Source: Opinion, Portland Press Herald December 12, 2016
Time to Support Maine AllCare
Dr. Phil Caper
Founding board member of Maine AllCare
For the past six years, I and a handful of Maine volunteers have been donating our time, efforts and treasure to Maine AllCare, a non-profit organization, that is unique in Maine in its commitment to bringing real structural healthcare reform to Maine and the rest of the United States.
During the past 15 years, we have witnessed the coming - and going - of “Dirigo”, an unsuccessful effort to “reform” the Maine healthcare system by tinkering around the edges of our existing insurance-based for profit system of health insurance. We have also witnessed the coming - and now going - of the Affordable Care Act, a national system based on propping up and augmenting the commercial insurance system and the for-profit system of health care delivery. Even most of the non-profit co-ops established by the ACA, have gone belly-up. Maine’s co-op’s future is tenuous.
The most obvious beneficiaries of the ACA have been health insurance, pharmaceutical and medical device corporations, (whose market caps have risen sharply since the laws’s enactment), and corporate hospital systems. The losers have been the public, with steadily rising insurance premiums and out-of-pocket costs coupled with shrinking coverage despite a rise in the number of people covered - by lousy and unstable insurance - and doctors and other caregivers, who are being crushed by the new administrative burdens created by the ACA.
With the election of Donald Trump and a Congress dominated by a Republican party committed to repealing the ACA (to be replaced by we know not what), the ACA is likely to be changed beyond recognition. Most of the ideas now being floated by Republican health policy wonks have failed in the past. Even Medicare, one of the most successful and popular federal programs ever created, is now under threat despite its 50 year track record of bi-partisan support. Read More
“It’s the Economics!” – A clear call for universal health care from a Maine small business
Editor’s note: The following letter appeared November 18, 2016 in the Bangor Daily News, The Ellsworth American and The Weekly Packet detailing the financial plight of a Blue Hill small business, Lucy’s Granola due to sky high health insurance costs. It is a clear cry to make health care accessible and affordable by everyone in Maine. Please join our work – Subscribe and Support Maine AllCare – in helping Maine businesses owners and their employees become more healthy and successful. You may request a health policy expert to speak before your business group by writing to us.
Fix our health care system
Our family of five should be part of the effort to ensure the success of Maine’s economy. We run a small business with six employees, all paid above the minimum wage. We hire Maine-based consultants and suppliers to help us continue and grow our business.
Despite this, we are now looking for full-time jobs that come with health insurance benefits as we can no longer afford private health insurance. In 2016, we have paid Anthem Blue Cross and Blue Shield $24,257.28 for insurance. Our family deductible is $10,000. By the end of this year, we will have paid more than $34,000 for health insurance for our healthy family. Had we enrolled under the Affordable Health Act our costs would have been more as we do not qualify for the subsidy.
In 2017, Anthem has quoted $33,229.68 for our insurance, not including the $14,300 deductible. That comes to over $47,000 for 2017. Under the Affordable Care Act Bronze Plan, we might be able to bring our costs down to between $36,000 and $40,000. That’s hardly “affordable.”
Today’s health insurance costs are the greatest threat to our economy’s growth and success. Clearly, neither private health insurance nor the Affordable Care Act is affordable for our family. With the result of the election, there is an assumption that the Affordable Care Act will be overturned. We need our elected officials to recognize that their failure to develop a truly affordable health insurance system is preventing the success and growth of our state and national economies. It is long past time that the state and federal governments resolve this crisis.
East Blue Hill
How free coupons for patients help drugmakers hike prices by 1,000%
By Melody Petersen
LA Times, Dec. 5, 2016
Editor’s note: Patients beware! Instead of slowing, drug price increases are accelerating, now in the form of “free” coupons. You can help turn things around by supporting and subscribing to Maine AllCare.
Horizon Pharma charges more than $2,000 for a month’s supply of a prescription pain reliever that is the combination of two cheap drugs available separately over the counter.
Another company, Novum, sells a small tube of a prescription skin rash cream, containing two inexpensive decades-old medicines, for nearly $8,000.
What is key to the companies’ business plan of raising prices by 1,000% or more?
The answer: coupons that deliver Horizon’s pain reliever Vimovo and Novum’s skin cream Alcortin A for as little as nothing to the patient, while leaving America’s health system to pick up much of the rest of the price. Experts warn that the coupons, increasingly being used by dozens of companies, are sharply adding to the nation’s medicine bill. That cost is passed along to most Americans through higher insurance premiums and taxes needed to pay for government health programs.
The success of Horizon and Novum using this strategy demonstrates how America’s convoluted and opaque system of paying for prescription drugs enables executives to set extraordinary prices on modest medicines that have been around for years. The coupons keep patients and doctors from seeing the medicine’s true price tag. (Read More)
Our new bumper stickers are here and ready to be mailed to you!
Please show your support for universal health care by making an online contribution of $4 or more and we’ll mail to you one of these bright, colorful 10x3 inch bumper stickers. HEALTH CARE FOR EVERYONE IN MAINE is a clear message to your community. It affirms that you support a transition to a publicly funded system of comprehensive care accessible to every person in our state – one that will improve both individual health and business productivity, and will costs less overall than what we are paying today.
We welcome contributions in any amount – they are tax deductible – but our main goal is to increase visible support in each community throughout our state.
'Maine' reasons for universal health care
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What Can Maine Doctors Do?
Return medicine to its healing roots — help educate and advocate for universal, single-payer health care that covers every Maine resident
- Join Maine AllCare mailing list, and volunteer to help, including supporting financially
- Join PNHP — www.pnhp.org
- Visit our websites regularly — www.maineallcare.org & www.philcaper.net for more information
- Organize and make your voices heard through the Maine Medical Association
- Doctors have lost influence during the past 30 years or so, but we are far from powerless – they don’t have much of a business without us!
- Doctors are still influential – make your views known
- Write op-eds and letters to the Editor of your local paper
- Testify in person and in writing before the relevant legislative committees when legislation affecting health care is being considered. MAC can help organize these efforts
- Organize speaking events directed at professions and lay audiences for Maine AllCare speakers
- Grand rounds
- Local and specialty medical societies
- Community forums, church groups, Rotary Clubs, Lions Clubs, Chambers of Commerce
If you have ideas about how else we might advance the cause of universal health care here in Maine, please write to us at firstname.lastname@example.org and and put "Idea" in the Subject line. Thank you.
Maine Voices: Trump’s health care policy appears heavy on complexity, light on mercy
Letting the states decide how to insure residents might lead to a cobweb of unwieldy regulations.
By Daniel C. Bryant
The Press Herald, December 5, 2016
CAPE ELIZABETH — Will Donald Trump make our country’s health care system great again? Of course, for many it was never that great in the first place, but it is important to consider what changes may lie ahead during a Trump presidency. For this, we can turn to his website, where he promises to:
- Repeal the Affordable Care Act. Though Mr. Trump has suggested he may keep some features of the ACA, this may mean that 20 million people will lose their health insurance and millions more will find it increasingly hard to find affordable policies with reasonable coverage.
- Replace the ACA with health savings accounts. In the HSA scheme, individuals with high-deductible plans can set aside thousands of dollars of income a year, tax free, to pay future health care costs.
This, of course, limits HSAs to those with extra money to set aside, who will then be faced with the recurring quandary of whether a medical problem “deserves” their depleting their account or should be ignored because something worse might come along.
- Return health insurance regulation to the states. Dealing with 50 different sets of insurance regulations will be a challenge both to businesses with employees living in multiple states and to the companies that provide insurance to those businesses.
And people with costly medical problems will be tempted to move to states that require insurers to offer good coverage, thus burdening those well-intentioned states; while businesses will be tempted to move to states with low coverage requirements and premiums, thus forcing poorer policies on their employees.
- Maximize flexibility for states in administering Medicaid. Like the above, this “states’ rights” emphasis would give states so inclined a tool for modifying their demographics to their economic advantage: namely, by keeping out the poor and the sick.
- Enable people to purchase insurance across state lines. The resulting competition might well reduce premiums, but in order to maintain their bottom lines, for-profit insurers would have to compensate by reducing coverage or provider reimbursement. And it will be tricky, indeed, for insurers to sell group and individual policies across state lines if every state has a different set of regulations.
- Re-establish high-risk pools. By segregating the sick or likely-to-get-sick into “pools,” we shift some of the extra cost of their care to them, and away from the already more fortunate. The balance of the cost must then be paid by the government, which may or may not be willing to do so.
This all flies in the face of the basic idea of insurance, which is to spread cost over the fortunate as well as the unfortunate, not concentrate it. And what is even worse, it perpetuates a two-class system – normal people, and the sick and poor.
- “Modernize” Medicare. This is too vague a prescription to try to interpret at this point; it could mean anything from lowering the age limit and increasing coverage, to phasing out the program altogether.
Reviewing Mr. Trump’s likely health care policies, we can note two themes, both of concern – complexity and inequity.
Complexity, and its associated financial costs, would come from the co-existence of millions of HSAs, millions of individual and employer-sponsored insurance plans and a variety of Medicaid and other governmental programs, all operating within the competing regulations of the 50 different states among which people and businesses are constantly moving.
Inequity, and its associated social costs, would come from the vastly different access to health care that people of different means and locales would have.
The Affordable Care Act, too, is complex, and, though much more equitable than Mr. Trump’s policies, may well not survive. As for the system that the president-elect’s policies would lead to, it will be unlikely to survive either because of its own complexities, and should not because of its inequities.
In the aftermath of both Barack Obama’s and Mr. Trump’s efforts at health care reform, we will be left then to design a new system, preferably the one we should have had all along – a simple and equitable system of the single-payer, Medicare-for-All type, similar to those that every other industrialized country has adopted.
No, Donald Trump will probably not make our health care system great again, but he may, if inadvertently, help to make it great at last.
Maine Voices: The problem isn’t Obamacare; it’s the insurance companies
Patients and primary care physicians are getting the raw end of the deal for the sake of corporate profits.
By Cathleen London, MD
November 28, 2016, The Portland Press Herald
Editor’s note: The following Portland Press Herald article by Dr. Cathleen London, a primary care physician in one of the underserved areas of Maine, shares her real life personal challenges with insurance companies. The examples she cites are very persuasive reasons for transforming our current, wasteful health care financing system into a publicly funded system – one that covers everyone and is paid for by each of us.
MILBRIDGE — With the recent news about increases in premiums for health plans sold through the Affordable Care Act marketplace, everyone wants to vilify the ACA. The ACA is but a symptom of the issue. Where are our policy dollars going?
As a primary care physician, I am on the front lines. Milbridge is remote. In good weather, we are 30 to 40 minutes from the nearest emergency room, so my office operates as an urgent care facility as well as a family medical practice.
It can take 20 minutes for an ambulance to get here (as it did one time when I had a patient in ventricular tachycardia — a fatal rhythm). I have to be stocked to stabilize and treat.
We are also about two hours from specialist care. Fortunately, I am trained to handle about 90 percent of medical problems, as my patients often do not want or do not have the resources to travel. I have to be prepared for much more than I did in Boston or New York City, where I had colleagues and other materials down the hall or nearby. No longer do I have a hospital blocks away.
One evening I was almost home after a full day’s work. Around 7:30, I got a call on the emergency line regarding an 82-year-old man who had fallen and split his head open. His wife wanted to know if I could see him, even though he was not a patient of mine.
Instead of sending them to the ER, I went back to the office. I spent 90 minutes evaluating him, suturing his wound and making sure that nothing more sinister had occurred than a loss of footing by a man who has mild dementia. When I was sure that the man would be safe, I let them go.
I billed a total of $789 for the visit, repair, after-hours and emergency care costs. Stating that the after-hours and emergency services had been billed incorrectly, Martin’s Point Health Care threw out the claims and reimbursed me $105, which does not even cover the suture and other materials I used.
I called them about their decision, said that it was not right and let them know they’d lose me if they reimbursed this as a routine patient visit. They replied, “Go ahead and send your termination letter” – which I did.
The same day, Anthem Blue Cross kept me on the phone for 45 minutes regarding a breast MRI recommended by radiologists on a woman whose mother and sister had died of breast cancer. She’d had five months of breast discharge that wasn’t traceable to anything benign (and it turns out the MRI is highly suspicious for cancer).
Anthem did not want to approve the MRI unless it was to localize a lesion for biopsy, even though the mammogram had been inconclusive! This should have been a slam-dunk fast track to approval; instead, dealing with Anthem wasted a good part of my day.
Then Aetna told me there is no way to negotiate fees in Maine. I was somewhat flabbergasted. I do more here than I did in either Brookline, Massachusetts, or New York. The rates should be higher given the level of care I am providing. I have chosen not to participate with them. This only hurts patients; however, I cannot keep losing money on visits.
I do lose money on MaineCare – their reimbursement is below what it costs me to see a patient. For now, that is a decision that I am living with.
I had thought those losses would be offset by private insurance companies, but their cost shifting to patients is obscene. I pay half of my employees’ health insurance, though I’m not required to by law – I just think it is the right thing to do.
My personal policy costs close to $900 a month for me and my sons (all healthy), and each of us has a $6,000 deductible. This means I am paying rack rate for a policy that provides only bare-bones coverage.
Something is wrong with the system. In one day, I encountered everything wrong with insurance. I am not trying to scam the system. I am literally trying to survive. I am trying to give care in an underserved area.
This is not the fault of Obamacare, which stopped the most egregious problems with insurance companies. Remember lifetime caps? Remember denials for pre-existing conditions? Remember the retroactive cancellation of insurance policies? Returning to that is not an option.
One answer is direct primary care: contracting straight with patients to provide their care, instead of going through insurance companies to get paid. I offer it (though I still accept Medicare, MaineCare and some private insurers). Many of my colleagues have also opted for direct primary care – they’ve experienced the same frustrations I have.
Something has to change if we are to attract up-and-coming medical students to primary care and retain practicing physicians. When both patients and physicians are frustrated, we know that only greed is winning, and the blame for that lies with corporations.