<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.0 Transitional//EN">
<HTML><HEAD>
<META content="text/html; charset=iso-8859-1" http-equiv=Content-Type>
<META name=GENERATOR content="MSHTML 8.00.6001.23532">
<STYLE></STYLE>
</HEAD>
<BODY bgColor=#ffffff>
<DIV> </DIV>
<DIV style="FONT: 10pt arial">----- Original Message -----
<DIV style="BACKGROUND: #e4e4e4; font-color: black"><B>From:</B> <A
title=davidjohnson1451@comcast.net
href="mailto:davidjohnson1451@comcast.net">David Johnson</A> </DIV>
<DIV><B>Sent:</B> Wednesday, October 16, 2013 9:42 AM</DIV>
<DIV><B>Subject:</B> Beyond the spin, some facts about the Affordable Care
Act</DIV></DIV>
<DIV><BR></DIV>
<DIV><FONT face=Arial>" What we are hearing in the US is fear-mongering
from extreme right-wing groups, <BR>who have gone so far as to shut down our
government in their attempt to remove <BR>funding for the health law, and
deceptions from Democrats and their front groups <BR>about the virtues of the
ACA. </FONT></DIV>
<DIV><FONT face=Arial>In fact, the ACA was <BR>born in a right-wing think tank,
the Heritage Foundation, and is only supported <BR>by "progressives" because it
was passed by a Democratic president. "<BR></DIV></FONT>
<DIV><FONT face=Arial><STRONG><FONT size=5>Beyond the spin, some facts about the
Affordable Care Act<BR></FONT><BR>The ACA will actually hinder efforts towards
adopting a single-payer system, <BR>writes health care reform
advocate.<BR><BR>By Dr. Margaret Flowers<BR>Al Jazeera, October 14,
2013<BR></STRONG><BR><BR><STRONG>On the first day that the new health insurance
exchanges went into effect as <BR>part of the new health law, the Affordable
Care Act (ACA), I was caught off <BR>guard by a question asked by</STRONG> <FONT
size=4>Bruce Dixon of the Black Agenda Report.</FONT> </FONT></DIV>
<DIV><FONT face=Arial><STRONG></STRONG></FONT> </DIV>
<DIV><FONT face=Arial><STRONG>I was prepared to detail the complexities of the
ACA, but Dixon's only question was:</STRONG></FONT></DIV>
<DIV><FONT face=Arial><STRONG><BR></STRONG><FONT size=4>"What would it be like
if this was the first day of a single-payer health
<BR>system?"</FONT></FONT></DIV>
<DIV><FONT face=Arial></FONT> </DIV>
<DIV><FONT face=Arial><STRONG>Most media outlets in the US are solely focused on
the ACA - either promoting it as a positive step or calling for its repeal.
This limited debate <BR>misses the facts that a single payer health
system, also called Medicare for <BR>all, would both resolve the fundamental
failings of our current system and is <BR>the solution favored by most
Americans.<BR><BR>What we are hearing in the US is fear-mongering from extreme
right-wing groups, <BR>who have gone so far as to shut down our government in
their attempt to remove <BR>funding for the health law, and deceptions from
Democrats and their front groups <BR>about the virtues of the ACA. This is what
happens when a basic issue such as <BR>health care is determined by politics
instead of policy. In fact, the ACA was <BR>born in a right-wing think tank, the
Heritage Foundation, and is only supported <BR>by "progressives" because it was
passed by a Democratic president.<BR><BR>I suspect this manufactured confusion
may sort itself out over time as more <BR>people discover that having health
insurance in the US doesn't guarantee access <BR>to necessary care. In the
meantime, I will try to cut through the spin and <BR>hyperbole to explain why
the ACA is not a step in the right direction and what <BR>health care would look
like if we implemented a publicly-financed "Medicare for <BR>All".<BR><BR>Here
are the top three facts that need to be addressed:<BR><BR>• The rise of health
care costs are slowing, but not because of the ACA.<BR><BR>• More people will
have health insurance but that doesn't mean they will have <BR>access to health
care.<BR><BR>• The ACA further privatises our health care system, which is the
opposite of <BR>single payer.<BR><BR>White House spokesperson Jay Carney stated
numerous times recently that the <BR>slowing of the rise of health care spending
in the United States is a result of <BR>the Affordable Care Act. In fact, the
slowing of total health care spending <BR>actually began after the economic
crisis of 2008, which was prior to the ACA <BR>being signed into law in 2010. As
I wrote earlier this year, the slowing of <BR>health care spending was due to
self-rationing. As more of the cost of health <BR>care is shifted onto the
individual, we see less utilisation of health services.<BR><BR>For example, a
recent report found that low-income workers with health plans <BR>that required
high out-of-pocket payments in Massachusetts did not go to the <BR>emergency
department for serious medical conditions because of the costs. They <BR>had 25
to 30 percent fewer visits, whereas high income workers with similar <BR>plans
did not reduce their visits. A health survey from 2012 found significant
<BR>increases in the number of people who did not get care because of the cost
(80 <BR>million total), who had difficulty paying medical bills (75 million) and
who <BR>went into bankruptcy as a result (4 million over 2 years).<BR><BR>It is
not likely that the ACA will have a positive effect on health care <BR>spending,
by which I mean making health care more affordable. As economist Dean <BR>Baker
writes, we will continue to pay high prices for medications, medical <BR>devices
and physicians. Although there are proven methods to control health care
<BR>costs such as simplified administration, global budgets and negotiating bulk
<BR>prices, none of them were included in the ACA. In fact, the ACA increases
our <BR>already enormous administrative costs by adding new levels of
administration to <BR>our health system.<BR><BR>While it is true that because of
the ACA more people will have health insurance <BR>in the US, what is not
discussed is that tens of millions of people will still <BR>be without health
insurance of any kind. There are 48 million people without <BR>insurance and
that number is expected to fall to 31 million in 2019. Although <BR>historically
in the US, estimates of new coverage are always overblown. At the <BR>state
level, similar new programs that were predicted to lead to universal
<BR>coverage fell far short of their goals and ultimately failed completely.
Even <BR>though, because of the ACA, young adults up to the age of 26 can stay
on their <BR>parent's health plans, this has had only a tepid effect. The
percentage of 19 to <BR>26 year olds without insurance has fallen from 48 to
41.<BR><BR>Health insurance does not equate to healthcare<BR><BR>In the US,
having health insurance does not guarantee access to necessary health <BR>care.
The ACA will increase the number of people who have inadequate insurance
<BR>which requires high out-of-pocket costs and does not cover all necessary
<BR>services. This trend towards underinsurance has been growing steadily over
the <BR>past decade so that currently about one-third of employer-based health
insurance <BR>and half of individual plans are high-deductible plans. It is
expected that in <BR>2014, 44 percent of major US companies will only offer
high-deductible health <BR>plans.<BR><BR>The ACA has significantly lowered the
bar for what is considered to be adequate <BR>health insurance coverage. On the
new health insurance exchanges, plans are <BR>offered based on four tiers. The
Platinum plans will pay for 90 percent of <BR>covered care and Bronze plans, the
lowest tier, will pay for 60 percent of <BR>covered services. It is important to
distinguish that these levels are only for <BR>covered services because people
don't usually understand that they will have to <BR>pay for uncovered services
and out-of-network services. Unfortunately, the use <BR>of out-of-network
services is often involuntary and occurs without being known <BR>at the time of
care, especially in emergency situations.<BR><BR>Subsidies are being offered to
help people purchase insurance. These exist on a <BR>sliding scale for people
who earn 133 to 400 percent of the Federal Poverty <BR>Level (FPL). If an
uninsured person earns below 133 percent of the FPL and lives <BR>in one of the
26 states that did not expand their Medicaid programs, that person <BR>is likely
to be out of luck. And the subsidies only apply to the Silver plans, <BR>which
cover 70 percent, or to higher level plans. Because the subsidies are
<BR>believed to be inadequate, it is expected that many people will choose the
least <BR>expensive Silver or Bronze plans.<BR><BR>Subsidies can only be used to
purchase plans in the state or federal exchanges. <BR>Employees will not qualify
for subsidies to purchase insurance offered by their <BR>employer; but if what
their employer offers costs above a certain percentage of <BR>their income, they
can purchase insurance on the exchange and possibly receive a <BR>subsidy. Some
employers will stop offering insurance and will instead provide <BR>what is
called premium support, or funds that can be used for buying insurance. <BR>And
some employers will decrease their employee's hours below the 30-hour per
<BR>week threshold that relieves them from the mandate to provide insurance or
pay a <BR>penalty. These actions will push more people into the
exchanges.<BR><BR>Pre-existing caveats<BR><BR>Insurance companies have a long
history in the US of skirting regulations that <BR>interfere with profits. So,
while insurers can't exclude sick people, they can <BR>avoid areas where there
are sick people. For example, several of the large <BR>insurance companies are
selling plans on only a small number of exchanges, <BR>preferring to sell plans
mostly to businesses instead. And companies that sell <BR>plans on the exchanges
are restricting their networks. They avoid hospitals that <BR>care for
complicated patients and keep the number of doctors in their plans low,
<BR>making it more likely that people will have to go out of network and pay
more of <BR>the costs of care.<BR><BR>And while companies can't charge more to
people with health problems as <BR>individuals, they can charge up to three
times more based on age and can charge <BR>more in geographic areas where the
population has more health problems or the <BR>costs of care are higher. It is
expected that if a company finds they can't make <BR>enough profit in a
particular area, they can just pull their plans from that <BR>area. These are
some of the most obvious ways that insurers will game the <BR>system. The
largest insurance companies assisted with writing the law and then <BR>with the
regulations that accompanied it, so we will see what other tactics they
<BR>employ as time goes on.<BR><BR>The new health system is complex by design
because that inhibits transparency <BR>and accountability. Imagine what we would
be seeing right now if instead of the <BR>ACA, we had passed HR 676, also known
as Expanded and Improved Medicare for All. <BR>This would have created a single
publicly funded non-profit universal and <BR>comprehensive national health
insurance. Overnight, everyone living in the US <BR>would be eligible for care
without financial barriers. Any person who showed up <BR>to a health facility
for care would be admitted because they would be <BR>automatically enrolled.
Every person would have the right to receive the care <BR>they need rather than
the care they can afford.<BR><BR>Some people believe that the ACA is a step
towards a Medicare for all health <BR>system, but it actually takes us towards
greater privatisation of our health <BR>system which is the opposite direction.
Over a trillion dollars of public funds <BR>will go directly to private
insurance companies to subsidise the purchase of <BR>inadequate health plans.
Nothing was done to stem the tide of large health <BR>corporations that are
acquiring and consolidating health facilities. And since <BR>the ACA was passed
in 2010, our public insurances, Medicaid and Medicare, have <BR>become more
privatised. Private Managed Care organisations are taking over <BR>Medicaid
plans. And Medicare Advantage plans, private insurance plans that are <BR>more
expensive than traditional Medicare, were supposed to be curtailed by the
<BR>ACA but have actually grown by more than 30 percent.<BR><BR>We have not
changed the fundamental problem with the health care system in the <BR>US: that
health care is treated as a commodity to be bought on the market rather <BR>than
as a good that all people need. In fact, the dominant message in the mass
<BR>media is that the ACA has created a health insurance marketplace as if this
is a <BR>good thing for patients. The United States is the only industrialised
nation <BR>that uses a market-based health system and it has clearly failed. The
US spends <BR>the most by far on health care and has low life expectancies and
poor health <BR>outcomes to show for it. I often say that if our health system
was a medical <BR>experiment, it would have to be stopped for ethical
reasons.<BR><BR>Perhaps television comedian Jon Stewart summed it up the best
when he recently <BR>said, "I don't understand the idea of staying with a
market-based solution for a <BR>problem where people can't be smart consumers.
There are too many externalities <BR>in health care that I honestly don't
understand, why businesses would jump at <BR>the chance to decouple health
insurance from their responsibility, and why the <BR>government wouldn't jump at
the chance to create a single-payer that simplifies <BR>this whole gobbledegook
and creates the program that I think America deserves."<BR><BR>Only a single
payer, Medicare for all health system will begin to correct the <BR>many
problems with the health care system in the United States. Grassroots <BR>groups
across the country continue to organise support for Medicare for all. And
<BR>just as similar groups did in Canada and Mexico, we believe that one day we
will <BR>succeed as well. We aspire to join the ranks of civilised countries who
<BR>understand that a healthy population makes a better society and is best
achieved <BR>through national health insurance.<BR><BR><BR>Margaret Flowers, MD,
served as Congressional Fellow for Physicians for a <BR>National Health
Programand is on the board of Healthcare-Now. She is co-director <BR>of It's Our
Economy and co-host of Clearing the FOG Radio
Show</STRONG>.<BR></DIV></FONT></BODY></HTML>