Craig Brooks 
Member since Nov 30, 2017



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Re: “Healthcare for All

Feedback from an expert:
On Dec 7, 2017, at 2:44 PM, Kip wrote:

You should tell the reader to look at two documents: The q and a document on SB 562 prepared by Healthy California; and the Lewin Group's analysis of the first "single payer" bill introduced in CA in 2003.

The q and a document on 562 is here . At page 6 you read this question: "Is there a role for Kaiser Permanente and other integrated health systems?" The answer given is: "Yes. Healthy California members can choose to enroll with ... HMOs, including Kaiser Permanente."

The Lewin document is here . It reviews SB 921, the predecessor to 562 introduced by Senator Shiela Kuehl in 2003. 562 is different in some ways from 921, but not in the basic multi-HMO structure that Californians will live under if 562 is enacted. 921 used the same circular, flabby definition of "integrated delivery system" 562 uses, namely:
"Integrated health care delivery system" means a provider organization that meets all of the following criteria:

(1) Is fully integrated operationally and clinically to provide a broad range of health-care services, including preventative care, prenatal and well-baby care, immunizations, screening diagnostics, emergency services, hospital and medical services, surgical services, and ancillary services.

(2) Is compensated using capitation or facility budgets, except for copayments, for the provision of health care services.

Here is how Lewin describes the "single payer" system under 921 in their 2005 report, The Health Care For All Californians Act....
People would have the choice of selecting their own primary provider or being covered through an HMO or other integrated delivery system that would be paid a risk adjusted amount to cover all costs for enrollees. [p 2]

HMO Coverage Option

Beneficiaries would have the option of selecting their own primary provider or enrolling in integrated delivery system models such as Health Maintenance Organizations (HMO). The following would apply:

People are generally assumed to be required to remain in the plan for a year. However, there is a three month trial period in which patients may disenroll for any reason. They may also disenroll at any time if the health plan can not provide needed care. In addition, patients may appeal to the Consumer Advocate (created under the program) for early disenrollment, that would be provided if deemed warranted; and Payments to the plan would be risk-adjusted and calibrated so that enrollment in HMOs is budget neutral to the Act. For example, if the HMO for some reason enrolls a disproportionate share of older people, the amount of money needed to provide the services they require would on average be substantially greater than the cost of care for those who do not join the HMO (who are disproportionately younger). Thus, in this example, we would assume that the payments to the HMO are adjusted to reflect the higher cost of caring for those who enroll in the HMO. Payment adjustments of this type are to avoid either under-funding or over-funding care for HMOs.... [pages 6-7]
It doesn't get much more obvious than this.

I don't agree with everything Lewin says about real and bogus single-payer bills, including what it said about 921. But their characterization of "IDS" as just another word for "HMO" is accurate.


Posted by Craig Brooks on 12/09/2017 at 5:27 AM

Re: “Healthcare for All

My concern comes from communications last Summer pasted below. It is about HMOs, MCOs, integrated health care entities -- whatever they are called. The concern is that turning the system over to such places, be they for profit or not, is a waste of money. I hope that SB 642 is not the same as the Assembly bill A-4738. The concern for that CA model mentioned below was that it all gets turned over to one big HMO - Kaiser. [BTW -- Kip Sullivan is one of the foremost experts on single payer]
On Sun, Jul 2, 2017 at 6:09 AM, kiprs wrote:
I haven't had time to read the NY bill. I read something months ago that led me to believe it has the same enormous HMO loophole in it that SB 562 in CA has.

I'm talking to docs in PNHP in CA and at the national level about educating the public about these HMO loopholes. Hope we can generate some publicity in the not too distant future. Here in MN we face a very similar threat. DHS, Tina Liebling and other DFLers want to promote "integrated delivery systems" as if they were different from HMOs. IDS's will get lots of support from Dems and Republicans. IDSs will either serve as an excuse not to give John M's bill a hearing, or legislators will demand that John amend his bill to permit IDSs/HMOs, if we haven't done a better job of educating the public that IDSs are just HMOs in drag.


On 2017-07-01 10:54, Craig Brooks wrote:

be interested in your take on this politician's response.

---------- Forwarded message ----------
From: Health Affairs
Date: Sat, Jul 1, 2017 at 9:17 AM
Subject: [Health Affairs Blog] New Comment Posted to "State Single Payer And Medicaid Buy-In: A Look At California, New York, And Nevada"

A new comment has been posted to "State Single Payer And Medicaid Buy-In: A Look At California, New York, And Nevada":
Author: Richard N. Gottfried
Web Site:
Message: I am the Assembly sponsor of the NY Health Act (the current bill number is actually A.4738) and chair of the Assembly Health Committee. The bill will reduce overall spending in NY by about $45 billion net, mainly from cutting out insurance company administrative cost and profit, reducing health care provider administrative costs, and negotiating for 20 million customers to lower prices from drug companies, and counting increased utilization and provider rates. Our arithmetic assumes Medicaid and Medicare provider rates will increase. The $90 billion in "new revenue" will replace much more than that now spent on premiums, deductibles, copays, and out-of-network charges. For a detailed analysis see:

Posted by Craig Brooks on 12/02/2017 at 5:26 AM

Re: “Healthcare for All

I have heard that S.B. 562 includes provisions having the system turned over to one private managed care company, i.e. an insurance company. I'd like to find out if this is true. Kaiser comes to mind. CA can create a model for the country. I would hate it to be with the expensive, unproven, unaccountable MCO model.

Posted by Craig Brooks on 11/30/2017 at 5:09 AM

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