Liz Fowler is Back!  And She’s Writing U. S. Health Policy Again

By Kay Tillow

Liz Fowler is back! For those who followed the battles of the health care reform of 2009-2010, no name rouses more controversy than that of Elizabeth “Liz” Fowler who, as Chief Health Counsel to Senate Finance Committee Chairman Max Baucus, played a critical role in the writing of the Affordable Care Act.

Fowler, former vice president of public policy and external affairs at Wellpoint, the giant health insurance company that later became Anthem, wrote the reform policy to protect the future and the profits of the industry from which she came. Thanks to her efforts, Anthem and other for-profit insurance companies prospered from Fowler’s ability to craft the Affordable Care Act to their liking. In 2020, Anthem reported over $4.5 billion in net income. Now Liz Fowler is back, writing U. S. health care policy in line with insurance company desires. President Biden appointed her to head up the Center for Medicare and Medicaid Innovation (CMMI) within the Center for Medicare and Medicaid Services (CMS). She’s back to the top spot to direct the future of health care.

Back in 2009, the insurance industry and anti-single payer policy experts promoted CMMI and wrote it into the Affordable Care Act to promote cost cutting in Medicare, Medicaid and CHIP through value-based payment models. But CMMI’s work is based on the wrong-headed theory that U. S. healthcare is too expensive because of overuse. Value-based payment advocates claim that too many doctors and hospitals are giving too much care. CMMI wants to reverse the payment scheme and pay doctors and hospitals more for doing less. They contend they will be paying for quality or value rather than quantity. Their attempts to force doctors to fill out endless forms are stressing physicians, but they have yet to find a way to accurately measure value. CMMI is working from a false premise:  in the U.S., patients see their doctors an average of 4 times annually while in the U. K., France, Canada, Australia, Germany and Japan, patients see their physicians from 5 to over 12 times a year. In the U.S., Americans spend an average of .6 days per year in the hospital, whereas residents of other wealthy countries spend up to three times that number. So, if Americans are seeing their doctors less and spending fewer days in the hospital, why are we still spending more than wealthy countries on health care?

There is a battle raging over what must be done to cover everyone and rein in costs. Single payer, improved Medicare for All, advocates assert that the key is to remove profit-making insurance companies and hospitals from the system, slashing administrative waste to the point where savings can improve care for those who are covered and expand it to those who are uninsured. Costs will be stabilized and even reduced because the profitmaking mechanisms are the source of the high costs, not the overutilization of services. Single payer advocates point to the fact that the U.S. spends on health care about double, per capita, what other wealthy countries spend. Yet the US has, on average, worse outcomes. A plan to remove profit-making from the system is the only plan that would rein in costs. The CMMI, meanwhile, is constructed around insurance company magical thinking of health care reform: cut costs while giving less but better care.

Over the past decade, CMMI has experimented by setting up a number of alternate payment schemes designed to shift insurance risk onto hospitals and physicians. The results have not been good. Most of the CMMI experiments have been disappointing—either they don’t improve care, or they worsen care, or they don’t save money.  Only 4 models of over 48 experiments have been adopted. The conclusion should be that if we are to expand care and reduce costs, we should adopt a well-designed national single payer plan. But the Biden Administration has rejected that logical conclusion. Instead, the President has brought back Liz Fowler to find a way to make their pro-insurance company plan work. The voluntary experiments of the CMMI have not proven the quality gains and cost saving that the insurance industry and its loyal experts predicted. Thus, Liz Fowler to the rescue. Fowler and others have hinted that they’re looking to move from voluntary to mandatory experiments that will force greater risks onto physicians, other caregivers, and hospitals.

How much more of this nonsensical misery must the nation endure? A decade ago, Marcia Angell, MD, former editor of the New England Journal of Medicine, explained that in a for-profit insurance system, costs and care move in the same direction. To increase care, cover more people with better care, costs are increased as well. In a for-profit system, cutting costs also cuts care. To shift the dynamics and improve care while reining in costs, one must change to a single payer, not-for-profit system. She was right.

When Senator Max Baucus refused to allow single payer advocates to participate in the hearings on the Affordable Care Act, nurses, doctors, and others stood to speak. Baucus called the police and had them arrested. But their courage to act sparked a debate and planted a banner for single payer. It’s time to lift up that banner once again.

Originally published on Counterpunch.

https://www.counterpunch.org/2021/06/07/liz-fowler-is-back-and-shes-writing-us-health-policy-again/

Distributed by:

All Unions Committee for Single Payer Health Care

P. O. Box 17595

Louisville, KY 40217

nursenpo@aol.com

https://www.unionsforsinglepayer.org/

06/08/2021

By Kay Tillow

https://www.dailykos.com/stories/2020/9/14/1977397/-Beyond-the-Medicare-Advantage-Scam?_=2020-09-14T14:32:05.883-07:00

In a television ad repeated incessantly, 60’s quarterback star Joe Namath reads his lines to promote the Medicare Coverage Helpline.  “Are you getting all the benefits you deserve?”  He ticks off the new benefits.  You may be able to lower your out of pocket costs and get extra benefit now, he says.

The ad announces that the Center for Medicare and Medicaid Services has officially authorized new benefits that Medicare Advantage Plans may include.  “One simple call gives you free, professional assistance to help you get more benefits and save money,” says Namath.  It sounds like a public service announcement from Medicare.

But it isn’t.  It’s a pitch to sign up in the privatized, for-profit Medicare Advantage plans—and it’s a scam.  It is true that a person may be able to lower monthly costs by enrolling in one of these plans.  That’s a powerful incentive in a time when the majority of seniors live on tight budgets, many just an inch from disaster.  The laws and regulations allow these insurance companies to lure seniors away from traditional Medicare, and Congresspersons of both parties should be held responsible.

Namath continues:   “And like you I’m at home staying safe, but I wanted to get this message out.  To make these uncertain times easier and safer while at home, Medicare Advantage plans have added new benefits including telephone appointments with your doctors, in home aides, home delivered meals, home delivered prescriptions, and so much more.”

He makes it seem to be a new opportunity provided by Medicare because of the corona virus that is keeping us homebound.

“But you don’t get all the benefits automatically, you need to enroll.  The easiest way to enroll is to call the Medicare Coverage Helpline.  It’s now more important than ever to make sure that your Medicare coverage is up to date,” says Namath.

It mimics a public service announcement—there are new benefits to help out in the pandemic but the benefits aren’t automatic, you have to enroll.  That doesn’t sound like you are abandoning your traditional Medicare plan and allowing Medicare to give an annual sum to the for-profit insurance company that has now taken you into its scheme.  But once you sign up, you’ve been had.

You may be okay for a time and save money monthly – as long as you don’t get sick.  Once you need to use the plan, you will discover the problems that come from being in a for-profit plan that makes more when it denies you care.  Your choice of physicians will be restricted to a list.  The specialist you need may not be anywhere near where you live.  The hospitals and rehabs centers will be limited.   The post-hospitalization facility available to you is likely to be the one with the worst reputation.  The drugs you need may now cost a fortune.

Tom Mills of San Diego  was in one of these Medicare Advantage plans.  Following a mitral valve repair and a mild stroke, his plan began to charge him hundreds of dollars in monthly copays for drugs and other services.  He had to pay $295 a night for a hospital stay.

Then he learned the even worse news.  If he tries to escape these exorbitant costs by returning to traditional Medicare and a prescription plan, he will need a supplemental Medigap plan to handle the 20% copays and deductibles.   But he now has a pre-existing condition.  A broker for health insurance told Mills that no supplemental plan would cover him and that applying would be a waste of time.

Namath didn’t mention that in the ad.

When seniors first sign up for a Medicare plan, they are protected by law against discrimination for pre-existing conditions in the purchase of a Medigap plan.  But when a person tries to change back to traditional Medicare later, that protection is gone.   Only four states have regulations to prohibit such practices.

Mr. Mills no longer saves that monthly sum on his Medicare Advantage plan;  he pays extra.

The Medicare Advantage Plans are smiling all the way to the bank.  In 2019 each Medicare Advantage beneficiary cost taxpayers $11,822 while those in original Medicare cost $10,813 each—that’s over $1,000 more and over 9% more per person for the for-profit insurers!

The Center for Medicare and Medicaid Services estimates that the Medicare Advantage insurers will be overpaid by $200 billion over the next decade.

Despite the problems of purchasing a Medigap plan, the negative experiences that Medicare Advantage patients encounter once they get sick induce many to return to traditional Medicare.  It all works so well for the insurance companies!  While the patient is healthy with few expenses, the company rakes in the money.  Once the patient becomes ill and needs more care, many patients, facing massive expenses, will return to original Medicare.  Now the extra expenses of a sicker patient will fall on the public once again.

That’s the way this for-profit system functions.  The poor, the disabled, the sick and the elderly are covered under the public programs, Medicaid and Medicare, leaving the healthy, vibrant families to the private insurers who profit from the lower costs of care for the healthy.

Not only do these Medicare Advantage Insurance companies profit at the public trough, they use the seniors who are signed up in their plans to lobby Congress to continue with these rip-offs.  America’s Health Insurance Plans (AHIP), the organization of health insurance companies, keeps the deceptions going by telling seniors to let their Congressperson know that their Medicare plan is in jeopardy.  All legislative efforts to reduce the massive ill-gotten gains of these companies are defeated by AHIP’s shrewd use of the popular “protect Medicare” sentiment to ward off any reform of the Medicare Advantage plans.

In 2019 368 members of Congress, a solid majority, signed the letter in favor of Medicare Advantage plans. AHIP thanked Congress for the overwhelming support.

The Senate letter includes 66 signatures and the House letter over 300, including many who ought to know better.

The insurance industry manipulates our democracy.

That’s just the beginning of the shameful marketing of Medicare Advantage plans.  The Joe Namath ad for the Medicare Coverage Helpline includes some tiny print that no one could possibly read on the television.  The fine print of the ad says “The Medicare Coverage Helpline is a private for-profit lead generation campaign and does not offer insurance and is not an insurance agency or broker.  Your call is sold to a licensed insurance agent….”

The ad also states that Medicare Coverage Helpline…(and others) are all service marks or trademarks owned by TogetherHealth PAP, LLC.”  In June of 2019, TogetherHealth was acquired by Health Insurance Innovations, a company that is facing at least two class-action lawsuits over its alleged role in a health insurance scam that bilked millions of dollars from consumers and that the FTC shut down last fall, reported Truth in Advertising.

Now the Medicare Payment Advisory Commission (MedPAC) announces that Medicare is spending more than planned during the pandemic and that funds will run short by 2024.  There is a solution to all of this.  A well-designed national single payer plan, an Improved Medicare for All, would boot the Medicare Advantage cheats, solve Medicare’s funding future, and cover everyone, not just the elderly, for all medically necessary care.

Such a plan has been set forth by Physicians for a National Health Program.

The plan removes the profits from the system, allowing our wealth to instead expand care to all, ending forever the for-profit scams and the denial of care because of inability to pay.

All Unions Committee for Single Payer Health Care

P. O. Box 17595

Louisville, KY 40217

http://unionsforsinglepayer.org

Single-payer health care – its time has come: Mark Dimondstein

WASHINGTON, D.C. — Congress is back from its summer recess and the problems with our nation’s health care system haven’t gone away. How to fix health care is once again being hotly debated. Recently, President Donald Trump warned Republican senators that they must do something or be confronted with the dangers of “single-payer” health care. But, single-payer shouldn’t be the boogeyman — its time has come.

As a postal worker and now president of the American Postal Workers Union, I’ve had many occasions to meet with Canadian postal workers. The lives and dreams of postal workers just across Lake Erie are similar to workers in Northeast Ohio and other parts of the United States. One huge difference stands out – Canadian health care. Canadians never worry about being denied access to medical care. Unlike in the United States, no one is forced to choose between food and medicine. A major illness won’t drive them to bankruptcy or out of their homes.

Canada’s single-payer health care system is similar to Medicare but in Canada every man, woman and child has cradle-to-grave coverage for their doctor, hospital and nursing care – with full choice of physicians. The government also negotiates affordable drug costs with pharmaceutical companies.

2009: The ins and outs of Canada’s health system

Imagine how much less stressful our lives would be without co-pays, deductibles, billing for services, lifetime limits or huge insurance premiums. According to University of Massachusetts Economics Professor Gerald Friedman, 95 percent of U.S. households would save money under a single-payer plan.

It is striking that the Canadian success is rarely discussed in the current health care debate. The leadership of both major political parties treat health care as a privilege rather than a human right. The profits of the medical industrial complex sadly take center stage over the people’s interests.

Most of the Democratic Party leadership is wedded to the Affordable Care Act (ACA). While some measures of the ACA should be preserved, such as coverage for the 153 million Americans with pre-existing conditions, the law has failed. It is not affordable. It contains no public option, does nothing to lower pharmaceutical prices, is a boon to the insurance companies and still leaves tens of millions uninsured and millions more with inferior insurance plans.

The failed legislation promoted by the Republican leadership is far worse. The GOP plans would gut Medicaid (used by one in five Americans and two-thirds of nursing home patients). Their plans would drive 22 million people from health insurance rolls, according to the Congressional Budget Office; incentivize employers to eliminate health coverage; limit coverage for pre-existing conditions; and drastically raise medical costs for seniors – all while giving billions in tax breaks to the wealthiest.

Most workers our union represents have employer-based health insurance. Every year we are paying more and receiving fewer benefits. A postal employee typically pays $6,000 a year for their share of family plan premiums – plus co-pays, deductibles and co-insurance.  A “Canadian style” system would offer financial relief, even to those currently insured.

Donald Trump was right back in 2000 when he said: “We must have universal health care. Just imagine the improved quality of life for our society as a whole….The Canadian-style, single-payer system… helps Canadians live longer and healthier than Americans…. There are fewer medical lawsuits, less loss of labor to sickness, and lower costs to companies paying for the medical care of their employees.”

According to the most recent figures, the United States spends 17.8 percent of GDP on health care — more per capita than any other country. More than 25 percent of health care expenses are administrative – money diverted to needless insurance industry overhead and profits. (Twice that of Canada.)  U.S. citizens average $9,000 a year in health-related costs.

Yet, health outcomes are dismal. The United States ranks 34th in life expectancy. (Canada ranks 13.) A 2017 study by the Commonwealth Fund, found that the United States ranks last of the 11 most “developed” countries in health care quality, access, results and efficiency.

The ACA should be replaced with a better system. The recent debate between bad (“Obamacare”) and worse (“Trumpcare”) fails to meet the health care needs of the 99 percent. Let’s learn from our neighbor and demand single-payer universal health coverage – “Medicare for All!”

It is a proven, simple, cost-effective, and just way to heal what ails us.

Mark Dimondstein is president of the 200,000-member American Postal Workers Union and a vice president of the AFL-CIO.

http://tinyurl.com/yanzznro

Issued by:

Kay Tillow, Coordinator

All Unions Committee for Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551

Email: nursenpo@aol.com
http://unionsforsinglepayer.org
https://www.facebook.com/unionsforsinglepayer

HR 676 would institute a single payer health care system by expanding a
greatly improved Medicare to everyone residing in the U. S. Patients will
choose their own physicians and hospitals.

HR 676 would cover every person for all necessary medical care including
prescription drugs, hospital, surgical, outpatient services, primary and
preventive care, emergency services, dental (including oral surgery,
periodontics, endodontics), mental health, home health, physical therapy,
rehabilitation (including for substance abuse), vision care and correction,
hearing services including hearing aids, chiropractic, durable medical
equipment, palliative care, podiatric care, and long term care.

HR 676 ends deductibles and co-payments. HR 676 would save hundreds of
billions annually by eliminating the high overhead and profits of the
private health insurance industry.

HR 676 has been endorsed by 633 union organizations including 154 Central
Labor Councils/Area Labor Federations and 44 state AFL-CIO’s (KY, PA, CT,
OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX,
IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV, MA,
RI, NH, ID).

The list of union endorsers.
The sample endorsement resolution.

09/25/2017

AFGE Local 2809 President, John Walton, Jr., reports that his local has endorsed HR 676, national single payer legislation sponsored by Congressman John Conyers.  The local represents approximately 500 members who work at the Social Security Direct Data Operations Center in Wilkes Barre, PA.  The members handle national 800 calls from across the country and seek to resolve issues and answer questions for the public and others.  A recent hiring freeze caused some delays in the processing of forms related to Part D Prescription benefits.

Iris Rakowski, Night Shift Chief Steward, and Martin Vasquez, Sergeant at Arms for the local spoke with Unions for Single Payer.  They report that the membership has seen health care premiums rise and indicated that even a modest increase can create hardship.  They note that in spite of the misconception that government workers make a lot of money, their members make $35,000 to $50,000 on average.

As health care premiums have risen, some workers have had to downgrade their health plan from standard to basic.  That move increases the co-pays charged when the worker seeks care.  And there are deductibles.

The workers choose from a wide variety of plans so there are many different kinds of coverage.  Some workers are in narrow networks and have had to travel more than an hour to Allentown or Bethlehem to be able to see the appropriate in network specialist.

HR 676 was brought to their attention when Dr. Andy Coates, Past President of Physicians for a National Health Program, addressed the Greater Wilkes Barre Central Labor Council earlier this year.  “He provided us with a lot of good information that we weren’t aware of,” said Vasquez.  “We are for everybody.  Our motto is fair and equitable.  We think everyone should be treated with respect–not as a dollar sign.”  So they took a stand for HR 676, Expanded and Improved Medicare for All.

The local joined with other unions in a rally on Saturday May 13, 2017 at Kirby Park in Wilkes Barre from 10 AM to 4 PM.  Labor is united in fighting back against efforts to take away prevailing wage laws, to impose “right to work for less” legislation and other efforts to destroy union rights and to eliminate due process.  The local is working to defeat the anti-worker Hice Act on the national level in addition to supporting HR 676.

Issued by:

Kay Tillow

All Unions Committee for Single Payer Health Care–HR 676
c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551

Email: nursenpo@aol.com
http://unionsforsinglepayer.org
https://www.facebook.com/unionsforsinglepayer

HR 676 would institute a single payer health care system by expanding a
greatly improved Medicare to everyone residing in the U. S. Patients will
choose their own physicians and hospitals.

HR 676 would cover every person for all necessary medical care including
prescription drugs, hospital, surgical, outpatient services, primary and
preventive care, emergency services, dental (including oral surgery,
periodontics, endodontics), mental health, home health, physical therapy,
rehabilitation (including for substance abuse), vision care and correction,
hearing services including hearing aids, chiropractic, durable medical
equipment, palliative care, podiatric care, and long term care.

HR 676 ends deductibles and co-payments. HR 676 would save hundreds of
billions annually by eliminating the high overhead and profits of the
private health insurance industry.

HR 676 has been endorsed by 630 union organizations including 152 Central
Labor Councils/Area Labor Federations and 44 state AFL-CIO’s (KY, PA, CT,
OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX,
IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NJ, NY, NV, MA,
RI, NH, ID).

The list of union endorsers.
The sample endorsement resolution.

06/08/2017

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