The LA Times is either willfully ignorant in not knowing how the insurance industry operates or they don't care and want to push a leftist agenda in gaining a Single Payor health plan.
Here is one of the funniest columns you will read on healthcare reform. As usual, my comments are in red.
Thanks to Trump and the GOP, a California single-payer healthcare system is now possible
By: David Lazarus
Could California have its own single-payer health insurance system providing coverage for all residents? A bill has been introduced in the state Legislature that would do just that — and its chances of success could be vastly improved by President Trump and the Republican-controlled Congress.
Thanks, guys!
First, a little history lesson. Stick with me because this is important.
California flirted with a single-payer system when the Legislature signed off on the idea in 2006 and again in 2008. The bills were vetoed by former Gov. Arnold Schwarzenegger, who declared in 2006 that “socialized medicine is not the solution to our state’s healthcare problems.”
He was right.
Those legislative efforts were spearheaded by Sheila Kuehl, who was then a state senator and is now a Los Angeles County supervisor. She and I spoke frequently during California’s flirtation with single payer and we caught up on the topic this week.
Her biggest mistake in 2008, Kuehl told me, was not effectively countering the “socialized medicine” line from Republicans and conservative critics.
You mean you couldn't pull the wool over the people's eyes good enough.
“What we should have done from the very beginning was use the phrase ‘Medicare for all,’ ” she said. “People are familiar with how Medicare works. They would have understood that we weren’t taking over healthcare providers.”
And obviously you aren't familiar with how Medicare works. Medicare is not "free" insurance and you have had to "pay" into it through quarters of qualified employment to be eligible or pay a large premium to participate. Actually YES, YOU ARE taking over healthcare providers but you are doing it in such an insidious manner. The regulations you create for providers to be considered for "Medicare Assignment" absolutely reeks of government control.
Under the typical single-payer system, payroll taxes replace premiums, deductibles and co-pays as a funding mechanism for health insurance. This is how almost all other developed countries succeed in providing affordable coverage for everyone — and for about half as much as what Americans pay.
Hmmm....under the old system that "didn't work", premiums were taken out of payroll. What makes this any better? What are the utilization numbers in those "developed nations"? What are the pools and the demographics? You are comparing apples to artichokes and then hailing some sort of success.
No one is proposing a government takeover of hospitals and doctors’ offices.
See above. Yes you are. You may not be educated enough to realize it, though. Those of us in the industry know otherwise. When the government sets plan descriptions, sets MLR rates, sets up exchanges, certifies both providers and brokers and then is the approving body for rate structures both new and renewal...what else do you call this other than government takeover?
“Single-payer isn’t socialized medicine,” Kuehl said. “It has nothing to do with hospitals and doctors. It’s purely a form of insurance. But we didn’t communicate that as well as we could have.”
No, you explained your position most admirably. We who disagree just pointed out your flaws and the public agreed with us. See my previous quote above this for the evidence.
Messaging aside, she thinks the public has become more open to new ideas.
Only because the last idea in the Affordable Care Act was so horrible.
“With so much uncertainty from the Trump administration,” Kuehl said, “I’m more convinced than ever that single-payer is the way to go for California. It’s a very, very good idea.”
Uncertainty from Trump? His voice and his position is the most stable we have seen on this issue in years. You may not agree with his policies but they are transparent and doable.
The idea is back in play thanks to state Sen. Ricardo Lara (D-Bell Gardens), who last week introduced a bill aimed at creating a Medicare-for-all system for Californians.
It doesn’t yet say how this would be accomplished. Instead, it declares the Legislature’s “intent” to pass a law that would “establish a comprehensive universal single-payer healthcare coverage program and a healthcare cost control system for the benefit of all residents of the state.”
Healthcare Control System......read, "rationing". You see as I will explain further down in this column, there are only a few ways to lower healthcare expenditures.
Details, presumably, will come later.
Of course, they will. You have to pass it to see what's in it. Leave it to California to employ one of the tactics used by their most "popular" representative, Nancy Pelosi.
“If Republicans abandon California and Congress moves to cut Medicaid, we will insist that the federal government treat us like any other state and give us the flexibility and freedom to address the health needs of our entire population through a universal healthcare system,” Lara told me.
Ok fine, no problem. Let's say that California decides to go it alone and form their own utopian single payor plan. What happens to residents when they travel? What happens when your Malibu resident movie star decides to jump over fly over country and go to NY and suddenly needs care. Who pays? Yes, the ACA says emergency care is mandated but if California builds a single payor plan, that is outside of the ACA, no state will honor California's contracts. So, in fact, a California resident traveling out of state runs the risk of having no insurance because there will be no reciprocity agreement in place. Reality sorta sucks, doesn't it?
Studies have shown that a single-payer system would result in lower out-of-pocket costs for most California residents.
See below. I address this outright lie.
But one big problem with Kuehl’s earlier bills was how the $100-billion Medi-Cal program — the state’s version of Medicaid — would integrate with a California single-payer system. Medi-Cal covers about a third of the state’s population. About $67 billion in funding comes from the federal government.
Your Medicaid problem is one third of your population and you think diverting that money to the remainder of your population will lower out of pocket costs to your residents? This is insanity. How do you cover the utilization costs of the remaining two thirds while keeping the guaranteed issue and the no Pre-X clause? Who eats those utilization charges?
That state-federal partnership meant Washington would have needed to sign off on any move to incorporate Medi-Cal into a state single-payer plan, and Kuehl acknowledged at the time that this probably would have been hard to obtain.
Thanks to Trump and the Republican-controlled Congress, things are now very different.
“We should give our great state governors the resources and flexibility they need with Medicaid to make sure no one is left out,” Trump said in his speech to Congress this week.
What he and Republican leaders mean by that is giving states a fixed amount of Medicaid money in the form of block grants to cover low-income people. States currently are guaranteed at least $1 in federal funds for every $1 in state spending.
The Republicans’ goal is for the federal government to pay less for Medicaid annually. But what they’re also unintentionally doing is removing perhaps the biggest obstacle to California and other states establishing their own single-payer systems.
It should be all government's responsibility to find ways to pay less for their social safety net. There are ways if you are open minded enough to see them and not glued to Single Payor.
With block grants, states wouldn’t need congressional approval to use Medicaid money for a broader insurance program.
True but what happens when you apply the Medicaid grant into the general treasury to pay for all of "Cali-Care" or whatever you call it only to find out it wasn't enough? If you are getting crushed and need that Medicaid block grant, expanding your eligible pool is potentially budget crushing and fiscally irresponsible.
“Yes, that solves the problem,” said Gerald Kominski, director of the UCLA Center for Health Policy Research.
See above. No, it doesn't.
But he noted that block grants create a different issue in the form of program sustainability. Unless the annual grants grow with healthcare costs, states will find themselves increasingly underfunded in covering Medicaid populations.
If you can't handle your Medicaid problem now, how are taxes going to handle a situation that will only get worse tenfold when you then take on the healthcare platform for your entire state???
“If the grants are linked to inflation, that won’t be sufficient,” Kominski said. “Healthcare spending always grows faster than the overall economy.”
And a California Single Payer plan will remedy that how exactly?
The average cost of living for Americans rose about 2% last year. Healthcare spending, meanwhile, climbed 4.8%, and is expected by the Centers for Medicare and Medicaid Services to rise 5.4% this year.
Once again, utilization is the killer. Single payer does nothing to address that. No matter who is paying the bills, utilization is utilization. No matter who is paying the bills, actuarial science is present. The only way you can lower costs is by doing a few things none of which will be popular. You can reduce access or limit exposure through limited participation networks, higher deductibles and coinsurances to the insured. Unfortunately that will be extremely unpopular with voters. You can reduce reimbursements to providers through renegotiating capitation or reducing fee for service payments. Unfortunately, that will make doctors unhappy and they in turn will refuse to accept that network leaving members out in the cold and again, making voters unhappy.
“Block grants are a poison pill,” Kominski said. “They’re a slow-acting poison that cuts off your healthcare funds.”
That’s not an insurmountable problem. California could structure a single-payer system so that it’s sustained by a greater share of state tax revenue, with program efficiencies offsetting a gradual decline in federal dollars.
And how pray tell do you do this with your already bloated public assistance entitlement budget along with your state government employee benefit requirements?
A 2005 study by the Lewin Group found that a single-payer insurance plan would save California nearly $344 billion over 10 years, primarily by streamlining bureaucratic overhead and relying more on bulk purchases of prescription drugs and medical equipment.
Are you really going to use a 12 year old study to justify an ever expanding and bloated healthcare platform? Bulk purchases do nothing to remedy the problems brought on by utilization. You don't believe me? Ask United Healthcare what happens when you offer a zero premium Open Access Point of Service Medicare plan in an area that demographically skews heavy towards a medicare eligible population. Let's just say it lasted one year before they lost their shirts and had to discontinue the plan and move them to the Open Access HMO Medicare plan. Utilization is the killer. Learn that and you will see where the real problem lies in your plan.
The study also predicted a significant economic boost for businesses because they’d no longer be responsible for employees’ health coverage. This, in turn, would probably spur job creation.
Wrong. The fact is most businesses were already paying the 10% employer minimum contribution. Let's say the premium for a single employee is $350 dollars and the employer is paying the 10% minimum with a roster of 10 employees. The savings would be $350. What employee are you going to hire for $350 a month?
A single-payer system would be a clear improvement for California and would serve as a model for the rest of the nation. Don’t forget: Canada didn’t adopt a single-payer system overnight. It rolled out its universal-coverage program gradually, province by province. The same methodical approach would be prudent for the United States.
And yet Canadians in the province of Ontario run into Buffalo NY for treatment or major surgery.
But now another question arises: What sort of single-payer system do we want? They’re not all created equal.
Are you serious?!?! Single Payor not all created equal? If it is single payor it is single payor. One governing body that adjudicates claims, designs products, credentials providers, approves brokers and sets/approves rates.
On Tuesday, we’ll look at alternative approaches to covering everyone.
I've already done it. Go to my blog.
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