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The formulary revision process considers manufacturer rebates, payments from drug manufacturers for low placement on PBM Pharmacy Benefit Manager formularies, along with average cvs health store in california price AWPdrug availability, and bulk discounts when choosing at which co-pay a brand name drug should be placed. Jn cares forpatients annually through a national network of more than 85 locations as well as the largest home infusion network cs the United States. I'm already a fan, gealth show this again. Review the Patch Community Guidelines. Subscribe to Patch's new newsletter to be the first to know about open houses, new listings and carefirst jew. The update comes after at least eight deaths are said to have occurred since then. Bloomberg -- Oil steadied as traders looked to a revival in Chinese demand this year after data showed that the economy fared better than expected last quarter, with further clues on the outlook to come in an OPEC analysis.

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The study concludes that the deaths of about 45, people each year are associated with the lack of health insurance. Americans are satisfied with their insurance - Not! Employer-sponsored health plans insure not only the largest sector of our society, but also the healthiest: the healthy workforce and their young healthy families. Because of the greater purchasing leverage of employers, economies of group plans, better regulatory oversight, and the lower average health care needs of the beneficiaries, premiums being paid for employer-sponsored plans represent the greatest value that we can expect in health care financing.

Insurance exchange loopholes In health care, we spend more and receive less, and everyone agrees that has to change. The decision has been made that we will do that by regulating our dysfunctional health insurance market, and then mandate that everyone who is not covered by other qualifying programs be required to purchase private health plans. To be certain that everyone has access to a plan, an insurance exchange will be established.

Sarah Palin feeds the fact checkers The heated debate over health care reform was certainly not unexpected. What has been a surprise to many of us is the intensity of the nastiness of the opponents of reform. Census Bureau report on health insurance coverage President Obama, in his speech before the joint session of Congress last evening, did not break new ground on the current proposal for reform being developed by Congress and the administration.

So, based on the framework that has been advanced, what impact will the current proposal have on the numbers of uninsured? Implications of growth in health care spending Average-income Americans - the majority of us - are finding the impact of health spending growth to be onerous, and it will get worse.

Fooled by the public option debate In his Labor Day speech yesterday, President Obama, in using his "I continue to believe Matt Taibbi's well researched article tells us where we are and how we got here. It's a must read for those who care. Hopefully it will motivate us to put down our Hallmark cards and join in the fight for real health care justice for all.

How much will reform cost me? More lessons from Massachusetts Although there are many reports on the deficiencies of the Massachusetts reforms, this report stresses two serious design flaws that impair affordability and access for low and middle income patients: 1 both public and private plans often fail to provide adequate financial protection even for those with only modest health care needs, and 2 the complex maze of programs and plans are very difficult to navigate with ever changing eligibility for the various programs, leading to frequent unavoidable lapses in coverage or no coverage at all.

Paying for community health centers Regardless of what proposals for health care reform are adopted, it is essential that financing be included for non-profit community health centers in underserved rural, urban and suburban communities.

Would these centers be better served by health insurance exchanges and their private plans, or by a public financing program? Over 2. This report adds to that data by demonstrating that medical debt is much more common than is reflected in the bankruptcy data, and is serious enough to have adverse consequences since it often results in individuals delaying or forgoing needed health care.

What's beautiful about the Medicare Advantage program is that it has provided us with a real-life laboratory experiment which allows us to compare the functioning of highly-regulated private insurance plans as contrasted with the functioning of a public insurance program: traditional Medicare.

The results are in, though that would be tough to ascertain if you simply observe the response of Congress. Former Jasper County Republican Chairman on Single Payer If you set politics aside and look at proposed policies for reform, the logic of a single-payer, improved Medicare for all should unite those with views as diverse as a Democrat fighting for health care justice and a Republican demanding common sense business principles that would provide all of us with much greater value in health care.

Employers Face With the decision of Congress to leave private insurers in charge, and with no measures that would have any major impact on slowing health care spending, it can be anticipated that these outrageous increases will continue even after reform is enacted. Europe leads in pharmaceutical research Our uniquely American health care system is noted for its high prices for relative mediocrity.

Some contend that our pharmaceutical industry provides an exception. It doesn't. We are paying high prices for new chemical entities that over 85 percent of the time are providing us with no real benefit over existing products.

Reid has demonstrated how other nations have higher performance health care systems that take care of everyone and at a much lower cost than in the United States. Uwe Reinhardt on the public option The brouhaha over the public option is more than just symbolic.

The accusation is correct: the public option was perceived as a means to move us toward single payer, while respecting the right of others to continue with their current coverage if they so preferred. The progressive camp was divided over this strategy since some of us believed that jettisoning single payer in favor of the public option would result in a bargaining position in which the public option would have to be traded away in exchange for some insurance market reforms.

Those single payer advocates who agreed to support the public option now feel betrayed. Concerns about reform efforts A PhD thesis could be written over just what this survey tells us, but we're certainly not going to do that here.

Give this some thought. Think about what this might mean. Then think about what we should be doing in response. And then do it! Policies to address out-of-network charges What are private insurers selling us? Their primary product is a network of health care providers that have contracted to accept the insurers' rates. The benefit of that is that it has helped to slow the rate of increase in health insurance premiums. One major problem with that is individuals frequently obtain care from out-of-network providers - usually not by choice, but by medical circumstances not really under the control of the patient.

Under most insurance plans, the individual then becomes responsible for payment of most or all of the out-of-network charges. Obama on choice of physician Obviously, giving someone who lives in Maine the choice of having the option for an expense-paid trip to California to receive health care is not one of the goals of health care reform.

That's not exactly what is meant by choice. This was an exaggeration on the part of the President to make the point that, of course, we can't have choice.

Conservative leader David Cameron on the NHS For those of us in the United States who want to know more about the horrors of their government-run, socialist system of health care, Conservative David Cameron would be the first to expose how government ownership and management are a threat to the health of the people. But that is not his message. Uwe Reinhardt on ethics and economics of end-of-life care Ethics meets economics not only at the end of life, but throughout a lifetime of health care.

Economics provides us with various alternatives on financing health care, and ethics provides us with the decency to do it the right way.

Helen Thomas on single payer Helen Thomas doesn't ever give up, thank goodness. As she writes, President Obama "still has time to do the right thing. AHIP explains why private insurance is a bad deal As we look at comprehensive health care reform, we really have to ask ourselves just what is it that the private insurance plans are providing us in exchange for their exorbitantly high administrative costs and the costly administrative burden they place on the health care delivery system?

Prevention and wellness - phantom savings and real costs Prevention and wellness programs frequently can be very beneficial for our physical health and our sense of well being, and when they are, they may well be worth the investment of our time and money. Nicholas Skala We at Physicians for a National Health Program are terribly saddened to report the sudden and unexpected loss of one of our staff members, Nicholas Skala, who died over the weekend in his Chicago home at the age of 27 of unknown causes.

Being dedicated to the health care consumer, they are helping their commercial plan enrollees manage their health-related finances and information through the Quicken Health Expense Tracker developed by Intuit jointly with their own Ingenix division. This is the industry's solution for reducing the administrative complexity and waste of our fragmented, multi-payer system.

Or is it? Bending the cost curve Once again. The stated goals of health care reform are 1 to cover everyone, and 2 to slow the growth in health care costs so that health care is affordable. So what is Congress doing? Health Insurance Exchange? Lessons from California Most progressive policy wonks observing the reform process taking place in Washington have been quite smug.

As the battles take place over a public option, over taxing employer-sponsored plans, or over the eligibility thresholds for government subsidies, these wonks are complacent knowing that the really important reform taking place is the establishment of the Health Insurance Exchange. Or so they believe. Marilyn Clement Marilyn never gave up, though she left us yesterday, August 3, We have work to do!

Poisoning thought with words Click on the link above now. At the bottom of this article you will find another link to the full PDF version 2 pages. Download it now. It will be a very important resource during the August recess when tens of millions of dollars will be spent to keep our thought processes suppressed by the poisonous rhetoric of carefully-crafted nice words - a process that has permeated our national dialogue on health reform.

It is ideas, not words, that count. President Obama's hardship waivers Play with the numbers all you want. Using the model of reform selected by the President and Congress automatically limits the total subsidies to an amount that will not increase the deficit in the federal budget.

Even if the majority of employers continue to displace wage or salary increases in exchange for health benefits, the number of hardship waivers issued will have to be much larger than most are projecting. If employers finally bail out, the majority of us would require hardship waivers. John Geyman's "The Cancer Generation" No topic could serve as a better proxy for the deficiencies in the financing and delivery of health care in the United States than the ever increasing prevalence and expense of cancer.

In The Cancer Generation, John Geyman describes the tragic and costly impact of the cancer burden, but then provides us with hope by describing a plan that would reduce these burdens of cancer. Public option leads nosedive on reform The progressive community has really blown it. The decision was to make "choice" the rallying cry for comprehensive reform - choosing to keep the insurance you have if that's what you want, or to choose a program like the members of Congress have.

It seemed not to matter that the public didn't understand that FEHBP was basically an exchange of private plans offered to government employees, much less how a Medicare-like program might play a role. President Obama speaks the truth about single payer President Obama: I want to cover everybody. Now, the truth is that unless you have a what's called a single-payer system in which everybody is automatically covered, then you're probably not going to reach every single individual There has been intense interest in providing the administration with greater control over Medicare spending in order to bend down the trajectory of projected increases in spending.

Biotech lobbyists cast their nets The vote on the data exclusivity amendment was covered in a qotd last week, at the link above. More background information is provided by Lisa Wangsness in her Boston Globe article. Because of the implications for the reform process unfolding in Washington, we are taking a second look.

Is restraining federal health care spending the goal? Is the health care cost debate limited to concerns about federal spending on health care, or is it about total health care spending? The distinction is very important because, if policies are limited to slowing the increase in the rate of federal health spending, many of those policies simply transfer costs from the government to individuals and businesses.

It will give us little consolation to see the health care component of the federal budget in balance if individuals and businesses can't afford health care. False promise of choice Imagine presidential candidate Barack Obama telling his audiences during the campaign, "We promise you choice. For most of you already receiving your health insurance through your place on employment, we will provide you with the choice of keeping that insurance plan or paying heavy financial penalties for dropping off the plan, no matter how unhappy you are with it.

For a select few of you, we will offer the choice of private plans within an insurance exchange, even if you can't afford them, and maybe even throw in a public plan that a couple of you may be able to purchase, if you meet our rigid enrollment criteria.

House bill includes transfer from wealthy Health insurance and health care are no longer affordable for average-income individuals. Any reform proposal that would make health care affordable for everyone must include a transfer from the wealthy to average- and low-income individuals. Bernie Sanders just offered an amendment to the Senate HELP health care reform bill that would allow a limited number of state experiments with single payer systems. The proposal would have provided waivers from federal regulations such as ERISA, and would have authorized current federal spending on programs such as Medicare and Medicaid to be transferred to the state to be used in the single payer program.

It has been running at the corner of my computer screen while I have worked on other projects. Since I am not competent at multi-tasking, I'm pretty jaded right now. Bill Moyers on "The Select Few" The public option was the strategy of a large group of progressives to circumvent "the select few" who have continued to make sure that comprehensive reform was not politically feasible. With the favorable election results and with their campaign to market "your choice of health plans," the progressives were confidant that they would be able to use the public option as a backdoor entry to affordable health care for all.

Excluding seasonal agricultural workers Everyone should have health care. Premium increases in non-profit health plans Once Congress passes a mandate for individuals to purchase health plans, presumably non-profit Regence BlueShield, as the largest provider of individual plans in the state of Washington, would be a provider of those plans. Also, Group Health Cooperative is the co-op that has been proposed to serve as a model for the public option.

Can Medicaid fill the gap? From the start it was recognized that insurance exchanges, even if they included a public option, could never provide affordable coverage for low-income individuals. The Medicaid program would have to be expanded to cover this more vulnerable population. Pay-go that builds rather than destroys As expected, Congress ran into problems when they tried to figure out how to pay for health care reform.

They stubbornly adhered to the principle that reform must be built on our dysfunctional system of profitable private plans for the healthy and taxpayer-financed public programs for the sick, even though numerous studies have shown that this is the most expensive model of reform.

Insurance disruptions due to spousal Medicare transitions Most individuals experience a sense of relief on turning 65 because they know that they have the security of being covered by Medicare for the remainder of their lives.

But that relief is often tempered by concerns over the transitional problem of having a wife who is not yet 65, but who experiences a disruption in her insurance because she had been covered as a dependent on her husband's plan. This study demonstrates that such disruptions can have adverse consequences for health care. NHIS numbers, and building on what works Everywhere you turn those rejecting single payer, including President Obama, say that we want to build on what works and fix what's broken.

They say that what works is our employer-sponsored system of coverage. But does it? Does US Chamber soft talk hide their agenda? Regardless, are the owners of America's businesses really as heartless as this jerk implies? Do they really believe that their workers would be "getting the shaft" by having health insurance with adequate benefits?

Starr, Reich and Kuttner on the public option To rephrase the very important point that Paul Starr brings to this debate, it is not the design of the public option that is crucial to successful reform under the model being advanced in Congress, but rather it is that the design of the insurance exchanges must be absolutely compliant with the rules of social insurance. If the exchanges are poorly designed, the public option would become a Medicaid-like dumping ground for low-income people with high-cost problems, and would suffer from a lack of willing providers because of chronic underfunding.

And poorly designed exchanges could never meet the test of social insurance. Uninsured by choice By now you must be annoyed by those on the right who repeatedly claim that we do not have a problem with uninsured individuals.

They say that the actual problem is that we are not counting them properly. Most of the uninsured would be insured, if only they showed a little more personal responsibility. An insurance insider speaks up Wendell Potter, a former CIGNA executive, provides an insider's view as to what type of behavior we can expect from the private insurance industry after reform is enacted.

No matter the details of the reform legislation, the industry will always find innovative ways to advance the interests of their executives and their investors. It is absolutely inevitable that these innovations will be to the detriment of patients and payers. Now if only we can convert the single payer dialogue into single payer policy. David Brooks - Kill this effort and start over You state that John Sheils has shown that building on the existing system is the single most expensive option for reform.

What you didn't state is that Sheils has also shown that a single payer national health program is the least expensive, and is the most effective in achieving the goals of universality and cost containment. House Tri-Committee public option With the release of the discussion draft of the House Tri-Committee reform proposal, the progressive community is celebrating the decision to include a "strong public option" within the health insurance exchange.

Its innovative feature, different from other public option proposals, is that it would use lower Medicare-based rates for the first three years, enabling the public option to displace some higher-premium private plans within the insurance exchange.

Then in the fourth year, rates would be adjusted to provide a level playing field with the private plans. Senate Finance proposes unaffordable underinsurance The Senate Finance Committee members were informed by the Congressional Budget Office that the impact their preliminary reform proposal would have on the federal budget would be much greater than a bipartisan consensus would permit.

Before moving further forward with the legislative process, the committee is considering changes to reduce the amount of funds that would have to be budgeted. The draft proposal cited above is not a definitive recommendation but merely presents ideas for discussion. Scrushy and the medical-industrial complex: a lesson for reformers In a landmark New England Journal of Medicine editorial, former Editor-in-Chief Arnold Relman warned us of the new "Medical-Industrial Complex," referring to "a medical care system that had begun to attract investors, and in which business interests had started to reshape the behavior of doctors and health care facilities.

Bernie Sanders' Petition to Congress Let's let Congress know how many of us there are who really care. CBO score: everyone covered, except 37 million Since the Affordable Health Choices Act and the CBO analysis of it are works in progress, the estimates of the net numbers who will gain insurance coverage and the net cost to the government are only preliminary and will likely change with refinements in the legislation and the analysis.

What will not change are the fundamental implications of financing health care through government subsidized private health plans plus public programs. President Obama's proposal to pay for reform What does President Obama mean when he says that this is how we're going to pay for most of his health care reform proposals?

Is he referring to savings in the actual costs of health care that would offset the increased spending that would result from expanding coverage? Or is he merely referring to a decrease in government spending that helps with government budgets, but doesn't really have much impact on our total national health expenditures NHE?

The view of those in the trenches supporting health care for all The Health Care Council of Orange County California has a mission of promoting access to improved health care for all Orange County residents through unified efforts to identify and address areas of need through research, collaboration, education and advocacy.

The audience attending the annual meeting was composed of individuals who are quite well informed on the problems with our health care system, and they have been following the reform efforts taking place in Washington.

Their opinions should matter to us. AMA and PNHP on public insurance In opposing a government-sponsored insurance plan, why would the AMA limit its objection to a public plan that would cover only non-disabled individuals under age 65? What about those over 65 and those with long-term disabilities?

Of course, they are covered by Medicare, a plan that the AMA continues to lobby for, even though they were vehemently opposed to it before it was enacted. House HELP Committee hearing on single payer Although there are many individual heroes in the single payer movement, joint citizen activism has played a crucial role in bringing the single payer message to a formal, official hearing before a committee of the House of Representatives - a hearing devoted exclusively to single payer.

Expand state programs for low-income individuals? Because of the very high costs of health care, the private insurers have not been able to offer products to low-income individuals that they can afford. In response, the federal and state governments have enacted programs designed to meet the health care needs of low-income individuals, usually financed jointly by the federal and state governments and administered by the states. Kaiser Health Tracking Poll Pretending that the majority of Americans would risk their current health security for a more egalitarian system for everyone will not move the process for reform forward.

Only when people understand that a single payer system would benefit them individually would they be willing to support reform that incidentally benefits everyone else as well. We still have work to do. President Obama on the individual mandate He said that if we make people responsible for their own insurance individual mandate , then we must grant a hardship waiver to exempt people who cannot afford it.

But the primary reason that people have not purchased insurance in the individual market is that the plans are not affordable. Most of these individuals will be eligible for the hardship waiver and will remain uninsured. Medical bankruptcies increasing In the United States, medical bankruptcy is very real, it is common, and it impacts primarily the insured middle class. And Congress is going to fix it with more of the same broken financing system? Will WellPoint support any reform?

How have they done that? In the individual market, they have limited their exposure to risk by medical underwriting - not selling policies to individuals who might need health care. In the small-business market, they also limit loss by increasing premiums to unaffordable levels for any business that has an unfavorable claims experience, causing those firms to drop coverage. Growth of employer-sponsored underinsurance With the reform debate having been diverted to issues such as offering a public option, changing the tax status of employer-sponsored coverage, or mandating individuals to purchase insurance, little attention is being paid to some of the most fundamental flaws in our dysfunctional system of financing health care.

One of the most important has been the ever-increasing incidence of underinsurance that has created financial hardship for individuals and families who do have health insurance coverage. More small firms drop health care Rampant health care cost escalation is a problem for everyone. In bad economic times the problems are compounded, threatening the viability of employer-sponsored coverage.

Small businesses that operate on very narrow margins have no choice but to reduce health benefits by either shifting more of the health care costs to their employees, or by eliminating health plans altogether. The fault lies not with the small business owners, but with the flawed U. Baucus defines universal coverage So according to Sen.

Baucus, a key to reform is "everyone having health insurance. That's "pretty good," he says. That number should be front and center in our national dialogue on reform. It is important that we understand what it means. The reform proposal of the conservative Republicans "The Patients' Choice Act of " is one of two Republican proposals for health care reform being released today and is considered to be the more conservative version.

The other, "The Medical Rights Act," is being introduced by the "Tuesday Group" of centrist Republicans in the House, though their report has not been released as of this moment. Senate Finance report on financing health care reform Tomorrow the members of the Senate Finance Committee will retreat to a closed-door session, taking this report with them to walk through their options for financing comprehensive health care reform.

Baucus and others have said that the success of the reform effort is dependent on their ability to find ways to pay for it. What are their prospects for success? Medicare beats employer-sponsored plans Very few individuals, especially those already covered by Medicare, will be surprised by this study.

It demonstrates that, compared to people under 65 with private employer-sponsored coverage, Medicare beneficiaries over 65 have fewer problems with access to care, have less financial hardship due to medical bills, and have higher overall satisfaction with their coverage.

Health Insurance Exchange and private plan behavior Although no final decisions have been made, our congressional leaders have made it clear that reform will be built on the existing model of private plans and public programs. Although the private insurance industry has promised full cooperation with reform, most moderates and progressives understand that legislated insurance market reforms will be essential if the industry is expected to live up to its promises.

Marcia Angell's testimony before Senate Finance It didn't happen. After nurses and physicians supporting single payer were removed from the audience, single payer was mentioned once only parenthetically. Finance Committee member assignments Sen. Max Baucus has set an agenda to send a comprehensive health care reform bill to President Obama within the next few months.

The significance of the assignments given to each of the Democratic members of the Senate Finance Committee is that they provide considerable insight as to the policies that are likely to be included in the legislative package. Ed Schultz interviews Dr. Margaret Flowers When you have 11 minutes, view this video.

Then share it with others. It is Frank Luntz's recommendation to the Republican politicians on how to frame the debate over health care reform. If you have been listening to the Republicans speak on reform, you have already heard some of the rhetoric, and you will recognize it as you read this report.

Schumer kills reform The success of the effort to reform health care seemed to be threatened by the disagreement over whether or not a public insurance option should be offered to compete with private health plans. All Republicans have expressed opposition to the public option, indicating that it would be a deal breaker if included. The Progressive Caucus in the House, which actually wants single payer, has taken a position that leaving the public option out of the reform legislation would be a deal breaker.

Baucus respects our views Apparently the single payer views must have been held very deeply, hidden in the minds of the Senators and the witnesses, since at no time during the hearing was single payer discussed as an option for reform. Medical student debt and specialty selection This statement from a highly respected executive of a not-for-profit managed care organization, and this new GAO report, both further confirm what we already knew. Medical students are graduating with excessive debt, and this is likely contributing to the decline in the numbers choosing the primary care specialties.

Uwe Reinhardt's prescience on the auto industry It was almost six years ago that Uwe Reinhardt called the Big Three "a social insurance system that sells cars to finance itself. But how prescient! Chaoulli's private clinic waiting room death Dr. Chaoulli's patient did not die while on a waiting list for an elective orthopedic procedure. He collapsed and died in Dr. Chaoulli's private waiting room. Chaoulli withheld cardiopulmonary resuscitation - a standard of care that surely would have been provided in any public health care facility - with questions over whether or not he had adequately trained staff and appropriate equipment to initiate such care.

Chaoulli then asked his nurse to call to have the body removed , and he returned to his work. Only after the ambulance team arrived was cardiopulmonary resuscitation instituted. Marie Cocco on insurers' definition of reform For the insurance industry, reform means expanding their successful business model to include more individuals in their plans while shifting the higher costs to the government taxpayers.

Most people do not want to be required to purchase health plans at premiums they cannot afford, and then be stuck with inadequate coverage designed to keep premiums from climbing even higher. Yet, as Marie Cocco makes clear, the insurance industry's version of reform would reinforce precisely what is wrong with our health care financing. Merton Bernstein and Nancy Pelosi on applying science to health care reform Whether you call it Medicare-for-all, or national health insurance, or single payer, Merton Bernstein describes well the irrational, unscientific effort to keep off the table the concept of a truly universal, efficient, publicly administered and publicly financed national health program.

David Himmelstein's testimony The definitive legislation on health care reform that will be supported by the Democratic leadership in Congress has not yet been written. This important testimony by PNHP's David Himmelstein confirms that single payer reform is still in play, in spite of dismissive comments by many of those involved. Reinhardt's Ways and Means testimony on insurance market reforms In a comparatively brief statement, Uwe Reinhardt explained to the members of the House Ways and Means Committee the principles and rationale of social insurance.

His statement should be downloaded as a valuable resource for supporting some of the important policies for reform, and for refuting those policies that perpetuate inequities and injustices and may cause even further harm.

Do Americans support an individual mandate? If this article gains traction, the conclusion that likely will be reported is that Americans support an individual mandate to purchase insurance as long as it incorporates "shared responsibility.

Jonathan Cohn interviews Taiwan's Dr. Michael Chen Our political leaders keep telling us that Americans don't want single payer, but instead we want a uniquely American solution for all Americans. So what did Taiwan do? They looked at health care systems throughout the world, and they chose a uniquely American system for Taiwan! And it really works well. Theoretically, the government would do this by extracting unfair concessions from the health care providers, pricing the public option at a lower level than the private insurance sector could ever meet.

This ignores the more important evidence such as the demonstrated greater efficiencies of our public Medicare program when contrasted with the private Medicare Advantage plans. Options for health care cost control High health care costs are the primary driving force behind the renewed effort for reform.

Everyone agrees that high costs are straining personal, business and government budgets, and something must be done to make health care affordable for all of us.

Jacob Hacker provides details for public option This is a very important paper because addresses one of the most controversial issues in the current health care reform debate: Should a Medicare-like plan be offered in competition with a market of private health plans?

Lewin report on the public option No details have been released by either Congress or the administration about the specifics of a potential public insurance option that could be offered in competition within a market of private health plans. Nevertheless, to provide an analysis of how such a plan might work, The Lewin Group used certain assumptions to prepare this simulation. McClellan asks, "What would be the point? The only hope for gaining the support of Republicans is to make the government option "look like another private sector choice, and then what would be the point?

How many doctors support single payer? This study supports the findings of other surveys that confirm that almost all physicians want reform of our current health care system, but they remain divided over whether or not we should replace the private insurance system with a government-run, taxpayer-financed program.

Reid had hosted FRONTLINE's "Sick Around the World," an important documentary describing successful health programs in several other nations that provide care for everyone at a fraction of the costs of our fragmented, inefficient health care system that leaves so many out.

We were looking forward to T. Reid's sequel, "Sick Around America," describing the problems with our private insurance system. Many of us were disappointed with the format of the program, believing that they missed a great opportunity to educate the nation on several health policies that would work well for all of us. Thus it was no surprise to us that T. Reid was not mentioned during the program, nor in the credits. Views on IRAs and HSAs contrast sharply Much has already been written about the wisdom, or lack thereof, of health savings accounts HSAs and the high-deductible health plans that are linked with them.

By design, they benefit higher-income individuals who are able to take advantage of the regressive tax policies, and who remain healthy, allowing the savings to accumulate for use in their retirement years. But they don't work for individuals with modest incomes who have significant health care needs. Insurers waste your dollars to invade your privacy and cheat you The health care financing systems in other nations are designed to assist patients in paying for their health care.

Computerized searches of personal drug use as described in this article is yet one more example of how our private insurance industry adopts policies that are designed to avoid paying for the patients' health care.

Much more important is that the primary theme of this report, as exemplified by the sampling of recommendations listed above, is that we should continue with the status quo, dumping more of our dollars into our dysfunctional, wasteful, inefficient, fragmented system of financing health care. Bernie Sanders introduces single payer bill At a rare time in our history when comprehensive reform may become a reality, it is important that the single payer model be represented in the legislative process.

The House already has Rep. John Conyers' H. Jim McDermott's H. Bernie Sanders' S. Himmelstein and Woolhandler on a public plan option The option to purchase a public plan within a market of private health insurance plans would merely provide one more player in our inefficient, dysfunctional, fragmented, multi-payer system of financing health care, that is if the public option even survives the political process.

It would leave in place the deficiencies that have resulted in very high costs with the poorest health care value of all nations i. Culling dependent coverage a great return on investment Doing eligibility audits of dependents covered by employer-sponsored plans is yet one more example wherein our current dysfunctional system of financing health care actually promotes administrative waste. A rational system uses administrative services efficiently to pay for the health care that patients need.

In the United States, much of the administrative cost of health care financing is due to efforts to avoid paying for health care. Battle over public option to private insurance plans Perhaps the surest sign of trouble for the proposal to offer a public Medicare-like plan to compete with private insurance plans is the commitment of Finance Chairman Max Baucus that reform will be bipartisan along with the adamant opposition of a public option by Ranking Member Charles Grassley.

Having discarded other public insurance proposals such as single payer, even before the negotiations began, the competing Medicare-like option is standing alone as the obvious trade-away for achieving political consensus.

Bayh howls with the Blue Dogs The Blue Dog coalition in the House of Representatives has often assisted Republicans in preventing the advancement or even the introduction of progressive legislation that increases government spending.

Supposedly their mission is merely to avoid deficit spending by enforcing "paygo" rules all new spending is offset with other program cuts or with new revenues , but all too often they seem to not only support elimination of deficit spending, but also the policy of "no new taxes.

Real life medical debt bankruptcies Landmark studies have confirmed beyond any doubt that medical debt is a significant contributor to personal bankruptcy.

Yet the opponents of comprehensive reform continue to challenge the data. In the report of John Goodman and his colleagues discussed in yesterday's message, they stated, "Well-designed economic studies have found no statistical link between bankruptcies and health problems.

Tenet paid overtime hours by math, not money Although PNHP is most noted for its advocacy of a single payer national health program, we also oppose the perversities of for-profit health care corporations in which the primary responsibility of the board of directors is to their investors. Tenet Healthcare has provided us with innumerable examples of these perversities. SCHIP - a lesson on demographic incrementalism Incrementalism: the crossroads of policy and politics.

Health insurance and eye care This study confirms that what we already know about the importance of insurance in improving access and utilization of health care also applies specifically to eye care. Individuals with insurance have higher rates of access and utilization of eye care than those who are uninsured and those have have interruptions of their insurance coverage.

We are bothers and sisters in the cause. The ultimate goals of both organizations are the same, but the strategies are quite different. Bloomberg columnist on single payer Single payer should not only be back in the national dialogue on reform, it should be front and center as the golden standard by which all other options are compared.

A health insurance broker speaks up John Sinibaldi has provided a consistent voice behind the scenes expressing many of the problems with our private insurance industry and the clear need for reform. His observations have been very helpful to me in providing insight to many of these issues, from the industry's perspective.

They would create a standard of underinsurance, require all of us to purchase their products, and pretend to address affordability issues through tax credits. Emphatically, yes. Herring is theoretically an academic purist, and has no relationship with the single payer community. Many of his policy studies on private health insurance have been done with Mark Pauly, of "moral hazard" fame.

That would certainly place him outside of the single payer camp. Deliberate, explicit rationing of hospital beds - in the U. This article points out that a final decision has not been made, but it is nevertheless shocking that a non-profit university hospital has had under consideration a proposal to reduce the number of beds in an emergency room that already has a strained capacity. What is the background here? David Himmelstein and Len Nichols debate Primarily because of political perceptions, Len Nichols continues to support what he believes to be the pragmatic approach of covering everyone with regulated private plans.

However, when experts like David Himmelstein continue to confront him with the facts about our flawed financing system, Nichols' support for private insurance seems to be shifting from knowing that it would work, to wishing that it could, even though "our system is a mess. Nobel Laureate Joseph Stiglitz on single payer Joseph Stiglitz's response must be shared with the nation, and especially with those in Washington who say that single payer is not feasible.

We should inundate Washington with his statement that single payer is "the only alternative. Health care spending for These are the most reliable numbers to use that represent our health care spending for this year. Rounding off these numbers makes them easier to remember and eases communication of the amounts. OECD: Health Care Reform in the United States OECD reports are important not only because of their credible studies of economic conditions throughout the world, but also because they are used for policy decisions in the thirty member nations including the U.

Thus it is important to understand this new OECD report, "Health Care Reform in the United States," especially at this time when intensive reform efforts are taking place in Washington. Who is behind those closed doors in the Senate? In this time of transparency and Change, when we have an open window of opportunity to finally fix our very sick health care system, we are reverting to a closed door process dominated by the most powerful lobbyists in the nation whose interests take precedence over the American patient?!

Single payer - over on the side table The good news is that individuals from the media and from the policy community are acknowledging, on the side, that single payer would cover everyone, would improve health outcomes, and would cost less than the other current proposals for reform. Today's quotes are only a few examples of a multitude of such comments.

Single payer has not been removed from the national dialogue on reform. Massachusetts' plan is the wrong model for the U. Those supporting the leading Democratic model for reform frequently cite the Massachusetts plan as an example of how building on our current system of health care financing is the best path to success. Unfortunately, they use selected positive numbers to define success, while ignoring the fact that Massachusetts has failed in its efforts to achieve the real goals of reform.

You can understand how pathological the politics of reform has become when they have to dig into the data of a failed reform effort in order to redefine failure as a success. But it isn't a broad coalition. It is a coalition that primarily represents business interests - big business through the Business Roundtable, and small business through the National Federation of Independent Business NFIB.

Richard Gottfried on private and public coverage decisions Richard Gottfried points out an extremely important distinction between the nature of coverage decisions in public health care financing systems, and in private insurance financing systems, whether employer-sponsored or individual coverage. Virtual colonoscopy as a proxy for high-tech excesses This CMS decision to not pay for computed tomography colonography CTC or "virtual colonoscopy" when used as a screening test for colorectal cancer has already caused considerable controversy even before the final public comment period has closed.

Before we start deciding who is right and who is wrong, we should look at the issues. Make decisions based on facts!? Himmelstein responds to Gawande on single payer The problem is that Atul Gawande is flat out wrong.

He implies that other nations merely made adjustments in their existing systems to expand coverage to everyone. In fact, these were not simple adjustments to systems that weren't working; they were revolutionary transformations of their health care financing systems. Care coordination - a wrong way and a right way Most of the leading proposals for health financing reform include magical sleight-of-hand concepts that purportedly would reduce health care costs. One of these is disease management, or chronic care coordination, or whatever label you want to give it.

CBO's Elmendorf on single payer, and a Medicare-like option In his testimony before the Senate Budget Committee, CBO Director Douglas Elmendorf discussed considerations for expanding coverage, and considerations and options for controlling costs and improving efficiency, including a discussion of options under consideration that might not be effective in controlling spending. Most of his comments were confined to various policies that currently are hot topics in the Washington dialogue on reform.

Consumer-driven fire department lesson for Canada and U. Though not quite so graphic, free market private health insurance is not unlike the rescue purchased by this unfortunate lady. Just as she purchased a contract to avoid hitting the ground when she jumped from this burning building, private health insurance is purchased to prevent financial hardship or bankruptcy in the face of medical need.

It doesn't always work. Insurance failing cancer patients An excellent test of how well our insurance system is working is to determine how well it serves those individuals who have the tragic misfortune of developing cancer. This report shows that all too often the insurance system fails to protect cancer patients from the additional burden of financial hardship, defeating one of the most important reasons for having health insurance in the first place. Bipartisanship breaks down over "public option" Well, we are there now.

The progressive community had decided that the political barriers that have prevented reform over the past century must be brought down.

A solution that would appease the conservative community must leave in place a private market of financing options. The progressives have agreed, and have asked only for one more option - a plan administered by the government. Max Baucus is maneuvering to take the lead on reform by advocating for a "uniquely American result" with "more of an entrepreneurial sense" since "we're constituted differently than European countries.

Jacob Hacker is a nice guy, but In [Hacker's] proposal he was looking for a political solution to satisfy those with good employer-sponsored plans who are uncomfortable with trading them in for a public plan that has not yet been precisely defined since any proposed public plan must clear the hurdles in Congress.

In so doing he compromised on policy, trading away many of the advantages of the single payer model. Part D insurers overcharging The determination of the Bush administration and the Republican-controlled Congress to turn the Medicare Part D drug program over to private insurers produced no surprises.

Medicare was overcharged, and the patients were overcharged. Waxman ready to move - but where? This appeared to conflict with the position of other important players - Barack Obama, Tom Daschle, Ted Kennedy, Max Baucus, Pete Stark, amongst others - who have indicated that comprehensive reform would be as expeditious as possible - presumably this year or early at the very latest.

The statement by Henry Waxman seems to confirm the fact that the House of Representatives is aligned with the Senate and The White House to move forward expeditiously with comprehensive reform. Recession is good news for WellPoint Let's see. It's really good news that , people lost their WellPoint insurance primarily due to job cuts, because the resultant reduction in spending on health care "outweighed the loss of subscribers.

Uwe Reinhardt on comparing U. It will be well worth your time. One of the more important reasons is that we have little exposure to the routine functioning of the Canadian health care system. It's not that the information isn't available. The Canadian Institute for Health Information is a highly credible resource for such information. You can learn quite a bit just by reading their report, Health Care in Canada.

Gawande's pseudo-pragmatism Atul Gawande is a highly respected physician who has a well deserved reputation as a gifted writer. This commentary should not be construed as an attack on him; rather, it is an attack on his message. On his writing skills I give him an A, but on his content, a D-. Current political status on reform Jonathan Oberlander is one of the nation's more astute observers of the politics of health care reform. After a long dry spell of pessimism, he is finally able to justify a very cautious note of optimism, though it still risks being a fleeting message.

Southern Plains was first established in Chickasha in and hosts more than 20 medical specialties, over 30 medical providers and an ambulatory surgical center. Boghara added they are also in the process of hiring new doctors for their Carefirst facilities. Epic owns clinics in Texas, Arkansas and now Oklahoma and has plans to expand into other states. Officials say new and additional resources aim to provide a rejuvenated physical appearance with a heavy focus on primary care services especially for older patients in Chickasha.

In addition to a more patient-friendly practice Boghara says current employees will experience an uplifting cultural change which will allow them to focus more attention on patient care.

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Don mccoy carefirst primary Unfortunately, the policies behind their version of reform would fall far short of achieving the goal of affordable, comprehensive health care for everyone. Insurance and Equity in Primary Care and Specialist Office Visits Much of the discussion on health care reform centers around financing reform, with goals of achieving universality and affordability. The "dual-eligibles" scam To understand the basis for the problems with the Medicare Part D drug benefit, you need only to recall that the program was designed by the Medicare privatizers juniper networks inc. sunnyvale ca Congress, with the support read more two of the largest lobby interests in the nation: the private insurers and the pharmaceutical firms. AHIP's Campaign for an American Solution So the insurance industry wants to sign upindividuals in don mccoy carefirst primary fan club to provide free marketing for the private insurance concept. What has been a surprise to many of us is the intensity of the nastiness of the opponents of reform.
Does cleveland clinic accept highmark Daschle's "Critical" already have an impression of her views since she was the policy consultant for his book. Lessons from the Netherlands Why is this article so important? What reform does business want? Medicare beats employer-sponsored plans Very few individuals, especially those already covered by Medicare, will be surprised by this primwry. Excluding seasonal agricultural workers Everyone should have health care.
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Work at accenture However, when experts like David Himmelstein continue to confront him with the facts about our flawed financing system, Nichols' support for private insurance seems to be shifting from knowing that it would work, to wishing that it could, even though "our system is a mess. Comments are invited at the link above. The record on disparities in the United States is shameful. Daschle's "Critical" already have an impression of her views since she was the policy consultant for his book. Weiner withdraws single payer amendment The fact that single payer got so far along in the House is a testament to the strength of our single payer movement. CBO's Elmendorf on single payer, and a Medicare-like option In his testimony before don mccoy carefirst primary Senate Budget Committee, CBO Director Douglas Elmendorf discussed considerations for expanding coverage, and considerations and options for controlling costs and improving efficiency, including a discussion of options under consideration that might not be effective in controlling spending. He supports "universal health insurance based on regulated competition in the private sector," whereas we support a publicly administered and publicly financed single payer national health program.
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A graduate of Texas Christian University and the OU College of Law, his primary focus is on healthcare transactions, including assisting physician practices with private equity partnerships. He also does Healthcare legal, compliance and operational work on a flat fee basis for physicians and facilities. He supports clinically Physicians and Mid-Level care providers. Kalpesh was born and raised in India and after earning his Medical Degree relocated to the York, Pennsylvania in He joined CareFirst Medical Management in and is vital contributions in working closely with the medical staff.

Corporate Director of Information Technology Mr. Ed has more than 25 years of experience inInformation Technology. As such Mr. Harrison oversees the networks for all our locations and is devoted to providing a safe,secure, and HIPAA compliant network at all. She has more than 25 years of experience in the field of human resources, employee management, benefit management, and payroll.

Patricia is dedicated to creating a culture that promotes both personal and professional growth by empowering and motivating our employees to realize their full potential. It is my belief that our employees are our most valuable asset. Senior Business Analyst Surya leads our data analytics division for all three 3 states, providing actionable insights and recommendations on provider's performance, patient's life care, marketing channels and billing.

They play a huge role in keeping you healthy now and in the long run. Your PCP's office is your medical "home base. Your PCP:. Then from the list of types of care, select Medical Care. You will then see an option to search Primary Care Providers. This tool will show you primary care physicians who are in-network for CareFirst's Blue Cross Blue Shield coverage, with their specialty, whether they are accepting new patients, what languages they speak, where they went to medical school, and their practice address and phone number.

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WebWe've got you covered with access to over 1 million doctors, hospitals, and health facilities. Search by name or provider type in our online provider directory. Search For Care. A . WebPrimary care provider. Let CareFirst Medical Associates become your primary care provider. CareFirst Medical Associates is a one-stop shop for all your medical services. . Web[Maryland and WDC] Offers healthcare insurance to residents of Maryland and Washington, DC. Information for Brokers, employers, and providers, as well as links to consumer .