Medicare for All – RI Future

October 17, 2016October 21, 2016

First Neighborhood Health Station breaks ground in Central Falls

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Think of it as the “Deepwater Wind” of health care: Innovation, starting in Rhode Island, that could be a model for the world. That’s how revolutionary the concept of the Neighborhood Health Station could be, and the first one is being rolled out in Central Falls.

Perhaps overshadowed by a visit from actress Viola Davis, the groundbreaking for the new Neighborhood Health Station in Central Falls heralds the beginning of a new paradigm in health care, one meant to serve the needs of the community, not the convenience of the provider. The Blackstone Valley Community Health Care (BVCHC) Neighborhood Health Station will be located at 1000 Broad St in Central Falls, and will offer primary care, walk-in primary care, dental care, a pharmacy, physical therapy, pediatric care, occupational therapy, mental health services, Ob/Gyn services, radiology and more; serving over 14,000 patients and 50,000 visits a year.

Upon completion in 2018, the city of Central Falls will benefit from having “comprehensive services offered under one roof, where clinical professionals can collaborate face-to-face for improved care coordination” and “same-day sick appointments with convenient hours (8 am to 8 pm) on week days and additional weekend hours, enabling individuals and families to access health and medical services close to home, when it is most convenient for them.”

BVCHC hopes to cover 90 percent of Central Falls residents. “Using medical records to identify at-risk patients, we will continue to collaborate using community resources and with the new health building, we are confident that we can improve public outcomes,” said BVCHC Senior Clinical and Population Health Officer Michael Fine, M.D., who now also serves as Health Policy Advisor to the City of Central Falls.

Based on public meetings with residents, three public health priorities were identified: the community wanted their kids to be safe in school, they needed access to a gymnasium and they wanted better access to primary care.

Based on this input, the team designing the center identified five short term goals. Pregnancy prevention: BVCHC partnered with the school system and Brown University’s Residency Program in Family Medicine to create a school-based health clinic at Central Falls High School to bring prevention and same-day clinical care to the adolescents of Central Falls and to reduce the rate of adolescent pregnancy through education and prevention programs. (Central Falls’ high school pregnancy is 4X the state average).
Multidisciplinary management of individual cases: participants in this collaboration come from all facets of the community, including doctors, dentists, substance abuse, mental health, home care, housing, legal, needle exchange, immigration, transportation, social service, insurers and hospitals. Together, they meet bi-weekly to create customized plans to organize care for the people in Central Falls who are at the highest medical and social risk.
Mitigation of EMS use: people who use the Central Falls EMS more than four times a year have been identified, outreach has been made and they have been introduced to BVCHC where they can get help with medical, mental health and substance abuse issues and where referrals can be made for housing that they might need.
Access to exercise opportunities: The mayor now leads city walks to get people moving every two weeks (organized by Parks and Rec, publicized by BVCHC and housing authority and staffed by both parks and rec and BVCHC). A regular schedule of free busing from Central Falls (three pickup sites at Notre Dame and the housing authority) to the Pawtucket YMCA and to the Lincoln YMCA (for access to swimming pools) was introduced.
Identification of needs within public housing: the city’s community health worker in public housing now brings individual situations and stories to the multi-disciplinary team about tenants, primarily the elderly who are most at risk, to the team to find solutions to their needs.

Innovation is desperately needed in health care. When we as a nation inevitably pass some form of “Medicare for All” single payer health care system it will be vitally important to keep costs down and people healthy. Neighborhood Health Stations point the way.

“None of us,” said Dr. Michael Fine, former head of the Rhode Island Department of Health, “have ever lived in a place where it doesn’t matter if you’re rich or poor, black or white, whether you speak English or Spanish or another language, whether you walk, take the bus or drive a car, where it doesn’t matter if you have papers or not, whether you can read or not, whether you walk on two feet, or walk with assistance… we’ve never seen a place in which everyone matters, in which we look out for everyone. Whether they came to the health center this year or not, whether they do what doctors recommend or not, whether they choose to live differently or not, we stand here today with a different vision: A vision of a place in which everyone matters. It’s a vision of what Reverend Doctor Martin Luther King Jr. called ‘a beloved community.’”

Below, watch Dr. Fine, former head of the RI Department of Health, explain the importance of Neighborhood Health Stations.

March 1, 2016March 1, 2016

Bernie Sanders in Milton ahead of Super Tuesday

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Waiting for Bernie Sanders in the press line outside Milton High School in Massachusetts ahead of Super Tuesday, I talked to Rita Colaco, a journalist from Portugal. She’s surprised that I know where Portugal is, because most Americans she talks to think her country is part of Spain, or Puerto Rico. She was at a rally for Hillary Clinton in Boston earlier in the day, and now she’s covering a rally for Sanders. She’s in the United States for four days to cover Super Tuesday.

“So what do they think about this election in Portugal?” I ask.

“They think what you’re thinking over here,” says Colaco, “They see the popularity of Trump as funny.” The way she says funny, she doesn’t mean “Ha-Ha” funny. People from around the world are worried about what a Trump presidency means.

2016-02-29 Bernie Sanders 008 — John May

“I wouldn’t be here from Portugal if it wasn’t for Trump,” says Colaco. She hasn’t been able to find a rally for Trump in Massachusetts yet, though.

Inside the rally I meet an older couple who support Sanders, but they are realists, and will happily switch to Clinton if they have to. “We can’t let Donald Trump or Ted Cruz win,” says the woman, “That would be terrible, and I’m too old.”

John May from Franklin holds home made signs in support of Medicare for All. He knows the sales pitch well. “You can’t tell me that we can’t afford to do, in America, what every civilized country on Earth already does,” says May.

May lost two friends to pancreatic cancer years ago. They were diagnosed within weeks of each other and they died within weeks of each other. Their treatment was the same. The only difference between the two is that one friend lived in Denmark, the other in the United States.

The friend in Denmark, says May, spent his last six years of life with family and friends, unconcerned about the economic impact of his disease on himself and his loved ones.You can only begin to imagine the last years of the life of his American friend. That massive qualitative difference made May a supporter of single payer healthcare, and by extension, a supporter of Sanders.

My last conversation was with three girls, between 10 and 12 years old. They monkeyed around in front of my camera and were eager to be interviewed, but the adult with them asked that I not use the footage, since he wasn’t sure about their parent’s permission.

I asked the girls who they’re voting for.

“We can’t vote,” said the oldest, “but my Dad’s voting for Trump.”

“Trump?” I asked.

The girl shrugged. “Whatever.”

“I can’t decide between Bernie Sanders and Marco Rubio,” said the second girl.

“Really?” I asked, “how does that work? They’re not much alike on the issues.”

“I don’t know,” she said, honestly. “I just like them.”

“I’m still deciding between Hillary Clinton and Bernie Sanders,” said the youngest girl, “That’s why I’m here, to listen to what Sanders has to say.”

“You know,” I replied, “that makes sense.”

Then Sanders took the stage.

February 29, 2016February 28, 2016

Health insurance industry lawyer makes the case for single payer

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In speaking out against a bill that would make sure no pregnant person could be denied medical coverage due to their pregnancy, a health insurance lawyer unintentionally made a great case for a national, single payer health program.

Shawn Donahue is an attorney at Blue Cross & Blue Shield of Rhode Island and last Tuesday he spoke at the House Corporations Committee meeting to oppose a bill that would ensure “no pregnant applicant for medical insurance coverage would be denied coverage due to her pregnancy.”

I want to stress at the outset that Donahue seems like a decent man, and I sensed that he was somewhat uncomfortable speaking out against this bill.

“No one believes in the importance of pre-natal care more than Blue Cross,” said Donohue, “We’ve invested in it.”

That’s true. “Getting early and regular prenatal care is one of the most important things you can do for the health of both you and your baby,” says Blue Cross on its website. The site contains a wealth of information and advice on healthy pregnancies. But we don’t have to assume that Blue Cross is promoting neonatal care out of any sense of public service. Healthy pregnancies are cheaper for insurance companies. An insured baby, with proper neonatal care, is less likely to have expensive health problems going forward.

The importance of prenatal care is underscored by the health risks associated with not having such care.

“Women in the United States who do not receive prenatal care have an increased risk of experiencing a neonatal death… Lack of prenatal care is associated with a 40 percent increase in the risk of neonatal death overall…” says the Guttmacher Institute, citing a study, “Black women are more than three times as likely as white women not to receive prenatal care, and regardless of their prenatal care status, their infants are significantly more likely to die within their first 27 days of life than are infants born to white women.”

Other risks from not receiving adequate prenatal care include low birth weight for the infant, and pre-eclampsia, a form of organ damage, that affects the mother. From a human perspective, this is terrible and unnecessary. From the perspective of an insurance company, such health problems are expensive.

Yet, said Donohue, speaking for Blue Cross at the Rhode Island State House, “The only way insurance works is if you purchase it when you don’t need it so it’s there for you when you do. If you allow people a special enrollment period, whether they’re diabetics, cancer patients or pregnant people, they won’t buy it until they need it.”

The Affordable Care Act (ACA or Obamacare) mandates that Rhode Islanders buy private insurance on the state run health insurance exchange, HealthSourceRI. “If you’ve missed the open enrollment period,” said Donohue, “ you’ve broken the law and now you are penalized for that, and the penalties start to grow.”

Donahue is talking about financial penalties of course, but the real penalties from a societal point of view are dead babies, or babies and mothers with terrible health outcomes. Suddenly the financial penalty for not complying with the ACA mandate seems rather small and meaningless, doesn’t it? But more to the point, it’s exactly these negative health outcomes that Obamacare was supposed to address.

“We don’t let people buy insurance on their way to the hospital in an ambulance,” said Donahue. I would say that having to worry about financial issues during a medical emergency is a major system failure, and further, these gaps in care for vulnerable Americans expose the weaknesses in today’s for-profit health insurance industry, of which Blue Cross & Blue Shield of Rhode Island is a big part.

According to Physicians for a National Health Program (PNHP), “Single-payer national health insurance, also known as ‘Medicare for all,’ is a system in which a single public or quasi-public agency organizes health care financing, but the delivery of care remains largely in private hands. Under a single-payer system, all residents of the U.S. would be covered for all medically necessary services, including doctor, hospital, preventive, long-term care, mental health, reproductive health care, dental, vision, prescription drug and medical supply costs.

“The program would be funded by the savings obtained from replacing today’s inefficient, profit-oriented, multiple insurance payers with a single streamlined, nonprofit, public payer, and by modest new taxes based on ability to pay. Premiums would disappear; 95 percent of all households would save money. Patients would no longer face financial barriers to care such as co-pays and deductibles, and would regain free choice of doctor and hospital. Doctors would regain autonomy over patient care.”

On the national scene Bernie Sanders has championed single payer, calling it Medicare for All. “Health care must be recognized as a right, not a privilege,” says Sanders, “Every man, woman and child in our country should be able to access the health care they need regardless of their income. The only long-term solution to America’s health care crisis is a single-payer national health care program.”

State Representative Aaron Regunberg has introduced, for the second time, a bill to bring the benefits of a single payer health insurance program to Rhode Island. His bill would “act would repeal the ‘Rhode Island Health Care Reform Act of 2004 – Health Insurance Oversight’ as well as the ‘Rhode Island Health Benefit Exchange,’ and would establish the Rhode Island comprehensive health insurance program.”

His bill deserves our support.

January 20, 2016January 19, 2016

Dr. John Geyman explains why we need single-payer healthcare

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Have you been unimpressed with the recent claims in the presidential campaign that a single-payer “Medicare for all” healthcare plan would be untenable? Do you think Hillary Clinton is being disingenuous in arguing that the Affordable Care Act is the best Americans should expect in terms of health insurance?

You are not alone.

I recently sat down for an hour conversation with Dr. John Geyman, author of How Obamacare is Unsustainable: Why We Need a Single-Payer Solution For All Americans. He is a retired practitioner and professor emeritus of family medicine at the University of Washington School of Medicine in Seattle, where he served as chairman of the Department of Family Medicine from 1976 to 1990. He has written several books on a variety of topics related to the medical field and also writes occasionally for the Huffington Post.

During our conversation, we talked about the flaws in the AFA, how the medical-industrial complex has fundamentally warped the practice of medicine and how doctors are intended to relate to their patients, and what a single-payer system would look like. We also briefly touched on political campaign rhetoric and whether the Clinton, Sanders, and Republican campaigns are being honest when they criticize or defend the AFA.

January 8, 2016January 8, 2016

Improved Medicare For All: A talk with Oliver Fein, MD

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2016-01-07 Fein 01 — J. Mark Ryan of PNHP-RI and Dr. Oliver Fein

A single payer system could save the country over $400 billion a year says Dr. Oliver Fein, but he would prefer we call it “Improved Medicare For All.” Fein says that a system based on private insurance programs, like the one we have now, will not lead to universal coverage and will not create affordable coverage, whereas a Medicare for All system can lead to universal comprehensive coverage without costing more money.

In concert with Physicians for a National Health Program (PNHP-RI), gave a talk to a class of med students at Brown University’s Warren Alpert Medical School in Providence.

Bernie Sanders has been a strong advocate for a Medicare for All approach to our health care, including the idea among his campaign issues. “The United States is the only major nation in the industrialized world that does not guarantee health care as a right to its people,” Sanders said. “Meanwhile, we spend far more per capita on health care with worse results than other countries. It is time that we bring about a fundamental transformation of the American health care system.”

What Fein does in the lecture below is explain how our present healthcare system fails us, how a Medicare for All system will improve health care outcomes, and outline a possible path from our present system to universal health care for everyone.

[Adam Miner provided additional reporting, video and photographs.]

March 31, 2015March 31, 2015

Raimondo cherry picks data, overstates issues in Reinventing Medicaid

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Two single-payer advocacy groups, Rhode Island Chapters of Physicians for a National Health Program (PNHP) and HealthCare-Now, have prepared a report that is highly critical of Governor Gina Raimondo’s Reinventing Medicaid initiative.

The PNHP/HCN-RI report identifies five areas of concern and concludes that “Governor Raimondo has made it impossible” to achieve the goal of developing “a plan to improve the quality of care Rhode Islanders receive and reduce the costs for Rhode Island taxpayers.” The areas of concern cited in the analysis are:

1. presenting faulty and misleading data and analyses
2. misidentifying “problems;”
3. requiring unjustified budget cuts within preselected “six major strategies’”
4. not permitting consideration of the actual problem: private health insurance companies generating enormous administrative costs and improperly rationing care
5. not permitting consideration of an effective solution: a comprehensive single payer health care program for all Rhode Island residents such as that proposed by H5387, a single-payer health care bill introduced by Representative Aaron Regunberg.

The report says Raimondo overstates the percentage of the Rhode Island budget spent on Medicaid. She uses 31 percent, but the PNHP/HCN-RI report says the actual number is 22.1 percent. Further, Rhode Island’s expenditures are below the national average of 23.7 percent. And it should not be forgotten that most Medicaid expenses are reimbursed by the federal government dollar for dollar. Every dollar cut from state expenditures is two dollars cut from services.

The PNHP/HCN-RI report also accuses Raimondo of cherry picking data to paint the worst possible picture to create a false Medicaid crisis.

When Raimondo considers the drivers of high Medicaid costs, she ignores key problems. While Raimondo blames “High Utilization,” an “Aging Population” or “fraud, waste and abuse,” the PNHP/HCN-RI analysts note that her supporting data are questionable and we should be looking at the fact that “multiple payers create enormous excessive administrative costs and unfairly ration care.”

The report concludes by making the case for single-payer healthcare. Adopting such a program, says the PNHP, will:

Provide comprehensive health care coverage to all Rhode Island residents with most Rhode Islanders paying less for health care than they are currently paying;

Improve access to health care;

Save approximately $4000 per resident per year by 2024 and put more money into the Rhode Island economy.

Significantly reduce health care dollars spent on administrative costs and shift these dollars to actual provision of health care (providers would save almost $1 billion in administrative costs in the first year);

Decrease administrative burdens on health care providers and allow them to spend more time providing health care;

Eliminate the burden of health insurance costs and administrative obligations on Rhode Island businesses and thereby make them more competitive and profitable. In the first year, payroll contributions to the single payer plan would be over $1.2 billion less than current private health insurance premiums.

Contain health care costs (reduced administration and control over monopolistic pricing) would save 23% of current expenditures in the first year with larger savings in subsequent years.

Create a significant economic stimulus for the state by attracting businesses to and keeping businesses in Rhode Island because of reduced health insurance costs, a particular boon to small businesses and their employees.

Chair of the RI PNHP, J. Mark Ryan, MD., will be presenting some of this data at the next Reinventing Medicaid Town Hall Meeting at the East Bay Family Health Center, 6 John H Chafee Blvd, Newport at 6pm on April 1. You can see my coverage of the Providence Town Hall meeting here. For more on PHNP and single payer, see here.

February 3, 2015

‘Medicare for All’ advocates focus on Rhode Island

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Dr. Oliver Fein, representing Physicians for a National Health Program (PNHP-RI), gave a talk Monday night to a class of second year med students at Brown University’s Warren Alpert Medical School in Providence. The talk was open to the public, but due to the snow storm attendance was low. That’s too bad, because Dr. Fein’s talk was an informative and eye opening examination of both the history of public healthcare in the United States and the possibility of transforming the current system beyond Obamacare and towards a system of truly universal coverage, what supporters call, “Medicare for All.”

In the video, Dr. Fein covers the history of healthcare in the United States, starting with President Truman’s suggestion that some sort of universal health care program might be a good idea, right up to President Obama’s successful passage of the Affordable Care Act. (For Dr. Fein’s summary, go here.)

At the 17 minute 30 second mark Fein leaves history behind and explicates the ideas behind a single payer healthcare model, or what he calls an “Improved Medicare for All.” Such a system would build upon and expand Medicare to the entire population, improve and expand coverage in the areas of preventive services, dental care and long term care, eliminate deductibles and co-payments, expand drug coverage (eliminating the “donut hole”) and redesign physician reimbursement.

Several points leapt out at me during Dr. Fein’s presentation. Using data from 2009, Fein reported that 62% of personal bankruptcies were due to medical expenses and 75% of those who declared bankruptcy had health insurance. For too many people, it seems, health insurance did nothing to prevent financial disaster.

Fein also reported that overhead costs in administering Medicare run about 3.1%. Commercial healthcare runs near 20%. This means that 17 cents (or more) of every health care dollar is wasted on administrative costs or corporate profits under our current system of private insurance. This is money that could be going towards patient care.

Fein concluded that a system based on private insurance programs will not lead to universal coverage and will not create affordable coverage, whereas a Medicare for All system can lead to universal comprehensive coverage without costing more money.

“What will happen if we don’t do this?” asked Fein in conclusion, “By [the year] 2038 a person’s entire household income will… have to pay for health insurance. A condition that’s not compatible with life.”

Rhode Island

Gerald Friedman, a PhD and Professor of Economics at the University of Massachusetts at Amherst released a 41 page report earlier this month on the possibility of adopting a single payer healthcare system here in Rhode Island. Friedman maintains that a single payer plan would result in significant savings for most Rhode Islanders and only increase healthcare spending for those making over $466,667 a year.

Representative Aaron Regunberg, from the East Side’s District 4, is planning to introduce legislation for a statewide single payer healthcare plan this session. Model legislation from the PNHP is available here.

More information about the Rhode Island branch of the PNHP can be found at their website.