Letters to the editor of the New York Times

The New York Times
September 25, 2007

Health Coverage in the Balance

To the Editor:

Re “The Battle Over Health Care” (editorial, Sept. 23):

As long as we continue to build on our current fragmented system of financing health care through a multitude of private plans and public programs, we will never get a handle on rising health care costs.

The administrative efficiencies of a single national health insurance program would free up enough funds to pay for care for the uninsured and under-insured. But reducing administrative waste alone is not enough.

With our own national health program we could improve incentives that would reinforce our rapidly deteriorating primary care infrastructure. Providing everyone with access to a primary care medical home has been demonstrated to slow cost increases while improving quality.

Appropriate specialized high-tech services certainly provide value, but such care very often is overused, resulting in no benefit while driving up costs. A trusted primary care practitioner can provide each of us with advice on those services that actually would be of benefit.

Don McCanne, M.D.
Senior Health Policy Fellow
Physicians for a National Health Program
San Juan Capistrano, Calif.
Sept. 23, 2007

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To the Editor:

It is amazing how the presidential candidates are determined to come up with health insurance programs that are invariably complicated, often tied to employers, and frequently based on taxation gimmicks. They seem to ignore the one insurance program that is overwhelmingly popular and already has infrastructure in place: Medicare.

It is a highly efficient program that confounds all the critics of government-run health care. There are no restrictions on choosing doctors, the medical providers do not work for the government, and the processing of insurance claims is virtually transparent to the consumer.

In fact, from a consumer standpoint, Medicare is the best health insurance program ever invented.

The easiest solution to the problem of health care coverage, without resorting to one of the half-baked schemes offered by the candidates, is to simply offer Medicare coverage to anyone who wants it.

Of course, indigent people would be given a break on premiums. Employers could still offer insurance coverage if they wish, as a way of attracting employees. And if an individual does not like Medicare coverage he can still go to the private market.

As for states enacting their own insurance plans, sure, go to it. But let’s also offer consumers another choice: voluntary Medicare. Then, the consumers themselves, not the politicians, can decide whether they want public or private health insurance.

Ron Sheppe
Rochester, N.H., Sept. 23, 2007

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To the Editor:

Thank you for your excellent editorial focusing on the heath care “debate.” There is another major factor in the debate, however, that was largely absent from your editorial. Specifically, your discussion only briefly touched on excessive insurance company costs and profits.

You commented on the fact that all of the Democratic candidates are looking at a system of universal coverage provided by private insurance companies and government programs. While that is likely our current political reality, it does not negate the need to look far more closely at insurance companies.

The fact is that private insurance companies spend far more on administrative costs than their government counterparts. Further, the amount of profit that the insurance companies retain is often excessive. If the United States is going to provide care to an additional 47 million people, we cannot afford inefficient administrative systems and the payment of outrageous profits to insurance companies.

Ellen Schiff
Los Angeles, Sept. 23, 2007

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To the Editor:

Your editorial about the extremely important issue of health care for Americans makes a significant contribution to the debate on how best to improve on the problem.

While I take no exception to your favoring the Democrats on this issue (I am a Republican), I must state my disappointment at your failure to mention the impact of ever-expanding litigation on the surging cost associated with health care.

The proliferating number of lawsuits causes not only an unaffordable cost of malpractice insurance (which patients end up paying for and drives many doctors into earlier retirement, with the consequential loss of much needed experience), but results in unnecessary and very costly over-prescribing.

Enrique Sosa
Key Biscayne, Fla., Sept. 23, 2007

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To the Editor:

The Democratic candidates for president all have similar proposals, which are steps in the right direction, but as your editorial points out, they lack measures for cutting costs. The most effective way to cut costs is to adopt a single-payer system, which is now available as Medicare, and would cut administration costs in half.

Since that seems to be beyond the pale, it is doubtful that any realistic cost savings will occur. It is apparent that a reassessment and redefinition of hospital goals and practices is in order.

Hospitals should be cooperative institutions rather than competitive institutions. As long as hospitals are profit-seeking and competitive, all will need to be full-service hospitals, maintain significant advertising and public relations budgets, and continue the plethora of building and expansion programs. Like all profit-seeking corporations, they can’t afford to appear as second best.

Hospitals are not the only problem area. Medical schools, insurance companies, pharmaceutical corporations and physicians all contribute to the high cost of health care. As long as we continue the myth of health care as market-driven and profit-oriented, the costs will continue to increase. The Democrats should have enough backbone to do the right thing and endorse what we all know is best: a single-payer system.

Harry E. Berndt
Webster Groves, Mo., Sept. 23, 2007

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To the Editor:

Your attempt to address “The Battle Over Health Care” is admirable, but your conclusions under the heading of “What’s Missing” are as timid as those of the political candidates. If we value the health of our citizens, then just as we provide basic fire protection and police protection, we should also provide basic medical protection.

We cannot morally countenance winners and losers in the free-market sense in health care, just as we cannot in security and fire protection. It’s time to drop the ridiculous phobia of the “single payer” system and set about designing the most efficient government-run program we can, caring for the greatest number of people without driving up costs artificially for third parties like insurance industries.

Pam Dassenko
San Luis Obispo, Calif.

Sept. 23, 2007
The writer is a dentist.

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To the Editor:

Paul Krugman’s mention of the scare tactics of health care reform opponents should have included the demonization of universal health care by the news media among his fears (“Health Care Hopes,” column, Sept. 21).

Despite polls suggesting a high popularity for such a system, the news media regurgitate myths and fail to explain the proposals of the health care debate. Single-payer health care is frequently described as “government run” or “socialized medicine,” even though the Canadian, French and German systems involve private doctors, hospitals and other caregivers who merely get paid by the government. Even Senator Hillary Rodham Clinton’s tempered proposal that would involve a private-government partnership did not escape inaccurate accusations.

Until the mainstream media stop distorting reality on behalf of the industry, health care reform will remain at the fringe of political viability, and it will be dead on arrival for the foreseeable future.

Spyros Andreopoulos
Stanford, Calif., Sept. 21, 2007
The writer is director emeritus, Office of Communication and Public Affairs, Stanford University Medical Center.

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To the Editor:

Could a Democratic candidate’s determination to deliver on his or her health care promise to voters be undermined by large contributions from companies in the insurance and pharmaceutical industries? And why does it take so much political courage to give the American people what they want? Is there a correlation here?

Barbara H. Peters
Richmond, Va., Sept. 21, 2007

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Woolhandler and Himmelstein in the Boston Globe

Health Reform Failure
By Steffie Woolhandler and David U. Himmelstein
Boston Globe
September 17, 2007

In 1966 - just before Medicare and Medicaid were launched - 47 million Americans were uninsured. By 1975, the United States had reached an all time low of 21 million without coverage. Now, according to the Census Bureau's latest figures, we're back where we started, with 47 million uninsured in 2006 - up 2.2 million since 2005. But this time, most of the uninsured are neither poor nor elderly.

The middle class is being priced out of healthcare. Virtually all of this year's increase was among families with incomes above $50,000; in fact, two-thirds of the newly uncovered were in the above-$75,000 group. And full-time workers accounted for 56 percent of the increase, with their children making up much of the rest.

The new Census numbers are particularly disheartening for anyone hoping for a Massachusetts miracle. In the Commonwealth, 651,000 residents are uninsured, 65 percent more than the figure used by state leaders in planning for health reform. Their numbers came from a telephone survey done in English and Spanish. But that misses people who lack a land-line phone - 43.9 percent of phoneless adults are uninsured, according to other studies.

It also skips over the 523,000 non-English speakers in Massachusetts whose native language isn't Spanish (e.g. Portuguese, Chinese, or Haitian-Creole), another group with a high uninsurance rate. In contrast, the Census Bureau goes door-to-door for its survey and has translators for almost every language. It gets a more complete picture.

In sum, Massachusetts health reform planners have been wishing away a quarter of a million uninsured people. Recent Patrick administration claims that health reform is succeeding are based on cooked books. According to the state's figures, almost half of the previously uninsured gained coverage under the health reform bill by July 1. But according to the Census Bureau, the new sign-ups amount to less than one-quarter of the uninsured. Moreover, it's likely that much of that gain has already been wiped out by shrinking job-based coverage - a longstanding and nationwide trend.

Why has progress been so meager? Because most of the promised new coverage is of the "buy it yourself" variety, with scant help offered to the struggling middle class. According to the Census Bureau, only 28 percent of Massachusetts uninsured have incomes low enough to qualify for free coverage. Thirty-four percent more can get partial subsidies - but the premiums and co-payments remain a barrier for many in this near-poor group.

And 244,000 of Massachusetts uninsured get zero assistance - just a stiff fine if they don't buy coverage. A couple in their late 50s faces a minimum premium of $8,638 annually, for a policy with no drug coverage at all and a $2,000 deductible per person before insurance even kicks in. Such skimpy yet costly coverage is, in many cases, worse than no coverage at all. Illness will still bring crippling medical bills - but the $8,638 annual premium will empty their bank accounts even before the bills start arriving. Little wonder that barely 2 percent of those required to buy such coverage have thus far signed up.

While the middle class sinks, the health reform law has buoyed our state's wealthiest health institutions. Hospitals like Massachusetts General are reporting record profits and enjoying rate increases tucked into the reform package. Blue Cross and other insurers that lobbied hard for the law stand to gain billions from the reform, which shrinks their contribution to the state's free care pool and will force hundreds of thousands to purchase their defective products. Meanwhile, new rules for the free care pool will drastically cut funding for the hundreds of thousands who remain uninsured, and for the safety-net hospitals and clinics that care for them. (Disclosure - we've practiced for the past 25 years at a public hospital that is currently undergoing massive budget cuts.)

Health reform built on private insurance isn't working and can't work; it costs too much and delivers too little. At present, bureaucracy consumes 31 percent of each healthcare dollar. The Connector - the new state agency created to broker coverage under the reform law - is adding another 4.5 percent to the already sky-high overhead charged by private insurers. Administrative costs at Blue Cross are nearly five times higher than Medicare's and 11 times those in Canada's single payer system. Single payer reform could save $7.7 billion annually on paperwork and insurance profits in Massachusetts, enough to cover all of the uninsured and to upgrade coverage for the rest of us.

Of course, single payer reform is anathema to the health insurance industry. But breaking their stranglehold on our health system and our politicians is the only way for health reform to get beyond square one.

Dr. Steffie Woolhandler and Dr. David Himmelstein co-founded Physicians for a National Health Program and are primary care doctors at Cambridge Hospital.

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Testimony in Glens Falls (part 2): Matt Funicello

NYS Department of Health
Public Health Care Forum
Glens Falls Civic Center
Sept. 5th, 2007

Remarks of Matt Funiciello
Small Business Owner
Rock Hill Bakehouse
Moreau, NY

Greetings, everyone. My name is Matt Funiciello and I am here today on behalf of New York's small business owners and workers. For those who are not already aware, I own and run Rock Hill Bakehouse, a small wholesale bread bakery in Moreau, N.Y. We have about 40 employees.

The Empire State's website steers new business owners to some answers about health coverage for their workers. It recommends looking at programs such as Child Health Plus and Healthy New York. It says to consult with the NFIB, The Business Council of New York State, The Retail Council of New York State and the NYS Chamber of Commerce. With all due respect, these entities do not represent me, nor do they represent the majority of small business in New York State. Neither is it their responsibility to provide or suggest health care, affordable or otherwise, for small business employers and workers. I believe this is the duty of the federal government. This, of course, means that the burden of responsibility actually falls to our state government. So, here we are today to talk to our state. Lets hope that its listening.

Like most small business owners, I want the best for my employees. I want to do well, myself, but I also want them to do well. As any intelligent person will tell you, these desires are, by no means, mutually exclusive. People will often tell me that I am an exception in that regard. I strongly and absolutely disagree. Most small businesspeople I know care very deeply about their workers. We are just frustrated and embattled. Taxes, fees, inspections, forms, penalties, loans, regulations, certifications, paperwork. All of this has to be dealt with on top of running one's business. We are tasked with finding a way to pay fair wages and with providing health care coverage for our employees. This is simply not possible under the current system.

Ironically, we are also tasked with paying for the state-run health plans that many small business workers simply aren't poor enough to join! So, we can't afford exorbitantly priced HMO coverage but our government is more than happy to demand that we pay for the health care plans they've set up to help the working poor. These plans are primarily for those stuck working at fast food franchises and big box retailers where workers are paid very little for their labor.

Let me make something absolutely clear. My complaint is never about being asked to help those who need help. My complaint is that it is no accident that a big box worker is paid so little that they qualify for food stamps and state-subsidized health care. It is by design. And because of that design, I and many other small business taxpayers are footing the bill for the underpaid workers of some of the most profitable corporations around while our own workers can't afford coverage.

This knowledge of the “upside down pyramid” leaves many small business people feeling embittered, especially knowing that the answers are right in front of our faces. Our elected officials simply have to muster up enough political backbone to do what is right.

When it comes to health care there are three basic roads a small business can currently take. The first, we'll call the “Tough Love Road”. We simply tell our workers the truth. No one in this country (with the noted exception of some elected officials) is able to afford reasonable and effective health benefits, so why should we be any different? Get your own health insurance. We can't afford to help you out. Sink or swim. Dog eat dog. We'll help you wade through paperwork and we'll garnish your check as required by law but ... thats it, man! Sorry. This, sadly, is the road chosen by many small businesses.

The second road is called the “Big Box Road”. This involves emulating the corporate strategy of paying your workers just the right amount so that they are classified as working poor and are therefore eligible for food stamps and state-run health care.
So, Road #1 is Tough Love. No one can afford health care. You're on your own. Road #2 is the Big Box Road. Pay your workers little enough that they are eligible for taxpayer funded benefits.

Lets just say for a moment, that plans 1 & 2 just don't work for me. Lets say I'm just not mean enough to deny my workers benefits I know they desperately need. Lets say that I suffer from the twin maladies of dignity and conscience which prevent me from behaving like corporate America, crying poor while passing the hat around to pay for my own workers' benefits. What do I do? What is Road #3 for me?

Well, Road #3 for me is to bite the bullet and offer up the services of our friendly neighborhood HMO. The result? Most of our employees choose not to donate their hard-earned resource to the health care industry at all because luxuries like transportation, housing and shelter keep getting in the way. While there is certainly some money left at the end of each pay period, it is certainly not enough to fund a family's health care needs. Many of my employees who elect to take coverage have to wonder if paying far too much for far too little is really all that much better than living without the coverage in the first place.

The average annual cost for bad HMO coverage for the family of one of my workers is $10,685.16. When you figure in the co-pays, the prescriptions, medical billing firms' obvious policy of double-billing and the HMOs' regular refusal to pay for services rendered, we might just as well round it up to an even $12,000 a year. Thats $1,000 a month or $230 dollars every single week. Thats what it actually amounts to. Now, $230 dollars a week for someone who works as a skilled laborer in the food business is simply not “affordable” coverage.

When one of my workers asks me about health insurance for them or their family, I have been known to cringe because I know that what they are really asking me, in effect, is to find a way to come up with that extra $12,000 dollars. With 40 employees, many of whom have families, full coverage for all of my employees would cost us in the hundreds of thousands, annually! In case there was any question in anyone's mind about whether or not a small business can afford to absorb that coast, the answer is NO, we just don't have that kind of money “kicking around”.

How dare our government put small business in the middle of this nightmare? I suspect its largely because our elected officials depend on corporate campaign donations, many of which come from HMO's and pharmaceutical companies. I imagine those would likely stop if these officials showed some real backbone and threatened to level the health care playing field. I also think that elected officials have trouble seeing the problem for what it is when they have such great health care themselves. I don't think that any elected official in this country should have state-funded health benefits until everyone else living here has them first. Leaving small business to take on this Herculean problem is not the right answer. Its cowardly and unfair and we all know it.

I spent about 15 years living in Canada and I still have relatives who live there. While a landed immigrant in Canada, I was covered by OHIP, the Ontario Health Insurance Plan. Simply put, everyone in Canada is paying for their health care when they pay their taxes and as a result every single Canadian has free health care. There are no co-pays or denials, no paperwork to fill out when you visit the doctor. “How can this be?” my fellow Americans ask me. “How is this even possible? Gosh, those poor Canadians must be taxed to death.”

We need to be honest. Canadians are not taxed to death. In fact, according to Dr. Stef Woolhandler, of the Harvard Medical School, Americans are paying 83% more for their health care than Canadians do. 83%!! Also, I can't speak for all Canadians but the ones I know pay comparable income taxes to what we pay. Unlike us, they aren't saddled with crippling $230 a week premiums in order to protect their families, either!

“Well, what about denial of care? We've heard that Canadians have to wait for years to get an operation.” That is just more propaganda designed to make us think that their system is flawed. If you really want to know the truth, just ask any Canadian if they are willing to switch Health Care systems with you. When you find one who is, let me know. I've got a bridge for sale ...

I will admit that a friend of mine did break his foot in about 6 different places in a dirtbike accident once and when he got to the hospital, they put him in a cast and sent him out to walk with crutches on his badly broken foot without pins or an operation. Three months later, doctors at a more competent facility operated to fuse his broken bones allwoing him to walk again but poorly. He is a plumber and he works with his son. It is not a small thing that he can't walk properly. It is his livelihood their incompetence has threatened.

I also know someone whose daughter needed to be shipped from one hospital to another with a kidney problem. Her HMO authorized it verbally and then later refused to pay it. The family was alter billed $1800 dollars by the ambulance service.
I know a women who was in a car accident and had multiple hairline fractures in both legs. They told her she was fine based on her x-rays, refused to keep her overnight and gave her pain meds to bring home. They told her that she just needed to walk around as much as possible to help the healing.

These three things all happened in New York State, not in Canada. Does that surprise anyone here?

My mother lives in Canada. She received a Cochlear Implant several months ago, a procedure which costs about $65,000, at 65 years of age. There was no charge at all, no co-pay and free therapy without a scrap of paperwork filled out. Meanwhile in NY, a friend just told me yesterday of her grandfather's plight. He was refused a Cochlear implant because his health coverage stated that it was “an unnecessary procedure unlikely to improve his quality of life.” Why didn't he get to make that decision for himself as my mother did?

I have never heard of or seen anyone ever being denied care in a Canadian hospital. Ever. These are outright lies being told so that we will feel that our own problem here is hopeless. It really is not hopeless at all ... unless we think that some giant conscienceless corporations bent on subjugating the entire human race have taken over our country and are running our health care system ... Well, maybe we better move along.

I know firsthand that the level of service provided in Canadian hospitals and medical facilities is just fine. In process of fact, I think its better than ours. It's a fact that Canadians live longer than we do. Why then do we believe the propaganda handed to us by the corporate media and the corporate health care system? If there are no crippling taxes and its cheaper in cost and there are no ridiculous denials and long waits for service .... why didn't we know about a system like this earlier? Why don't we already have this kind of health care?

Simply put, its because we are regularly misled by the media and by so-called industry experts who have an axe to grind selling us lies about the Canadian system and other systems like it. This disinformation campaign has been used to justify the insane waste and needless profit inherent to our own system.

I know that we Americans are loathe to admit that anyone can do something better than we can. Well, let me say it right here, Canadians (and according to the World Health Organization, at least 36 other industrialized nations) are kicking our butts at health care and they've all done it by removing profit and waste from the equation. They have recognized that the waste, fraud and excess inherent to our health care industry is immoral. They feel sorry for us.

Lets talk about what IS possible and how we can move forward. We all know the federal government is never going to change anything as long as there is no catalyst to foment that change, SO, New York State can, and must, be that catalyst when it comes to health care. Governor Spitzer has promised us a new day with justice and liberty for all and what better way to prove that he means it than to resolve the biggest problem we have as citizens of the state?

I come here today with a simple answer. Providing health care for everyone does not require any special fiscal tools or slights of hand. It only requires the strength of will and the good sense to know that providing health care for everyone is essential in a civilized nation. Attaining this goal will only require that our elected officials actually represent the PEOPLE'S will instead of the will of their corporate campaign donors.

Some great basic groundwork for funding has already been provided by the PNHP (Physicians for a National Health Plan). These people have spelled out the nuts and bolts of current waste and excess and have suggested how we might re-channel our resource to fully fund a single-payer health care system in our state and in our country. We simply need to implement their proposals. It is truly that simple, regardless of what the naysayers and the self-interested may predict. It will work. I've personally seen it work.

PNHP's Single-Payer system funds health care by using what is already being misused. Their proposal takes what is already being spent on health care and simply reapportions it so that everyone is covered. To understand this, one needs to know that we are currently spending $2 TRILLION dollars a year on health care and we have 45 million uninsured. Thats $6,600 per person and that's about 2-3 times what any of the 36 nations who have real health care are spending per capita and these systems all insure EVERYONE inside their borders. We are ALREADY spending far more than enough to cover everyone - It just doesn't make any sense that so many are uncovered or are covered so poorly!

If we followed the Canadian example, they spend about half of what we do and live several years longer than we do, where would be the harm? Talk about win/win! Why not emulate a system that's been working so well for over 35 years?

In closing, I would ask that as we craft answers to this problem, lets leave special interests and their profit motive at the door. They should have had no place in this discussion all along. Instead, theirs are the only voices anyone has been listening to. They should be unwelcome in any serious discussion on health care reform. They are the ones who brought us to where we are today. Thank you.

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Testimony in Glens Falls (part 1): Paul Winkeller

NYS Department of Health
Public Health Care Forum
Glens Falls Civic Center
Sept. 5th, 2007

My name is Paul Winkeller and I am the Executive Director of the Capital District chapter of Physicians For A National Health Program. PNHP is a national non-profit organization that for twenty years has been an advocate for a single payer “Medicare For All” type health care delivery system for the United States. Nationally, PNHP represents more than 14,000 physicians and allied health care professionals. Our membership in New York State exceeds one thousand, nearly all physicians.

While a national solution to the health care system is obviously preferable than fifty separate approaches, because our PNHP chapter is located in the State Capitol, our membership has a keen interest in statewide as well as national solutions. We are thrilled by the opportunity to testify at this public hearing and congratulate the Spitzer Administration for beginning an open and collaborative process in solving the challenge of providing every New Yorker with decent, affordable and comprehensive health care.

It should be noted that PNHP members and PNHP chapters throughout this country are actively involved in this same process – many other states, such as California, Georgia and Illinois, are similarly engaged in examining and debating options for achieving universal access to health care. In the case of California, both houses of the state legislature passed a single payer bill, which was unfortunately, but predicable politically, terminated by Governor Schwarzenegger.

As I am sure you will hear others tell you today – with more eloquence, in more detail and backed by an enormous amount of data - a single payer system would align us with all of America’s major western industrialized rivals, whose own single payer systems, in varying forms and each one tailored to their country’s unique political, economic and social exigencies, have largely stripped out, or tightly regulated, the for-profit dimension in the delivery of health care that is so dominant in our own state and country. Because our competitors in the global marketplace are able to provide all their citizens with decent, affordable and comprehensive health care at a much smaller per capita cost, these countries, especially in select industries such as the manufacture of automobiles, are winning the global game for market dominance.

Even more telling, and on a much more individual level, these same countries with their less expensive and far more comprehensive health care delivery systems, are winning the battle in objective, data driven outcomes that define what it means to be healthy – longevity, obesity, and rates of heart disease, certain cancers, diabetes and many other devastating, life threatening and life shortening afflictions.

Certainly, we have great health care in America, that is accompanied by cutting edge technology and advanced research – and yes, anecdotally, we hear plenty of stories about very ill and usually very wealthy foreigners coming to elite clinics around our country for treatment. However, it is important to keep one’s eyes on the data - PNHP is a very data driven and evidence based organization for the real story. The American health care system is expensive and wasteful in terms of administrative costs, by the latest count excludes more than 47 million Americans, and as anyone in this room who has battled with their HMO can attest, the day to day reality of receiving treatment, getting treatment approved or receiving reimbursement for treatment already paid for out of pocket, is maddening, frustrating and ultimately quite sad and unnerving. Please visit www.pnhp.org for all sorts of data and links to other important public health oriented web sites.

There is a reason why Michael Moore titled his most recent movie SICKO. The so-called system in our state and country is, well, nuts. By the way, I hope everyone in this room makes time to see Michael Moore’s film – even if it is a bit heavy handed in places the best description of the movie I have heard, from PNHP's great allies at the California Nurses Association, is that it is the G rated version of an X rated story. Upon release of the SICKO DVD later this fall, our PNHP chapter, and PNHP chapters across the country, are planning house parties and other public showings. If you want an invite, please send me an email: pnhpcapitaldistrict@nycap.rr.com

I would urge the policy makers and state employees engaged in this examination of universal health care coverage options to be very, very wary when the current dominant stakeholders in our systems – the for profit HMOs and Big Pharma – roll out their slick TV, radio and internet ad campaigns railing against Single Payer and Socialized Medicine. The systems in place in other countries are publicly financed, private delivery systems where there is more, not less choice, in terms of doctors and treatment. Health care in these countries is considered a right, not a commodity or profit center. We New Yorkers, with our history of innovative public policy and the need to care for our neediest citizens built right in to our State Constitution, need to really ask ourselves, throughout the process that begins today, a lot of hard, soul-searching questions about our fundamental values and priorities.

Focus on data and outcomes and beware the myth-making campaign(s) certain to come about phoney issues like waiting lines. Countries like Canada measure waiting lines, and like any well run business, the regional health care administrators in that country use that data to shorten the time it takes to receive treatment. We don’t measure waiting lines in our country. Instead, we practice a sort of chaos theory approach when it comes to getting service – in general, the better your private insurance and the more money you are willing to spend, the better and faster the care. No one in Canada is denied treatment for an emergency or life-threatening condition. And no one in this room can get a new hip, today, on demand.

Beware the elephant in the room analogy. About a year ago I was at meeting in NYC that included a former Albany official who is now a major player in health care reform in this state. The California Legislature had just passed single payer legislation and he observed that this development made single payer the “elephant in the room” – hard not to notice, impossible to argue with from a financial or administrative efficiency perspective but, well, you know, it's politically infeasible. Implicit in his statement is the idea that the HMOs, Big Pharma and the politicians whose campaigns these entrenched and selfish interests help fund just wouldn’t, couldn’t, allow such a dramatic, and simple, transformation of the system. That kind of cynicism is poisoning and paralyzing. If I had a dollar for every time I have heard the two words “politically infeasible” associated with the two words “Single Payer” I might just be able to get my own hip replaced – today!

Beware the argument that a transformation of our health care system to single payer would cost our state and national economy tens or hundreds of thousands of jobs. I come from an employment and training background, particularly as it involves disadvantaged young adults, and I can attest that our state and this country have a wonderful and well coordinated employment and training system. My wife is a physician who is Chair of a department at a major nearby academic medical center. Many of the finest nurses in her department have left to become HMO bureaucrats – these are fine people who chose the field of healing out of a deep desire to help and take care of sick people. How ironic that many, drawn by higher salaries and better benefits, are now care-denying, paper pushing drones within an HMO superstructure. It would not be hard to put these folks back on to their original career trajectory. Baby Boomers like many of us in the room are going to need their help – and the sooner the better!

The big question to many of us in Physicians For A National Health Program is whether a Governor who as a courageous Attorney General was known as the Sheriff of Wall Street can now be the Sheriff of HMOs and Big Pharma in New York State. By taking on businesses marked by stunning profits, rapacious payouts and golden parachutes, and horrifying administrative inefficiencies, can he and his staff figure out a better way of providing health care for every New Yorker. PNHP knows the way, and you have heard it from most of the people and organizations testifying at this hearing today – single payer.

Beware another clever disinformation campaign disguised as an engaging infomercial, of the variety we had more than a decade ago when a young Clinton Administration tried to have its own Listening Campaign about health care options. Those infomercials marked the rise of HMOs, who have given us out of control costs annually far exceeding the rate of inflation, concomitant with a decline in many health outcomes measured by any objective yardstick.

If and when you see something like these infomercials again – and this time they will be on TV, the radio AND the internet - it’ll be the beginning of another chapter in the horror movie known as the multi-payer U.S. health care system.

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