Hidden Costs of Settling for Alternatives to Single Payer Plans
President Obama initially excluded SP advocates from his health care summit. Senator Baucus has not only arrested medical advocates of SP seeking representation, but has also held a secret, closed-door hearing, apparently for industry-based health care advocates only. These undemocratic tactics impede the unity that will be needed for any public option, whether or not SP is ultimately on or off the table. Instead, it drives a wedge between public health care advocates and may well be a formula for depressing the party’s base rather than energizing the forces seeking health care reform.
Recommendations for Action
Citizens favoring single payer owe it to themselves to take action on this issue. Contacting the California Nurses Association or Physicians for a National Health Program (see opening sentence) is one option. Finally, whether you support Single Payer or an incrementalist public option plan, anyone favoring free speech and representative democracy should also contact Democratic party leaders to insist that all ideas must be on the table. In addition, if advocates of single payer are ejected from Congressional meetings for requesting representation, Democratic party officials should be urged to work with local police to avoid arrests for such advocates. Finally, the practice of closed-door, secret meetings with health-industry-only representatives must be ended immediately.
Sunday, May 31, 2009
Guess who’s coming to dinner?
After months of proclaiming that single payer is off the table, Senator Max Baucus (D-Montana) has invited five key single payer advocates to meet with him in Washington, D.C. this week.
On Wednesday June 3, Senator Baucus will meet with Dr. David Himmelstein, Associate Professor of Medicine at Harvard Medical School and co-founder of Physicians for a National Health Program (PNHP), Dr. Marcia Angell, Senior Lecturer, Harvard Medical School and former editor-in-chief of the New England Journal of Medicine, Dr. Oliver Fein, Associate Dean, Cornell Weill Medical School, and President of PNHP, Rose Ann DeMoro, executive director of the California Nurses Association, and Geri Jenkins, president of California Nurses Association.
“Bowing to mounting pressure from single payer advocates around the nation, Senator Baucus has asked to meet with some representatives of the single payer movement,” Dr. Himmelstein said. “It’s the thirteen people who braved arrest at Senate Finance Committee hearing, the hundreds of single payer supporters who’ve shadowed Senator Baucus in his home state of Montana, and the thousands who have put pressure other members of Congress who have created this opening. We have no illusions that our discussions alone will persuade Senator Baucus to back a single payer bill. But the meeting is a clear indication that demonstrations and activism can move even our money-corrupted political culture.”
Read More at Single Payer Action
On Friday in San Francisco, about 200 single-payer proponents held a rally in front of the Federal Building and headed in small groups to Rep. Nancy Pelosi's office to urge the speaker of the House, who was in China, to back single-payer legislation and give its supporters a seat at the table of the health reform debate. The public appeals were part of a series of demonstrations being held in more than 50 U.S. cities over the next few days to encourage lawmakers to enact a single-payer plan.
Sen. Max Baucus' insistence that consideration of a national single-payer health plan at this point will squander a golden opportunity for health care reform in the United States continues to be met with stiff resistance from many of his constituents.
'The word 'insurance' does not equal health care,' Janelle Kuechle of Polson said at a meeting here Thursday. 'If I have to pay a $900 premium to have health insurance with a $10,000 deductible, that is not health care.'
But Baucus - whose staff has fanned out across Montana this week for two dozen 'listening sessions' on the subject - was also hit from another angle when he sent a representative to the Flathead Indian Reservation.
'I hope any plan does not forget about the nation's first people,' said Dr. LeAnna Muzquiz of St. Ignatius.
Then Kevin Howlett told Richard Litsey, counsel and senior adviser on Indian affairs for the Senate Finance Committee Baucus chairs, that the senator's plan largely does just that.
'I can find nothing in his white paper,' said Howlett, director of the Confederated Salish and Kootenai Tribes' Health and Human Services Department, 'that provides for Native American health care on a par with the rest of the country.'
Saturday, May 30, 2009
If you haven’t already, read Atul Gawande’s piece on health reform in the New Yorker, largely centered around McAllen, Texas, the community in America with the highest health care costs.
I agree with Gawande that we could end up with a public health insurance option that doesn’t foster the right incentives to control costs, and that wouldn’t be a big victory. But while Gawande is proposing some kind of outside board to control these incentives, I wonder if the public health insurance option isn’t the place where these reforms are put into action.
Think about it: One advantage to a public health insurance option is that it is transparent. Private insurance doesn’t tell you what they pay for services, how often these services are used, and whether these services have improved patient outcomes. A public health insurance option could make that data available and work with it to improve care and control costs. This data would put the public health insurance option in the perfect position to figure out why some places in America cost so much more and why their outcomes aren’t any better, and how to fix that.
We must get costs down, that much is clear. We need the tools to do it. I’m pretty convinced the public health insurance option can be at least a crucial part of that toolset.
Read More at The Seminal
Most Americans fear private health insurance companies won't be there for them when they get sick. As the debate heats up, it's really clear that a strong public health insurance plan must be a no-compromise element of any health care reform package. According to the Harris Poll only 7% of people judge private health insurance companies to be 'honest and trustworthy.' Trust in private health plans ranks above tobacco (2%) and oil companies (4%) but below hospitals (31%) and banks (21%).
People have a lot of reason to be suspicious about whether private insurance will cover them when they fall ill. A report from the American Cancer Society and Kaiser Family Foundation showed that despite having private health insurance, cancer patients are running up large debts, filing for personal bankruptcy, and even delaying or forgoing treatment because they can't afford care.
This is one of the reasons why a Lake Research poll found that a whopping 73% of voters want everyone to have a choice of a public health insurance plan while only 15% want everyone to have private insurance.
An accessible public plan is critically needed for Americans who want an option they can be confident will be there when they need it.
The few details about Senator Kennedy's planned health care proposal show that it goes further than the Schumer so-called compromise and is to the left of Senator Max Baucus' white paper
Kennedy is expected to present the bill to the White House on Monday, and the Democrats on the Senate health committee is scheduled to meet on Tuesday. The article notes that the committee could begin making changes to the bill on June 16.
We have until June 16th to effect any changes that we WANT to Senator Kennedy's bill, and we'll definitely KEEP UP the pressure on these Senate Finance Committee members starting Monday.
Read More....: "
Friday, May 29, 2009
By Andrew Coates, MD | Healthcare-NOW!
The Democratic National Committee (DNC), at its Organizing for America website, barackobama.com, has initiated nationally coordinated local events in June, the “Health Care Organizing Kickoff.”
Organizers will call local contacts using an “Invite Call Script:”
“For decades, health care reform has been blocked by special interest lobbying and political point-scoring in Washington. We’re doing everything we can to make sure real reform happens this year. We’re starting by doing something real here in our own community.”
The DNC hope is to solicit personal stories “about the importance of health care reform in your life” and to organize house parties to discuss the President’s “principles” and to plan volunteer activities on the weekend of June 27, a “local Health Care Day of Service.” Participants will be asked to “brainstorm” about volunteering for a day at a community health center, or hosting an SCHIP education program, or holding a blood donation drive, or running “a healthy food drive/health care fair.”
Back in December the Obama-Biden transition team organized thousands of “Health Care Community Discussions.” The President-elect (with Tom Daschle) issued a call for “health care reform that comes from the ground up.”
As the community meetings occurred, PNHP received a flood of reports from participants that single payer was the unanimous recommendation from hundreds of gatherings. The official report confirmed that single-payer reform was discussed by 27% of 3,276 house parties (at least 884 meetings) and admitted that “the majority of those groups supported this idea.”
This support came in spite of the fact that participants and moderators were instructed to follow a script that appeared custom-tailored to keep single payer out of the discussion. The official instructions offered reform based upon employer-sponsored health insurance as the only option:
“In addition to employer-based coverage, would the group like the option to purchase a private plan through an insurance-exchange or a public plan like Medicare?”
Even so, more than 1 of 4 meetings proposed that a single publicly financed national health program was the answer to the American health care crisis.
The transition team report blamed the popularity of single payer on “encouragement by advocacy groups,” characterized the proposal as “radical change” and devoted about one solitary page in a 122-page document, enough to dismiss single payer proposal and its advocates. So much for health reform that comes from the ground up.
This year a nationwide movement for single payer national health insurance has taken root progressively. At every turn — from the White House summit to the regional White House forums to the Senate Committee on Finance to the halls of the Capitol to our home congressional districts — single payer advocates have been there. So often now we are the only ones at the meeting not paid to attend. Our movement has grown strong enough to inspire righteous and dignified civil disobedience.
Obviously it is time for the Democratic National Committee to “kickoff” and do “something real” for “real reform.” Let us hope that millions join the campaign. Really.
Imagine a day of service in which volunteers organize a free personal bankruptcy clinic, or a bus trip to Canada to purchase prescription drugs, or an advance-planning workshop about Medicaid enrollment to cover nursing home costs, or a session on how to appeal the hospital bill, or a day of tabulations of insurance industry profits, overhead and campaign donations, or a seminar on how to raise the most money — raffles, dances and bake sales — when the volunteer fire company goes all out for the local child with leukemia who has exhausted the parents’ insurance benefit…
The majority of the nation knows that the only proposal that will fulfill your principles, Mr. President — reduce costs, expand our choice of health care provider and give access to excellent health care to everyone — is a single payer national health program.
Mr. President, your nation needs you to get real, get back to health reform that comes from the ground up and keep the promise:
“The system we have now might work for the powerful and well-connected interests that have run Washington for far too long, but I don’t. I work for the American people. I didn’t come here to do the same thing we’ve been doing or to take small steps forward, I came to provide the sweeping change that this country demanded when it went to the polls in November.”
— President Obama, February 28, 2009, “Keeping Promises.”
I just love how all of these opposition groups to President Obama’s health care plan front like they’re real, grassroots organizations. AHIP’s Campaign for an American Solution? Fake! Rick Scott’s Conservatives for Patients’ Rights? Funded with his ill-gotten gains. And now there’s Patients United Now.
As I noted yesterday, Patients United Now (or PUN for short!), is a front group for Americans for Prosperity, a group behind the lobbyist-funded tea parties last month. Igor Volsky at Think Progress has put together some of the history of Americans for Prosperity. Even though on PUN’s website they claim that they are “people just like you,” they are actually just corporate-funded lobbyists
Read More at The Seminal
Since there's suddenly a lot of talk about the long waits for treatment in Canada--and how reform will supposedly produce similarly long waits here--this seems like a fine time to remind people that long waits for treatment already exist here.
From Business Week, in July 2007:both data and anecdotes show that the American people are already waiting as long or longer than patients living with universal health-care systems. ...
If you find a suspicious-looking mole and want to see a dermatologist, you can expect an average wait of 38 days in the U.S., and up to 73 days if you live in Boston, according to researchers at the University of California at San Francisco who studied the matter. Got a knee injury? A 2004 survey by medical recruitment firm Merritt, Hawkins & Associates found the average time needed to see an orthopedic surgeon ranges from 8 days in Atlanta to 43 days in Los Angeles. Nationwide, the average is 17 days. ...
There is no systemized collection of data on wait times in the U.S. That makes it difficult to draw comparisons with countries that have national health systems, where wait times are not only tracked but made public. However, a 2005 survey by the Commonwealth Fund of sick adults in six nations found that only 47% of U.S. patients could get a same- or next-day appointment for a medical problem, worse than every other country except Canada.
The Commonwealth survey did find that U.S. patients had the second-shortest wait times if they wished to see a specialist or have nonemergency surgery, such as a hip replacement or cataract operation (Germany, which has national health care, came in first on both measures). But Gerard F. Anderson, a health policy expert at Johns Hopkins University, says doctors in countries where there are lengthy queues for elective surgeries put at-risk patients on the list long before their need is critical. "Their wait might be uncomfortable, but it makes very little clinical difference," he says.
Source: The Treatment
A true public plan cannot rely on private insurers to set premiums, provider rates, or terms of coverage, and it must be publicly accountable at the national level. The simplest, most workable, most cost-effective, and most attractive way to achieve these crucial goals is to model the new public plan on Medicare, the successful and popular public health insurance program for the elderly and disabled.
A Medicare-like public plan would be much more stable and secure than other approaches. It would provide the broadest possible choice of doctors. It could be offered throughout the nation on the same terms. It would have the lowest administrative costs. And its bargaining power and large risk pool would allow it to offer the most affordable possible premiums and most effectively restrain costs while upgrading the quality of care.
Read More at OurFuture.org
About 1 million adult Californians seek health care in Mexico each year – and that figure is likely growing as the recession expands the ranks of the uninsured who are drawn to cheaper care south of the border, said the lead researcher of the first major report on the topic released Tuesday.
Centrist Democratic Sen. Ben Nelson (Neb.) is under attack from an advertising campaign that criticizes his opposition to President Obama’s healthcare plan.
The Web and direct-mail ads specifically take on Nelson for opposing Obama’s proposal to create a public health insurance program consumers could choose instead of private plans. The $10,000 ad campaign is paid for by Change Congress, an advocacy group that is calling for publicly financed elections.
The Change Congress ads charge that Nelson’s opposition to a public health insurance plan is linked to campaign funds he has received from health insurance groups. Citing data from the Center for Responsive Politics, the ads say Nelson has accepted $2 million from health insurance companies over three Senate campaigns.
Nelson argues a public health insurance plan would ruin employer-sponsored private health insurance plans. He told CQ the inclusion of a public plan in a healthcare reform bill was a deal-breaker for him.
TheHill.com - Read More...
Thursday, May 28, 2009
Dean's stop in Denver is part of his summer tour with his Democracy for America political group to address health care. He said if President Barack Obama's health care plan gets changed and excludes the option of Medicare, 'then it is not health care reform.'
'Legislation rises and falls on whether the American public is allowed to choose universally available public option or not,' he said.
According to an April report from Families USA, a liberal group supporting health coverage for all, 1.4 million Coloradans were uninsured at some point last year. Nearly 77 percent of them went without insurance for at least a six-month period from 2007 and 2008, the report said.
'We can do better than this,' Dean said. 'It's time to take this out of the hands of congress and let the people speak.'
To the Editor:
As a family physician for 47 years, I totally agree with Paul Krugman’s May 22 column, “Blue Double Cross.” Health care insurers are more bureaucratic than any government agency. They often deny choice of doctor, and refuse to pay for care.
My experience with the government programs, Medicare and Medicaid, is that the reimbursement for services may be low, but there is one uniform set of rules to follow.
Each health care insurer has a different set of rules. The reimbursement for services varies widely and the doctor sometimes doesn’t know where to send the patient for laboratory or other tests. Furthermore, the physician often doesn’t know whether the prescriptions he or she writes will be covered.
As Mr. Krugman reports, insurance companies are still bad for your health.
Melvin H. Kirschner
Granada Hills, Calif., May 22, 2009
To the Editor:
I am a dual citizen, born and raised in Canada. After attending graduate school in the United States, I returned to Canada, first of all because of its much better health system. During my time in the United States, I heard many astonishing lies about Canadian health care.
Someone said that Canadians can’t choose their own doctors. Sorry, wrong. It’s Americans whose choice is constrained, by health maintenance organizations.
Another person said Canadian-style care is more expensive. In fact, Canadians pay far less and still get a high standard of care and are healthier and live longer than Americans.
Someone else said that Canadian health insurance involves tons of paperwork. Wrong again. Canadian medical insurance and billing is a miracle of simplicity and economy. Anyone who has ever been to an American hospital knows how much paperwork — mostly financial — is involved, and how many different bills they get from how many different parties.
Americans deserve far better than their current system, because most of them can’t simply move to a country with a rational, humane vision of health care.
Toronto, May 22, 2009
An overhaul of the health care system won’t pass the U.S. House of Representatives unless it includes a government-financed insurance plan for consumers, the head of the House’s tax-writing committee said.
Representative Charles Rangel said a public plan is essential to compete with private insurers and hold down medical costs. A Senate proposal that doesn’t contain the public option is “totally unacceptable,” the New York Democrat, chairman of the House Ways and Means Committee, said in an interview today.
This online video game from the California Nurses Association and National Nurses Organizing Committee, features an everyday patient trying to win healthcare from her insurance company. In each case, the insurer wins. Finally, as a bonus round, the patient spins to choose a healthcare system—and is fortunate to land on the single-payer model, which is succeeding in much of the rest of the industrialized world and which has been introduced in Congress as HR 676 (Conyers - MI) and S 703 (Sanders - VT).
"With Congress expected to debate health care reform next week, advocates of a single payer health care system rallied Wednesday outside the Springfield office of Massachusetts Congressman Richard Neal."
Listen to audio at WAMC:
"Physicians and patients in France expect to get the latest and greatest treatments, with minimal interference and minimal waiting. They're also willing to tolerate some inequality, albeit far less than Americans are. (In France, private supplemental insurance and an allowance for some doctors to charge extra fees creates a de facto two-tiered system, although the gap between the two tiers isn't that large and even people in the lower tier get timely, high quality care along with generous protection from medical expenses.)
Canadians don't like to wait and don't like to be denied the most advanced care, either. But they seem to have more strongly egalitarian values than the French do. That helps explain their rigidly centralized system, which provides extraordinary financial protection for all people, does so uniformly for the entire population, but sometimes sacrifices convenience and immediate access to advanced care."
Labels: health care reform
"U.S. families with health insurance are paying an estimated $1,017 more in annual premiums to compensate providers for healthcare to the uninsured, a report released on Thursday said."
"New York City has agreed to pay $2 million to the family of a woman who died last year on the floor of the psychiatric emergency room at Kings County Hospital Center after waiting more than 24 hours to be treated."
Read More... NYTimes.com:
Wednesday, May 27, 2009
"Americans for Prosperity, the right-wing group last seen sponsoring Joe the Plumber's speaking tour against card-check legislation, is getting into the health care debate. And it's making arguments with all of the nuance and rigor you'd expect.
The vehicle for these arguments is a new advertisement, launched as part of the 'Patients United Now' project and set to air this weekend, according to a source familiar with the ad buy. The tv spot features Shana Holmes--a Canadian woman who, according to the ad, suffered from brain cancer and came to the U.S. in order to get life-saving treatment."
The National Economic & Social Rights Initiative (NESRI) has released an in-depth analysis of four single-payer bills that are currently in the U.S. Congress and State Legislatures. The assessment measures the bills against human rights standards, and shows that single-payer plans are superior to market-based proposals because they go further towards creating a system that is universal, equitable and accountable to the people.
Read the report here [PDF]
"When the time came for questions, McArthur stood up and asked a simple question. Looking across a standing-room-only crowd of about 275, he asked how many were happy with their employer-based health insurance.
Less than 10 people raised their hands.
“The number is bogus,” McArthur said. “It s not working for 95 percent of us.” McArthur drew resounding applause.
In fact, any mention of single-payer health care insurance brought raucous cheers and clapping. Any other solution to health care reform - including Baucus “balanced” plan that would create a mix of public and private plans - was received more coolly."
A new U.S. Senate resolution demands that a public health insurance option be included in health care reform legislation now being developed behind closed doors in the Senate Finance Committee.
A public insurance plan option for workers and families who either have private insurance coverage or no coverage at all is one of the AFL-CIO’s key health care reform principles. It has been vigorously attacked by the private insurance industry and most congressional Republicans.
Sen. Sherrod Brown (D-Ohio), along with 27 co-sponsors, introduced the resolution yesterday.
Tuesday, May 26, 2009
For most of the last century, no single group was a bigger obstacle to universal health care than organized medicine. Today, perhaps no single group stands more united in support of some form of universal coverage.
Now, surveys reveal that overwhelming numbers of physicians resent the current crazy patchwork health care system, which fixes their reimbursements, regulates and too often denies patient care, and piles physicians with paperwork so unending and from so many directions that the average doctor has little time left over to challenge the status quo.
Add to all this the frustration arising from working for no pay to coordinate care and provide care after hours, from struggling with the cost of health care insurance for their own employees, and from seeing their uninsured and underinsured patients go without recommended care, and what emerges is widespread physician support of radical reform.
More than four-fifths of physicians now agree that our health care system either needs fundamental changes or should be rebuilt completely
Accelerating health-care premiums and sharp revenue shortfalls due to the recession are forcing some small companies to choose between dropping health insurance or laying off workers -- or staying in business at all.
Read More at WSJ.com:
"The health care industry has spent $134 million on lobbying this year to keep its profits high and public health in the shadows."
So the banks were too big to fail and now, apparently, health care is too big to fix, at least the way a majority of people indicate they would like it to be fixed, with a single payer option. President Obama favors a public health plan competing with the medical cartel that he hopes will create a real market that would bring down costs. But single payer has vanished from his radar.
Nor is single payer getting much coverage in the mainstream media. Barely a mention was given to the hundreds of doctors, nurses and other health care professionals who came to Washington last week to protest the absence of official debate over single payer.
Wheelers and dealers from the health sector aren’t waiting for that moment. According to the non-partisan Center for Responsive Politics, they’ve spent more than $134 million on lobbying in the first quarter of 2009 alone. And some already are shelling out big bucks for a publicity blitz and ads attacking any health care reform that threatens to reduce the profits from sickness and disease.
The Washington Post’s health care reform blog reported Tuesday that Blue Cross Blue Shield of North Carolina has hired an outside PR firm to put together a video campaign assaulting Obama’s public plan. And this month alone, the group Conservatives for Patients’ Rights is spending more than a million dollars for attack ads. They’ve hired a public relations firm called CRC – Creative Response Concepts. You remember them – the same high-minded folks who brought you the Swift Boat Veterans for Truth, the gang who savaged John Kerry’s service record in Vietnam.
Read More at AlterNet:
Advocates of a single payer health care system held a silent protest demonstration at Senator Ron Wyden’s town hall meeting in Forest Grove, Oregon on Sunday.
The protesters demanded that Senator Wyden open the debate on health care reform to include advocates of a single payer, everybody in, nobody out, free choice of doctor and hospital health care system.
The protesters charged that Senator Wyden is backing a health care plan that is mere piecemeal tinkering of the current system.
About ten minutes into the event Rick Staggenborg MD, of Physicians for a National Health Program (PNHP), asked Senator Wyden if he would sit down with single payer advocates.
Wyden remains steadfastly opposed to single payer, but said he would sit down with the single payer advocates.
But Senator Wyden did nothing to ensure that single payer advocates were represented in recent Senate Finance Committee hearings.
Big business and health insurance companies dominated the sessions.
More than 41 witnesses testified over three days of hearings on health care before the Committee.
Not one of the 41 was an advocate of a single payer system — even though recent polls show that the majority of Americans, the majority of doctors and even the majority of health economists favor a single payer system.
Thirteen doctors, nurses, lawyers and other single payer activists were arrested at those hearings for demanding that one single payer advocate be allowed to testify.
All were charged with “disruption of Congress” and face arraignment starting this week in Washington, D.C.
About fifteen minutes into the Wyden town hall meeting, five single payer activists walked to the front of the room and put on surgical masks with messages written on them.
“Everybody in. Nobody out,” read one.
Another read — “Healthcare is for people, not for profit.”
The activists were Single Payer Action’s Philip Kauffman, Dr. Joe Eusterman of PNHP, Jamie Partridge of the Portland Jobs with Justice Healthcare Committee, an unidentified woman, and Martha Perez, a healthcare professional based in Portland.
Wyden did not recognize the silent protesters until a news photographer began taking photos.
Wyden then turned and was surprised by the presence of the protesters. (See video here.)
But the protesters continued their silent protest as a backdrop to Senator Wyden as he took questions for over an hour.
About 60 citizens attended the town hall meeting.
“A majority of the people who attended the Wyden town hall meeting support single payer and many thanked us for our silent protest,” said Kauffman. “Wyden parroted the insurance industry line that we need a ‘uniquely American’ approach to healthcare. At that point a member of the audience said — ‘I think we already have a uniquely American system. It doesn’t work.’”
“I respect what Senator Wyden has done for this state and country,” Dr. Eusterman said. “He has been courageous and honorable, but on the issue of health care, he is dead wrong.”
More at Single Payer Action:
It seems hard to believe to us, but there is actually a debate going on about whether health care reform should include a public plan option – as opposed to only private insurance plans. (Never mind whether health care reform should simply be one public plan, or a choice of public plans!)
We have discussed why a public plan is necessary. The inevitable conclusion is that any reasonable approach to health care reform must include, at the very least, a public option.
But what would a public plan look like? What elements of a public plan are essential? Here are the indispensible dozen elements:
1. Like the long-standing, public Medicare program, the plan should be available to all, throughout the United States, without exclusions for pre-existing medical conditions, and with community rating (the same base premium for all, regardless of age, medical history or other “category” that the person may fit into).
2. The public plan should resemble the traditional, public Medicare program. (Polls show that 80% of Medicare beneficiaries are either “extremely” or “very” satisfied with Medicare.) In designing health care reform policy makers should learn from the successes of traditional Medicare and the costs of privatization.
3. The public plan, as well as any other plans authorized by Congress, should receive additional payments or “risk adjustments” for sicker or more costly patients. This is necessary so no plan ends up being a default for more costly people with the result that it becomes insolvent.
4. The public plan’s benefits should be at least as broad as traditional Medicare, and should be enhanced by adding coverage for mental health, dental services, long term care, vision care and eyeglasses, hearing aides, and increased coverage for preventive services.
5. A greater emphasis should be placed on primary care, especially for manageable chronic conditions. This emphasis should be financially encouraged with incentives to providers and enrollees. Perhaps most importantly, the plans should have a clear rule that care designed to maintain (as well as to “improve”) function or health status is covered.
6. Out-of-pocket expenses should be limited. Public plan premiums (and those of private plans, if they are to be offered) should be affordable, with no co-insurance or deductibles. Although there is a school of thought that requiring patient co-pays makes them better health care consumers, studies show that when cost sharing required, many people cannot afford it and forego necessary medical care or prescription medication. The result: more serious medical conditions and more costly care down the line. (Rosenthal, What Works in Market-Oriented Health Policy, New England Journal of Medicine, May 21, 2009)
7. Subsidies should be provided for lower income persons, based on a sliding scale, which would assist with premium payments. Premium costs should capture regional costs differences, as should subsidies to lower income people.
8. The public plan should have the authority to negotiate prices with health care providers and pharmaceutical companies.
9. Enrollment procedures and time frames in the public plan should be user-friendly. Eligible persons should be able to move freely between whatever plans are offered, particularly when there has been a change in an employer’s health care coverage or a change in the individual’s circumstances.
10. There should be a simple, easy to use appeals process for (public and private) plan participants based on the Medicare appeals process, and assuring that all current due process and appeal protections guaranteed to Medicare beneficiaries are afforded to participants in plans created through health reform, including the public plan and any private plans.
11. The public plan should include financial payments to providers for offering interpreter services and for translation of materials into the major languages of the enrollees whom they serve. Education and training should be offered to providers to assure that treatment and patient education is culturally relevant, in order to assure positive health outcomes and minimize the need for more expensive care down the line.
12. US citizen-children and the parents of those children, if the parents reside in the United States, should be eligible to purchase insurance through the public plan.
These dozen essential elements of health care reform would ensure that enrollees are able to access comprehensive, affordable health care and achieve positive health outcomes at a reasonable cost to society.
Isn’t that what health care and health care reform should be all about?
Source: CMA Health Policy Consultants
Monday, May 25, 2009
Monterey physician Bradley Carpentier found himself spending so much time fighting with health insurers to get approvals for the treatments he prescribed for his patients that he decided to wage his own lobbying effort.
Carpentier formed a new political action committee - Stop Practicing Medicine - to target the long-standing practice of insurers hiring doctors to review physician decisions, even though the insurer-hired doctors had never seen or talked to the patient whose care they were scrutinizing.
Insurers defend the practice, saying such doctors often serve as a second set of eyes to ensure patients are receiving the most appropriate and effective treatments. But Carpentier, along with patients and other doctors who support his position, says insurers are denying and delaying care.
"In case you had any doubts, here’s the real reason why insurance companies don’t want health care reform to include a so-called public option: These champions of freemarket capitalism know that they simply can’t compete with a government-run plan."
Survey results demonstrate that Medicare beneficiaries are less likely than those with private coverage to report negative experiences with their insurance plans — including having expensive medical bills for noncovered services, being charged a lot more than insurance would pay, and physicians’ not taking their insurance….
Mother Jones | Read More....:
Sunday, May 24, 2009
"The usual complaints levied against the universal systems are that they will ration care, you have long waiting times for doctors, and quality of care then suffers. It seems to be a given that in the United States with our private system that we have better access, better quality, and fewer mistakes. But what do the data show?"
Check the actual data - great article.
Read it all:
"Washington's abuzz about health care, but why isn't a single-payer plan an option on the table? Public Citizen's Dr. Sidney Wolfe and Physicians for a National Health Program's Dr. David Himmelstein on the political and logistical feasibility of health care reform."
Video and Transcript here
Saturday, May 23, 2009
Ezra Klein, a prominent health care and political journalist-blogger, was recently interviewed by Mike Dennison, a reporter with Lee Newspaper’s Montana State Bureau. The interview addressed the hearings on health care reform being held by Sens. Max Baucus of Montana and Chuck Grassley of Iowa. Baucus is the chairman and Grassley is the ranking member of the Senate Finance Committee. The most important question in the interview was, 'Shouldn't a single-payer or Medicare-for-all system of universal coverage be considered?' Klein replied: 'When the politicians say, 'We're going to take what you have now away and you can trust the federal government to do this [health care] now' – that scares the hell out of people.”
If Congress won't even consider a single-payer health care system, what kind of a "system" will our nation and we, as individuals, end up with? I am convinced the outcome will be even more complicated and detrimental than what we have now, a hodge-podge on top of an already existing hodge-podge of insurance plans. In other words, no plan and certainly no "system.”
There will continue to be for-profit and not-for-profit insurance companies that you will receive through your employers, which will continue to make them less then competitive in world markets, or you will be forced to buy it individually and, if you can not afford it, we will be given a public assistance to do so – not bad so far (don't get excited taxpayer, you are already paying for it). You must remember that you will probably change jobs seven times like most Americans and have to buy some kind of bridge coverage in between those jobs and, if you're broke, prove it to the system you need some financial help.
But wait, we will still keep children's health care for kids when some employer won't cover them. If you make too much money, you will have to buy through a private insurance company to get coverage. Then we will still want to have veterans’ coverage and their hospitals, and rightly so, along with Indian health care. Your spouse may not have veterans or Indian coverage; will they have to get coverage through there employer, maybe on the open market? Will these plans have to be changed when you move across the nation, the region? Maybe only the state you live in? Will it be the same type of coverage as you move across the nation? Then in order to keep the profit margins up for the insurance industry, once you hit 55, and you become unemployed and sick you loss your coverage, you can buy in to Medicare at the full price around $1,200 per month. You get the picture. There's a million more hang ups to make life a little more confusing.
A Medicare type plan, Single-Payer for all, with everybody in and nobody out, is the most efficient. It will save $400 billion for the American tax payer every year. That’s less than the $700 billion Sens. Baucus and Grassley are going to spend, money they helped to set aside in the last budget. The Single-Payer savings could be used to help cover the 50 million uninsured. The Single-Payer would concentrate on prevention, free choice of doctors and hospitals, no more in-network, out-of-network, deductibles, exclusions, and co-pay. According to recent polls, the majority of the American people, doctors and nurses and health economists want Single-Payer. Why don't Max Baucus and Chuck Grassley?
Call them, e-mail them and write them. Tell them America needs Single-Payer.
As US health care costs rise, so do insurance premiums and the amount of money employers spend on them—from 1996 to 2005, the average contribution rose by 5 percent a year in real terms, to $5,068. Some employers are rescinding health care benefits altogether, while others are limiting the number of eligible employees, so enrollment in employer-paid schemes is stagnating or declining, according to a McKinsey Global Institute study. This research also reveals growing disparities in the percentage of employees at different income levels receiving employer-paid health benefits: only 22 percent of employees in the lowest income group (earning an average of $14,800 a year), but 56 percent, 81 percent, and 89 percent of those in the lower-middle, upper-middle, and top income groups, respectively.
Friday, May 22, 2009
"Family physicians are seeing evidence of the recession's impact on access to health care for Americans, and are offering more charity care, lower fees and free screenings to a growing number of needy patients, according to a survey published on May 19 by the American Academy of Family Physicians.
In a national poll of Academy members, signs of the negative impact of the recession on health care included an increase in appointment cancellations, reported by 58 percent of respondents, and patients expressing concerns over their ability to pay for health care, reported by almost 90 percent of those surveyed.
Other signs of the recession's impact were an increase in patients' stress symptoms, reported by 87 percent of doctors surveyed, and an increase in the number of uninsured patients, noted by 73 percent of respondents. The majority of doctors surveyed (66 percent) were acting to help ease the burden by changing patients to generic prescriptions and providing discounted or free services."
A portion of the suffering has been gauged: L. P. Casalino, S. Nicholson, D. N. Gans et al., “What Does It Cost Physician Practices to Interact with Health Insurance Plans?” Health Affairs Web Exclusive, May 14, 2009, gives us numbers–and they agree with my doctor.
* Physicians, on average, spent 142.3 hours per year interacting with health plans, or 3.0 hours per week and 2.7 physician work weeks per year. Primary care physicians spent significantly more time (164.9 hours per year) than medical specialists (123.7 hours) or surgical specialists (100.3 hours).
* Nursing staff spent an additional 23 weeks per year per physician interacting with health plans, while clerical staff spent 44 weeks and senior administrators spent 2.6 weeks doing so.
* Compared with other interactions, physicians, on average, spent more time dealing with formularies (78.2 hours for primary care doctors, for example), and the least on submitting or reviewing health plan quality data (1.9 hours annually for all physicians).
* Converted into dollars, practices spent an average of $68,274 per physician per year interacting with health plans; primary care practices spent $64,859 annually per physician, nearly one-third of the income, plus benefits, of the typical primary care physician.
The authors further note that “the estimated $31 billion in costs physician practices incur in their interactions with health plans comprises 6.9 percent of all U.S. expenditures for physicians and clinical services. That is six times the amount the federal government spends annually on the Children’s Health Insurance Program (CHIP).
Read More... HEALTH REFORM WATCH:
Thursday, May 21, 2009
"Achieving comprehensive health reform has emerged as a leading priority of the President and Congress. President Obama has outlined eight principles for health reform, seeking to address not only the 45 million people who lack health insurance, but also rising health care costs and lack of quality. In Congress, a number of comprehensive reform proposals have been announced as the debate begins over how to overhaul the health care system.
This interactive side-by-side compares the leading comprehensive reform proposals across a number of key characteristics and plan components. Included in this side-by-side are proposals for moving toward universal coverage that have been put forward by the President and Members of Congress. In an effort to capture the most important proposals, we have included those that have been formally introduced as legislation as well as those that have been offered as principles or in White Paper form. This side-by-side will be regularly updated to reflect changes in the proposals and to incorporate major new proposals as they are announced."
More at the Kaiser Family Foundation:
This report uses the Health Insurance Policy Simulation Model (HIPSM) to quantify the intermediate and longer-term implications if America’s health care system is not significantly overhauled. Under a range of economic scenarios, the analysis shows an increasing strain on business owners and their employees over the next decade if reform is not enacted. There would be a dramatic decline in the number of people insured through employers, and millions more could become uninsured. There would be large growth in Medicaid/CHIP enrollment and spending, and increased spending on uncompensated health care. Middle-income working families would be the most affected.
"This is a look at some of the top total compensation packages from 2008 based on information gathered from the U.S. Security and Exchange Commission."
"Companies are getting walloped by higher than expected costs just when they can least afford it. Employers had figured on a 6% hike in health care this year, but it now looks as if the increase will be closer to 7.5%. The spike is due to employees making more trips to the doctor and dentist and undergoing more exams, tests and treatment, a common occurrence in a recession. It’s driven by stress related illnesses and by workers worried that they’d better race to use their benefits while they still have them."
Read More... - Kiplinger.com
Contrary to popular belief, the United States actually spends just as much on social programs (pensions, health care, education, etc.) as just about any other country in the world. The key difference between the United States and other wealthy democracies is where the money comes from. Specifically, in the United States, many people pay for social services straight out of their pockets, rather than having the public sector (aka, the government) provide the services.
In 1960, the United States was equal to other wealthy democracies in terms of overall social spending from the public sector. During the 1960's, we continued to increase our nationa level of public sector spending through programs like Medicare and Medicaid. However, since that time, while other wealthy democracies experienced a vast increase in public sector social spending, the United States has experienced little change (PDF, page 4). What has changed in the United States is a vast increase in private spending on social programs. In 1980, the 4.4% of the United States GDP was private expenditure on things like health care and education, but by 2005 that number had increased to 9.4% (source: OECD). While other wealthy democracies increased their public sector spending on social programs, the United States increased its private sector spending on social programs.
A public health care option is the first major step required to redress this inequality. There is no such thing as health care reform without a public option. Lacking a public option, our health care system will continue on its current path of skyrocketing costs and inequality of access. We already have as much health care as other wealthy democracies--ours just costs to damn much and access to it is distributed unequally. Any health care reform without a public option should be actively opposed.
The grand arc of American politics over the last forty years is about inequality. Changing that arc requires a public health care option that is available to all Americans. Anything less does change the arc at all. We have to stop increasing private social spending a as a percentage of GDP.
Wednesday, May 20, 2009
Rising health care costs coupled with eroding health care benefits are having a substantial effect on Americans' ability to get needed health care, with women particularly affected. Women experience cost-related access problems and medical bill problems more often than men. In 2007, more than half (52%) of women reported problems accessing needed care because of cost and 45 percent of women accrued medical debt or reported problems with medical bills. Since women use more health care services than men, they are more exposed to the fragmentation and failings of the current health care system—underscoring the need for affordable and high-quality health insurance coverage that is available to all.
by Robert Reich
"It’s still possible that the House could come up with a real Medicare-like public option and that Senate Dems could pass it under a reconciliation bill needing just 51 votes. But it won’t happen without a great deal of pressure from the White House and the public. Big Pharma, Big Insurance, and the rest of Big Med are pushing hard in the opposite direction. And Democrats are now giving away the store. As things are now going, we’ll end up with a universal health-care bill this year that politicians, including our President, will claim as a big step forward when it’s really a step sideways."
Read It All...:
"Employees' share of medical expenses rises 10.6% from last year, according to industry survey."
To the Editor:
David Leonhardt, in his May 13 column (”Health Care, a Lesson in Pain,” Economic Scene), is quite right that “the only way to have a sustainable universal health care system is to control costs.” But in analyzing the experts’ testimony before the Senate Finance Committee on how to pay for health care, he did not mention a solution that neither the experts nor the committee wants to consider: major reform of the system.
Runaway costs are due largely to high overhead expenses throughout the system, and to the excessive use of expensive technology. Both of these result from a health care system that is organized like a profit-seeking industry instead of a social service.
If we want health care to be a universal entitlement, it cannot be controlled by market forces and the financial interests of insurers and providers (and the investors who own such a large part of the system).
Some kind of government-regulated single-payer insurance plan and a reorganized nonprofit medical care delivery system may be “off the table” for policy makers right now, but we will never achieve affordable universal coverage without major reform that deals with the real causes of medical inflation.
We don’t need more money; we need a new system.
Arnold S. Relman
The writers, medical doctors, are former editors in chief of The New England Journal of Medicine.
"Activists backing President Barack Obama's health care overhaul are asking the Justice Department to open a wide-ranging investigation of what they say is monopoly-like power in the hands of major insurers."
These are salad days for Democratic lobbyists, because deep pocket interests - health insurance companies, Big Pharma, oil and gas and coal companies, the utilities and, of course, the banks - are buying them up to help harness the gale winds of change. Get ready to be dazzled - the strategies employed will reflect the imagination of Washington's most clever operators.
Outside the photo op, however, the reality was very different. A new report released today by Health Care for America Now, a leading citizens' coalition pushing for comprehensive health care reform, put the industry claims in sharp relief.
The HCAN report shows that after 400 mergers involving health insurers over the last 13 years, concentration has gone up in local markets across the country. The single largest provider of small group coverage (for small businesses, for example) controlled a median market share of 47% in 2008. The AMA says 94% of insurance markets in the US are highly concentrated.
The result, of course, is soaring prices - with premiums up, on average, more than 87% over the past six years. Profits at 10 of the country's largest publicly traded health insurance companies in 2007 rose from $2.4 to 12.9 billion (428%) from 2000 to 2007. The CEOs of these companies in 2007 alone collected an average compensation of $11.9 million each. Nice work if you can get it.
Insurers use their position to pass rising costs onto the insured. And, not surprisingly, Medicare does better. A recent study by University of California professor Jacob Hacker for the Institute for America's Future (which I co-direct) shows that from 1997 to 2006, private health insurance spending per enrollee grew at an annual rate of 7.3% while that of Medicare was at 4.6%, or more than one-third less.
The concentration of insurance markets and the lack of private competition provide compelling reasons for the Congress to establish a public plan like Medicare as an option for those seeking insurance. Give consumers a real choice. The public plan would provide both a benchmark for private plans and much needed competition in what are now perversely concentrated markets.
Those opposing health care reform are usually insurance industry CEOs and sales brokers, because they are the make-work middlemen pocketing the cash. Unfortunately, many non-insurance executives can’t see the forest through the trees. Their business “partners” from the insurance sector are dipping into their health care wallets, in some cases to make up for losses in other areas like Katrina and the stock market. It is a total waste.
The smartest thing we could do -- both as a nation and business community -- is to switch to a single-payer Medicare-for-all system of health care. As a Medicare patient and former CEO, I think it’s great. I get sick, I get care and the caregiver gets paid. I go to the same private hospital and physician I have for years; they just send the bill to Medicare instead. I just don't deal with the insurance company.
Every U.S. citizen should have this level of care, including politicians. If they want anything outside of the norm, like cosmetic surgery, they can pay for it on the outside the old-fashioned, free-market way, with cash dollars.
A Medicare-for-all system would not only save consumers $400 billion per year; it would save every U.S. corporation $6,500 per employee per year in health care premiums. How’s that for a bailout? But this one isn’t going to just the bankers.
Ask the Big Three how important that is. They now manufacture more cars in Canada because they only pay $800 per employee. And 80 percent of Canadians prefer their health care system to ours, even with their wait times. But since we spend twice what they do, wait times will not be an issue.
So the government has done some pretty stupid things and they’ll continue doing stupid things on health care because the insurance industry has given congress $46 million in campaign contributions. What else would you expect them to do? Money talks!
That insurance bureaucracy is draining 31 percent of health care costs, money that should instead be spent on physicians, nurses and hospitals.
Unless the business community steps in and demands a single payer fix we are doomed for years of the same. Senators Herb Kohl and Russ Feingold must pressure Sen. Max Baucus and the Finance Committee to put single-payer on the table, and they must be encouraged to co-sign Sen. Bernie Sanders’ SB703 (the senate version of HR676). Only then can our economy turn around the way it should.
Read More - BizTimes:
Sunday, May 17, 2009
"Physicians have long expressed dissatisfaction with the time they and their staffs spend interacting with health plans. However, little information exists about the extent of these interactions. We conducted a national survey on this subject of physicians and practice administrators. Physicians reported spending three hours weekly interacting with plans; nursing and clerical staff spent much larger amounts of time. When time is converted to dollars, we estimate that the national time cost to practices of interactions with plans is at least $23 billion to $31 billion each year."
Full text available here.
"It shouldn't be this hard to get the healthcare you seek. A sister's cancer and son's mugging illustrate what it takes."
It doesn't have to be this difficult, of course, to get proper care when you're sick or injured. But we've got an insane system, protected by powerful lobbies that put dollars ahead of health.
President Obama seems to have lost the nerve to follow through on his onetime support for a single-payer universal healthcare system. Now that he's elbow-deep in the muck, with vested interests swarming like leeches, it's not clear what he wants or how long the American public's overwhelming desire for change will be ignored.
Read it all....
"Senate Finance Committee chairman Max Baucus, the insurance industry-friendly Democrat who is managing show hearings on healthcare reform, has come up with a novel way to express his commitment to care for the almost 50 million Americans who have no healthcare and roughly equal number who have inadequate care.
The senior senator from Montana is ordering the arrest of doctors and nurses."
"Even as rising unemployment strips people of health insurance, sending many to emergency departments for care, doctors on the front lines say the lingering recession is also prompting an unexpected outcome.
More patients, they say, are refusing potentially costly procedures ranging from tests to confirm heart attacks to overnight stays to monitor dangerous infections."
Friday, May 15, 2009
by Jason Rosenbaum
Just four days after standing next to President Obama and declaring their commitment to control health care costs to the tune of $2 trillion over 10 years, the insurance industry, drug and medical device makers, and hospital groups are backing off their promise:
Why do they still have a seat at the table?
Read it all...
Thursday, May 14, 2009
Tuesday, May 12, 2009
In a national Commonwealth Fund survey, elderly Medicare beneficiaries reported greater overall satisfaction with their health coverage, better access to care, and fewer problems paying medical bills than people covered by employer-sponsored plans. The findings bolster the argument that offering a public insurance plan similar to Medicare to the under-65 population has the potential to improve access and reduce costs.
Monday, May 11, 2009
Today, surveys reveal overwhelming numbers of physicians resentful towards the current crazy patchwork health care system, which fixes their reimbursements, regulates and too often denies patient care, and piles physicians with paperwork so unending and from so many directions the average doctor has little time leftover to challenge the status quo.
Add to all this the frustration felt at working for no pay coordinating care and providing care after hours, at struggling with the cost of health care insurance for their own employees, and at seeing their uninsured and underinsured patients go without recommended care, and what emerges is a prescription for widespread physician support of radical reform.
Over four-fifths of physicians now agree that either fundamental changes are needed in our health care system, or that it needs completely rebuilt.
On April 27th, forty-four national physician organizations wrote to Senate Majority Leader Harry Reid to outline their common goals and strategies "for improving health care delivery and making affordable, high-quality care available to all Americans." The co-signatories included the largest groups representing America’s family physicians, internists, obstetricians and gynecologists, and surgeons.
The letter’s sentiments mirror the results of a national survey of physicians published in January by the Journal of General Internal Medicine, which found that only a small fraction of U.S. physicians supported leaving the U.S. health care financing system as it is. Nearly half favored either tax incentives or penalties to encourage the purchase of medical insurance, and four in ten preferred a government-run, single-payor, taxpayer-financed national health insurance program.
Just six years ago, similar polling found only 1 in 4 physicians supporting a single-payor system.
These findings challenge the public perception that American doctors are by and large unsympathetic to growing call for an overhaul of our costly and deeply unequal current health care system. Nine in ten physicians in fact agreed that every American should receive needed medical care regardless of ability to pay. Physician attitudes have undergone a marked turnabout in the last four decades.
The American College of Physicians, a national association representing 124,000 internists and internal medicine subspecialists, has been the medical organization perhaps most vocal in support of universal health care coverage. The ACP takes the position that "health insurance coverage and benefits should be continuous and not dependent on place of residence or employment status."
In December 2007, the organization became the first and thus far only medical association to endorse a single-payor national health insurance system as a viable option to achieve universal health care. The only alternative option the ACP recommends is a private/public model, much like what the Obama administration proposes. The ACP warns, however, that this health care model will likely result in inequities in coverage, and higher costs when compared to a single-payor system.
Every other national primary care organization likewise strongly favors universal health care coverage. The American Academy of Family Physicians, a national association representing 94,000 family doctors, crafted a health care reform proposal in 2001 which advocates for "a national health system with a basic set of benefits offered to all individuals."
The American Academy of Pediatrics, representing over 60,000 pediatricians nationwide, endorses the idea that "quality health insurance should be a right, regardless of income, for every child, pregnant woman, their families, and ultimately all individuals." Nine in ten pediatricians recently surveyed said they wanted a health insurance program that would cover all children in this country.
And the American Academy of Obstetricians and Gynecologists, a national association representing 52,000 obstetricians and gynecologists, has issued a national health care reform agenda entitled "Health Care For Women, Health Care For All", which "call[s] on Congress and the States to cover all people in the U.S."
What is Success?
Successful health care reform is not "something that gets Obama's signature." Instead success is something that solves the core problems. So that means we must define what the core problems are, and therefore what our goals should be, before we can assess any possible solution.
Problems and Goals
- Problem: Health care is unaffordable. Goal: Guarantee no American ever has to worry about whether they can afford treatment again. The #1 problem, and therefore #1 goal of reform, is that too many Americans cannot afford to get the health care they need. All other problems stem from this one. This has a massive, even catastrophic ripple effect throughout society and the economy, from epidemic disease, untreated illnesses, and the economic consequences of all of this. Any health care reform we produce should make health care affordable to everyone, not by an insurer's promise, but through a clear regulatory and financial mechanism. Many of us believe the only way to achieve this is through single-payer. I am open to other options, but they must demonstrate the guarantee of affordability that we all know single-payer ensures.
- Problem: Health care is unavailable. Goal: Guarantee every American has access to the appropriate level of health care they need within or a reasonable distance from their community. This is often a consequence of #1, but also stems from other sources. Many places in America do not have enough doctors, even if you are ensured. I live in such a place - Monterey, California. We are a wealthy community but few doctors accept new patients, and many common insurance plans are not accepted by a surprisingly high number of doctors - ob/gyn in particular. Some "reformers" dismiss this issue or view it as unimportant, but it affects a hell of a lot more people than is generally realized, especially if you're not in the upper middle class or higher. As with #1, single payer guarantees availability. Other options might too, but they must demonstrate this can be done as a consequence of the system they propose, and not out of a promise. In particular, any reform must guarantee that anyone with insurance can get care whenever they need it - care on demand. This requires, among other things, that any "public option" be accepted by any health care provider.
- Problem: Costs are rising. Goal: Ensure that costs are handled in a way that does not undermine goals 1 and 2. This is not necessarily a bad thing, but it is something that must be dealt with. Single-payer offers the benefit of ensuring low overhead costs, and because of its mechanisms is likely to produce more preventive care, saving money in the long run. Again, it's possible this could be solved through other means, but that must be demonstrated and not promised. The recent news of health insurers offering $2 trillion in cost savings should not be taken seriously since it is a mere promise, and not backed up by either laws or procedures.
- Update [2009-5-11 11:31:46 by eugene]: As explained by DrFerbie in a comment below: Problem - The Healthcare system impacts the entire economic viability of the United States. Goal - Create a healthcare system which contains costs, fosters the ability of employees to change jobs without the the threat of loss of insurance, manages expenses for companies and levels the competitive playing field with foreign competitors. (Note: I'd intended to build this out of point #1, but DrFerbie is right that it should be specifically included here.)
I believe these to be the three primary problems that any health care reform must solve. Many of us single-payer advocates have constructed a rich language to advance these causes - such as the argument that health care is a human right. I fully agree with this, and believe that health care should be provided on demand without out-of-pocket costs of any kind. But I acknowledge those are frames to a solution to the
threefour problems above. I'm open to other frames and other solutions - but they must address the above problems and meet the above goals. If they fail to do so, they must be rejected out of hand.
The Politics of Reform
What is happening to us right now is that we are being told that the right solutions to the problems have to take a back seat to "political realities." In other words, we cannot merely craft something that is sensible and workable and implement it. Instead we must be willing to accept something potentially flawed and unworkable if it is what can pass the Congress and get Obama's signature - or so we're told.
This is an unusually bad approach to both health care reform and to maintaining our political majorities. The reason is it assumes that the short-term is all that matters, and that building prosperity, solving health care reform for decades to come, and building a lasting progressive political majority do not matter at all.
Too many people are stuck fighting the last war. Their frame of reference is 1994. "If only we could have gotten something passed," they say, "we'd have been OK." This is a debatable interpretation of history, but it also defies both common sense as well as the present political situation.
The truth of the matter is this: Obama's current popularity is likely to ensure victories in 2010 and probably 2012 (though we must not take these victories for granted - we must produce them, they don't fall in our laps). But beyond that, it's quite unclear what will occur. Despite the rhetoric of a dying Republican Party, they are wealthy and clever. After two more defeats they will start to figure things out, just as Democrats did after 2004.
That's why the medium-term matters so much. If we lose Congress in 2014 and the White House in 2016 without having written into stone a health care reform the way we did Social Security in 1935 and Medicare in 1965, we will have failed. Republicans will return and dismantle the short-term benefits, such as they were.
Further, a health care reform that does not fix the problems or meet the goals outlined above is likely to produce political failure through its own failure. There is no surer way to destroy the gains of the last two election cycles than to fail to actually solve the problems facing this country or to not fulfill our promises and our hopes.
By the mid-Teens we need to be watching a health care system settle in and produce real benefits. We probably have some space, actually, to see some short-term bumps, since it would take a massive shift in fortunes for us to be in jeopardy of losing in 2010 or 2012. After that, though, we need to be able to point to measurable results, especially towards the end of Obama's second term.
This isn't an abstract concern. I take this from the experience of the Labour Party in Britain, which is about to experience a severe defeat, perhaps along the lines of 1979, at the next general election. Under Tony Blair and Gordon Brown Labour proved able to provide short-term economic growth. But they failed to produce a newer, more stable system and method of producing that growth - they ignored the medium-term and the long-term. When the economic "boom" of the Labour years started unraveling in 2007, the party's political fortunes took a severe hit, and Brown seems incapable of recovering ground lost to the Conservatives.
This is particularly stunning given how pathetic the Tories looked in the years after Labour's 1997 victory. Anyone who followed British politics between about 1997 and 2005 knew that the Conservative Party had become a joke - disdained by the public and under the control of inward-focused ideologues who cared more about enforcing adherence to an unpopular right-wing party line than in appealing to the public. William Hague and Iain Duncan Smith are just the British versions of Eric Cantor and Michael Steele.
And yet the Conservative Party now enjoys a massive poll lead over Labour - between 18 and 22 percentage points according to the most recent data.
Labour totally failed to provide for the medium-term. And that in turn is because they failed to provide any truly new basis for the British economy, failed to provide any truly lasting and self-sustaining reforms.
There is every reason to believe the same can happen here in the United States to the Democratic Party - particularly on health care, but on broader economic policy issues as well. In fact, health care IS the economy - the competitiveness of US businesses, the ability and willingness of consumers to spend money - is dependent on Americans no longer worrying about the cost of or ability to access health care.
True Political Reality
I'm sure some will still argue that merely stating the above truths won't flip Specter's or Nelson's or Baucus's vote.
And yet we must remember that there are other ways to flip their votes without crafting a reform package that will fail to meet our long-term health care and political objectives.
The normal rules of politics have not been suspended. Those Senators are not immune to pressure. They are not immune to a public movement, any more than FDR was immune to a public movement on Social Security. When he was elected in 1932 he said he would not implement government-operated old-age pensions. So Dr. Francis Townsend and many others started a movement to demand government do precisely that. By 1935 FDR had embraced the reform as his own, labeled it "Social Security" and ensured it not only passed, but would last for a very long time. Its success helped solidify a decades-long Democratic political majority.
Baucus, Nelson, Specter, and the others all have their pressure points, their weaknesses. Good politics involves identifying and exploiting those weaknesses.
True political reality isn't throwing up your hands at the Senate's 60-vote cloture rule (which itself can be changed). True political reality is understanding that certain elemental political facts are never in suspension, especially in a liberal democracy. Senators can be moved by public pressure, properly conceived and applied.
What You Can Take Away From This Diary
- The health care reform debate MUST be oriented around problems and their solutions - NOT around whether we can get a label ("public option") signed by Obama. If labels were all that matters, Bush's Healthy Forests plan would have been a brilliant plan.
- "Political realities" dictate the approach laid out directly above. If we do not follow that approach, we run an unacceptable risk of failing to solve the basic health care problem and blowing up the Democratic majorities we worked hard to win.
- A successful health care plan does not rely on promises to achieve its goals. Nor, in fact, does it rely on Democratic control of government (although it can produce it!).
- You may not agree with my listing of the problems and their solutions - and I encourage you to propose alternatives or modifications in the comments. But you need to start debating health care from that kind of basis, especially on this blog.
Health care reform is, I believe, the most important battle we will fight in Obama's first term. We have NO room for error. We MUST get it right.
Optimism is a virtue; it leads us to see the best in people despite their flaws, and to envision a better future even when we can clearly see the obstacles that lie in the path to that future.
But blind optimism is no virtue. Naive or overeager optimism can lead us to ignore the fact that most people have mixed motives, and to cling so tightly to our vision of an idealized future that we become blind to the practical challenges we need to overcome to reach it. Wiser optimists trust - but verify; they have faith in the better, without ignoring the worse, angels of human nature.
On Sunday afternoon, two senior Obama Administration officials unexpectedly called a telephonic press conference to announce what they cast as a tremendous, positive new development in the healthcare reform effort. And they seemed genuinely, sincerely excited about this mysterious new development -- excited enough to buzz every national journalist's BlackBerry with an invitation to the conference call in the middle of Mother's Day. Because the President himself will be announcing this development officially on Monday, they embargoed the information (forbade reporters from releasing it) until 9 pm ET Sunday, and made the call -- arranged by the White House press office -- "on background," asking not to be identified by name or position.
Quite a buildup. So what was the big news? Simply this: a coalition of health insurance, hospital, pharmaceutical, and physician trade groups, plus a major union, will promise the President Monday that they will reduce the rate of future growth in the cost of healthcare by 1.5% per year for the next decade.
That's it. And the President will be announcing it himself Monday morning [update: according to CNN, 12:30 ET, 9:30 PT], presumably with equal excitement. [More HuffPost reporting on this call here.]
The big news, in other words, is that healthcare will continue to be increasingly expensive for consumers, employers, and governments, but not quite as quickly as it was going to be. 7% per year inflation will become 5.5% per year inflation -- that is, if the participants keep their promise. Which, according to the officials, they'll do, not because there's any kind of enforcement mechanism - there isn't one - but simply because they're "Americans."
(That's a quote from one of the administration officials, by the way: these for-profit healthcare industry groups are going to reduce costs, and potentially profits, simply because they're good "Americans.")
The senior administration officials were hyperbolic about this news. One, focusing on the political battle to enact healthcare reform, called the trade groups' pledge "a game changer."
The other official, focusing on economic issues, saw this as nothing less than the salvation of the entire federal budget:"I don't think there could be a more significant step to help struggling families and to help the federal budget than reducing the growth rate of healthcare spending by 1.5 percentage points per year. With regard to the federal budget... the only way that we are going to restore the nation to a sound fiscal path over the long term is to reduce the growth rate in health care costs... Reducing the growth rate of health care costs overall by 1.5% per year would virtually eliminate the nation's long term fiscal gap. ... This, by an order of magnitude, is far more important [than Social Security or related reforms] to the fiscal trajectory that we're on, especially over the long term, than anything else that could be done."
Remember, we're talking about slightly reducing the rate of growth in health care costs, not a reduction in health care costs themselves. That's what's supposedly going to save both American families and the nation's fiscal problems "over the long term."
The journalists on the call, understandably, were more skeptical. The biggies queued up to ask questions: reporters from the New York Times, Wall Street Journal, Associated Press, Washington Post, NBC News, CNN, Los Angeles Times, Reuters. Some asked for wonkish, green-eyeshade details (answers were rarely forthcoming).
Other reporters questioned what mechanisms were in place for making sure those promises are kept (answer: there are none). In response to a question from Reuters, one of the officials put his trust in the bully pulpit and the Fourth Estate, saying, "I don't know how many of you have made, in-person, a commitment to the President of the United States... There will be accountability not only through regular check-ins with the President of the United States but also through the media, because I have no doubt that you all will be checking up on them."
The other official simply believes that pharmaceutical, insurance and hospital trade groups are acting in patriotic good faith, saying, "These are very sophisticated trade associations which in the past have, one could argue, dragged their feet when it came to the subject of health care reform and certainly cost containment. [Now they're] coming forward voluntarily, approaching this President and saying, we want to be part of the solution, we want to be part of getting health care reform done... That fundamentally aligns these major provider groups with the President's goal of getting health care reform done this year. That is a game changer in our opinion."
Eliza Marcus of Bloomberg and Michael Fletcher of the Washington Post asked outright whether the healthcare industry was buying something with this concession. One of the officials dismissed the possibility, denying that there have been any discussions at all about the public plan or any other quid pro quo and instead casting the industry coalition's promise in purely patriotic terms: "They put it to me that everybody must share responsibility.... [T]hey want to get everybody covered... and they said to me, we know we have to do our part.... [T]his is them coming forward as Americans to get this done."
At face value, the health industry groups' announcement is good news. Even Paul Krugman, a consistent Cassandra of late, seems pleased. What's puzzling is the Administration's eagerness to accept it at face value. The group making this pledge includes private health insurers, medical device manufacturers, a pharmaceutical manufacturer, and the pharmaceutical manufacturers' trade group (PhRMA).
If you want a sense of how loyal and reliable this group is, you may be interested to note that PhRMA is represented in these negotiations by former Congressman Billy Tauzin, who (as a Democrat) co-founded the anti-progressive Blue Dog Coalition, then left the party to become a Republican, fought for pharmacy industry interests while in office, and finally began working on PhRMA's payroll literally the same day he left Congress. PhRMA (pronounced "Pharma") has never in its existence made a concession without something being in it for them. Most (though not all) of the groups participating in this initiative historically have opposed health care reform, and most are large donors to the Republican and Vichy Dem politicians who are preparing to mount a political and rhetorical battle against health care reform, as evidenced most recently by the leak of Republican pollster Frank Luntz's crassly cynical talking points memo (teaching opponents of healthcare reform how to "spin" Obama's plan so it sounds like Mandatory Gay Nazi Communism).
The biggest concern most members of this "patriotic" coalition have about Obama's reform plans is his intention to include a "public plan" -- i.e., a Medicare-style, government-run health plan that anyone could subscribe to, just like they can subscribe to Blue Cross, Kaiser or any other private insurance. That government-backed option terrifies the for-profit healthcare industry, because they know they can't compete with it. Medicare, for all its faults, still has the lowest administrative costs than any other health provider in the country; it has no need to deliver profits to shareholders, its executives are paid far less than their counterparts in the private sector, and it delivers competent care to millions of Americans who otherwise would go uninsured. Not only is a Medicare-style public health plan a competitive threat to the for-profits, but it's a political threat as well: for-profit providers know that if millions of Americans sign up for federally-run, nonprofit healthcare and see that it actually works -- that their fears of rationed care and needless deaths aren't borne out -- then the inertia towards single-payer healthcare for everyone may become an unstoppable juggernaut.
For that reason, it's hard to believe that a coalition including PhRMA, Kaiser, the nation's largest hospital coalitions, and other for-profit providers aren't angling, at a minimum, to curry enough favor with the Administration that Obama feels obligated to drop the public plan option -- just as he "compromised" on aspects of FISA, healthcare components in the stimulus package, and other controversially progressive aspects of his original platform. But the senior Administration officials speaking to reporters on Sunday seemed genuinely nonplussed that anyone would think such a quid pro quo might be under, if not on top of, the negotiating table.
The last question of the conference call, happily, went to me. I wanted, first, to confirm that the grand announcement was merely about a reduction in cost increases, not a reduction in cost, and second, to know whether Obama, himself, still considered a public health care option to be beyond negotiation. I figured, if Obama is unstinting in his support of the public option, it doesn't matter what the trade groups think they're buying with this concession, right?
I didn't like the answers I got, though. The first told me that the Administration is getting too excited about too little; a reduction in the rate of growth is less relief than American families and employers need, and the second fell short of the adamant reassurance I wanted to hear. But decide for yourself:Bellows: "I have two questions. The first is following up on Michael Fletcher's and Eliza Marcus' questions: is the President still insistent that a public health plan will be among the options offered to people, or is that a bargaining chip in any way? And the second question, following up on Andrew Beatty's: is it correct that the cost per capita will still increase, just not as much as it previously was projected to?"
Senior Administration Official #1: "On the second question, the answer to that is yes. Again, what we're talking about here is reducing the growth rate, so yes, health care costs, you should anticipate health care costs will continue to rise, but achieving a slowdown in the rate at which they increase is a, would be a huge accomplishment in terms of freeing up resources for other priorities and in terms of relieving pressure on the federal budget."
The official continued with a justification for accepting continued healthcare cost increases:"One of the reasons that you should expect health care costs to continue to increase is not only that the population is aging, which puts some upward pressure on health spending, but also that as incomes rise over time, it is natural that people want to spend part of their additional income on health care...."
On whether the public plan is non-negotiable:Bellows: "The second question?"
Senior Administration Official #2: "On the public plan, this event with the President tomorrow [Monday] is not about the public plan, we've had no discussion with this group about he public plan, in fact, if I look at the list of trade associations that are part of this, there are different views about it, but the President likes the public plan, it's part of his campaign plan [sic: platform?]."
My beef? Simply that liking a plan is weaker than labelling it non-negotiable. The lack of adamancy troubles me.
One of the Obama administration's mantras is "don't let the perfect become the enemy of the good." But in these times, with Obama's still-strong mandate for change and the American people's rare but undeniable hunger for reform, their motto ought to be: "Don't let the good be the enemy of the perfect."
Radical health care reform -- reform that doesn't shave health care costs for regular people and their employers, but slashes them; reform that doesn't force single-payer healthcare on the American people, but demonstrates that it can work well and therefore sets the stage for their eventual acceptance of it -- is within Obama's grasp. He'd be wrong to settle for merely "good" health care -- for health care that merely slows the rate at which costs increase, or health care that doesn't include a government-payer option to demonstrate that a government-sponsored plan can provide better care at lower cost than profit-driven private plans. He would, to paraphrase Chief of Staff Rahm Emanuel, be wasting a crisis.
Anyone paying attention to the economic policies of industrially successful nations knows that single-payer, low-cost healthcare is key to America's future. By taking for-profit corporate lobbyists like Billy Tauzin at their word, by considering their unenforceable promise of future good behavior as if it were a tangible present good, is Obama setting himself up to deviate from the clear path to that future? Obama has, within his grasp, that once-in-a-lifetime rarity: a plan that is both nearly perfect, AND achievable. Will he give in when the for-profit healthcare industry, inevitably, asks that the public option be watered down or taken off the table altogether -- or will the president keep his word to the American people -- people who have put their trust in his commitment to collaborate, but not to compromise?