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Health care in America

IT IS now nearly a year since the roll-out of Obamacare. The launch was a shambles, and Obamacare is a totem for every American who hates big government. Republicans will deride it, yet again, in the mid-term elections.

Obamacare is indeed costly and overcomplicated. Yet it is not to blame for America’s health mess, and it could just contain the beginnings of a partial solution to it. But that will only happen if politicians treat health care like a patient: first, diagnose the disease, then examine whether Barack Obama’s treatment helped, and then ask what will make the patient better.

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    Begin with the disease. At the core of America’s problems with health care is a great delusion: it likes to think it has a vibrant private marketplace. In fact the country has long had a subsidy-laden system that is the most expensive and complicated in the world, with much of the government cash going to the rich, millions of people left out and little individual responsibility.

    America devotes 17% of GDP to health care, compared with 9% in Britain, yet nearly 50m Americans were uninsured in 2012 and life expectancy is slightly below average for a rich country. And the taxpayer foots much of the bill: government health spending per head in 2012, before Obamacare’s main provisions took effect, was 50% higher than in Britain, which has a nationalised health system. Some spending, such as the huge Medicare programme for the elderly and Medicaid for the hard-up, is obvious. But much is opaque.

    Employer-sponsored coverage is tax exempt, costing the government at least $200 billion a year. These subsidies fuel health-care inflation and favour rich employees, who would pay higher taxes if they were compensated with wages alone. Just as bad, roughly half the population finds that their health insurance is tied to a job; this makes it harder for them to switch employers. Rising premiums come out of wages; health-care inflation is one of the main reasons why pay for the average American has stagnated. Meanwhile many of the uninsured are free-riders: young people who do not buy insurance but rely on costly emergency rooms if something awful happens.

    The system seems designed to encourage waste. Doctors are often paid for every test or invasive procedure, rather than for keeping patients well. Patients don’t know what anything costs, and the bill will in any case be settled by a third party, so they don’t haggle. Prices can be sky-high and vary wildly. A mammogram in New York may be less than $100 or more than $1,700. No matter what the Republicans say, this is not a free market in any normal sense. But what about the treatment?

    Ironically the “socialist” Mr Obama did not do the one thing that might have cut taxpayers’ costs dramatically: introduce a European “single payer” health-care system (with ideally some small treatment user fees to deter overuse). Instead he tried to tweak America’s system in two ways—to expand coverage and to reduce costs. So Medicaid now covers the not-very-well-off as well as the truly poor (at least, in Democratic states), and Obamacare bans insurers from charging sick people higher premiums. To expand insurers’ pool of patients and keep costs down, it required Americans to buy insurance or pay a penalty. To make insurance-buying easier, Mr Obama introduced online exchanges where people can shop for a health plan, and offered subsidies to those who cannot afford one.

    The results are mixed. Practically every competent health-industry lobbyist managed to insert a line protecting the services his paymasters provide—so Obamacare is too costly and too complicated, but it is doing a little better than it is given credit for (see article). The share of uninsured 18-64-year-olds has fallen from 18.5% in the second quarter of 2013 to 13.9% in the second quarter of 2014 according to a survey. This is probably due mostly to the expansion of publicly funded Medicaid, rather than people flocking to the Obamacare exchanges, on which people buy their own insurance. Encouragingly, health-care inflation has also fallen back, though that may largely be because of a weak economy.

    So what would make American health care better now? Since its failings lie more within the system than with the president’s attempt to reform it, health reformers should concentrate on three areas that could make its flawed market work better: directing handouts towards the poor rather than the affluent, nudging individuals to take charge of their own health care, and making sure that prices are transparent.

    Injecting the right people

    For a start, Congress should move towards scrapping both the tax break for employer-provided health insurance and the requirement that firms offer it. Those savings could be used to help cover subsidies for the poor. Without the tax distortion, employers would pay higher wages instead of benefits and workers would shop around for the best value health plans.

    That is already beginning to happen. Flawed though they are, Obamacare’s exchanges could be the foundation of a new model. Employers are already making employees pay more of their own individual health costs upfront. A worker who has to pay the first $1,000 of his annual bills out of his own pocket is far more likely to shop around. And as patients become more like consumers, health-care providers are improving their game (see article). Walmart and other retailers are selling basic medical services more cheaply and outside usual hours.

    Reform will work only if prices are transparent. This is where antitrust and other competition authorities could come in. Cosy deals between hospitals and insurers that suppress price information should be barred. The government should release more data on the price and quality of doctors. In April it published doctors’ charges for treating elderly patients, but largely withheld the most useful information, such as data showing doctors’ treatment of specific patients over time.

    Obamacare’s effects will not be fully understood for years; but it will never be the core of the problem. If America wants to stick to the idea that it has a health-care market, then it should focus on trying to make it more like a market—with prices, competitors and some form of choice.

    Article source:

    Ebola outbreak: Health team ‘found dead’ in Guinea

    Guinean health workers wearing protective suits at a hospital in Conakry - 14 September 2014Some villagers in Guinea have been scared by the appearance of health workers trying to combat Ebola

    Officials in Guinea searching for a team of health workers and journalists who went missing while trying to raise awareness of Ebola have found several bodies.

    A spokesman for Guinea’s government said the bodies included those of three journalists in the team.

    They went missing after being attacked on Tuesday in a village near the southern city of Nzerekore.

    More than 2,600 people have now died from the Ebola outbreak in West Africa.

    It is the world’s worst outbreak of the deadly disease, with officials warning that more than 20,000 people could ultimately be infected.

    Ebola Outbreak

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    The BBC looks at the scale of the challenge the Ebola outbreak presents

    West African media divided on response to Ebola

    The three doctors and three journalists disappeared after being pelted with stones by residents when they arrived in the village of Wome – near where the Ebola outbreak was first recorded.

    One of the journalists managed to escape and told reporters that she could hear the villagers looking for them while she was hiding.

    A government delegation, led by the health minister, had been dispatched to the region but they were unable to reach the village by road because a main bridge had been blocked.

    ‘Killed in cold blood’

    On Thursday night, government spokesman Albert Damantang Camara said eight bodies had been found, including those of three journalists.

    He said they had been recovered from the septic tank of a primary school in the village, adding that the victims had been “killed in cold blood by the villagers”.

    The reason for the killings is unclear, but correspondents say many people in the region distrust health officials and have refused to co-operate with authorities, fearing that a diagnosis means certain death.

    Last month, riots erupted in the area of Guinea where the health team went missing after rumours that medics who were disinfecting a market were contaminating people.

    Map of Guinea showing the capital Conakry and the southern city of Nzerekore - 18 September 2014

    Speaking on Thursday, President Francois Hollande said France was setting up a military hospital in Guinea as part of his country’s efforts to support the West African nations affected by the outbreak.

    He said the hospital was a sign that France’s contribution was not just financial, adding that it would be in “the forests of Guinea, in the heart of the outbreak”.

    Market in Sierra Leone

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    The BBC’s Umaru Fofana reports on a chaotic lockdown in Sierra Leone

    The World Health Organisation said on Thursday that more than 700 new cases of Ebola have emerged in West Africa in just a week, showing that the outbreak was accelerating.

    It said there had been more than 5,300 cases in total and that half of those were recorded in the past three weeks.

    The epidemic has struck Liberia, Sierra Leone, Guinea, Nigeria and Senegal.

    A three-day lockdown is starting in Sierra Leone at 00:00 GMT in a bid to stop the disease spreading.

    Ebola virus disease (EVD)

    • Symptoms include high fever, bleeding and central nervous system damage
    • Spread by body fluids, such as blood and saliva
    • Current outbreak has mortality rate of about 55%
    • Incubation period is two to 21 days
    • There is no proven vaccine or cure

    Press divided on response to Ebola

    Ebola: Mapping the outbreak

    How bad can it get?

    ‘Biological war’: A week on the Ebola frontline


    Have you been affected by the Ebola outbreak? You can send us your experiences by emailing

    Alternatively, you can get in touch using the form below.

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    After Ebola: Rebuilding Liberia’s health care infrastructure

    Last July the Ministry of Health building in Monrovia, Liberia’s capital city, was set on fire. We were shocked: Our designers had been in that exact building only a few months before, presenting a final draft of National Health Infrastructure Standards that we were then helping develop. According to reports, a man whose relative had just died of Ebola started the fire at the Ministry of Health. In his infinite grief, this man retaliated against the Liberian government, whose failure to contain the outbreak he held responsible for the tragic loss of a relative.

    This man’s anger against the Ministry of Health is understandable. As Ebola continues to spread, destroying lives across Liberia and down the West African coast, many people (nationals and foreigners alike) have called out the Liberian government for its failure to stem the epidemic, branding the health system in our global conversation with the shameful verdict of incompetence.

    Continue reading below

    These judgments of the health system are not without truth. At the moment of the Ebola outbreak, Liberia’s health system was indeed weakened and vulnerable. The country was (and still is) recovering from a devastating civil war, which ended only ten years ago. This civil war decimated the nation’s health system, destroying by its end 354 of Liberia’s 550 medical facilities.

    EDITORIAL: Risking everything to help Ebola victims

    Today, Liberia’s health infrastructure is dangerously underdeveloped. The condition of many of the hospitals we visited often during our time in Liberia speak to this inadequacy. For instance, the John F. Kennedy Medical Center, a vestige of Cold War American-funded aid initiatives and one of Liberia’s leading hospitals, was in shambles due to highly unrealistic maintenance costs. Redemption Hospital, another important health facility in Monrovia, was in fact converted from a building that had previously been used as a warehouse. As a consequence, the building suffered from dark and labyrinthine corridors, its walls stained with water, and its floors and ceilings showing signs of dilapidation.

    And yet, the Liberian Ministry of Health was not earlier this year ignorant of these problems. More importantly, the Liberian government was in fact researching, planning for, and enacting the radical, challenging improvements that were necessary to repair their national health system.

    What is in danger of being lost in the conversation is that the Liberian government was, just before the Ebola outbreak, beginning to take significant and decisive steps towards a new, better, and stronger Liberian health care system — a system that included, at its core, an improved health infrastructure.

    Our design nonprofit has worked with governments and health ministries across the African continent, and we were impressed by the leadership of President Ellen Johnson Sirleaf and Minister of Health Dr. Walter Gwenigale, who are making important investments to shore up Liberia’s health systems and infrastructure. Indeed, when we first arrived in Liberia in 2010, the Ministry was in the process of developing a 10-year, comprehensive national health policy and roadmap for development, which would support the distribution of medical care from Monrovia, the capital, into the many less urban counties that make up the rest of the country. (We completed this work in partnership with the JSI Research and Training Institute, under the Rebuilding Basic Health Services project with funding from USAID.)

    Along with this new national health policy, the Ministry had already developed a new design for Redemption Hospital and a host of other ‘shovel-ready’ projects which would shore up the country’s weak health infrastructure and help the country move towards its long-term national health goals. This, from our perspective, is where Liberia was on the eve of the outbreak — poised to make dramatic changes to its medical system that would improve the future health and well being of its citizens.

    The country, of course, was not ready for Ebola. Not many other countries would be. And what is needed now is targeted, strategic support from the international community, as President Obama called for yesterday in a speech at the Centers for Disease Control, that resonates in productive ways with the Liberian government’s existing national health policy goals.

    Indeed, as international action is taken, parties should respect the Liberian government’s vision to develop a durable and resilient health infrastructure that can support a durable and resilient health system. In other words, we recognize that there is a temptation in this moment of crisis to respond to Ebola with a fleet of emergency shelters, tents, and other short-term strategies to try and stem the epidemic. But (as we saw, for instance, with cholera in Haiti), these kinds of responses are inadequate for safe patient isolation but also in the long-term. Temporary, poorly designed — or even, un-designed — health facilities, while a part of the emergency response, cannot be the entirety of our response. If they are, such structures will not only fail to solve health crises, but may themselves also become health hazards.

    There is a second reason to be wary of emergency tents and similar improvised infrastructure: Such makeshift interventions cannot blind us from the opportunity to invest in infrastructure that will prevent and control such outbreaks in the future.

    The international community has already begun to respond to Ebola with injections of funding and aid. This aid is an incredible opportunity in the midst of incredible tragedy to secure the resources necessary to achieve the infrastructure goals that are already laid out in the Liberian government’s admirable national health policy. If done intelligently, such action would couple the necessary speed of emergency tents with the durability and resilience of long-term infrastructure. This building strategy is not only vital in the current outbreak — it is an investment in the future health of Liberians.

    VOXOP: Ebola raises fears, ethical questions

    It is possible to curb this outbreak; in fact, Liberia is well poised to do so and lead by example in West Africa. What remains is the financial support to invest in stated priorities as outlined in its the National Health Infrastructure Policy, and a perception shift to acknowledge we must provide and ensure safe hospitals.

    When Ebola is all over, the international community will have an important opportunity to consider how and what to invest in to ensure such a devastating outbreak does not occur again. We must choose to build better buildings. Only then will health infrastructure systems finally be strong enough to resist such formidable challenges to their resilience.

    Article source:

    Apple iOS 8 Software Bug Affects Health Apps

    Associated Press

    A bug in Apple’s new iOS 8 software for mobile devices is prompting the company to withhold apps that use a highly touted feature for keeping track of fitness and health data.

    Apple says it hopes to have HealthKit apps restored to its app store by the end of the month. Affected apps include Carrot Fit, WebMD and AskMD. Apple didn’t provide details on what went wrong.

    The iOS 8 software became available Wednesday. HealthKit is supposed to create a central repository for health and fitness data, so that apps have a better picture of your overall wellness and can even recommend trips to the doctor.

    Apple’s new iPhones have sensors to monitor fitness activities, and its upcoming Apple Watch will have a heart-rate monitor.

    Article source:

    Health Officials: Enterovirus Cases Confirmed In NY, NJ And Connecticut

    CBS New York (con’t)

    Affordable Care Act Updates:

    Health News Information:

    TRENTON, N.J. (CBSNewYork/AP) — The New York City area, New Jersey and Connecticut are seeing their first cases of the uncommon respiratory illness that has shown up in children in a dozen states.

    Health officials said Wednesday that a New York City child and a Long Island elementary school student have been diagnosed with enterovirus D68.

    Officials say the Long Island patient is recovering at home in North Hempstead.

    Health Officials: Enterovirus Case Confirmed In New Jersey

    wcbs880 audio player bg Health Officials: Enterovirus Cases Confirmed In NY, NJ And Connecticutwcbs880 audio logo Health Officials: Enterovirus Cases Confirmed In NY, NJ And Connecticut

    They didn’t provide information on the other child’s condition.

    Meanwhile, enterovirus D68 was identified in a specimen sent to the Centers for Disease Control and Prevention by a Philadelphia hospital where a New Jersey child was being treated.

    EXTRA: Enterovirus D68: What Every Parent Should Know

    The New Jersey Health Department says the child, who has not been identified by age, town or name, has improved and been discharged. It is the first-ever enterovirus D68 case in the state.

    Connecticut also confirmed its first case of the illness Wednesday. Dr. Karen Santucci of Yale-New Haven Hospital’s children’s emergency department said a 6-year-old girl was treated there last week and discharged.

    Other hospitals in Connecticut have suspected cases of enterovirus D68 and are awaiting test results.

    Doctors also suspect a handful of children who are recovering at Maria Fareri Children’s Hospital at Westchester Medical Center were stricken with the virus.

    Last week, New York state’s Health Department said there are confirmed cases of the virus in central New York and in the Albany area.

    According to the CDC, there have been 140 lab-confirmed cases in 16 states. No deaths have been reported.

    New Jersey Health Commissioner Mary O’Dowd is advising parents and health care providers to be aware of the symptoms, which include cough, runny nose, sneezing and muscle aches and possibly a low-grade fever.

    “The New Jersey Department of Health is closely monitoring for increases in respiratory illness in hospitals around the state,” O’Dowd said in a statement. “If you, or your child, are experiencing cold-like symptoms and are having difficulty breathing, contact your health care provider right away.”

    New York City health officials say they, too, have been monitoring hospital admissions to “to detect changes in the number of children admitted for respiratory illness, asthma, and influenza-like illness.”

    The virus is spread through contact with an infected person or via contaminated surfaces.

    New Jersey Health Department epidemiologist Dr. Tina Tan said enterovirus is fairly common among kids this time of year.

    “But enterovius D68 is a little bit less common,” she told WCBS 880’s Levon Putney.

    Tan said children with underlying illnesses, such as asthma, seem to experience more severe complications.

    “We remind New Yorkers that the best way to prevent the spread of many infectious diseases is through frequent and thorough hand washing, and parents with concerns should consult their child’s doctor,” the NYC Health Department said in a statement.

    Nassau County Commissioner of Health Dr. Lawrence Eisenstein also advises parents to avoid sending sick children to school and other public places.

    In addition to urging people to wash their hands thoroughly, the Nassau County Department of Health recommends the following steps to protect against enterovirus 68:

    • Avoid touching eyes, nose and mouth with unwashed hands
    • Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick
    • Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.

    For more information from the New Jersey Department of Health, click here.

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    (TM and © Copyright 2014 CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2014 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report

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    Health Law’s Election Impact Is Dimming

    Though Republicans continue to hammer away at the Affordable Care Act, the health-insurance law is losing some of its punch in the 2014 campaign.

    Polls show that voters don’t see the law as a top concern, and both Democrats and Republicans say the election will turn on a range of issues.

    That outlook is causing both parties to adjust. While some Republicans had billed the election as a referendum on the health law, the GOP is…

    Article source:

    Partners in Health staff to join African Ebola fight

    The global effort to battle the Ebola outbreak in Africa is getting a new player: Partners in Health, the Boston-based international aid organization.

    Six leaders of the group are scheduled to arrive in Liberia on Tuesday evening to lay the groundwork for a new push against the virulent disease in rural areas of that country and Sierra Leone.

    Continue reading below

    While international aid has focused on the fast-growing epidemic in cities, Partners in Health intends to set up treatment units in the remote countryside where most people live, places where getting to the nearest clinic requires an eight-hour walk or longer.

    “We expect we’ll be able to bring in scores of providers within very short order and also to train hundreds on the ground,” said Paul Farmer, the organization’s cofounder and chief strategist, who will be among those traveling to the region.

    During the current trip, the six visitors will meet with local authorities and assess the needs before returning home to marshal resources. The agency has launched an appeal for staff and supplies, looking for nurses, physicians, lab consultants, logistical managers, and others.

    Partners in Health will be teaming with two local organizations that it has aided and advised in the past, Last Mile Health in Grand Gedeh, Liberia, and Wellbody Alliance in Kono, Sierra Leone. The goal will be to treat Ebola cases and work with local authorities to contain the spread of the disease, which has claimed more than 2,400 lives this year.

    Partners in Health will work with these agencies to deploy and expand their cadre of community health workers, local people who are trained and employed to bring health information and services to remote areas. These people already serve as trusted liaisons to the health care system. To fight Ebola, they can help identify illness, bring sick people to treatment, and track those who may have been exposed.

    “This model will really reach people, destigmatize the disease, and get people the care they need at any earlier time point,” said Dr. Joia Mukherjee, chief medical officer of Partners in Health and one of the six headed to Liberia. “We’re hoping to get somewhat ahead of the epidemic in those areas.”

    Dr. Raj Panjabi, cofounder and CEO of Last Mile Health, said that about 15 possible or confirmed cases of Ebola have been identified among the half-million people living in Liberia’s six southern counties. But two-thirds of those cases occurred in the past three weeks, suggesting an accelerating spread of the illness. And there is not one Ebola treatment center in the region.

    In the process of coping with Ebola, Panjabi said, it is hoped that Partners in Health will strengthen the health care system in Liberia and Sierra Leone for the long haul.

    “We are going to do our best to make sure that this is a serious long-term commitment,” Farmer said.

    Farmer also wants to demonstrate that Ebola doesn’t need to be so deadly. Historically, he said, “there’s been no overlap with Ebola and modern medicine.” But the zero fatality rate among the American doctors who got proper medical care after being exposed to the disease shows that good medical care save lives.

    “Boston has a huge amount of medical resources, and in my experience if they’re deployed wisely, you can save a lot of lives,” Farmer said.

    Partners in Health is not primarily an emergency-response group, although it has experience with emergencies, such as the Haiti earthquake. But Farmer said he felt a “pervasive anxiety” about the needlessly high death rate from Ebola and now is “relieved” to be heading out there to help. His first stop will be a meeting with President Ellen Johnson Sirleaf of Liberia.

    The agency’s board approved this significant expansion of its mission late last week. Partners in Health has a presence in Haiti, Rwanda, Lesotho, Malawi, Mexico, Russia, Peru, and the Navajo nation in the southwestern United States.

    Farmer added that Ebola is not the only concern in the region.

    “The other thing that was so disturbing — what happens to people who have malaria or women in childbirth?” he said. “If the health centers close, as many of them have, they don’t get basic primary care. . . . How many kids are going to die from malaria, how many women are going to die in childbirth, because of Ebola and fear of Ebola?”

    Panjabi said that the Open Society Foundation had provided $4 million in seed money for the effort.

    Article source:

    VT Health Connect website shut down for repairs

    Anyone clicking on the Vermont Health Connect website sees a message in bold black letters on a pale green screen that advises the site is down for maintenance.

    This will be more than a short-term shut down, Gov. Peter Shumlin and his top health officials explained Tuesday. It could be weeks before health insurance customers would be able to resume buying plans, check accounts or pay electronically on Vermont Health Connect. In the interim, all Health Connect related transactions will be handled by call center personnel.

    Vermont Health Connect, a federally mandated online marketplace for health insurance, has never fully functioned. Since it went live Oct. 1, state officials and several consultants have wrestled to identify problems and make fixes while continuing to operate the website.


    New consultant details exchange’s shortcomings

    State replaces CGI, original exchange developer

    “As all Vermonters know, we’ve had disappointment after disappointment with the Vermont Health Connect website,” the governor said Tuesday. “I have been very frustrated that the website remains incomplete. Bringing down the site now to make improvements with our new partner Optum is the best choice to deliver a well-functioning, secure website for customers by the open enrollment period that begins November 15.”

    Although health care is the top issue in this year’s gubernatorial race, Democratic incumbent Shumlin said politics wasn’t a consideration when he weighed whether to shut down the website. “My job is to make the right decision.”

    Acting Human Services Secretary Harry Chen recommended the shutdown to the governor over the weekend. Shumlin agreed and ordered it shut down Monday night.

    “It doesn’t make sense to keep doing the same thing and expect a different result,” Chen said Tuesday about continuing to try to fix the website while operating it. “This is a prudent choice to have better operations, better security and a better consumer experience.”

    Chen acknowledged the downside to shutting down.

    “Vermonters have doubts about our ability to come through and to some this might seem confirmatory of that,” he said. “I see it as preventive medicine to get things to run smoothing by Nov. 15.”

    Shumlin recently moved Chen, a former emergency room doctor who has been serving as health commissioner, into the top job at the Agency of Human Services. The governor asked Chen to evaluate and potentially shake up operations in the agency, which has struggled with child protection troubles as well as the challenges posed by the malfunctioning health insurance exchange.


    “I’m really surprised,” Trinka Kerr, health care advocate with Legal Aid said about the shutdown. “We had no idea. I hope it means they can get it running smoothly.”

    Kerr and her staff work with Vermonters who have problems with government health programs, including Vermont Health Connect.

    “Right now we have a lot of concerns about how things will work for people while the site is down,” Kerr said. Many people signing up for insurance on the exchange qualify for federal assistance to pay their monthly premiums, she noted. “If people call and are trying to enroll, will someone be able to figure out what the subsidy is?”

    Skeptics and critics of the administration’s implementation of Vermont Health Connect welcomed the shutdown announcement.

    Republican Lt. Gov. Phil Scott said taking the troubled website offline was both appropriate and long overdue.

    “It’s my belief we should transition to the much simpler and fully functional federal exchange that 27 other states have successfully used, and that seven more are working with in partnership with the government,” Scott said in an email statement. “I want the exchange to work. But I think it’s time to face reality and admit we need to stop trying to “get it right” with Vermont Health Connect and do the right thing for Vermonters.”

    Dean Corren, the Progressive/Democrat challenging Scott’s re-election bid, countered that closing down Vermont Health Connect permanently and shifting to the federal exchange was “an unworkable approach, and no solution. Not only would it mean greater costs for lower income Vermonters, it would eliminate the coverage standards that Vermonters have adopted.”

    Corren also noted that the website’s difficulties are “mostly due to the complexity of the current, insurance company-based hodge-podge.” A single-payer system, which Corren advocates, would be much simpler.

    Dan Feliciano, the Libertarian candidate for governor, has made health care the focus of his challenge of Shumlin.

    “I still think Vermont Health Connect is going to be a disaster,” Feliciano said, but praised the decision to shut it down. He had worried that trying to fix computer code while continuing to operate the site could put Vermonters’ personal information at risk.

    “I still say keep it down and put it to bed,” Feliciano said. Like Scott, Feliciano favors abandoning Vermont Health Connect and switching to the federal health insurance exchange.


    In addition to announcing a shutdown, Shumlin and Chen said that Lawrence Miller, chief of health reform on the governor’s staff, would take charge of Vermont Health Connect.

    The health insurance exchange has been overseen by Mark Larson, commissioner of the Department of Vermont Health Access. Larson remains commissioner with responsibility for Medicaid. He will retain a role advising on Vermont Health Connect, Chen said, “but he isn’t going to make the decisions.”

    Last January, Shumlin asked Miller, while still Secretary of Commerce, to assist Larson in solving the problems plaguing Vermont Health Connect. The governor subsequently brought Miller onto his personal staff to focus full-time on health reform.

    Chen proposed the new organization with Miller handling operational leadership for Vermont Health Connect. It is modeled on the incident command structure used to enable multiple organizations work together in emergencies. “This makes it much more clear who is in charge.”

    “We are unifying everything that has to do with Vermont Health Connect under one chain of command,” Miller said.

    Both Miller and Chen said the sudden decision to shut down the website wasn’t triggered by a security breach. “This is not a discovery of a compromise of security,” Miller said. Rather, he said, “We had a lot of things we were working on and we weren’t getting them complete in the time we wanted them completed.”

    Before shutting down the website, Miller said the administration talked with Optum, the consultant hired in June to replace the original private partner developing the website, CGI. The state also advised the federal agency — Centers for Medicare and Medicaid Services — that regulates health insurance exchanges.

    CMS is fully supportive of the decision,” Miller said.

    “Establishing this online health insurance network has been challenging from the start, to say the least,” Miller said. “It is critical that we take advantage of this period of relatively low-volume use to improve Vermont Health Connect’s operations, technology and security, and turn around the difficulties Vermonters have experienced with our website.”

    Optum, hired in June, has provided 125 call takers, doubling the number of people available to take customer queries. With Optum’s help, the state has whittled the backlog of people needing revisions to their insurance records from 14,000 to about 2,500, Miller said. He expects the backlog to be eliminated by the end of the September or early October.

    Chen said the new chain of command structure for Vermont Health Connect would remain in effect through the open enrollment period, which runs from Nov. 15 through Feb. 15. He said it was too early to say if it would become the permanent organizational structure for Vermont Health Connect.

    “Once we get to a more stable state, we will make a decision,” Chen said.

    Contact Nancy Remsen at 578-5685 or Follow Nancy on Twitter at

    Copyright 2014 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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    Health Law Falls Flat With Kentucky Voters, Even Those It Helps

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    Growing Burden of Employer-Provider Health Care Has Accelerated Under …

    There’s been a fierce debate over whether Obamacare has increased health insurance premiums. Progressives have argued Obamacare is working due to modest projected premium increases on the Exchanges for 2015. Conservatives have retorted that “there can be no doubt that health care today is more costly than it would have been without Obamacare.”  But this argument has focused on the health Exchanges, where only 7-8 million people bought their coverage in 2014. Readers would do well to remember that more than 20 times that number of people rely on employer-provided health benefits (Table C-1).  In the employer-based market, the adverse effects of Obamacare on premiums and affordability are strikingly obvious.  The growing burden of employer-provided health care has accelerated under Obamacare.  And yet the New York Times would have you believe everything is hunky-dory since “the growth in health insurance premiums was only 3 percent between 2013 and 2014. That’s tied for the lowest rate of increase since Kaiser started measuring (this is the 16th year of the survey).”  This view is dead wrong: here’s why.


    This chart is based on the average premiums for family coverage just reported in the most recent annual Employer Health Benefits Survey conducted Kaiser Family Foundation/Health Research Educational Trust. This is one of the most authoritative (and long-running) sources of premiums for employer-sponsored health insurance. I’ve divided that premium by the average wages and salaries per full-time equivalent employee, as reported by the Bureau of Economic Analysis [1]. Again, these are the most authoritative data available on the earnings of U.S. workers.  Dividing average premiums into average earnings allows us to quickly see how much more quickly health insurance premiums are rising relative to the ability of the average worker to afford them.

    Most discussions of premium trends have failed to address the reality that the purported slowdown in health spending in recent years has occurred at a time that worker earnings also have slowed down relative to earlier periods. For example, the increase in average wages salaries between calendar year 2012 and calendar year 2013 was only 0.7%. With the exception of the increase from 2008 to 2009 (remember that the recession officially began in December 2007 and ended in June 2009), this was the lowest rate of increase in all the years since 1999–a period which saw increases of 3.0% or more in 6 different years.  In contrast, family health insurance premiums rose 3.8% between 2012 and 2013–a modest increase in absolute terms, but vastly faster than the rise of average wages and salaries.

    In short, for the vast majority of Americans, employer-provided health coverage has become more unaffordable under Obamacare. Moreover, readers can see with their own eyes that the pace at which health care is becoming more unaffordable has accelerated rather than dissipated following passage of the “Affordable” Care Act.


    Did The Typical Family Save $2500 in Premiums?

    First as candidate and then as president, Barack Obama promised (more than a dozen times) that under his health plan, the typical family would enjoy savings of $2500 a year (!) [2]. The latest KFF/HRET figures are an unpleasant reminder of just how badly that promise was broken.  Average premiums for employer-sponsored family health insurance coverage grew from $13,375 in 2009 to $16,834 in 2014–an increase of $3,459 or 4.7%. This is more than double the annual increase in earnings per FTE worker (2.2%) during the same period [3].

    Too many people focus on the raw rate of increase in health insurance premiums without considering what was happening the worker earnings. 4.7% admittedly is lower than the 5.5% average annual increase  in premiums observed from 2005 to 2006 and 2007 to 2008.  But earnings growth during those two years was 4.6% and 4.5% respectively, meaning that that growth in health insurance premiums was outstripping wage growth by only 1% a year or less. In contrast, under Obamacare growth in family health insurance premiums have outstripped wage growth by an amount that is 2-1/2 times as large. Which world would you rather live in? One in which higher premiums are accompanied by wage growth that lags only 1% behind premium growth? Or a world with lower growth in premiums in which growth in wages lags 2.5% behind premium growth?

    Reform alternatives such as Avik Roy’s transcending Obamacare plan have demonstrated decisively that it is possible to cover more people while lowering premiums rather than increasing them.  Indeed, lowering premiums is generally a much more sensible and effective strategy than trying to force people to buy coverage they don’t want.   The evidence is undeniable: nearly every Obamacare promise has been broken. Isn’t it time to swap this lemon law for something vastly superior?



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    READ CHRIS’ BOOKThe American Health Economy Illustrated (AEI Press, 2012), available at Amazon and other major retailers. Follow @ConoverChris on Twitter Twitter, and The Apothecary on Facebook. Or, sign up to receive a weekly e-mail digest of articles from The Apothecary.

    INVESTORS’ NOTE: The biggest publicly-traded players in Obamacare’s health insurance exchanges are Aetna Aetna (NYSE:AET), Humana Humana (NYSE:HUM), Cigna (NYSE:CI), Molina (NYSE:MOH), WellPoint (NYSE:WLP), and Centene (NYSE:CNC), in order of the number of uninsured exchange-eligible Americans for whom their plans are available.



    [1] The BEA data only go through calendar year 2013, whereas the latest KFF/HRET premium data have been reported for 2014. For purposes of analysis, I’ve simply assumed that the increase in wages between 2012 and 2013 will continue through 2014. This may be an optimistic assumption, as the Bureau of Labor Statistics Employer Cost Index shows that wages and salaries for private sector workers grew 2.1% over the 12 month period ending December 2013 but only 1.9% over the 12 month period ending June 2014.

    [2] Candidate Obama promised on June 5, 2008: “We’ll lower premiums by up to $2,500 for a typical family per year. .  .  . We’ll do it by the end of my first term.”  Although the claim that this would happen by the end of his first term later was relaxed, this promise was reiterated at least 14 times, most recently in a campaign speech on July 16, 2012.

    [3] If we use 2010 as the base year, the story is even worse: premiums were $13,770 that year, so the annual increase in premiums subsequently has been 5.2% vs. average annual earnings growth of only 1.8%.

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