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<p class=MsoNormal><font size=2 face=Calibri><span style='font-size:11.0pt;
font-family:"Calibri","sans-serif"'>Single payer is the obvious answer.
Insurance companies will do whatever it takes to thwart Medicare for All. Be
prepared.<o:p></o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Calibri><span style='font-size:11.0pt;
font-family:"Calibri","sans-serif"'><o:p> </o:p></span></font></p>
<p class=MsoNormal><font size=2 face=Calibri><span style='font-size:11.0pt;
font-family:"Calibri","sans-serif"'><o:p> </o:p></span></font></p>
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<div style='border:none;border-top:solid #B5C4DF 1.0pt;padding:3.0pt 0in 0in 0in'>
<p class=MsoNormal><b><font size=2 face=Tahoma><span style='font-size:10.0pt;
font-family:"Tahoma","sans-serif";font-weight:bold'>From:</span></font></b><font
size=2 face=Tahoma><span style='font-size:10.0pt;font-family:"Tahoma","sans-serif"'>
occupymendocino-bounces@lists.mcn.org
[mailto:occupymendocino-bounces@lists.mcn.org] <b><span style='font-weight:
bold'>On Behalf Of </span></b>Richard Karch<br>
<b><span style='font-weight:bold'>Sent:</span></b> Tuesday, October 25, 2016
12:02 PM<br>
<b><span style='font-weight:bold'>To:</span></b> occupymendocino@lists.mcn.org<br>
<b><span style='font-weight:bold'>Subject:</span></b> [Occupymendocino]
Affordable Health Care info<o:p></o:p></span></font></p>
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<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>The New York Times<o:p></o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>October 24, 2016<o:p></o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Why the U.S. Still Trails Many Wealthy Nations in Access to Care<o:p></o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>By Aaron E. Carroll<o:p></o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Many are still unhappy with Obamacare.<o:p></o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>The main intent of the Affordable Care Act was to expand the safety net
(Medicaid), regulate the non-employer-based private insurance market (the
insurance exchanges) and help people buy that insurance (subsidies) in order to
reduce the number of Americans who are uninsured.<o:p></o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>On those metrics, it appears to be succeeding.<o:p></o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>First and foremost, Obamacare was about improving access to health
care. While it did improve access to insurance, in many, many other ways the
United States is falling short. Things are likely to get worse before they get
better.<o:p></o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Even with Obamacare, the United States still ranks poorly among
comparable countries in insurance coverage. Even in 2016, when the rate of
insured is the best it has ever been in the United States, Americans still have
a greater percent of the population uninsured than pretty much any other
industrialized nation in the world.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Access is about more than insurance, though. Every few years, the
Commonwealth Fund conducts an international survey of patients. The last time
the fund fielded the survey was in 2013, and it sampled patients in 11
different countries, all of them on the high end of the worldwide socioeconomic
spectrum.<o:p></o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>When asked if patients could get a same-day or next-day appointment
with their provider when they were sick or needed care, 52 percent of Americans
said no. This placed the United States next to last among these countries. Only
Canada (59 percent) was worse.<o:p></o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>When asked whether it was “somewhat” or “very easy” to get care after
regular working hours, the United States placed eighth, beating France, Canada
(again) and Sweden. Because of this, at least in part, Americans are more
likely to use the emergency room for care.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Primary care physicians feel this pinch as well. When the Commonwealth
Fund surveyed them in 10 countries, doctors in the United States ranked ninth
(ahead of Canada) in being “well prepared” to manage the care of patients with
complex needs. They ranked last in whether staff made home visits. They also
ranked last, by far, in whether practices had arrangements so that patients
could see a doctor or nurse after hours without going to the emergency
department.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Why is this? One of the reasons is manpower. The United States, for all
its spending, has fewer general practitioners per population than any of these
other countries.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>The biggest access problem in the United States is the expense of
obtaining care. More than one third of Americans said they did not fill a
prescription they were given, did not visit the doctor they should have or did
not get the tests that were ordered because of the cost.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Perhaps most telling, when adults were asked about their views of the
health care system in 2013, 75 percent of Americans said that it needed
fundamental change, or that it needed to be completely rebuilt. This percentage
was higher than for any other country surveyed, Canada included. Primary care
physicians feel similarly. Yet years after the Affordable Care Act was passed,
Americans are still litigating whether to return to the previous system.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Access was a problem before. Access is a problem now. Americans can’t
seem to have a discussion on how to make that better. Without that, it’s hard
to see how things will improve.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><a
href="http://www.nytimes.com/2016/10/25/upshot/why-the-us-still-trails-many-wealthy-nations-in-access-to-care.html">http://www.nytimes.com/2016/10/25/upshot/why-the-us-still-trails-many-wealthy-nations-in-access-to-care.html</a><o:p></o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
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<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>===<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Comment by Don McCanne<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>The point here is that, although the Affordable Care Act (ACA) did
expand the percentage of people with some form of health insurance, it still
leaves us worse off than other nations in the percent of individuals remaining
uninsured, and it didn’t fix other problems such as impaired access to health
care.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>Canada also scored poorly, near the United States, on some of these
measures. This is partly due to our similar cultures, and both nations need to
improve. In fact, Canada is making a concerted effort to address its problems
with queues. But it is important to note that this does not mean that Canada’s
single payer system has failed them. Not reported here are much more important
measures in which Canada is clearly superior to the United States as a direct
result of their single payer financing system: universality, equity,
portability of coverage, elimination of financial barriers through first dollar
coverage, reduction of administrative waste through public administration, and
other efficiencies that have resulted in much lower per capita spending.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>This month there is a campaign to tout the successes of ACA in order to
reduce concerns about the announcement of the double digit increases in
premiums for the ACA exchange plans. But when you objectively evaluate the
successes, with the exception of the expansion of Medicaid, these improvements
are almost negligible when compared to the improvements that Canada already has
in place by virtue of the Canada Health Act that provides support for the
single payer systems in their provinces.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>As Aaron Carroll states, if we want improvement, we need to have a
discussion on how to make the system better. Since ACA is falling so short,
that discussion needs to center around truly effective reform, including a
single payer national health program.<o:p></o:p></span></font></p>
</div>
<div>
<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'><o:p> </o:p></span></font></p>
</div>
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<p class=MsoNormal><font size=3 face="Times New Roman"><span style='font-size:
12.0pt'>_______________________________________________<o:p></o:p></span></font></p>
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