On The Ed Show, Vermont Senator Bernie Sanders talks about the Arlen Specter defection to the Democrats, and how the grassroots now has to rise up and demand single-payer universal health care if they want it. 4/28/09
Thursday, April 30, 2009
On The Ed Show, Vermont Senator Bernie Sanders talks about the Arlen Specter defection to the Democrats, and how the grassroots now has to rise up and demand single-payer universal health care if they want it. 4/28/09
Tuesday, April 28, 2009
Fifteen years ago the private health insurance industry told Congress and the nation that it could fix the health care mess if government got out of the way. The insurers said that they would control costs for American families and businesses and improve the quality of care. The American people, American business and the Congress aren't about to buy that line again.
The result of leaving health care reform to the insurance industry is that health insurance premiums have gone up six times faster than wages in the past nine years. Those dollars are buying skimpier health coverage with high deductibles and caps on benefits, resulting in more and more insured people being forced into medical bankruptcy. Businesses that are struggling to meet health care costs in a global economy and dropping coverage, so much so that now 1 out of 3Americans under the age of 65 has been uninsured at some time in the past two years. Health care eats up 16% of our economy, up from 11% when the nation decided to leave the private insurance in charge.
The insurance industry and their defenders on the ideological right are resorting to the same name tired name calling that worked for them the past, "government-run" health care. It's a desperate attempt to fend off a sensible government role in making health care affordable to our families, businesses and nation. This time it won't work. The President and leadership in Congress -- and the American -- people support a two-pronged role for government. One, set rules so that the private insurance industry can't continue to put profits before our health. Two, offer a choice of private insurance or a public health insurance plan, so people aren't stuck only with private insurance.
The fact is that if private insurers controlled health care inflation as well as Medicare has over the past decade, businesses and families would see much lower premiums than they do today. Between 1997 and 2006, per enrollee spending in private insurance grew 59% faster than spending in Medicare. And Medicare has the tougher job, because it cares for the most expensive population: the elderly and those with serious disabilities.
One reason that private insurers have gotten away with skyrocketing premium increases is that they have a near monopoly across the nation. According to data from the American Medical Association, in virtually every metropolitan area in the country (96%) the insurance market is dominated by so few insurers so as to be considered "highly-concentrated." A public health insurance option coupled with a regulated private insurance market will break the stranglehold a handful of companies have on the insurance market. Most importantly, under these reforms consumers will be able to vote with their feet when their health care plan -- public or private -- doesn't work for them.
In fact, the main argument that the industry and the right has with offering the choice of a public health insurance option is that too many Americans will choose it. If private insurers are really more efficient than government, they shouldn't have any trouble competing with a public health insurance plan. It's the height of irony that the defenders of free markets are opposed to competition. But when it comes to health care, which is a public good, public insurers really are more efficient.
There is broad agreement that America's health care system does not deliver the value we need. Today, private insurers have little incentive to develop sophisticated disease management programs, since such programs may attract sicker patients into their plan. And when care improvements are achieved, private plans have no incentive to share best practices with industry competitors. A new public health insurance plan would create a mechanism for the development of innovative and transparent payment mechanisms, the expansion of quality incentives, and the adoption of evidence-based protocols. As the Veterans Health Administration and Medicare have proven capable of doing, a new public health insurance program could lead the way in advancing electronic medical records, creating incentives for greater integration of delivery systems, and establishing improved measures of quality.
The American public gets it. In a national survey of voters taken last year, four-out-of-five voters (79%) said that the insurance industry puts profits before people. A Kaiser Family Foundation poll released this week found that two-thirds (67%) of U.S. residents "strongly" or "somewhat" favor establishing a public health insurance option "similar to Medicare."
Polling by Lake Research Partners this January found that the public believes that the choice of a public health insurance option will lower costs, improve quality, and increase competition. The poll paired the strongest conservative attacks -- "rationing", "government bureaucracy", losing private health insurance and being dumped into a public plan -- against the arguments for the choice of a public health insurance plan. In every case the public favors the pro-public health insurance option, in most cases by margins of better than two-to-one. For example, 61% agree that a public health insurance plan will be better able to control costs by using its purchasing power to drive competition. Voters reject by wide margins claims that a public health insurance plan will limit access, with 66% of voters agreeing that a public health insurance plan will provide an affordable option with a wide choice of doctors.
The question before Congress is whether it will follow the will of the American people. Or, instead, bow to the private insurance industry and other interests that stand to lose if reforms are passed to really make health care more affordable. The President and Congressional leadership share a strong commitment to reforms that will guarantee good, affordable coverage for all, with a choice of private or public health insurance. We know opponents will use scare tactics across the country and a huge corporate lobbying presence inside the Beltway to block reform. Progressive leaders in Congress and Health Care for America Now will be working hard to keep the American public engaged in this fight over the next months. Our success will be the hallmark of a new era in American politics in which the public good is put ahead of corporate excess and greed.
Sunday, April 26, 2009
We have a lot to do if we want real, workable health care reform. Luckily, there are many grassroots organizations working hard to make it easy for everyone to do something. I will try to keep this post with current actions at the top of this blog (will shift it back up once or twice a day as needed) as long as the items are active.
1 - TELL REPRESENTATIVE PELOSI TO PUT SINGLE PAYER ON THE AGENDA
A copy of your efax will go to Nancy Pelosi, Dan Bernal (Legislative Aide to Representative Pelosi), Joel Segal (Aide to Representative Conyers), Senatory Max Baucus and The White Office of Health Reform.
2 - Tell Congress to support Single-Payer healthace for everyone in America!
Send a message to:
* Representative Charles Rangel
* Representative George Miller
* Representative Henry Waxman
* Senator Edward Kennedy
* Senator Max Baucus
3 - National Lobby Day and Rally for Single-Payer in DC
When: Wednesday, May 13 at 12:00pm - 2:00pm
Where: Upper Senate Park, Washington DC (near Union Station Metro Stop)
If you cannot make it to be with us in D.C. then mark your calendar and start calling your representative and senators at noon on the 13th.
It appears that Congressional leaders are being deliberately dismissive of single-payer to the point of ludicrous statements. It's like they have put their fingers in their ears and are yelling 'I can't hear you, I can't hear you.' Here they are in all their Congressional 'member' glory:
Baucus a few days ago: 'Everything BUT single payer is on the table. Single payer if off the table'
Pelosi: "In our caucus, over and over again, we hear single payer, single payer, single payer. Well, it's not going to be a single payer."
Pelosi's aide: "Where are the phone calls, e-mails and faxes in support of single-payer? Speaker Pelosi has been in favor of single-payer for a long time. Now make us do it."
OK. We are up to the challenge. He wants to see the faxes. Let's break their damn fax machines with the faxes.
You can send a fax right now to Pelosi, Baucus, the aide and the White House.
So let them see what happens when they ask for faxes. Then maybe they will have to take their fingers out of their ears.
eFax - Pelosi Put Single Payer on the Agenda
Help put these ads on the air.
Congress is writing health care reform as we sit here and preach to the choir. It's time to stop preaching to the choir. It's time to get the Mike Farrell ads on TV. Now. Not in a month.
Donate today and help raise the $50,000.00 we need. If everyone donates 50 dollars, we can do it. If everyone donates 100 dollars, we can do it faster.
See all the ads here:
Donate today. The time is short
Pelosi Pushes For Truth Commission - Hotline On Call
Speaker Nancy Pelosi chatted with reporters during a Christian Science Monitor event in Washington.
On health care reform:
'This is a very exciting initiative for us. It's going to be historic in its nature when it is passed by the Congress, and I believe that it will be. ... We are all working in partnership on this. It's teamwork. ... As our members came back from their recess, a great deal of what they heard out there was public options, public options, public options, public options. In our caucus, over and over again, we hear single payer, single payer, single payer. Well, it's not going to be a single payer. ... We had an opportunity for that awhile back, and it was not realized. And that's not what it's going to be. So we had to take people from a place that they see universal, affordable, quality health care available best in single payer and say this can be achieved in other ways.'
Well, Nancy, we have never tried for single payer before and the nation has never needed it as much as it does now.
As Don McCanne says:
"Nancy Pelosi’s comments reveal just how determined the Congressional leadership is in keeping single payer off the table. Presumably her comment that “we had an opportunity for that awhile back” refers to the Clinton effort at reform, even though that was a process that quite explicitly excluded single payer as a reform model. The closest the nation has come to embracing the single payer model is the enactment of Medicare. Even though the program requires updating, it has been more effective and more efficient than any other program. A new and improved Medicare is precisely the reform that the nation needs.
For an administration and a Congress that advocates for using science in policy decisions, it is astounding that they would reject health policy science and leave us in the Dark Ages in health care reform."
Google Book Search:
By Institute of Medicine (U.S.). Committee on the Consequences of Uninsurance"
Hidden Cost, Value Lost, the fifth of a series of six books on the consequences of uninsurance in the United States, illustrates some of the economic and social losses to the country when maintaining so many people without health insurance. The book explores the potential economic and societal benefits that could be realized if everyone had health insurance on a continuous basis, as people over age 65 currently do with Medicare. 'Hidden Costs, Value Lost concludes that the estimated benefits across society gained by providing the uninsured with the kind and amount of health services that the insured use, are likely greater than the additional social costs of doing so. The potential economic value to be gained in better health outcomes from uninterrupted coverage for all Americans is estimated to be between $65 and $130 billion each year.
Saturday, April 25, 2009
The U.S. Centers for Disease Control and Prevention said on Friday it was too late to contain the swine flu outbreak in the United States.
Aren't we glad that we have a Universal Health Care plan so everyone feeling like they are getting the flu can see a doctor? Oh wait.... we don't.....
Science does not permit ideology to foreclose inquiry; it requires facing facts and following where they and logic lead. Hence many cheered when President Barack Obama announced that science is back, that predisposition will no longer be permitted to trump reality. Everyone knew he was talking about stem cell research.
Who could have guessed that the Obama administration and key congressional players would exclude single-payer/Medicare-for-all programs from consideration even though that means ignoring the cost savings of hundreds of billions of dollars in private plans’ nonbenefit costs? Further, administration health experts advertise their focus on avoiding incentives for unnecessary treatment, but pay no mind to the expensive distortions that follow from physicians’ ownership interests in high-cost equipment and services. Odd that the scientific method does not apply to medical care where science should govern.
Snubbing And Chiding Single-Payer Advocates
Until the day before the Health Care Summit, no advocate of single-payer/Medicare-for-all had been invited to rub shoulders at the White House conference with the hordes of insurance and drug manufacturer officials and lobbyists, right-wing think-tank pundits, major employers and their organizations, and hospital executives — all deeply implicated in the design, execution, and defense of the current dysfunctional medical care insurance nonsystem — the supposed object of “reform.” An 11th hour invitation came only after a threatened demonstration by doctors, nurses, and medical students who back a single-payer proposal sponsored by 94 members of the U.S. House of Representatives. Even the legendarily unbiased Congressional Budget Office had shortly before issued two large studies of medical care, totaling about 400 pages, containing only a few cursory paragraphs about single payer/Medicare-for-all.
The president opened and closed the one-day summit with his usual splendidly composed summary of hurdles to providing medical care to all and curbing costs. He had sharp words only for “bleeding-heart liberals,” chiding them for inattention to costs although they repeatedly stress the huge savings single-payer/Medicare-for-all could deliver. It is his experts who persistently ignore those cost savings while pursuing possibly desirable but unproven methods of reducing costs. So, for example, claims are made for vast savings by health information technology (IT), such as computerization of patient records, which might reduce medical errors if a uniform nationwide system becomes operational — years hence. Similarly, it is unproven that paying health care providers based on outcomes would be feasible; with hundreds of millions of billings, assessing the efficacy of each treatment seems impossible — and impossibly costly.
Savings From Medicare-For-All
Medicare-for-all would save hundreds of billions every year. Private insurers expend enormous sums for insurer commissions, advertising, Wall-Street-scale executive compensation, and profits. In contrast, Medicare spends little or nothing on these unnecessary, unproductive activities. Health care providers and private plans struggle with thousands of different billing schedules. As the New York Times reported: “The average provider — doctors or hospitals — has between 5 and 100 reimbursement rates for the same procedure. . . . A hospital chain may have 150 rates for the same procedure.”
In contrast, Medicare districts employ only one. That helps explain why Medicare’s nonbenefit expenditures require only 4 percent of benefit outlays while private plans expend far more — on the order of 20% for publicly traded companies and as much as 31% of premium for some. We are talking real money. A recent McKinsey Quarterly article found that medical care insurer billing consumes more than $300 billion a year, costing 15 percent or more of medical outlays. Medicare-for-all would make do on a sliver of that. (Harvard Medical School economist Rashi Fein tells the story of a former colleague working at a Montreal hospital, where three people processed bills there, primarily for traveling Americans. Later he worked at Chicago’s Michael Reese Hospital, where the billing facility, jammed with clerks at computers, stretched a football field’s length in two directions.)
Understand that Medicare uses private insurers to administer its program and pays private providers to deliver care; patients select their providers, a choice many private plans limit. Medicare confines its payments to a fee schedule it promulgates after receiving the advice of the Medical Payment Advisory Commission (MedPAC), which comprises a variety of practitioners and others. That price constraint reduces costs. But the big savings come from simplified billing/payment procedures.
In addition, Medicare delivers its benefits at lower cost than means-tested programs like Medicaid and the Children’s Health Insurance Program (CHIP). Absorbing all such programs (and there are many) into Medicare would save tens of billions more and speed up providing care.
Opponents dismiss Medicare-for-all as a “one-size-fits-all” formula. Well, who among us knows how to estimate when we or a family member will need medical care? Who among us can gauge when a heart attack may strike or a drunken driver will cross the median? In this world full of uncertainty, we all share the same need for assured medical care — that’s the size Medicare-for-all fits.
The Effects Of Conflicts Of Interest
Studies repeatedly show that medical care providers with ownership interests in labs and high-cost devices like computed tomography (CT) scan and magnetic resonance imaging (MRI) machines prescribe those services far more than those who do not own any. Medical societies should ban such conflicts of interest; if they don’t, Medicare, which attempts to curb them, should forbid them completely. That would save billions and confine providers to their proper role: treatment based on medical grounds uninfluenced by profit.
So why do the Obama medical care gurus, Senator Baucus and Senator Grassley, and the Congressional Budget Office exclude Medicare-for-all, although it would save far more than any rival plan? In large measure, that results from the propaganda war on single-payer. President Obama says that it would be impractical to try to substitute Medicare for “legacy” private plans because so many are “accustomed to” them. But “accustomed to” simply does not describe plans that are melting down, disappearing, and becoming constantly more unaffordable.
Further, Medicare does not charge higher rates for pre-existing conditions or for elderly and female patients as private plans do, thereby encouraging employers to discriminate in employment. Moreover, with everyone covered for all needed medical care, the greater part of malpractice compensation — medical repair — would be met without the delay and expenses of medical malpractice disputes and litigation.
Yet the Obama, Baucus, Grassley, CBO, and other playlists exclude consideration of Medicare-for-all. With rising discomfort with the price tag of recovery programs, those desiring comprehensive health care cannot afford to disregard a program with such enormous savings. If Medicare-for-all gets “on the table” before the Senate Finance and House Ways and Means committees, the CBO must report its vast savings and its greater efficiency and effectiveness compared with more expensive alternatives. Only by censorship — only by treating Medicare-for-all as nonexistent — can lesser alternatives be discussed with a straight face.
And censorship is not compatible with science.
Friday, April 24, 2009
In a meeting with House Republicans at the White House Thursday, President Obama reminded the minority that the last time he reached out to them, they reacted with zero votes -- twice -- for his stimulus package. And then he reminded them again. And again. And again.
Obama also offered payback for that goose egg. A major overhaul of the health care system, he told the Republican leadership, would be done using a legislative process known as reconciliation, meaning that the GOP won't be able to filibuster it.
Congress has until October 15 to pass health care or student lending reform under the normal process. If it doesn't, reconciliation can be used to eliminate the 60-vote requirement.
Democratic aides said that Obama made clear to the GOP leadership that he would continue to work in a bipartisan way, but that they didn't have veto power over health care policy. GOP aides, however, said that Obama was pretty clear that reconciliation would be used. "From what was told me, it sounded more like he would almost definitely use reconciliation for healthcare. I don't think he hedged much," said one.
Universal coverage could help "significantly" reduce health disparities, according to a Commonwealth Fund-supported study published in the Annals of Internal Medicine.
The study, by J. Michael McWilliams, MD, Ph.D., and colleagues at Harvard University, found that Medicare coverage makes a difference in the health of racial, ethnic and challenged socio-economic populations for patients with diabetes and cardiovascular disease. Based on the study, the authors believe that universal coverage may reduce these types of health disparities in the general population.
The authors reviewed health data from more than 6,000 people aged 40 to 85 with at least one of the following conditions: diabetes, hypertension, coronary heart disease or stroke. They found that while overall improvements have been made in controlling the diseases, racial, ethnic and socioeconomic differences have remained the same or in some cases worsened in the pre-Medicare population.
However, at age 65, when people become eligible for healthcare coverage under the Medicare program, those differences were reduced significantly. The study found that for blood sugar levels with diabetes, educational disparities decreased by 83 percent, while racial and ethnic disparities fell by 78 percent. For total cholesterol levels, educational disparities disappeared altogether. And, for systolic blood pressure, racial disparities decreased by 60 percent.
"The results of this study make it clear that guaranteeing access to affordable insurance for all Americans is the essential first step toward a high performing healthcare system and a healthier America," said Commonwealth Fund President Karen Davis. "As our leaders look toward health reform it is critical that they take into account the value of healthcare coverage for everyone and ensure that all Americans have the ability to obtain insurance."
Thursday, April 23, 2009
David Himmelstein, Associate Professor of Medicine at Harvard University, testifies at a hearing investigating ways to reduce the cost of health insurance for employers, employees and their families on April 23, 2009.
Dr. McCanne tells us:
The definitive legislation on health care reform that will be supported by the Democratic leadership in Congress has not yet been written. This important testimony by PNHP’s David Himmelstein confirms that single payer reform is still in play, in spite of dismissive comments by many of those involved.
Instead of sitting back and observing the process, it is imperative that we intensify our efforts to deliver the single payer message. The physical and financial health of the people of our nation depend on it.
Transcript of Dr. Himmelstein's testimony:
Health, Employment, Labor, and Pensions Subcommittee Hearing
United States House of Representatives
Committee on Education and Labor
April 23, 2009
Testimony of David U. Himmelstein, M.D.
Mr. Chairman, members of the Committee. My name is David Himmelstein. I am a primary care doctor in Cambridge, Massachusetts and Associate Professor of Medicine at Harvard. I also serve as National Spokesperson for Physicians for a National Health Program. Our 15,000 physician members support non-profit, single payer national health insurance because of overwhelming evidence that lesser reforms will fail.
Health reform must address the cost crisis for insured as well as uninsured Americans. My research group found that illness and medical bills caused about half of all personal bankruptcies in 2001, and even more than that in 2007. Strikingly, three quarters of the medically bankrupt were insured. But their coverage was too skimpy to protect them from financial collapse.
A single payer reform would make care affordable through vast savings on bureaucracy and profits. As my colleagues and I have shown in research published in the New England Journal of Medicine, administration consumes 31% of health spending in the U.S., nearly double what Canada spends. In other words, if we cut our bureaucratic costs to Canadian levels, we’d save nearly $400 billion annually — more than enough to cover the uninsured and to eliminate copayments and deductibles for all Americans. By simplifying its payment system Canada has cut insurance overhead to 1% of premiums — one twentieth of Aetna’s overhead - and eliminated mounds of expensive paperwork for doctors and hospitals. In fact, while cutting insurance overhead could save us $131 billion annually, our insurers waste much more than that because of the useless paperwork they inflict on doctors and hospitals.
A Canadian hospital gets paid like a fire department does in the U.S. It negotiates a global budget with the single insurance plan in its province, and gets one check each month that covers virtually all costs. They don’t have to bill for each bandaid and aspirin tablet. At my hospital, we know our budget on January 1, but we collect it piecemeal in fights with hundreds of insurers over thousands of bills each day. The result is that hundreds of people work for Mass General’s billing department, while Toronto General employs only a handful — mostly to send bills to Americans who wander across the border. Altogether, U.S. hospitals could save about $120 billion annually on bureaucracy under a single payer system.
And doctors in the U.S. waste about $95 billion each year fighting with insurance companies and filling out useless paperwork.
Unfortunately, these massive potential savings on bureaucracy can only be achieved through a single payer reform. A health reform plan that includes a public plan option might realize some savings on insurance overhead. However, as long as multiple private plans coexist with the public plan, hospitals and doctors would have to maintain their costly billing and internal cost tracking apparatus. Indeed, my colleagues and I estimate that even if half of all privately insured Americans switched to a public plan with overhead at Medicare’s level, the administrative savings would amount to only 9% of the savings under single payer.
While administrative savings from a reform that includes a Medicare-like public plan option are modest, at least they’re real. In contrast, other widely touted cost control measures are completely illusory. A raft of studies shows that prevention saves lives, but usually costs money. The recently-completed Medicare demonstration project found no cost savings from chronic disease management programs. And the claim that computers will save money is based on pure conjecture. Indeed, in a study of 3000 U.S. hospitals that my colleagues and I have recently completed, the most computerized hospitals had, if anything, slightly higher costs.
My home state of Massachusetts recent experience with health reform illustrates the dangers of believing overly optimistic cost control claims. Before its passage, the reform’s backers made many of the same claims for savings that we’re hearing today in Washington. Prevention, disease management, computers, and a health insurance exchange were supposed to make reform affordable. Instead, costs have skyrocketed, rising 23% between 2005 and 2007, and the insurance exchange adds 4% for its own administrative costs on top of the already high overhead charged by private insurers. As a result, one in five Massachusetts residents went without care last year because they couldn’t afford it. Hundreds of thousands remain uninsured, and the state has drained money from safety net hospitals and clinics to kept the reform afloat.
In sum, a single payer reform would make universal, comprehensive coverage affordable by diverting hundreds of billions of dollars from bureaucracy to patient care. Lesser reforms — even those that include a public plan option — cannot realize such savings. While reforms that maintain a major role for private insurers may be politically attractive, they are economically and medically nonsensical.
Putting Bill Maher’s recent words into action, “Health insurance is like a hospital gown, chances are your ass isn’t covered,” bare-bottom protesters wore hospital gowns and dressed as Insurance Executives. The protesters jumped through hoops held by the insurance executives symbolizing the proverbial hoops that doctors, nurses, and patients have to go through in the current corporatized health insurance system.
PHIMG, Healthcare-NOW!, Progressive Democrats of America, and Act Up! marched in lock step on Saturday, April 4th with United for Peace and Justice and Bail Out the People through Wall St. to support strengthening the workforce by urging Congress to pass HR676, expanding Medicare into a single-payer system, to provide true universal health care to all.
On the following Monday, PHIMG brought the Not Covered Campaign to Congressman Charles Rangel’s office, whose 2008 campaign received three times the amount of campaign contributions from health insurance and pharmaceutical companies as his last run in ‘04, while conveniently not cosponsoring HR 676 for single-payer health care, as he has in the past.
The group also had a list of demands including meeting with him, cosponsoring the bill, using his power as the Chair of the Ways and Means Committee to hold single-payer health care hearings, and including single-payer advocates - not just the health insurance corporations in the national health care dialog Obama’s administration is so open to having. Barack Obama also supported single-payer health care before his run for President made his campaign the top recipient of contributions from the health insurance and pharmaceutical industry.
The group received confirmation that Rangel does support HR 676, and just hasn't signed on yet. Advocates and constituents look forward to a long sought meeting with Rangel's staff next week.
The Not Covered Campaign will be in full swing all summer long calling out the Congresspersons that let campaign contributions stand in the way of providing all citizens with single-payer health care - one by one. It’s critical that citizens act now and push Congress to pass HR 676 before inadequate reform maintaining corporate interests over patients passes. Join the fight for single-payer health care now!
Connecticut lawmakers voted late Wednesday to update the state's marriage laws to conform with last fall's landmark state Supreme Court ruling allowing gay and lesbian couples to marry.
read more | digg story
Like the derivatives that wrecked the housing market, profit-seeking insurers have created a convoluted system that siphons off one out of every three health-care dollars for themselves, giving Americans less care for more money than any place else in the developed world.
In reform legislation, it's crucial to include what has been called a Medicare-for-All option that would give consumers a chance to buy care directly and pressure private insurers to improve what they offer.
Without such a choice, health-care "reform" could turn out to be like Wall Street bailouts that shovel money to Citibank, Bank of America and AIG and leave all the decisions about spending it to their discretion.
The National Nurses Organizing Committee/California Nurses Association (NNOC/CNA), the nation's largest RN union and professional association, today announces a national online advertising campaign beginning this week that calls on key Congressional leaders to protect the public – not the profit motives of the insurance industry – through a system of guaranteed, single-payer healthcare reform. The ads are also sponsored by the Massachusetts Nurses Association.
Wednesday, April 22, 2009
Republicans did start a “health care task force” led by minority leader John Boehner back in February. So far, all we’ve seen from them are a few quotes in the paper and some misleading press releases from Boehner. Certainly, there’s been no serious policy proposals. As Politico points out, a lot of Republican “ideas” on health care died with John McCain’s candidacy.
Boehner, of course, was the guy leading the charge on the GOP alternative to the budget, if by alternative you mean a budget without any details or numbers. I wonder if Boehner’s health care plan will look similar. Judging by the health care section in the alternative “budget” (a budget document without numbers deserves those quotation marks), America may be able to look forward to a similar substance-less plan:
Republicans look across the health reform battlefield and see the Democrats organized, energized and flush with cash — with several groups lined up to promote the president’s plan, and a message honed by years of preparation.
Then they look into their own camp — and get nervous.
There’s no Republican plan yet. No Republicans leading the charge who have coalesced the party behind them. Their message is still vague and unformed. Their natural allies among insurers, drug makers and doctors remain at the negotiating table with the Democrats.
So Republicans now worry the party has waited so long to figure out where it stands that it will make it harder to block what President Barack Obama is trying to do.
The void on the right has been so vast that a millionaire health care entrepreneur named Rick Scott stepped into it as the unlikely face of Republican opposition. His record isn’t spotless, having lost control of Columbia/HCA, then the country's largest hospital company, in 1997 amid a Medicare investigation. (Scott was not charged with any wrongdoing.) But he is the only one so far to put up money.
Now running a chain of urgent care clinics in Florida, Scott plans to spend at least $5 million to push a limited-government, free-market approach to medicine. He has assembled a staff of 12, hired the Virginia public relations firm that assisted Swift Boat Veterans for Truth, bought six weeks of radio and TV ads, and commissioned a poll by Republican strategist Tony Fabrizio.
He shared the data with members of Congress last week, and visited Grover Norquist’s Wednesday meeting of conservatives the week before to screen segments of a forthcoming documentary on the Canadian and British health care systems.
More than 70 House Democrats recently warned party leaders that they will not support a broad health reform bill that does not offer consumers a government-sponsored policy, and two unions withdrew from a high-profile health coalition because it would not endorse a public plan.
"It's way too early" to abandon what it considers a central plank in health reform, said Andy Stern, president of the Service Employees International Union. He said the organization pulled out of the bipartisan Health Reform Dialogue because it feared its friends in the coalition were sacrificing core principles too soon. "You don't make compromises with your allies."
Last week, two top administration officials suggested that Obama is open to compromise on the public plan, comments that set off alarm bells in some corners of his party.
We have to keep the pressure on the House and the Senate. Single Payer is the absolute best plan, but we cannot allow them to accept any plan that does not provide a public option.
With skyrocketing costs and 47 million Americans uninsured, it's obvious that health care has become a serious domestic crisis. President Obama made it a centerpiece of his campaign and has since moved to amend the moldering system. But before reform legislation can pass, Americans must realize what the biggest historical obstacle to universal health care has been: themselves.
There are two main types of universal health care opponents: a) special interests pursuing their own agendas and b) those who reject government activism on principle. The former will forever fight to preserve their power over the system, largely at the expense of the people. The latter ought to know that by encouraging their leaders to sit idly by, they're effectively digging their own graves.
A sea of Americans view government as innately flawed and incapable of improving their conditions. Many of these individuals, instead of voting for candidates interested in ameliorating their health care woes, elect those who believe government should stay out of their lives. And so the tide persists as a self-defeating, self-fulfilling prophecy.
The AMA, insurance companies and the pharmaceutical industry have long battled national health care because it would weaken their stranglehold over the populous. On numerous occasions they've spent extraordinary sums of money to engulf attempts at reform -- be it during the progressive era in the early 1900s, Truman in the 1940s or Clinton-care in the 1990s. (They even fought Medicare and Medicaid tooth and nail in the 1960s.) But the alarming reality is that these monsters wield much of their power from the very people they consistently swindle and cheat.
In the '90s, insurance companies sank the Clinton Health Security Act by convincing Americans that it would curtail their menu of medical options. As a result, tens of millions ended up without a menu altogether, many of whom have since plunged into bankruptcy due to unbearable medical bills. A very similar episode occurred in the '40s under Harry Truman, with the AMA leading the charge. Both times, the ensuing anti-reform wave drowned the Democratic Party for its efforts to rescue the uninsured.
The virulent obstructionism and influence wielded by these special interests is disheartening, to say the least. But let's not forget how helpless they'll be once ordinary people stop buying into their propaganda and understand that they're being conned.
Anybody who wants to solve America's health care predicament must first reject the naysayers who dogmatically vilify government and glorify the private entities that have failed us. The current system encourages exclusion of those who need medical care the most, and only government has the power to restructure these incentives.
Remember also that there is no such thing as a free lunch, which some people are apparently holding out for. Poll a group of Americans and ask them whether they'd like to have a national, government-sponsored health care program; the answer is resoundingly positive. Then ask the same group whether they're willing to pay higher taxes to make it happen, and watch the number shrink (although both figures are gradually rising over time).
The tragedy is that an effective national program, despite the costs, would be more economically sound as it would minimize the enormous out-of-pocket expenditures millions are currently subject to. It would also encourage preventive medicine, thus saving many lives by catching illnesses early. The United States, with one in six uninsured, spends far more per capita on health care than countries like France and Canada, which manage to insure all their citizens. And contrary to popular myth, quality of care is no better here.
The good news is that the winds of today are blowing against the obstructionists. There is currently a deluge of populist determination to overhaul the health care system. But the necessary reforms will only succeed when Americans get serious and see through the nonsense that has allowed this broken system to persist.
So during the upcoming debate on health care reform, don't be swept away by sneering slogans like "socialized medicine" or harebrained ads comparing universal health care to the Russian Revolution. Remember whose interests the medical establishment and their partners in Congress have at heart. Demand that your government stand up for you. If you think your leaders can help you, you may well be right. If you think they can't, you'll definitely be right.
Statement of Uwe E. Reinhardt, Ph.D.
House Committee on Ways and Means
April 22, 2009
Most industrialized nations in the OECD, along with Taiwan, seek to operate their health systems on the Principle of Social Solidarity. It means to them that health care is to be viewed as a so-called “social good,” like elementary and secondary education in the United States. That perspective, in turn, implies that the financial burden of health care for the nation as a whole should be allocated to individual members of society roughly in accordance with the individual’s ability to pay, and that needed health care should be available to all members of society on toughly equal terms.
If the health system is to operated subject to this distributive social ethic, it requires that government either operate the financing, risk-pooling and purchasing functions directly (as is the case in Canada, Taiwan and the UK, for example) or that government tightly regulate all three functions, even if they are actually performed by private institutions outside of government proper (as is the case in Germany, the Netherlands and Switzerland).
Unfortunately, the United States never has been able to evolve a widely shared consensus on the distributive social ethic that ought to govern the U.S. health system. The bewildering American health system reflects that lack of consensus.
A much mouthed mantra in our debate on health policy is that “we all want the same thing in health care, but merely quibble over the means to get there.” Nothing could be further from the truth. That debate has been and continues to be a tenacious ideological fight over the social ethic that ought to govern American health care; but we camouflage it as a technical debate strictly over means.
My plea before this Committee and to the Congress is that any health reform proposal put before the American people be preceded with a preamble that clearly articulates the social goals our health system is supposed to pursue and the social ethic it is to observe. Policy makers in other nations routinely do so and accept the constraints that this preamble imposes on their design of health reform. It would be helpful to have a clearly articulated statement on the social ethics for American health care as well.
You should read his entire statement.
But what is shared responsibility? The responsibility of the individual is to pay his/her portion of the premium plus all out-of-pocket expenses, including cost sharing and costs of products and services not covered by the insurance plan. The responsibility of the employer is to pay a portion of the employee’s insurance premium, but economists agree that it is really the individual’s forgone wage increases that pays the premium. The government’s responsibility is to pay for part or all of the care provided to individuals who do not have the funds to pay for care, but it is really ultimately individuals who are paying the taxes that fund the government programs. And the responsibility of the private insurance industry? They don’t pay into the system; they take a large amount of funds out of the system - funds that again are ultimately paid by individuals.
So "shared responsibility" is not a sharing of responsibility; all of the responsibility falls on individuals. "Shared responsibility" is merely a rhetorical framing that advances the interests of some of the stakeholders, especially the private insurance industry.
Even if the respondents to the survey accepted the concept of shared responsibility, it would be a real stretch to conclude that a 48 percent support of a stand-alone mandate means that the public is opposed, whereas a 59 percent support of a mandate with shared responsibility is a solid public endorsement (11 percent difference). This is not a ringing endorsement of a concept that is more of a marketing slogan than a genuine policy proposal.
That said, there is an important take-home message from this survey. Those opposed seemed to understand the policy principles involved. Republicans were opposed because of higher taxes and greater government involvement. Democrats were opposed because a single government health program was needed instead of a mandate to purchase private plans that might not be affordable.
Pretending that the marketing ploy of shared responsibility will bring us bipartisan consensus on reform will only reinforce the process that we are about to see. The Republicans have already gained the greatest concession - single payer is off the table - and they will continue to use the process to gain further concessions that will destroy any semblance of health care equity, and then they will vote against the final bill anyway.
WASHINGTON — With solid majorities in both houses of Congress, Democrats are tempted to use their political muscle to speed passage of health care legislation with minimal concessions to the Republican minority.
That approach may be the only way they can fulfill President Obama’s campaign promises, but it carries high risks as well.
In the budget blueprint for the coming year, Democrats may resort to an obscure procedure known as reconciliation to clear the way for Senate passage of a comprehensive health bill with a 51-vote majority, rather than the 60 votes that would otherwise be needed.
A health care bill written mainly or entirely by Democrats would look different from a bipartisan product. It would almost surely create a new public health insurance program, to compete with private insurers. It would require employers to provide insurance to employees or contribute to its cost. Employers who already offer insurance to their workers could be required to provide more or different benefits, and Congress could limit the tax breaks now available for such employer-provided insurance.
The committee chairmen writing the Senate health bill, Max Baucus of Montana and Edward M. Kennedy of Massachusetts, both Democrats, have been assiduously courting business groups and labor unions, consumer groups, doctors, hospital executives and other health care providers.
Those groups — eager for a seat at the table, eager to sound constructive — have been remarkably restrained so far. They have held back in their criticism of proposals being seriously considered by Congress and the White House. But the strains are beginning to show. Labor leaders have conveyed their concern about taxing health benefits to Mr. Baucus in the strongest possible terms. Employers have warned Congress against requiring them to provide any specific amount of insurance.
Steven Kreisberg, director of collective bargaining and health care policy at the American Federation of State, County and Municipal Employees, said: “We absolutely oppose a change in the tax treatment of employee health benefits. It would endanger the current employer-based health care system at a time when we are trying to sustain it.”
Tuesday, April 21, 2009
Healthcare-NOW! - Mark Your Calendar!
When: Wednesday, May 13 at 12:00pm - 2:00pm
Where: Upper Senate Park, Washington DC (near Union Station Metro Stop)
Wednesday, May 13th, is the National Lobby Day and Rally for Single-Payer in Washington DC. Leading the charge is the California Nurses Association 500 nurses strong to lobby and rally for single-payer in the nation’s capital. Joined by the Leadership Conference for Guaranteed Health Care, we want to use this opportunity to make the single-payer message loud and strong for our legislators to hear.
So mark your calendars and if at all possible, please join us! The rally is at noon, but if you would like to join a delegation to meet with your representative, please contact Katie Robbins asap - email@example.com or 1-800-453-1305.
If you cannot make it to be with us in D.C. then mark your calendar and start calling your representative and senators at noon on the 13th.
Monday, April 20, 2009
At the 2009 World Health Care Congress, TNR senior editor Jonathan Cohn sat down with Dr. Michael Chen, Vice President and CFO of Taiwan's National Health Insurance Bureau, to discuss the results of Taiwan's switch to a universal health care system.
Symbolism counts in Washington, and Obama's request that his Cabinet officers come up with $100 million in spending cuts will be played up by the White House as the beginning of a major effort to trim unnecessary government spending. It's part of the president's effort to reach out to Republicans (and calm the nerves of "blue-dog" Democrats) worried about all the money the administration has spent and still wants to spend -- $787 billion on the stimulus, $700 billion committed to the bank and auto bailouts, and, most important, $3.5 trillion for the next 10 years, including universal healthcare. Throw in the cost of a cap-and-trade system to control climate change and you're talking big money.
Over the longer term, Obama must be careful not to put entitlement programs on the chopping block as part of a "grand bargain" to elicit Republican support for healthcare and cap-and-trade. Social Security is not in dire straits; it can be made flush for the next 75 years by ever-so-slightly lifting the ceiling on the portion of income subject to Social Security payroll taxes (and if Democrats are reluctant to do that on incomes over $100,000, then they could do so on incomes over $250,000).
Medicaid and Medicare are in trouble because healthcare costs are rising so fast, which argues for healthcare reform rather than cuts in these important programs. Yet if healthcare reform has any prayer of controlling the rising tide of healthcare costs, the plan must allow beneficiaries to opt into a public insurance plan -- something Republicans and the healthcare establishment are determined to fight. So it's critically important that the Senate wrap healthcare into a reconciliation bill that can be enacted by a majority vote in the Senate.
Obama should fast-track healthcare and stop trying to court Republicans. Every House Republican and all but three Senate Republicans voted against the stimulus; all Republicans in both houses voted against the budget. During the recess they hosted "tea parties" claiming that Americans are overtaxed. Over the weekend, House Minority Leader John Boehner called the idea of carbon-induced climate change "almost comical."
Sunday, April 19, 2009
Over the past 50 years, US workers have come to expect employers to pay for some part of employee health insurance; many consider this an important part of overall compensation. However, recent economic trends have resulted in a growing disparity in health care coverage and affordability. A study by the McKinsey Global Institute (MGI) identified three divergent categories of workers that are emerging from trends in health care coverage and income growth.
The top-income category (earning on average $210,100 annually1) has enjoyed rising incomes and growing employer-paid health care benefits, which have made their out-of-pocket spending on health care a relatively small and affordable portion of total spending. The higher-middle-income category (earning an average of $84,800 annually) and the lower-middle-income group (earning on average $41,500), have also seen increasing benefits and incomes—but at a much slower rate, making the uncovered portion of their health care costs ever-more expensive. In the bottom-income category (earning an average of $14,800 a year), incomes have been stagnant, and their employers are less likely to pay for their health insurance. This group is finding any health care difficult, if not impossible, to afford.
....What we pay for the necessities of life does not remain static over time. In 1935, food accounted for 34 percent of all spending in the United States. In 1959, it accounted for 25 percent. Today it's more like 16 percent. If agriculture's green revolution can halve the proportion of family budgets devoted to purchasing food, why can't expensive scientific and technological advances in medicine take up the slack with health care spending? In fact, they have. In 1959, health care accounted for about 5 percent of all spending in the United States; today it's about 16 percent. During this period, life expectancy has increased about 10 years. A bargain!
But compared with what other countries are getting for their health care buck, it isn't a bargain at all. In Canada and France, for instance, health care accounts for 10 percent of all spending, as compared with the United States' 16 percent. Yet life expectancy is higher, and infant mortality is lower. The United States ranks 50th in life expectancy among the nations of the world, well behind not only Canada and France (which rank 8th and 9th) but also Israel (13th), Jordan (38th), and Bosnia and Herzegovina (43rd).
The problem is largely one of maldistribution. The United States is a great place to be sick if you're rich and a terrible place to be sick if you're poor or middle class. Wealthy people can afford to pay the rising cost of health care; poor and middle-income people can't. This problem obviously becomes worse as the cost spirals upward. According to a study in the April 2009 McKinsey Quarterly, between 1996 and 2005, households that received health insurance through work saw their premiums rise from 7 percent of their total income on average to 10 percent. You could argue that medical advances during this decade justified Americans digging deeper into their pockets for health care. But some dug deeper than others. For households earning more than $130,000, the bump was from 2.6 percent of total income to an irritating but still-manageable 3.3 percent. For households earning less than $27,300, however, the bump was from an already high 14 percent of total income to an extremely burdensome 20 percent.
Remember, too, that like all forms of employer compensation, health insurance gets lavished more generously on higher-paid employees. When the price of health care rises, employers stop offering it to the grunts, or stop offering it with co-payments the grunts can afford. Between 2001 and 2004, the percentage of employees covered by employer-provided health insurance dropped from 81 percent to 77 percent. Two-thirds of these newly uninsured were low-income households. By 2005, 89 percent of all households earning more than $130,000 had employer-provided health insurance, compared with only 22 percent of all households earning less than $27,300. Among middle-income households earning $27,000 to $58,000, only 56 percent had employer-provided health insurance. "Employers are spending more on health care per employee," the McKinsey report concludes, "but for fewer employees." Medical inflation is causing even minimally decent health care to become a luxury item. That's intolerable.
For both money have-nots and good-health have-nots, even the most radical options under consideration by the Obama administration are a poor substitute for a government program funded entirely by taxes—no enrollment necessary—that provides health care to all comers. But if we can't get health care for all, the least we owe the have-nots is to lower health care costs to the maximum extent possible without compromising quality. Ignoring the whining of insurance companies that stand to lose market share to Obama's cheaper "public option" is a good start.
Saturday, April 18, 2009
Sen. Max Baucus, Chair of the Senate Finance Committee, and Sen. Chuck Grassley, Ranking Member of the same, have put together an ambitious schedule dedicated to producing a health care reform bill by the summer. Their next wave of roundtable discussions is set to begin April 21.
Curiously, despite the fact that the VA has shown far more success managing patients with chronic diseases and comparative effectiveness research, as well as Health IT, no one from the VA will be present. No one representing coordinated care – not even from the Mayo Clinic. No one to talk about the medical home. No patient advocates. Only one “activist” group in the National Partnership for Women and Families (a great advocacy group, but hardly the first name you think of in the health care reform community.)
However in the group of 12 invited participants, there will be 4 (FOUR!) individuals working for the insurance industry in some form or fashion.
There’s Dr. Allan M. Korn, Chief Medical Office for the Blue Cross Blue Shield Association. There’s Roy Williams, CEO of Aetna. There’s Glenn Hackbarth, who is currently chair of MedPac, the payment advisory committee tasked with analyzing cost and quality of care in Medicare. What prepared Mr. Hackbrath for being able to advise Medicare on, say, how much we should pay the private plans that make up Medicare Advantage? How about some time as an executive for Harvard Community Health Plan? There’s also Dr. Glenn Steele, also with a background as a surgeon, who’s president of the Geisinger Health System in Danville, PA, a network of provider physicians and hospitals, complete with … yes, surprise, the Geisinger Health Plan, selling HMO and PPO products since the 1970s.
Write to Baucus and Grassley and demand a fair debate and a fair balance of speakers as they work towards universal health care. Make sure they know we are paying attention. Tell them that their job is to help create a plan that best help American Citizens, not the insurance industry. And I hope you will add that you really want to have a spokesperson for single payer at the table.
Click here for more information.
Click here to send an email.
Universal Health Care - Change.org
From Remarks as delivered by Kelly Cuvar at a roundtable on health care reform with Sen. Kirsten Gillibrand (D-NY)
The second thing you need to know about me is that I was diagnosed with cancer ten years ago, when I was nineteen. I have had cancer ever since then. I have never been in remission. What I didn't know then -- my young nineteen year old self didn't have a clue -- was that for the rest of my life, the fact that I had cancer would be considered a huge hurdle that was made manifest in every aspect of my life -- that I'd have a pre-existing condition forever, and it would creep into everything I ever did.
Surviving and learning to live with cancer would not just be managing the disease physically, which is hard enough. The American health care system in general and my insurance providers in particular have been a greater affliction for me than cancer. Every single financial and life decision I make revolves around maintaining my ability to get vital health care. Where I live, if I can marry, if I can buy a home, changing my career, going back to school -- it is all mediated through my disease.
I am going to be absolutely honest with you: having to worry about insurance, and to constantly fight for and pay for and find money for payments, is worse than having cancer. I know that sounds ludicrous, but I am better able to deal with dealing with my illness than I am when I am fighting with insurers, or now that I am unemployed, worrying about how I can maintain my coverage. This is more stressful than any of the treatments I've received over the last ten years, and any of the consequences of them.
What the cancer hasn’t been able to do, our broken health care system has done: force me to deal with anxiety on levels that I've never known before. I am frightened, and it is all I think about.
If you can say with honesty that worrying about insurance is more stressful than worrying about being ill with a chronic and life-threatening disease, what does that say about the state of healthcare right now?
Friday, April 17, 2009
You can almost see the political landscape shift these days. Once, back in the days after the election, we weren’t even sure if the public health insurance option was on the table. Then, when President Obama and Congress reassured us, and now, we’re arguing over whether it should be able to bargain for rates or not...
Read it all at The Seminal
Members of Congress are building momentum to pass a public insurance plan for health care. Millions in our country don't have any health coverage at all and millions more have coverage that, like in this video, is getting in the way of the best medical care. If we want to provide quality, affordable health care to everyone in our communities, it's critical that we have every option on the table --- and that includes a public insurance plan.
But the insurance companies want to do everything they can to stop us from having a public choice because they like having a monopoloy and driving up costs (and their profits). And they'll win, unless you help us stop them.
Truth is, a public option for health care will make sure that everyone in this country will have access to quality, affordable health care. Whichever option you choose, private or public, you will be guaranteed health benefits that will meet your needs under a payment plan that is based on your income. Providing a public option that is protected by the government will make sure that the health of our communities will come before the profits of private insurance by forcing them to compete fairly. (Visit our partner, Health Care For America Now! for more information)
A public plan for health care is our best chance to fix health care and fix our economy. Now we need you help in making sure that a public health insurance plan becomes a reality.
Sign the petition supporting the need for a public option for health care.
An Oklahoma man who lost an eye and a leg in Iraq says the giant insurance company AIG refused to provide him a new plastic leg and fought to keep from paying for a wheelchair or glasses for the eye in which he has 30 percent vision.
"They bought the cheapest thing that they could get away with," said 51-year old John Woodson, a truck driver for the KBR contracting firm who lost his leg when his truck hit a roadside bomb in Iraq.
Woodson is covered by AIG under a government-mandated program that provides medical and disability benefits for employees working for U.S. contractors in Iraq and Afghanistan. AIG covers about 90 percent of the claims for overseas workers.
Woodson says he was told by an AIG representative in the hospital that he would be fully covered by AIG, but that when he returned home, he quickly discovered AIG was prepared to challenge almost all of his medical needs.
Someone explain again why we need private insurance for health care? Why can't we open Medicare to include us all?
Watch 20/20 Friday at 10pm E.T. to see this joint investigation involving the Los Angeles Times and Pro Publica, a non-profit investigative group.
Warren is an expert on consumer debt and bankruptcy, and she could surely take a gander at the plans being floated to keep the healthcare industry happy and see if those same plans will keep America's working and middle classes happy and healthy. I'd like to see her overview of what would happen to an average American family if someone got sick, couldn't work for a bit and needed care under the plans being offered by our Congress. I am betting we wouldn't like what she'd tell us.
So, knowing this has become strictly a financial and taxpayer-funded deal in the making, I want Warren to look things over and tell me a few things. Straight up. Clear and clean. She is smart enough to be defending us all surrounding the TARP deal - and asking the sticky wicket questions. Like, where is all the money going? And why are taxpayers being screwed over when it's our money bailing out these huge financial interests? I love when I hear this no-nonsense, down-to-earth woman speak truth to power. She speaks for me, and I like the sense of honor and justice she brings to the discourse. Better yet, she isn't funded by the special interests dictating what gets said.
Professor Warren could sure look at where the healthcare dollars are going to go too. Which CEOs are traveling in style while policy-holders and patients die or wait for care? Which hospitals and industry groups are enjoying huge tax breaks and write-offs while premium-paying, tax-paying Americans wonder if they can see a doctor or afford a prescription? Which healthcare industry pirates are holding which government leaders hostage and demanding the ransom of blind loyalty and national servitude? How are those insurance company profits doing in the current economic downturn? And how are their stockholders being told the companies will profit going forward?
We deserve these answers before we bail out the healthcare industry. We need an Elizabeth Warren asking the questions and reporting to some committee of Congress that will actually take sides in this healthcare reform effort - and the side they take needs to be ours. The taxpayers. The funders of the whole damned show.
We, the taxpayers of this nation, write all of the checks - the Congressional payroll and benefit checks, the tax subsidies, the bail-outs, the premiums, the co-pays and deductibles and therefore even the insurance company, pharmaceutical company and hospital corporation stockholder dividends. An estimated $2 trillion over the next 10 years to give the insurance industry everything they want in this system. $2 trillion. We ought to at least have an accurate accounting of what we're paying for, eh?
And then how about an accurate comparison of all the viable options before us, like a publicly funded, privately delivered plan? I'd like this before we just give away the farm.
In Canada, it took the dogged determination of one province, Saskatchewan, and a visionary leader Tommy Douglas, to pave the path to a national health care system, which they call Medicare.
For all the detractors of the Canadian system in the studios of Fox News and the board rooms of rightwing think tanks, consider this one note: In 2004, the Canadian Broadcasting Corporation conducted a national poll to select the greatest Canadian of all time. The winner in a landslide -- Tommy Douglas.
While the federal window remains open for reform, with two national single payer bills, John Conyers' HR 676 in the House and now Bernie Sanders' S 703 in the Senate, many nurses, doctors, and health activists are turning to the states to lead as well.
More than a half dozen U.S. states now are considering legislation to establish single payer systems, essentially an expanded and updated form of the U.S. Medicare system to cover everyone in their states. Here's a roundup of some of the state bills:
The latest bill SB 810 passed its first legislative test Wednesday in the Senate Health Committee on a party line 7-4 vote before a room packed with nurses, doctors, medical students, California School Employees Association members, and healthcare activists.
In her lead testimony, Malinda Markowitz, RN, co-president of the California Nurses Association/National Nurses Organizing Committee noted that "nurses know insurance companies don't provide any value whatsoever in the delivery of medicine. Under SB 810, we would be free of their interference, their denial of care, their massive bureaucracy, and their waste of healthcare dollars."
UC Irvine medical student Parker Duncan said that he did not want to “be in a world not doing what I was trained to do,” referring to the paperwork that is one of the expensive burdens that undermine the ability of the current system to deliver health care.
Twice this decade California's legislature passed earlier versions of SB 810 (SB 840 carried by now retired Sen. Sheila Kuehl), but the bills were vetoed by Gov. Arnold Schwarzenegger. State activists say they will continue to push single payer in California, even if they need to wait until the next governor, who won't be Schwarzenegger, is elected in 2010.
House Bill 1273 by Fort Collins Democrat John Kefalas, passed its first vote in the state House April 6. The bill sets up a 23-member commission to design a universal health-insurance system.
"Our current health-care system is not well," Kefalas said. "Our current health-care system is unsustainable, with the cost of health care and the numbers of the uninsured rising dramatically."
Press reports note a state Blue Ribbon Commission on Health Care Reform two years ago studied single payer and found it was the only approach that saved money compared to what Coloradans now spent on healthcare.
HB 311, the Healthcare for All Illinois Act, sponsored by Rep. Mary Flowers, had its first hearing in March. Though no votes have been taken yet, the new Gov. Pat Quinn is a long time supporter of single payer reform.
At an introductory press conference, Brenda Langford, Cook County RN, said that “Illinois can once again be a symbol of hope and progress for our nation. Nurses are tired of watching our patients suffer from denial of care and lack of access to coverage. We see far too much of this at Cook County hospitals—and that’s why we support guaranteed healthcare through a single-payer system.”
LD 1365, sponsored by Brunswick Rep. Charles Priest, and co-sponsored from legislators from all over the state, had its first hearing April 13.
The hearing came just days after both houses of the Maine legislature passed resolutions calling on President Obama and Congress to enact federal single payer legislation. A poll this winter showed 52 percent of Maine physicians also favor single payer.
As Cathy Herlihy of the Maine State Nurses Association put it in a state forum featuring U.S. Senator Olympia Snowe, a single-payer system is the “the only solution,” she said. “We do not have time to wait. Our health should not be sacrificed for limited reforms.”.
Two single payer bills are alive in the state, House Bill 1660, the “Family and Business Healthcare Security Act of 2009,” and Senate Bill 300.
Gov. Ed Rendell has said that if a single payer bill were to make it to his desk, he will sign it, reports Chuck Pennachio of Health Care for All Pennsylvania.
The state Democratic House Caucus is holding a public forum on the bill Friday, April 17 at 10 a.m. at the University of Pennsylvania campus in Philadelphia, featuring speakers from Physicians for a National Health Program, the Pennsylvania Association of Staff Nurses and Allied Professionals, and other single payer supporters..
The hearing comes on the heels of a resolution passed by the Philadelphia City Council calling for both state and federal lawmakers to establish a single-payer health system.
Single payer bills are also on the docket in Minnesota, Missouri, and Washington.
This January, Audra officially joined the ranks of the 17 million uninsured women across the nation. On a dwindling income and without health insurance, it became much more difficult to manage her chronic conditions--diabetes and hypertension--which require regular medication and a strict diet. 'I was at the point where I was compromising with the food, and compromising with the medicine,' Audra said. 'I stopped taking my blood sugar in the morning because I knew that I couldn't do anything to make it better.'
Audra's plight demonstrates how much these tough economic times have exacerbated the already severe problems that more and more people face in our current health system. A new U.S. Labor Department unemployment report shows that 663,000 more Americans lost their jobs in March--raising the nation's unemployment rate to a 26-year high of 8.5 percent. For many who have lost their jobs, they've also lost their employer-sponsored health insurance benefits.
In our broken health care system, nearly one in five women is uninsured. Even for those who have health insurance, women are more likely than men to have health coverage that has too many gaps, including large co-pays, life-time limits, and exclusions or limitations in needed services like mental health care or prescription drugs. Since women, on average, have lower incomes than men, they are at particular risk of financial barriers to care; one in four women says that she is unable to pay her medical bills, and women are more likely than men to delay or go without needed health care because of cost.
Wednesday, April 15, 2009
Offering a public plan option within a market of private health plans has been one of the more controversial proposals during the current national dialogue on health care reform.
The opponents of the public option, especially the private insurance industry and the Republican members of Congress, insist that a government-sponsored plan would be an unfair competitor and drive the private insurance industry out of business. Theoretically, the government would do this by extracting unfair concessions from the health care providers, pricing the public option at a lower level than the private insurance sector could ever meet. (This ignores the more important evidence such as the demonstrated greater efficiencies of our public Medicare program when contrasted with the private Medicare Advantage plans.)
The supporters of a public option, especially the progressive community, contend that the public option would be a superior product made more affordable by reducing administrative inefficiencies. They contend that competition would motivate a massive shift to the public option, bringing us much closer to the single payer model that many in the progressive community prefer. (Much has been said about why this approach actually sacrifices most of the single payer advantages and would likely never lead to a single payer system.)
Professor Jacob Hacker of the University of California at Berkeley (and formerly at Yale) has been a leading proponent of reform based on a national insurance exchange of private plans with the addition of a public plan option. And what does he have to say about the impact that a public plan option would have on market share for the private health plans? He says that under his proposal, “more Americans have private insurance after reform than do before — either through their employer or through the new national insurance exchange.”
Get That? Even with a Medicare-like public plan option, the market for the private insurers will expand! That is the real tragedy of this debate over a public plan option. It has led us away from the debate we should be having instead: an affordable single payer national health program for everyone, versus expansion of our over-priced, inequitable, and inefficient system of financing health care through private plans and public programs
Forget about the public plan option! Let’s get rid of the private health plans, and go with single payer!
Tuesday, April 14, 2009
As the pinch is being felt throughout the economy our company is also getting squeezed. Our situation is not as bad as some, but we are taking some measures such as furlough time to reduce payroll and energy saving evaluations to decrease energy costs. Unfortunately, there is an aspect that is out of management’s direct control and it is an area where people across the nation feel the pinch, Health Insurance.
This year, at open enrollment, our costs are increasing ever so slightly. Approximately an additional fifteen dollars for a family plan per pay period, but this is not the painful or shocking aspect. It was expected, with state of the financial system in the United States, that costs would go up. It was not expected that after management shopped our group plan around and kept payer costs as close as possible to current rates, our deductible would triple. This increase will bring the amount to a level that will put much preventive medicine and specialist care out of reach for many of the blue collar workers employed at the facility. Naturally, the new plan was quite shocker to everyone enrolled.
So what is the solution? Bite the bullet and incur the cost. Forgo important medical treatment that may be preventative, or highly needed because you lack the funding?
Much derision is piled upon ’single payer healthcare’ as socialized, or communist medicine. But, I will admit my agreement with the current presidential administration, looming much larger than the banking crisis and more impactful on our lives are the ballooning healthcare costs. Something must be done, and the opponents may balk at ‘paying for the welfare moms to have more babies’, but the truth is, no matter the system there will always be cheats and the good of the whole must be considered.
If the nation does not get a leash on this elephant in the room there will be a much larger impending financial crisis facing this nation and its citizens.
Sunday, April 12, 2009
Maine Wire - wbztv.com: "AUGUSTA, Maine (AP) The Maine Nurses Association says registered nurses from throughout the state will be joined by physicians, patients and health care activists Monday at a legislative hearing on a single-payer health care bill sponsored by Democratic Rep. Charles Priest of Brunswick.
The state bill is similar to a federal measure, the United States National Health Care Act, that would establish a publicly financed health care program.
Last week, Maine lawmakers passed a resolution calling on President Obama and Congress to establish a single-payer health system that covers everyone.
The Senate passed the nonbinding resolution by a 20-15 vote on Wednesday, a day after the House did the same by a 91-52 vote."
As America prepares to reform our health care system, I wish to add some convictions reached while practicing surgery for nearly a half-century. Until about 15 years ago, doctors were powerful leaders in the health care system, taking their responsibilities seriously, and the system worked well. Then, dark clouds began to assemble and physicians began to lose their grip.
As the system faltered, physicians were not part of any changes except as pawns and bystanders. In short supply, we had crushing demands due to patient loads and were required to run practices of increasing complexity.
New arrivals appeared, calling themselves “health care professionals.” Seemingly overnight, they were “stakeholders,” and a metamorphosis occurred as medicine became big business. A new gold rush was on, lured by the attraction of the health care dollar.
The language of medicine changed with the arrival of HMOs, PPOs, surgicenters, for-profit hospitals and other schemes popping up like dandelions, fertilized by health care dollars totaling more than 15 percent of our GDP. Special interests arrived in the form of the health insurance and pharmaceutical industries, distributing lobby dollars in all directions and receiving free range in return. Multimillion-dollar salaries and billions in stock options were awarded while the steely-gray clenched faces of bankruptcy adorned middle America.
Hospitals joined in, finding a way to control pesky doctors — they hired them — spawning an undesirable side effect of antagonistic competition. Hospital bills joined inflation in the health care sector, and ear-popping predictions were heard that health care soon would become 20 percent of gross domestic product — up from 7.2 percent in 1970. The cost of all U.S. health care surged to top $8,000 per person annually while Canada’s cost for universal health care was half that, and our outcomes were no better than theirs.
Our system lacks social justice for some 45 million Americans without health insurance and more who are underinsured. Huge layoffs due to the current recession are adding to these alarming numbers daily, with workers and dependents suddenly uninsured. Another surge is expected soon, when unemployed new college graduates hit the streets. We are ready to improve this situation by passage of universal health care legislation now.
Beyond that is a way to really fix the health care system. It is called “single payer.” Call upon our federal government to implement such a program, recalling that it already runs some of the world’s best and most efficient health care programs including Medicare, the National Institutes of Health, the Centers for Disease Control and Prevention and military medicine.
Be aware that single-payer is not socialized medicine. Single payer just means the government is acting as an administrator and best understood as being “Medicare for all.” Note that only about 5 percent of Medicare dollars are used in administering the program, while private cost for the same service consumes 30 percent of premium dollars — largely due to profit.
The new administration seems set on reducing health care costs and instituting a system of universal health care while leaving the current system in place, and adding a new federal health care insurance option. This is not adequate. The prior administration wanted an income tax deduction for health care insurance costs, plus health savings accounts — both are flawed and inadequate.
In his June 13, 2005, column in The New York Times, “One Nation Insured,” Paul Krugman convincingly extols the virtues of single payer. Krugman, a Times writer and professor at Princeton, was recently awarded the Nobel Prize in economics. Ask Paul. If still skeptical, ask Joe. Joseph Stiglitz, when recently asked “Do you support single-payer health care?” answered. “I think I’ve reluctantly come to the view that it’s the only alternative.” Stiglitz is a Columbia professor — and also a Nobel Prize-winning economist.
Single payer could lead a powerful surge to recovery — sort of an economic wonder drug. Polls of Americans strongly favor single payer, yet our government seems reluctant to address this eye-to-eye preferring lesser action and tweaking along as before. We need to send a message to Washington, reminding it who their employers are. There is enough unemployment already, so we do not want to send pink slips to D.C. Feeling bad for the fat -cat special interests is intolerable, not after what they have done to us. Anything less may result in further collapse of a frail, teetering relic. We are near a solution of a serious issue confronting our economy. Doing the right thing now is crucial.
Saturday, April 11, 2009
During a panel discussion the other day, I mentioned that health care is going to bankrupt our society if we keep spending more and more money on it.
It's a familiar refrain. Almost everybody involved with the health care debate says similar things. And yet, as I heard the words pass my lips for the gazillionth time, I couldn't help but think they weren't quite true.
There is no iron law of economics that holds we can't spend 20, 30, or even 40 percent of our wealth on medical care. In the aggregate, it's a matter of choices and trade-offs. If we pay more for health care, it simply means less money left over for other things. And, on the whole, there are surely some luxury goods that we could do without.
Think of this way. If you could live in a world where nobody died from cancer, but flat-screen televisions cost $20,000 a piece--in other words, beyond the reach of all but the richest Americans--would you take that deal? I sure would.
The real trouble with health care is that we're not getting our money's worth. You can see this most clearly in the famous studies by Dartmouth's John Wennberg, who has demonstrated that the intensity (and cost) of medical care in the U.S. differs wildly by region but without any corresponding difference in results. Senior citizens in Miami famously get more care, for more money, than their counterparts in Minneapolis. But they don't seem to be better off. International comparisons of health care show more or less the same thing.
So the choice isn't between curing cancer and having flat-screen televisions. It's between paying for a lot of unnecessary, unhelpful medical care and having flat-screen televisions. That's a little different.
This matters because, truth be told, it's not clear how well--if at all--many reforms designed to reduce the cost of medical care will actually work. That point comes through in a new paper from the Annals in Internal Medicine, written by Ted Marmor, Jonathan Oberlander, and Joseph White. The authors are skeptical that improving information technology, basing treatment on evidence, and other innovations will really make a difference on cost--as the Obama administration, among others, is hoping.
I've yet to study the paper that closely, but the argument is certainly plausible. And the authors are experts who should be taking seriously. (Treatment readers will recognize Oberlander from past posts.)
But even if the paper is correct and those innovations didn't reduce costs, they would still make a difference: They would produce better, more effective medical care. Ten or twenty years hence, we might find ourselves spending far more money on health care. But we'd at least have the knowledge that the money was being put to good use. That alone makes these initiatives worthwhile (as the writers readily acknowledge).
Of course, there's one other problem with spending a ton of money on health care. For an upper-middle-class professional, spending an extra few thousand dollars a year on health care might mean giving up a big television or other luxuries. But for everybody else, it would mean giving up more essential purchases--even basic necessities.
If, as a society, we think it's ok to spend an ever-increasing share of our wealth on medical care, we also have a responsiblity to make sure everybody can afford that care on an individual basis. That's going to mean creating a universal health care system in which all Americans have access to affordable and high-quality treatment. And the more expensive health care is on the whole, the more such a system has to distribute money from the haves to the have-nots.