Dutch Fight to Take Health Care Away from Private Insurers

Holland-plus-medicalBrussels   What is the old saying? Something like, I’ve seen the future and it is in the Netherlands at least when we are talking about the inevitable fight to come someday in the United States to seize control of our national health care programs from big health care insurers. On the way between Germany and Belgium, I had the opportunity to meet with several organizers and campaigners who have built a powerful effort in Holland on this issue and are finding the response amazing with the potential to dominate the campaigns in the country’s elections in the spring of 2017.

If you were paying close attention during the health care debates in recent years over the Affordable Care Act or Obamacare, as it is known popularly, you often heard about the health care insurance scheme in the Netherlands which was better in its broad coverage of the population but, unlike many other countries, was provided by private, rather than public, insurers. Meeting with the organizers, I came to understand the situation a bit better. Everyone pays the equivalent of about one-hundred euros or $112 per month to private companies for insurance. I was fuzzy on exactly how this part works but the fact that they mentioned that much of the Dutch public’s opposition was rooted in disgust at the millions and millions spent by the insurers in advertising and promotion leads me to believe that a family chooses an insurer for their coverage.

There’s also a hammer to the head in this program along the lines of the deductibles that come under Obamacare. Everyone has coverage and everyone pays, but when they actually use the insurance, they have to come up with another 385 euros or $429. For some reason it is called an “own risk” payment, since if you don’t need to buy medicine or go to the doctor, your monthly payments are more like a healthcare tax or donation, so that when you do utilize the system, this is more like an admissions fee. Similar to the US experience with high deductibles blocking utilization under Obamacare, estimates are that 20% of the Dutch people are avoiding accessing the healthcare system, even when they need it, because they cannot afford the additional payment.

So the campaign is seeking to get rid of that payment of course, but also to move to a national healthcare fund more along the lines of the national healthcare program enjoyed by other countries. The support for their campaign has surpassed all expectations, and that’s part of what brought us together in this exciting conversation. In less than two months about 60,000 people have signed up to support the campaign either online or directly, and, amazingly, almost half of them are taking the additional step of asking for an “action” package on steps they can take in their communities to build the campaign.

With elections happening in mid-March of next year, this campaign couldn’t have been timed any better, so if it continues to build momentum in the summer, this could be the issue that dominates progressive debate at every level during the election. Meanwhile, regional meetings throughout the country are also pulling in crowds double, triple, and quadruple of organizers’ expectations, more are set coming off the summer with big demonstrations and other actions planned in the fall. They are riding the whirlwind here, and while they are doing so, as I said earlier, they are running the pilot program that organizers in the United States and elsewhere will need to be studying and copying in order to deal with many of the same issues involving national – and better – healthcare in our countries.

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Is Their Hope for Obamacare?

77639392New Orleans     A federal court somewhere gave new hope to the haters that the subsidies the Affordable Care Act to lower income families might be blocked.  The Administration says they will win on appeal.  But, this is only one cloud of many in the building thunderstorm.

            Insurance companies and those that follow them are almost universally saying that there will be significant price hikes in 2017.  Others are dropping by the wayside, largely because of their own bad pricing and marketing decisions, but nothing keeps them from finger pointing as they leave.  In many ways this was predictable.  As the signature legacy of President Obama, they are smart enough to wait until his long goodbye transitions into whatever and both he and Congress are lame ducks caught in a quacking stalemate, and roll up heavy on Clinton or Trump with the fait accompli

            Clinton has flirted towards the left with a vague proposal to potentially allow people 50 or 55 years of age to “buy into” Medicare, which would expand the coverage to millions more, if they have the money.  What it would still not do is solve any of the problems that continue to weigh heavily on Obamacare.

            Drug prices have continued to rise for example.  In fact, drug profiteering still seems a winning business plan despite the problems with Valeant and profiteers. 

            Charity requirements for nonprofits are still largely more pretense than policy.  Modern Healthcare reported 7 of the 10 most profitable hospitals of the top one-hundred in the country, according to a researcher at John Hopkins, were tax exempt nonprofits.  The three most profitable for profits were all part of the HCA chain and all three were in states like Texas and Florida that have not extended coverage under Obamacare.  Nonprofits were very well represented in the top 100, including Herman Memorial which has been the target of campaigns by Local 100 United Labor Unions and community allies in Houston and Ochsner, headquartered in New Orleans, which has also been called out for its miserly charity record.

            Emergency room doctors are reporting that half or more of the patients they are seeing are coming in late and with insurance, but had delayed seeking care because of the astronomical level of their deductibles, equivalent to having no insurance at all.   Employers of lower waged workers continue to develop such minimal coverage programs with impunity.  The coming year will see an even higher level of penalties appropriated against lower income workers who are running from the cost, deductibles, and copays, but will be caught by the mandated penalties.

            The bottom line is that, like any major piece of new potentially groundbreaking, safety net legislation there are problems.  There are pieces that beg to be fixed.  Meanwhile the deadlock in Congress simply lets the sores fester and pain endure without stepping up and fixing what is broken.  Health care continues to be a political football, as politicians maintain the fiction that this is all part of the game, rather than coming to terms with the fact that for many low and moderate income families, it’s life and death.

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Hillary: Forget the Young Women, Go for the Moms

Lucia McBath, left, mother of Jordan Davis, and Maria Hamilton, mother of Dontre Hamilton, react as Sybrina Fulton, mother of Trayvon Martin, talks about her son next to Democratic presidential candidate Hillary Clinton during a rally at the Central Baptist Church in Columbia, S.C. Image: Jacquelyn Martin/Associated Press Juana_summers By Juana Summers Feb 23, 2016

Lucia McBath, left, mother of Jordan Davis, and Maria Hamilton, mother of Dontre Hamilton, react as Sybrina Fulton, mother of Trayvon Martin, talks about her son next to Democratic presidential candidate Hillary Clinton during a rally at the Central Baptist Church in Columbia, S.C. Image: Jacquelyn Martin/Associated Press

New Orleans    Hillary Clinton is having well-documented problems appealing to young women. Backers like Gloria Steinem have been no help to her. She can talk about student loans and the need to get a woman elected, but where she’s getting traction, very cleverly, is with the “moms,” and if we were whispering advice in her ear, it would have to be: “do more of that, sister!”

Brilliantly, she seems to have reached out and courted African-American mothers of young men shot by police. The Times detailed her outreach, and it’s a textbook example of the advantage of a well-organized internal campaign organization and uber-professional campaign staffers. She sent them handwritten notes on Christmas cards about their losses. She followed up with other hand-written notes. She got some of them together for a 3-hour dinner in Chicago, and this wasn’t a Michelle Obama healthy sprouts special, this was old time, down home, Southern cooking, featuring pork chops, fried okra, and apple pie. She did what she does best as the every diligent, super-student in the room, listening and taking notes while they told their stories. She put them on the road together to appear at meetings and rallies, where she smartly introduces them to much better applause than she gets on her best lines. OK, sure the story was planted with the Times and pushed along and facilitated by the campaign, but that also proves my earlier point about how well organized and professional her campaign has the ability to be. Undoubtedly, this kind of outreach has been pure gold in sending her message, silently and with strength, to the African-American community. Who wants to see another grinning politician or wannabe, if you can stand in applause for sister in pain?

If something is working, why not do more of it? Hillary should double-down on the “mom” vote. Heck, they vote more than young women anyway, when push comes to shove.

But, why not do more and prove to the rest of us that you will be our standard bearer?

Why not argue more aggressively for family leave that means something? Not just some unpaid leave if you’re lucky enough to work for a big company, but real leave for pregnancy with support and pay for everyone?

Why is Clinton not making paid sick leave a bigger issue for working mothers – and fathers! There’s increasing support for such leave in statehouses and cities, why not carry that banner?

And, here’s the kicker? Isn’t it finally time to talk about universal daycare? The advantages are immense: job creation, more women in the workforce, less loss of working hours, earlier education of children, huge financial savings for families, reduced inequality, and just plain peace of mind. You want moms – and a heck of a lot of dads – then finally fix daycare and take it out of the shadows of always low-waged and often informal employment and create something that supports families and children. Moms would crowd the rallies and stand in line for a candidate really committed to delivering on this issue.

And, besides we should all whisper to Secretary Clinton, universal adequate and affordable daycare for children is a core feminist issue. Surprise yourself, go one-hundred percent for the moms, and see if positions like these, sincerely felt and strongly argued, don’t bring even young women to your side as well.

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Please enjoy The Jayhawks’ Quiet Corners & Empty Spaces.  Thanks to KABF.

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Draining Bloated Drug Prices

Little Rock  Something big is happening among drug companies. They aren’t exactly on the run, but they are at least feeling the heat, so there may be hope for the rest of us.

Let’s look at how the evidence is starting to add up:

  • Turing Pharmaceuticals and its CEO have become the face of exploitation as he testifies before Congress on video screen from jail on stock manipulation charges after having become the picture of greed by upping the price of rare, minimally manufactured drugs for specific diseases by predatory multiples.
  • Valeant, a high flying drug company that assembled its meteoric rise by buying other companies and drugs in recent years has suffered an almost 50% meltdown of its value recently, pushed out its CEO and finance people for suspected earnings misstatements, and shattered the reputation of William Ackerman, a previously highflying private equity mogul who has also lost a fortune and has joined their board to try to stop the bleeding.
  • Anthem, the insurance company, is suing Express Scripts, the prescription drug middleman for $15 billion in damages in a huge pot-calling-the-kettle-black suit alleging that they violated their contract by piling on excessive charges through “unduly high pricing” and “an obscene profit windfall.” This is rich because usually when consumers buy drugs there is already a margin for the benefit manager larded into the price, so we’re really the ones paying. Anthem is charging that there is about $13 billion in such overcharges wrapped into the life of their contract. It’s little mystery that even though Anthem is crying like a stuck pig, the real victim here is the final customer: us!
  • Meanwhile giant drug purveyor, Lilly, is barking up one tree after another complaining about proposals from President Obama under the Affordable Care Act and others from Hillary Clinton and Bernie Sanders that would try to assign the research and development costs from the drug companies to specific drugs in order to rein in pricing. The company’s argument is that, hey, we spent almost $5 billion on R&D about 10% of all R&D spent in the pharmaceutical industry, and it wants us all to shut-up and accept their word rather than coming up with an assessment of drug-by-drug figures on their expenditures. Right, like they don’t do this in-house and already know, huh? They are the cause though that leads to this effect. If they didn’t arbitrarily inflate the costs of drugs against the desperate needs of the sick in their market, this wouldn’t be an issue. What goes around, comes around.

Ok, these are small signs often nestled in the business pages of local and national newspapers, but it’s spring, a season of renewed hope, so let’s take a deep breath and hope that these are real signs that finally a level of rationality may finally be imposed on the predatory pricing schemes of drugs that literally mean the difference between affording life or choosing death.

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Drug Makers and Drug Access are Out of Control

indexNew Orleans   In the fight against the Affordable Care Act much was made of so-called “death panels,” as many may remember. Years go by and now we have something in place a lot like that now, and there’s not much never mind. When it comes to money or life, pretty much everyone has become resigned to the realization that money will win almost every time in such a contest.

Nonetheless, recent news that there were as many as 150 different drugs in critically short supply was not sobering, but shocking. The rationales were across the board, and they included production and manufacturing problems, abandonment by companies of drugs because of puny sales, supply line problems, and probably hoarding, though I don’t remember that being on the list. Some of it also had to do with predatory pricing on some drug therapies by companies charging exorbitantly for new treatments, like Hepatitis C, where almost $90,000 per year was standard, based on the companies’ argument that the cost was cheaper than transplants. The stories of hospitals unable to get enough chemo and other cancer drugs so they were having to lower dosages, deny access, try something else, or choose between the old and young in a deadly triage based on these shortages were horrible.

Having recently interviewed James Lieber about similar issues, many of which he had researched in his book, Medical Error, I reached out for him to give me a better understanding on whether the problem was the way I was looking or what I was seeing. Lieber’s finger pointed right at the drug companies:

 

Yes, these shortages and triaging are highly conducive to medication errors. Big Pharma plays a lot of games with pricing, and shortages which are often artificial is a main one. Another, which is related, is for hospitals to get kickbacks when they order high priced drugs, especially chemo agents, which can be in short supply. The dangers are real when physicians can’t order and nurses can’t administer the right medicine. It’s unethical practice in both professions. For people to sit in hospitals compounding by hand basic medicine is a crude throwback. Modern medicine requires adequate supplies of pre-measured drugs in the correct dosages. And where is the FDA which should be guarding our safety in this space? In bed with Pharma that’s where.

Yeah, good point! Where the heck is the Federal Drug Administration, supposedly a watchdog and regulatory agency of the US Government? Shouldn’t they be watching over this and both talking and swinging a big stick? How about some executive orders on this, President Obama?

Lieber has a recommendation, though it’s in the “pay me now or pay me later” vein. He says, let’s put clinical pharmacists in the mix right at the point of care:

I’m a big fan of clinical pharmacists who should round with doctors in hospitals and long term care making sure that patients get the right meds from the start. This cuts way down on errors, but is often considered an unnecessary expense.

Lieber also pointed me in the direction of my brothers and sisters at ACORN Canada, where they don’t have this problem. As Lieber says,

Truth to tell we’ll probably always lose this battle as long as all providers have to compete for and in formularies that rarely have complete stocks, a byproduct of our dysfunctional multi-payer system.

 

Maybe that’s not much comfort to us now, but it’s worth remembering that we don’t have to live – or die – this way.

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Congress is the Undercard, the Real Fight for Healthcare is Still Corporate

imrs.phpNew Orleans   Recently the House of Representatives voted to repeal the Affordable Care Act for something like the 62nd time. They have now almost banned Obamacare from being funded as many times as they have barred ACORN! The more you understand about the continued tug of war behind the scene with employers, hospitals, drug companies, doctors, and insurance companies, the more you realize the political machinations on the front pages are window dressing, just part of the puppet show as the pols are pulled back and forth, up and down by the big players. Not to mix too many metaphors, but they are the weak under-card in this fight, while the heavyweights are the companies punching back and forth for advantage.

Of course we have the scandalous way that some drug companies are trying to play arbitrage with people’s health and hike the prices of rare drugs through the roof, regardless of the body count, not caring about anything other than making Wall Street happy. This situation is so grotesque that Congress may be forced to do something about it. We also have 800 pound gorilla setting on the examining table and continuing to pose the most serious problem, increasingly noticed, but left unattended, and that is the persistent problem that employers did not play fair on Obamacare and have largely squeezed through the loopholes, providing coverage in name only with deductibles, co-payments, and monthly bills all collectively so high that millions of lower waged workers are having to embrace the fines, because actual health coverage on offer is financially out of their reach and unreasonable.

A story in Modern Healthcare about the insurance companies’ tug of war was also depressing and enlightening particularly because the companies continue to play such a huge, daunting role in the exchanges, pricing, and coverage. CMS, the Obamacare administrator, is trying to nail down regulations for 2017, understanding that they need to lock as many backdoors as possible before the Obamas pack out of the White House. They proposed a rule that would require any health insurers to require all insurer networks “to include hospitals and doctors within certain travel times or distances from members. There would also be minimum provider-to-member ratios for some medical specialties. The CMS wanted to make sure consumers had access to enough healthcare providers as more insurers moved to narrow-network products.”

And, that’s when everything hit the fan. The CMS is basically trying to make sure that those who buy into care get a standard package across the country to meet their health needs. The insurers and some of their buddies in the state insurance commission offices, who are most frequently their captive audiences, in some states are crying like stuck pigs. They claim they want to tailor the networks to each state rather than have a federal cookie cutter approach, but the real deal is likely just making a deal that makes the big insurers they are used to currying happier to do business with them. Many hospitals and doctor groups line up with CMS on this one rather than being hammered even harder by the insurance bullies. According to Modern Healthcare some of them even advocate that “the CMS…go a step further and build network standards for appointment wait times.”

Meanwhile hospitals and doctors have their own issues. Doctors employed by hospitals in Oregon have even organized a union because of rough handling by the hospitals. Hospitals are being scored by CMS for service, recovery, and billing and some of the outfits that can’t make the mark are squealing about the scores rather than trying to do better on the tests. Meanwhile hospital requirements for providing affordable care to justify their tax exemptions, enjoyed by many, are still resisting and avoiding any accountability.

My best advice is to not take your eye off of the healthcare fight. It’s a long way from over yet, and any notion that we won, has been gone since the early rounds.

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Please enjoy Since You Been Gone by The Heavy.  Thanks to KABF.

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