May 06th, 2017

Everyone in this picture is a RAGING FAR-RIGHT WING GLOBAL 1% WALL STREET ONE WORLD ONE GOVERNANCE CLINTON NEO-LIBERAL and yes, they pushed through an Affordable Care Act that was written by global health industry corporations.  Nothing the current Republicans do can be worse.  Any citizen shouting to protect ACA is a 5% to the 1% global Wall Street player.  Trump will simply MOVE FORWARD the goal of only that global 1% and their 2% accessing quality health care in the US with 99% of WE THE PEOPLE accessing only preventative health care for all.

REAL left social progressives want this in health care policy:

End Affordable Care Act policies that mandate health insurance purchase; that create global health monopolies through ACOs----Accountable Care Managed Care Organizations----they are simply creating monopolies that will end with health costs soaring as with any monopoly; that privatize our Federal Medicare and Medicaid Trusts with those funds being POOLED into a health funding structure that is NOT equal access and ends with those funds simply subsidizing health industry profits.  Our Federal Medicare was regulated to provide EQUAL ACCESS because all citizens paid the same PAYROLL TAX RATE to assure they had access to these public programs----

We cannot return to a REAL MEDICARE FOR ALL structure until we do all of the above.  Any group advocating for MEDICARE FOR ALL---UNIVERSAL CARE---SINGLE-PAYER without shouting to reverse all of the above are simply that 5% to the 1% pushing the ONE WORLD ONE WORLD HEALTH ORGANIZATION preventative care for all being established in all Foreign Economic Zones.

When national media print graphs saying Singapore, Taiwan, Mexico, Ecuador, Bahrain all have UNIVERSAL HEALTH CARE they are not talking about American developed nation quality of care---they are talking about the United Nations preventative health care for all----wellness, communicable disease control, and mental health rehabilitation.


REAL left social progressives for health care justice are PROTESTING THEIR GLOBAL CORPORATE CAMPUS IVY LEAGUE UNIVERSITY HEALTH SYSTEMS locally----such as Johns Hopkins to break down these structures built with the fraud and corruption of our Medicare and Medicaid programs these few decades.

 We can reverse this MOVING FORWARD global Wall Street health system structure by actions LOCALLY----not by shaking our fists at Trump.


Sidelined Democrats let grass roots 'resistance' lead the way on health care fight

From left, House Minority Leader Nancy Pelosi of Calif., accompanied by Democratic Whip Steny Hoyer, D-Md., Rep. Joseph Crowley, D-N.Y., and Jim Clyburn, D-S.C. take questions from members of the media during a news conference on Capitol Hill in Washington, Friday, March 24, 2017.




Republican leaders have abruptly pulled their troubled health care overhaul bill off the House floor, short of votes and eager to avoid a humiliating defeat for President Donald Trump and GOP leaders. Pelosi is mocking House Republicans for failing to repeal and replace President Barack Obama's health law. (AP Photo/Andrew Harnik) (Andrew Harnik / AP)


David WeigelWashington PostRep. Raja Krishnamoorthi, D-Ill., a freshman from a safe seat in Chicago's suburbs, was just about to deliver his speech against the American Health Care Act when he heard a commotion on the House floor. The bill was being pulled. Democrats, who up until that moment thought the Republicans might yank a rabbit out of the hat, began celebrating, and Krishnamoorthi thought back to election night, when he learned that he would be coming to Washington with President Donald Trump.


"I thought this repeal bill would sail through," he said. "It was the president's number one priority. And what was incredible about this process was the phone calls -- we had 1,959 phone calls in opposition to the American Health Care Act. We had 30 for it."


On Friday afternoon, as congressional Democrats learned that the GOP had essentially given up on repealing the Affordable Care Act, none of them took the credit. They had never really cohered around an anti-AHCA message. (As recently as Wednesday, House Democratic leader Nancy Pelosi was still using the phrase "make America sick again," which most Democrats had abandoned.) They'd been sidelined legislatively, as Republicans tried to pass a bill on party lines. They'd never called supporters to the Capitol for a show of force, as Republicans had done, several times, during the 2009-2010 fight to pass the Affordable Care Act.


Instead, Democrats watched as a roiling, well-organized "resistance" bombarded Republicans with calls and filled their town hall meetings with skeptics. The Indivisible coalition, founded after the 2016 election by former congressional aides who knew how to lobby their old bosses, was the newest and flashiest. But it was joined by MoveOn, which reported 40,000 calls to congressional offices from its members; by Planned Parenthood, directly under the AHCA's gun; by the Democratic National Committee, fresh off a divisive leadership race; and by the AARP, which branded the bill as an "age tax" before Democrats had come up with a counterattack.

You wouldn't let a little thing like not having a corkscrew stop you from enjoying that bottle of wine you just bought, right? Watch these videos to see what lengths people will go to to open a bottle of wine in a pinch.


Congressional Democrats did prime the pump. After their surprise 2016 defeat, they made Sen. Bernie Sanders, I-Vt., the outreach director of the Senate caucus. Sanders's first project was "Our First Stand," a series of rallies around the country, organized by local Democrats and following a simple format. Elected officials would speak; they would then pass the microphone to constituents who had positive stories to tell about the ACA.


President Trump addresses the cancellation of a vote Friday on the GOP's plan to overhaul the Affordable Care Act.
"What we're starting to do, for the first time in the modern history of the Democratic Party, is active grass-roots organizing," Sanders said in a January interview. "We're working with unions, we're working with senior groups, and we're working with health-care groups. We're trying to rally the American people so we can do what they want. And that is not the repeal of the Affordable Care Act."


The turnout for the rallies exceeded expectations, though their aggregate total, over 70-odd cities, would be dwarfed by the Women's March one week later. More importantly, they proved that there was a previously untapped well of goodwill for the ACA -- which had polled negatively for seven years -- and it smoothed over divisions inside the party. Days after Barack Obama had blamed "Bernie Sanders supporters" for undermining support for the ACA, Sanders was using his campaign mailing list to save the law.


"It was the town halls, and the stories, that convinced me that people might actually stop this bill," said Tom Perriello, a former Democratic congressman now running an insurgent campaign for governor of Virginia, with his career-ending vote for the ACA front and center.


The outsider approach to lobbying grew from there, in ways that quickly came to worry Republicans. Indivisible-affiliated groups advertised congressional town halls and flooded them. Like the Jan. 14 rallies, the town hall tactic mirrored what the tea party movement did in 2009. Like the Democrats of that year, many Republicans responded glibly, blaming out-of-state (or district) rabble-rousers and searching for the invisible hand of George Soros. Among the Republicans who took the protests seriously was Rep. Mo Brooks, R-Ala., who would go on to oppose AHCA from the right.


"I don't know if we're going to be able to repeal Obamacare now because these folks who support Obamacare are very active," Brooks told a radio host in February. "They're putting pressure on congressman and there's not a counter-effort to steel the spine of some of these congressmen in tossup districts around the country."

Beltway groups were helping organize the opposition, and did not pretend otherwise. But they were effective because they had actual grass-roots buy-in. Elizabeth Juviler co-founded an Indivisible group in the district of Rep. Rodney Frelinghuysen, R-N.J. "He'd never taken a position against the party," Juviler said in an interview. "By all accounts, he's an affable person, but he wasn't accessible."
The group,

NJ11th for Change, birddogged the Republican congressman with two tactics. First, it held mock town hall events in all four of the counties he represented. "Thousands" of people showed, according to Juviler; all were informed of how to call his office. When the health-care bill was dropped, Frelinghuysen was besieged with calls. And on Friday, he announced that he would oppose AHCA. According to Joe Dinkin, a spokesman for the Working Families Party, there were dozens of stories like that.


"For the first time in a long time, a pretty sizable number of Republicans were more scared of grass-roots energy of the left than of primaries on the right," said Dinkin.
House Speaker Paul D. Ryan addresses the cancellation of a vote Friday on the GOP's plan to overhaul the Affordable Care Act.


Helpless to defeat the bill with their numbers -- and not even consulted by Republicans who intended to push it through -- Democrats counted on the grass-roots energy to grind the majority down. There was no big rally at the Capitol, because the activism in districts was seen as more effective.



"Those big rallies get a lot of media coverage, but they're not effective," said Rep. Raul Grijalva, D-Ariz., the co-chairman of the Congressional Progressive Caucus.

This week, as Republicans fumbled the AHCA, Democrats held relatively low-key events to draw attention to their fight. At each, they credited activists with slowing down the bill, and derided Republicans for being led by Trump's whims.
"Organizers had a first victory today," said Rep. Primila Jayapal, D-Wash., at a small CPC rally after the bill's delay Thursday. "Across the country, they pummeled Republicans for this horrible bill."


And when the bill was pulled, Pelosi joined a rally of just a few dozen people across from the Capitol, organized by MoveOn.org. She took off her heels and led the crowd in a literal jump for joy, as the members of her emboldened caucus began fundraising off the Republican failure.


"You organized across the country," read a fundraising email from Rep. Gerry Connolly, D-Va., after the vote. "You showed up to Republicans' townhalls and told them your stories about the ACA saving your life. You called your Representatives and asked them to vote no. Members of Congress reported receiving thousands of calls from constituents almost uniformly against repeal."


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The idea that virtually everyone likes the theory of ACOs is FALSE---most people both consumers and health care workers do not LIKE ACOs.  As this article states breaking ANTI-TRUST AND MONOPOLY LAWS for goodness sake cannot be good.

'While virtually everyone likes the theory of ACOs, many are objecting to the details. The trade association of health insurers – America’s Health Insurance Plans – believes ACOs could drive up costs if groups of hospitals and doctors dominate markets and demand high rates from insurers.

To accommodate ACOs, federal regulators believe they may need changes in anti-trust laws, which forbid companies from monopolizing markets, and anti-kickback healthcare laws, which are meant to block hospitals from rewarding doctors who send patients their way'.

Will ACOs create a revolution in American healthcare?


Last year, when blocked arteries landed Syed Abdul Qadri, 68, in Jackson Memorial Hospital, the public facility was struggling with some tough statistics: One in four of its heart patients was being readmitted within 30 days, a performance that put Jackson in the bottom quarter of hospitals in America.


The hospital steered Qadri into a pilot program aimed at reducing hospital readmissions through follow-up care — a concept that’s a forerunner of a major medical revolution coming to American healthcare.

In this new healthcare world prompted by national healthcare reforms, systems like Jackson will be held accountable for patients’ care even after they leave the hospital, a restructuring that will push doctors, hospitals, home healthcare agencies and others to work together in new organizations to improve patient care — or suffer financial penalties.


In Qadri’s case, a nurse visited his home in South Miami-Dade to make sure he filled his prescriptions, bought the proper medications for his heart and understood the importance of diet. She left him 10 frozen healthy meals, an improvement on the “spicy and greasy food I usually eat,” he said. The nurse promised to check in with him regularly to see how he was doing and provide more meals, he said.
A model of care that doesn’t stop when a patient leaves the hospital is one of the new ideas now shaping America’s healthcare future. And though Qadri’s case later became complicated by a heart attack, his experience offers lessons on some of the pluses and minuses the new system may offer.


At present, providers are paid on an à la carte basis — each test, each hospital admission is paid individually. The more tests, the more hospitalizations, the higher the pay for providers.


That will change starting next year when the healthcare reform act will start to favor groups of hospitals, doctors and others who band together into accountable care organizations, or ACOs, that will be rewarded for good outcomes of patients and penalized for bad outcomes. The penalty: If too many patients return within 30 days to a hospital, Medicare will penalize the facility by reducing its reimbursement rate by 1 percent starting in 2013 and by 3 percent in 2015, says Steven Ullmann, a health policy professor at the University of Miami.


Ullmann and other healthcare experts are convinced that where Medicare leads, commercial insurers will follow, joining the push toward ACOs. “It’s a wave that’s occurring,” Ullmann says. “You’re starting to see the preliminary adjustment going on. The jury is still out on how much it’s going to do.”


The wave is already influencing some areas of healthcare. Baptist Health South Florida has hired 80 doctors, at least in part to be ready for the ACO days. Elsewhere in the country, health insurers like Humana and Cigna are buying up physician practices for the same reason – a move that has massive implications.
Medicare is now forming regulations for the ACOs, which could be owned by one entity (such as a hospital) or be a network of independent doctors and facilities working together. With the stakes so high, hospitals, doctors, insurers and many others are objecting to the proposed regulations, some of which will kick in next year, as they seek the best possible deal for themselves.



“The rules are likely to change,” says Mike Segal, a healthcare specialist at Broad and Cassel, a Florida law firm. “Every trade organization is trashing them.”
But even if the objections lead to the courts killing healthcare reform, Segal says, that won’t stop the ACO trend: “It’s not going away. The idea of providing better quality care at lower cost through collaboration is here to stay. Fee-for-service as we know it is an endangered species.”



Current proposals envision ACOs starting out with the more traditional fee-for-service model – a separate payment for each service performed – but Ullmann says that’s only because Washington doesn’t want to stack on too many reforms all at once.


Eventually, Ullmann and most other healthcare experts believe, payments to ACOs will be “bundled,” meaning that the group of providers will receive a lump sum for handling “an episode of care,” such as a heart attack, rather than for each separate service to treat the heart attack. Another approach would be for the ACO to be paid to cover a year’s worth of care for a person, whether the person gets sick or not.
At present, providers make their money when people get sick. In the future, providers may need to emphasize wellness, says Thinh Tran, chief quality officer for Baptist Health South Florida.


Baptist recently launched a voluntary wellness program for employees with chronic conditions that could lay the groundwork for an ACO. A nurse, health coach and nutritionist work with the employee. One does a home visit, arriving with a basket of fruit and healthy recipes, going through the cupboards and offering a critique. A blood pressure cuff connects to a home computer, allowing the coach to monitor the person’s care daily – from afar.


While virtually everyone likes the theory of ACOs, many are objecting to the details. The trade association of health insurers – America’s Health Insurance Plans – believes ACOs could drive up costs if groups of hospitals and doctors dominate markets and demand high rates from insurers.


To accommodate ACOs, federal regulators believe they may need changes in anti-trust laws, which forbid companies from monopolizing markets, and anti-kickback healthcare laws, which are meant to block hospitals from rewarding doctors who send patients their way. AHIP, the insurers’ trade association, warns that loosening anti-trust laws could create monopolies that would result in higher insurance rates for consumers. In theory, anyone can form an ACO, but the expenses are huge, including coordinated billing and accounting operations, and software for integrated electronic record-keeping. That makes it likely that most ACOs will be formed by major hospital groups or big investors who will want a return on their money, said Segal, the healthcare lawyer.


“My concern is that the larger hospitals are going to be at the front of this, because they have the capital,” says Bernd Wollschlaeger, a family practice physician in North Miami Beach and former president of the Dade County Medical Association. “A group of physicians may not reach a critical mass,” though Wollschlaeger believes doctors may do a better job of lowering patient costs.


All these factors make the ACO situation “incredibly complex,” says Segal, the healthcare lawyer.
That’s certainly the case with Qadri, the South Miami-Dade heart patient. He says that when his 10 meals ran out, he called several times to the nurse’s company, Independent Living Systems, to get more meals that he says had been promised him. He says no one called back. In April, he had a heart attack and was rushed to Baptist Hospital. There’s no way of knowing if the heart attack could have been prevented by more care from ILS.


Jeffrey King, an ILS vice president, says his staff tried to find a free-meal program for Qadri, who is uninsured, but couldn’t find one he qualified for. “We tried our best. Resources are limited,” he said. He says ILS records indicate a staffer made five follow-up calls to Qadri over 30 days as the program required, and connected with him on all but one of them.


Qadri’s case also beings up another potential ACO issue. He was treated at two hospitals. If Baptist and Jackson were ACOs, which organization should be rewarded or punished for the outcome of his care? Medicare’s answer is that at the end of each year, the insurer will decide retroactively what ACO treated the patient the most, and assign him to that organization for measuring rewards and penalties on outcomes – a situation that has many hospitals concerned they may get blamed for outcomes they had no control over.

Qadri is listed as a Jackson success story because he hasn’t returned to Jackson Memorial. Kevin Andrews, vice president for quality and patient safety, acknowledges that Jackson doesn’t track patients who go elsewhere, but “we’re trying to get a handle on that.”


The Jackson pilot program covered 200 heart patients. Andrews estimates the pilot caused the 30-day readmission rate to drop by a third. Andrews estimated that the $81,000 investment saved Jackson about $400,000 on readmission charges.


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Left social progressive PROTECT free market as we stand for broad local economies with strong small and regional businesses competing with corporations.  Global Wall Street killed free market when they ignored monopoly and anti-trust laws creating this stagnant and captured US economy we have today. 

WE THE PEOPLE ALWAYS LOSE WHEN WE LOSE FREE MARKET CAPITALISM.

That is what ACO policies do and we have decades of data showing these ACOs do not provide lower cost health care and expand access---we know it does not do this.

'Under an ACO the consumer holds little power to make informed decisions on the care they receive, and competition may only diminish as ACOs transform into larger organizations. We have to return to a true market system based with true incentives and consumer choice to provide better quality at lower costs'.

Our US Medicare and Medicaid Trust structure worked to CONTROL PROFITEERING----it allowed our Federal Medicare to negotiate price controls that did not eliminate PROFITS BY HEALTH INSTITUTIONS----it limited extreme profiteering.  Our health institutions were earning millions in profits before CLINTON/BUSH/OBAMA allowed systemic looting of our Federal health programs.

RETURNING TO OUR FEDERAL MEDICARE AND EXPANDING IT TO ALL CITIZENS ALLOWS FOR PRIVATE HEALTH INSTITUTIONS TO COMPETE AND PROFIT WHILE CONTROLLING COSTS AND FUNDING ACCESS FOR ALL.


Healthcare

Accountable Care Organizations: Straying Further from A Free Market System

Posted on October 19, 2012 by markgiguere

Accountable care organizations (ACOs) are federal programs under the Patient Protection and Affordable Care Act (ACA) that incentivize health care providers to reduce costs and improve quality of care.  Theoretically, under the ACO model, physicians coordinate with hospitals to create a large organization that provides streamlined, coordinated care to patients.  The ACO model hopes to provide better quality care while simultaneously lowering costs by providing feedback to the health care providers. By focusing on the needs of patients and linking payments to outcomes, these delivery system reforms hope to help improve the health of individuals and communities while slowing cost growth.


Supporters of the ACO model produce a utopian vision of physicians and other health care providers collaborating with hospitals to provide more coordinated care.  Hospitals, with a large infrastructure and leading technologies like electronic medical records, allow doctors and hospitals to work together to provide high quality care at a lower cost through the elimination of excessive and/or redundant testing and procedures.  In such ACOs, doctors are able to work with one another and alongside each other to see that their patients receive the best care throughout their illness. ACOs will create an environment in which professionals will be able to share opinions and consult one another about the best options for a patients care.


Here’s where the music stops.


These large organizations, carrying clear infrastructural and technological advantages, will likely create monopolies rather than a competitive market.  In a free-market system, suppliers are held accountable for their products and services.  With these large organizations, however, risk, responsibility, and accountability of individual physicians are reduced. In a competitive market, consumers hold the health care providers accountable for the quality of care that they receive.  Accountability is what drives the competition to lower the costs while simultaneously trying to improve quality of care. ACOs will stray further from the free-market system and create monopolies due to a more advanced infrastructure and the reduction of risk and accountability for individual physicians.


A key aspect of an ACO is its performance measurement, which informs consumers and providers of the quality of care being provided.  This aspect was created to make doctors more aware of the quality of their care and about other doctors’ practices that are improving quality.  These performance measurements are also used to inform consumers seeking affordable, high quality care. In theory, these performance measures create a free-market-like system by informing the consumers of the high quality ACOs and allowing them to make their own decision on which provider to choose.  Although performance measurements inform consumers, they are not market-based because they do not allow consumers to make fully informed choices about their coverage and care. The proposed impact of these performance measurements overestimates consumer ability to drive competition.  The arrangements made between employee insurance and providers, which restricts consumers to certain providers actually limits competition.


The performance measurements are also used to incentivize ACOs to improve care while reducing costs.  ACOs receive a portion of their savings if they successfully reduce costs while sustaining or improving its quality measurement.  Creating this incentive hypothetically makes an ACO more aware of the relationship between cost and quality in their practices and can create change if the incentive is great enough. Markets that are truly consumer driven do not need to create artificial incentives to improve quality and performance.


In the free market, competition among a large number of small groups drives quality up and costs down.  Competitors are constantly working to improve their products, attract consumers, and increase market share. Under an ACO the consumer holds little power to make informed decisions on the care they receive, and competition may only diminish as ACOs transform into larger organizations. We have to return to a true market system based with true incentives and consumer choice to provide better quality at lower costs.

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We knew this BEFORE all of Affordable Care Act policy based on creating global health system monopolies.  On top of this consolidation to monopoly came creation of PUBLIC HEALTH COMMISSIONS----just as with our STATE PUBLIC SERVICE COMMISSIONS----that of course are filled with people tied to health corporations.  These are the structures that need to be reversed----locally we simply need to pursue massive health industry frauds and misappropriated funds to bring a global Johns Hopkins to being that EXPANDED AND IMPROVED MEDICARE FOR ALL

When global Wall Street 5% simply shout for SINGLE-PAYER/UNIVERSAL CARE they are moving towards that GUTTED OF FUNDING MEDICAID FOR ALL.


Costs of A Hospital Monopoly in One Underserved County
Feb 28, 2017

By NIRAN AL-AGBA, MD

There is a growing body of evidence that hospital mergers lead to higher prices for consumers, employers, insurance, and government.  It is imperative to educate patients and lawmakers as to how the consolidation of hospitals and medical practices raise costs, decrease access, eliminate jobs, and ultimately reduce care quality as a result.  Lawmakers should focus on this “first pillar” of cost control as they go back to the drawing board. 


In 2010, there were 66 hospital mergers in this country. Since the Affordable Care Act went into effect the rate of hospital consolidation has increased by 70 percent. By creating incentives for physicians and health providers to coordinate under accountable care organizations (ACOs), the ACA hindered the ability of regulators to block hospital mergers while incentivizing hospital consolidation. 


In addition, there has been a dramatic increase in hospitals gobbling up independent providers and becoming powerful regional monopolies.  According to a 2012 study by the Robert Wood Johnson Foundation, “the magnitude of price increases when hospitals merge in concentrated markets is typically quite large, most exceeding 20 percent.” Forbes’ Avvik Roy, gave an excellent presentation on this particular subject in 2012.  “You have to get at the errors in public policies which drive the hospitals to merge.” He concluded that government must do more to fight consolidation among hospitals.  He is right.   

For years, the concern that mergers drove up prices was largely anecdotal.  A recent paper authored by Northwestern’s Leemore Dafny, Columbia’s Kate Ho, and Harvard’s Robin Lee provides some definitive proof that when hospitals consolidate, prices increase substantially.  The effect is actually worsened directly in proportion to proximity of the merging hospitals.  “If you are doing it because you think in the long run it will serve your community well, you should think twice,” Dafny said.  As of right now, cross-market mergers aren’t scrutinized at the state or federal level.  This must change.  A statement issued by the American Hospital Association (AHA) in response to Dafny’s paper said mergers provide patients with access to care and they are not a meaningful predictor of price change.

A study published by the National Bureau of Economic Research, conducted by Zack Cooper of Yale University, Stuart Craig of the University of Pennsylvania, Martin Gaynor of Carnegie Mellon, and John Van Reenen of the London School of Economics, sheds light on the real cost of reduced competition among hospitals: hospital prices are 15.3 percent higher when a hospital had no competition compared in markets with four or more hospitals, amounting to a cost difference of up to $2000 per admission. Hospital prices are 6.4 percent higher in markets with two hospitals and those with three are 4.8 percent more expensive when compared to markets with four hospitals.


The case for hospital consolidation has been supported by the American Hospital Association, the leading industry trade group, which spent $15 million on lobbying in 2015 (a decrease from $20 million in 2014).  Consolidation allows hospital conglomerates to control vast market shares, which has translated into political clout while allowing more leverage in negotiations with private insurers. 

“What’s been so interesting for me is to see how aggressive the American Hospital Association has been in coming after me,” says Cooper, who claims the American Hospital Association has funded a couple of critical reports about his paper. 

“I have never seen the evidence that consolidation improves quality in the health care space. I have never seen a study that comes out and says that consolidation makes things better,” says Cooper. Neither have I; consolidation does not improve quality.  Cooper, like Mr. Roy, suggests rigorous antitrust legislation and increasing competition among hospitals as possible solutions.


Harrison Medical Center is the hospital in which I was born and had expanded into two campuses before being “acquired” by CHI Franciscan Health two years ago.  CHI purchased numerous small medical practices, the last independent orthopedic group, and most recently, merged with the largest multispecialty physician group in the county, the Doctors Clinic. 



Prior to these mergers, 65% of physicians in Kitsap County, where I live, were independent.  That number has plummeted to a dismal 27%.  Both hospitals are currently owned and operated by CHI Franciscan and now they want to merge into one structure for an “ultra” monopoly.  Every cardiologist, oncologist, pulmonologist, urologist, and vascular and orthopedic surgeon in my county are employed or under contract with CHI Franciscan Health. 

In the last two years, Kitsap County has lost consumer choice, employer choice, physician choice, insurance choice and access for healthcare services. Physician groups merging with CHI Franciscan are forbidden from using the local ambulatory surgery center (ASC) for outpatient procedures.  The hospital insists on exclusive use of their Hospital Outpatient Department (HOPDs) instead.  It is a well-known fact costs at HOPDs are substantially higher when compared to identical procedures done at ASCs. 

According to FAIR health, the cost difference (zip code specific) between the two locations is striking:


Colonoscopy: 
ASC – $1250 ($500 out of pocket)
HOPD: $4250 ($1000 out of pocket)
Echocardiogram:
ASC $500 ($200 out of pocket)
HOPD: $4250 ($1250 out of pocket)
Arthroscopy of Knee: 
ASC – $3600 ($1070 out of pocket)
HOPD: $13,000 ($3900 out of pocket)
Hernia Repair: 
ASC – $2500 ($750 out of pocket)
HOPD: $19,000 ($5700 out of pocket)


The above estimates do not include the physician bill or charges for equipment. 
In 2009, President Obama spoke in Grand Junction, Colorado to highlight a locality where (to quote Tom Brokaw) “health care works”. Their unique model focused on provider-insurer partnerships to reduce Medicare costs and was lauded by policy makers and media outlets as the epitome of efficiency in healthcare but, the devil is always in the details.  The 50,000 residents of Grand Junction are served by a single hospital, much like Kitsap County, Washington soon.  It turns out Grand Junction is one of the most expensive healthcare markets in the country.  The lack of local competition helped drive Medicare costs down—Grand Junction had the third-lowest Medicare spending per beneficiary in 2011. However, the monopolistic conditions drove private prices way up —the city has the ninth-highest inpatient prices in the country.


The more government reduces payments to physicians, the more hospital consolidation is encouraged to decrease cost and leverage market forces.  This drives prices up for patients with private insurance.  Higher prices in less competitive markets amounts to higher premiums passed on to employers and individuals who see bigger bills under their high-deductible health plans.  Cities with higher premiums on the Affordable Care Act’s insurance exchanges tend to be those cities with high priced hospitals. Increased concentration in health care victimizes consumers, as hospitals leverage their market position and drive up prices.

Maybe it is time to borrow a page from the Justice Department playbook and scrutinize hospital consolidations more closely, blocking them if necessary for the “greater good.”  Recently, two federal judges blocked separate health insurance company merger attempts, Aetna-Humana and Cigna-Anthem.  The Justice Department opposed both because “the competition among these insurers that has pushed them to provide lower premiums, higher quality care and better benefits would be eliminated.”  Opposing creation of monopolies in healthcare is something both liberals and conservatives alike should hypothetically oppose.  We have 3.4 trillion reasons to sit up and pay attention. 
Niran Al-Agba is a pediatrician based in Washington State.

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The Affordable Care Act these several years built ACOs just for our Federal Medicare/Medicaid ----separating seniors and low-income patients in MOVING FORWARD two tiered levels of care. When seniors and low-income are taken out of our main stream hospital and clinic care system and isolated profits soar for those global health systems. Then these same systems can exclude and build that global health tourism targeting only the global richest allowing ordinary medical procedure rates to SOAR----as is happening today.
When the 5% to the 1% global Wall Street Clinton/Obama players shout UNIVERSAL CARE----SINGLE-PAYER they are leaving these MEDICARE/MEDICAID ACOs in place making them the target of what they are calling LEFT SOCIAL HEALTH CARE. A separate funding system for segregated patients trapped in a lower-tier of health care is NOT WHAT EXPANDED AND IMPROVED MEDICARE FOR ALL looks like. We want to return to all hospitals taking all patients and having the ability to treat all disease vectors. Of course there have always been specialty institutions but ordinary health care starts in our communities for 99% OF WE THE PEOPLE.

Funding these newly created lower-tiered MEDICARE/MEDICAID structures is NOT universal care----it is moving towards that ONE WORLD ONE WORLD HEALTH ORGANIZATION UNIVERSAL CARE for 99% of global citizens.


Medicare-Medicaid Accountable Care Organization (ACO) Model

The Medicare-Medicaid ACO (MMACO) Model is focused on improving quality of care and reducing costs for Medicare-Medicaid enrollees. The MMACO Model builds on the Medicare Shared Savings Program (Shared Savings Program), in which groups of providers take on accountability for the Medicare costs and quality of care for Medicare patients. Through the Model, CMS will partner with interested states to offer new and existing Shared Savings Program ACOs the opportunity to take on accountability for the Medicaid costs for their assigned Medicare-Medicaid enrollees.


Model Details

Some of the highest-need, highest risk Medicare beneficiaries are those enrolled in both Medicare and Medicaid. In current Medicare ACO initiatives, beneficiaries who are Medicare-Medicaid enrollees may be attributed to ACOs. The Medicare ACO, however, does not have financial accountability for the Medicaid expenditures for those beneficiaries.


The Medicare-Medicaid ACO Model is an initiative designed by the CMS Innovation Center for new and existing Shared Savings Program ACOs wishing to take on accountability for the full spectrum of Medicare Part A, Part B, Medicaid costs, and quality for their patients. Certain aspects of the Model may vary by state but the over-arching principles and parameters will be consistent across the Model. If Medicare-Medicaid ACOs in the state generate Medicare savings for their Medicare-Medicaid enrollees, states (as well as the Medicare-Medicaid ACO) may be eligible to share in those savings with CMS.

Through the Medicare-Medicaid ACO Model, CMS seeks to encourage participation from safety-net providers in Alternative Payment Models. Medicare-Medicaid ACOs that qualify as “Safety-Net ACOs” will be eligible to receive pre-payment of Medicare shared savings to support the ACO’s investment in care coordination infrastructure.

CMS has released a Request for Letters of Intent from states that wish to work with CMS to design certain state-specific elements of the Model, such as the details of the Medicaid financial methodology and shared savings/shared losses arrangements, selection of additional quality measures, and additional ACO eligibility requirements. States will also have the option to include additional Medicare-Medicaid enrollees not assigned under the Shared Savings Program and/or Medicaid beneficiaries in the target population for the Model, subject to CMS approval.


State Eligibility

The Medicare-Medicaid ACO Model is open to all states and the District of Columbia that have a sufficient number of Medicare-Medicaid enrollees in fee-for-service Medicaid. CMS will enter into participation agreements with up to six states, with preference given to states with low Medicare ACO saturation. Additional eligibility requirements and details about the application process are provided in the Request for Letters of Intent.

States must follow all rules, including those related to Medicaid coverage, payment and fiscal administration that apply under the approach they are approved to offer. CMS will work with states to determine the appropriate Medicaid authority for their desired approach. State participation in the Model is contingent upon obtaining any necessary approvals and/or waivers from CMS.


How to Apply - States

States may choose from three options for when the first 12-month performance period for the Medicare-Medicaid ACO Model will begin for ACOs in the state: January 1, 2018; January 1, 2019; or January 1, 2020.
For consideration to begin the first performance year of the Model on January 1 of the year indicated, interested states must submit an LOI no later than 11:59pm Eastern Time on or before the following dates:
State's Preferred 1st Performance Year
Start Date
 Deadline to Submit Letter of Intent
 
2018January 20, 2017
2019August 4, 2017
2020August 3, 2018

CMS encourages interested states to submit a Letter of Intent as early as possible to begin the development of the state-specific aspects of the Model and the Model application process. The steps necessary to finalize the state-specific aspects of the Model may vary by state, therefore submitting a Letter of Intent prior to the applicable deadline is not a guarantee that the Medicare-Medicaid ACO Model in that state will begin on the state’s preferred first performance year start date. Letters of Intent from states must be accompanied by at least one letter of interest from a provider or provider organization in the state.

A Letter of Intent template is provided in Appendix A of the Request for Letters of Intent (PDF). Letters of Intent must be submitted by email to MMACO@cms.hhs.gov.
Section IV. of the Request for Letters of Intent (PDF) provides information on the application process.


How to Apply - ACOs

CMS is not yet accepting applications from ACOs to participate in the MMACO Model. Once a state’s application is approved, a Request for Applications to ACOs will be released to providers in the state. Providers wishing to participate in the development of the state-specific aspects of the Model may submit a letter of interest along with the state’s Letter of Intent.

________________________________________

'The lowest out-of-network deductible, for CHO’s “gold” plan in the Affordable Care Act marketplace, will increase by 472 percent, from $2,500 to $14,300'

While our middle/working class citizens struggle just to meet deductibles, co-pays, and premiums our affluent citizens with all that disposable income having breezed by that fully funded premium GOLD PLAN having no deductibles and co-pays and 100% coverage of all health costs----are now FEELING THE BURN.  A predatory global health system will be milking those affluent having that disposable income LITERALLY TO DEATH----as 99% of US citizens fall into impoverishment relegated to that lower-tier GUTTED OF FUNDING MEDICAID FOR ALL.

There will be no winners in MOVING FORWARD this global health system structure ---only a system catering to designer medicine for the global 1% and their 2%.  Neither today's Republicans with Trump nor Democrats with global Wall Street Clinton/Obama neo-liberals intend on STOPPING MOVING FORWARD global health care.  The Republicans will POSE CONSERVATIVE by claiming they do not want MANDATED INSURANCE----when they do------the global Wall Street Clinton neo-liberals will continue to sell to the poor citizens that they are getting access to care WHEN THEY ARE NOT.  

PLEASE FIGHT THIS ATTACK ON OUR US DEVELOPED NATION STRONG PUBLIC HEALTH CARE AND COVERAGE BY HOLDING LOCAL IVY LEAGUE AND GLOBAL HEALTH CAMPUSES IN YOUR NECK OF THE WOODS FOR WHAT EVERYONE KNOWS WAS MASSIVE FRAUDS OF OUR FEDERAL MEDICARE AND MEDICAID TRUSTS.THIS ALONE WOULD FULLY FUND REAL LEFT EXPANDED AND IMPROVED MEDICARE FOR ALL.

Posted October 28, 2016
Updated October 28, 2016



 Out-of-network costs to soar for members of Maine health insurance co-op


Deductibles will rise as much as 472 percent next year as Community Health Options pressures members to use cheaper in-network services.
By J. Craig AndersonStaff Writer


Lewiston-based health insurance co-op Community Health Options will increase its deductibles for out-of-network medical care by as much as 472 percent in 2017, hoping to curb its members’ use of the expensive option.



The lowest out-of-network deductible, for CHO’s “gold” plan in the Affordable Care Act marketplace, will increase by 472 percent, from $2,500 to $14,300, according to the Maine Bureau of Insurance. At the opposite end of the spectrum, the out-of-network deductible for CHO’s “catastrophic” plan will increase by 168 percent, from $8,000 to $21,450. Deductibles for its four most popular “silver” plans will increase by 186 percent, from $5,000 to $14,300.


Meanwhile, premiums for CHO individual insurance plans in 2017 are increasing by an average of 25.5 percent, although subsidies will offset most of those increases. Deductibles for in-network care also are increasing for many CHO plans but will remain far lower than out-of-network deductibles. They will range from $1,200 to $7,150 in 2017, compared with $750 to $6,850 in 2016.


The dramatic increase in out-of-network deductibles is intended to tamp down an ongoing problem of too many CHO policyholders seeking medical services outside of Maine, said Kevin Lewis, the co-op’s chief executive. Such services are more expensive for CHO, which has been operating at a net loss since 2015.


“We’ve gone to great lengths to provide a solid and respectable array of in-network providers,” Lewis said. “This encourages people to stay in the network.”

Insurance companies sign contracts with a wide range of medical care providers, under which the providers agree to charge contractually agreed-upon rates for their services. Those providers are considered “in network.” All others are “out of network” and do not have to charge specific rates, so their fees are usually higher.


Lewis said CHO’s network is extensive in Maine, covering nearly all medical providers. Still, he said it appears that some CHO policyholders have moved out of state and are receiving the more expensive out-of-network treatment on an ongoing basis. He said those policyholders should switch to another insurer in their new state.
“It makes sense to have a different carrier” under those circumstances, said Lewis, who did not provide specific data on out-of-network costs.


But Emily Brostek, executive director of the Augusta-based nonprofit Consumers for Affordable Health Care, said the out-of-network deductible increase may make CHO a less appealing choice for part-year residents, seasonal workers and college students who split their time between Maine and elsewhere.


“We have seen a lot of people gravitate toward (CHO’s) products because they did spend a large part of the year outside the state,” Brostek said. “If they get a Community Health Options plan (for 2017), then they might not have access to a primary care provider during the times of the year that they’re not in Maine.”


SERIES OF COST-SAVING MEASURES


CHO is one of about two dozen insurance cooperatives to start under ACA, the federal health insurance law. They were intended to take a slice of the insurance markets created by the act and provide competition to for-profit insurers. About half those cooperatives had folded by the end of 2015, and CHO was the only cooperative in the nation to make money during 2014, its first year of operation.


It has been a popular choice for Mainers looking for health insurance. CHO signed up about 40,000 policyholders in its first year, posted a slight increase in enrollments in 2015, and has about 77,000 policyholders now. About 11,000 of those policyholders are in New Hampshire, where CHO plans to discontinue coverage in 2017 and move customers to other providers.


Lewis has said CHO’s customers accessed significantly more health care in 2015 than during the cooperative’s first year, driving up costs. As with most U.S. insurers, soaring drug costs contributed to the increased claims that the co-op handled.
In 2015, CHO reported a $31 million loss and was forced to set aside an additional $43 million in reserves to cover potential losses this year.
In addition to deductible and premium increases, CHO has implemented other cost-saving measures for 2017, including the elimination of coverage for elective abortions and adult vision care.
It also is raising its out-of-pocket maximum for all policyholders to $21,450 for out-of-network care in 2017, said Eric Cioppa, Maine’s superintendent of insurance. The maximum currently ranges from $8,250 to $19,000, depending on the plan, he said.


State-approved rate increases for the coming year average in the double digits for all carriers’ individual health plans and about half of all small-group plans in Maine, according to the Bureau of Insurance. Maine’s health insurance rates already rank among the highest in the nation, in part because of the state’s relatively sparse population and high percentage of elderly residents. They also are affected by national trends, including rising prescription prices and treatment costs.


CONSUMER ALERT: POLICIES CHANGING


All three of Maine’s remaining ACA marketplace insurance providers – CHO, Anthem and Harvard Pilgrim Health Care – are raising premiums and making changes to their various individual and small-group insurance plans for 2017, the bureau has said. It has recommended that consumers shop around for the best deals when ACA enrollment for 2017 opens Tuesday.
But the issue of skyrocketing out-of-network deductibles is specific to CHO, because Maine’s other individual insurance providers – with the exception of Anthem in parts of northern Maine – don’t offer coverage for out-of-network care, the bureau said.


While CHO’s network in Maine is extensive, insurance policyholders occasionally may find that a specialist or hospital worker involved in their care requires an out-of-network fee. Still, Cioppa suggested that the massive deductible increases probably will have little effect on the typical CHO policyholder, because most patients tend to stay in network.

“Our empirical analysis of the claims database, and other analyses by the American Academy of Actuaries, indicate that relatively little utilization actually occurs out of network in terms of total dollars,” he said.


Brostek, the consumer advocate, said insurance plans are so complex that many policyholders might not notice significant changes such as big increases in their out-of-network deductibles until it’s too late. She recommended that Maine consumers with questions about which 2017 plan is best for them take advantage of free help that’s available by visiting enroll207.com or calling Consumers for Affordable Health Care’s hotline at (800) 965-7476.


“People really need to be conscious of these other changes that are happening in plans,” Brostek said. “It’s not like you can change midyear if you find out the plan isn’t what you thought it was.”


_______________________________________________
BERNIE KNOWS THAT LEAVING THESE ACO STRUCTURES IN PLACE WHILE PUSHING MEDICARE FOR ALL WOULD END WITH FUNDING FOR THESE LOWER-TIERED ACO MEDICARE/MEDICAID STRUCTURES.

This is how we know Bernie Sanders is simply that Wall Street player---he is working for that ONE WORLD ONE WORLD HEALTH PREVENTATIVE CARE FOR ALL.  Bernie ran his MEDICARE FOR ALL policy platform saying Affordable Care Act is a good start so his plan simply moves forward this gutted of funding MEDICAID FOR ALL---calling that single-payer/universal care as does WORLD HEALTH ORGANIZATION.


BERNIE SANDERS TRYING TO MAKE A FAR-RIGHT WING ATTACK ON OUR STRONG DEVELOPED NATION HEALTH CARE SYSTEM SOUND MARXIST----HEALTH CARE FOR ALL.

Make no mistake---the United Nations and World Health Organization today are filled with global 1% and their 2% pushing Foreign Economic Zones and global neo-liberalism and moving towards ONE WORLD ONE GOVERNANCE so they are not looking for strong, developed world health outcomes.  They are protecting this TWO TIERED HEALTH STRUCTURE for the global rich.

'Days after Barack Obama had blamed "Bernie Sanders supporters" for undermining support for the ACA, Sanders was using his campaign mailing list to save the law'.

REAL left social progressives HAVE NO NATIONAL LEADERSHIP now---and our state Democratic Committees are captured too----WE THE PEOPLE must act as a 99% vs 1% locally to reverse this dismantling of our PRE-PAID PUBLIC HEALTH CARE.


THE US HEALTH CARE STRUCTURE WAS NOT WORKING BECAUSE OF MASSIVE HEALTH INDUSTRY FRAUDS AND PROFITEERING----THAT IS THE PROBLEM WITH COVERAGE FOR ALL----SIMPLE OVERSIGHT AND ACCOUNTABILITY SOLVES THAT.


Cruz, Sanders face off on Obamacare
By MJ Lee and Eli Watkins, CNN


Updated 4:48 AM ET, Wed February 8, 2017



Now Playing Cruz, Sanders debate...  

Cruz, Sanders debate Obamacare in 90 seconds 01:30Washington (CNN)Sen. Ted Cruz urged fellow Republicans Tuesday to quickly "honor the promises" the party made over the years to repeal Obamacare.

"2010, 2014, 2016, I believe were a mandate from the voters. We're tired of the premiums going up. We're tired of deductibles going up," Cruz said at a CNN town hall debate with Sen. Bernie Sanders over the future of Obamacare. "Should Congress move swiftly to repeal Obamacare? Absolutely."


Cruz and Sanders -- two senators with diametrically opposed views of government's role in health care -- faced off at the debate moderated by CNN's Jake Tapper and Dana Bash and featuring questions from an audience consisting of both defenders and critics of the Affordable Care Act.


Cruz's call on his party to "repeal every word of Obamacare" came as the GOP is grappling with how quickly to repeal the law. The party hasn't yet reached a consensus on an alternative to the law. President Donald Trump said Sunday that a replacement plan may not be rolled out until next year.


The GOP's incredible, shrinking Obamacare repeal

The town hall debate underscored the many challenges surrounding efforts to dismantle the Affordable Care Act -- a sweeping health care law that covers some 20 million Americans. The evening began with each lawmaker laying out starkly different views of the controversial law.




Sanders: Republicans in a panic over Obamacare 02:23
"If you are one of 20 million Americans who finally has received health insurance, forget about it -- you're gone," Sanders warned about repealing Obamacare. "That means when you get sick, you ain't gonna be able to go to the doctor. And when you end up in the hospital, you'll be paying those bills for the rest of your life, or maybe you'll go bankrupt."
Cruz, a Texas Republican who made his name in national politics by fiercely opposing the health care law, said former President Barack Obama made a series of promises that were broken.
"If you like your doctor, you can keep your doctor," Cruz said. "Millions discovered that was not true."


Policy issues

Several policy questions are at the center of the ongoing battle about reforming Obamacare, including the popular provision to protect people with pre-existing conditions and the controversial mandate that nearly all Americans get coverage. Republican lawmakers are also wrestling with how to live up to their promises to make Obamacare more affordable and to reform Medicaid.




How can GOP protect those who rely on ACA?

03:15
The CNN debate highlighted how Republicans and Democrats fundamentally disagree on many of these issues.
One woman in the audience, Neosho Ponder, spoke about her fight against breast cancer and said she was undergoing radiation treatment. Ponder expressed fear that without Obamacare, she wouldn't be able to afford health insurance.

Cruz insisted that Republican lawmakers support prohibiting insurance companies from canceling coverage for someone just because they are sick. All GOP proposals that have been introduced to replace Obamacare with, Cruz said, "prohibit companies from jacking up the insurance rates because they got sick or injured."


Sanders was incredulous.


"Ted, I cannot believe what you just said. It's a direct contradiction of everything you ran for President on," he said. "What Ted has said is he wants to get rid of all federal mandates. Did you say that a hundred times?"
"I didn't say it once," Cruz said. "Virtually all of the Republican legislation that has been filed — that the Democrats have opposed — maintains a continuity of coverage."


The issue of pre-existing conditions came up again when Maria Shahid Rowe, a woman who is five-months pregnant, said she was worried she wouldn't be able to get health coverage without Obamacare.
Cruz responded that Democrats are mandating that people get "every coverage on earth -- and it sounds really good."


However, "you should get the policies that meet your needs," he said.
Sanders shot back that before Obamacare, Shahid Rowe's pregnancy would have been treated as a pre-existing condition. "What Ted is really telling you is they will not guarantee coverage for you."
Another woman in the audience, Melissa Borkowski, told Sanders she simply can't afford the health services she needs. Burkowski recently had an abnormal Pap smear, but said she couldn't get additional tests because she hasn't met her out-of-pocket deductible. Her fear: that she may now have undiagnosed cancer.


Sanders, who repeatedly stressed that Obamacare was far from perfect, said it is "totally absurd" that Borkowski has such an "outrageous deductible."


"If you were in Canada, you know what? You would get the health care that you need," he said. "The idea that we have policies like that, like the one you describe, is clearly an outrage."
Cruz lamented that coverage choices have gone down "dramatically" since Obamacare became law. The senator, whose Canadian birthplace became a political controversy during his 2016 presidential run, also added: "Bernie mentions Canada quite a bit. I know quite a bit about Canadian health care. I was born there. You know Bernie, that may be the best argument against your position. Look what it produced."


Sanders joked as he gestured at Cruz: "Look what the result is."


'Employer mandate'

Another key pillar of Obamacare that came up was the so-called "employer mandate" -- the law's requirement that small businesses employing 50 or more workers to provide healthcare for its employees.

LaRonda Hunter, who owns five hair salons in Texas, said she can't afford to provide coverage to her employees because of low profit margins and that the Obamacare rule is preventing her from growing her business.
Sanders responded with what he prefaced would be "an answer you will not be happy with."


"I'm sorry, I think that in America today, everybody should have health care. And if you have more than 50 people, you know what, I think I'm afraid to tell you, but I think you will have to provide health insurance," Sanders said.
Cruz shot back that Democrats have turned small businesses into a "bad actor."
"Millions of businesses are being told by Democrats: tough luck," Sanders said. "It's one of the most damaging things about Obamacare."



One more area where the parties diverge is Medicaid. Democrats championed expanding coverage for low-income Americans by expanding Medicaid to more adults. Republicans, on the other hand, want to curtail federal responsibility for the program by capping funding.


At Tuesday night's debate, Carol Hardaway shared that she has multiple sclerosis, which created challenges in her walking, speech and vision. When the Affordable Care Act passed, Hardaway said, she moved from Texas -- a state that has not expanded Medicaid -- to Maryland, which has, and was able to receive treatments right away.


Hardaway posed a question to Cruz that Republicans are struggling to answer: Can he guarantee that people like her would continue to be protected?
Cruz referred to Medicaid as a "profoundly troubled program" akin to "rationed care."
"We should have a system that allows as many people as possible to be on the private health insurance of your choice rather than Medicaid," Cruz said, noting that wait times under the program has gone up.
But when Tapper asked Hardaway whether Cruz had answered her question, she indicated that he had not.

Drastically different approaches


Cruz and Sanders both ran unsuccessfully for president in 2016 and have their own ideas on reforming the health care system and making coverage more affordable for everyone. Their approaches, however, are drastically different.
Sanders is a proponent of a "single-payer" federal health care system, or as he refers to it: "Medicare for All." During the presidential campaign, the Vermont senator outlined a government-run program that would offer Americans comprehensive care covering everything from doctors' visits to hospital stays, to vision, dental and mental health services.

He is a proponent of hiking taxes on the wealthy to pay for his proposed system.

Cruz, meanwhile, has railed against Obamacare for years and has vowed to fully repeal "every word" of the law. The Texas firebrand made his name in national politics in 2013 when he gave a more than 20-hour marathon speech to oppose funding for the Affordable Care Act.

Despite their contrasting views on health care, there was a rare moment of agreement for the two senators: the pharmaceutical industry. Sanders asked Cruz to partner with him in taking on drug companies -- "the greediest of many greedy corporate interests in Washington" -- by supporting legislation to have Medicare negotiate prices with the industry.

"I would love for us to work together in going after big Pharma," Cruz said, though he stressed that it is the U.S. Food and Drug Administration that is enforcing an important ban.
Congressional Republicans are paving the way to repeal significant portions of Obamacare. Senior lawmakers are currently crafting an Obamacare repeal bill that requires just a simple majority of senators for approval.


But the discussions over creating an alternative to the controversial law has exposed tensions within the GOP. Many Republican lawmakers have grown increasingly wary of the political consequences of a quick and sweeping repeal of Obamacare, and some have more openly begun to discuss "repairing" the law and keeping aspects of it that are popular.


That note of caution clashes with impatience among some conservative members of the GOP conference, who fear that anything short of a swift repeal of Obamacare will be unacceptable to their constituents.

Trump, who campaigned on repealing and replacing Obamacare, said over the weekend that rolling out a new healthcare system will likely be a drawn-out process.
"I would like to say by the end of the year at least the rudiments, but we should have something within the year and the following year," Trump said.

____________________________________________

'Trump: Australia has better healthcare system than US
By Nikita Vladimirov - 05/04/17 09:06 PM EDT'


AND HERE IT IS=====AUSTRALIA HAS INDEED INSTALLED THE ONE WORLD ONE WORLD HEALTH ORGANIZATION STRUCTURE AND HERE IS BOTH TRUMP AND BERNIE SANDERS LOVING IT.

'Sen. Bernie Sanders (I-Vt.) seized on Trump's remarks about the Australian system, which consists of both public and private markets, with its publicly funded universal healthcare system working alongside medical services provided by the private sector'.

What Sanders is supporting is just what we discussed---that separate ACO structure for Medicare and Medicaid Sanders thinks is fine wanting that to be what is called the SOCIALIST UNIVERSAL SYSTEM meanwhile the top tier global health system geared toward the global rich 1% is what our US health care system for all 99% used to be.


Bernie Sanders and Trump both agreeing that the lower-tier ACOs for the 99% are just great for WORLD HEALTH ORGANIZATION FUNDING.



 Comprehensive primary health care under neo-liberalism in Australia
Contents:

Abstract

This paper applies a critical analysis of the impact of neo-liberal driven management reform to examine changes in Australian primary health care (PHC) services over five years. The implementation of comprehensive approaches to primary health care (PHC) in seven services: five state-managed and two non-government organisations (NGOs) was tracked from 2009 to 2014. Two questions are addressed: 1) How did the ability of Australian PHC services to implement comprehensive PHC change over the period 2009–2014? 2) To what extent is the ability of the PHC services to implement comprehensive PHC shaped by neo-liberal health sector reform processes?



 THE KEY TERMS IN THIS GLOBAL WALL STREET PLAYER TALKING POINTS------CREATION OF A DUAL SYSTEM---PUBLIC AND PRIVATE HEALTH INSURANCE---so in US our Federal Medicare and Medicaid was integrated into our strong system -----what Affordable Care Act did was create those tiered systems with 99% of citizens being pushed into PREVENTATIVE CARE FOR ALL................

Chile's neoliberal health reform: An assessment and a critique

Jean-Pierre Unger and Pierre De Paepe are in the Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium. Giorgio Solimano Cantuarias and Oscar Arteaga Herrera are in the School of Public Health–Faculty of Medicine, University of Chile, Santiago, Chile
PLoS Med 5(4): e79 doi:10.1371/journal.pmed.0050079 – April 2008

Available online

Summary points

The Chilean health system underwent a drastic neoliberal reform in the 1980s, with the creation of a dual system: public and private health insurance and public and private provision of health services.

This reform served as a model for later World Bank–inspired reforms in countries like Colombia.


The private part of the Chilean health system, including private insurers and private providers, is highly inefficient and has decreased solidarity between rich and poor, sick and healthy, and young and old.

In spite of serious underfinancing during the Pinochet years, the public health component remains the backbone of the system and is responsible for the good health status of the Chilean population.
The Chilean health reform has lessons for other countries in Latin America and elsewhere: privatisation of health insurance services may not have the expected results according to neoliberal doctrine. On the contrary, it may increase unfairness in financing and inequitable access to quality care.


***********************
Trump: Australia has better healthcare system than US
By Nikita Vladimirov - 05/04/17 09:06 PM EDT
684
34,010

Trump just now to Australia's PM: "You have better health care than we do."


FYI: Australia has universal health care. pic.twitter.com/CuqrPHyFWn


— Kyle Griffin (@kylegriffin1) May 5, 2017
President Trump remarked Thursday that Australia has a better healthcare system than the U.S.


Trump's comments in a meeting with Australian Prime Minister Malcolm Turnbull came shortly after the commander in chief praised the GOP healthcare bill passed in the House earlier in the day.


"It's a very good bill right now. The premiums are going to come down very substantially. The deductibles are going to come down. It's going to be fantastic healthcare. Right now ObamaCare is failing; we have a failing healthcare," Trump said.


"Our great gentleman and my friend, from Australia ... you have better healthcare than we do," Trump added, turning toward Turnbull.



Sen. Bernie Sanders (I-Vt.) seized on Trump's remarks about the Australian system, which consists of both public and private markets, with its publicly funded universal healthcare system working alongside medical services provided by the private sector.


SAME AS THE NEO-LIBERAL CHILEAN REFORM.......

"That's great. Let's take a look at the Australian healthcare system. Maybe he wants to take a look at the Canadian healthcare system or systems throughout Europe," Sanders, an advocate of a single-payer system, told MSNBC's Chris Hayes.


"Thank you, Mr. President. Let us move to a Medicare-for-all system that does what every other major country on earth does — guarantee healthcare to all people at a fraction of the cost per capita that we spend. Thank you, Mr. President. We'll quote you on the floor of the Senate."


Earlier on Thursday, the GOP-controlled House narrowly passed legislation aimed at repealing and replacing ObamaCare, sending their bill to the Senate, where it faces an uncertain future.