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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Thursday, July 25, 2013

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Tuesday, July 23, 2013

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Wednesday, July 17, 2013

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Friday, July 12, 2013

‘Obamacare’ Bends for Big Business… Again

Critics blast Obama’s decision to delay mandated employer health insurance in Affordable Care Act that was already a concession to private industry

The one-year delay of what Obama touted as a 'key provision' to his plan will apply to businesses that employ 50 or more full-time workers. The change was announced by the Treasury Department as a concession to big business after employer complaints over the rule's complexity, it said.

Critics charge that this latest delay exposes an underlying truth: Obamacare has been a concession to big business all along, aimed at deepening the privatization of the U.S. health care industry that is responsible for the current crisis.

"The whole bill is built around the needs of the insurance and pharmaceutical industries," Ida Hellander, director of health policy and programs for Physicians for a National Health Program, told Common Dreams. "The delay is just a symptom of this bill being too complicated and too burdensome for the many people who will be uninsured or under-insured under Obamacare."

Single-payer healthcare advocates blast the bill that will leave many without insurance, or with inadequate insurance, while fattening the coffers of the private insurance industry responsible for the current healthcare crisis that has ranked the U.S. lowest in life expectancy among the world's 'wealthiest' nations.

"This is is one more piece of evidence that we will have to replace the current healthcare system with HR 676—the improved and extended medicare for all, single payer bill that provides coverage for everyone," Don Bechler, chair of Single Payer Now, told Common Dreams.

Furthermore, critics charge that Obamacare's complex web of publicly and privately funded insurance plans are complicated, fragmented, and simply leave many people out of the equation. A recent Health Affairs study finds that approximately 30 million in the U.S. will remain uninsuredunder Obamacare.

"What we are seeing is a tremendous fragmentation of our health system," says Hellander. "This is the natural result of centralizing the private healthcare industry. We have already had a 50-year experiment with private healthcare. It has been a failure."

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Former Insurance Exec Offers An Insider's Look At Obamacare

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An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans

by Wendell Potter

Hardcover, 277 pages | purchase

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On March 23, 2010, the Patient Protection and Affordable Care Act was signed into law. It's aimed at making health insurance more affordable and reducing the overall costs of health care.

Some parts of the law have already gone into effect: Insurers can't impose lifetime dollar limits on essential benefits, like hospital stays; children can stay on their parents' plan until they're 26; children with pre-existing conditions can't be denied coverage; and all new insurance plans must cover preventive care and medical screenings.

On Jan. 1, 2014, the heart of the law is scheduled to be up and running, as well: State exchanges are being established where people who don't get health insurance through their workplace will be able to shop for a plan. Sign-ups will begin Oct. 1. These plans must meet certain standards of quality and must be explained clearly with no fine print. And federal subsidies will be available for those who qualify for financial help.

Wendell Potter is the former vice president of corporate communications at the health insurance company Cigna.

Emily Potter/Courtesy of Emily Potter

Even as that date approaches, critics of the health care law are trying to halt the changes. Just last week, when the Obama administration announced it would delay for a year the requirement that employers with 50 or more full-time workers offer health insurance, critics said the move showed the law is fundamentally flawed, and its implementation a mess.

Will the exchanges be up and running in every state? Will insurance be affordable for everyone? Will this radical restructuring of the business of insurance actually work? Wendell Potter, a senior analyst at the Center for Public Integrity, thinks there will be glitches, but he sees that the Affordable Care Act is moving ahead.

He believes that getting more people insured will lower costs in the end. "People who don't have insurance, they still get sick, and they get injured," he tells Fresh Air's Dave Davies, "and most of them, when they do, go to the emergency room. Hospitals can't often collect money from those folks because they often don't have the money to pay for it. They can't turn them away; it's called 'uncompensated care,' but that's a misnomer. Somebody has to pay for that care, and that somebody is you and me if we have private coverage."

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Potter worked inside the insurance industry for 20 years, most recently as head of communications for Cigna. He left that job and now advocates for ways the industry can reform.

Interview Highlights

On how competition will help affordable care

"We're seeing that the competition is working in keeping the rates low, and in some cases insurers that were offering policies, or saying they were going to charge more than their competitors, have come back and said, 'After we saw the competitor's rates, we're going to resubmit.' "

On how the terms of policies will change with the Affordable Care Act

"In today's world there's no standard definition of things like 'co-insurance' or 'co-payments.' People don't know, necessarily, what a lot of the terms are, but they'll have to be spelled out by any health plan that is offering coverage through the exchange. We'll be able to compare one plan with another, and information will have to be presented in a standardized format, not unlike the food labels and nutrition labels on food that we buy in the grocery store. In fact, that was kind of a model that Congress looked at. ... And something that will be going away will be the fine print. And that's where a lot of the most important information has been hidden. ... [I]nsurance companies will no longer be able to hide the most important elements of what is covered and what's not. It will have to be stated very explicitly and in language that people can understand."

On "junk" health insurance plans

"There are junk plans that are out there today, and some of the biggest insurance companies sell them, and they're very profitable for insurance companies. And a lot of people don't know they're in junk plans until they get sick or injured. And they find out at a time when it's really � quite frankly � too late, that they're not adequately covered. And some [plans] have lifetime or annual caps on how much the insurance companies will pay. And, increasingly, plans have very high deductibles. Insurance companies in these cases don't pay anything for coverage until you've paid quite a bit of money out of your own pocket. That's not a big deal for people who are quite wealthy or healthy or don't really need insurance, but for the rest of us � for folks who get sick occasionally, or get very sick, or injured, or who are not as young and healthy as we once were � these plans are not necessarily the best things since sliced bread."

Read an excerpt of Deadly Spin

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Thursday, July 11, 2013

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Wednesday, July 3, 2013

Canadians pay taxes for universal healthcare, and now they’re richer than us

I�ve been watching with some dismay the wrestling match going on between the governor and the Maine Legislature over the opportunity offered by the federal Affordable Care Act to expand our MaineCare program.

Proponents of expansion of MaineCare make their argument on both moral and economic grounds. Such expansion would provide health care coverage for almost 70,000 low-income Mainers who will otherwise receive no assistance from the ACA. More coverage would result in better management of our burgeoning level of chronic illness as our population ages. That will drive down the use of expensive crisis-oriented emergency services as well as the illness-inducing stress produced by out-of-control health care bills in low-income patients already afflicted by poor health.

Since 100 percent of the costs of the proposed expansion would be borne by the federal government for at least the first three years of the program (gradually reduced to 90 percent by 2020), MaineCare expansion under the ACA would also provide significant economic benefits to Maine in the form of federal dollars and the jobs they will create in every county in the state. According to a new study released last week by the Maine Center for Economic Policy and Maine Equal Justice Partners, if MaineCare were expanded under the terms of the ACA it would stimulate more than $350 million in economic activity, lead to the creation of 3,100 new jobs, and result in the generation of up to $18 million in state and local taxes.

Since the Legislature has now refused to override the governor�s veto of the expansion, those federal dollars (including those originating from Maine taxpayers) and their associated benefits will go to other states that accept the deal.

Some opponents of expansion claim that they don�t trust the feds to keep their word (even though it�s now written into law) and that we won�t be able to get rid of the extra costs should they renege on their commitment. Others are simply philosophically opposed to bigger government. It seems as though some are opposing MaineCare expansion simply out of spite.

This fight could be avoided, and is just a symptom of a more fundamental underlying disease � the way we pay for health care in the U.S. Our insurance-based system requires that we slice and dice our population into �risk categories.�

This phenomenon was made worse by PL 90, the �pro-competition� health insurance reform law passed by the Republican legislature in 2011. Now we�re seeing older, rural Mainers pitted against younger, urban ones. This type of discrimination is the very basis of the insurance business.

Many conservatives still characterize Medicaid as �welfare,� and many think of it as such. Presumably other types of health care coverage have been �earned� (think veterans and the military, highly paid executives, union members and congressional staff). We resent our tax dollars going to �freeloaders.� Until the slicing and dicing is ended, the finger pointing, blame shifting and their attendant political wars will continue.

In sharp contrast, our Canadian neighbors feel much differently. Asked if they resent their tax dollars being spent to provide health care to those who can�t afford it on their own, they say they can�t think of a better way to spend them. �Isn�t that what democracy is all about?� I�ve heard Canadian physicians say, �Our universal health care is the highest expression of Canadians caring for each other.�

Here in Maine, the response tends to be much different. Canadians seem to think health care is a human right. We don�t � yet.

If everybody was in the same health care system in the U.S., as is the norm in most wealthy nations, we would be having a much different and more civil conversation than what we are now witnessing in Augusta. No other wealthy country relies on the exorbitantly expensive and divisive practice of insurance underwriting to finance their health care system. They finance their publicly administered systems through broad-based taxes or a simplified system of tax-like, highly regulated premiums. Participation is mandatory and universal.

Taxation gets a bad rap in the U.S. and consequently is politically radioactive. Yet it is the most efficient, most enforceable and fairest way to finance a universal health care system.

In her excellent New Yorker essay called �Tax Time,� Jill LePore points out that taxes are what we pay for civilized society, for modernity and for prosperity. Taxes insure domestic tranquility, provide for the common defense, promote the general welfare, and take some of the edge off of extreme poverty. Taxes protect property and the environment, make business possible and pay for roads, schools, bridges, police, teachers, doctors, nursing homes and medicine.

Oliver Wendell Holmes once said, �Taxes are what we pay for a civilized society.� The wealthy pay more because they have benefited more.

Canada�s tax-financed health care system covers everybody, gets better results, costs about two-thirds of what ours does and is far more popular than ours with both their public and their politicians. There is no opposition to it in the Canadian Parliament.

What�s not to like about that?

Oh yes, and the average Canadian is now wealthier than the average American. Their far more efficient and effective tax-based health care system is part of the reason.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.

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