News & Opinion

FYI

On March 10, 2011 Ohio State Senator Michael Skindell filed SB112 which establishes the Ohio Health Care Plan.

SPAN Conference Recap

On Saturday April 16th advocates for a universal single payer health care system for Ohio came together in Columbus. At the start of our day attendees were treated to a skit “911….It’s an Emergency” performed by the Not Ready for Prime Time SPANiacs. The premise was that of a call to 911 from a desperate homeowner whose house is being invaded and spouse accosted. Hilarity ensues when the operator must first identify the homeowner’s policy particulars including contract number, level of coverage, deductable and co-pays all while the intruder is threatening life and limb. Let’s hope John Q Public chooses the right network before it’s too late. Stellar performances were turned in by Drew Hellebrand, Debbie Silverstein, John Ross and Mary Nichols-Rhodes.

How preposterous that our disease treatment health care non-system actually functions in this way!

051508DonnaSmithCompressedDonna Smith, CNA/NNU national community organizer, and PDA Healthcare not Warfare national  co-chair then led the meeting through the torturous way in which too many Americans’ lives are turned inside-out by an insurance/medical complex when they fall ill. Donna’s powerful personal story as depicted in the Michael Moore documentary “Sicko” lays bare the lack of caring and empathy the health care industry shows for us all. Quoting Ms. Smith from a message she sent to the One Payer States collaborative today: 

“I had the good fortune to spend the weekend in Columbus, OH, at the SPAN Ohio annual conference.  It was an incredible reminder and affirmation of why we all came together in this collaborative effort a year ago in Wayne, PA. Ohio, like so many of our states, has well-informed and passionate advocates for single-payer healthcare, and also like so many of our states faces daunting challenges in moving forward in the current political environment.  Yet, through the association with other states and with each other, potential for progress even in this period is made much stronger.” 

davesteilDavid Steil, president of healthcare4allpa.org, business owner and former Pennsylvania state representative with the Republican Party made the next presentation which illustrated his realization that the best and most efficient way to make provision of the health care all people need is the single payer concept we all advocate. David’s 35+ years of management experience making products and meeting payroll have left him with no doubt what is needed. He expounded on the precepts that government exists to do what “we cannot do for ourselves”. He even quoted a French philosopher from 1762 who observed “Man is not free when deprived of education and health”. A concept we in SPAN Ohio have endorsed in our recognition of empathy as the soul of democracy. Who said there were none but Democrats that could support such a concept?

The afternoon sessions were dedicated the PPACA vs. HCFAOA, a seminar on lobbying techniques by our lobby committee co-chairs and Mr. Steil’s presentation on how to win the support of business leadership. Mr. Steil expressed his appreciation for the intense questions and stimulating dialog that gave him new energy for the work ahead at home in Pennsylvania. Vann Seawell, SPAN Secretary, and Barb Walden, SPAN Treasurer, did a fantastic job on the entire event.

S915/HR1200 - The Healthcare Wisdom We Can Trust

By: nationalnursesmovement Tuesday May 10, 2011

Today, it is official. Two amazing and courageous elected officials stood with nurses and patients to introduce legislation that moves beyond the current health reform effort and forward to a healthy system for all.

Sen. Bernie Sanders, I-VT, and Rep. Jim McDermott, D-WA, have been allies in the cause for decades. There are not young fellows in terms of legislative or life experience.

Both stood together to introduce the American Health Security Act of 2011 – single-payer, Medicare for All style coverage that would be administered by the states. S915 and HR 1200. Sound policy. Sound thinking. Perfect timing.

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Rep. McDermott (D-WA) on the left and Sen. Sanders (I-VT) on the right.

We can all look at the statistics and the motivations of those who offer the numbers, but these two elected officials stand with us —the patients, the nurses, the workers, the people – as surely as night follows day. It is rare to see moments when the people’s business intersects with the political moment. And it is even more rare to see those elected officials who look to the needs of their constituents and the nation and stand up for policy that uplifts – even if some powerful financial interests see things another way.

The work ahead may be daunting, but with advocates like National Nurse United, and co-president Jean Ross, RN, standing in support of AHSA of 2011, S915/HR1200, the path seems navigable, if challenging. Jean was convincing and committed today as she mentioned her own son and his struggle to secure healthcare in the midst of the current for-profit system that often leaves patients left behind and nurses holding hands and hearts. “We hear the stories,” said Ross, “We hear what others do not.”

The American Health Security Act is also backed by the AFL-CIO and its 13 million members. Arlene Holt-Baker, executive vice president, spoke on behalf of the national AFL-CIO at today’s press conference.

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Jean Ross, RN, NNU co-president

This was not an effort to criticize or condemn the Patient Protection and Affordable Care Act of 2010, said Sanders and McDermott, but the opportunity to move beyond and to finally realize the goal of workers all over this nation to provide healthcare as a basic human right to all.

As a patient and as someone who went broke (though supposedly fully insured), I watched today’s events with a combination of wonder and worry and praise. I continue to believe – even in the face of all evidence to the contrary – that with the help of the nurses we will achieve healthcare as a human right and we will do so without outright revolution because of lawmakers like Sen. Sanders and Rep. McDermott. We can do it if we stand together with enough clarity and enough solidarity.

My worry related more to the wonderful man I married who is in every way my partner in this struggle and who was at the moment of the press conference in consultation about his own most recent health crisis. Even with full coverage, it is still up to his supplemental insurance carrier to determine if the care his doctor wants to give will be approved. My worry for him would be so very much different if we would change the motivations from profit first to healthcare first. The American Health Security Act of 2011 reaches ever closer to that day.

Finally, I stood with labor leaders – and I am not one of their stature – who have worked so hard to advance anything related to healthcare reform and with whom I have sometimes had differences. But today, we stood as Americans who believe that working class people and our kids and our grandkids deserve the right to healthcare as a human right provided under the social insurance model and not as some privilege granted only to the wealthy and the powerful.

Great day. A celebration of life. The American health Security Act of 2011.

S915/HR1200 – Sen. Bernie Sanders and Rep. Jim McDermott. We can do this.

View Sanders News Conference

Read the AFL-CIO blog  

Read about the event in The Nation

Update on Vermont Health Care Legislation

Last Tuesday I participated in a conference call with others from across the country that explored the progress within Vermont to enact a bill H202. Dr. Deborah Richter explained that the finance committee was poised to pass the legislation on to the full Senate within days and that the final vote could come as early as Friday April 22, 2011. As it turns out Vermont budget considerations pushed the consideration into this week.

Tuesday April 26, 2011 the Vermont Senate held final debate on and voted on H202 the Health Care Reform that will establish what will eventually be called Green Mountain Care. This law will initially establish an exchange in Vermont as stipulated under the Federal PPACA and form a board to organize health care provision in Vermont that will eventually evolve into a universal single payer system. For the first time in Vermont, health care will be considered a public good and human right. The final vote count in the Senate at 3:00 PM was 21-9 for passage. Since some provisions were added in the Senate, the full measure must be sent back to the Vermont House of Representatives for concurrence. The initial passage in the House was by a margin of 94-49 therefore passage of the amended bill on concurrence is expected soon. Hear Rachel Maddow interview of Vermont governor Peter Shumlin on this issue.

Kurt Bateman, Director

SPAN Ohio

State Reps Introduce Ohio Health Security Act

FOR IMMEDIATE RELEASE: JUNE 29, 2011

Contact: Jordan Plottner, Legislative Aide, (614) 466-9435
Kevin Pangrace, Legislative Aide, (614) 466-3350
 
Reps. Hagan and Foley introduce Ohio Health Security Act
Bill would make Ohio the second state in the nation with universal healthcare
 
COLUMBUS- State Reps. Bob Hagan (D-Youngstown) and Mike Foley (D-Cleveland) introduced HB 287 today, the Ohio Health Security Act.  This bill would provide for the administration of a universal, single-payer healthcare plan in the state of Ohio.  Currently, Vermont is the only state in the United States to have implemented a universal healthcare program.
 
“Financing health care in this state and nation is broken. The lack of clear, comprehensive, immediate and long-term solution to the problem by policy-makers in Columbus and Washington will only worsen the problems we now face as patients, employees, employers, and doctors in the present health care system,” Rep. Hagan said. “We cannot, as a society, afford to subsidize the insurance industry with outrageous premiums that don’t actually pay for our health care, but pay for corporate bonuses and executive compensation.”
 
In a message from Kurt Bateman, director of the Single-Payer Action Network (SPAN), to Reps. Foley and Hagan, Mr. Bateman says of the bill “The Ohio Health Security Act is a positive remedy for the dramatic increase in Ohioans who are losing access to care and the unsustainable rise in healthcare costs that threatens access to care so many of our families, neighbors, friends and businesses.”
 
“The Ohio Health Security Act will bring Ohioans in line with the rest of the modern world .” Rep. Foley added, “We only have the best healthcare system in the world if everyone has equal access to it, this bill will provide for that.”
 
Note: A companion bill, SB 112, was introduced in the Ohio Senate by State Senator Michael Skindell in March of this year.

SPAN Ohio Reporting from DC

LCSP Annual Meeting

Greetings from the nation’s capitol! This past weekend, under the sponsorship of my local UAW-CAP Council, I attended the Labor Campaign For Single Payer (LCSP) annual meeting at the National Labor College in Silver Spring, MD. The meeting convened on Friday afternoon at AFL-CIO Headquarters in Washington DC.   Joining us there were Congressmen John Conyers (H.R. 676) and Dennis Kucinich. Congressman Jim McDermott (H.R.1200) called in by phone. They all expressed their appreciation for advocates keeping the drive for universal health care alive and well in the wake of the federal Patient Protection and Affordable Care Act (PPACA) that passed last year.  Also addressing the gathering was the President of the AFL-CIO, Richard Trumka. President Trumka expressed his support for further reforms needed in order to advance single payer healthcare. While we were always aware of the shortcomings of the PPACA, President Trumka, for the first time of which I am aware, publicly expressed his disappointment with the result and even publicly apologized to Congressman Kucinich for not having done more to support Single Payer. He pledged to rectify that going forward and pointed to the AFL-CIO endorsement of Senator Sander’s S.915, American Health Security Act of 2011, as a concrete example of that forward looking approach. I believe we are witnessing a positive change in the approach labor organizations will be taking on our issue.

Action Request

Tomorrow, June 7, 2011, I have an appointment with Senator Sherrod Brown’s staff to make a more formal request for Senator Brown to co-sponsor S915, the American Health Security Act of 2011. Please call Senator Brown’s office (202) 224-2315 and voice your support. Though I didn’t get an appointment with Ohio’s Senator Rob Portman (202-224-3353) call and tell him as well. I’ll be dropping in to tell his staff! When you call, tell them: MEDICARE WORKS and you support MEDICARE FOR ALL, and you want the Senator to support the American Health Security Act of 2011 (S.915), which ensures that all Americans have equal access to comprehensive health care and frees patients from fear of medical bankruptcy while bringing skyrocketing costs under control. Our friends in the California Nurses Association and National Nurses United will be on the hill as well.

Columbus local action: Sponsored by Ohio Alliance For Retired Americans

What: “Hands off Medicare”—“Don’t Make Us Work ’Til We Die” – Walk and Press Conference
When: Thursday June 9, 2011 11:30 a.m-12:15 p.m.          Gather at 11:15 a.m.
Where: Jerry Hammond Building – Franklin County Job Center
1111 East Broad Street, (Broad and Ohio across from Jenkins Terrace Senior Housing Complex) Columbus, Ohio.

Kurt Bateman, Director SPAN Ohio

Got Health Insurance Through Your Employer? Maybe Not for Long

Wendell Potter

Analyst, Center for Public Integrity; Former insurance company executive; Author

Got Health Insurance Through Your Employer? Maybe Not for Long (But Not Because of Reform)

Posted: 06/16/11 10:05 AM ET

The global consulting firm McKinsey & Company set off a firestorm when it released a report last week suggesting that 30 percent of U.S. businesses will stop offering health care benefits to their employees after most of the provisions of the Affordable Care Act go into effect in 2014.

The White House was quick to challenge the validity of the report, noting that McKinsey has so far refused to provide any details of the methodology used to reach its conclusion. All McKinsey will say is that its report was based on a survey of 1,300 employers and "other proprietary research."

White House deputy chief of staff Nancy-Ann DeParle, who previously headed the president's office of health care reform, called it an "outlier" and cited other studies predicting that that few if any employers would drop coverage because of the Affordable Health Care Act.

Congressional Republicans were just as quick to defend the McKinsey report, which they are citing as fresh evidence that the new federal law -- crafted in part to protect the employer-based system -- will have disastrous consequences.

Who's right? Well, pardon the cliché, but only time will tell. What we can say with certitude right now is that the hubbub over the McKinsey report has obscured a reality neither side is acknowledging. What is indisputably true is that the employer-based system has been crumbling for several years. And, with or without the Affordable Care Act, it's very possibly on its last legs. Repealing the law, as every GOP presidential candidate pledged to do during the debate in New Hampshire Tuesday night, would probably only hasten its complete collapse.

When I began working in the insurance industry in 1989, the vast majority of Americans -- well over two-thirds of the population -- got their coverage through employers. Just about every year since then, the percentage has been declining.

According to the Economic Policy Institute, the share of Americans with employer-sponsored health insurance declined from 64.2 percent in 2000 to 58.5 percent in 2008. Most of that decline occurred during the Bush administration, and before the most recent recession began.

The figure is undoubtedly lower today because millions of workers lost their jobs -- and along with them, their health insurance -- during the recent economic downtown. When the recession officially began in December 2007, the U.S. unemployment rate was just 5 percent. It peaked at 10.1 percent in October 2009, four months after the official end of the recession, but it is still more than 9 percent today.

Another factor in the decline of Americans with employer-sponsored coverage is that the number of businesses still offering it has also dropped precipitously in recent years. The Kaiser Family Foundation, which keeps track of health insurance trends, found that the number of firms offering coverage fell from 69 percent in 2000 to 60 percent in 2009. The erosion was even more pronounced among companies with fewer than 10 workers, falling from 57 percent to 46 percent during the same period.

According to Gallup, the situation has only gotten worse since 2009. In a November 2010 Gallup poll, just 44.8 percent of American adults reported having health insurance provided through their employer.

One of the less obvious reasons for the unraveling of the employer-based system is that an ever-increasing number of workers are taking a pass on the coverage even if their employers still offer it, according to the Employee Benefit Research Institute. Why? Because employers are requiring that their workers pay a bigger portion of the premiums, and they're making them pay more out of their own pockets in the form of higher deductibles and co-payments. Many workers simply can't afford to take on the additional financial burden.

The insurance industry has also played a leading role in the decline of the employer-based system. The reason more and more small employers are no longer offering coverage is because many of them have been "purged" by their insurance carriers. Insurers routinely "purge" employer customers they believe have become too much of a risk to profits. All it takes is one employee of a small business -- or the spouse or child of one employee -- to get critically ill for the company's insurer to jack up rates so high that the business owner has no choice but to drop coverage for everyone.

A survey conducted last month by Crain's Detroit Business of 300 Michigan small businesses found that 24 percent considered canceling their health care coverage this year, primarily because of premium increases demanded by their insurance carriers.

Behind all these numbers are real people. In the coming weeks, to take us from the abstract world of figures to the real world of American-style health insurance, I will be writing about the experiences of several small business owners who say they want to continue offering health care benefits to their employees but are finding it increasingly difficult to do so.

Ohio Loses Vibrant Leader for Health Care Justice

SmiddieObit 

Bob (William Robert) Smiddie
Harrisonville,Ohio
2/6/1931-6/20/2011

Bob (William Robert) Smiddie, age 80, of the Harrisonville area passed away on June 20 at his home surrounded by family after a prolonged battle with cancer.  He was loved and admired for his folk pottery adorned with flowers, his plays that combined imaginative humor with strong social justice messages, and his tireless political activism on behalf of those without. He was a Democratic precinct committeeman who worked well with local Republicans and never turned down a chance to have civil discourse with others on his causes for social justice.  Because he believed that healthcare was a human right and should not be run for profit he has been a leading light in the Ohio Single Payer Action Network for the last ten years.  No matter how difficult the odds were against his convictions, he lived with the philosophy, “Never give up.”

Besides his large number of loving friends, Smiddie’s sparkling blue eyes and delightful story-telling will be most missed by his wife, Beth Amoriya of the Harrisonville area, son Kyle Smiddie, of Newark, NJ; daughters, Laura James, her husband Alan and daughter Nora of Chicago, IL; Kellie Smiddie, her husband Kevin Corp and three children, James, Annie, and Michelle of Cleveland, OH; Angel Newberry, her husband Ray and daughter Reilly of Canal Winchester, OH; and his sister, Frances Moore of Kingston, TN.

There will be calling hours at Anderson McDaniel Funeral Home in Pomeroy on Wednesday, June 22 from 2-4 and 6-8 PM followed by burial in McMinnville, TN.  A memorial service will be scheduled in Athens at a later date.  At Mr. Smiddie's request, rather than flowers please make a contribution to The Remote Area Free Clinic Fund, c/o Rural Action, PO Box 157, Trimble, OH 45782.

Why Medicare is the Solution - Not the Problem

Sunday 24 July 2011

by: Robert Reich, Robert Reich's Blog | Op-Ed

Not only is Social Security on the chopping block in order to respond to Republican extortion. So is Medicare.

But Medicare isn’t the nation’s budgetary problems. It’s the solution. The real problem is the soaring costs of health care that lie beneath Medicare. They’re costs all of us are bearing in the form of soaring premiums, co-payments, and deductibles.

Medicare offers a means of reducing these costs — if Washington would let it.

Let me explain.

Americans spend more on health care per person than any other advanced nation and get less for our money. Yearly public and private healthcare spending is $7,538 per person. That’s almost two and a half times the average of other advanced nations.

Yet the typical American lives 77.9 years – less than the average 79.4 years in other advanced nations. And we have the highest rate of infant mortality of all advanced nations.

Medical costs are soaring because our health-care system is totally screwed up. Doctors and hospitals have every incentive to spend on unnecessary tests, drugs, and procedures.

You have lower back pain? Almost 95% of such cases are best relieved through physical therapy. But doctors and hospitals routinely do expensive MRI’s, and then refer patients to orthopedic surgeons who often do even more costly surgery. Why? There’s not much money in physical therapy.

Your diabetes, asthma, or heart condition is acting up? If you go to the hospital, 20 percent of the time you’re back there within a month. You wouldn’t be nearly as likely to return if a nurse visited you at home to make sure you were taking your medications. This is common practice in other advanced countries. So why don’t nurses do home visits to Americans with acute conditions? Hospitals aren’t paid for it.

America spends $30 billion a year fixing medical errors – the worst rate among advanced countries. Why? Among other reasons because we keep patient records on computers that can’t share the data. Patient records are continuously re-written on pieces of paper, and then re-entered into different computers. That spells error.

Meanwhile, administrative costs eat up 15 to 30 percent of all healthcare spending in the United States. That’s twice the rate of most other advanced nations. Where does this money go? Mainly into collecting money: Doctors collect from hospitals and insurers, hospitals collect from insurers, insurers collect from companies or from policy holders.

A major occupational category at most hospitals is “billing clerk.” A third of nursing hours are devoted to documenting what’s happened so insurers have proof.

Trying to slow the rise in Medicare costs doesn’t deal with any of this. It will just limit the amounts seniors can spend, which means less care. As a practical matter it means more political battles, as seniors – whose clout will grow as boomers are added to the ranks – demand the limits be increased. (If you thought the demagoguery over “death panels” was bad, you ain’t seen nothin’ yet.)

Paul Ryan’s plan – to give seniors vouchers they can cash in with private for-profit insurers — would be even worse. It would funnel money into the hands of for-profit insurers, whose administrative costs are far higher than Medicare.

So what’s the answer? For starters, allow anyone at any age to join Medicare. Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

In addition, allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors, and pharmaceutical companies. This would help move health care from a fee-for-the-most-costly-service system into one designed to get the highest-quality outcomes most cheaply.

Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year. More Americans would get quality health care, and the long-term budget crisis would be sharply reduced.

Let me say it again: Medicare isn’t the problem. It’s the solution.

Robert Reich is Chancellor's Professor of Public Policy at the University of California at Berkeley. He has served in three national administrations, most recently as secretary of labor under President Bill Clinton. He has written thirteen books, including The Work of Nations, Locked in the Cabinet, Supercapitalism, and his most recent book, Aftershock. 

Berwick: "I've Got The Back" of Medicare Beneficiaries--The KHN Interview

As Republicans battle with Democrats and President Barack Obama over the future of the health care law, Donald Berwick, the administrator of the Centers for Medicare and Medicaid Services, is focused on something else.

"I go to work every morning with 100 million people in mind, Medicare and Medicaid beneficiaries," Berwick says, adding, "I can actually think about how to make things better for these people who depend on CMS to work in their interests."

Berwick, the former president and chief executive officer of the Institute for Healthcare Improvement, has been criticized by Republicans for his praise of the British National Health Service, as well as some of his past speeches and writings, which Republicans said showed that Berwick supported health care rationing – a charge he rejects. The controversy stalled his nomination and Obama moved Berwick into his post with a recess appointment last summer.

In a recent conversation with KHN's Mary Agnes Carey, Berwick discussed the agency's work with governors on Medicaid, how to make Medicare more efficient and what he's hearing from health care providers about a proposed Medicare regulation to create accountable care organizations, or ACOs, networks of doctors and hospitals that share responsibility for providing care to patients. This is an edited excerpt of that interview.

Q: Many state governors want federal officials to allow more flexibility on Medicaid. How is CMS responding to those concerns?

A: Each state is looking hard at Medicaid, which is a significant portion of state costs, and we need to be working with them to preserve the lifestyle and the well-being of the beneficiary and also to help the states with their problems. It's an area of a lot of work right now.

We have Medicaid action teams, which are available to any state. We'll be working together with states on the flexibilities they want and need, even while we are mindful of protecting the beneficiaries’ well-being and the proper stewardship of funding. We have many ways to help states and we are reaching out to them now.

Q: There's legislation pending on Capitol Hill that would waive the health law's maintenance of effort requirement for Medicaid. Are you concerned that proposal will become law?

A: I think it's important to maintain Medicaid coverage. The way out of the Medicaid dilemma is the same as it is for the rest of the American health care system, which is to improve care. Medicaid beneficiaries are very vulnerable. Their costs rise for the states as well as for them and the federal government when we don't properly coordinate their care, when we don't help them in their journeys through the care system. So we're focused on the improvement of care as the way to maintain the coverage and the well-being of the beneficiary.

Q: You're hearing a lot of complaints about the proposed regulation for accountable care organizations, or ACOs. Based on those comments, what changes might we see in the final regulation?

A: We're listening really closely. The comment period to me is exciting. Criticism is help. In this case, it's people coming at us with ideas about how to make the rule better. We'll be taking these comments very seriously so the final rule, I'm quite sure, will be improved over the current one from the viewpoint of the people we want to get engaged in the ACO world. We're on track to meet our deadline of having the program launch on Jan. 1, 2012. That's our goal and we're not giving up on that right now.

Q : You and others have been critical of Rep. Paul Ryan's "premium support" plan for Medicare. What's wrong with limiting the amount the federal government spends on beneficiaries?

A: I' not a fan of cutting care as the remedy to this problem. I think the focus should be on improving care and that's where the focus is. Most of the proposals I've seen on that side of the coin aren't about improving care at all. They are about shifting burdens to states and individuals who already are struggling to do the best they can. Medicare is a solid program. I go to work every morning with 100 million people in mind, Medicare and Medicaid beneficiaries. We're in a good partnership with states on Medicaid. I've got the back of the Medicare beneficiary. I can actually think about how to make things better for these people who depend on CMS to work in their interests.

Q: Short of major Medicare reform, what steps could the Medicare program take to reduce spending?

A: The main way we can work on costs while improving care is partnering with care providers. It's about pulling everybody together and deciding we are going to be cooperative with each other at getting what patients really want – better care at lower costs.

Q: You've given lectures to CMS employees. What do you talk about?

A: I want to help them understand more about how to improve their own work, and what it takes for a doctor or a nurse or a hospital to improve their work so we can be better partners with them. I've been teaching improvement. I've taught four, 90-minute classes, open to all employees. Those have been focused on quality and what's its nature and how does it improve? Customer focus, what does it mean to listen to a person you're trying to help? What Medicare does that can affect safety.

I'm a believer in that Gandhi quote, "You have to be the change you wish to see in the world." So we want health care to be continually improving, highly reliable, focused really on the needs of the people we're trying to help, joyful to work in. That's what we want from CMS, too, so we're working on internal change and external change.

Q: Your current recess appointment lasts until the end of this year. Have you had any conversations with anyone about your future?

A: This is a hard and exciting job. The way I'm dealing with the job is in the present. Every day, I'm going in and doing the very best I can do. The rest, what happens, happens. The [health care law] is a major, massive change in our policy opportunities. I really can work on behalf of improvement, which has been my life's work. And I'm doing that every day.

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