Will Ferrell and Larry the Cable Guy's take on the Affordable Care Act and Single Payer

Not This Will Ferrell

Healthcare for All PA board member Will Ferrell (not the star of Anchoman 2) has shared the great clip above of NBCs medical analyst Dr. Nancy Snyderman endorsing single payer. I had to share with you all.  Will Ferrell has also had an Op/Ed posted in the Delaware County Times  on Dec 13 seen at the bottom.

Below is comedian Larry the Cable Guy telling Sean Hannity his opinion of the Affordable Care Act.  Unlike other rantings and ravings on Fox News, this is actually funny.

SINGLE-PAYER, MEDICAL INSURANCE, and the CORBETT PLAN

Recently, Governor Corbett unveiled a Medicaid expansion plan called Healthy Pennsylvania.  Few would disagree with the Governor’s objectives of increasing access, improving quality and making healthcare affordable for all Pennsylvanians. 

Medicaid is a healthcare program funded by both the state and the federal government that provides direct care to individuals with limited income.  The fastest growing population group in this category are seniors whose income falls within the threshold of income limits for Medicaid. In effect Medicaid supplements Medicare which is for all people over the age of 65. Medicaid has income limits, while Medicare does not.  Most of the Medicaid supplement is used for long term care facilities.

Under the Affordable HealthCare Act, states may expand the eligibility for Medicaid, with the Federal Government picking up much of the cost. This expansion is optional for the states, although many states have already agreed to sign on.

Note, it is important to distinguish between health insurance and healthcare. Healthcare programs such as Medicaid and Medicare pay directly the doctors and hospitals that provide healthcare services to people.

With health insurance, people pay premiums to private insurance companies, who then pay the doctors and hospitals for healthcare services provided to those paying the premiums. Under Governor Corbett’s plan federal Medicaid funds would be used to buy health insurance for eligible participants, rather than providing direct healthcare.

HealthCare 4 All PA (HC4APA) believes this is a poor use of money that only increases the cost and limits the funding pool available to pay for actual healthcare.  The reasoning is simple-health insurance has administrative costs in excess of 15%, meaning that 15 cents of every dollar does not go to pay for healthcare. Contrast this with Medicare and Medicaid where administrative costs are about 3%.

Therefore, under the Governor’s plan to turn Medicaid healthcare into an insurance program, more money will be spent and fewer people will be treated due to this disparity in administrative costs. HC4APA also believes that decisions about your healthcare should be made by you and your doctor, not by an insurance company whose primary motivation is to receive more money in premiums than they must pay out to doctors and hospitals. 

HC4APA does agree with the Governor that the best healthcare delivery solutions are developed at the state and local government levels. States have often been called the laboratories of the nation. Following this ideal, HC4APA has developed a Single-Payer healthcare delivery system. Single-Payer simply means that Pennsylvania would develop a healthcare delivery system modeled after Medicare, meaning doctors and hospitals would be paid directly for healthcare services provided to each of us.

The system would be funded by taxes paid by all businesses and by all individuals.  It is clear, however that such taxes would be significantly lower than individuals and businesses are already paying in insurance premiums, deductibles and co-pays for healthcare. We can be confident of this because HC4APA contracted and paid for an Economic Impact Study (EIS) performed by several leading healthcare economists. This study demonstrated that Pennsylvania’s healthcare costs could be reduced by some $17 billion each year under a single- payer plan.

Currently, the costs of healthcare are very high and growing well ahead of the rate of inflation. If we, collectively, do not address these costs, the healthcare system will become unsustainable in its present configuration. A single-payer plan attacks those costs.

In addition, many other forms of business and personal insurance include healthcare cost components. These include vehicle and homeowners insurance and for businesses, workers compensation and liability insurance.  The costs of these insurance policies would also decline when the state implements single-payer.

The bottom line is that a single-payer healthcare plan costs less and fosters free and open market competition.  Single-payer moves the marketplace competition from the insurance company to the medical providers who will have to compete directly for your healthcare needs.

We encourage you to visit www.healthcare4allpa.org to learn more about the single-payer plan and to read the EIS that will document the value of the plan. Then become an activist by networking with family and friends, asking them to support the bill by calling their Legislators and ask them to vote for Senate Bill 400 and House Bill 1660. This will only happen if we the people want it to happen. We have the power.

William Ferrell

Board Member HC4APA  

**Related Posts**

New Op Ed from State President Dave Steil

Tom Tangretti Posts a Letter to the Editor in the Pittsburgh Post-Gazette on Single Payer

Dave Steil on Kate Loving Shenk's Radio Show

Dominick Buscemi has a Great Post on Single Payer in Allentown

The Oregon Health Experiment: The Gift That Keeps On Taking Away

Be prepared for a barrage of conservative criticism of the Affordable Care Act (ACA) that may be assumed to have negative implications for single-payer health care as well.

As I've noted before, the Oregon Health Experiment is a randomized control group design, far superior to most health care research. In 2008, Oregon hoped to expand Medicaid, but didn't have enough money, so they held a lottery. They invited everyone who was eligible to apply. Of the 90,000 applicants, 30,000 were randomly selected to receive Medicaid, while the losers became eligible for the control group. In previous data analyses, it was found that the Medicaid group spent 35% more on health care than the control group. They visited primary care physicians (PCPs) and were admitted to hospitals more often, and spent more on prescription drugs. They were also healthier and freer of financial worries, although most of the health differences are not statistically significant due to insufficient sample sizes in the study.

A new analysis by the Oregon research group reports that the Medicaid participants were also more likely to visit the emergency room (ER). Specifically, during their first 18 months on Medicaid, they made an average of 1.43 ER visits compared to 1.02 in the control group—a 40% difference.

This should not have been a surprise. If you reduce the cost of a service, people are more likely to use it. However, some ACA proponents claimed that Medicaid expansion would save money by reducing ER use. Although the ER accounts for only 4% of health care spending, an ER visit is more expensive than visiting a doctor. The pro-ACA argument was that if patients established a relationship with a PCP, they would have a place to go for medical care and these doctor visits would prevent potential emergencies. For example, Health and Human Services Secretary Kathleen Sebelius said in 2009:

Our health care system has forced to many uninsured Americans to depend on the emergency room for the care they need. We cannot wait for reform that gives all Americans the high quality, affordable care they need and helps prevent illnesses from turning into emergencies.

It is important to note that these results are not due to the fact that Medicaid provides health insurance for poor people. Private health insurance patients are also more likely to use the ER than the uninsured.

Increased ER use might not be seen as a problem if the visits were real emergencies. However, the study found ER use to be higher even for non-urgent care that should ideally have been treated by a PCP. These results could be used by the opposition to suggest that single-payer might cause an massive influx of people outside the ER waving torches and pitchforks and demanding free care.

There are several considerations that may place these results in clearer perspective.

• The time frame of the study, 18 months, may not have been sufficient to change uninsured people's lifelong habits of going to the ER every time they were sick. A three-year study of Romneycare in Massachusetts found an estimated 5-8% reduction in ER use.

• Medicaid expansion could have been accompanied by education regarding when to go to the ER and when to visit your PCP. Of course, some may argue that education is not enough and should be supplemented by punishment, such as a co-payment, for “inappropriate” ER use.

• Taking a broader view, the problem may be with the health care system rather than the patients. PCPs tend to be available Monday through Friday from 9 to 5—times that are inconvenient for most employed people. You can't always get same-day appointments with a PCP. A 2012 survey by the Commonwealth Fund found that in the US, only 35% of PCPs see patients after hours. In nine European countries and Canada, the average was 80%.

This study is one of a growing number that show that providing health insurance to the uninsured alone does not save money. The ACA contains some cost controls, such as the Independent Payment Advisory Board, which may eventually reduce costs. Single payer eliminates the cost of private insurance, which will save much more. Other changes may be needed. One of them may be asking PCPs to become more consumer-friendly by seeing more patients on evenings and weekends.

You may also be interested in reading:

Big News From Oregon--Not All of It Good

Tom Corbett to PA's Working Poor:  "Drop Dead"  Part 1.  Medicaid Improves Health and Saves Lives

Letters, . . . We Get Letters

When it comes to persuading the Pittsburgh Post-Gazette to publish my letters, I'm batting about .050. My one success, almost ten years ago, was a note about music. Of course, newspapers get many letters, and it's their right to choose which ones to publish. Ordinarily, I wouldn't bore you by griping about their decisions. However, I've managed to persuade myself that my latest experience may be of interest to other letter writers, so I'm going to risk playing the fool.

My story begins on December 8, when the P-G published Molly Rush's letter advocating single payer health care. This was followed on December 16 by a reply from Jim Roth—a pharmaceutical salesperson(!)—implying that single-payer is too costly and denies health care to some citizens. If you're going to continue, you should stop and read Mr. Roth's letter.

The next day, I wrote the following:

Mr. Roth notes that all countries with single-payer finance it with a value added tax. However, the type of tax used to fund health care is irrelevant. The important point is that single payer costs those countries considerably less than our complex system of public and private insurance. According to a 2013 report of the Organization for Economic Cooperation and Development (OECD), the US currently spends on average $8,508 per person each year on health care, compared to an OECD average of $3,322. Yet the US is 26^th out of 40 OECD countries in life expectancy. The amount Americans spend on health care due to the combined burden of taxes, insurance and out-of-pocket costs would be greatly reduced under single-payer.

Mr. Roth claims that people in single-payer countries have longer wait times for elective surgery and are sometimes denied such care. This depends on the country and what you consider “elective surgery.” US insurance companies also refuse to cover some elective procedures. However, if these were serious problems, you would expect residents of single-payer countries to be dissatisfied with their country's health care system. A 2013 survey by the Commonwealth Fund compared consumer satisfaction in the US to nine European countries and Canada, all with single-payer. Americans were by far the most dissatisfied,with 75% saying the system needs fundamental changes or should be completely rebuilt.

Finally, Mr. Roth suggests that we could lower health insurance costs by allowing it to be sold across state lines. It is true that if some states were to deregulate health insurance and if residents of any state were allowed to buy that product, premiums might come down. But those people would be buying insurance with little value should they become seriously ill. The Affordable Care Act is intended to prevent exploitation of consumers by establishing a baseline definition of adequate health insurance.

Of course, the primary purpose of single-payer is not just to save money, but to save the lives of some of the millions of Americans who are currently uninsured.

On December 29, the P-G published two replies to Mr. Roth. Both offered primarily anecdotal evidence suggesting that at least one family—the author's—had lived in a single-payer country and was satisfied with their health care system. The main difference between them is that the first referred to the British system and the second the Dutch. While both were well-written and persuasive, I thought they were redundant, and might have been better supplemented by my data referring to larger numbers of people and countries.

It's possible my letter was rejected because it is poorly written or exceeds their 250-word limit. However, Mr. Roth's letter, at 318 words, also breaks this rule, as do many others they publish. They could easily have edited my letter. Clearly, exceeding the word limit was a mistake. In retrospect, I should have dropped the third paragraph.

My hypothesis, based on this and other previous experiences, is that my letter was rejected because it contained too much data. Imagine an experiment in which parallel letters to the editor are sent to a random sample of newspapers. Both letters would make exactly the same points, but one would support each point with research, while the other would support them with anecdotes or merely claim that these were the author's personal opinions. My guess is that fewer of the data-driven letters would be published.

I have two possible, though somewhat inconsistent, explanations for my hypothesis. The first assumes that the editors wanted to present the single payer argument sympathetically. It's based on a common cognitive error known as the base-rate fallacy. People find anecdotal evidence more persuasive that statistical base rates, even though the base rates summarize data from larger, more representative samples. The people who made the decision may have found the two letters they published to be more persuasive than mine.

My second explanation makes the reasonable assumption that the gatekeepers at the P-G are opposed to single-payer. If so, they may assume that my inclusion of data makes the letter too persuasive. That is, they may be willing to acknowledge that there are some Pittsburghers who favor single-payer, but it may be unrealistic to expect them to publish statistics suggesting that the arguments of single-payer advocates are factually correct.

I hope I'm wrong. I really want to encourage the use of research evidence to change the health care system, and society in general, for the better. If this strategy is counterproductive, that's genuinely disturbing.

You may also be interested in reading:

Death By Anecdote, Part 1

Are You Feeling Lonely?

Gubernatorial Candidate Forum 1/26/14

This coming Sunday, January 26 the Pittsburgh 14th Ward Independent Democratic Club will be holding a forum of the eight candidates for Governor of PA,  It will be held in McConomy auditorium on the Carnegie Mellon Campus from 1-4 PM.  Below is information from the Facebook event page.  As a 501(c)4 organization, Healthcare for All PA/PUSH does not endorse candidates but encourages everyone to gather information on the process.

Pittsburgh 14th Ward Independent Democratic Club's Annual Meeting and Board Elections - We are taking this opportunity to also hold a forum for the eight candidates who have thrown their hats into the ring so far for Governor. 

The event is co-sponsored by the 14th Ward Democratic Committee, the 7th Ward Democratic Committee, and the CMU Young Democrats. 

This will be an excellent opportunity to hear about their stands on issues and state business that is important to you.

The membership drive and Board elections will be going on in the background; the main attraction is the Gubernatorial Candidates' Forum. The Forum is open to the public, but registered Democrats in the 14th Ward (Squirrel Hill, Point Breeze, Park Place, Swisshelm Park, and Regent Square) of Pittsburgh are welcome to join the Club.

**Related Posts**

MEDICAID, MEDICAL INSURANCE, HEALTH CARE and the CORBETT PLAN Op Ed by President Dave Steil

Tom Corbett: Conspiracy Theorist

Tom Corbett to PA's Working Poor: “Drop Dead!” Part 3.

Video from the Friedman Pittsburgh Talk is now Available

In an earlier post I showed the slides from the talk by Gerald Friedman on the economic impact study he conducted for Health Care for All PA.  He also gave talks in Lancaster (shown on PCN) and Philadelphia.  

Julie Sokolow of Healthy Artists has put together a video of his talk incorporating his slides.  The full slides from his talk are shown here.

Pennsylvania single payer november 2013 131103 from University of Pittsburgh

**Related Posts**

The Slides from the Friedman Talk

State of Working PA: Slowing Job Growth, Falling Wages Impede Recovery (and The Drop in Uninsured)

New Time Magazine Article on Healthcare Costs with 

Stewart Discussion Real Reasons for High Medical Costs

I Agree with Rick Santorum's comparison of the ACA and Apartheid, Sort Of

Former Sen. Rick Santorum actually compared the Affordable Care Act (or Obamacare as he calls it) to Apartheid South Africa.  Here is his quote as he was paying tribute to Nelson Mandela on Fox News “was fighting against some great injustice. I would make the argument that we have a great injustice going on right now in this country with an ever-increasing size of government that is taking over and controlling people’s lives — and Obamacare is front and center in that.”

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On the face of it this seems to ridiculous to comment on but ol' Rick might be on to something here. First lets look at the word apartheid,  In Dutch and it's dialect Afrikaans it means apartness.  Our pre ACA health care system definitely resembled an apartheid system with access to healthcare tied to employment, ability to pay, eligibility for Medicare or Medicaid, veterans status, and charity.  For decades the US was paired with South Africa as the only industrialized nations without a universal healthcare program and also with the death penalty.  

After Mandela was released, the right to access to medical care was affirmed in their constitution and the death penalty was abolished.  While leading almost all African nations, South Africa still lags behind the US and other developed nations in life expectancy and infant mortality due to low per capita income and other factors such as the AIDS epidemic as can be seen here. A description of their health system can be seen here.

The US system has passed and is in the process of implementing the Affordable Care Act.  It does some to alleviate the apartness of our health care system with the individual mandate and Medicaid expansion.  However in Pennsylvania and other states, some governors are refusing to expand Medicaid or expanding it with strings attached.  Those who are still not eligible have to purchase insurance or pay a fine. Single payer levels the playing field so everyone is no longer apart.  Until then apartheid remains in a modified form.  Sen. Santorum does raise some important issues just not in the way he intended.

**Related Posts**

The Affordable Care Act Having an Impact in Some States but not Pennsylvania

The Affordable Care Act (ACA) having little effect on PA's Uninsured Rate So Far

Santorum: No One Has Ever Died Because They Didn’t Have Health Care | The New Civil Rights Movement

Molly Rush: Letter to the Pittsburgh Post-Gazette

Single-payer is the way forward on health care

December 7, 2013

Letter writer Elizabeth Stelle of the Commonwealth Foundation sees government involvement in health care as a disaster and regulations and mandates as the cause of rising health care costs in this country (“Medicaid Is High Cost for Low Quality,” Dec. 2).

Rather than dealing with inadequacies of Medicaid she seems to support Gov. Tom Corbett’s refusal to extend coverage to 542,000 Pennsylvanians.

She fails to note that private insurers, drug companies and providers, whose primary interest is profits, are mainly responsible for rising health care costs.

The Department of Veterans Affairs pays 40 percent less for drugs because of its buying power.

I share Ms. Stelle’s concern about poor quality and high costs. As an analyst, is she aware of a recent study of state Senate Bill 400 by Gerald Friedman? He found that Pennsylvania could provide comprehensive care to every Pennsylvanian and save $17 billion a year through a single-payer system provided in the bill. Vermont just passed a single-payer system.

There’s nothing new about the idea. Every other industrialized country in the world has some version of government health care. They also have much healthier citizens. The United States is far behind these countries in health outcomes. Here, 120 people a day die due to a lack of health care. Half of all bankruptcies are due to medical bills. While Obamacare does provide some real improvements, it falls short due to its complexity and failure to cover everyone.

Go to www.healthcare4allPA.org. Then tell your state legislator to serve his or her constituents by co-sponsoring single-payer legislation.

MOLLY RUSH