families that face bankruptcy and exclusion from needed treatment.
While we in the United States spend far more on health care, per person, than any other nation, we’re way behind other wealthy countries when it comes to our actual health. The residents of 25 other countries—all of which spend less on health care than we do—can expect to live longer, on average, than U.S. residents. In a recent study of 19 industrialized countries, the United States came in last when it came to averting preventable death. Researchers say that amounts to more than a 100,000 avoidable deaths each year.
We devote 15 percent of our economy (by GDP) to paying for health care (or $6,402 per person each year), and still leave millions without coverage. In contrast, the French spend 11 percent of GDP on health care (or $3,374 per person) and cover everyone; the French live two years longer, on average, than Americans, and have better health by all key measures.
Follow the Money
If we’re spending so much for poor results, where is all the extra money going? Private, for-profit health insurance companies spend big on overhead: covering the paperwork and arguments about who will cover what, finding ways to avoid covering people who might require costly services, disputing charges from health care providers. They spend money on marketing and on lobbying Congress, federal regulators, and state lawmakers. They pay dividends to shareholders and they pay executives six- or seven-figure compensation packages. No wonder premiums keep rising.
None of these costs are incurred by Medicare or other national insurance programs.
Some argue that patients are better off with competing insurance companies because that gives them a choice. Perhaps this is true of a patient who spends many hours required to read the small print in competing insurance plans, producing spreadsheets to track the multiple variables, guessing what sort of coverage they and their family will need in years to come, and hoping that they made the right choice when an unexpected accident or illness means their life depends on the bet they made. On the other side, insurance companies have battalions of lawyers and adjusters making bets about coverage, co-pays, and deductibles—coming up with ways to cover less.
Asking each of us to choose among competing plans is like playing against the house in a casino—it might seem as though you’re getting choices among slot machines, but really, the odds are stacked against you whatever choice you make.
Where choice really matters to most people is in choosing health care providers. In France, where public financing of health care is the rule, patients actually have more choices among doctors than do Americans, who must choose among health care providers preferred by their insurance company.
So the doctors who are calling on the Supreme Court to strike down the individual mandate are on to something. Instead of locking us in even more tightly to an inefficient private insurance system, which has built-in incentives to take more of our money and do less for us, they argue we should switch gears. We’re spending $200 billion more per year than we would need to under a single-payer system, they say. We pay more out-of-pocket than other countries, and the Obama Affordable Care Act wouldn’t fix that.
What do Americans Want?
In poll after poll, a majority of Americans have expressed support for single-payer health care or national health insurance. This is true in spite of the near media blackout on this topic, and the failure of most national politicians to even consider single-payer as an option (the Obama administration and Democratic leadership in Congress excluded single-payer advocates from the key summits and hearings leading up to the passage of the health care bill).
In Massachusetts, which has had time to try out policies very similar to those in the Affordable Care Act, over 5 percent of the population remains uninsured. And, according to the doctors’ brief, local initiatives calling for single-payer health care passed by wide majorities in all the Massachusetts districts where they were on the ballot.
Vermont has adopted a single-payer health care plan, and the California Assembly twice passed single-payer, only to have it vetoed by the governor.
Single-payer health care, in short, is far more popular than the political establishment likes to admit—while requiring individuals to purchase health coverage from private insurance companies is wildly unpopular across the political spectrum. According to a recent poll, only a third of Americans favor the individual mandate, but 70 percent favor expanding the existing Medicaid program to cover more low-income, uninsured adults.
Here’s something to ask yourself: If you’re on Medicare now, would you give it up to move to a private insurance plan? If you’re not now covered and you could sign up for Medicare today, would you?
Medicare for All
That contrast offers a good starting point. We don’t need to assume that our health care policy must be designed to maintain the health-industrial complex and their lobbyists in the manner to which they have become accustomed. Instead, we can expand Medicare to cover more and more age groups, until everyone is covered. We could all then have access to a program that keeps overhead low, is wildly popular among its clients, and is similar to programs in Europe, Canada, Japan, and elsewhere that have excellent records of cost containment, universal coverage, and great health outcomes.
So what happens if the Supreme Court overturns the individual mandate or—as now seems possible—rejects the entire package? Such a move could turn out to be a great boon to those who doubt the wisdom of relying on private, profit-focused insurance companies to cover us when we get sick. It could offer us the opportunity to get the sort of proven universal coverage we can count on.
'As all this suggests, the TPP’s draft IP Chapter confirms many of the concerns put forward by public health advocates prior to its release. The TPP is a surgical strike against public health. The text demands that signatory parties amend their laws in a manner that risks the health of their citizens and is ethically questionable. Médecins Sans Frontières has warned: ‘The leak of the secret text confirms that the US government continues to steamroll its trading partners in the face of steadfast opposition over terms that will severely restrict access to affordable medicines for millions of people’'.
Here is a friend in Maryland sharing what finding health insurance is really like----Blue Cross Blue Shield plan:
Remember that article I shared that had Maryland with the lowest premium offerings in the nation-----well, there is the rub. It's like advertising a great sale price for a Smart phone then being soaked trying to use it. This father/son is paying around $3,000 a year for insurance and getting no benefit up to $10,000. How many families can afford that much of a deductible? Certainly not 70% and growing of American citizens.
'I have B/C BS Private Parent/Child Coverage with $10,000 dollar deductibles for EACH of us and no Prescription Plan...$249+/mo'
Obama and Congressional neo-liberals told us the health insurance MANDATE was all about taking money paid for these premiums to help subsidize the poor needing insurance. Let's take a look at how that worked.
If you remember, it was the Republican voters fighting this individual mandate in courts and as we see below-----the mandate is a Republican health policy meant to transfer the public subsidy that was being given to allow people care in the health system----for example, a person without insurance was taken to the closest hospital, the hospital would treat that person, and be subsidize for the costs via Federal rebate. There was absolutely no problem with this process except that corporations wanted that Federal subsidy to go towards corporate profits. We needed to get people out of emergency rooms but all that was needed were more public clinics. Emergency rooms were overflowing because public clinics/hospitals were being closed. But the ACA is about ending public health ergo---super-sizing private health insurance industry.
THAT IS WHAT THE SUBSIDY WITH THIS INDIVIDUAL MANDATE DOES-----IT SUBSIDIZES THE HEALTH INSURANCE INDUSTRY WHILE CONTROLLING WHERE, WHEN, AND HOW THAT PERSON ACCESSES HEALTH CARE.
So, people who were uninsured and used to simply fit in with existing health systems are now marginalized out of ordinary care with the money going to corporations that restrict now what care that person gets profiting greatly from doing it. The bootstrap people who think everyone needs to pay their way need to see the same amount of money is going out-----it simply takes away people's freedom of choice and quality of care. NO MONEY SAVED FOLKS!
The other part of the individual mandate was that the system would bolster insurance coverage for the poor.......ie Medicaid for All. Raise your hand if you knew Republican states would not embrace Medicaid expansion since they plan to end Medicaid? Raise your hand if you know Medicaid was gutted of funding as ACA was being written. This is indeed what happened and with other mechanisms to move new revenue from this mandate to corporate profit-----almost none of the tens of millions of poor that was supposed to be helped with the mandate actually were.
ALMOST EVERY PROGRESSIVE ISSUE IN THE AFFORDABLE CARE ACT HAS BEEN LOST OR MADE IRRELEVANT.
Look below how the penalty for not complying rises to be the same as the amount a person would pay for a premium....there is no escape. As someone who was lucky in health----I never went to the hospital until I was 55 for a broken leg. That means I would have paid for this insurance premium for 3 decades while not needing it. I understand the idea of having it for health disasters---but the past structure of subsidized hospital treatment took care of that occasional disaster with the cost of paying taxes.
The mandate was purely geared towards corporate profit.
Individual Mandate
(“Individual Shared Responsibility”)Beginning in 2014, the Affordable Care Act includes a mandate for most individuals to have healthcare coverage or pay a penalty for noncompliance. Individuals will be required to maintain Minimum Essential Coverage(MEC)for themselves and their dependents. The individual mandate is now referred to in the latest regulations as “individual shared responsibility.
The penalty for not complying with individual shared responsibility is:2014: $95 per adult in the family plus $47.50 per child, up to a maximum of $285 or 1 percent of household income, whichever is higher2015: $325 per uninsured person or 2 percent of household income2016 and after: $695 per uninsured person or 2.5 percent of household income
This is a good summary of what the individual mandate includes....ask yourself-----why do we need something so complicated?
Health Care Affordability and the Individual Mandate
April 5, 2010 - by Donny Shaw Open Congress Blog
One of the most important and most controversial parts of the new health care law, the Patient Protection and Affordable Care Act as amendment by the reconciliation bill, is that it requires all U.S. residents to have insurance or pay a tax penalty. This is known as the “individual mandate,” and although it is a Republican idea that has a long history of bipartisanship, both conservatives and progressives have recently focused their criticisms of the law on it — progressives because it will be a boon for private insurers and conservatives because it is a strong use of federal government authority.
In reality, it’s quite nuanced. The idea of the law is that it will control costs and provide enough government assistance that insurance will be affordable for everyone and that the individual mandate penalty will not have to be used. It will give out billions in “affordability credits” and it includes an economic hardship exemption so that people who can’t reasonably afford insurance under the new law won’t have to pay the tax.
Here’s a detailed rundown of how the affordability and individual mandate provisions would work, including, to the extent possible, how much money people will be expected to pay for insurance under the new law.
Under the new health care law, affordability credit levels will be tied to the cost of the “second lowest cost silver plan” on a state exchange. What is a “silver plan?” Basically, the exchanges under the new law will mirror the one that currently exists in Massachusetts, which divides health care plans into three levels of benefits — bronze, silver and gold — each of which has its own range of costs and services — i.e. silver low, silver medium and silver high.
The new health care law would limit premium contributions for the second lowest cost silver plan to the following percentages of income once fully implemented (in 2019):
- 133% up to 150% of Federal Poverty Level — 2%
- 150% up to 200% of Federal Poverty Level — 4%
- 200% up to 250% of Federal Poverty Level — 6.3%
- 250% up to 300% of Federal Poverty Level — 8.05%
- 300% up to 400% of Federal Poverty Level — 9.5%
According to the CBO, the average tax credit for an individual or family under the bill would be $6,000 per year. Beyond that, it is impossible to put accurate tax credit numbers to the different income ranges because the prices of the second lowest cost silver plans in each exchange haven’t been set yet.
But, if the cost of health care in a state is similar to what it is in Massachusetts right now, the subsidies levels would look like this:
- An individual earning $15,000 would receive $4,188 from the government, which more than covers the full cost of all bronze plans an the cheapest silver plan.
- An individual earning $23,000 would receive $3,039 from the government, which would cover cover all but $110 of the annual cost of the cheapest bronze plan, meaning that they could have monthly premiums as low as $10.
- An individual earning $33,000 would receive $1,353 from the government, which means they would be required to pay $1,803 for the cheapest bronze coverage, or a monthly premium of $150.25.
Now that we have an understanding on how the affordability credits work, we can look at the economic hardship exemption in the law, which would allow people that still can’t afford coverage to avoid paying the individual mandate tax penalty. First, here’s how it reads in the actual bill text:
‘(1) INDIVIDUALS WHO CANNOT AFFORD COVERAGE-
‘(A) IN GENERAL- Any applicable individual for any month if the applicable individual’s required contribution (determined on an annual basis) for coverage for the month exceeds 8 percent of such individual’s household income for the taxable year described in section 1412(b)(1)(B) of the Patient Protection and Affordable Care Act. For purposes of applying this subparagraph, the taxpayer’s household income shall be increased by any exclusion from gross income for any portion of the required contribution made through a salary reduction arrangement.
In other words, if the amount you would have to pay for the cheapest health care plan for the year is more than 8% of your annual income, you would be exempt from the tax penalty for not having coverage.
Since the tax credits are tied to premiums, this is really designed to keep people who earn above 400% of FPL and are ineligible for government assistance from having to pay any steep rate increases that may occur under the new law. If rates were the same as they are currently in Massachusetts, nobody would be exempt from the tax penalty from not having insurance. Rates would have to go up beyond that level for the hardship exemption to kick in for anyone. Here are a couple of scenarios:
- An individual earning $44,000 annually, which is just slightly above 400% of FPL, would not be required to have insurance or pay a tax penalty if the cheapest plan on the exchange cost more than $3,520 for the year, or $293 per month. If rates were similar to what they are in Massachusetts currently, this individual would be considered able to afford all levels of bronze plans and would not be exempt from the tax penalty if they didn’t comply with the mandate to have insurance..
- A couple earning $60,000 annually, which is just slightly above 400% of FPL, would not be required to have insurance or pay a tax penalty if the cheapest plan on the exchange cost more than $4,800 for the year, or $400 per month. If rates were similar to what they are in Massachusetts currently, this couple would be considered able to afford all levels of bronze plans and would not be exempt from the tax penalty if they didn’t comply with the mandate to have insurance.
This is the clue to why the mandate has nothing to do with using the young to subsidize the health care of the old or poor as we are told. The mandate was written by conservative Republican think tanks as 'personal responsibility' and a boon to corporate profit just as the auto insurance industry has become. Think about the tiered system and how Medicare as a Federal program will end with ACA. Think how over A TRILLION has been gutted from Medicare and Medicaid. Think how the structure of these plans with high-deductibles and co-pays that will hit the lower income families the most-----Medicaid being gutted of funding and made into a preventative clinic care. Does all that sound like policy written to help the old and poor access more health care? Of course not. The point of charging the young is to create huge profits for insurance corporations while they work hard to see that most people will not access care----especially the old and chronically ill.
THIS IS HOW YOU KNOW THE MANDATE WAS NEVER ABOUT FINDING FUNDS TO EXPAND HEALTH CARE COVERAGE.
The amount of money the Federal government sent to hospitals to subsidize uninsured care far exceeded what these costs for Medicaid insurance coverage will be.
Individual Mandate Was a Conservative Idea, WH Spokesman Reminds Reporters
June 28, 2012 - 6:09 AM By Susan Jones CNSNews
White House spokesman Jay Carney says the White House is awaiting the Supreme Court's decision on the Affordable Care Act just as everyone else is, and "we will be ready for the decision when in comes down."
And if the law's main funding mechanism -- the individual mandate -- is struck down? Well, that was a conservative idea anyway:
"Since you mentioned it, the mandate, the individual mandate, was a product of a conservative think tank," Carney told a reporter who brought up the topic.
"It was adopted by many leaders in the Republican Party in the '90s. It was adopted by and implemented by a Republican governor in Massachusetts. And while the President opposed it in the campaign, he -- in the process of crafting a health care reform bill in office -- was persuaded by experts in the field that it was the best and most efficient way to ensure that we can bring the largest number of people into and under coverage -- getting insurance coverage, and to allow for the -- to ensure that those with preexisting conditions get health care coverage."
Asked if Obama, in hindsight, still believes the mandate was the right way to go, Carney said, "He continues to believe that that was the most efficient and effective way to build on our private insurance system, to provide coverage to the most people in the most efficient way, and provide the benefits that I’ve described."
Carney said it seems that Republicans have made a "concerted decision" to abandon the individual mandate -- a "very mainstream conservative" idea -- once it was adopted by Democrats.
Carney insisted that "many, many legal scholars" have found the health care law to be constitutional -- and he stressed the "free" services that it bestows on American consumers.
"We await the Supreme Court decision, as does everyone, but while we do, we continue to implement the law. And I would note that thanks to the Affordable Care Act, 3.1 million more young adults who otherwise would have been uninsured have health insurance on their parent's plan, 5.3 million seniors with Medicare have saved $3.7 billion on their prescription drugs, and everyone on Medicare can get preventive services like mammograms for free -- again, because of the Affordable Care Act. And 54 million Americans with private insurance can now receive many preventive services without paying co-payments or deductibles."
Asked how the president will learn about the Supreme Court ruling, Carney said, "Well, we turn on televisions and radios and computers, and watch SCOTUS blog." He said the president will not receive advance word from a "airtight" Supreme Court.
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Below you see what the mandate revenue will subsidize rather than health access for the poor------it is a step to addressing this decades old SGR Medicare shortfall. This cap was placed to slow Medicare spending but it simply created the environment for health industry fraud to soar. Instead of allowing $138 billion flow freely into the health economy-----we watched as $200-400 billion in Medicare fraud each year took over. The reason that fraud is better than allowing the $138 billion to flow freely is that citizens get more care without the cap.....while with fraud, it goes right to corporate profits.
'This cap took $138 billion out of the Medicare disbursements.
According to Dr. Hoven, the costs associated with caring for seniors have risen 25 percent since 2001, but Medicare payments to doctors have not even increased 4 percent over the same time period'.
So, simply eliminating this SGR cap and rebuilding oversight and accountability in Medicare and health care in general would bring hundreds of billions of dollars back to health care economy. That's how twisted these policies are. Remember, the Medicare Trust has lost trillions of dollars to fraud and a new revenue source for Medicare will be needed-----ergo, the mandate will do for now.
You really cannot end SGR AND HAVE SYSTEMIC HEALTH INDUSRY FRAUD-- THAT IS WHY NEO-LIBERALS ARE PUTTING THIS OFF.
Docs disapprove of tying Medicare reform to ACA mandate
Author Kyle Murphy, PhD | Date March 24, 2014
A sizeable majority of physicians disagree with recent moves on Capitol Hill that ties the repeal of the Sustainable Growth Rate (SGR) to the delay of enforcing the individual mandate provision of the Affordable Care Act, according to a poll published by the American College of Physician Executives (ACPE). Of the 551 ACPE members surveyed, more than 80 percent (444/80.58%) responded no to the question of whether the SGR repeal and the ACA’s individual mandate should be linked as compared to one-fifth of that number responding in the affirmative (89/16.15%). The remaining 18 respondents remain unsure as to how the two provisions would affect each other.*
Editor’s note: The ACPE has issued a correction to its release, changing the number of respondents from 1081 to 551. “Repealing the outdated and ineffective SGR is not a partisan issue — it’s what’s best for health care,” ACPE President and CEO Peter Angood, MD, FRCS(C), FACS, FCCM, said in a public statement. “The poll results reflect the frustration many of our members feel after 17 years of short-term fixes. I believe we all feel strongly it’s time for a more permanent solution to our country’s Medicare funding challenges.” .........
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This is why we have ACA and not Expanded and Improved Medicare for All----
The Money Pit: Health Insurance Executives' Pay
Neil Wagner
Last year was a very good year for H. Edward Hanway. The CEO of Cigna made $14.6 million in 2009.(1) He retired on December 31. Here is some of what this money could have paid for, based on national averages:
- Health insurance for 3,000 individuals ($4,824 each) or 1,100 families ($13,375 each)
- 241 nurses ($60,000 per year each)
- 209,000 additional prescriptions filled ($70 each)
The total compensation for the top four executives under Ms. Braly at Wellpoint totaled $20 million in 2009, meaning Wellpoint paid out $33 million just to its top five executives.
Hanway's compensation isn't at all atypical. Ronald Williams, Aetna's CEO made over $18 million in 2009.(2) And Angela Braly, the CEO of Wellpoint, made $13.1 million in 2009.(3) This was a 51% increase over Ms. Braly's 2008 compensation, and it came at a time when Wellpoint's subsidiary, Anthem Blue Cross, proposed premium increases of up to 39% for Californians.
Hundreds of Millions of Dollars For Salaries, Not Care And these are just the salaries of CEOs. Health insurance companies have many other highly compensated, top-level executives. At Wellpoint, at least three of them received compensation increases of up to 75% in 2009.(4) The total compensation for the top four executives under Ms. Braly at Wellpoint totaled $20 million in 2009,(5) meaning Wellpoint paid out $33 million just to its top five executives.
The ten largest health insurance companies insured roughly 118 million Americans in 2008.(6) Taking Wellpoint's compensation figures as typical suggests that these 10 companies paid over $300 million dollars to their executives in 2009. While this is only a crude estimate, it serves to define a ballpark figure for overall executive compensation: hundreds of millions of dollars, at minimum. This is all money paid for by health insurance premiums that buys little or no health care. Some might call it a money pit for health care dollars.
Executive compensation isn't the only reason health care costs are so high. Hospital procedures have grown more costly and doctor's fees have also risen. But it's hard to imagine a health care system without doctors or hospitals. A health care system without health insurance executives is not only possible, it existed well into the 20th century. And the first widespread health insurance companies were non-profits.
The current health care system is nothing more than an accident of history. Melissa Thomasson, an economic historian and professor at the University of Miami (Ohio), published an article in 2003 which details the development of the U.S. health care system from its infancy.(7) This article shows that the system in place today is not part of the natural order of the universe; it evolved through a series of historical accidents. There is nothing sacred about it.
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Given the mandate and expanded Medicaid -----will any of those funds actually get to people's care? Absolutely not. These global corporations are geared to suck the Medicare Trust dry and make sure Medicaid funds go to profit and not people. That's what a Wall Street profit-driven health system will do.
The subsidies being directed to help the working and middle-class buy private insurance could have simply been sent to rebuild our public clinics and hospitals for free care.
This article addresses the other loss from the ACA reform----small business plans that were to help workers employed by small businesses. There is no way these plans will come about-----these workers will simply be pushed into the state health system at a Medicaid or Bronze plan level.
CLINTON WALL STREET NEO-LIBERALS STRIKE AGAIN WITH A MIRROR IMAGE BANKING DEREGULATION FOR THE HEALTH INDUSTRY!
Investing 10/01/2013 @ 3:33PM
ObamaCare Enriches Only The Health Insurance Giants and Their Shareholders
So far in 2013 the value of the S& P health insurance index has gained 43%. Thats more than double the gains made in the broad stock market index, the S & P 500. The shares of CIGNA are up 63%, Wellpoint 47% and United Healthcare 28%. And if you go back to the early 2010 passage of ObamaCare, you will find that Obama’s sellout of the public interest has allowed the public companies the ability to raise their premiums, especially on small business, dramatically multiply their profits and send the value of their common stocks up by 200%-300%. This is bloody scandalous and should be a cause for concern even as the Republican opponents of the bill threaten the close-down of the government.
We warned you back on December4, 2009 in my blog ” The Horrendous Truth About Health Care Reform” that the Obama White House was handing a “ free ride for the health insurance industry” that would allow premium hikes of 8%-10% a year by CIGNA, Humana HUM -0.84%, Aetna AET -1.19%, UnitedHealth Group UNH -0.89% and Wellpoint, and as well a $500 billion taxpayer subsidy, a half trillion dollars without any requirement that the health insurers had to spend the subsidy on medical care. Several US Senators including Jay Rockefeller of West Virginia spoke to me openly of the outrageous sellout being foisted on the nation’s uninsured citizens.
At the time I wrote, Goldman Sachs research operation estimated that the 5 giants would increase profits by 10% a year from 2010 to 2019, sending their shares up an average of 59%. In truth, the shares of CIGNA and some others are up a multiple of several times since the contest was resolved by a very tight vote in early 2010. One startling reason for this amazing performance was that Obama took off the table “proposals to significantly reduce health care costs” as the giveaway in getting the bill through, according to Ron Susskind’s best-selling book ,”Confidence Men,” which I wrote about in a blog on September 24, 2011. ( “Obama’s Incoherent Policy-Making”) Some 3 years later, UnitedHealthCare Group(UNH) was rewarded by being added to the elite list of the Dow 30 industrials.
I understood belatedly that there would have been no Affordable Care Act of 2010 if the White House had not given into demands from the giant profit-making health insurance companies. Had he not done so, I am being assured that there would have been no bill passed, a priority goal that Obama promised in his 2008 Presidential campaign. How the profits have risen so impressively requires further investigation as the bill is meant to limit the profits earned to 20% of the revenues.
One of the other downsides to the supposed reform bill was the surprisingly unfair treatment of small business owners who faced even larger potential premiums for their employees. It has been the fear of these higher health costs that has resulted in the overwhelming trend toward hiring part-time employees whom the employers need not offer healthcare insurance.
So much for the reforms embedded in the mis-labeled Affordable Care Act of 2010. It may not die a bloody demise this month, but it is certain to be reformed itself, let’s hope for the benefit of the 300 million, not just the millions of lucky shareholders who may have understood the ramification of ObamaCare, which was to multiply the profits of five giant insurance companies, just as the major bank oligopoly was rewarded by the federal bailouts and Fed monetary policy.
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You know if a world-reknown and much beloved Doctors Without Borders bashes the US for TPP and its affects on public health-----that Obama and neo-liberals do not have any good news for the citizens of the US through the Affordable Care Act. The ACA is simply set to move the US to meet the standards that may come about in these TPP agreements.
Being tied to a mandated private insurance law at a time when US health institutions are growing as fast as possible to become global health systems WILL NOT END WELL!
TPP draft reveals surgical strike on public health
2 December 2013 Authors: Alexandra Phelan, Georgetown University, and Matthew Rimmer, ANU
On 13 November, WikiLeaks released a secret draft text of the Intellectual Property Chapter of the Trans-Pacific Partnership (TPP). The text reveals substantive proposals for expanded protection in respect of copyright, patent, trade mark and trade secrets law, and intellectual property enforcement. Across this, there is much cause for concern. In particular, the IP Chapter poses worrying challenges for patient care, access to medicines, and public health across the Pacific Rim. As WikiLeaks Editor-in-Chief Julian Assange warned, ‘[i]f you’re ill now or might one day be ill, the TPP has you in its crosshairs’.
With the drafting notes intact in the leaked TPP draft, the text reveals a fierce battle amongst the Pacific Rim nations over patent law, public health, and the objectives and the principles behind the TPP’s IP Chapter.
New Zealand, Canada, Singapore, Chile, Malaysia and Vietnam have proposed that the agreement should ‘support each Party’s right to protect public health, including by facilitating timely access to affordable medicines’. As an additional clause, New Zealand, Canada, Singapore, Chile and Malaysia have proposed the agreement should recognise that countries can ‘adopt measures necessary to protect public health and nutrition’.
The US and Japan opposed such recognition of the importance of public health in the agreement’s objectives, with Peru, Brunei Darussalam and Mexico withdrawing their names from the proposal to include public health in the TPP objectives. In contrast, Australia has reserved its position on the scope of the objectives — a disappointing stance given that Australian leaders have publicly emphasised the importance of public health measures, such as access to medicines and the plain packaging of tobacco products.
The TPP contains a raft of measures designed to boost the position of patent holders in the fields of pharmaceutical drugs, medicine and biotechnology.
The US has proposed a broad approach to patent law — demanding that plants, animals and medical procedures be subject to patent protection by Pacific Rim members. This could result, particularly for medical procedures, in greater patent litigation against doctors, surgeons and medical professionals.
In addition, the US has argued for extensions of the patent term in respect of pharmaceutical drugs, including extensions where there have been regulatory delays -- something which could result in skyrocketing healthcare prices. A review of pharmaceutical drug patents in Australia, for example, found that patent term extensions were exceedingly expensive in Australia.
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.
The US also argues for patent-registration linkages to marketing regimes. There has been significant debate over the protection of undisclosed data for regulatory purposes. The US has proposed 12 years for data exclusivity for biological medical products, though the text on this proposal was, unfortunately, not amongst the leaked material. The US has also controversially pushed for the cross-border seizure of infringing IP in transit. In light of past controversies with the seizure of Indian generic drugs, it is possible that such text could result in the interdiction of medicines in transit.
Given what is at stake, the TPP is a matter of life and death: it will affect access to life-saving medicines, drugs and treatments in developed and developing countries across the Pacific.
It is also very questionable whether the TPP’s IP Chapter fully embodies international understandings about the need for flexible public health measures, as reflected in the WTO through the Doha Declaration on the TRIPS Agreement and Public Health 2001 and the Decision of the General Council of 30 August 2003.
The US and its allies have proposed measures that would raise prices and reduce competition. This includes the Obama administration’s revocation of a 2007 agreement between the Bush administration and the Democrat-controlled Congress to give developing countries more flexible access to medicines through IP laws. In addition, the US has sought to limit the use of compulsory licensing, which would provide access to patented inventions in respect of medicines.
A group of five countries — Canada, Chile, Malaysia, New Zealand and Singapore — have put forward a counter-proposal to the US demands on medicines. Krista Cox of Knowledge Ecology International observed that the counter-proposal ‘preserves TRIPS flexibilities, and specifically takes into account important factors including the public interest, levels of development, and the potential for abuse of intellectual property rights by the right holders’.
Australia has been passive in the debate over access to medicines. Earlier this year, the Coalition party, then in opposition, opposed a bill that would have provided for the export of essential medicines to developing countries. It will be interesting to see what stance the now in-office Coalition government will take in the TPP on IP and drug pricing.
As all this suggests, the TPP’s draft IP Chapter confirms many of the concerns put forward by public health advocates prior to its release. The TPP is a surgical strike against public health. The text demands that signatory parties amend their laws in a manner that risks the health of their citizens and is ethically questionable. Médecins Sans Frontières has warned: ‘The leak of the secret text confirms that the US government continues to steamroll its trading partners in the face of steadfast opposition over terms that will severely restrict access to affordable medicines for millions of people’.
Obama may struggle, though, to obtain support for the TPP from the US Congress. Indeed, 151 House Democrats and 25 House Republicans have already signalled their opposition to granting Obama a fast-track authority for the TPP. And, on the 27 November, after much criticism at the Salt Lake City talks, the USTR announced that it will put forward new revised proposals on intellectual property and access to medicines in the TPP. It remains to be seen whether such proposals will remain unpalatable to the other Pacific Rim nations.
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Of course none of this is necessary as we fight for Expanded and Improved Medicare for All. Again, between the Federal funds being sent for Medicare and Medicaid, with all of the funds designated for subsidizing buying private insurance, and with rebuilding oversight and accountability throughout the health system-----
JUST USING THESE SOURCES WOULD GET ANY STATE WELL ON ITS WAY TO A FULLY FUNDED PUBLIC MEDICARE FOR ALL SYSTEM.
Obama and neo-liberals have sent hundreds of billions of dollars and more to build an insurance network that already exists in Medicare. They did that because that expect that private network to replace Medicare.......we can protect Medicare by adopting these public health systems in each state.
How to Fix Health Care Without the Mandate
June 27, 2012 by Healthcare-NOW!
Why truly affordable care means single-payer.
By Sarah van Gelder for Yes! –
What happens if the Supreme Court strikes down the “individual mandate” in the health care reform law?
Commentators ranging from former Labor Secretary Robert Reich to Forbes Magazine columnist Rick Ungar agree: Such a decision could open the door to single-payer health care—perhaps even make it inevitable.
This may be the best news about health care in years. Because ever since Republicans convinced the Obama administration to drop the “public option” in the Affordable Care Act, health reform has been in trouble. True, most Americans favor many of the provisions of Affordable Care Act. But the overall plan rests on forcing you and me to buy insurance from the same companies that have been driving up the costs of health care all along—the same companies that have been finding creative ways to avoid covering needed care, shifting costs on to patients, and endlessly increasing premiums and out-of-pocket expenses for all of us.
Forcing all Americans into a failed system is bad policy, and it’s not just President Obama’s opponents who say so.
What the Doctors Ordered
When the Supreme Court agreed to hear a challenge to the Affordable Care Act brought by 26 state attorneys general, one of the supporting briefs came from an unexpected source—a group of 50 doctors who believe that single-payer health care is the way to cover everyone and contain costs. As a model for a revamped health care system, they point to Medicare, which covers millions of seniors while devoting just 2 percent of expenditures to overhead (compared to as much as 16 percent for private insurers).
In spite of all the fear about government involvement in health care, Medicare is enormously popular; in a recent poll, two-thirds of Americans oppose changing Medicare to something more like private insurance. In the Medicare model, as in Canada’s single-payer system, health care providers are in private practice, but the government acts as insurer, covering everyone. The money for the program comes from payroll taxes.
This model is just one of a variety of ways that industrialized countries provide universal coverage; only the United States does not yet offer universal coverage at all, and the impact of our fragmented, privatized approach ripples throughout the economy and into the lives of families that face bankruptcy and exclusion from needed treatment.
While we in the United States spend far more on health care, per person, than any other nation, we’re way behind other wealthy countries when it comes to our actual health. The residents of 25 other countries—all of which spend less on health care than we do—can expect to live longer, on average, than U.S. residents. In a recent study of 19 industrialized countries, the United States came in last when it came to averting preventable death. Researchers say that amounts to more than a 100,000 avoidable deaths each year.
We devote 15 percent of our economy (by GDP) to paying for health care (or $6,402 per person each year), and still leave millions without coverage. In contrast, the French spend 11 percent of GDP on health care (or $3,374 per person) and cover everyone; the French live two years longer, on average, than Americans, and have better health by all key measures.
Follow the Money
If we’re spending so much for poor results, where is all the extra money going? Private, for-profit health insurance companies spend big on overhead: covering the paperwork and arguments about who will cover what, finding ways to avoid covering people who might require costly services, disputing charges from health care providers. They spend money on marketing and on lobbying Congress, federal regulators, and state lawmakers. They pay dividends to shareholders and they pay executives six- or seven-figure compensation packages. No wonder premiums keep rising.
None of these costs are incurred by Medicare or other national insurance programs.
Some argue that patients are better off with competing insurance companies because that gives them a choice. Perhaps this is true of a patient who spends many hours required to read the small print in competing insurance plans, producing spreadsheets to track the multiple variables, guessing what sort of coverage they and their family will need in years to come, and hoping that they made the right choice when an unexpected accident or illness means their life depends on the bet they made. On the other side, insurance companies have battalions of lawyers and adjusters making bets about coverage, co-pays, and deductibles—coming up with ways to cover less.
Asking each of us to choose among competing plans is like playing against the house in a casino—it might seem as though you’re getting choices among slot machines, but really, the odds are stacked against you whatever choice you make.
Where choice really matters to most people is in choosing health care providers. In France, where public financing of health care is the rule, patients actually have more choices among doctors than do Americans, who must choose among health care providers preferred by their insurance company.
So the doctors who are calling on the Supreme Court to strike down the individual mandate are on to something. Instead of locking us in even more tightly to an inefficient private insurance system, which has built-in incentives to take more of our money and do less for us, they argue we should switch gears. We’re spending $200 billion more per year than we would need to under a single-payer system, they say. We pay more out-of-pocket than other countries, and the Obama Affordable Care Act wouldn’t fix that.
What do Americans Want?
In poll after poll, a majority of Americans have expressed support for single-payer health care or national health insurance. This is true in spite of the near media blackout on this topic, and the failure of most national politicians to even consider single-payer as an option (the Obama administration and Democratic leadership in Congress excluded single-payer advocates from the key summits and hearings leading up to the passage of the health care bill).
In Massachusetts, which has had time to try out policies very similar to those in the Affordable Care Act, over 5 percent of the population remains uninsured. And, according to the doctors’ brief, local initiatives calling for single-payer health care passed by wide majorities in all the Massachusetts districts where they were on the ballot.
Vermont has adopted a single-payer health care plan, and the California Assembly twice passed single-payer, only to have it vetoed by the governor.
Single-payer health care, in short, is far more popular than the political establishment likes to admit—while requiring individuals to purchase health coverage from private insurance companies is wildly unpopular across the political spectrum. According to a recent poll, only a third of Americans favor the individual mandate, but 70 percent favor expanding the existing Medicaid program to cover more low-income, uninsured adults.
Here’s something to ask yourself: If you’re on Medicare now, would you give it up to move to a private insurance plan? If you’re not now covered and you could sign up for Medicare today, would you?
Medicare for All
That contrast offers a good starting point. We don’t need to assume that our health care policy must be designed to maintain the health-industrial complex and their lobbyists in the manner to which they have become accustomed. Instead, we can expand Medicare to cover more and more age groups, until everyone is covered. We could all then have access to a program that keeps overhead low, is wildly popular among its clients, and is similar to programs in Europe, Canada, Japan, and elsewhere that have excellent records of cost containment, universal coverage, and great health outcomes.
So what happens if the Supreme Court overturns the individual mandate or—as now seems possible—rejects the entire package? Such a move could turn out to be a great boon to those who doubt the wisdom of relying on private, profit-focused insurance companies to cover us when we get sick. It could offer us the opportunity to get the sort of proven universal coverage we can count on.
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