Wednesday, November 20, 2013

Report Back: CPATH to USTR - U.S. Must Protect Public Health in the TPP

The U.S. Trade Representative gave new meaning to the phrase, "magical thinking" at a Nov. 18 talk in San Francisco. And new urgency to the demand for an honest debate on the economy and on the Trans Pacific Partnership (TPP).
 
Last week, Wikileaks released the most detailed report of the proposed trade agreement to date It reveals the full text of the controversial intellectual property chapter, that would govern fundamental rights including access to medicinesinternet freedom, and cigarette package warning labels. In addition, it shows which countries support which versions of the proposals.
The U.S. does not look good. The leaked documents delineate that the U.S. would allow corporations including Big Tobacco and Big Pharma to rake in enormous profits while exposing the public's health to continued havoc by challenging tobacco control regulations, extending patent and trademark rights that would raise the prices of medicines, and raise the cost and availability of health care through patenting surgical techniques, for example. Disturbing enough.
Scores of members of Congress had already signed letters denouncing these proposals, and pledging to block them. Public health and medical organizations, and entire nations, have urged the U.S. to curb these abuses.
But on November 18, United States Trade Representative Michael Froman and Agriculture Secretary Tom Vilsack engaged in a discussion at the Commonwealth Club of San Francisco, moderated by the Club's Greg Dalton. When Dalton specifically asked U.S.T.R. Froman to address concerns regarding the trade pact's limits on internet freedom and access to medicines, he got back the same happy talk the Administration has been babbling all along.
In a breath-taking effort to imagine that the entire population had lost the capacity for literacy, Froman asserted, "What we're trying to do with the TransPacific Partnership is open up markets in some of the fastest growing regions in the world, raising standards on labor, the environment, access to medicines, intellectual property rights, and create new disciplines for the 21st century global economy."
He went on to claim both that the TPP was the most transparent trade agreement ever negotiated, in view of the USTR's many consultations with every sector of American society, and that the American people would only fully understand how beneficial the TPP is once the negotiations are concluded and the public sees the final product.
Just prior to the public event, San Francisco Supervisor Eric Mar and Co-Directors of the Center for Policy Analysis on Trade and Health (CPATH), met briefly with Ambassador Froman, and urged him to protect public health and rein in Big Tobacco in the TPP trade negotiations.
Supervisor Mar presented USTR Froman with a letter expressing his deep concerns that the provisions of the recently leaked Intellectual Property Chapter of the TPP "may undermine the right and ability of local, state, and national governments of participating countries from exercising their domestic sovereignty in order to adopt or maintain measures to reduce tobacco use and to prevent the harm it causes to public health." The letter posed key questions on U.S. proposals related to intellectual property rights and the tobacco industry, and requested a written response on how U.S. proposals will ensure that the United States and other TPP nations will be able to fully implement and enforce strong tobacco control legislation.
CPATH Co-Directors Ellen R. Shaffer and Joe Brenner articulated the concerns of major U.S. medical and public health groups, which are calling on the U.S. to take a leadership role to protect the public's health from tobacco-related disease and death, and to carve-out tobacco from the TPP negotiations. They presented a binder of letters and statements from CPATH, the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Congress of Obstetricians and Gynecologists, American Public Health Association, CA Health Officers Association, California Council of Local Health Officers, and the Public Health Institute, CA-Public Health Association-North, and Alameda County Public Health Commission.
During questions from the public, CPATH Co-Director Joe Brenner asked, "San Francisco and California have taken effective action to reduce tobacco-related disease and death. When California attempted to ban the carcinogen MTBE from gasoline to protect health for years ago, a Canadian company, which made a component, filed trade charges against the U.S. and sued for $970 million for lost profits under "investor-state" provisions in NAFTA. The U.S. is proposing to give corporations these same rights in the TPP, including to challenge local tobacco control regulations. Why?" USTR Froman responded that the U.S. has never lost a court challenge under these provisions, and that new TPP provisions are different. Wait 'til we see it.
"The ongoing efforts to usher through in secrecy a pact with nations representing 40% of the globe's gross domestic product is corroding our democracy," says Shaffer. "For example, an editorial in Bloomberg erroneously equated the secrecy of the TPP with the embattled but entirely transparent Obamacare health care reform program.
"To be clear: Trade negotiations have been a corporate-controlled subterranean process for decades. The Obama Administration didn't start this. But it has utterly abandoned the responsibility to change it. It is an anomaly in our democracy which we can no longer tolerate. The technical details matter, and we have a right to understand the fine print as well as the broad strokes. The United States must lead the way towards a 21st century trade agreement, that starts, proceeds and ends with a fully public debate."
Your support makes our work possible. Please contribute today:

Saturday, November 9, 2013

NYT: Why Some People Can’t Keep Their Insurance Plans


http://www.nytimes.com/interactive/2013/10/30/us/why-some-people-cant-keep-their-insurance-plans.html?ref=politics

Despite repeated assertions by President Obama that people who like their health insurance will be able to keep it under the new health care law, many people who bought insurance on their own — a small fraction of the insurance market — will have to buy new plans. Related Article »

Medicare, Medicaid,
military coverage
Share of people with
employer-sponsored
insurance
29%
49%
Uninsured
5%
16%
Individual market
10-15 million people
Policies must meet new standards ...
Beginning Jan. 1, new policies issued must cover a minimum share of health care expenses and offer 10 “essential health benefits”:
1.
Outpatient care
7.
Rehabilitative and habilitative
services and devices
2.
Emergency room visits
3.
Hospitalization
8.
Lab tests
4.
Maternity and newborn care
9.
Preventive services and
chronic disease care
5.
Mental health and
substance use treatments
10.
Pediatric services, including
dental and vision
6.
Prescription drugs
... unless a plan is grandfathered in ...
If a policy was in effect when the law passed in March 2010 and has not been changed significantly, people already on the plan could remain on it, and the plan would not have to meet the new requirements.
 
... but many people will need to purchase a new plan because:
• Many plans do not currently meet the law’s standards for coverage.
• Most people in the individual market do not keep their policies for more than a year, so most would not be eligible to be grandfathered.
• Insurance companies cannot change grandfathered plans or sell them to new customers, so they have incentive to cancel the policies.
Some people will also move to Medicaid coverage.
More than one million low-income adults currently in the individual market will be newly eligible for Medicaid in 2014 because they live in a state that has decided to expand the program.
 
Why Rates Are Increasing for Some People
The total cost of policies will be higher on average ...
Many plans offered on the individual market will have more benefits and more consumer protections than they did before. The pools will also cost more for insurance companies since they cannot deny people with pre-existing conditions.
In the individual market,
on average, rates for group will:
... but people will be affected differently ...
INCREASE
DECREASE
SEX The law bans insurers from charging women higher premiums than men of the same age.
MEN
WOMEN
AGE The law bans insurers from charging older adults more than three times the amount they charge younger adults.
YOUNG
OLD
HEALTH The law bans insurers from charging people with health problems more.
HEALTHY
UNHEALTHY
... and many people will be eligible for government subsidies.
An estimated 48 percent of people on the individual market will be eligible for tax credits to reduce their costs, based on their income level.

Obamacare: Making Lemonade

Responding to:
PERSPECTIVE
J. F. Wharam and Others
N Engl J Med 369:1481, October 17, 2013

The authors point out the real and predictable failings of a market-based health care system: it costs too much (duh).  And they suggest more market-based reforms to fix the problems of unaffordably high deductibles and co-pays in the Obamacare health insurance exchanges (premiums could be lower too).  California is perfectly poised to leverage the situation by taking the obvious next step towards a single payer system (a goal for 2017): authorize the elected Insurance Commissioner to set the prices of the health insurance plans. The legislation's been introduced and almost passed several times.  The Exchanges have already whittled down the insurance plans to only a few left standing, and set compulsory enrollment, and standardized benefits. Chopping their rates and profits gets pretty close to the role health insurance plans already now play in Medicare, as third party administrators.  

Sunday, October 6, 2013

Ellen Shaffer in the Media

Dr Ellen Shaffer reacts to the United States Government being shutdown
Cameron Green speaks to Co-Director of the Centre for Policy Analysis Dr Ellen Shaffer
ABC NewsRadio Afternoons - Last updated 16:07 Duration 7:12
ABC Australia 9-30-13
 
 

Impact of the Shutdown! Economic and Healthcare

The government shutdown will be the topic of conversation from the economic impacts to how long it may last.  Christian Dorsey, of the Economic Policy Institute, will talk about how the shutdown effects the lives of real people (as opposed to politicians and the next election) and the politics behind it.  Dr. Ellen Shaffer, UCSF, will talk about how the Affordable Care Act (ACA) is being impacted, if at all, and how the ACA will impact the lives of millions of currently uninsured Americans. 

Thursday, February 14, 2013

Shaffer in AJPH on the Affordable Care Act: The Value of Systemic Disruption

AJPH: The ACA; Value of Systemic Disruption – Ellen R Shaffer

It is important to recognize the political and policy accomplishments of the Patient Protection and Affordable Care Act (ACA), anticipate its limitations, and use the levers it provides strategically to address the problems it does not resolve.  Passage of the ACA broke the political logjam that long stymied national progress toward equitable, quality, universal, affordable health care. It extends coverage for the uninsured, who are disproportionately low income and people of color, curbs health insurance abuses, and initiates improvements in the quality of care.   However, challenges to affordability and cost control persist.
 
Public health advocates should mobilize for coverage for abortion care and for immigrants, encourage public-sector involvement in negotiating health care prices, and counter disinformation by opponents on the right.

Tables in the article summarize major changes in coverage, insurance company protections, and quality/affordability.

 (Am J Public Health. Published online ahead of print February 14, 2013: e1–e4. doi:10.2105/ AJPH.2012.301180

Tuesday, October 16, 2012

Best tweet of the night

MR summary: Mexican drug lords use Obamacare 2 buy guns frm Libyan terrorists 2 sell 2 single moms who dont have time to make dinner

Arrogant, racist Romney could not believe that the President actually remembered accurately his own statement in the Rose Garden labeling the Libyan incident an act of terrorism.  And still didn't believe it til Candy Crowley confirmed it.  (He didn't ask if she was married.)

Saturday, August 25, 2012

Women, Choice and Power

Turns out, women are a key voting bloc in the upcoming election. It's up to us not only to get each other engaged, and voting. but to demand credible commitments that address our concerns.

Here are our choices heading into the political conventions:

A Republican Party fueled with unprecedented gushers of corporate cash that draws political life support from the medieval wing of several fundamentalist religions, whose fantastical beliefs about women's biology are rooted in their ironclad devotion to patriarchy.

A Democratic Party also overly dependent on the parasitic finance sector, that is now reaching back to the Lily Ledbetter Equal Pay Act of 2009 to symbolize its commitment to women's economic empowerment. It depends for political fuel in no small part on the indisputable fact that the Republicans are profoundly scary.

Polls show the 2 running neck in neck.

In fact, this election offers women a clear choice. The Republican platform would make criminals of the 30% of American women who've had an abortion (including me, once because of a fetal anomaly diagnosed in my second trimester). The Affordable Care Act, which Paul Ryan has voted repeatedly to repeal, assures more affordable birth control and extends Medicare's financial health, in contrast to Ryan's proposal to privatize it.

But it's not enough to debunk the opposition's lies, or to point out that they rely on stoking fear and anger. Some recent polls of women who are not politically active show that they do react viscerally to the demeaning insults slung by decision-makers they perceive as "mean, old, white men." But they are living difficult lives, bounded not only by state legislatures that snatch away their birth control and penalize them for their reproductive decisions, but by extensive financial hardship. One quote: "I'm happy this month that I haven't had to sell plasma to feed my children."

So here are some things to call for in Charlotte:

1. An iron clad commitment to preserving and protecting Social Security and Medicare. These two programs form the bedrock of women's financial security as we age. They are under attack explicitly by the Republicans. And too frequently for comfort, our side also periodically lip synchs the lies about the needs to reform these "entitlements." Let's hear Sen. Majority Leader Harry Reid and future House Speaker Nancy Pelosi confirm that the programs are solvent, and that they will not compromise on preserving and improving these programs.

2. It's great that Nancy Keenan of NARAL and Cecile Richards of Planned Parenthood will be speaking. Women's rights to make their own decisions about their reproductive health are fundamental to our economic and personal wellbeing, including access to legal, affordable birth control and abortion. We hope their introductions will include words of support from HHS and the Surgeon General.

3. Finally: Lots of women. On the podium, speaking, in charge, active, visible, and vocal. Women of all races, and for that matter, candidates for races. We know who the top ticket nominees are. Let's give a boost to the EMILY's List all-star roster of pro-choice Democratic women candidates, people like Maggie Hassan for governor of New Hampshire, Congressional candidates like Grace Meng, Christie Vilsack, Val Demings, and Tammy Duckworth, and Elizabeth Warren and Tammy Baldwin for Senate, and of course, incumbent Sen. Claire McCaskill. Since Canadian-born former governor Jennifer Granholm can't run for president, nominate her now for a Cabinet post, if she wants one, and give her air time.

We're going to write checks, emails and op eds, as well as getting out the vote. We have power. Let's recognize and exercise it.