Quote of the Month
Dr. Stephen Kemble:
“A lot of money flows through public programs, particularly Medicare and Medicaid.
Private business interests want to tap into this money, but processing claims is only about 2% of these dollars. If private business interests can persuade government programs to allow them to take on insurance risk and manage care they can reap 12% to 40% of the health care dollars!“
We are celebrating this holiday season!
As the dark turns to light we are celebrating our health care victories with a permanent spot for updates and invites to comment on the Universal Health Care Commission meeting!
Thanks to your support, all eyes are on Washington State as we move towards publicly funded and administered state-based healthcare!
2021 has produced a bumper for health care legislative victories in Washington. Beginning with the UHCC, they include the creation of health equity zones, increasing affordability of standardized plans on the Health Benefit Exchange, producing/distributing/purchasing generic drugs and insulin, and the Health Systems Transparency Board.
Our December issue highlights our annual meeting with a big thank you to Marcia Stedman for her exemplary leadership over the past five years, and a hearty welcome to our new President Ronnie Shure. We would also like to thank Dr. Kemble for explaining in great detail how shifting of risk profitizes our healthcare system.
We are pleased to announce that we were able to reach our fundraising goal of $12,000 thanks to you.
We would like to thank each and every one of you for supporting our work.
And off we go merrily into the holiday season and a brand new year!
The purpose of the Universal Health Care Commission is to create immediate and impactful change in Washington’s health care delivery system and to prepare for a unified financing system that makes healthcare more accessible and affordable for all Washington residents.
Click here to sign up for UHCC announcements.
What’s the role of the commission?
The purpose of the commission is to:
- Make the health care system more accessible by increasing access to quality, affordable health care.
- Prepare the state for the creation of a health care system that provides coverage and access for all Washington residents:
Through a unified financing system.
Once the federal government approves this new health care system.
The next meeting of the Commission is Jan. 4th. Click here to join. The meeting will focus on the adoption of the charter for their work. This is a chance for the Commissioners to hear your comments. If you missed the first meeting of the Commission here is the link to the recording.
Federal Action 1
Build Back Better: Email and Call Your Representative & Senators
If you’ve called before, call again!
Democrats have announced a deal to empower Medicare to negotiate lower drug prices as part of the Build Back Better package. It is just a start, but it would be a major setback for Big Pharma that’s difficult to reverse and even harder to justify not expanding in the future. Big Pharma is going to fight until the President’s signature is dry on the bill — so we must keep up the pressure!
We encourage everyone to take one minute to send emails to your Representative and Senators to say you’re counting on them to pass a BBB bill that will lower drug prices, expand Medicare benefits and enact all the proposed healthcare and social infrastructure improvements that Washingtonians so urgently need.
It’s also worthwhile to deliver your message with a phone call. If you’ve called before, call again! Every call is tallied and can make a difference.
Call the Congressional Switchboard: (202) 224-3121 to deliver this message:
Keep robust negotiation of lower drug prices and expansion of Medicare benefits in the Build Back Better reconciliation package! A SUPERMAJORITY of the American people support these proposals.
Federal Action 2
Stop Direct Contracting Entities (DCEs) from taking over traditional Medicare
In 2020, the Trump Administration launched a new policy “experiment” designed to privatize traditional Medicare.
Under this model, the Centers for Medicare and Medicaid Services (CMS) could move more than 30 million traditional Medicare beneficiaries into mostly commercial, for-profit plans called Direct Contracting Entities (DCE) without the enrollees’ understanding or consent.
In ways similar to commercial Medicare Advantage plans, DCEs have the potential to interfere with care decisions and waste taxpayer money when compared with the efficiency of traditional Medicare.
The Biden Administration is moving the DCE program forward, threatening the future of Medicare as we know it.
This petition has been updated slightly for clarity. Click here to sign
Health Care for All-Washington’s 2021 Annual Meeting
Highlights from Dr. Kemble’s talk:
A lot of money flows through public programs, particularly Medicare and Medicaid.
Private business interests want to tap into this money, but claims processing is only about 2% of healthcare dollars. If private business interests can persuade government programs to allow them to take on insurance risk and manage care they can reap 12% to 40% of the health care dollars!
They invented a rationale to tap into this money, which is built on partial truths.
Government is always inefficient. Private insurance companies can manage health care to make it more cost effective
The major driver of excessive costs in US healthcare is fee for service because it incentivizes doctors to deliver an excessive volume of largely unnecessary care.
Only we, the insurance companies, can rein them in.
Turning health care over to capitated private entities makes costs predictable as competition and market forces will control the costs.
Care is fragmented under fee for service.
Private health plans and integrated delivery systems can more effectively coordinate care, restrain unnecessary care, improve access and reduce cost.
ACA has accelerated privatization (as an unintended consequence) of requiring everyone to move away from fee-for-service with its volume incentives and replace it with Value-Based Payment.
The claims are that we can reduce cost, eliminate fragmentation and improve quality by shifting insurance risk on to providers through Accountable Care Organizations. So comes the practice of large insurance plans and hospital chains paid with capitation to buy-out physician practices and integrate them.
None of this is actually true! It's all made up to serve the insurance industry's interest in tapping into the finances of public publicly funded programs. Large numbers of politicians and health policy experts have been drinking this hallucinogenic kool-aid.
Read the full blog on Dr. Kemble's presentation here.
Find a PDF of his slideshow here.
Questions & Answers from Dr. Kemble
Q: Can fee for service models focus on preventive care as much as curative care?
Yes, all you need to do is have a procedure code for preventive care that has a fee attached to it and you can include it in a fee-for-service system. There's nothing about fee-for-service that would interfere with or discourage preventive care.
Q: Are doctors now paid solely by diagnosis? Don't they have to supply supporting data or treatments, for example up-coding from obesity to morbid obesity doesn't require BMI data or weight loss plan is that right? How can they up-code and not incur more expense without additional treatment?
You have to distinguish between the way a risk bearing entity health plan is paid and how a doctor is paid. In a Medicare Advantage Plan they are paid by the person and then adjusted based on the diagnoses. The doctor may still be paid with fee-for-service, so they need to submit a diagnosis to support a claim, but it doesn't matter which diagnosis they choose. A diagnosis is all they need. So the health plan comes to the doctor's office and says you put in a diagnosis of obesity, would you think this patient might qualify for morbid obesity, and if yes, the plan gets more money for that. But not the doctor. So if you capitate the doctor, which is being done in many places, then the doctor is the one with the incentive to up-grade. The moment you say that doctors are not getting an incentive to up-code, it's really at the plan level.
Q: These issues that you've been raising have also been raised by advocates working for universal health plans in New York and California. What is the impact so far because those states also seem very interested in healthcare reform?
In California the problem is some on the Healthy California Commission are invested in the Kaiser system, in HMOs and ACOs, and even though these concerns have been raised, they basically got their fingers in their ears. While there is a process now to develop a new bill for California, California already has a great bill available. AB1400 Guaranteed Health Care for All, all but excludes HMOs like Kaiser and ACOs.
AB1400 proposed to pay a hospital and the physician group together on a global operating budget. This approach basically preserves the hospital and doctor as an integrated system and eliminates the insurance functions. Furthermore, because there are no members that are being paid per capita, HMO’s like Kaiser become an open system with no opportunity for profit or loss, no funding for empire building and chain development.
The second part to this question is will Secretary Becerra, Department of Health and Human Services, do anything to curtail Direct Contracting Entity scheme for 2022? What exactly has been put on hold for 2023? Do we have reason to think that the administration understands and is opposed to this and other forms of privatization of Medicare?
This is a serious problem Four members of the U.S. House of Representatives (Reps. Mark Pocan, Bill Pascrell, Jr., Lloyd Doggett, and Katie Porter) sent a letter to Dept. of Health and Human Services Secretary Xavier Becerra expressing concern about Medicare Direct Contracting and calling for an immediate freeze of the program because so many are funded by venture capital or insurance companies. But as yet there has been no response.
To dig a bit deeper into Medicare Direct Contracting Services. There are two models, the Geographic Model and the Professional Direct Contracting Model. The Geo model has 15 geographic regions and requires everyone in that area to be assigned to an ACO or an HMO. It would totally privatize Medicare. The vast majority of beneficiaries in an area will not know that they have been assigned to an ACO or HMO. Many will not understand what a Direct Contracting Entity is and what mandatory beneficiary participation will mean for their care and existing provider relationships.
The Geo model has been put on hold but has not been killed. Until people in leadership positions at Centers for Medicare & Medicaid Services are either gone or dissuaded of their false beliefs, we are in constant danger from risk shifting as the solution to our so-called health care cost problems.
Q: Can you explain the difference in operating and capital budgets in global budgets and what we have now in our private system?
I'll first cover our private system which uses both operating or capitation to fund capital expenditures. If they are capitated, a certain amount is spent on healthcare and a certain amount is set aside to build a new hospital wing or new facilities. It is a competitive environment of trying to beat out other hospitals by having facilities. But the problem is you end up with duplications in a community with ensuing waste.
A global operating budget only covers operating expenses, with capital expenditures funded from a separate fund allocated according to community needs. For example in trying to decide where to place another MRI the commission sees hospitals are clustered in the suburbs and with none or one in the inner city or in rural areas. So obviously the commission would decide to build a hospital in those areas of poverty not another suburban hospital
There would be no way the hospital with the global operating budget would be able to fund capital expenditures except by applying for that grant from the separate fund by showing the need and getting paid to fill it.
Q: It is my understanding that Congress has no authority over the Direct Contracting Entity (DCE) privatization schemes, who should we lobby to address this draconian policy?
The Affordable Care Act includes the Center for Medicare and Medicaid Innovation (CMMI), which has been given the authority to try new ways of paying for care primarily by pushing for shifting insurance risk onto providers. CMMI can do whatever they want with no input from Congress, so we need to change the law that created the CMMI and strip it out of the Affordable Care Act.
Highlights from the Annual Meeting
We approved the minutes from the November 15 2020 annual meeting
Welcome new members. We are excited to announce that HCFA – WA membership grew by 12% this year.
We have strengthened our relationships with legislators and become more effective lobbyists
We have increased our statewide outreach through our monthly Second Wednesday Speaker Series. The 2021 series has had a focus on a variety of topics such as the Indian Health System, how racism creates health inequities and the legislation to address the current mental health crisis. The December series introduced the members of the Universal Health Care Commission. If you missed any of these events, or want to watch again, click here!
Welcome new President of HCFA – WA Ronnie Shure.
Ronnie’s statement: I have been active in health care reform since graduating from pharmacy school in 1970. It's been so exciting to be a part of this movement in Washington with a great part of it working with Marcia and this powerful board of directors. I am excited to stand on Marcia’s shoulders to move universal health care forward.
Welcome new Vice President of HCFA – WA Chris Covert-Bowlds
Chris’s Statement: As a family doctor I'm very motivated to help get health coverage for everybody in the state. I believe Americans all deserve affordable health coverage, as a human right, and we need to tell the stories to move people’s hearts and minds to achieve this life-saving goal of social justice. I will always remember the suffering of two women who died very early: one due to breast cancer, and the other due to untreated heart disease, because of their lack of health insurance. That is an outrage, and should not happen to anyone. Every American has a right to attorney, if accused of a crime, and every American should have the right to health care.
Welcome Peter Lucas as the Treasurer of HCFA – WA
Peter’s statement: I'm a practicing psychiatrist with first-hand knowledge of how our dysfunctional healthcare system gives patients the shaft. I have been involved with single-payer work both with Physicians For National Health Program and with this organization for many years. I think HCFA-WA is well situated to get the single-payer health care bill implemented.
Welcome new board member Connie Rock
Connie’s statement: Although I'm not a health care professional like so many of us, my life has been impacted by a health care system that just doesn't work. Several years ago a close family member experienced a health crisis with emergency responders having to break down her door. She was in and out of the ER 13 times over a matter of months. When insurance wouldn't cover a $30,000 a year life-saving drug I was absolutely panicked. Nobody should ever go through this! This story has a good ending as she qualified for a financial assistance program for this life-saving drug she so desperately needed, but not everybody is so fortunate. I believe with all my heart that we can change our broken health care system through sustained advocacy leading to policy change and this is exactly what HCFA - WA is working for.
Welcome Sydnie Jones, HCFA-WA long time Communications Specialist and essential member of the communications team.
Approved the 2021 HCFA – WA strategic plan and budget. We updated the strategic plan with a focus on equitable care, the Universal Health Care Commission and ensuring that the various Work Groups and Boards are funded and supported to carry out their work on affordable insulin and generic prescription drugs, health care costs, and health system transparency.
Thank you all!
Saying Goodbye to Marcia Stedman
Marcia, it is sad to say goodbye to you as our President, but good that you are still here as our Immediate Past President!
After many heartfelt goodbyes from HCFA-WA friends, we’d like to share comments from Senator Annette Cleveland, Chair of the Senate Health and Long Term Care Committee:
“ …As Marcia is handing over the baton I am really grateful for this opportunity to share special recognition that Marcia so very much deserves. As a member of the legislature now for nearly a decade and as chair of the Senate Healthcare Committee I've had the just distinct pleasure of working with Marcia to further our shared goal of healthcare for all in the state of Washington. For those of you who know Marcia I don't have to tell you she is a strong advocate. She is proactive, she is patient, she is soft-spoken but she is tenacious. She is firm, strong, respectful and always very positive. It's really this unique combination of qualities that has made Marcia so successful on your behalf. In Olympia you all well understand that it's positive relationships built on trust built on respect that effectively get things done. Marcia’s attention to building those strong enduring relationships, in my opinion, is exactly what has made HCFA-WA the leading voice on universal health care in this state.
I think someone else alluded to her strong understanding of the legislative process and of the fact that you know policy making has to first begin with building a really strong foundation in order to then be successful in the future and continue to drive toward that final goal. Oftentimes I think about how building a strong policy is a lot like building a house. You have to first lay a firm foundation that's going to then support a sound structure. But laying a foundation takes meticulous work and sometimes it's frustrating particularly because that foundation is not always visible from the street. But it's absolutely essential if the house that you're building is going to stand the test of time. So Marcia, what I want to convey today to you is that the foundation that you have laid is going to allow for the sound structure to be built that's going to stand the test of time. From the passage of legislation to create the Universal Health Care Work Group to all of the long hours spent participating in that work that created The Universal Health Care Commission, the foundation is firmly in place and now begins the work of putting the walls up. So Marcia, thank you for all your hard work. Thank you for making it possible for others to continue this important work. I look forward to seeing you in Olympia.”
Bill of the Month
The culprit seems to be private equity's involvement in the ER health care the husband received.
As a follow up here is a NYTimes article on Hospitals and Insurers Didn’t Want You to See These Prices. Here’s Why.
As we move towards universal health care (UHC) here in Washington, we ask whether UHC really reduces inequity. This peer review article from Canada finds that while access to universal health care does increase access to family physicians and hospital services, it finds that specialist services are underused. This has the potential to widen the socioeconomic gap in health. Socioeconomic disparities in health care use: Does universal coverage reduce inequalities in health?
In keeping with this month’s federal Call for Action on the Build Back Better Act, the Kaiser Foundation Policy Watch Explains that Key Provisions for Maternal Health Within the Build Back Better Act would improve maternal health, particularly for people of color. From expanding Medicaid postpartum coverage to establishing a national paid family leave policy, the BBBA could provide more support to states and community organizations working to improve maternal health. Please do call you MoC for action on this!
Tues, Jan. 4
Universal Health Care Commission Meeting #2
Check here for info and materials.
Mon, Jan. 10
2022 Session of the WA State Legislature begins
Wed, Jan. 12
2nd Wednesday Speaker Series
Do you think Universal Health Care is worth fighting for?
Then join us.
We're Health Care for All - WA and we’ve been fighting for Universal Health for over two decades, and, now, finally, we’re making real progress.
In fact, there's so much good news we need help in our COMMUNICATIONS TEAM to get out all the information. If you’re passionate about HC then WE NEED YOU. From the newly formed UHCC to the upcoming legislative session - information is vital! And that’s where you come in. Are you digital-media savvy? Do you like to write? We need your help, your passion and your voice.