From editor at unionsforsinglepayerhealthcare.org Sun May 5 22:14:34 2013 From: editor at unionsforsinglepayerhealthcare.org (Single Payer News) Date: Sun, 5 May 2013 22:14:34 -0400 Subject: The unhappy marriage of economics and health care Message-ID: <5ed6c5cd9356577c8fcdab075479a5f3.squirrel@unionsforsinglepayerhealthcare.org> The unhappy marriage of economics and health care America?s health care system is collapsing, and we can blame the Economics profession. Most economists approach health care in the wrong way, viewing it as a commodity like shoes or the laptop on which I write. Instead, health care is an idiosyncratic commodity, subject to uncertainty and ?asymmetric information? leading to destructive behavior. Trying to force health care into a box, treating it like other commodities, economists have promoted cost sharing, market competition, and insurance oversight of health care providers that have inflated the administrative burden while denying ever more Americans access. Health care spending has been rising throughout the world as aging and more affluent populations spend on their health. Nowhere, however, has the cost of health care risen as fast as in the United States where costs soared because of rising administrative expense. Compared with other affluent countries in the Organization for Economic Cooperation and Development (the OECD), the United States spends over twice as much per person as is spent elsewhere. Before 1971 when Canada enacted its Medicare program, a single-payer government funded health care system, Canada spent a higher share of its national income on health care than did the United States; since then, however, while Canada has controlled costs, spending has soared in the United States so that we now spend over $3000 more per person. That is $12,000 for a family of four that is not available for travel, education, housing, or food. Elsewhere, increases in health care spending have been associated with improvements in the provision of health care and, therefore, go with increasing life expectancy. In the United States, however, spending has increased because of rising administrative costs and increases in the price of prescription drugs and, therefore, has yielded relatively few benefits in improvements in care. Comparing changes in health-care spending and life expectancy between 1971 and 2008, other affluent OECD members gained a year of life expectancy for every $453 in spending; in the United States, however, life expectancy has increased less and spending has risen sharply more so that each year of increased life expectancy has cost over twice as much as in these other countries. Health care spending in the United States has increased by $1283 for every additional year of life expectancy; had our spending per year of added life increased at only the rate of other countries we would be spending over $4500 less per person, $18,000 saved for the average family of four. Most of the difference in relative expenditures, most of the growing waste in spending in the United States, is due to increasing administrative costs in the provision of private health insurance and in the billing and insurance operations within doctors? offices and in hospitals. The average physician in the United States now spends four-times as much interacting with insurance companies as does the average physician in Ontario, Canada, over $80,000 per physician compared with a little over $20,000 in Ontario. Prescription drug prices and administrative expenses have been the fastest rising costs in the United States health care system; from 1980 to 2005, administrative costs rose by 1300% while drug prices rose by nearly 2000%. There are now 2.5 million administrative support personnel in the American health care system; more than the number of nurses, and five times the number of physicians. We now have more health-care managers than physicians and surgeons. Rising costs drive up health insurance premiums so that a family health insurance plan now costs about 40% of the average family wage income, up from 7% in 1960. Rising costs are denying ever more Americans access to health care even while businesses and governments wrestle with rising health care spending that squeezes resources available for other purposes. While other countries have controlled health care costs by restraining administrative expenses and drug prices, ballooning costs in the United States come from policies promoted by economists who have urged governments and providers to control costs by making consumers responsible for more of the costs even while raising administrative costs and ignoring monopolistic pricing of pharmaceuticals. Viewing the injured, sick, and disabled as ?consumers,? economists see insurance as the source of rising costs because they are not responsible for the costs of care they receive and, therefore, overuse health care. Rising copayments and deductibles are intended to discourage ?consumers? from ?abusing? health care, as if the victims of auto accidents or cancer should shop around for cheaper, and competition among insurers while limiting provider services by providing more administrative supervision. Ignoring evidence that Americans are less likely to see doctors and other health providers than are residents of other affluent countries, these economists have blamed the high cost of our health care on insurance which, they assume, leads to wasteful over-practice and the provision of unnecessary health care services. Their solution is greater cost sharing, more regulation of providers, capitation, and even the end to insurance by substituting medical savings accounts for insurance. For 40 years, many economists? have promoted increasing cost sharing through higher copayments and deductibles, the replacement of fee-for-service payment systems with capitation where providers are paid a fixed amount for patients as in Health Maintenance Organizations, and competition where multiple insurers offer a variety of plans catered to individual consumer?s interests and in competition with each other. Far from limiting health care cost increases, these practices have produced the worst of all worlds, rising costs along with restrictions on access. Costs have risen because these recommendations have inflated the administrative burden in health care, the costs of the billing and insurance activities within provider offices as well as the cost of the health insurance industry itself. While restricting access, limiting the benefit to Americans of some of the dramatic improvements in health care practice of the last decades, these practices have not bent the cost curve or slowed health care inflation even while denying more and more Americans access to affordable health care. The failure of price incentives and competition to control health care costs could have been predicted had economists appreciated that health insurance is not a commodity and the sick are not consumers like those shopping for the best pair of sandals or brand of peanut butter. Producers of commodities might try to accommodate consumer wishes because they can profit by selling more. Health insurers, on the contrary, can better increase their profits by selling less, by identifying people likely to need care and driving them away (?lemon dropping?) even while attracting the lucky and healthy (?cherry picking?). Most health care expenditures go to a relatively few people, the unlucky who develop an illness or suffer an accident; insurers, therefore, can dramatically lower their costs by finding those who will be expensive and getting rid of their business; encouraging them to find another insurance plan or even to die. A form of ?adverse selection,? or screening of potential customers by insurance companies, can be profitable for the individual firm but it comes at the cost of raising costs for the community as a whole. As a country, we now spend almost $200 billion administering the health insurance industry and over $800 billion in administering the health care industry, or over a quarter of total spending. Add to this the inefficiency in delivery that comes from a fragmented finance system that inhibits coordination of care, and the inflated prices for prescription drugs, and easily a third of total spending is wasted or going to monopolistic profits. The waste involved in the current system has a redeeming feature: it provides abundant space for an improved system that could improve access and services even while dramatically lowering costs by eliminating administrative waste. If we lowered administrative costs and drug prices to the Canadian level, we could save nearly $600 billion dollars, more than enough to provide coverage to all of the uninsured while improving access for the millions of underinsured. If we see past the bad recommendations of market-fundamentalists, we can improve health care and save money. An outcome that even economists should favor. Gerald Friedman Professor of Economics University of Massachusetts at Amherst, Amherst, MA. 01003 gfriedma at econs.umass.edu Professor Friedman has written extensively on single payer health care and HR 676. His article explaining the economics of single payer is available here: http://www.pnhp.org/sites/default/files/docs/2012/Dollars%20and%20Sense.pdf Distributed by: All Unions Committee for Single Payer Health Care--HR 676 c/o Nurses Professional Organization (NPO) 1169 Eastern Parkway, Suite 2218 Louisville, KY 40217 (502) 636 1551 Email: nursenpo at aol.com http://unionsforsinglepayer.org 5/5/13 To STOP receiving these emails reply with REMOVE in subject line. From editor at unionsforsinglepayerhealthcare.org Mon May 13 22:09:54 2013 From: editor at unionsforsinglepayerhealthcare.org (Single Payer News) Date: Mon, 13 May 2013 22:09:54 -0400 Subject: Wed. May 15: National Call-In Day for HR 676, single payer health care Message-ID: <00bfe253d91e42a2ee1a81fc2c4a21a2.squirrel@unionsforsinglepayerhealthcare.org> Wed. May 15: National Call-In Day for HR 676, single payer health care The All Unions Committee for Single Payer Health Care?HR 676 is pleased to join with a number of progressive organizations and individuals to support a nationwide call-in day on Wednesday, May 15, 2013, to increase awareness and co-sponsors in Congress for HR 676. The call-in day was initiated by Progressive Democrats of America (PDA). Please take a moment on Wednesday, May 15th to make a call in support of Rep. John Conyers' HR 676 "Expanded and Improved Medicare for All" bill which currently has 42 co-sponsors. Go here to call your Congressperson: http://hq-salsa3.salsalabs.com/o/1987/p/dia/action/public/index.sjs?action_KEY=9658 More than 600 unions have endorsed HR 676. When we take action together, we can break down the corporate barriers that have prevented the democratic will of the people from bringing health care to everyone. Winning more cosponsors is a beginning. For more information on Conyers' bill, including cosponsors and text, go here http://www.govtrack.us/congress/bills/113/hr676 We must challenge Congress and the nation to move forward to single-payer health care, enhanced Medicare for All. That's why we're backing Representative John Conyers bill H.R. 676, that would establish a non-profit, universal, single-payer health care program, an improved "Medicare for All" act. Please use this link to call your Congressperson: http://hq-salsa3.salsalabs.com/o/1987/p/dia/action/public/index.sjs?action_KEY=9658 PDA will also include HR 676 in its monthly letter-drop to Congress. Details for the letter-drop are here: http://www.pdacommunity.org/issues/educate-congress Congressman John Conyers, Jr., is a member of the National Advisory Board of Progressive Democrats of America, PDA, and speaks highly of PDA: "As the second-longest-serving Democrat in the House of Representatives, I know what I am talking about when I say that no one has worked harder on the issues protecting Social Security, fighting for a full employment economy and national health care both inside and outside the Democratic Party, than PDA." PDA and others are planning for more events in conjunction with the upcoming date of July 30th, the 48th anniversary of the passage of Medicare--our own publicly-financed, universal health care plan, which lifted a generation of seniors out of poverty. Please ask your congressperson to cosponsor HR 676 by using this link: http://hq-salsa3.salsalabs.com/o/1987/p/dia/action/public/index.sjs?action_KEY=9658 Among the supporters of this national call-in day are: Quentin Young, M.D. - Single Payer Activist Thom Hartmann - National TV and Radio Host / Best-Selling Author Jean Ross - National Nurses United (NNU) Mark Dudzic - Labor Campaign For Single Payer Robert Score - IATSE-Local 1 Willie Adams - International Longshore and Warehouse Union (ILWU) Kay Tillow - All Unions Committee for Single Payer Health Care--HR 676 Tim Carpenter - Progressive Democrats of America (PDA) Mimi Kennedy, Chair, Progressive Democrats of America (PDA) Donna Smith - Chair, Healthcare not Warfare Campaign Benjamin Day - Healthcare NOW! Ture Turnbull - MassCare Maria Svat - Democratic Socialists of America (DSA) Distributed by: All Unions Committee for Single Payer Health Care--HR 676 c/o Nurses Professional Organization (NPO) 1169 Eastern Parkway, Suite 2218 Louisville, KY 40217 (502) 636 1551 Email: nursenpo at aol.com http://unionsforsinglepayer.org 5/14/13 To STOP receiving these emails reply with REMOVE in subject line. From editor at unionsforsinglepayerhealthcare.org Tue May 21 22:40:55 2013 From: editor at unionsforsinglepayerhealthcare.org (Single Payer News) Date: Tue, 21 May 2013 22:40:55 -0400 Subject: Some unions protest =?iso-8859-1?Q?Obamacare=92s_impact_on_Multiemployer_Health_Plans?= Message-ID: <5e80895fd5bd62e6a240e74123f1de94.squirrel@unionsforsinglepayerhealthcare.org> Some unions protest Obamacare?s impact on Multiemployer Health Plans http://my.firedoglake.com/kaytillow/2013/05/21/some-unions-protest-obamacares-impact-on-multiemployer-health-plans/ The Affordable Care Act (ACA) of 2010, also known as Obamacare, presents challenges to the multiemployer plans through which some unions bargain collectively to provide health care insurance for their members. These plans, often called Taft Hartley Plans, currently cover about 26 million workers, families, and retirees. Unless there is a major regulatory change made by Health and Human Services, these union negotiated plans will be struck a harsh blow once the exchanges go into effect in 2014. A quiet effort by many unions to persuade the Obama administration to make this change is now becoming very public. In an Op Ed published in The Hill, Joseph T. Hansen, President of the United Food and Commercial Workers (UFCW), said, ?But as currently interpreted, the ACA would block these plans from the law?s benefits (such as the subsidy for lower-income individuals and families) while subjecting them to the law?s penalties (like the $63 per insured person to subsidize Big Insurance). This creates unstoppable incentives for employers to reduce weekly hours for workers currently on our plans and push them onto the exchanges where many will pay higher costs for poorer insurance with a more limited network of providers. In other words, they will be forced to change their coverage and quite possibly their doctor. Others will be channeled into Medicaid, where taxpayers must pick up the tab. ?In addition, the ACA includes a fine for failing to cover full-time workers but includes no such penalty for part-timers (defined as working less than 30 hours a week). As a result, many employers are either reducing hours below 30 or discontinuing part-time health coverage altogether. This is a cut in pay and benefits workers simply cannot afford. For example, a worker making $10 an hour that has his or her schedule cut by six hours a week would lose $3,100 a year in income. With millions of workers impacted, this would have a devastating effect on our economy.? http://thehill.com/opinion/op-ed/300823-treat-nonprofit-healthcare-fairly The effort of unions to persuade the Obama administration to change the regulations in order to resolve the problems was reported in the January 30, 2013 Wall St. Journal. ?Top officers at the International Brotherhood of Teamsters, the AFL-CIO and other large labor groups plan to keep pressing the Obama administration to expand the federal subsidies to these jointly run plans, warning that unionized employers may otherwise drop coverage.? "We are going back to the administration to say that this is not acceptable," said Ken Hall, general secretary-treasurer for the Teamsters, according to the WSJ article. http://online.wsj.com/article/SB10001424127887323854904578260313912570432.html Many unions have been working through the National Coordinating Committee for Multiemployer Plans (NCCMP) to find a solution. In a memorandum to the Department of Health and Human Services, the NCCMP stated: ?If subsidies are available only for plans purchased through Exchanges, employers contributing to multiemployer plans will face tremendous economic pressure to stop contributing to multiemployer plans . Many employers will feel the need to drop coverage and access the subsidies to remain competitive.? http://www.nccmp.org/pdfs/NCCMP%20Follow%20Up%20Memo%20August%2030%202011.pdf On April 16, 2013, the United Union of roofers, Waterproofers and Allied Workers International President Kinsey M. Robinson issued a statement calling for a repeal or complete reform of President Obama?s Affordable Care Act (ACA). He stated that the union has supported President Obama for both terms in office but that the union?s concerns ?over certain provisions in the ACA have not been addressed, or in some instances, totally ignored.? ?In the rush to achieve its passage, many of the Act's provisions were not fully conceived, resulting in unintended consequences that are inconsistent with the promise that those who were satisfied with their employer sponsored coverage could keep it. These provisions jeopardize our multi-employer health plans, have the potential to cause a loss of work for our members, create an unfair bidding advantage for those contractors who do not provide health coverage to their workers, and in the worst case, may cause our members and their families to lose the benefits they currently enjoy as participants in multi-employer health plans,? Robinson stated. http://www.unionroofers.com/political/issue.aspx/49775 The Cornell University Industrial and Labor Relations School recently held a special workshop on The Affordable Care Act: Impact on Multiemployer Plans. The materials from that educational event are available here: http://www.ilr.cornell.edu/law/events/The-Affordable-Care-Act-Impact-on-Multiemployer-Plans.html So far there is no adequate answer from the Obama administation to the efforts of unions to resolve the issues. The state exchanges must be in place by October of 2013 so that they are ready to go by January 1, 2014. Many of the unions involved contend that regulations for the ACA could be written to allow the employers that pay into these union negotiated plans to receive the same subsidies that employers will receive in the exchanges. So far, that has not happened. This is one of many conundrums that face unions as the costs of health care in our corporate-controlled, profit-oriented system make the maintenance of health benefits increasingly difficult to achieve. This growing crisis underlines the need for unions to press for passage of HR 676, Expanded and Improved Medicare for All, national single payer health insurance. HR 676 has been reintroduced by Congressman John Conyers (D. MI) into the 113th Congress and has 41 cosponsors. This real solution awaits a dynamic, massive, in-the-streets movement that makes sound health policy also politically feasible. Such a solution would improve the lives of all workers by assuring that everyone has all medically necessary care with no co-pays and no deductibles. Even dental care and long term care are covered. Private for-profit health insurance companies and the massive waste they cause would be removed. Unions would free their health care from corporate control as labor has done in other industrialized countries where some form of publicly funded single payer care is guaranteed. Care would be expanded and costs brought under control. By leading this fight for universal care, unions would once again prove that social justice can be achieved through the leadership of the nation?s organized workers. With all of labor harmed by the attacks in Wisconsin, the ?right to work for less? in Michigan and Indiana, a host of Koch-sponsored legislation in states across the country, and the brutal assault on pensions, what better way to fight back than to use labor?s vast grass roots mobilizing clout to promote HR 676? The union movement will grow as it leads this vital struggle. Labor has always led progress for workers, and that progress also lifts up the nation. Distributed by: All Unions Committee for Single Payer Health Care--HR 676 c/o Nurses Professional Organization (NPO) 1169 Eastern Parkway, Suite 2218 Louisville, KY 40217 (502) 636 1551 Email: nursenpo at aol.com http://unionsforsinglepayer.org 5/21/13 To STOP receiving these emails reply with REMOVE in subject line. From editor at unionsforsinglepayerhealthcare.org Tue May 28 22:44:47 2013 From: editor at unionsforsinglepayerhealthcare.org (Single Payer News) Date: Tue, 28 May 2013 22:44:47 -0400 Subject: New Hampshire AFL-CIO Endorses HR 676 Message-ID: <6435509e187b12fc1f7c80e9d4971499.squirrel@unionsforsinglepayerhealthcare.org> New Hampshire AFL-CIO Endorses HR 676 ?On Saturday, May 4th the New Hampshire AFL-CIO unanimously passed a resolution supporting HR 676 and the adoption of a national single payer health care system that covers all Americans for all necessary medical care including prescription drugs and dental,? reported President Mark MacKenzie. New Hampshire is the 42nd State AFL-CIO Federation to endorse HR 676, Expanded and Improved Medicare for All, sponsored by Congressman John Conyers (D-MI). ?HR 676 will save hundreds of billions of dollars by eliminating the private health insurance industry with its high overhead and profits,? said MacKenzie. ?As President of the New Hampshire AFL-CIO I am proud to have our members actively participate in the movement to win passage of HR 676 and to make health care a human right.? On May 21, 2013, HR 676 gained another co-sponsor in Congress with the addition of Danny Davis (IL-7). HR 676 now has 42 co-sponsors. #30# HR 676 would institute a single payer health care system by expanding a greatly improved Medicare to everyone residing in the U. S. HR 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental (including oral surgery, periodontics, endodontics), mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care and correction, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, podiatric care, and long term care. HR 676 ends deductibles and co-payments. HR 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs. In the current Congress, HR 676 has 42 co-sponsors in addition to Conyers. HR 676 has been endorsed by 601 union organizations including 145 Central Labor Councils/Area Labor Federations and 42 state AFL-CIO's (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV, MA, RI, & NH). For further information, a list of union endorsers, or a sample endorsement resolution, contact: Kay Tillow All Unions Committee for Single Payer Health Care--HR 676 c/o Nurses Professional Organization (NPO) 1169 Eastern Parkway, Suite 2218 Louisville, KY 40217 (502) 636 1551 Email: nursenpo at aol.com http://unionsforsinglepayer.org 5/28/13 To STOP receiving these emails reply with REMOVE in subject line.