- The Institute for Health & Socio-Economic Policy
(IHSP) is "non-profit policy and research group and is the exclusive
research arm of the California Nurses Association/National Nurses Organizing
Committee, (focusing on) current political/economic policy analysis in
health care and other Industries....to enhance, promote and defend the
quality of life for all."
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- In January, it released a "First-of-Its Kind Study"
titled, "Single Payer/Medicare for All: An Economic Stimulus Plan
for the Nation" to reform the system by providing universal care,
adding productive new jobs, billions in public and private revenues, billions
more in employee compensation, and added tax revenues. More on that below.
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- IHSP calls its study an "econometric," not
an "arithmetical" health care system analysis, covering both
their costs and economic benefits to the nation. Its methodology drew on:
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- "widely-used and accessible data bases and econometric
models which are capable of showing how changes in one economic variable
(such as health demand, pricing of services, or taxation of consumers and
employers) will affect not only the health care sectors directly, but also
their suppliers....their employees and their households, and the generation
of federal, state, and local taxes."
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- Elements of its comprehensive coverage include:
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- -- universal eligibility; everybody in, no one excluded;
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- -- everyone under a uniform single standard similar to
Medicare Parts A, B, and D; and
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- -- all enrollees having "the same health services,
costs, eligibility requirements, and administrative cost burden.
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- Indirect Transactions/Activity
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- These occur when providers buy services or supplies to
deliver care:
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- -- in America, $2.1 trillion in expenditures generates
an additional $1.37 trillion in indirect transactions;
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- -- manufacturing with $307.6 billion benefits most; and
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- -- in 2006, health care totaled 9.2% of GDP.
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- Induced Transactions
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- These are health care worker household consumption transactions,
and the indirect sector spending their income:
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- -- they total an estimated $2.3 trillion; and
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- -- again, manufacturing benefits most with another $442.8
billion, for an indirect $750.4 billion total.
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- Total Revenue Generation
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- IHSP "calculated the economic multiplier to be 2.78,
nearly three times the revenues generated within the industry proper."
Total direct and indirect health care revenue is $5.856 trillion.
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- Tax Revenues Generated
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- -- federal: $538.3 in 2006; and
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- -- state and local: $826 billion.
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- Employment
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- -- 18 million health care workers;
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- -- another 26 million jobs in other industries for a
45 million total; and
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- -- nationwide, "health care value added generated
12.1% of employee compensation, and 10.5% of total employment."
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- Occupations
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- Health service industries include 511 occupations, 43%
in management, administration, finance, physical plant operations, and
many other non-health related fields. Registered nurses number about 2.1
million, about 25% of health care professionals. Nursing aides, orderlies,
attendants and home health aides comprise another 25%. Doctors are 3% of
the total.
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- Initial Findings
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- Medicare for all, including Part D will generate:
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- -- $317 billion in increased public and private revenues;
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- -- 2.6 million new permanent jobs at an average income
of $38,262 annually;
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- -- $100 billion in worker compensation;
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- -- $44 billion in new tax revenue - "exclusive of
the funding changes to replace employer insurance contributions;"
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- -- Medicare Part B coverage for 2.6 million Medicare
enrollees;
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- -- Part D coverage for 15 million more;
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- -- full coverage for the 50 million or more uninsured
and millions more underinsured;
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- -- elimination of the uninsured's uncompensated demands
on providers;
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- -- 27.7 million Medicaid recipients will get the same
coverage as others, not the inconsistent kind now offered;
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- -- elimination of $134.9 billion in state and local expenditures
and $175.7 billion for the federal government;
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- -- for the privately insured, ending problems of eligibility,
exclusions, family coverage, premium costs, high out-of-pocket ones, and
likelihood to be uninsured if lose employment;
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- -- for employers, replacing their administrative and
financial burden under a shared universal approach;
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- -- for taxpayers, a reduction of $56 billion in unnecessary,
unproductive insurance costs; and
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- -- for the nation, joining the rest of the industrialized
world that provides universal coverage.
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- Enhanced Medicare for All
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- -- adding 2.6 million Part A only enrollees and 15 million
without Part D will cost about $59 billion, 62% publicly borne;
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- -- the added expense will generate an additional $154.7
billion in total economic activity, about one million new jobs earning
$43.2 billion, and new tax revenues of about $21.2 billion.
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- Covering the Uninsured
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- For a net total spending increase (net of the eliminated
costs for the uninsured) of $44 billion "in 2006 values," a $120
billion in economic impact will be generated, 945,600 new jobs will be
created earning $36.5 billion, and $16.5 billion in taxes will be raised.
In addition, the formerly uninsured will pay a small premium above their
current expense, but will get greatly enhanced care. Providers will also
reduce losses because of non-payments, and emergency rooms will function
as intended.
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- Medicaid
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- The current system is fragmented, inconsistent, expensive,
and fails to provide the full range of preventive and routine care. Discontinuing
it at the federal and state levels will generate a "total net direct
economic impact" of $16.2 billion dollars breaking down as follows:
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- -- total new expenditures of $88.9 billion; and
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- -- discontinuance of $72.7 billion in costs.
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- Total economic activity will increase by $43 billion.
About 336,900 new jobs will be created generating $14.3 billion annually,
and tax revenue increases of $6.3 billion.
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- Medicare Coverage for the Privately Insured
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- It will bring 196.1 million new enrollees into the new
program, standardize their coverage, replace the above enumerated problems,
and eliminate an onerous burden on employers that paid (in 2006) 71% of
insurance premiums, or $510 billion annually. Burdensome administrative
costs will also be eliminated, an estimated $56 billion.
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- The net effect will shift an employer obligation to public
funding and not increase national health costs. It will require more public
administrative capacity, and possibly a new or revised tax structure to
replace the current privately-financed system.
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- An Overview of the Health Care Industry
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- Providers include hospitals, physicians and other health
care professionals, nursing care, home health care, ambulatory health services,
laboratories and testing facilities, and others. They're closely linked
to pharmaceutical, medical equipment, and other producers and suppliers.
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- Employer-provided coverage is the largest funding source.
Privately insured households pay deductibles, or co-pays, and often part
of the insurance premium. Taxpayers are the second largest funding source,
through federal, state, and local health care programs, including Medicare,
Medicaid, and others.
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- IHSP's report includes a detailed analysis of US health
care in 2006, including the composition of the industry, its share of the
economy, and the full, direct and indirect, impact that health care activities
have on other economic sectors.
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- Conclusion
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- IHSP's study concludes that:
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- "a comprehensive Medicare based Single Payer system
can make significant contributions to access of quality care for all US
residents and in the process generate a much needed and very substantial
economic stimulus in the form of jobs, enhanced business and public revenues
and increased wages for the population at large." All this for a small
net $63 billion increase yielding much more in benefits.
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- According to Geri Jenkins, co-president of the National
Nurses Organizing Committee/California Nurses Association (NNOC/CNA):
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- IHSP's analysis shows "for the first time that a
single-payer system could not only solve our healthcare crisis, but also
substantially contribute to putting America back to work and assisting
the economic recovery."
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- The study's lead author and director of the Institute
for Health and Socio-Economic Policy (the NNOC/CNA research arm), Don DeMoro,
added:
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- "If we were to expand our present Medicare system
to cover all Americans, the economic stimulus alone would create an immense
engine that would help drive our national economy for decades to come."
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- All for a tiny fraction of the Wall Street bailouts that
looted the federal Treasury, gravely harmed the country, and delayed for
a future time a far more serious day of reckoning.
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- Physicians for a National Health Program (PNHP) Support
for Universal Single-Payer Coverage
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- PNHP calls the current system "outrageously expensive,
yet inadequate" because of the 50 million or more uninsured and another
30 million or more underinsured. It spends more and delivers less through:
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- "a patchwork system of for-profit payers. Private
insurers necessarily waste health dollars on things (unrelated to care):
overhead, underwriting, billing, sales and marketing (plus) huge profits
and exorbitant executive pay. Doctors and hospitals must maintain costly
administrative staffs to deal with the bureaucracy (consuming nearly one-third)
of Americans' health dollars." The potential savings from single-payer
financing is "more than $350 billion per year....enough to" cover
everyone at no more than the current cost and perhaps less depending on
services provided and if government negotiates lower drug prices the way
other countries do.
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- Consider the benefits - single-payer will cover "all
medically necessary services, including: doctor, hospital, preventive,
long-term care, mental health, reproductive health care, dental, vision,
prescription drug and medical supply costs. Patients" will have free
choice of providers, and doctors will "regain autonomy over patient
care," no longer restricted by insurance company gatekeepers. Overall,
health care in America will achieve a quantum leap improvement compared
to the dysfuntional state it's now in, worse still if Obamacare passes.
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- "HR 3962: Affordable Health Care for America Act"
- The Public Betrayal Act to Enrich the Insurance, Drug, and Large Hospital
Chain Cartels
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- On November 7, by a narrow 51 - 49% majority, the House
passed legislation former CIGNA executive, now critic, Wendall Potter calls
"the Insurance Company Profit Protection and Enhancement Act."
Add the drug and hospital chain cartels that will profit hugely if it's
enacted.
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- Voting for it - 219 Democrats and one Republican. Against
it were the remaining Republicans and 39 Democrats.
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- Among its supporters were cosponsors of "HR 676:
United States National Health Care Act or the Expanded and Improved Medicare
for All Act," including universal single-payer advocates:
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- -- Anthony Weiner (D. NY);
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- -- Danny Davis (D. IL), this writer's representative;
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- -- Jesse Jackson, Jr. (D. IL);
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- -- Barney Frank (D. MA); and
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- -- Barbara Lee (D. CA).
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- Dennis Kucinich (D. OH) explained "Why I Voted No,"
saying:
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- The current "for-profit insurance system....makes
money (by denying) health care." HR 3962 strengthens the source of
the problem. "Clearly, the insurance companies are the problem, not
the solution. They are driving up the cost of health care." They're
the reason why "31 cents of every health care dollar goes to administrative
costs, not toward providing care. Even those with insurance are at risk.
The single biggest cause of bankruptcies in the US is health policies that
do not cover you when you get sick."
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- Instead of fixing the problem, HR 3962 "accelerate(s)
the privatization of health care. (It) inevitably will lead to even more
costs, more subsidies, and higher profits for insurance companies - a bailout
under a blue cross. (The bill) continues the redistribution of wealth to
Wall Street at the expense of" Americans getting the kind of health
care they deserve and badly need.
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- Former president of Physicians for a National Health
Program, Dr. John Geyman, cited HR 3962 saying "No Bill is Better
Than a Bad Bill" in enumerating its negatives, including:
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- -- enriching providers "on the backs of patients
and their families;"
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- -- having "no effective cost containment mechanisms;"
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- -- a public option available only to about six million
people or 2% of the population, and in 2013 will cost more than private
programs for sicker people because insurers are unrestricted on what they
can charge;
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- -- health care will be more, not less expensive; and
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- -- will still leave millions uninsured and millions more
underinsured.
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- "In sum, this (monster won't) fix the major problems
of cost and affordable access. (It) will add new layers of bureaucracy
and complexity, is not fiscally responsible, and is not sustainable."
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- Debate now shifts to the Senate where the best outcome
will be killing Obamacare because "no bill is better than a bad"
one.
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- The California Nurses Association (NSA) said the following:
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- "This Bill Fails to Control Costs." While providing
"limited assistance for some, the inconvenient truth is (it falls)
far short in effective controls on skyrocketing insurance, pharmaceutical
and hospital costs, (does) little to stop insurance companies from denying
needed medical care recommended by doctors, and (provides) little relief
for Americans with employer-sponsored insurance worried about health security
for themselves and their families." And the Senate legislation is
even worse.
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- The National Organization for Women said the "Bill
Obliterates Women's Fundamental Right to Choose" that became law in
the landmark 1973 Roe v. Wade decision, and is still the law of the land.
The Court held that a woman may abort her pregnancy for any reason, up
to when "the fetus becomes viable."
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- HR 3962 violates that right. Except in cases of rape,
incest, or if a woman faces death, the Stupak (D. MI) amendment prohibits
using federal money for insurance covering abortion. It prevents women
participating in insurance exchanges from using their own money to buy
abortion coverage. It denies low-income women access to it entirely.
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- According to the Congressional Budget Office (CBO), it:
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- -- will cost $1.055 trillion over the next decade, netting
out at $894 billion after revenue enhancements;
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- -- mandates coverage and penalizes those without it up
to 2.5% of their income;
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- -- insurance for individuals earning $44,000 pre-tax
will be $5,300, plus another $2,000 in out-of-pocket expenses for an annual
$7,300 total, or 17% of their annual income; families earning $102,000
pre-tax will pay $15,000 in premiums plus another $5,300 in out-of-pocket
costs for a total annual $20,300 cost, or 20% of their annual income; those
earning below these amounts will be eligible for subsidies, based on a
sliding scale, paid directly to insurers;
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- -- includes a watered-down public option by setting up
insurance exchanges through which low income households are subsidized
to make coverage more affordable; the plan is so weak, only an estimated
6 million or fewer will qualify; Physicians for a National Health Program
(PNHP) lists myths and facts about it below;
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- -- expands eligibility for Medicaid;
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- -- lowers the federal deficit by $104 billion by 2019
and even more in the following ten years;
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- -- "substantially reduce(s) the growth of Medicare's
payment rates for most services" by cutting over $400 billion in costs;
the true figure is much higher; more on that below; and
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- -- leaves 18 million uninsured by 2019, including about
six million undocumented immigrants; the Senate Finance Committee's bill
leaves 25 million uninsured.
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- Pre-existing condition exclusions will be prohibited,
but insurers may charge what they wish, so effectively nothing changes.
Endorsing the bill:
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- -- the drug cartel;
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- -- the American Medical Association;
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- -- the US Conference of Catholic Bishops because of the
anti-abortion provision; and
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- -- the AARP, an insurance/financial broker masquerading
as an advocacy group for anyone aged 50 or older.
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- The Centers for Medicare & Medicaid Services' (CMS)
Assessment of Medicare Cuts Under HR 3962
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- On November 13, CMS released estimates of the "costs,
savings, and coverage impacts" of HR 3962, showing Medicare spending
will be cut by a draconian $570.6 billion, well above the CBO figure. Enrollees
unable to cover the difference will be devastated. Millions will get less
care when they most need it. In some cases, hospitals and nursing homes
may deny it altogether.
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- Medicare will introduce "permanent annual productivity
adjustments to price updates for institutional providers" to maximize
"efficiency" - costing $282 billion, over half the total cuts.
They'll affect acute care hospitals, nursing facilities, and home health
agencies, and be based on economic productivity overall, but CMS notes
that:
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- "Except in the case of physician services, we are
not aware of any empirical evidence demonstrating the medical community's
ability to achieve productivity improvements equal to those of (the) overall
economy."
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- As a result, provider costs will rise faster than Medicare
payment increases. They, in turn, will reduce care or opt out of the program
altogether. Many providers have done it because of low compensation. CMS
states:
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- "Providers for whom Medicare constitutes a substantive
portion of their business could find it difficult to remain profitable
and might end their participation in the program (possibly jeopardizing
access to care for beneficiaries)."
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- Medicaid eligibility will also be impacted, threatening
access for millions of poor people, dependent on it as their sole source
of care. Although HR 3962 increases spending by $77.5 billion to cover
the cost of new enrollees, CMS says higher demand may cause providers:
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- "to accept more patients who have private insurance
(with relatively attractive payment rates) and fewer Medicaid" ones
because it won't be cost effective to do it.
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