Tuesday, July 30, 2013

Montana's State-Run Free Clinic Sees Early Success

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Montana opened the first government-run medical clinic for state employees last fall. A year later, the state says the clinic is already saving money.

Dan Boyce for NPR

Montana opened the first government-run medical clinic for state employees last fall. A year later, the state says the clinic is already saving money.

Dan Boyce for NPR

A year ago, Montana opened the nation's first clinic for free primary healthcare services to its state government employees. The Helena, Mont., clinic was pitched as a way to improve overall employee health, but the idea has faced its fair share of political opposition.

A year later, the state says the clinic is already saving money.

Pamela Weitz, a 61-year-old state library technician, was skeptical about the place at first.

"I thought it was just the goofiest idea, but you know, it's really good," she says. In the last year, she's been there for checkups, blood tests and flu shots. She doesn't have to go; she still has her normal health insurance provided by the state. But at the clinic, she has no co-pays, no deductibles. It's free.

That's the case for the Helena area's 11,000 state workers and their dependents. With an appointment, patients wait just a couple minutes to see a doctor. Visitation is more than 75 percent higher than initial estimates.

"For goodness sakes, of course the employees and the retirees like it, it's free," says Republican State Sen. Dave Lewis.

He wonders what that free price tag is actually costing the state government as well as the wider Helena community.

"If they're taking money out of the hospital's pocket, the hospital's raising the price on other things to offset that," Lewis says.

He and others faulted then-Gov. Brian Schweitzer for moving ahead with the clinic last year without approval of the state legislature, although it was not needed.

Now, Lewis is a retired state employee himself. He says, personally, he does like going there, too.

"They're wonderful people, they do a great job, but as a legislator, I wonder how in the heck we can pay for it very long," Lewis says.

Lower Costs For Employees And Montana

The state contracts with a private company to run the facility and pays for everything � wages of the staff, total costs of all the visits. Those are all new expenses, and they all come from the budget for state employee healthcare.

Even so, division manager Russ Hill says it's actually costing the state $1,500,000 less for healthcare than before the clinic opened.

"Because there's no markup, our cost per visit is lower than in a private fee-for-service environment," Hill says.

Physicians are paid by the hour, not by the number of procedures they prescribe like many in the private sector. The state is able to buy supplies at lower prices.

“ Because there's no markup, our cost per visit is lower than in a private fee-for-service environment.- Russ Hill of the Montana Health Center Bottom line: a patient's visit to the employee health clinic costs the state about half what it would cost if that patient went to a private doctor. And because it's free to patients, hundreds of people have come in who had not seen a doctor for at least two years. Hill says the facility is catching a lot, including 600 people who have diabetes, 1,300 people with high cholesterol, 1,600 people with high blood pressure and 2,600 patients diagnosed as obese. Treating these conditions early could avoid heart attacks, amputations, or other expensive hospital visits down the line, saving the state more money. Clinic operations director and physician's assistant Jimmie Barnwell says this model feels more rewarding to him. "Having those barriers of time and money taken out of the way are a big part [of what gets] people to come into the clinic. But then, when they come into the clinic, they get a lot of face time with the nurses and the doctors," Barnwell says. That personal attention has proved valuable for library technician Pamela Weitz. A mammogram late last year found a lump. "That doctor called me like three or four times, and I had like three letters from the clinic reminding me, 'You can't let this go, you've got to follow up on it,' " she says. Two more mammograms and an ultrasound later, doctors think it's just a calcium deposit, but they want her to keep watching it and come in for another mammogram in October. Weitz says they've had that same persistence with her other health issues like her high blood pressure. She feels the clinic really cares about her. "Yeah, they've been very good, very good," she says. Montana recently opened a second state employee health clinic in Billings, the state's largest city. Others are in the works. Share Facebook Twitter Google+ Email Comment More From Health Care Health CarePfizer Announces It's Splitting Up Its Drug BusinessHealth CareMontana's State-Run Free Clinic Sees Early SuccessHealth CareCanvassers For Health Coverage Find Few Takers In Boca RatonHealthPanel Urges Lung Cancer Screening For Millions Of Americans

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Sunday, July 28, 2013

Time To Get Out Of The High-Risk Health Insurance Pool?

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Friday, July 26, 2013

For Bioethicist With Ailing Spouse, End-Of-Life Issues Hit Home

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Margaret Battin's husband, Brooke Hopkins, was left quadriplegic after he collided with an oncoming bicycle while cycling down a hill in Salt Lake City.

Courtesy of The New York Times

Margaret Battin's husband, Brooke Hopkins, was left quadriplegic after he collided with an oncoming bicycle while cycling down a hill in Salt Lake City.

Courtesy of The New York Times

After writing books and essays about end-of-life issues, and advocating for the right to die, bioethicist Margaret Battin is wrestling with the issue in her own family. Her husband, Brooke Hopkins, an English professor at the University of Utah, where she also teaches, broke his neck in a bicycle accident in 2008, leaving him with quadriplegia and dependent on life support technology. In order to breathe, he requires a ventilator some of the time and a diaphragmatic pacer all the time. He receives his nutrition through a feeding tube.

Hopkins' living will gives him the right to decline this technology, and although he's chosen to keep living, there have been times he's told his wife he wants to die, and she's had to decide how literally to interpret his words.

In her academic life, Battin has also had to reflect on the positions she's taken in the past to see if she still believes in them. She and her husband are in their early 70s. She's a distinguished professor of philosophy and still teaches full time. When Hopkins is doing well, and not suffering from one of the many infections that have plagued him since the accident, he's able to do some teaching from his home, talk with friends who come to visit, go in his wheelchair on walks with his wife and even occasionally get taken to a concert or museum.

Battin and Hopkins were profiled in the cover story of last Sunday's New York Times Magazine. Battin tells Fresh Air's Terry Gross about what happened right after the accident, and the responsibility of deciding if someone is genuine in their wish to die.

Interview Highlights

On whether, post-accident, she and her husband discussed if he wanted to live or die

"It's odd ... that we didn't have that conversation. At least, I don't recall that conversation. I think it's because in those early days you are so intent on survival. He had had quite a respiratory infection at the time of the accident, which he had gotten campaigning during the 2008 election just prior to that. So the probability of him even surviving the accident, or the immediate period afterward, wasn't particularly good. Our efforts, his and mine, and everybody else's were focused on survival: Can he pull through these respiratory problems? Once those were a little more stabilized and he was able to communicate, there's a whole new phenomenon, and that's the ... enormous expression of love and affection and ... concern from family members, friends, people you haven't seen for ... five years, this overwhelming involving and concern by other people. ...

"So your sense of whether you want to continue or not ... your circumstances are so altered, and altered by this phenomenon that doesn't occur for most people in their ordinary lives; you don't have all of your entire family and your entire range of friends all showering you with love all at once. That's quite heady in a way. It's quite wonderful. ... You might even say it's sublime and it's extraordinary. That made a huge amount of difference at the beginning. ...

"At the beginning we had been told that the paralysis, initial paralysis, would last five to six weeks anyway, and only after that would you have some sense of realistic prognosis. So, while you worry about it, you ... knew that there was no point in thinking about it until after this period. Would he be able to get up and walk away eventually? Well, maybe. That's the kind of thing you can't tell. ... So such a choice would've been premature. Also, walking isn't the only thing in the world. So one begins to recognize that one will begin thinking about how to adapt to a very changed situation."

On the responsibility of deciding if someone is genuine in their wish to die

"I think you have to take it seriously. That doesn't mean that because he says, 'I want to die right now,' that you have to marshal action about it. ...

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"It's not easy, I can tell you that. It doesn't diminish in any way my belief that people � my belief and firmly considered position that people ought to be able, ought to be legally protected, legally empowered to control the character of their own deaths. That is, I do favor legalization of Death with Dignity laws, but that doesn't mean that these decisions are always easy. There [are] some differences. Brooke is not terminally ill, in any standard sense, although his life in certain ways is precarious, his survival. I'm not a physician, I don't pretend to be, so under the Death with Dignity laws it would be the physician that made the determination of whether ceding to this request was appropriate or not. ... If a physician under these laws were to receive a request from a patient and had any doubts about competency, they would be expected to request a psychological or psychiatric consult."

On her husband's accident hitting so close to her academic expertise

"To have it become so real, that someone you love � and love a lot, deeply � would be enmeshed in the same ... very kind of choice you had been thinking about academically for so long is an extraordinary experience. In one way, it's a healthy experience as it forces me to rethink everything. And even doing that, and even given the acute agony of being so close to something that is so difficult, it doesn't change my basic position that people should be recognized to have the right to not only live their lives in ways of their own choosing, providing of course that they don't harm others ... be the architects of their own lives, but that includes the very ... ends of their lives. You shouldn't have to lose those rights just at the end, especially since the very end makes the greatest amount of difference to some people, and also to some of their loved ones around them."

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Thursday, July 25, 2013

Full-Time Vs. Part-Time Workers: Restaurants Weigh Obamacare

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The California Tortilla chain is one company still deciding how to react to the new health care requirements for business, set to take effect next year.

John Ydstie/NPR

The California Tortilla chain is one company still deciding how to react to the new health care requirements for business, set to take effect next year.

John Ydstie/NPR

Many businesses that don't offer health insurance to all their employees breathed a sigh of relief earlier this month when they learned they'd have an extra year to comply with the new health care law or face stiff penalties.

President Obama delayed the requirement for businesses with 50 or more employees after complaints that the plan was too complicated to implement by the original deadline, January 2014. Now, the restaurant industry, which employs a lot of part-time employees, is weighing strategies for how to respond.

At a California Tortilla restaurant in downtown Washington, D.C., managers say they're still figuring out what strategy to use to comply with the new law's mandate to provide health insurance for all workers who put in at least 30 hours a week: whether they should trim hours, hire more part-timers or leave things unchanged.

But management at another fast-food chain has made a decision. White Castle decided it will not fire full-time employees or cut benefits as a result of the new health care law, says Vice President Jamie Richardson. These full-time employees, who make up roughly half of White Castle's 9,600-member workforce, are already covered by the company's health care plan.

"If you're full-time at White Castle, you're going to stay full-time at White Castle," Richardson says. But as White Castle looks into the future after the new law takes effect, Richardson says the company is considering hiring only part-time workers.

The reason is simply cost, he says.

"If we were to keep our health insurance program exactly like it is with no changes, every forecast we've looked at has indicated our costs will go up 24 percent," he says.

The profit per employee in restaurants is only $750 per year, says Richardson, much lower than in most other industries. So, he says, adding health insurance as a benefit for all employees over 30 hours, as the health care law requires, isn't feasible.

But for another restaurant owner, the calculation is very different. Jeff Benjamin has four restaurants in the Philadelphia area and is planning three more. This past spring he invited a dozen restaurateurs from other cities to meet in Chicago to brainstorm strategies to respond to Obamacare's employer mandate. Adding more part-time workers, less than 30 hours a week, was one idea, but Benjamin says it didn't get traction.

"I really only think one or two of the folks in the room suggested it," he says. "All of them kind of agreed that there are too many fixed costs to having an employee to make it worthwhile to go the part-time route."

Having two part-timers instead of one full-time employee doubles the cost of things like training, scheduling and uniforms, Benjamin says.

"I'm a big fan of [the idea that] full-time employees give you full-time work," he says. "And sometimes as you lower people's hours they may not be as committed. So, I love to be able to give someone a full-time job."

Shots - Health News GOP Says, Why Not Delay That Health Care Law, Like, Forever? Business A Restaurant Brainstorms How To Afford Obamacare

But Benjamin acknowledges that his staffing needs and profit margins are different from a fast-food chain like White Castle, and that's why they have different calculations about hiring part-timers. A number of big fast-food chains have said they'll use the strategy of increasing part-time workers, although one, Darden Restaurants, which owns Olive Garden and Red Lobster, has reversed course. Part of the reason was a public backlash to the decision that hurt their business.

A recent survey from the U.S. Chamber of Commerce found that half of the small businesses responding said they will reduce hours or add more part-timers in response to the law. But there are no hard data, so far, showing the industry moving to more part-time employees, says Scott DeFife, a spokesman for the National Restaurant Association.

"There's no big strategic part-time shift," he says. "In fact, data shows that in the past year average hours per employee is going up."

The National Restaurant Association hopes that Congress will use the one-year delay to make the law less burdensome to employers, DeFife says. But that would mean they'd provide fewer of their workers with health insurance.

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Wednesday, July 24, 2013

Obama Turns To Comedians To Promote Health Coverage

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Friday, July 19, 2013

White House Muddles Obamacare Messaging — Again

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For A Long And Healthy Life, It Matters Where You Live

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Tuesday, July 16, 2013

Doctors Heed Prescription For Computerized Records

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Friday, July 12, 2013

Will A Health Insurer Sponsor The Next 'Jackass' Movie?

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Tuesday, July 9, 2013

Insurance Pitch To Young Adults Started In Fenway Park

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Monday, July 8, 2013

New Handicapped Sign Rolls Into New York City

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This new handicapped sign will appear in New York City this summer.

Sara Hendren

This new handicapped sign will appear in New York City this summer.

Sara Hendren

The handicapped sign is getting a new look � at least in New York City.

The initial design, created in 1968, depicted a person with no head in a wheelchair. The sign has changed since then � the figure eventually got a head � and now it's trying something new.

Sara Hendren, a Harvard graduate design student, is co-creator of a guerrilla street art project that replaces the old sign with something more active.

"You'll notice in the old international symbol of access, the posture of the figure is unnaturally erect in the chair," she says. "There's something very mechanical about that."

Hendren's new design looks more like a person wheeling him or herself independently. "Ours is also leaning forward in the chair. There's a clear sense of movement, self-navigation through the world," she says.

A Sign That Brings A New Attitude

It might not seem like much of a difference, but it was enough to fire up a young man with cerebral palsy named Brendon Hildreth, who uses a wheelchair. He and Hendren met as the project gained momentum, and the North Carolina 22-year-old adopted the icon as his own.

Hendren says Hildreth has become a kind of one-man machine around this symbol. He's made t-shirts with his family and has invited local businesses and institutions to change their signage.

Hildreth can only speak through a machine that he types into, and people have looked at him differently all his life.

"He's someone who has been treated as though he had less of a complex and interesting life and wishes for his future," Hendren says.

Enlarge image i

In the beginning of their project, Sara Hendren and Brian Glenney stuck their new design over existing handicapped signs around Boston.

Darcy Hildreth

In the beginning of their project, Sara Hendren and Brian Glenney stuck their new design over existing handicapped signs around Boston.

Darcy Hildreth

Guerrilla Art Tactics

That misperception is what drew Hendren and her partner, Brian Glenney, to start this project. It helped that Glenney, an assistant professor at Gordon College in Massachusetts, is also somewhat of a graffiti artist on the side.

"He said, 'Well, why don't we do something?' He was used to kind of altering public property," Hendren says.

They went all over Boston, putting stickers of the new symbol over with the symbol we're all familiar with.

People began to notice, in part because what Hendren and Glenney were doing � defacing public property � is technically illegal.

"That's true, but we were glad we did, because we raised some conversation," Hendren says.

The response was so strong that they ended up sending stickers to people around the country. It took just one cold call to to reach Victor Calise, New York City's commissioner for people with disabilities, and convince him to join the cause. This summer, the old symbol will be replaced with the new one in all five boroughs.

The Power Of Symbols

But for all the successes, the project still has its critics.

"We've certainly had people who say, 'It's just an image, and I'd rather you spend your time lobbying for other kinds of concrete changes,' " Hendren says.

But she sees the new, more active symbol as an opportunity to open the conversation and change people's perceptions.

"An icon, an image, a symbol, can be a really powerful kind of seed for much larger efforts," Hendren says.

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Saturday, July 6, 2013

Anthony Weiner’s single-payer plan is progressive, but not single-payer

Advocates for a single-payer health care plan see plenty of reasons to like Anthony Weiner’s proposed overhaul of the city’s health system. They just think it’s mislabeled.

“Well as I understand his proposal, it’s not what I would call a single-payer proposal, but it has some useful elements,” said David Himmelstein, a professor of public health at Hunter College, and a co-founder of Physicians for a National Health Program.

Weiner has made health care the key component of his mayoral campaign so far, pledging to implement a single-payer plan like the one he loudly argued for during the national debate over health care back in 2009.

Back then, Weiner seemed motivated primarily by a desire for national publicity, actually delivering a message on health care that served him well politically but was at odds with the president’s agendaand that of more serious Democratic advocates of universal health care in Congress. 

While Weiner clearly sees a political opportunity in health care reform now as well, he is at least advocating something that, as mayor, he’d theoretically have a chance of putting into practice.

“Single-payer health care is on the ballot,” Weiner proclaimed in the subject line of a fund-raising email last month, a few days after Weiner devoted his first big policy speech to his health care plan, at an event his campaign dubbed “Big Thought Thursday.”

A subsequent email to a list of Hillary Clinton’s 2008 alumni asked, “Will you help Anthony stand up for single-payer health care?“

Weiner’s basic idea is to convene a task force of city department heads and nonprofit leaders to design an overhaul of the city’s health care system, in order to consolidate the nearly $16 billion the city spends each year on health care into a single system overseen by a deputy mayor for health care innovation. 

“We should make New York City the single-payer laboratory for the rest of the country,” he said at his policy speech.

By his own admission, the plan is a rough sketch, with details to be filled in by the task force. 

But the crux of the idea is that municipal workers and retirees could be united under a single health insurance plan, overseen by the city, which could also cover undocumented immigrants not covered by President Obama’s new health reforms, with an eye toward one day opening the city’s plan to all New Yorkers.

That’s something advocates of universal health care would certainly regard as progress, even if it’s not anything they’d recognize as single-payer.

“Single-payer really means there’s just one payer left in the health care system,” said Himmelstein. “You can’t really do that as the mayor of New York, because Medicare would still exist and private employers, private plans would still exist, so there would still be multiple payers. But I think having a large public plan that encompasses a large piece of the market makes a lot of sense.”

Asked by WNYC’s Brian Lehrer on July 3 whether the plan could accurately be billed as single-payer, Weiner responded by talking generally about the inefficiencies in the current model, and then said, “I guess the best way to look at this is, this is for city workers, for the uninsured, for retirees, this would be Medicare for all New Yorkers who are eligible. But I’m also going to try to expand this to cover the undocumented who are not going to be covered under Obamacare who are going to cost us a great deal of money if we don’t cover them.”

Health care reformers say the potential benefits of Weiner’s plan are great, with the possibility of expanding coverage to more New Yorkers, while reducing the profit-making role of insurance companies and utilizing the city’s leverage to reduce rates and drive down premiums.

“His thinking on health coverage is certainly in the right place,” said Assemblyman Dick Gottfried, who has repeatedly sponsored bills in Albany to create a statewide single-payer system (and who has not endorsed anyone for mayor). “And part of that thinking is the notion that a publicly run plan with as broad a base as possible can do a much better job than relying on insurance companies as a middle man.”

But the potential implementation could be difficult.

Himmelstein said insurance companies would “fight tooth and nail to stop this from happening,” since any talk of containing costs is essentially “cost-containment from their hide.”

Weiner has been dismissive of that kind of opposition.

In his speech, Weiner said the city could leverage its power within the existing private insurance structure, or that it could wholly control the plan, or a hybrid option, with the city contracting an insurance company for administrative costs, like Medicare and Medicaid do. But he made clear that he wasn’t at all concerned with preserving their profits in the current system.

“It’s not my burden as the mayor of the city of New York to protect that,” he said. “My burden as the mayor of the city of New York is to get reasonable costs for high-quality care.” The first line of his fund-raising email touting single-payer read as follows: “If you are a health insurance executive, you may want to stop reading right here.”

He has also struck a combative posture with regard to municipal unions, who he has suggested should pay 10 percent of their own premiums (25 percent for smokers). Weiner has framed the contributions as way of reducing costs and saving the city money that might then be put toward new union contracts that include raises. But the unions, which are some of the most politically powerful in the city, might prefer the raises without the new system, or the added contributions.

“The experience of doing this in other contexts has been challenging because the employees are not always happy to move into whatever plan the city might set up,” said Dr. Sherry Glied, a professor at Columbia’s Mailman School of Public Health and a former Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services under President Obama.

(Himmelstein and Gottfried both suggested Weiner’s fixed-rate contribution was less desirable than a system that spreads the costs, since Weiner’s proposal would extract roughly the same contribution payment from, say, a highly paid CUNY chancellor as it would an administrative assistant or bus driver, who earns significantly less.)

Asked about the need for state or federal support, Weiner, referring to his proposed task force, said “there is no one who is sitting at that table who really needs to get a go-ahead from the state or federal government.”

But any attempts to extend his proposals beyond municipal workers, toward a more robust public plan that would be open to all New York City residents�something more akin to a single-payer system or a public option�would have to navigate a thicket of state and federal regulations.

Covering the undocumented population also presents its own set of problems, since undocumented immigrants are expressly barred from receiving any of the federal subsidies that generally apply to other low-income populations.

Medicaid and Medicare are largely covered by state and federal requirements, with Maryland as the only state that currently enjoys a federal waiver to negotiate its own rates (a waiver the state is fighting to preserve). 

“I think if there’s going to be a single-payer system, given the way that health care is regulated in our country, it will have to be at a state level at the least, or at the federal level,” said Glied, who suggested the city’s efforts might be better focused on enrolling the uninsured in the national reforms set to take effect next year. “It would just be very difficult to manage it, given the governance structure of health insurance and health care delivery, at a city level.”

PNHP note: For additional commentary on Weiner’s proposal, see Leonard Rodberg’s blog posting titled “Should we support Anthony Weiner�s �single-payer� plan?“

Anthony Weiner’s single-payer plan is progressive, but not single-payer

Advocates for a single-payer health care plan see plenty of reasons to like Anthony Weiner’s proposed overhaul of the city’s health system. They just think it’s mislabeled.

“Well as I understand his proposal, it’s not what I would call a single-payer proposal, but it has some useful elements,” said David Himmelstein, a professor of public health at Hunter College, and a co-founder of Physicians for a National Health Program.

Weiner has made health care the key component of his mayoral campaign so far, pledging to implement a single-payer plan like the one he loudly argued for during the national debate over health care back in 2009.

Back then, Weiner seemed motivated primarily by a desire for national publicity, actually delivering a message on health care that served him well politically but was at odds with the president’s agendaand that of more serious Democratic advocates of universal health care in Congress. 

While Weiner clearly sees a political opportunity in health care reform now as well, he is at least advocating something that, as mayor, he’d theoretically have a chance of putting into practice.

“Single-payer health care is on the ballot,” Weiner proclaimed in the subject line of a fund-raising email last month, a few days after Weiner devoted his first big policy speech to his health care plan, at an event his campaign dubbed “Big Thought Thursday.”

A subsequent email to a list of Hillary Clinton’s 2008 alumni asked, “Will you help Anthony stand up for single-payer health care?“

Weiner’s basic idea is to convene a task force of city department heads and nonprofit leaders to design an overhaul of the city’s health care system, in order to consolidate the nearly $16 billion the city spends each year on health care into a single system overseen by a deputy mayor for health care innovation. 

“We should make New York City the single-payer laboratory for the rest of the country,” he said at his policy speech.

By his own admission, the plan is a rough sketch, with details to be filled in by the task force. 

But the crux of the idea is that municipal workers and retirees could be united under a single health insurance plan, overseen by the city, which could also cover undocumented immigrants not covered by President Obama’s new health reforms, with an eye toward one day opening the city’s plan to all New Yorkers.

That’s something advocates of universal health care would certainly regard as progress, even if it’s not anything they’d recognize as single-payer.

“Single-payer really means there’s just one payer left in the health care system,” said Himmelstein. “You can’t really do that as the mayor of New York, because Medicare would still exist and private employers, private plans would still exist, so there would still be multiple payers. But I think having a large public plan that encompasses a large piece of the market makes a lot of sense.”

Asked by WNYC’s Brian Lehrer on July 3 whether the plan could accurately be billed as single-payer, Weiner responded by talking generally about the inefficiencies in the current model, and then said, “I guess the best way to look at this is, this is for city workers, for the uninsured, for retirees, this would be Medicare for all New Yorkers who are eligible. But I’m also going to try to expand this to cover the undocumented who are not going to be covered under Obamacare who are going to cost us a great deal of money if we don’t cover them.”

Health care reformers say the potential benefits of Weiner’s plan are great, with the possibility of expanding coverage to more New Yorkers, while reducing the profit-making role of insurance companies and utilizing the city’s leverage to reduce rates and drive down premiums.

“His thinking on health coverage is certainly in the right place,” said Assemblyman Dick Gottfried, who has repeatedly sponsored bills in Albany to create a statewide single-payer system (and who has not endorsed anyone for mayor). “And part of that thinking is the notion that a publicly run plan with as broad a base as possible can do a much better job than relying on insurance companies as a middle man.”

But the potential implementation could be difficult.

Himmelstein said insurance companies would “fight tooth and nail to stop this from happening,” since any talk of containing costs is essentially “cost-containment from their hide.”

Weiner has been dismissive of that kind of opposition.

In his speech, Weiner said the city could leverage its power within the existing private insurance structure, or that it could wholly control the plan, or a hybrid option, with the city contracting an insurance company for administrative costs, like Medicare and Medicaid do. But he made clear that he wasn’t at all concerned with preserving their profits in the current system.

“It’s not my burden as the mayor of the city of New York to protect that,” he said. “My burden as the mayor of the city of New York is to get reasonable costs for high-quality care.” The first line of his fund-raising email touting single-payer read as follows: “If you are a health insurance executive, you may want to stop reading right here.”

He has also struck a combative posture with regard to municipal unions, who he has suggested should pay 10 percent of their own premiums (25 percent for smokers). Weiner has framed the contributions as way of reducing costs and saving the city money that might then be put toward new union contracts that include raises. But the unions, which are some of the most politically powerful in the city, might prefer the raises without the new system, or the added contributions.

“The experience of doing this in other contexts has been challenging because the employees are not always happy to move into whatever plan the city might set up,” said Dr. Sherry Glied, a professor at Columbia’s Mailman School of Public Health and a former Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services under President Obama.

(Himmelstein and Gottfried both suggested Weiner’s fixed-rate contribution was less desirable than a system that spreads the costs, since Weiner’s proposal would extract roughly the same contribution payment from, say, a highly paid CUNY chancellor as it would an administrative assistant or bus driver, who earns significantly less.)

Asked about the need for state or federal support, Weiner, referring to his proposed task force, said “there is no one who is sitting at that table who really needs to get a go-ahead from the state or federal government.”

But any attempts to extend his proposals beyond municipal workers, toward a more robust public plan that would be open to all New York City residents�something more akin to a single-payer system or a public option�would have to navigate a thicket of state and federal regulations.

Covering the undocumented population also presents its own set of problems, since undocumented immigrants are expressly barred from receiving any of the federal subsidies that generally apply to other low-income populations.

Medicaid and Medicare are largely covered by state and federal requirements, with Maryland as the only state that currently enjoys a federal waiver to negotiate its own rates (a waiver the state is fighting to preserve). 

“I think if there’s going to be a single-payer system, given the way that health care is regulated in our country, it will have to be at a state level at the least, or at the federal level,” said Glied, who suggested the city’s efforts might be better focused on enrolling the uninsured in the national reforms set to take effect next year. “It would just be very difficult to manage it, given the governance structure of health insurance and health care delivery, at a city level.”

PNHP note: For additional commentary on Weiner’s proposal, see Leonard Rodberg’s blog posting titled “Should we support Anthony Weiner�s �single-payer� plan?“

Friday, July 5, 2013

How To Make Disease Prevention An Easier Sell

More From Shots - Health News HealthGenes May Reveal When Aspirin Won't Reduce Heart RiskHealthHow Sunscreen Can Burn YouHealth CareA Busy ER Doctor Slows Down To Help Patients Cope With AdversityHealthGut Bacteria We Pick Up As Kids Stick With Us For Decades

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Thursday, July 4, 2013

Idaho AFL-CIO endorses HR 676, National Single Payer Health Care

From UnionsForSinglePayer.org –

Rian Van Leuven, President of the Idaho State AFL-CIO, announced that on June 12, 2013, the delegates to the 55th Annual Idaho State AFL-CIO Convention passed a resolution to publicly endorse and support H.R. 676, Single Payer Healthcare.

Further the resolution states “That the Idaho State AFL-CIO will develop working relationships with community organizations in Idaho which advocate for single-payer healthcare and Medicaid expansion.”

Louis Schlickman, MD, an Idaho physician who practices in Meridian and is Co Chair of the Physicians for a National Health Program state chapter, showed the movie Escape Fire and made a single payer presentation to the convention prior to the passage of the resolution.

After the resolution for HR 676 was passed by the Idaho State AFL-CIO Convention, Dr. Schlickman stated that, �Collectively we are all realizing that unions in general can play a huge role in helping others, not just union workers, see the merit in a single payer financing system of care.�

Dr. Schlickman observed that union members �have seen how one unexpected illness or injury leads to significant catastrophes of health and income status. And most important, they understand the issue of solidarity.�

Idaho is the 43rd State AFL-CIO Federation to endorse HR 676, which was introduced into the 113th Congress by Representative John Conyers (D MI). The bill is subtitled Expanded and Improved Medicare for All.

Wednesday, July 3, 2013

Savory And Sweet: A Taste For Infertility

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Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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Federal Rule Extends Subsidies For College Students

More From Shots - Health News HealthCuring Drug-Resistant Tuberculosis In Kids Takes CreativityHealthFederal Rule Extends Subsidies For College StudentsHealthSavory And Sweet: A Taste For Infertility HealthTo Make Hearing Aids Affordable, Firm Turns On Bluetooth

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Comments   You must be signed in to leave a comment. Sign In / Register

Please keep your community civil. All comments must follow the NPR.org Community rules and terms of use, and will be moderated prior to posting. NPR reserves the right to use the comments we receive, in whole or in part, and to use the commenter's name and location, in any medium. See also the Terms of Use, Privacy Policy and Community FAQ.

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