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.
By Robert Reich, Robert Reich's Blog, August 16, 2011
Why the new healthcare law should have been based on Medicare. (And what Democrats should have learned by now.)
Two appellate judges in Atlanta - one appointed by President Bill Clinton and one by George H.W. Bush - have just decided the Constitution doesn't allow the federal government to require individuals to buy health insurance.
The decision is a major defeat for the White House. The so-called "individual mandate" is a cornerstone of the Affordable Care Act, President Obama's 2010 healthcare reform law, scheduled to go into effect in 2014.
The whole idea of the law is to pool heath risks. Only if everyone buys insurance can insurers afford to cover people with preexisting conditions, or pay the costs of catastrophic diseases.
The issue is now headed for the Supreme Court (another appellate court has upheld the law's constitutionality) where the prognosis isn't good. The Court's Republican-appointed majority has not exactly distinguished itself by its progressive views.
Chalk up another one for the GOP, outwitting and outflanking the President and the Democrats.
Remember the health-care debate? Congressional Republicans refused to consider a single-payer system that would automatically pool risks. They wouldn't even consider giving people the option of buying into it.
The President and the Democrats caved, as they have on almost everything. They came up with a compromise that kept health care in the hands of private insurance companies.
The only way to spread the risk in such a system is to require everyone buy insurance.
Which is exactly what the two appellate judges in Atlanta object to. The Constitution, in their view, doesn't allow the federal government to compel citizens to buy something. "Congress may regulate commercial actors," they write. "But what Congress cannot do under the Commerce Clause is mandate that individuals enter into contracts with private insurance companies for the purchase of an expensive product from the time they are born until the time they die."
Most Americans seem to agree. According to polls, 60 percent of the public opposes the individual mandate. Many on the right believe it a threat to individual liberty. Many on the left object to being required to buy something from a private company.
Had the President and the Democrats stuck to their guns during the health-care debate and insisted on Medicare for all, or at least a public option, they wouldn't now be facing the possible unraveling of the new healthcare law.
After all, Social Security and Medicare - the nation's two most popular safety nets - require every working American to "buy" them. The purchase happens automatically in the form of a deduction from everyone's paychecks.
But because Social Security and Medicare are government programs they don't feel like mandatory purchases. They're more like tax payments, which is what they are - payroll taxes.
There's no question payroll taxes are constitutional, because there's no doubt that the federal government can tax people in order to finance particular public benefits.
Americans don't mind mandates in the form of payroll taxes for Social Security or Medicare. In fact, both programs are so popular even conservative Republicans were heard to shout "don't take away my Medicare!" at rallies opposed to the new health care law.
Requiring citizens to buy something from a private company is entirely different. If Congress can require citizens to buy health insurance from the private sector, reasoned the two appellate judges in Atlanta, what's to stop it from requiring citizens to buy anything else? If the law were to stand, "a future Congress similarly would be able to articulate a unique problem … compelling Americans to purchase a certain product from a private company."
Other federal judges in district courts - one in Virginia and another in Florida - have struck down the law on similar grounds. They said the federal government has no more constitutional authority requiring citizens to buy insurance than requiring them to buy broccoli or asparagus. (The Florida judge referred to broccoli; the Virginia judge to asparagus.)
Social Security and Medicare aren't broccoli or asparagus. They're as American as hot dogs and apple pie.
The Republican strategy should now be clear: Privatize anything that might otherwise be a public program financed by tax dollars. Then argue in the courts that any mandatory purchase of it is unconstitutional because it exceeds the government's authority. And rally the public against the requirement.
Remember this next time you hear Republican candidates touting Paul Ryan's plan for turning Medicare into vouchers for seniors to buy private health insurance.
So what do Obama and the Democrats do if the individual mandate in the new healthcare law gets struck down by the Supreme Court?
Immediately propose what they should have proposed right from the start - universal healthcare based on Medicare for all, financed by payroll taxes. The public will be behind them, as will the courts.
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 latest book, "AFTERSHOCK: The Next Economy and America's Future." His 'Marketplace' commentaries can be found on publicradio.com and iTunes.
The Huffington Post Laura Hibbard First Posted: 9/3/11 12:32 PM ET Updated: 9/3/11 01:14 PM ET
Kyle Willis, a 24-year-old man from Ohio, died on Wednesday from a tooth infection, Cincinati's WLWT reported.
According to the station, Willis' wisdom tooth began hurting two weeks ago, and dentists said it needed to be removed.
Willis, however, was a single father without health insurance, and couldn't afford the procedure.
After developing severe headaches and facial swelling, he went to the emergency room.
Although doctors recommended antibiotics and pain medication, Willis could only afford one.
Patti Collins, Willis's aunt, told WLWT what happened next.
"'The (doctors) gave him antibiotic and pain medication. But he couldn't afford to pay for the antibiotic, so he chose the pain meds, which was not what he needed,' Collins said. Doctors told Willis' family that while the pain had stopped, the infection kept spreading -- eventually attacking his brain and causing it to swell."
Willis leaves behind a 6-year-old daughter, and family members are hoping to create a fund for her future college education.
Dr. Irvin Silverstein, a dentist at the University of California told ABC news that Willis' story isn't uncommon.
"People don't realize that dental disease can cause serious illness.The problems are not just cosmetic. Many people die from dental disease. When people are unemployed or don't have insurance, where do they go? What do they do? Silverstein said. People end up dying, and these are the most treatable, preventable diseases in the world."
Four years ago, 12-year-old Demonte Drived died after his mother, Alyce, couldn't find a dentist who took Medicaid and bacteria from a tooth abscess spread to his brain.
A Kaiser Family Foundation report found that between 2007 and 2008, the number of uninsured adults rose by 1.5 million.
ABC news added that in April the same foundation also found that 33% of people skipped dental care because they could not afford it.
Street Speech, The Voice from the Streets of Columbus, Dec 2-15, 2011
The New Homeless, by Eileen Hiltbrand, Street Speech vendor
Before I became homeless my vision of the homeless was that of a scraggly man with a bottle of cheap booze wrapped in a paper bag, begging for spare change and sleeping under a bridge. Oh how experiences can change one's perspective.
I am homeless. I have a college degree in business and in which I graduated Summa Cum Laude from the Ohio State University. I also have a Doctorate in which I graduated Cum Laude. You wouldn't picture me as "one of those homeless people." Yet I am.
There are many of me out here. We sell these papers to keep a roof over our heads, provide the basics that we all need on a daily basis, or to pay our medical needs and co-pays. That's not to say that some of us aren't those "scraggly men" who live under a bridge. Please don't assume, however, that the image of the "scraggly man" represents the whole of us.
Each of us are unique and different as to what brought us into homelessness. In my case, I developed heart problems/failures in March of 2005. Six weeks later, I woke up from a coma owing $1.2 million for healthcare. Thereafter, I lost my house and subsequently a condo that I rented. Although I had health insurance my entire life, United Health Care denied my claims and I was too sick, and they were too big for me to fight. Ergo, I found myself homeless.
I won't go into details about the basements, carports, etc. into which I crawled to find a warm place to sleep. Needless to say, those of us who are homeless are not all derelicts, drunks, or crack-heads.
Let me just say thank-you for purchasing our papers when you see us standing out on these street corners. I can only speak for myself but it means the world and my life to me. Thank you.
About Street Speech
Street Speech is a monthly social justice newspaper, published by the Columbus Coalition for the Homeless since March 2008. Street Speech serves as a voice for the most vulnerable in our community by publishing articles and creative writing by currently and formerly homeless individuals and by educating the community about the issues facing homeless persons in Columbus
Official estimates by the Census Bureau showing an increase of about 1 million in the number of Americans without health insurance in 2010 – to a 35-year high of 49.9 million persons, or 16.3 percent of the population, under the bureau’s revised calculation method – underscore the urgency of going beyond the Obama administration’s federal health law and swiftly implementing a single-payer, improved Medicare-for-all program, spokespersons for Physicians for a National Health Program said today.
"Tragically, we know that the new figures of uninsured mean a preventable annual death toll of about 50,000 people -- that's about one death every 10 minutes," said Dr. Garrett Adams, president of PNHP, a nationwide organization of 18,000 physicians. (photo: Joe Newman / Public Citizen) Employment-based coverage continued to decline. The bureau said 55.3 percent of Americans were covered by employment-based plans in 2010, down from 56.1 percent in 2009. It was the eleventh consecutive year of decline, from 64.2 percent in 2000.
In Massachusetts, whose 2006 health reform is widely viewed as the model for the federal health law, 370,000 people remained uninsured in 2010, representing 5.6 percent of the population, a jump from 4.3 percent who were uninsured in 2009.
Some states posted greater than a 3-percentage-point to 5-percentage-point increase in their uninsured rate, namely Idaho, Louisiana, Mississippi, Montana and South Carolina. In terms of absolute numbers, Louisiana had the largest increase in the number of uninsured, 240,700, followed by New York (177,700) and South Carolina (173,300). (See link to table of historical state-based data below.)
Among various population groups, the greatest loss of coverage was among working-age adults between the ages of 35 and 64, people with incomes below $49,999, and people with disabilities. Hispanics continue to disproportionately face uninsurance (30.7 percent), compared with blacks (20.8 percent), Asians (18.1 percent) and non-Hispanic whites (11.7 percent).
About 7.3 million children remain uninsured, the bureau said. Young people between the ages of 19 to 25 had a drop of 1.6 percentage points in their uninsurance rate, a figure the Census Bureau suggests is linked to the federal health law’s provision that allows dependent children to be covered under a parent’s health plan.
Lack of health insurance is known to have deadly consequences. A 2009 study in the American Journal of Public Health showed that 45,000 deaths annually can be linked to lack of coverage. Along the same lines, studies have shown that uninsured people with chronic illnesses like heart disease often delay or forgo care, often leading to serious complications of their medical condition and, in some cases, premature death.
"Tragically, we know that the new figures of uninsured mean a preventable annual death toll of about 50,000 people -- that's about one death every 10 minutes," said Dr. Garrett Adams, president of PNHP, a nationwide organization of 18,000 physicians.
The Louisville, Ky.-based physician said that even if the administration's new health law works as planned, the Congressional Budget Office estimates 23 million people will remain uninsured in 2019.
Adams was in Washington today, testifying before a subcommittee of the Senate Health, Education, Labor and Pensions Committee on the topic, “Is poverty a death sentence?”
Significantly, the Census Bureau said the number of people living in poverty, 46.2 million, is the largest number recorded in the 52 years such estimates have been published.
The increase in the uninsured would have been significantly higher had it not been for an increase in the number of people covered by government health programs such as Medicare, Medicaid, and military health care. Some in Congress have urged substantial cuts to such programs, particularly Medicare and Medicaid. If implemented, such cuts would almost certainly increase the uninsured rate in years ahead.
"The only remedy for this persistent problem is to insure everyone," Dr. Adams said. "And the only way to insure everyone at a reasonable cost is to enact single-payer national health insurance, an improved Medicare for all. Single payer would streamline bureaucracy, saving $400 billion a year on administrative overhead, enough to pay for all the uninsured and to upgrade everyone else's coverage. The new system’s bargaining clout would also help rein in rising costs."
Dr. Steffie Woolhandler, professor at the City University of New York School of Public Health and visiting professor of medicine at Harvard Medical School, noted that the Census Bureau was once again silent on the pervasive problem of "underinsurance."
"Not having health insurance, or having poor quality insurance that doesn't protect you from financial hardship in the face of medical need, is a source of mounting stress, personal bankruptcy and poor medical outcomes," Woolhandler said.
Referring to the Affordable Care Act, she said, “The new law’s subsidies for health insurance will not be sufficient to provide quality and affordable coverage to the vast majority of Americans. Tens of millions will remain uninsured, underinsured and without access to care. We need more fundamental reform. We need a single-payer national health insurance program."
FOR IMMEDIATE RELEASE:
3:00 PM Sept. 26, 2011
SPAN OHIO OPPOSES OHIO BALLOT ISSUE #3
Amendment to the Ohio Constitution
Single Payer Action Network Ohio is opposed to amending the Ohio constitution as stipulated in ballot issue 3 slated for the November ballot.
First there are serious fundamental legal contradictions within issue 3 that call into question the validity of states to attempt nullification of federal statutes in this way. Second, the idea that Ohio would amend its constitution to preclude the citizens of this state from enacting legislation through democratically elected representatives is antithetical to the freedoms we value as a self governing society. In addition, state laws already enacted with respect to health care access whether through workers compensation or state administered federal safety net programs, could be harmed dramatically by this vaguely written and poorly informed restrictive covenant.
Lastly, in spite of the passage of federal legislation to regulate and expand health insurance access, much more action is needed to secure the access to necessary care that enables the exercise of individual freedom. Tying the hands of state representatives with an amendment to the Ohio Constitution that says in effect “the state may not act” is inherently undemocratic and restricts the democratic freedoms of Ohio citizens.
Vote NO on Ohio Ballot Issue #3
Contact: Kurt Bateman, Director
The Healthcare Movie, a documentary film narrated by Keifer Sutherland, will be shown across the state wherever we can gather a group. The film deals with the ways in which the U.S. and Canadian healthcare systems diverged over the past half century and how cultural perceptions can be changed to improve the provision of care. So organize a potluck at a space in your community where the film can be played from DVD and projected with an adequate audio system. The film runs about one hour and discussion will follow. In addition, there will be an opportunity to participate in the Healthcare Human Rights Collaboration picture petition and obtain copies of the official Healthcare for All Ohioans Act petitions for circulation. To preview a trailer for the movie go to: http://www.healthcaremovie.net/. Contact SPAN State Director Kurt Bateman to schedule your screening today! Phone 614-562-1066 or email email@example.com.
FOR IMMEDIATE RELEASE:
Single-Payer Action Network Ohio Disappointed But Undeterred by Passage of State Issue 3
Columbus, Ohio – November 15, 2011 - On Tuesday November 8, 2011 Ohio voters approved Issue 3, the so-called health care freedom amendment to the Ohio constitution.
Single Payer Action Network Ohio (SPAN Ohio) was disappointed by the passage of Issue 3 but will not be deterred from our goal of comprehensive lifetime health care for all. Our educational and public policy organizing efforts continue unabated.
Issue 3 was aimed at the Patient Protection and Affordable Care Act (PPACA) passed by Congress in 2010 but is expected to negatively affect many health care programs in Ohio as was made clear by the almost universal condemnation of the proposal by newspaper editorial boards across the political spectrum.
Issue 3’s impact on the provision of health care in Ohio will be determined in large part by the outcome of constitutional challenges to federal health care reform now moving through the courts. The US Supreme Court will ultimately decide the issue.
Regardless of their decision, SPAN Ohio will continue its efforts to educate the state legislature and the public at large on the need for a single-payer health care system as the most efficient means of providing every Ohioan with what is a basic human necessity.
Kurt Bateman, Director
Single Payer Action Network Ohio
New York Times - June 12, 2011
By PAUL KRUGMAN
Every once in a while a politician comes up with an idea that’s so bad, so wrongheaded, that you’re almost grateful. For really bad ideas can help illustrate the extent to which policy discourse has gone off the rails.
And so it was with Senator Joseph Lieberman’s proposal, released last week, to raise the age for Medicare eligibility from 65 to 67.
Like Republicans who want to end Medicare as we know it and replace it with (grossly inadequate) insurance vouchers, Mr. Lieberman describes his proposal as a way to save Medicare. It wouldn’t actually do that. But more to the point, our goal shouldn’t be to “save Medicare,” whatever that means. It should be to ensure that Americans get the health care they need, at a cost the nation can afford.
And here’s what you need to know: Medicare actually saves money — a lot of money — compared with relying on private insurance companies. And this in turn means that pushing people out of Medicare, in addition to depriving many Americans of needed care, would almost surely end up increasing total health care costs.
The idea of Medicare as a money-saving program may seem hard to grasp. After all, hasn’t Medicare spending risen dramatically over time? Yes, it has: adjusting for overall inflation, Medicare spending per beneficiary rose more than 400 percent from 1969 to 2009.
But inflation-adjusted premiums on private health insurance rose more than 700 percent over the same period. So while it’s true that Medicare has done an inadequate job of controlling costs, the private sector has done much worse. And if we deny Medicare to 65- and 66-year-olds, we’ll be forcing them to get private insurance — if they can — that will cost much more than it would have cost to provide the same coverage through Medicare.
By the way, we have direct evidence about the higher costs of private insurance via the Medicare Advantage program, which allows Medicare beneficiaries to get their coverage through the private sector. This was supposed to save money; in fact, the program costs taxpayers substantially more per beneficiary than traditional Medicare.
And then there’s the international evidence. The United States has the most privatized health care system in the advanced world; it also has, by far, the most expensive care, without gaining any clear advantage in quality for all that spending. Health is one area in which the public sector consistently does a better job than the private sector at controlling costs.
Indeed, as the economist (and former Reagan adviser) Bruce Bartlett points out, high U.S. private spending on health care, compared with spending in other advanced countries, just about wipes out any benefit we might receive from our relatively low tax burden. So where’s the gain from pushing seniors out of an admittedly expensive system, Medicare, into even more expensive private health insurance?
Wait, it gets worse. Not every 65- or 66-year-old denied Medicare would be able to get private coverage — in fact, many would find themselves uninsured. So what would these seniors do?
Well, as the health economists Austin Frakt and Aaron Carroll document, right now Americans in their early 60s without health insurance routinely delay needed care, only to become very expensive Medicare recipients once they reach 65. This pattern would be even stronger and more destructive if Medicare eligibility were delayed. As a result, Mr. Frakt and Mr. Carroll suggest, Medicare spending might actually go up, not down, under Mr. Lieberman’s proposal.
O.K., the obvious question: If Medicare is so much better than private insurance, why didn’t the Affordable Care Act simply extend Medicare to cover everyone? The answer, of course, was interest-group politics: realistically, given the insurance industry’s power, Medicare for all wasn’t going to pass, so advocates of universal coverage, myself included, were willing to settle for half a loaf. But the fact that it seemed politically necessary to accept a second-best solution for younger Americans is no reason to start dismantling the superior system we already have for those 65 and over.
Now, none of what I have said should be taken as a reason to be complacent about rising health care costs. Both Medicare and private insurance will be unsustainable unless there are major cost-control efforts — the kinds of efforts that are actually in the Affordable Care Act, and which Republicans demagogued with cries of “death panels.”
The point, however, is that privatizing health insurance for seniors, which is what Mr. Lieberman is in effect proposing — and which is the essence of the G.O.P. plan — hurts rather than helps the cause of cost control. If we really want to hold down costs, we should be seeking to offer Medicare-type programs to as many Americans as possible.
Published on Friday, December 23, 2011 by In These Times
With a raft of new Charles Dickens biographies hitting bookstores this fall, it is difficult not to quote the classic chronicler of the Victorian era's polarities when describing the state of America's healthcare system: "It was the best of times, it was the worst of times.”
The good times are concentrated among corporate executives. Healthcare, insurance and drug company CEOs have actually managed to displace bankers as the best-rewarded bosses in America. The Guardian archly reported recenty: "Pity Wall Street's bankers. Once the highest-paid bosses in the land, they are now also-rans. The real money is in healthcare and drugs, according to the latest survey of executive pay."
Among the big winners in healthcare listed by the UK-based newspaper:
John Hammergren, chief executive of McKesson Corporation, a pharmaceutical distribution corporation, took home a breathtaking $145,266,971 in 2010.
- Joel Gemunder, outgoing president of Omnicare, a pharmacy company that dispenses drugs in nursing homes, benefited handsomely from s 2010 total pay package worth $98,283,242.
- “CVS Caremark, which operates 7,000 pharmacies across the US, awarded chief executive Thomas Ryan $68,079,823 in 2010.
- Ronald Williams, boss of health insurance giant Aetna, made $57,787,786 in 2010.
But for America’s healthcare consumers, the bad times got worse. Despite the slow-moving implementation of the 2010 Patient Protection and Affordable Care Act (PPACA), the system’s vital signs indicated critical condition:
- 53 million Americans are now uninsured, up from 34 million in 1990.
- As many as 82,000 Americans die annually due to a lack of access to healthcare, according to a new Commonwealth Fund study that roughly doubles the previous estimate.
- 62% of personal bankruptcies are accounted for by an unaffordable stack of medical bills brought on by a family members’ health crisis.
Sweeping cuts in Medicaid by U.S. governors threaten to throw more people, including children, into icy uninsured waters. For example, Wisconsin Gov. Scott Walker is aiming to slice Medicaid rolls by 65,000, including 30,000 children.
Healthcare insurance has become so expensive that Americans have cut back on their visits to doctor’s offices by 17 percent, even as a growing share of Americans admit that they have skipped needed medical care because high-cost, high-deductible plans continue to proliferate.
But even with the implementation of state-level healthcare exchanges under the PPACA (aka, “Obamacare”), don’t expect much improvement except in curbing the most egregious abuses of insurers, warns Dr. Don McCanne, senior health policy fellow of the Physicians for a National Healthcare Programs.
Once the exchanges are in place in 2014, moderate-income Americans are certain to find themselves ensnarled in fights with the IRS over the proper level of subsidies they need to pay for a level of healthcare insurance that many doctors consider “skimpy."
Until the point where the inadequacy of PPACAA’s coverage becomes clear and Americans grow infuriated over fighting to pay for inadequate coverage., we seem destined for several more years of "unaffordable under-insurance," as McCanne told In These Times earlier this month. When frustration over the new status quo boils over, Americans will be ready to have a serious debate about the single-payer "Medicare for all” plan that replaces for-profit insurers.