Physicians for a National Health Program Capital District (NY) Chapter

Student Rally in Vermont: A Huge Success!

2011-03-31T19:25:00.009-04:00

Great article to read in The New England Journal of Medicine

2011-03-23T21:56:00.006-04:00

State-Based, Single Payer Health Care - A Solution for the United States?

William C. Hsiao, Ph.D.
Department of Health Policy and Management
Harvard School of Public Health, Boston MA

Read the article

Disclosure forms provided by the author are available with the full text of this article at NEJM.org.
This article was published on March 16, 2011, at NEJM.org.

H.R. 676 is Re-Introduced! See the Press Release from PNHP

2011-02-20T00:10:00.005-05:00

FOR IMMEDIATE RELEASE
February 15, 2011
Contact:
Garrett Adams, M.D., president, Physicians for a National Health Program
Margaret Flowers, M.D., congressional fellow
Quentin Young, M.D., national coordinator, (312) 782-6006
Mark Almberg, communications director, (312) 782-6006, mark@pnhp.org

Doctors’ group hails reintroduction of Medicare-for-all bill

Single-payer health program would cover all 51 million uninsured, upgrade everyone’s benefits and save $400 billion annually on bureaucracy, physicians say

A nationwide physicians’ group today hailed the reintroduction of a popular federal bill that would quickly upgrade the Medicare program and expand it to cover the entire population.

The “Expanded and Improved Medicare for All Act,” H.R. 676, sponsored by Rep. John Conyers Jr., D-Mich., would replace today’s private health insurers – and the Obama law’s individual mandate, which is being challenged as unconstitutional – with a single, streamlined public agency that would pay all medical claims, much like Medicare works for seniors today. (See bill summary here.)

“There’s no doubt that expanding Medicare to all is both constitutional and the most cost-effective way to cover everyone,” said Dr. Garrett Adams, president of Physicians for a National Health Program. “A national single-payer program would save over $400 billion a year on bureaucracy and paperwork alone. Plus, it would use proven, effective cost-control techniques like negotiating drug prices and hospital budgets.”

“An improved Medicare-for-all program would provide comprehensive coverage to all of the 51 million people who are currently uninsured and enhance the coverage that everyone else has, by eliminating co-pays and deductibles,” Adams said. “It would go far beyond the new health law, which would still leave 23 million people uninsured in 2019.”

“In these difficult economic times, with lack of health coverage leading to thousands of deaths and personal bankruptcies each year, and states struggling to pay the high costs of Medicaid and health coverage for state workers and retirees, everyone’s taking another look at single payer,” he said. “Legislation that could lead to a single-payer plan was just introduced last week in Vermont, led by a push from the governor and a report by Harvard economist William Hsiao that single payer would cover everyone and save the state $490 million in 2015 and at about four times that much by 2024.”

“Surveys have repeatedly shown that about two-thirds of the public supports a Medicare-for-all approach,” Adams said. “And a recent survey of physicians shows that a solid majority now favor government legislation to create national health insurance.”

“As the founder of a free medical clinic in rural Tennessee, I can assure you that the need for fundamental health care reform has never been greater,” he said. “It’s time to stop putting the interests of private insurance companies over patient needs and adopt a single-payer national health program in the U.S.”

Source: pnhpcalifornia.org

Kucinich Kicks off Health Care Debate with Renewed Call for Single-Payer

2011-01-18T20:36:00.006-05:00

WASHINGTON - January 18 - Speaking today on the House floor, Congressman Dennis Kucinich (D-OH) opposed efforts to repeal health care reform and also renewed his call for a single-payer health care system.

“Everyone knows that health insurance companies make money by NOT providing health care. After all they are in the insurance business. They are not charities.

“With as many as 129 million Americans suffering from pre-existing conditions, insurance companies want Congress to repeal health care reform. The provisions which require covering people with pre-existing conditions would eventually cut into insurance company profits.

“Repeal means Americans will continue to pay more for insurance but get less, that is, if they can afford health care insurance in the first place.

“The very idea of health care reform solely within the context of a for-profit system has been more than problematic. Today, 50 million Americans have no health insurance. What are we going to do for them?

“Rather than waste time on debating how much reform insurance companies will permit - - if any - - it is time to change the debate. It is time to end the for-profit health care model. It is time for not-for-profit health care, single-payer, universal, Medicare for All - - with an emphasis on wellness and personal responsibility. More about that tomorrow.”

Kucinich was a co-author of Medicare For All, H.R. 676, in the 111th Congress. The bill is expected to be reintroduced in the 112th Congress as well.

Source: Common Dreams

The Annual Drama of the ‘Doc Fix’

2011-01-03T23:19:00.007-05:00

By Uwe E. Reinhardt

“Medicare fees to be cut by 25% in 2011,” was the alarming headline in Internal Medicine News on Nov. 3. “Unless Congress acts,” the story continued.

After much suspense and breathless media reports, Congress did act.

So on Wednesday, just in the nick of time, President Obama signed into law a delay of one year for such a disastrous cut. Once again, near disaster had been averted in a recurring drama that reminds one of nothing so much as Kabuki theater.

After all, we had been near the brink many times before, several times in 2010 alone, and each time Congress shrank back from the abyss. By now, the movement is predictable.

But who, then, are the misanthropes who so frighten the daylights out of our senior citizens and the physicians who treat them — or may not?

It turns out not to be a human being at all!

Instead, it is just an innocent formula that Congress imposed on itself as part of the Balanced Budget Act of 1997.

The formula is widely known as the S.G.R., which stands for sustainable growth rate. It replaced what previously had been known as the volume performance standard, enacted as a companion to the Medicare fee schedule introduced as part of the Omnibus Budget Reconciliation Act of 1989.

As might be expected, the precise workings of the S.G.R. formula are daunting and would probably bore most readers; but those interested in the topic can find details online.
In a nutshell, the formula was intended to keep the overall growth of Medicare spending on physician services and certain items incidental to those services (laboratory tests, imaging services and physician-administered drugs) in line with the nation’s ability to pay for that care — measured by the growth of gross domestic product per capita — after accommodating spending increases justified by the growth in the Medicare population, by changes in the law, and by the cost of operating the typical medical practice. These practice costs are tracked by the Medicare Economic Index, widely known as M.E.I.

In effect, the S.G.R. formula forces Medicare to establish in one year a global budget for Medicare spending on physician services in the following year. If that budget is exceeded by actual spending, then the annual update in Medicare’s physician fees in subsequent years — i.e., the increases in the conversion factor for the Medicare fee schedule described in my earlier posts — is to be reduced so that, over time, cumulative actual spending will come in line with the cumulative spending allowed by the S.G.R. construct, both as of April 1, 1996.

The chart below, from a Congressional Research Service analysis, shows how these cumulative spending numbers have behaved over time.

It is seen that in the early years after April 1, 1996, actual spending actually fell short of the budgeted spending allowed by the S.G.R. formula. Subsequent fee updates therefore exceeded the M.E.I. index (see the next chart below).

Since 2002, however, the trajectory of the two cumulative spending figures has reversed, which means that, in principle, the annual fee updates would be reduced and could be negative.

The next chart, taken from the same source, illustrates the relationship between the fee updates dictated by the S.G.R. formula, the actual fee updates passed into law by Congress year after year, and the M.E.I. index of medical-practice costs.

It will be noted that in 2002, Congress actually allowed the S.G.R. formula to dictate the fee update, which spelled a reduction in the conversion factor of 4.8 percent (compare the yellow and the blue bars for that year). It must have come as a shock to physicians. Note that the M.E.I. index for that year rose by 2.6 percent (the green bar).

Thereafter, however, Congress has year after year overridden its own S.G.R. formula with annual legislative “doc fixes,” as a comparison of the blue and yellow bars for these years shows. In common parlance, Congress has kicked the can of budget maintenance down the road year after year, in the process making a mockery of the entire S.G.R. construct.

Because under the S.G.R. construct the annual Medicare fee update (the change in the fee-schedule conversion factor) is to be adjusted not only for the prior year’s difference between actual and S.G.R.-allowed spending on physician services, but also for part of the cumulative differences in these spending figures as of April 1, 1996, the resulting update for calendar year 2011 should, in principle, have resulted in the previously mentioned 25 percent reduction in fees.

But once again common sense triumphed over an equation and Medicare fees will stay at the level to which they had been raised earlier in the fall.

And why this recurring drama over Medicare fees? The chart below provides a clue.

Source: Staff presentation at Dec. 2, 2010 meeting of Medicare Payment Advisory Commission

The lowest line in the first chart (in red) shows Medicare’s fee increases from 2000 to 2009. These updates look so miserly as to make a taxpayer blush.

After all, that line is so much lower than the green line, which represents growth in the M.E.I., the index that measures the annual increase in the cost of operating a medical practice. The American Medical Association believes that the annual fee updates should be based on that index rather than the S.G.R. formula (see “Definitions” in this presentation). At first glance, this recommendation has intuitive appeal.

Indeed, even if one assumed that the M.E.I. should be adjusted downward a bit because physicians should be able over time to increase the productivity with which practice inputs are used, basing fees on the productivity adjusted M.E.I. (the blue line) would still have raised Medicare’s physician fees substantially more than the actual fee increases.

Finally, however, the top line (in black) shows that, in spite of Medicare’s miserly fee updates, total Medicare spending on physician services per Medicare beneficiary actually has grown by fully 60 percent from 2000 to 2009, at an average annual compound rate of 5.4 percent.

That per-beneficiary spending increase looks anything but miserly. Thus, after blushing over miserly fee updates, taxpayers might go on to ask physicians why an average annual compound increase of 5.4 percent in spending per Medicare beneficiary was not enough to give the nation’s elderly good medical care and, if it was not enough, what would have been an adequate annual increase in Medicare spending on physician services — perhaps 7 percent, or 10 percent, of 15 percent, or how much?

Might not a nation breaking under the load of its rising government deficits and private health care spending want to know how much health spending would be enough in the eyes of its physicians?

The difference between the growth in Medicare fees and the growth in Medicare spending is, of course, the growth in the volume of services sold, so to speak, to Medicare. I shall have more to report on it in my next post.

Source: economix.blog.nytimes

Uwe E. Reinhardt is an economics professor at Princeton. He has some financial interests in the health care field.

SENATOR JOHN MARTY EXPLAINS THE MINNESOTA HEALTH PLAN

2010-12-18T00:03:00.008-05:00

This excellent video from Minnesota Senate video features a cogent explanation of the MHP - check it out!

About John Marty:

John has been a state senator for 23 years, and a strong advocate for government ethics, environmental protection, and health care reform.

The son of Dr. Martin Marty, a renowned author, minister and theologian, and his wife Elsa, John grew up in a home engaged in the civil rights and anti-poverty movements, where his parents taught him deeply rooted values, such as respecting the dignity of every human being, the value of working hard and playing fair, and the importance of taking responsibility to bring change when confronting injustice.

John attended St. Olaf College in Northfield and received a B.A. in Ethics in 1978. After college, he worked as a researcher and a foundation grant administrator. During this time, he met his wife Connie. They have raised two children, Elsa and Micah.

John won a major upset victory for state Senate in Roseville in 1986. He first became known statewide for his work in ethics and campaign finance reform. In 1993, he authored successful legislation to reduce the impact of special interest money on the political process. John was also the author of landmark legislation that prohibited lobbyists and interest groups from giving gifts to public officials. He has been a tireless voice for government reform and continues to press for legislation to end the influence of special interest money in politics.

John has been a strong advocate for public investments in education that enable children to reach their full potential. He has been a leading advocate for early childhood health and education and other initiatives to help children succeed. He co-chaired the Legislative Commission to End Poverty and works for legislation to ensure that all workers receive a living wage. Marty is the former chair of the Senate Environment Committee and has been an outspoken leader on environmental protection issues. He is a past recipient of the Sierra Club Environmentalist of the Year Award.

John currently chairs the Minnesota Senate Health, Housing and Family Security Committee. He is author of the Minnesota Health Plan, a bold Single-Payer Health Plan that would cover all Minnesotans for all their medical needs, including mental health and chemical dependency. He has been successful in gaining the support of one-third of the legislature as co-authors.

Source: Minnesota Health Plan and John Marty website

See PNHP Minnesota Chapter Resolution

Private Insurance Induced Stress Disorder (PIISD)

2010-12-01T00:29:00.003-05:00

by Russell Mokhiber

Pissed off?

Maybe it’s your insurance company.

A Maryland psychiatrist thinks it might be.

Writing in the current issue of Psychiatric Times, Dr. Carol Paris lays out the diagnostic criteria for something she calls Private Insurance Induced Stress Disorder (PIISD).
“Mental illness can sometimes be triggered by abnormalities of brain chemistry,” Dr. Paris said. “But in this case it’s triggered by outside forces – in particular, large corporations.”

Dr. Paris lays out four criteria for diagnosing PIISD.

Criteria A: The person has been exposed to a traumatic insurance-induced event in which both of the following have been present:

•The person has experienced a health insurance traumatic event, due either to lack of access to health insurance, or due to failure of their health insurance to meet their health care needs.
•The person’s traumatic response involved intense fear, helplessness, anger, and confusion and was caused by financial considerations that seriously complicate their (or their patient’s) medical treatment and recovery.

Criterion B: The traumatic event is persistently re-experienced in one (or more) of the following ways:

•Feelings of anger, frustration, and shame at the thought of one’s inability to access (or provide) needed care.
•Feelings of alienation from and abandonment by one’s countrymen and elected officials, precipitated by exposure to any form of corporate-controlled news media coverage of the health care crisis.
•Feelings of inadequacy, as an individual, as a family member, or as a physician/provider, due to the repeated inability to obtain needed care for oneself, one’s family member, or one’s patient.
•Avoidance of seeking, or providing, needed care due to fear of serious financial strain or even bankruptcy.
•Fear of an acute confusional state or other cognitive disorder following attempts to understand one’s EOBs (explanation of benefits).

Criterion C: Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness, as indicated by three or more of the following:

•Efforts to avoid thoughts, feelings or conversations about anything related to health insurance or healthcare.
•Efforts to avoid interactions with physicians, hospitals or health care centers that arouse recollection of the trauma. In the case of physicians, efforts to avoid patients who are experiencing health insurance trauma.
•Markedly diminished interest or participation in significant activities.
•Feelings of detachment or estrangement from others.
•Restricted range of affect (e.g., unable to experience feelings of wellbeing)
•Sense of foreshortened future (e.g. does not expect to have a career, marriage, children, or a normal life span). In the case of physicians, does not expect to remain in practice, anticipates early retirement or disability due to consequences of health insurance trauma.

Criterion D: Persistent symptoms of increased arousal, as indicated by two or more of the following:

•Difficulty falling or staying asleep, due to intrusive thoughts about the health insurance trauma.
•Irritability or outbursts of anger. In the case of physicians, this often results in sanctions, possible loss of hospital privileges, and being labeled a “disruptive physician.” In the case of patients, it often results in suspiciousness directed at one’s physician, often being labeled a “difficult patient.”
•Difficulty concentrating, resulting in functional impairment and further jeopardizing career, health, and sense of wellbeing.
•Hypervigilance, (e.g., won’t let children play on playground equipment for fear of minor injury resulting in possible retraumatizing need to interact with one’s health insurance company).

Criterion E: The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Dr. Paris warns in the article that “this diagnosis is not currently reimbursed by health insurance carriers.”

Published on Wednesday, November 23, 2010 by singlepayeraction.org

Russell Mokhiber is editor of the Washington, D.C.-based Corporate Crime Reporter. He is also founder of singlepayeraction.org.

The Culture of Excess

2010-05-21T00:12:00.003-04:00

How America Lost Self-Control and Why We Need to Redefine Success

By J.R. Slosar
Praeger/ABC-CLIO

From the Introduction

The first chapter provides a background of definition and symptoms of narcissism and its application to our culture and society. The complexity of the concept is presented from history, research, and application. Chapter 2 separates out the factors in the economic marketplace that contribute to cultural narcissism. Chapter 3 focuses on coping with the impact of the factors of cultural narcissism, and explores reality and loss, rigidity and self-destruction, and perfectionism and deception. The fourth chapter looks at our avoidance and anxiety of numbers, math or quantitative analysis, a cultural weakness that opens the door to faulty comparisons and poor decisions. A different perspective is offered in Chapter 5, as our health care system is offered as a primary example of how our society sanctions cultural narcissism and self-defeating behavior. Chapter 6 focuses upon changes in reality and hero images as representative of today’s cultural narcissism. An analysis of sports as a dramatic seeking of reality is discussed. Chapter 7 discusses identity theory and development with the focus on today’s youth and how they see and present themselves. Finally, the last chapter summarizes, integrates, and offers structural recommendations to help change directions and return to a more balanced and realistic appraisal of our economic system and our day-to-day lives and decisions.

From Chapter 5 – Health Care: Waste, Excess and Brokers

The dramatic insistence on free market principles and competition determines the way health care is delivered today. The entire process exemplifies the culture of excess and cultural narcissism. The excess comes from the tremendous waste of money and resources. This is coupled with the ability of brokers and corporate entities to overcharge and take out money at everyone else’s expense. These are the entitled “me” in the equation. The rest of us continue to pay more and more and even get less and less. Or, many just cannot afford health care at all. Facts and meaningful comparisons are dismissed and not considered by the fear of an alternative labeled as Socialism.

From Chapter 8 – Generation We

To address current trends, our culture must develop a new generation that will move toward a different concept and process of attaining success or “making it.” This new concept is based on connectedness with culture and has a broader perspective of inclusiveness. It also involves having less sense of entitlement, more realistic expectations, and more willingness to regulate one’s own behavior and the marketplace we live in. These are the components need to develop a Generation of We. To effect these changes will mean challenging basic economic assumptions and the elevated status of established economic theories and principles. In turn, we must challenge our current definition of success. The transition from a “me” society to a “we” society can be framed as the classic dichotomy of individualism versus collectivism. But it is a larger and more complex issue than that.

The literature in social psychology is extensive in arguing about the issue of what comes first in order to change. Is it necessary to change behavior first, for change to occur – or is it necessary to change attitude before behavior change can occur? The dichotomy of behavior versus attitude for individuals to change is also applicable to our culture. Changes in individual behavior will principally follow changes dictated by policy. Our mass consumption society will only redirect when forced to. Narcissistic entitlement is too high – self-control is pummeled and expectations of voluntary change are naive. The cycle and patterns of the culture of excess are too ingrained. As a result, regulation in policy will be an important factor in the change process, and replace the conscious efforts of deregulation and no regulation. As discussed earlier, the cultural deregulation and no regulation movement has deregulated our inner mechanisms of individual self-control. Changes in attitude and thinking will also be related to policy; however, confrontation must occur between current attitudes and thinking that is “me based.” Challenging some existing and entrenched beliefs about economics and economic growth will be necessary for change to occur.

http://www.cultureofexcess.com/

A False Promise of Reform

2010-03-22T20:55:00.002-04:00

March 22 - The following statement was released today by leaders of Physicians for a National Health Program, www.pnhp.org. Their signatures appear below.

As much as we would like to join the celebration of the House's passage of the health bill last night, in good conscience we cannot. We take no comfort in seeing aspirin dispensed for the treatment of cancer.

Instead of eliminating the root of the problem - the profit-driven, private health insurance industry - this costly new legislation will enrich and further entrench these firms. The bill would require millions of Americans to buy private insurers' defective products, and turn over to them vast amounts of public money.

The hype surrounding the new health bill is belied by the facts:

* About 23 million people will remain uninsured nine years out. That figure translates into an estimated 23,000 unnecessary deaths annually and an incalculable toll of suffering.

* Millions of middle-income people will be pressured to buy commercial health insurance policies costing up to 9.5 percent of their income but covering an average of only 70 percent of their medical expenses, potentially leaving them vulnerable to financial ruin if they become seriously ill. Many will find such policies too expensive to afford or, if they do buy them, too expensive to use because of the high co-pays and deductibles.

* Insurance firms will be handed at least $447 billion in taxpayer money to subsidize the purchase of their shoddy products. This money will enhance their financial and political power, and with it their ability to block future reform.

* The bill will drain about $40 billion from Medicare payments to safety-net hospitals, threatening the care of the tens of millions who will remain uninsured.

* People with employer-based coverage will be locked into their plan's limited network of providers, face ever-rising costs and erosion of their health benefits. Many, even most, will eventually face steep taxes on their benefits as the cost of insurance grows.

* Health care costs will continue to skyrocket, as the experience with the Massachusetts plan (after which this bill is patterned) amply demonstrates.

* The much-vaunted insurance regulations - e.g. ending denials on the basis of pre-existing conditions - are riddled with loopholes, thanks to the central role that insurers played in crafting the legislation. Older people can be charged up to three times more than their younger counterparts, and large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017.

* Women's reproductive rights will be further eroded, thanks to the burdensome segregation of insurance funds for abortion and for all other medical services.

It didn't have to be like this. Whatever salutary measures are contained in this bill, e.g. additional funding for community health centers, could have been enacted on a stand-alone basis.

Similarly, the expansion of Medicaid - a woefully underfunded program that provides substandard care for the poor - could have been done separately, along with an increase in federal appropriations to upgrade its quality.

But instead the Congress and the Obama administration have saddled Americans with an expensive package of onerous individual mandates, new taxes on workers' health plans, countless sweetheart deals with the insurers and Big Pharma, and a perpetuation of the fragmented, dysfunctional, and unsustainable system that is taking such a heavy toll on our health and economy today.

This bill's passage reflects political considerations, not sound health policy. As physicians, we cannot accept this inversion of priorities. We seek evidence-based remedies that will truly help our patients, not placebos.

A genuine remedy is in plain sight. Sooner rather than later, our nation will have to adopt a single-payer national health insurance program, an improved Medicare for all. Only a single-payer plan can assure truly universal, comprehensive and affordable care to all.

By replacing the private insurers with a streamlined system of public financing, our nation could save $400 billion annually in unnecessary, wasteful administrative costs. That's enough to cover all the uninsured and to upgrade everyone else's coverage without having to increase overall U.S. health spending by one penny.

Moreover, only a single-payer system offers effective tools for cost control like bulk purchasing, negotiated fees, global hospital budgeting and capital planning.

Polls show nearly two-thirds of the public supports such an approach, and a recent survey shows 59 percent of U.S. physicians support government action to establish national health insurance. All that is required to achieve it is the political will.

The major provisions of the present bill do not go into effect until 2014. Although we will be counseled to "wait and see" how this reform plays out, we cannot wait, nor can our patients. The stakes are too high.

We pledge to continue our work for the only equitable, financially responsible and humane remedy for our health care mess: single-payer national health insurance, an expanded and improved Medicare for All.

Oliver Fein, M.D. President	Garrett Adams, M.D. President-elect	Claudia Fegan, M.D. Past President

Margaret Flowers, M.D. Congressional Fellow	David Himmelstein, M.D. Co-founder	Steffie Woolhandler, M.D. Co-founder

Quentin Young, M.D. National Coordinator	Don McCanne, M.D. Senior Health Policy Fellow

2010-02-07T23:54:00.002-05:00

The banner made by Dr. Flowers and Dr. Paris that they carried to the Obama meeting site where they were arrested, now due to go on tour around the country.

Photo courtesy of: Jon Flanders

Obama Should Seize Moment to Push for Medicare for All

2010-01-24T22:08:00.004-05:00

Dr. Quentin Young comments on Massachusetts election, next steps for health reform

"President Obama and Congress should seize this moment to change course and re-inspire the U.S. public with a plan that is simple, clear, workable, fiscally responsible, comprehensive and truly universal -- namely, single-payer Medicare for All," said Dr. Quentin Young, national coordinator of Physicians for a National Health Program.

Young dismissed suggestions by some that the House should adopt the Senate bill as it presently reads, send it to the president's desk, and have Congress improve upon it later. "The Senate bill is rotten," he said. "It's a huge financial handout to the for-profit insurers and big drug companies. If passed, it will still leave at least 20 million uninsured and millions more unable to afford the care they need.

"Yesterday's Supreme Court decision removing bans on corporate contributions in candidate elections will only make this fatally flawed bill even more difficult to improve upon," he said. "It's too laden with concession after concession to the private health industry to serve as a starting point."

"Instead, we need to start anew and build on a system that we know works well, is cost-efficient and that could quickly be extended to cover everybody," Young said. "That's the Medicare program, which was implemented within one year of its enactment in 1965 and now covers about 45 million people, mainly seniors and the totally disabled."

"Extending Medicare to cover the entire population would result in $400 billion savings annually by eliminating the administrative waste -- the unnecessary paperwork and bureaucracy -- inflicted on the U.S. economy by the private health insurers," he said. "That would be enough to ensure high-quality coverage for everybody."

Young said it would be a mistake to interpret the election of Republican Scott Brown to the late Sen. Edward Kennedy's seat as a rejection by voters of fundamental health reform. Many independents and Democrats voted for Brown or stayed home because of mounting economic insecurity and their belief that the health reform process led by the Democrats had been corrupted by the big insurance and drug companies, he said. Union voters were especially angry with the proposed excise tax on workers' health plans.

"It was more of a protest vote," he said.

Young pointed to a 2008 ballot initiative in 10 legislative districts in Massachusetts, including one that overlaps with Brown's state senatorial district, that asked voters if they support "legislation creating a cost-effective, single-payer health insurance system that is available to all residents, and oppose laws penalizing those who fail to obtain health insurance," i.e. an individual mandate.

"Seventy-three percent of Massachusetts voters in these districts voted for a single-payer program and against the individual mandate, a hallmark of their own state's plan," Young said. "The Massachusetts plan is now in financial trouble. It's fair to assume that those who voted this way in 2008, like many others in exit polls this week, believe the bills in Congress don't go far enough toward real reform."

"Nationwide," he said, "polls show about two-thirds of the U.S. population would favor a Medicare-for-All approach, and a solid majority of physicians now support efforts to establish national health insurance."

Young also pointed to the robust movement in several states, including California and Vermont, where physicians, among others, are pressing for single payer at the state level.

Nearly 1,000 health professional students and their allies rallied on the steps of the State Capitol in Sacramento, Calif., on Jan. 11, in support of S.B. 810, a single-payer bill that was reintroduced Thursday in the Legislature, he said. Similar bills were approved twice by California lawmakers in recent years, only to be vetoed by Gov. Arnold Schwarzenegger.

In Vermont, some 300 citizens bearing thousands of petition signatures flooded the chambers of the State Capitol in Montpelier on Jan. 12, calling for enactment of a similar proposal there. Many participants said the national bills were completely inadequate to address the state's urgent health care needs, Young said.

A bold policy shift to single payer on the national level is more plausible than many people think, given the public's support for such an approach, he said, and given the Medicare program's "44-year track record of proven success."

Whatever deficiencies the Medicare program presently has could be easily remedied in a streamlined, better-funded single-payer system, he said. "In fact, single-payer Medicare for All would yield enormous efficiencies and savings through measures like bulk buying and negotiated fees, benefiting everyone and making the program sustainable for future generations. It would also be a much-needed boon to our economy."

"The president and Congress, if they truly stand up against the insurance and drug companies and press for single-payer Medicare for All, will find a public and a medical community ready and willing to support them," he said.

Source: Commondreams.org

Senate Speech Heralds a New Social Movement

2009-12-20T22:44:00.004-05:00

By Margaret Flowers and Andy Coates

This week the sincere effort of millions of people across the nation once again proved effective in the face of determined opposition from the White House and Congress, as single payer health reform reached another milestone in its historic journey.

When the Senate initiated its debate on health insurance reform, Senator Bernie Sanders offered a single-payer amendment, with co-sponsors Sherrod Brown and Roland Burris. Initially Senate Majority Leader Harry Reid skipped over it, allowing other amendments to come to the floor instead.

But nationwide events on International Human Rights Day, the delivery of paper “bodies” to the senate offices, non-violent civil disobiedience including nine arrests at Senator Schumer’s office, and hundreds of thousands of emails and phone calls and faxes to the Senate evidently changed Reid’s mind.

When Sanders introduced his amendment the Senator from Oklahoma, Dr. Coburn, rose according to the rules of the Senate to insist that the bill be read in full. It was estimated that reading the 767-page bill would take days, stalling a galloping Senate process.

We wondered: Could this be an unexpected gift? If Senator Lieberman could make an intransigent stand on behalf of the insurance companies, would Sanders make a stand on behalf of the health of the people?

Reading the bill would prompt our movement to swing into action yet again. We would invite the nation to tune in to C-SPAN to hear how a national single payer health system would provide comprehensive high-quality health care to all citizens. Yet Coburn’s maneuver had its effect.

Reid demanded that Sanders withdraw the amendment, for the Senate timetable leading up to Christmas could not be delayed. Besides insurance reform, there was the pressing issue of funding the wars.

Within 3 hours Sanders agreed. In return he got 30 minutes on the Senate floor.

Sanders’ speech was riveting. He spoke the words that we have been waiting to hear for so long. He spoke about the beauty and simplicity of Medicare for All. He spoke about having the courage to stand up to the medical-industrial complex which profits at the expense of human suffering.

Most importantly, Sanders spoke about the national movement for single payer being led by nurses, doctors, medical students, faith and labor organizations and people across the land of all backgrounds and beliefs. He declared that this strong movement is not going away and he announced that we will succeed.

So we will remember December 16th, 2009 as a turning point in the struggle for health care justice. Single payer started this year “off the table.” But the accumulating efforts of millions of people delivered it to the floor of the United States Senate.

To win single-payer health reform it will take many more speeches on the floor of Congress. And the only force that will propel Congress forward is a great social movement. In 2009 we have seen that movement rising up – and getting results.

Every day more people see that an effective and just health system is already at hand: a single-payer national health program modeled on the Medicare system. And every day that the White House and Congress delay single-payer reform, people suffer needlessly and die preventable deaths. Yet the Senate blunders on, with a colossal gift to the insurance industry.

It is time for the health of human beings to prevail. It is time to end the insurance cartel. Please join us as we continue forge the movement that will win Medicare for All.

Onward to single payer.

Margaret Flowers is a pediatrician in Baltimore, co-chair of the Maryland chapter of Physicians for a National Health Program (PNHP) and PNHP Congressional Fellow. Andy Coates is an internist in Albany, secretary of the Capital District (NY) chapter of PNHP and co-chair of Single Payer New York.

UNCARED FOR ON VETERANS’ DAY

2009-11-15T23:11:00.004-05:00

Re-reported, edited with brief comment by Carolyn Bennett

Nice holiday speeches but Washington politicians are at heart unconcerned about America's health.

"I feel a little bit like we're debating whether to give aspirin or Tylenol to a patient with breast cancer," Dr Steffie Woolhandler said about health care proposals moving pushed through Congress. "The patient needs surgery," she told interviewer Amy Goodman. "What's being debated in Washington is really Tylenol or aspirin...

"There are so many bad planks. This bill needs to be scratched and we need to start over."

The Democracy Now interview was pegged to a study by Harvard Medical School researchers that found an estimated "2,266 U.S. military veterans under the age of 65 died last year because they lacked health insurance and thus had reduced access to care." "More than 14 times the number of deaths (155) suffered by U.S. troops in Afghanistan in 2008." "More than twice as many as have died(911 as of October 31) since the war began in 2001."

VETERANS uncared for

The risk of dying elevates by about 40 percent among people who have no health insurance. Nationally a little less than 1.5 million veterans are uninsured. This means almost 2,300 veterans die every year due to lack of health insurance...

Many of these veterans would not be helped under the bills before the House and Senate... If they get subsidies at all, the subsidies will be too small to make health insurance affordable. These veterans are mostly working families, who don't have the money to buy private insurance but they have too much money to qualify for Medicaid or means-tested VA benefits.

… The Veterans Administration (VA) covers members of the armed services who have service-connected injuries (e.g., loss of limb) "[But] Many middle-income vets are not eligible for VA care - and that's who these uninsured veterans are..."

Veterans in middle-income ranges, out of the service for two, three or five years, working but not getting insurance through their work, these veterans could not qualify for VA care.

Moreover, there are a limited number of VA facilities. Though many cities have VA facilities, not all cities have them and many people just cannot get to a VA facility even if they were eligible.

"… The VA is a good system and actually a good safety net - if you can get access to it. Currently, however, there is just not the funding within the VA system to allow coverage of all veterans."

Many veterans "will continue to be uninsured under the House or Senate bills. Even if the bills work as planned - they will leave somewhere between a third and a half of all uninsured people still uninsured in the year 2020."

CARELESS SHIFT of WEALTH

Far from making health care affordable, private insurers, subsidized by taxpayers under legislation moving through Congress are getting millions of mandatory new customers.

"FIVE HUNDRED BILLION DOLLARS in subsidies to the private health insurance industry will have the effect of making the health insurance industry more powerful, making the health insurance lobby more powerful. Just as they've hijacked this process in Washington, it makes them more able to hijack political processes in the future."

From studies of bankruptcy - 62 percent of all bankruptcies in the United States are due, at least in part, to medical illness or medical bills; patients start their illness with private health insurance but are bankrupted anyway by coverage gaps: co-payments, deductibles and uncovered services - "we know that private health insurance is a defective product."

The House and Senate bills "do nothing to fix private health insurance; they merely make private health insurance mandatory for middle-income working people and force these people to take lots of money out of their pockets to buy this defective product."

Criminalization of health choice - the private health insurance industry's "number one demand was the so-called individual mandate that would make it illegal not to have health insurance. It will become a federal crime to be uninsured.

"If you have private health insurance through your work, and you hate your private health insurance, tough luck; you have to keep that insurance. The mandate means you have to keep it. You can't buy the public option. You probably won't be able to go through the exchange. So they've made private health insurance mandatory - giving them [private health insurers] hundreds of billions in new—mandatory new customers."

Physicians for a National Health Program wrote an "open letter asking President Obama "to Support Single-Payer Health Care." This is an excerpt.

"Democrats propose diverting additional billions to private insurers by requiring middle class Americans to purchase defective policies from these firms - policies with so many gaps and loopholes that they currently leave millions of our insured patients vulnerable to financial ruin.

"Moreover, a 'public plan option' would do little to mitigate the damage of a reform that perpetuates private insurers' dominant role. Even a robust public option would forego 90 percent of the bureaucratic savings achievable under single payer; and a kinder, gentler public option would quickly fail in a health care marketplace where competition involves a race to the bottom, not the top - where insurers compete by NOT paying for care.

"…This kind of public option would amount to a government-run clone of private insurance, reproducing the worst features of private plans."

Steffie Woolhandler, MD, MPH (co-editor, PNHP Newsletter) is an Associate Professor of Medicine at Harvard and co-director of the Harvard Medical School General Internal Medicine Fellowship program. Dr. Woolhandler has worked as a Robert Wood Johnson Foundation health policy fellow at the Institute of Medicine and the U.S. Congress (1990-91) and has written extensively on health policy. She is co-founder of Physicians for a National Health Program (PNHP) and a current member of the group's Board.

Dr. Woolhandler says, "The plight of the veterans epitomizes what happens to working families generally. Working families get caught in the middle-

They can't get Medicaid.
They can't get means-tested VA.
They can't afford private insurance, and
House and Senate bills don't really fix that problem.

Physicians for a National Health Program is "the only national physician organization in the United States dedicated exclusively to implementing a single-payer national health program."

Since 1987 Physicians for a National Health Program has advocated reform in the U.S. health care system. Comprised of 17,000 members and chapters across the United States, Physicians for a National Health Program is a single-issue organization advocating a universal, comprehensive single-payer national health program.

The group's members perform groundbreaking research on the health crisis and the need for fundamental reform, coordinate speakers and forums, participate in town hall meetings and debates, contribute scholarly articles to peer-reviewed medical journals, and appear regularly on media programs advocating for a single-payer system. They work to educate physicians and other health professionals about the benefits of a single-payer system—"including fewer administrative costs and affording health insurance for the 46 million Americans who have none." Members and physician activists work toward a single-payer national health program in their communities.

Source: thepeoplesvoice.org

Sit-ins call for Medicare for all

2009-11-05T22:00:00.002-05:00

As a plethora of “health care reform” bills circulate through the halls of Congress, a new movement is emerging on the streets—taking the fight for health care reform directly to the doors of the health insurance industry giants who, for all too long, have put their profits before people’s care. Using tactics reminiscent of the civil rights movement of the 1960s, Mobilization for Health Care for All has launched a “Patients Not Profits” campaign of sit-ins at insurance company offices across the U.S. to demand “Medicare for all.”

Launched at the end of September, when 16 activists were arrested for occupying the lobby of Aetna Inc. in New York to demand that the company approve immediate care for people with critical conditions, this movement has spread through coast-to-coast actions. On Oct. 15, sit-ins took place at offices of major insurers in nine cities. Since Oct. 28 direct actions against the health insurance industry and in favor of a single-payer health care system have been held in many others, including Augusta, Ga.; Columbus, Ohio; Sunrise, Fla.; Newark, N.J.; Seattle; Virginia Beach, Va.; and Warwick, R.I. More are planned through Nov. 4. To date, more than 200 people have risked arrest and the numbers are growing.

On Oct. 29 dozens marched outside the CareFirst office in Baltimore wearing bright yellow T-shirts with the slogan “People Not Profits,” while a smaller group went inside and got arrested. One arrestee was 81-year-old Charles Loubert, who was denied health care several years ago by his insurer. Dr. Margaret Flowers also took an arrest at the CareFirst office, despite the risk of a 6-month jail sentence for violating her probation from a previous arrest.

On Oct. 30 in Louisville, Ky., seven activists occupied the offices and lobby of the Humana Corporation for over 24 hours. They vowed to stay until Humana met their demands.

Outside the Blue Cross Blue Shield building in Philadelphia the same day, nearly 80 protesters picketed and chanted, “Let the corporate giants fall! Medicare for all!” in a spirited demonstration that drew in a number of passersby. Many were young adults from the population sector least likely to have employer-paid insurance. Members of the Student Healthcare Action Network were among 13 people arrested for blocking the building entrance.

Protesters have charged the health insurance industry with crimes including murder, breach of contract, theft and waste of U.S. health care dollars, and subverting democracy by spending huge amounts of health premium money on lobbying and contributing to politicians.

With all the congressional debate over a public option, these sit-ins are driving home the point that the real public option must be Medicare for all—a single-payer plan that cuts out the profits of the insurance company intermediaries.

Under the current system, at least 30 cents out of every dollar spent on health care goes to insurance company profits and administrative waste. According to health industry research firm McKinsey & Co., almost two-thirds of insurance company overhead goes to underwriting, sales and marketing—business costs that would not exist in a single-payer system.

While far more is spent on health care in the U.S. than in any other industrialized country, an estimated 50 million people are not insured and 45,000 die every year for lack of care. While providing everyone health care insurance, the single-payer plan would cut costs by using only one not-for-profit administrator.

The profits of the top 10 health insurance companies went up 428 percent from 2000 to 2007. CEOs of large health insurance companies typically make $7 million to $12 million a year or more in salaries. Aetna’s CEO, Ron Williams, made $24 million last year.

Mobilization for Health Care for All’s Web site notes, “The insurance companies are spending millions to confuse and scare the public to keep us from ending their grip on our health and our money. With tea-bagger town hall protestors and the right-wing noise machine on their side, they’re winning. We can’t let that happen. It’s time to take the fight to the real villain in the health care debate.”

These protests are also motivated by frustration over the slow progress and limited content of the bills in Congress that more and more appear to benefit the health insurance industry while still denying care to the millions in need.

Source: Workers World

The Fight for Better Health Care

2009-10-26T21:31:00.003-04:00

"One of the reasons that I am a strong proponent of a single-payer, Medicare-for-all proposal is that it is much less complicated than what we are going to end up with in Congress. A single-payer approach saves hundreds of billions of dollars a year because you don’t end up with thousands of different health insurance programs appealing to all different kinds of people and costing a fortune to administer. I am going to continue the fight for single-payer. I am cautiously optimistic that we may end up with legislation that will allow states to go forward with single-payer if they want to."
Bernie Sanders
Source: Senator Sanders Unfiltered

Health Insurance and Mortality in US Adults

2009-10-10T15:09:00.002-04:00

A Harvard study published in the online edition of the American Journal of Public Health estimates nearly 45,000 annual deaths are associated with lack of health insurance. That figure is about two and a half times higher than an estimate from the Institute of Medicine (IOM) in 2002.
The study found a 40 percent increased risk of death among the uninsured. As expected, death rates were also higher for males (37 percent increase), current or former smokers (102 percent and 42 percent increases), people who said that their health was fair or poor (126 percent increases), and those that examining physicians were in fair or poor health (222 percent increases).
Lead author Dr. Andrew Wilper, who worked at Harvard Medical School when the study was done and who now teaches at the University of Washington Medical School, said, "The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors and baseline health. We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease-but only if patients can get into our offices and afford their medications."
Dr. David Himmelstein, study co-author and an associate professor of medicine at Harvard, remarked, "The Institute of Medicine, using older studies, estimated that one American dies every 30 minutes from lack of health insurance. Even this grim figure is an underestimate-now one dies every 12 minutes."
A copy of the study is available at:
“Health Insurance and Mortality in U.S. Adults,” Andrew P. Wilper, M.D., M.P.H., Steffie Woolhandler, M.D., M.P.H., Karen E. Lasser, M.D., M.P.H., Danny McCormick, M.D., M.P.H., David H. Bor, M.D., and David U. Himmelstein, M.D. American Journal of Public Health, Sept. 17, 2009 (online); print edition Vol. 99, Issue 12, December 2009.

Notes on the status of health reform

2009-09-05T10:43:00.003-04:00

Andy Coates
5 September 2009

The election of Obama raised expectations for sweeping health reform sky high. But in spite of several self-imposed deadlines, Senate and House health reform bills were not ready by the time of the August Congressional recess, when passionate local debate erupted at Congressional home district town hall meetings.

The Onion pierced the din with truth: "After months of committee meetings and hundreds of hours of heated debate, the United States Congress remained deadlocked this week over the best possible way to deny Americans health care."

If the goals are health care for all and reduced costs of care, the measures being prepared in Congress will not reform the health system. Instead they amount to a massive taxpayer subsidy for the private health insurance industry.

In 2007, more than one of five working-age people were uninsured for a year or longer. One of six working people had health insurance insufficient to meet the expenses of a serious illness. And there were 8 million uninsured children in the United States. At least 5 million more people lost their health insurance in 2008 and 2009 thanks to galloping unemployment -- on top of years of progressively unaffordable health insurance, inadequate coverage, and steep out-of-pocket costs. The failing economy further accelerated the crisis in health care through devastating state and local cutbacks in safety net care.

Yet the Congressional bills that have come through committees, whose key provisions would not start until 2013, offer precious little relief for these ills.

Against this background, a nascent mass movement for single-payer national health insurance, plugging away for decades, steadily accumulates new force. Single payer would deliver all necessary care for all individuals, lifelong, with no co-pays and no deductibles, through a system in which health care would be publicly financed but privately delivered. By eliminating private insurance, single payer would save an estimated $400 billion annually in health spending. The single-payer bills in Congress are HR 676 and S 703. HR 676 has 86 co-sponsors and has been endorsed by over 500 labor bodies, including 39 state AFL-CIO federations.

Whether a bill passes or flounders this fall, the details in the proposals that have come through Congressional committees have little connection with the popular expectations and grassroots clamor this summer. If Congress enacts reform, in 2013, individuals will be required to purchase health insurance. This is the centerpiece of the "reform." The proposal has come straight from the insurance industry: criminalize the uninsured and subsidize unaffordable private insurance premiums with public funds.

Massachusetts as a Model

An "individual mandate" was enacted in Massachusetts under Governor Mitt Romney in 2006. All residents of the state were required to join the private insurance risk pool or pay a fine. (The state purchased health insurance for everyone with incomes below 150% of the federal poverty level and subsidized those making between 150% and 300% of that level.) This was said to reduce costs through an expansion of the risk pool. It did not.

A new state agency, the Commonwealth Health Insurance Connector, was established to match individuals to private insurance plans. The Connector employs more state workers to assist with the purchase of private health insurance than the province of Ontario's Medicare employs. Canada's Medicare is the agency that pays for all necessary medical services for all residents. Ontario's Medicare overhead is 1.3%. In Massachusetts, the Insurance Connector adds 4.5% in administrative cost to each policy it brokers.

The Massachusetts reform went into effect in 2007. As of March 2008, 40% of those uninsured in 2007 remained without coverage. High-deductible policies lowered premium costs by shifting more of the expense onto individuals. Physicians for a National Health Program found that a healthy 43 year-old man making just over $31,000 a year would have to pay $5,096 before any insurance coverage kicks in, with additional co-pay and co-insurance costs.

In Massachusetts when you lose your job you still lose your health insurance, the reform does not protect you from financial ruin when illness strikes, and health insurance remains far too expensive.

Neither is the program sustainable for the state. As the state budget deficit rises into the billions, funding for safety net programs and institutions has been slashed to keep the individual mandate afloat. Services that have been cut include care for the poor, emergency and primary care, mental health, and addiction care. A 2008 survey of opinion intended to bolster the program found that, of those directly affected by the reform in Massachusetts, 56% opposed the individual mandate and 50% said that it "is hurting" the uninsured. In July 2009, moreover, the state revoked subsidized health insurance for 30,000 legal immigrants.

For Healthy Profits

The "individual mandate" is a financial bonanza for the insurance industry just at time when the relentless rise in premiums, far ahead of wages, began to hit a ceiling of unaffordability.

An April 2008 New York Times business column about sagging profits at UnitedHealth carried a frank appraisal of the declining employer-sponsored private health insurance market. "It is never a good thing if many of your customers can no longer afford what you're selling," Reed Abelson wrote. "In recent years despite soaring medical costs, insurers have made big profits by keeping premiums well ahead of health care inflation. But analysts say that business strategy may be reaching its limits, with companies finding it harder to raise prices without losing substantial numbers of customers."

The article closed with a quote from a health business analyst: "The hail Mary may be that we turn to some sort of universal care."

Shortly after the Presidential election, the insurance industry officially embraced health care reform. A November 2008 press release from Blue Cross Blue Shield read: "The Blue Cross and Blue Shield Association (BCBSA) and the 39 member Blue Cross and Blue Shield companies today announced support for every individual being required to have coverage and all insurers being required to accept everyone regardless of their health status."

If the government would only criminalize the uninsured and pay the premiums for the poor, the industry said, it would stop denying people insurance coverage because they are ill. The industry further promised that women would no longer be charged more than men for health insurance -- again, if and only if the federal government would deliver paying customers -- and guarantee the payments too.

But there is growing recognition that the "reform" is most of all "truly meaningful" for the profitability of the Blue Cross Blue and Shield Association and its competitors. BusinessWeek announced on its front page: "The Health Insurers Have Already Won: How UnitedHealth and rival carriers, maneuvering behind the scenes in Washington, shaped health-care reform for their own benefit." A Los Angeles Times headline read: "Healthcare insurers get upper hand. Obama's overhaul fight is being won by the industry, experts say. The end result may be a financial 'bonanza.'"

Details of the Swindle

Congressional proposals include a minimum annual tax of $750 and/or a tax of 2.5% of adjusted income upon people who don't purchase health insurance. For those who still could not afford the premiums, a hardship waiver could be requested. The Senate HELP bill defines "unaffordable" as 12.5% of income or more.

Companies that presently arrange skimpy policies, for example the very high deductible plans like what Wal-Mart offers, would be protected by a grandfather clause and exempted from regulations setting forth minimum covered benefits. Recognizing that the costs of health insurance are a nonstarter for individuals, subsidies for private health insurance policies would be granted for people whose incomes are 400% of federal poverty or less. And tax credits would be given to small employers to subsidize the employer share of insurance premiums and grant payments to employers whose plans cover retirees aged 55-64.

But as the Congressional Budget Office began adding up the price tag -- over a trillion additional dollars in costs over the coming decade -- lawmakers moved to scale back the subsidy. According to the Los Angeles Times, "In May, the Senate Finance Committee discussed requiring that insurers reimburse at least 76% of policyholders' medical costs under the most affordable plans. Now the committee is considering setting the rate as low as 65%."

Bankruptcies in the United States in 2009 will affect 3.8 million people. Two-thirds are the result of debt due to illness -- more than three-fourths of them have health insurance. To prevent this, HR 3200 would cap personal costs (at $5,000 for an individual and $10,000 for a family) -- but only for covered services, not all out-of-pocket costs.

On top of this, the proposal would shift more costs to individuals. Invoking "shared responsibility," the House bill calls for employers to pick up at least 72.5% of the premium for an individual policy and 65% of the premium for a family. The Senate HELP bill would require employers to offer to pay 60% of the insurance premium. Consider that 40% (the direct cost to the employee) of the market price for insurance coverage for a family of four would equal two-fifths of about $16,000 -- $6,400 annually or $533 per month. Plus co-pays, deductibles, and the rest of the usual unaffordable out-of-pocket expenses.

Another feature of proposed bills is a government “exchange,” through which employers and individuals would be encouraged to purchase insurance. Individuals would not be allowed to use the exchange if their employers offer health insurance, including plans that were grandfathered. This agency would add yet another layer of expensive bureaucracy to the presently dysfunctional system, just as the Connector did in Massachusetts.

None of these changes would start until 2013. Some of the provisions that would begin in 2010 include new taxes, increasing Medicaid payment for primary care services to 80% of Medicare rates, and prohibiting insurance companies from recissions --- rescinding policies for reasons other than nonpayment of premiums (often the allegation of failing to disclose a pre-existing condition.)

"Public Option" Posturing

The "public option" refers to an idea that people and employers should be allowed to purchase insurance from a public program along the lines of Medicare. Proponents believe this would pressure the entire insurance market to reform itself. On moral grounds, supporters of the public option advance arguments similar to single-payer proponents: insurer profits amount to blood money, for every penny earned by the company is a penny's worth of care cheated from the effort to make a human being healthy. In comparison, a public program with the lowest possible overhead, its finances open for scrutiny, presents a morally defensible means of paying for care.

But the public option amounts to a moral posture, not a workable reform. Single payer would eliminate the insurance industry from health care; a "public option" cannot. A "public option" won't liberate the resources squandered by the private insurance companies. Instead, it adds duplicative waste in administrative overhead to the system.

The most relevant evidence comes from the state of Maine. Maine has offered a "public option" since 2003. In six years this program has managed to cover only 10% of the uninsured and has not forced its competitors to lower costs.

Perhaps the idea of a "public option," as a clever market-based scheme, reveals something about popular ideological illusions, for it relies upon a crude kind of "free markets equal low costs plus high quality." Of course this is not the way the market works. The laws of the health insurance market, in particular, dictate that the successful competitor will avoid insuring people who are sick and/or poor while recruiting customers who are healthy and wealthy.

Does it really make sense to believe that a "public option" tossed amid the heavily monopolized insurance market in the U.S. would stand a chance at competing for the healthy and wealthy patients? In the best case scenario, wouldn't such a program instead drive the system toward officially sanctioned disparities in care?

Historical note: once upon a time, as Medicare gained momentum required for Congressional passage, the "public option" was put forward by the AMA, Ronald Reagan Republicans, Dixiecrat Democrats, and other right-wing opponents of Medicare. The idea was to let seniors voluntarily purchase insurance from a public plan, in addition to private insurers, instead of enrolling all seniors in Medicare. Does it make sense to now embrace a proposal that was objectionable over 45 years ago?

Topsy Turvy

The "public option," more a political posture than a specific proposal, has given liberals and progressives a reason to support a reform that would be, at its heart, another spectacular taxpayer gift for a financial services industry, in which the government will hawk the product, coerce customers, and subsidize payments to companies. But the White House seems prepared to jettison even the "public option" in exchange for bipartisan support for the individual mandate, in spite of "public option" supporters' moral indignation.

Prevailing Democratic Party wisdom holds that the tragedy of the Clinton heath reform effort was a failure to maneuver legislation through Congress quickly, thanks to too much deal-making behind closed White House doors. The "nuance" of the Obama administration was to move the deal-making behind the closed doors of Congressional committees. Meanwhile the White House, in parallel, also sought closed-door deals palatable to "stakeholder" profiteers, hoping to expedite bipartisan compromise. History seems to have repeated itself -- if the first time tragedy, this time farce.

The Los Angeles Times reported that former Louisiana Congressman Billy Tauzin, President and CEO of the Pharmaceutical Research and Manufacturers of America (PhRMA), visited the White House six times. In exchange for a pharmaceutical industry promise to forgo $80 billion in profit over 10 years, Tauzin told the Los Angeles Times, the President promised not to allow importing of drugs from Canada or Europe and not to reform Medicare Part D. (Medicare Part D has been another government-delivered industry bonanza -- for it prohibits the government from bargaining for drug prices.) In return, PhRMA has pledged $150 million in advertising in support of the Presidents' reform effort.

Yet the Right, in response to the industry-friendly proposals moving through Congress, has attacked the entire reform (not just the public option) as if it were single-payer national health insurance! In the resulting gyrations, when PhRMA lobbyist and former House Republican leader Dick Armey joined the chorus of conservative talking heads attacking the Congressional bills as a "government takeover of health care," PhRMA forced his resignation from the lobbying firm.

Because the reform discussions have included Medicare cuts, the Right also found fertile ground among seniors. A Democratic Party-friendly poll found that 39% said "yes" when asked "Do you think the government should stay out of Medicare?"

So, at the end of August, the Republican Party took the position of "hands off Medicare." To leave in place "Medicare Advantage" (which pays private insurance companies 12 to 17% more than it pays for the costs of care of traditional Medicare) and Medicare Part D (another huge giveaway to the drug and insurance industry), the Republican Party tied itself in knots after decades of calling for the abolition of Medicare.

Also in the name of "keeping the government out of health care," the Republican Party came out in defense of the Veterans Administration, a socialized health care system directly owned and operated by the federal government.

In August, the Congressional Budget Office released a study that underscored once again evidence of superior quality of care at the VA: better than Medicare, better than private practice, and better than managed care.
If we were to engage in a truly evidence-based debate over how to pay for health care using a "uniquely American" model, it would be a debate between single payer, based on the Medicare model, and socialized medicine, like the VA.

From "Off the Table" to "On the Floor"

Single-payer national health insurance, after more than 20 years of accumulating evidence, now accumulates unprecedented popular support. Although polls have shown for decades that a majority, including physicians, favor national health insurance, the depth and passion of grassroots activism for the proposal is something new. For the first time, this fall, single payer may be voted on the floor of the House of Representatives.

At the end of July, as the Energy and Commerce Committee completed deliberations on HR 3200, Representative Anthony Weiner of New York, with six others, put forward an amendment to replace the text of HR 3200 with the text of HR 676. Committee Chair Waxman interrupted to say that House Speaker Nancy Pelosi offered to allow single payer to be voted on by the entire House of Representatives if the amendment were withdrawn from the Committee. Weiner accepted. Perhaps the prospect of defeating single payer on the floor of the House of Representatives seems, to the Democratic Party leadership, a way to at last get single payer off the table.

Single-payer activists have welcomed this turn of events, however, for it was the direct fruit of grassroots mobilization. The proposals before Congress, with the exception of HR 676 and S 703, will simply not work. Whatever happens in Congress this fall, the system will grow more dysfunctional. And with expectations for fundamental reform now raised even higher, excellent prospects to build a movement for single-payer national health insurance will persist.

Americans To Rally In D.C. For A Single Payer Healthcare System

2009-07-27T22:11:00.006-04:00

Thousands of people from across the nation will gather in Washington, D.C. on Thursday for a rally calling on Congress to pass legislation that includes a single payer health care system. Neither the House nor the Senate have taken a vote on a final health care reform bill.
The event is being organized by Healthcare NOW. Numerous community leaders will be at the rally and a few of the most progressive member of congress will be there too, including Congressman John Conyers, Congressman Dennis Kucinich, and Senator Bernie Sanders. Also attending will be President Obama’s former personal physician, Dr. David Scheiner, who received the cold shoulder from the White House last week after his invitation to a health care forum there was cancelled last minute. He claims that the White House didn’t want him to attend because he was going to ask about a single-payer plan.

Progressive democrats in Congress have pushed for the last two years to pass a single payer health care system, H.R. 676 - the Expanded and Improved Medicare for All Act. But the attempts to take the bill to the floor have always failed.

A single payer health care system, also referred to as “universal health care,” is what most industrialized countries have in place to provide health coverage to their citizens. It’s a system that allows the government to fund health care directly from patient to doctors and hospitals.

On July 17, Congressman Kucinich was able to introduce an amendment for a single payer option in the House’s version of the health care reform legislation being debated in Congress. The Kennedy-Dodd version in the Senate also includes such an option.

But Republicans continue to fiercely oppose the legislation and for-profit insurance companies have lobbied intensively to prevent lawmakers from adopting such a system because they would be put out of business. Many “Blue Dog” democrats such as Senator Max Baucus have also come against the single payer plan. Baucus is well-known in this debate for his deep ties to pharmaceutical companies and to for-profit health insurance interest.

President Barack Obama has expressed support for the single payer system, but only as “ideological.” He has been compromising more with CEOs of for-profit health care insurance companies and has not met with any other public health care advocates, except with an adviser or two from the Center for American Progress.

Over 80 percent of Americans have given a single payer health care plan their blessing, according to a recent poll. This has motivated members of congress such as Kucinich and Conyers to continue pushing for it.
The rally on Thursday will also include a lobby day for people to visit with their representatives and demand that they vote for legislation that includes the single payer option.

For more information on the rally and lobby day, click here.

Source: Dolores M Bernal

President of the USW union supports Single-Payer

2009-07-08T23:54:00.007-04:00

Paul Jay speaks to Leo Gerard, President of the United Steelworkers' union about
his fight for single-payer health care reform and the unionization legislation.
Gerard says that, "the unions are first and foremost going to be very active in the fight to pass the Employee Free Choice Act (EFCA) and the fight for health care reform.
"Speaking on the proposals of the Chairman of the Finance Committee, Gerard says, "I think Senator [Max] Baucus (D-MT) is off the mark," because the Senator's proposal to tax employer provided health care will, "drive more people out of the health care system."
Bio
Leo W. Gerard is a steelworker and president of the United Steelworkers (USW).
He was involved in the formation of the Industrial Union Council of the AFL-CIO, and in February 2003, was appointed to serve on the AFL-CIO's Executive Committee, as well as serving on its Executive Council.
He was named Chair of the AFL-CIO's Public Policy Committee in March 2005.

Source: The Real News Network

Dr. Oliver Fein Interview

2009-06-17T21:47:00.005-04:00

Single payer is often misunderstood.
Some people believe, for example, that you need to be single to get insurance under a single payer system.
That’s according to Dr. Oliver Fein, President of Physicians for a National Health Program and Professor of Clinical Medicine and Public Health at Cornell University.
“I’ve had people come up to me and say — you mean I have to be single to get into your plan? No no no no. We’re talking about Medicare for all. So there is a lot of educational work that needs to be done with the public,” Fein told Single Payer Action earlier this month.

That’s one reason why single payer is not gaining traction in this pivotal year.
“Also, there’s an enormous influence on Congress, on our political leaders through the private health insurance industry and the pharmaceutical industry — both of which wield disproportionate influence because of the amount of money that they’re able to pour into the system,” Fein said.

Dr. Marcia Angell says that because of the political forces arrayed against single payer, it’s not going to happen in this country.
Do you agree?
“In the short term that may be true,” Dr. Fein says. “But I really think that there is building sentiment that we need to really do some fundamental change. I’m not sure the public identifies quite yet with the term single payer. But I think that they do recognize that there needs to be fundamental change.”

Fein says that when he travels to speak about single payer, he asks the question:
— Do you want to keep the health insurance you currently have?
“And you know 5 to 10 percent of the audience say yes that’s what they want to do and the rest want some real change, they don’t want the present private health insurance industry.”

That sort of differs from what we are hearing from the anti-single payer camp — that surveys show that the majority of Americans want to keep their health insurance, no?
“I think those studies are really suspect at this point,” Fein says. “You have to dig much deeper about how were the question is asked. Were they really inquiring about a Medicare for all type of system? Or were they in fact given words that might turn people off like government run and that kind of thing?”

Source: Single Payer Action

Life expectancy could be topic in health care debate

2009-06-15T23:35:00.006-04:00

Source: UC Atlas of Global Inequality

Despite spending more money than any other country on health care, the United States does not lead the world in life expectancy, a long-known fact that some experts say could raise more questions in the health-care reform debate.
The United States ranks 50th out of 224 nations in life expectancy, with an average life span of 78.1 years, according to 2009 estimates from the CIA World Factbook.
Some argue part of the problem from the privatized nature of the U.S. health care system, whose reform is being vigorously debated on Capitol Hill.

"What we are able to find in the industrialized world is that life expectancy will be influenced in a beneficial manner to the extent that health care expenditure is publicly financed," said Harvey Brenner, professor of public health at the University of North Texas Health Science Center and Johns Hopkins University. "The higher the government expenditure on health care, the lower will be the mortality rate."
In countries where individuals pay for their own care, people often don't get treatment until their symptoms have become serious, Brenner said. There is also less emphasis on preventative care in those countries, he said.

An analysis by Bianca Frogner, postdoctoral fellow at the University of Illinois at Chicago's School of Public Health, supports the view that a Single-Payer system may be associated with higher life expectancy. The federal governments of countries such as Norway, Sweden, Denmark, Australia and Canada are the payers for the respective systems, and these countries have some of the highest life expectancies in the Organization of Economic Cooperation and Development.
"Inevitably the conversation about reforming our health care system focuses on the question of what are we getting for our money and how are others doing with their health care dollars. Life expectancy, along with mortality and morbidity rates, are fairly straightforward numbers to rely on," Frogner said in an e-mail.

A 2008 study in the Annals of Internal Medicine found that with the implementation of the Taiwan single payer systems, gain in life expectancy was slightly faster in the 10 years after reform than the 10 years prior to the reform.
Source: CNN

Everybody In, Nobody Out !

2009-06-07T23:24:00.010-04:00

Jammin' for a Single-Payer National Health Plan

Friday, June 12, 2009
5:30 p.m. - 10:00 p.m.
The Linda Norris Auditorium
339 Central Ave., Albany, NY

Music and entertainment by the bands Broadcast Live and Mother Mcrees,
the disc jockey Jardread, and the humorist Gregor Wynnyczuk.

Admission is based on ability to pay with a suggested contribution of $10 - $25.

Light refreshments will be provided with a cash bar for beer, wine and
non-alcoholic beverages.
The event is co-sponsored by Single-Payer New York, Troy Area Labor Council, Hunger Action Network of New York State,
Capital District Alliance for Universal Healthcare and
The Capital District Area Labor Federation.

For more information contact Connie LaPorta at:
connie3049@earthlink.net or 274-4863

Lobby and Rally in Support of Single Payer Universal Healthcare

2009-05-25T22:58:00.004-04:00

Wednesday, May 27, 2009

In coordination with Healthcare-NOW, single payer activists will be gathering all over the country to say:

Healthcare Yes! Insurance Companies No! Make Healthcare a Human Right!

Lobby State Legislators

Support State Senate Resolution in Support of HR 676, the federal Single Payer bill. Urge NYS lawmakers to adopt a State Payer Healthcare for All Program.

9:30 a.m. : Briefing. Westminster Presbyterian Church, 85 Chestnut St. Albany

11:00 a.m.-4:00 p.m. : Meeting with State Legislators

Rally at 12:00 noon
West Capitol Park, Albany

For more information go to: www.singlepayernewyork.org
E-mail: dunleamark@aol.com or call 518-434-7371, ext. 1

"Nurses say patients first ! Pass single payer !"

2009-05-13T21:57:00.012-04:00

Rose Ann DeMoro is president of the National Nurses Organizing Committee/
California Nurses Association. Idelson and Preston are spokespersons for NNOC/CNA, which just released a statement: "Registered nurses, physicians and healthcare activists delivered an emphatic protest before the Senate Finance Committee for its failure to open discussion on healthcare reform to nurses, doctors and other advocates of single-payer, guaranteed healthcare for all, while continuing to provide a red carpet to big insurance companies and other healthcare industry interests.
As the hearing opened, about 25 nurses stood up, turning their backs to the senators. Taped to each of their red shirts were signs that called on Congress to pass single payer.
"Nurses say patients first!", the signs read. "Pass single payer!"

"Five were arrested -- two RNs, members of the National Nurses Organizing Committee/California Nurses Association, two physicians, members of Physicians for a National Health Program, and a patient activist with PNHP and Health Care Now -- after vocally challenging the committee for what they called a stacked process against real debate.

"Marking the anniversary of the birth of Florence Nightingale, some 40 other RNs staged a silent protest -- standing before the committee in red nursing scrubs and turning their backs to show signs [critical of] America's Health Insurance Plans, the private insurance industry lobby arm that is given a regular voice by the Committee, chaired by Sen. Max Baucus, which is in the forefront of discussion on a health plan.

"What a disgrace that RNs and physicians are shut out and arrested while the insurance industry is given a seat at the table. We would expect that from the Bush administration, not in the time of the Obama administration. ... Tuesday morning's protest was also the kickoff of two national days of actions by RNs from across the U.S., coinciding with National Nurses Week."

Source: Common Dreams, NBC

Prime-time television endorsement of Single Payer

2009-05-01T22:53:00.005-04:00

MSNBC's Ed Schultz talks to Sen. Bernie Sanders, the Vermont legislator who introduced a single-payer bill into the Senate, S. 703, about the impact of Arlen Specter switching to the Democratic Party and the impact it will or won't have on getting health care reform passed. Sanders stresses the need for a strong grass roots movement to put pressure on the Congress to stand up to the insurance and drug companies and start acting in the interest of the voters.

Learn about Taiwan's Affordable Healthcare System

2009-04-15T23:33:00.016-04:00

Source: Government information office, Taiwan
Taiwan's compulsory comprehensive national healthcare system, called the National Health Insurance program, is recognized worldwide for its success in lifting the health levels of the nation's population. The government launched the NHI program in 1995 to provide universal healthcare, streamline the previous system-which included 13 different public health insurance plans- and rein in costs.
At the time of its implementation, the NHI program extended coverage to eight million uninsured citizens or 41 percent of the population, the majority of whom consisted of children, students, stay-at-home parents, the elderly, and the disabled. In 2007, over 22.6 million people, or 99 percent of the population, were enrolled in the NHI program.

Presentation by the Vice President of

Taiwan's Bureau of National Insurance,

Dr. Michael Chen, Ph.D. Economics

Thursday, April 23
7:30 p.m.
Sage College of Albany - Kahl Campus Center Room 224
140 New Scotland Ave. Albany, NY

Dr. Chen will share the particulars of his country's successful new National Health Insurance program with students and local health care reformers.

For more information contact
Steven A. Leibo Ph.D.
leibos@sage.edu
(518) 244-2330

Sponsored by the Sage Department of History, Law & Government
& Capital District Alliance for Universal Healthcare, Inc.

A Public Plan for Health Insurance?

2009-04-07T21:33:00.005-04:00

From The New York Times (Editorial)

President Obama has rightly called for sweeping health care reform and charged Congress with coming up with a program. Expect a tough political fight.

Already one of the most contentious issues is whether to include a new public plan option to compete with private insurance plans. Many Republicans deride it as “government-run health care” and a step toward “socialized medicine.” Democrats find the notion appealing — even of vital importance.

A new public plan — to offer consumers greater choice, keep the private plans honest and, one can hope, restrain the relentless growth in health care premiums and underlying medical costs — seems worth trying.

Any new public plan would constitute only part of a much broader effort to provide coverage for 46 million Americans who currently are uninsured and many more who may soon join their ranks. Other major parts under discussion include strengthening employer-provided coverage, expanding existing public programs such as Medicaid and creating a national health insurance exchange where individuals without employer coverage, small businesses and possibly others could buy policies at inexpensive group rates from qualified private plans and, we hope, from a new public plan as well.

Many reformers suggest that a public plan be modeled on Medicare. If crafted correctly, it would provide a valuable option for people who don’t trust private insurers to have a patient’s interest at heart and would offer a safe haven should private plans abandon a market, leaving their subscribers stranded. It would also serve as a competitive yardstick for measuring the performance of private plans.

A public plan might do a better job of slowing the growth of health care costs, although Medicare has not been notably successful in that regard. The public plan would almost certainly have lower administrative costs. And it could probably force doctors and hospitals to accept lower reimbursements than they negotiate with private insurers, allowing the public plan to charge lower premiums and attract more customers.

The insurance industry and leading Republicans decry that as unfair competition. Hospitals and doctors worry about being underpaid, but there is a limit to how low government reimbursements can fall without driving them out of the program.

What many critics seem to fear most is that a new public plan would sweep away its private competitors and evolve over time into a full-fledged single-payer system (sometimes called Medicare for all). No matter how fair the competition between public and private plans might be at the start, they warn that the government would find it irresistible to rig the outcome through its regulatory and pricing powers and its ability, in a pinch, to subsidize the public plan with taxpayers’ money.

That fear seems overblown. Innovative, nimble private plans with well-integrated service systems might outperform any government plan, just as some now outperform Medicare through better coordination of services, stronger preventive care and broader benefits.

A new public plan is neither the cornerstone of health care reform nor the death knell of private insurance. It should be tried as one element of comprehensive reform. If, over time, a vast majority decides the government plan is superior, so be it.

More than 300 people attend Single Payer event in Albany

2009-03-30T23:35:00.015-04:00

Cong. John Conyers and Dr. Andy Coates

(Photo courtesy of Jon Flanders)

More than 300 people attend into the Westminster Presbyterian Church in Albany on Sunday to hear Cong. John Conyers and Paul Tonko speak about the need for Single Payer Health Care.

The lead sponsor of the event was the Presbyterian Church USA and the event featured a panel of faith representatives speaking to the moral right for health care for all.
After the event, the speaker receiving the most praise was Dr. Andy Coates of PNHP, who explained Single Payer and its importance at the moment.
Participants wrote several hundred letters to their elected officials after the event.

Source: Single Payer New York

Single Payer activists, don't give up. As President Obama said in his press conference this week, "Persistence" !
(Comment by Dr. Don McCanne)

Congressmen will talk about health reform

2009-03-27T08:57:00.003-04:00

Single-payer advocates host forum Sunday in Albany to explain system

As the nation grapples with improving the health care system and making it more affordable, a contingent of people believe the answer is a single-payer system. But advocates worry that their idea is being sidelined.

Representatives of the single-payer movement were initially locked-out of health care summit called by President Barack Obama earlier this month until supporters raised a ruckus.

"I think mainstream wisdom in Washington is reform that is not built on the private health insurance industry will not pass," said Dr. Andrew Coates, an Albany doctor who is secretary of the Capital District Chapter of Physicians for a National Health Program. "They do not want a knock-down, drag-out fight."

Under a single-payer system, private doctors and hospitals deliver health care but the bill is paid by the government. It's also known as "Medicare for all."

Single-payer advocates will host a forum on Sunday at the Westminster Presbyterian Church to explain the system to people who are not familiar with it. U.S. Rep. John Conyers Jr. of Michigan, who has proposed a single-payer bill in Congress, will speak along with U.S. Rep. Paul Tonko, of Amsterdam, who signed on as a co-sponsor to his fellow Democrat's bill.

Conyers, who eventually attended Obama's health summit, said he presumes the late invitation was due to the administration's reluctance to give his bill prominence.

A single-payer system would eliminate the need for private health insurance and potentially wipe out the industry.

"The insurance lobby is the one that has kept us from a single-payer system for the last three or four generations," Conyers said in a telephone interview.

The Presbyterian Church USA has decided that a single-payer system is the best option for health reform, and is hosting 10 forums around the country to educate people about it.

Single-payer "streamlines what is the biggest waste in the system, which is the incredible (duplication) of effort and time doctors and practitioners spend just following the paper trail," said the Rev. Cass Shaw.

Shaw is leader of the Albany Presbytery, which represents 73 congregations and 8,000 Presbyterians in the Capital Region.

In addition to the congressmen, the forum will have a panel of faith leaders from churches, mosques and synagogues in the area.

"For us, it's a religious issue as well as a civic issue," Shaw said.

Sunday's free forum will be from 2 to 4:30 p.m. at Westminster Presbyterian Church, 262 State St., Albany. Call 434-7371 for more information.

Source: Times Union

Single-payer health care system touted

2009-03-18T23:10:00.006-04:00

About 150 people gathered to demonstrate in favor of a single-payer health care system before a White House Regional Forum on Health Reform at the University of Vermont in Burlington on Tuesday March 17, 2009.

Dr. John Walsh, a neuroscience researcher from Worcester, Mass., stood Tuesday with 150 other sign-carrying supporters of government-financed health care outside the building where 400 invited guests would attend a regional health care reform forum sponsored by the Obama White House.

Walsh passed out yellow fliers that denounced President Barack Obama for failing to live up to promises to consider a Canadian-style health insurance system. "Single payer is the choice in the polls," Walsh declared.

Rebecca Elgie, a retired teacher, traveled six hours from Ithaca, N.Y., because she has made advocacy for a single-payer system her cause. Three years ago she walked 400 miles across her state to raise awareness about the need for a better way to pay for health care. Elgie said, "The employee-based system has outlived its usefulness."

The rally greeted the invited guests as they strolled toward the Davis Center at the University of Vermont under a bright blue sky. "They need to know there is enough support for people to drop everything and come here to support single payer," said Dr. Deb Richter, a Montpelier family physician and prime force in the single-payer movement in Vermont.

"Barack Obama is with us," Richter told the rally participants. "President Obama is in a leaky boat out there in an ocean surrounded by sharks. We can’t expect President Obama to stick his toe in the water. He needs our help. That is why we are here today."

Many at the rally were sure single-payer advocates would be ignored during the forum, even though some, including Richter, had tickets. But Gov. Deval Patrick of Massachusetts, who co-hosted the forum with Gov. Jim Douglas of Vermont, didn’t duck the topic. He put a spotlight on it.

"Is there one way?" Patrick asked the audience. "Should we have a couple of different ways or should we have a national template? Let’s talk a little about single payer."

Patrick called on Richter, who sat in a front row in her white coat. Noting the administrative burden that physicians face dealing with dozens of health insurance payers, Richter asked, "Why would we even need private insurance?"

Source: Burlingtonfreepress.com

2009-03-12T23:04:00.003-04:00

Health Care for All is a Moral Imperative

A Congressional Town Hall
Meeting on HR-676

Single Payer “Medicare for All”

with

Rep. John Conyers (D-MI)

Lead sponsor of HR-676, The US National Health Care Act

and co-sponsor

Rep. Paul Tonko (D-NY)

Also invited:
Governor Paterson, Senators Schumer and Gillibrand and Representative Hinchey

Sunday, March 29, 2009
2:00– 4:30 pm

Westminster Presbyterian Church

262 State Street, Albany

(1/2 block west of State Capitol, parking entrance on Chestnut Street)

For more information: (518) 434-7371

www.singlepayernewyork.org

Is the Health Insurance Industry serious about reform?

2009-03-11T00:11:00.004-04:00

By Michael Hiltzik, Los Angeles Times

In December, the health insurance industry's trade group, AHIP (for America's Health Insurance Plans), said it had decided for the first time to support the principle of universal healthcare -- insuring everyone in America, regardless of health condition.

I was skeptical. And what I found by reading AHIP's 16-page policy brochure was that its position hadn't changed at all. Its version of "reform" comprises the same wish list that the industry has been pushing for decades.

Briefly, the industry wants the government to assume the cost of treating the sickest, and therefore most expensive, Americans. It wants the government to clamp down hard on doctors' and hospitals' fees. And it wants permission to offer stripped-down, low-benefit policies freed from pesky state regulations limiting their premiums.

Figuring out the industry's stance on healthcare reform is of paramount importance this year. President Obama's healthcare forum last Thursday demonstrated that the administration and Congress are girding for a big push to remake a tattered employer-based system that has left more than 45 million people without coverage.

But what role will private insurers play? What role do you think they should play?

Read the full column: Insurers' commitment to healthcare reform is only skin-deep

Michael Hiltzik's column appears Mondays and Thursdays in Los Angeles Times. Reach him at michael.hiltzik@latimes.com

Labor attorney graduate of Harvard Law School speaks on Single Payer

2009-02-25T10:55:00.012-05:00

Interesting Tom Geoghegan interview re single-payer health care.

Tom Geoghegan is an activist and labor attorney graduate of Harvard Law School.
He spent years writing about progressive causes for The New Republic.
Geoghegan had spent much of his career representing dislocated workers in the Illinois' South Side area.

Dr. Don McCanne

2009-02-03T00:18:00.005-05:00

Dr. Don McCanne: Quote of the Day in support of Single Payer

Dr. Don McCanne is PNHP's Senior Health Policy Fellow.
He served as President of Physicians for a National Health Program in 2003-2004.

Dr. McCanne has published a daily health policy "quote of the day" in support of single payer on-line for six years to wide acclaim in the health policy community. The focus of his work is "evidence-based" health policy and health care reform.

Dr. McCanne has given hundreds of talks to national and local medical professional, civic, and faith groups, and debated proponents of "free-market" based health reforms and health savings accounts as well as advocates of individual and employer mandates.

For three decades, Dr. McCanne allotted one-half of his practice hours as a family physician in San Clemente, California to indigent patients.
He was cited by the San Clemente City Council as being "...outspoken, especially when it involves the elderly and underprivileged, because he believes that the ability to pay should not be the major criterion for receiving health care."

Dr. McCanne has elected to dedicate the remainder of his productive years to full-time activism on behalf of the cause of non-profit national health insurance.

An archive of his daily postings is under Links on this website.

To subscribe to "Quote of the Day" via email click here:

Single-payer Health Care Would Benefit All

2008-09-08T22:25:00.001-04:00

By JAMES J. BARBA

Times Union
Wednesday, September 3, 2008

When the topic of universal health care for all Americans is discussed, I have often felt that the space separating the United States from the rest of the industrialized nations, all of which have universal coverage, is occupied by a brick wall. The wall symbolizes ignorance — not merely ignorance of the benefits of insuring all citizens, but ignorance of the component parts of a universal system: parts that can make a critical difference in how we can establish one; in what it will cost and in the issue of convenient access to care.

Dr. John Bennett, the new CEO of Capital District Physicians' Health Plan, is to be commended for his Aug. 22 op-ed piece, "Is single payer the right Rx?" He answers that question by asserting that universal coverage is the ideal all of our citizens. While Dr. Bennett doesn't believe the country needs to move to a single-payer system to get there, his concession in supporting universal coverage all but knocks that wall down.

Why? First, saying universal health care is ideal moves away from the shibboleth that such coverage is socialized medicine — which, by its very term, must be evil. Next, to have a physician of Dr. Bennett's stature adopt this position marks a departure from the days of old when the American Medical Association fought such coverage. And, finally, it is the giant political step that, once taken, leaves the remainder of the debate to mechanics: how do we pay for such coverage; what is the mechanism for such payment and how we phase it in.

Against this significant concession, the issue of a single payer versus a multiplicity of payers is an easier matter, and I think that we can resolve it rather quickly. There appears to be no debate whatever that our current means of delivering health care has become cripplingly expensive. To devote more than 16 percent (and climbing) of our gross domestic product to a single service, no matter how important, is not sustainable. Once we decide that we will have universal coverage, the only approach that will allow actual and substantial savings is a single payer. There are many reasons for this:

Multiple payers have multiple rules for authorizing services, billing and the supply of requested data on the care actually delivered. A single set of rules, which everyone in the provider community follows, will eliminate most of this costly bureaucratic expense.

A single information system would allow all providers to manage and supply data to the payer. The current system, whereby each payer requires health care providers to spend significant resources on billing information systems in order to get their bills paid, is extraordinarily expensive and wasteful.

A single-payer would have a single set of protocols for negotiating fees for services and for supplies, including drugs. Providers do not, as Dr. Bennett suggests, resent the federal government setting such fees as much as they object to having little ability to negotiate each year with dozens of private payers, each one of which has its own agenda and its own bottom lines to support. Allowing a single payer to establish reimbursements that flow from drug negotiations and similar competitive market actions can satisfy the providers and eliminate substantial expense.

Finally, and most important, nothing in Dr. Bennett's article addressed the issue of the uninsured. Unless we are willing to deal with those 46 million citizens, we have no real hope of taking the largest single cost out of American health care.

Far too many of uninsured individuals receive no preventive care, and, instead, crowd hospital emergency rooms when their health issues have become aggravated — and much more expensive to deal with. Our experience with managed care payers over the last 20 years has demonstrated that they are incapable of providing preventive care and/or disease and case management in any meaningful way, evidenced by the fact that premiums continue to rise. A study done five years ago, indicates that if the nation were to move to a single-payer system, the cost savings would be in the $200 to $300 billion dollar range. From that savings, the highest estimate I have seen for giving adequate health insurance coverage to all uninsured Americans is $125 billion.

A single payer can both create a rational and universal system for all Americans and save significant amounts of money. Whether we call that system "Medicare" or something else is not relevant. Whether we can afford to deliver access and care to every citizen is.

Dr. Bennett has conceded that universal coverage for all citizens is "the ideal." I know of no cost-effective way of reaching that ideal other than through a single payer.

James J. Barba is president and chief executive officer of Albany Medical Center.

The original op-ed by Dr. Bennett can be found here.

Single Payer New York

2008-08-09T08:24:00.001-04:00

On Saturday, September 13, 2008, single payer advocates from across New York will meet in Albany to form a new statewide organization. Our aim: to build an unbeatable movement for a single payer public system that would fully fund comprehensive health care, including prescription drugs, for all. We invite all single-payer supporters to join us!

Private insurance has no legitimate role to play in the care of patients. We believe it must be replaced by a public program of health financing. Under a single-payer healthcare system, we'll spend our healthcare dollars on care, not on bureaucratic waste, profit-making and corporate gain.

Our grassroots movement has gained momentum in 2008. Healthcare-NOW and other groups organized a nationwide protest on June 19 in support of single-payer healthcare. The U.S. Conference of Mayors, the New York State Assembly, and a growing number of unions and central labor bodies have all endorsed HR 676, the National Health Insurance Act. New studies found that a majority of physicians support national health insurance. And there is renewed support for single-payer among important groups like the League of Women Voters, the Unitarian Universalist Association and the Presbyterian Church USA.

Looking ahead, healthcare will continue to be a central issue in the presidential election. And New York State, with a new governor and a changing Senate, has initiated an official evaluation and discussion of proposals for universal healthcare. Now is the time to strengthen grassroots activism in support of a single national, publicly-financed healthcare plan.

Already a wide diversity of groups and individuals across New York are working for HR 676, and also for a New York state-based single payer system. We have worked together spontaneously, organically, and successfully. We also work with many other groups that promote "universal healthcare" or "affordable healthcare," but not necessarily single payer. We are appreciative of their efforts. But the evidence is convincing that single payer reform is crucial for our state and our nation.

A formal statewide grassroots coalition will allow us to share resources, local news, publications, speakers and more. We have much to learn from one another--and from other successful state-based single payer organizations. Together we can build a vigorous single payer voice in every county in New York State—and, ultimately, a new healthcare system.

Please join us!

New York State Nurses Association ~ Mike Keenan, President, Troy Area Labor Council, AFL-CIO ~ Kathleen Scales, Executive Director, Capital District Area Labor Federation, AFL-CIO ~ Healthcare-NOW ~ Health Care Work Group of Otsego, Delaware & Chenango Counties ~ Mark Dunlea, Executive Director, Hunger Action Network of New York State ~ Tompkins County Health Care Task Force ~ Solidarity Committee of the Capital District ~ Senior Legislative Action Committee of Sullivan County ~ League of Women Voters of Saratoga County ~ Patricia Friedland, member, Healthcare-NOW ~ Rev. Cass Shaw, Albany Presbytery ~ Long Island Coalition for a National Health Plan ~ Citizens for Universal Healthcare, Kingston ~ Joel Schwartz, President, CSEA Local 446, Staten Island Council ~ Christy Staats, Clifton Park Single Payer Committee ~ Barbara Warren, Executive Director, Citizens' Environmental Coalition ~ Jeff Vogel, Delegate Assembly member, 1199 United Healthcare Workers East / SEIU ~ New York Metro, Syracuse, Ithaca, Capital District, and Finger Lakes chapters of Physicians for a National Health Program ~ Douglas Delong, MD, Physicians for a National Health Program, Cooperstown ~ Richard Propp, MD, Capital District Alliance for Universal Healthcare, Inc. ~ Doug Bullock, 8th District Representative, Albany County Legislature ~ Dr. Mo Therese Hannah Professor of Psychology, Siena College ~ Tompkins County Religious Task Force for a Living Wage ~ Gloria Mattera and Peter LaVenia, Co-Chairs, Green Party of NYS ~ Tompkins County Workers' Center ~ Rochester Interfaith Health Care Coalition ~ Justin Cunningham, Executive Director, New York Statewide Senior Action

SINGLE PAYER NEW YORK
Albany Medical College - Saturday September 13th
10am to Noon – Healthcare-NOW Roadshow, featuring Donna Smith of “Sicko"
Noon – lunch, please RSVP if you would like a box lunch
1pm to 4pm - organizing and strategy meeting

To join Single Payer New York or for further information, send an email.

Keep Medicare as a family

2008-08-07T19:41:00.000-04:00

By RICHARD PROPP
Sunday, August 3, 2008
Times Union, Albany, NY

Dear Medicare:

Happy birthday!

Since I first met you on July 31, 1965, I have been smitten with your looks, your fairness, your support of the elderly without regard to social or economic status, skin color, ethnicity, intellectual IQ, emotional IQ, address, clubs, choice of transportation, hobbies, reading list, or favorite restaurant. You took care of our grandparents, our parents, and now you are taking care of us!

Your birth was not without pain. Some of the Southern congressmen could not stand the idea of people with differing skin colors being in the same hospital room. Eventually President Lyndon Johnson, his staff, and senior citizen groups, wore down Congress, the insurance industry, the unions, and the American Medical Association, and Medicare, health care for all Americans aged 65 and over, became law. It was implemented in July of 1966. Health care was not just a necessity, it was now a right for these folks.

In July of 1965, I was moonlighting as a substitute physician in Ravena in southern Albany County with Dr. John Mosher and Dr. Ira Lefevre while I was chief resident at Albany Hospital, now known, of course, as Albany Medical Center Hospital. (Dr. Richard T. Beebe was chief of medicine at Albany Hospital and allowed us to make ends meet in this way.) More than half of our patients in Ravena who were over 65 couldn't pay for their needed medical care and instead left vegetables and chickens at Mrs. Mosher's back door. When Medicare came in, it allowed older folks to be treated as paying patients, restoring their dignity and their ability to be diagnosed and treated at an early stage of their illness. Countless lives were saved and diseases prevented. Practitioners and hospitals flourished.

Through the years, dear Medicare, you have been declared broke and broken, and somehow in response to pressure by physicians and patients, wise and compassionate politicians have patched you up and you carry on.

In 2003 you were "modernized" by radical conservatives and the drug and insurance companies, and, frankly, you were exploited. We are just now waking up to the fact that the real goal of this "modernization" was privatization. We are now paying private insurance companies 13 percent more to deliver benefits to those 65 and older through these private Medicare Advantage plans than through traditional Medicare. This wasteful and unnecessary payment scheme was highlighted in the recent struggle over Medicare physician reimbursement rates and hopefully will be addressed through the political process over the next year.

Those of us who believe health care is not just a necessity, but should become a right for all, hope that sometime soon you will have a baby and expand your family!

That baby is already in gestation stage as HR676, Expanded and Improved Medicare for All.

More than 90 members of Congress have signed on in support of this legislation, and there is a strong and growing wave of grass-roots support, as well as in the medical community, local governmental entities, and the labor movement. Your overhead of 4 percent, dear Medicare, is one-sixth that of private insurance plans, and one third that of not-for-profit plans.

Among its many benefits, socially and economically, single payer improved and expanded Medicare for all would eliminate the huge administrative expense in time and staff to deal with myriad insurance company plan requirements and reduce overhead. Hospitals would have a guaranteed budget, and rural and urban physicians and other practitioners will have patients for whom they will get full reimbursement. At least 22,000 lives will be saved and over 500,000 medical bankruptcies will be avoided each year. Job mobility and the economy will improve as health insurance becomes separated from employment.

New opposition groups are arising, however, who are very clever about espousing "universal health care", but, upon scrutiny, what they are really supporting are private insurance-based plans and the status quo.

This is really like putting lipstick on a pig. Even with lipstick, pigs are still pigs.

Forcing everyone into private insurance plans is not the solution to our health care crisis for anyone except the insurance industry. We, your family, dear Medicare, seek to expose these efforts as the cynical delay and denial tactics they represent. We will not let your estimable reputation and outstanding 43 years of success be besmirched, or curtailed by your undermining and privatizing adversaries.

Medicare, we still love you.

Happy birthday, and many more!

Dr. Richard Propp is chair of the Capital District Alliance for Universal Healthcare, Inc. and a leader of the Capital District Chapter of Physicians for a National Health Program.

Chapter update: 2008 past and future

2008-02-18T09:39:00.000-05:00

Some of our activities so far in 2008

Chapter member have already participated this year in the following events (and probably more):
1/3 Sicko film showing and discussion at Bethlehem Public Library
1/7 Small group discussion about single payer health reform at a Delmar coffeehouse (follow-up to a showing of Sicko)
1/8 People's State of the State rally at the NY Capitol
1/17 Founding of the Syracuse chapter of PNHP, 2 public talks at
Upstate Medical University
1/28 Sicko film showing and discussion in Pine Hills neighborhood of
Albany
1/29 Op-ed by Dr. Propp in Times Union
1/31 Testimony to NYS Insurance Department against merger and
conversion of GHI and HIP to a for-profit health insurance company
1/31 Single payer presentation to >100 Public Employees Federation
union members at the department of Environmental Conservation
Ongoing: Participation in MSSNY task force on health reform
PNHP submitted a New York State single payer proposal for consideration by the Governor's commission that will study methods of attaining universal health coverage in New York.

Upcoming events

Monday, Feb 25, at 6:30 pm: Roundtable discussion of "Why American Needs National Health Insurance" at the Clifton-Park-Halfmoon Public Library, 475 Moe Road, Clifton Park. Panelists: Matt Funicello, owner of Rock Hill Bakehouse in Moreau; Patricia Reed, NP, League of Women Voters; Howard Tanenbaum, MD, ophthalmologist in Canada and the US, vice-chair of our PNHP chapter; Paul Sorum, MD, PhD, chair of our chapter. Moderator: Christy Staats, Clifton Park Single Payer Committee cstaats[at]nycap[dot]rr[dot]com.

Wednesday, Feb. 27, at 11 AM: Single payer press conference, in the LCA press room (room 130), Legislative Office Building, State and Swan Street. To support the resolution introduced by Assemblyman Ortiz (NY Assembly bill K779) to call on the US House of Representatives to pass the single-payer bill HR 676 and to support single payer at state level. Ortiz has confirmed attendance, Gottfried has been invited. SHOW THE PRESS AND THE LEGISLATURE THE STRENGTH OF SUPPORT FOR SINGLE PAYER! Contact Mark Dunlea (the organizer of the press conference) at Hunger Action Network, 434-7371 xt 1# if you want to participate.

Wednesday, Feb. 27, at 7:30 pm: the next meeting of the Executive Committee of our chapter. All chapter members are welcome to attend. Please e-mail us if you would like to come.

Thursday, Feb. 28: two different (though overlapping) coalitions of health care reformers are meeting in Albany! In the morning, at 9:30 am, the coalition of groups working for universal health insurance in NY organized by Mark Dunlea will meet at the Westminster Presbyterian Church, 85 Chestnut St. (1/2 block from the Capitol) to formulate a legislative agenda and plan of action. In the afternoon, the Health Care for All New York group will be meeting. It is organized by a variety of reformist organizations (including Citizen Action) that reject single payer as politically impossible and is funded by a grant from the Robert Wood Johnson Foundation. WE NEED TO KEEP REMINDING THESE COALTIONS (ESPECIALLY THE AFTERNOON GROUP) THAT SINGLE PAYER IS THE BEST SOLUTION. CAN ANYONE ATTEND EITHER OR BOTH OF THESE MEETINGS?

Friday, Feb. 29 at 7:00 pm: Showing of SICKO in downtown Troy at Christ Church on State St. and 5th Avenue (on Troy Night Out). Discussion afterwards led by Euthemia Matsoukas. HELP EUTHEMIA RALLY THE AUDIENCE TO WORK FOR SINGLE PAYER.

Sunday, Mar 2, 2:00-5:15 pm, at First Lutheran Church, 181 Western Ave, Albany: forum on health care and hunger, sponsored by Faith and Hunger Network, Capital District Alliance for Universal Healthcare (CDAUH), Interfaith Impact, FOCUS Churches, Bread for the World, and Reform Jewish Voice of NYS.
Agenda:
2:00 Welcome
2:15 Universal Health Care for NYS
a. 20 minutes - presentation from Spitzer administration on their health reform plans
b. 15 minutes - responses by leaders of faith community and CDAUH
c. 20 minutes - Q and A and comments
3:15 Bread for the World presentation on their Offering of Letters (international aid)
3:45 break
4:00 workshops
a. 2008 NYS Legislative Agenda on Ending Poverty - e.g., welfare, other - Mark Dunlea, Hunger Action Network
b. Speaking in the Faith Community on Economic Justice - Andreas Kriefall, ARISE
c. Other
5:00 Closing remarks, next steps
5:15 Adjournment
For more info, contact Mark Dunlea at Hunger Action Network, 434-7371 ext 1#

Saturday, Mar 8, 10:00 am-noon; panel discussion on health reform, sponsored by the League of Women Voters of Rensselaer County & the New York State Nurses Association. Panelists: Richard Kirsch, Executive Director of Citizen Action of NY (supporting a combined private-public plan); James Sinkoff, CEO Whitney M. Young Health Clinic; a representative from the NYS Nurses Association; and Paul Sorum, MD, PhD, chair of the Capital District Chapter of Physicians for a National Health Program

Saturday, Mar 8, all day - PNHP table at the downstate New York American College of Physicians meeting.

Saturday, Mar 8, 10am - 4pm - New York Metro PNHP chapter annual speakers training/leadership meeting - email for details

HOLD THE DATE: Tuesday, May 6: lobby the state legislators on single payer

GHI/HIP change could hurt health care

2008-02-09T12:11:00.000-05:00

By RICHARD PROPP
First published in the Albany Times Union
Tuesday, January 29, 2008

The huge combined health insurance company GHI/HIP wants to convert from nonprofit to for-profit status. Shocked? I doubt it. Empire Blue Cross-Blue Shield set the example in 2002.

So, if this new conversion application is approved, will Capital District Physicians Health Plan and MVP Health Care follow suit? As Oscar Wilde once said, "I can resist everything except temptation."

The Capital District Alliance for Universal Healthcare believes that health care is a necessity and a social good, and that everyone should have access to high-quality, appropriate and necessary health care. The GHI/HIP "for profit" quest does not appear to further that goal.

The GHI/HIP conversion issue emphasizes many of the ongoing concerns as to whether insurance companies should continue to play such a critical role in determining who gets health care, and how and when.

When a health insurance company seeks for-profit status, it appears it has made a decision to fundamentally change how it operates to acquire a large infusion of cash. This fundamental change will logically result in a shift from a consumer-satisfaction priority to a shareholder-satisfaction focus.

Shareholders need to be kept happy, and the way to keep them happy is to make the company very profitable. How can that possibly benefit the consumers, or would-be consumers, of health insurance products? It certainly won't bring down the cost of health insurance coverage.

There is no assurance, likewise, that the large infusion of cash generated by a conversion to for-profit status will be used to benefit those who have, or would like to be covered by, a health insurance policy. The history of Empire BCBS is relevant. Its assets were used to increase its CEO's total compensation of $2.1 million in 2002, the year it got approval to convert to for-profit, to $15.5 million in 2006.

GHI/HIP's request was first disclosed publicly Dec. 13 and requires careful scrutiny. Why is the Insurance Department review timeline so short? Hearings are scheduled today in New York City and Thursday in Albany. There is no justifiable reason to act in haste on this important issue. The Empire BCBS approval process took five years.

The following questions should be asked at the hearings so that an informed and thoughtful decision can be made:

* What are the consequences of the company going from an ethic of subscriber value to one of shareholder value?

* Will the need to assure adequate profits mean premiums will increase and that more care will be denied or delayed?

* 2.7 million people lack health insurance in New York. What effect will conversion have on that number?

* How much of the new revenues generated by going for-profit will finance GHI/HIP lobbyists, and will they work for consumers or shareholders?

* In four other states, Kansas, Maryland, Washington and North Carolina, requests for for-profit status were declined after serious scrutiny by insurance regulators, including the hiring of independent outside experts who studied the impact on the insurance market and access to health care, marketplace competition and industry concentration. Are there no other management alternatives to for-profit? Are relevant studies being carried out by this administration?

* GHI/HIP has $900 million in reserves and just bought Connecticare for $350 million. Why does GHI/HIP need for-profit status to secure its future?

Dr. Arnold Relman, a physician, teacher and thoughtful national medical leader, has written that the key to saving America's health care lies in having a nonprofit health care system that includes everyone. It seems to us that approving GHI/HIP's conversion is inconsistent with that idea, will only benefit the shareholders and executives, and will result in worse health care in New York state.

Richard Propp, M.D., is chair of the Capital District Alliance For Universal Healthcare Inc.

Dr. Sorum testifies

2008-02-08T20:17:00.000-05:00

Report on the GHI/HIP conversion hearing.

At the hearing, the 4 representatives from HIP/GHI argued, repeatedly, that they need to have access to public capital markets in order to get money to improve their infrastructure so that they can compete successfully with the big private insurers. The chair of the insurance department panel was obviously skeptical but asked mostly technical questions. (In fact, most of the capital investments would, I think, be for HIP's role as a health provider, not as an insurer--it apparently runs hospitals and community health centers.)

The first speaker, our own Arnie Ritterband, gave an eloquent and articulate condemnation of for-profit insurers. The second speaker, from HANYS (Hospital Association of NYS), talked like a PNHP member as well, citing (if I remember correctly) the overwhelming evidence that quality is lower with for-profit insurers. I was the third speaker and contended that for-profit is contrary to the nature of health care and health insurance; I will copy my testimony below. Finally, the head of the NY insurance lobby gave a quite incoherent defense of the merger. I left after that.

Two of the insurance panelists, Troy Oeschner and Kathy Shure, are on the governor's commission to study how to achieve universal health insurance in NY. Even if we didn't stop the merger (which will no doubt take place in spite of our arguments), our case against for-profit insurance might have an impact on the work of the commission.
Paul

Presentation to the Superintendent of Insurance in Opposition to the Planned Conversion to For-Profit Status of HIP and GHI
Albany, January 31, 2008

Paul Sorum., MD
Professor of Internal Medicine and Pediatrics
Albany Medical College

I am a primary care physician for children and adults. My patients expect me to take care of them, not to make profits off of them. I am a teacher of medical students and residents; these future doctors are bright and talented young people who could, if they chose, make lots of money in other careers, but they want, above all, to comfort and heal people who are ill.

The fundamental goal of health care is to provide care to all those who need it, whatever their income, their social status, their habits. It is not to make profits. The fundamental role of health insurance should be to enable patients and health care providers to come together-to provide access to patients and fair reimbursements to providers. It should not be a means of making profits.

Health care is a social good: it is in the interest of society and its members that everyone be as healthy and productive as possible. Health insurance plays, therefore, an important social role. It should not be allowed to become instead a machine to generate high salaries for executives and profits for investors.

The Spitzer administration is aware that all New Yorkers should have health insurance. It is aware of the social importance of health insurance and of society's responsibility to provide access to health care to its citizens. The Spitzer administration should not, therefore, allow health care to become even more subject to, and a victim of, the dictates of the insurance market.

If you allow HIP and GHI to merge and become an investor-owned, for-profit company, you will create a new imperative-the need to make profits for the investors, for the shareholders. How can the company do this? As you well know, it cannot raise premiums above those of its competitors if it wants to sell its health policies to employers (or, to a much lesser degree, to individuals). To get money for the investors, it must-and other for-profit health insurers do--decrease the percentage of premiums spent on actual health care services. To do this, the for-profit company must limit care when possible and must pass along expenses to patients and providers (in the form of denials of payments, prior authorizations, ever-changing formularies, and the hospital and office staff dedicated to submitting claims, obtaining prior authorizations, and the like). The patients, my staff, and I work for the insurance company so that it can pay its executives and shareholders.

No wonder then that, in ratings of health insurers in terms of customer satisfaction and quality, not-for-profit insurers do consistently as well as or better than for-profit insurers. For example, the Health Care Report Card for 2007 of the NYS Health Accountability Foundation (at http://hcrc.abouthealthquality.org) rates for Albany County 3 not-for-profits (CDPHP, MVP, and GHI) and 2 for-profits (Empire Blue Cross Blue Shield and Blue Shield of Northeastern New York). In customer satisfaction, CDPHP is first and MVP second, although GHI is last. In the NCQA/US News &World Report rankings of Best Health Plans in 2007, among commercial plans, Harvard Pilgrim Health Care (not-for-profit) is #1 in the country; MVP (not-for-profit ) at #19 is the highest in New York State.

I speak in the name of the current and future physicians who are dedicated, above all, to the health and well-being of their patients. I speak also in the name of their patients and of all other patients in New York State. I urge you to stop the scandal of using the health insurance of the people of New York as a means to generate high salaries for health insurance executives and profits for individual investors. I urge you to tell HIP and GHI that they must remain as not-for-profits dedicated to the good of individual patients and of the public.

A word about SCHIP

2007-11-18T20:56:00.000-05:00

Andrew D. Coates, MD

The recent proposal, vetoed by President Bush, to expand the State Children's Health Insurance Program represents an important effort to defend working families with uninsured children from the grim cruelty of paying out of pocket for the care of a sick child, which can too easily lead to financial ruin for the entire family and impediments, at least, to medical care for the child.

In a recent discussion one person characterized SCHIP as a step toward universal health insurance. Another said that it was a move in the right direction that helps lay the groundwork for a publicly-financed single-payer national health program.

What does SCHIP offer people who are serious about health care reform?

Significantly the call to expand SCHIP offers us some claim to our own humanity as the crisis in American health care deepens, a yawning chasm before us.

Each of us must have wondered how much longer will we find ourselves putting coins and dollars into humble jars and coffee cans at diner counters, supermarket bake sales and church fundraisers to try to raise money for the treatments for an uninsured child with a malignancy. (Money for the broke parents of a child who never did anything to anyone and who, even from the most conservative, fundamentalist, neo-liberal or Malthusian viewpoint, could never be said to deserve his illness.)

Will we find ourselves among those parents, as we spend the quiet hour after putting our child to bed, racked by worries that she might need to see a doctor or a dentist -- but where can we find the money and the time off work? And what if the doctor said there are more tests are needed, or a specialist, or a hospital?

What kind of society do we live in that provides, so readily, such personal desperation and such collective horror when a child is sick?

The SCHIP program not only promises to address this appalling situation by reducing the number of uninsured children but should cost society relatively little since children in America are by and large healthy and require, compared to older people, fewer expensive treatments, hospitalizations and interventions. So (like the 84% in the NY Times poll earlier this year) we can all agree that SCHIP should be expanded to include ALL of the more than 9 million children in America who have had no health insurance.

But what can we ask of SCHIP?

Launched in 1998 SCHIP did help to reduce the number of uninsured children until 2004. (The program gives a block grant to states to fund programs to either augment Medicaid benefits to children or a establish a separate subsidized health insurance for children, or some combination of these two.)

However the number of children losing private employer-based coverage progressively outstripped enrollment in SCHIP. Since 2004 the number of uninsured children has not risen incrementally, but radically, by more than 1 million children, through 2006.

Yet the Democratic Party SCHIP expansion proposal, introduced by Congressman Rangel (HR 976), did not aim to cover all children. It hoped to provide funds to cover 3.2 to 4.2 million children by 2012 -- less than half of those children lacking health insurance now.

Thus as private health insurance fails and ever more children lose coverage under private plans, this SCHIP expansion (as proposed and even if enacted) would struggle mightily to meet the needs. So one step forward, one step back.

Even worse, with the costs of health care progressively skyrocketing, and SCHIP a capped grant given out state by state, funding for those children now covered by SCHIP has become a crisis in many states. More, its delivery would remain widely variable, depending on the state. More realistically then, one step forward, two steps back.

For these reasons the SCHIP expansion proposal should not be called a step toward universal health insurance.

Instead it should be championed as a measure to defend children and families from the vicissitudes of the American health care debacle -- cruelties unleashed because our system is dominated by private employer-based health insurance. We should explain that SCHIP, a laudable social reform that has protected many families from ruin, does nothing -- absolutely nothing -- about the cause of the burgeoning number of uninsured children.

Reforms that rely on private health insurance, including those that set up publicly-financed insurance alongside the existing system (as SCHIP does), will simply not work.

They will be brought down by the harsh realities of health care bought and sold as a modern corporate commodity: soaring costs at every level, widening disparities in access and outcomes, deteriorating quality, lack of choice of provider or clinic or hospital and private health insurance that doesn't provide health security and is increasingly not affordable, even for those who have it.

Proposals for health reform that avoid this fundamental issue may slow or may accelerate the inhumanities of our health care system, but they will not get us across the chasm.

We have all felt the inhumanity of the American health care abyss, a chasm split open under the wedge of corporate health care, led by private health insurance. Standing up for SCHIP is one way to stand up against the social cruelties of our health system.

By advocating in favor of SCHIP but explaining what it can and can't do as well as why it is needed, the effort can indeed help us lay the groundwork for the reform that offers a true step forward, - the proposal for a publicly-financed single-payer national health program like the House Bill HR 676.

The past record of private health insurance corporations has disqualified them from continuing as the central force managing American health care. If we lack mainstream politicians with the courage to say so -- we should also see with confidence that these politicians are out of step with the American people, who recognize that private insurance has got to go.

While the question of what reform is politically possible today from mainstream Democratic Party politicians is important, the question of what reform will actually work should be more important.

We need ideas for reform that have some evidence behind them. Like the SCHIP expansion proposal, we should support a reform not because it might be enacted today, but because it can truly help people.

Single-payer national health insurance offers a clear idea for evidence-based reform that is comprehensive, workable and just. Its time is now.

Like the experimental frog

2007-11-13T22:23:00.001-05:00

This excellent article is short on solutions yet offers a useful sketch of the consequences of "cost-shifting" for working people -- health care "creep" indeed. We hope everyone looks to Don McCanne's Quote of the Day for regular news and policy updates.

A quiet drain on workers' wallets
Creeping cost of health care siphons pay bit by bit.
Patrick Flanigan
Staff writer
Rochester Democrat and Chronicle (where web posts gravitate to a debate over single payer)
published November 4, 2007

Call it health-care creep.

Many American workers and their families see how their share of health-care costs continues to rise each year — but not at a pace so alarming that they point to it as a single cause of economic pain.

The headlines and the national debate over health care focus on the more than 40 million Americans with no health insurance. But, year after year, added to increasing costs for gasoline and food, health-care costs for consumers are an increasing part of the equation.

Like the experimental frog who doesn't respond to the rising temperature of the water around him, many workers with employer-subsidized insurance tacitly accept the incremental growth of their health-care expenses.

"It's one of those things that comes right out of your paycheck, so you don't pay a lot of attention to it throughout the year," said Brad Rye of Webster, who works for Eric Mowers and Associates advertising and public relations. "But we always look at it very closely (when it's time to re-enroll for health insurance). We want to know what our best options are."

According to a national human-resources company, employees' contribution to health insurance premiums have risen on average by $3.31 a week since 2001, when the average employee share was $659 a year.

That weekly increase works out to about the price of a small latte at Starbucks. But tell the same worker that his or her family's annual premium contribution jumped to $1,690 — more than $1,000 from where it was seven years ago — and it quickly starts to look like a hefty expense.

What's more, according to the study conducted by Hewitt Associates, employees' deductibles, co-payments, co-insurance payments and other out-of-pocket expenses are also rising.

Hewitt estimates that in 2008, the average employee will spend a total of $3,597 for health care — up from $1,320 in 2001.

That's an additional $2,277 a year, or $43.78 a week.

Spreading the burden

Employers have been asking their workers to take on a growing share of the company's health-care expenses for about 25 years, said Gerry Wedig, a health-care economist at the University of Rochester. "They're just trying to find ways to get these costs under control," Wedig said. "Employers are reluctant to actually reduce wages, so it's one way to keep compensation in line without raising a lot of objection from employees."

Health care is one of the fastest growing segments of the American economy, accounting for about $2 trillion in annual spending or 16 percent of the nation's gross domestic product. According to a report by the Kaiser Family Foundation, health-care spending will continue to rise and could account for almost 20 percent of the GDP by 2016.

"Health care spending has exceeded economic growth in every recent decade," the authors wrote. "The persistence of this trend suggests systematic differences between health care and other economic sectors."

Experts cite a number of reasons behind the meteoric growth. These include advances in technology that have turned once-terminal illnesses into chronic conditions treated with expensive medications or procedures; the aging U.S. population; and increases in such diseases as obesity-related diabetes.

Even healthy behavior can drive the cost of health care, said Dr. David Wandtke, the vice chairman of imaging science at Strong Memorial Hospital.

"People are living longer, healthier lives," he said. "They're going to require and demand more medical treatment."

Radiology exams like CT scans and MRIs are among the most expensive procedures in health care and insurance providers are asking doctors to be more judicious about ordering the tests. But Wandtke, who agrees the providers have a legitimate concern, said that's easier said than done.

He offered the example of a 60-year-old patient who injured her back while exercising. Years ago, her doctor might prescribe two weeks of rest and order an MRI if the pain hasn't gone away.

"Now she wants to get back on the treadmill as soon as possible," he said. "She doesn't want to spend two weeks on the couch."

Sandy Parker, president of the Rochester Business Alliance, said such trends leave employers little choice.

"If a company wants to reinvest in its own business, they're not going to be able to absorb these (health care) costs," she said. "It's just too much of a burden."

John Hayes, co-owner of GLC Business Services of Rochester, said his facilities-management company has contracted several different insurance providers in recent years to find the most cost-effective benefits package. Still, the company has cut its subsidy of single employees' health insurance to 70 percent from 75 percent.

"It's one cost we really don't have any control over," he said. "The benefit can't be bottomless. You want to be a good steward of labor, but you have to remain competitive."

Certainly, individual workers bear that burden differently.

Paul Failing of Irondequoit said he's noticed his health-care premium rise each year when it's time to re-enroll for his insurance policy. But the ESL Federal Credit Union employee said he hasn't paid much more attention to it than that.

"I recently traded in my Ford Expedition for a Honda CRV to adjust for higher fuel prices," he said. "I haven't had to do anything like that for health care. I'm blessed with good health."

Webster resident Robert Herloski, though, has found himself becoming an increasingly savvy consumer of health care because of a recent change in his insurance plan.

Herloski's employer, the Xerox Corp., offered a plan a few years ago that combines a high deductible with a pre-tax savings account — so he and his wife must pay all their health expenses until they reach that threshold.

He uses receipts from previous doctor's appointments to stock the account for the next year's health care expenses. But he's often stymied because the medical procedures are listed in a code and he can't easily figure out the actual cost.

"A lot of organizations are trying to control their costs and one of the ways they're doing that is to ask employees to be more cognizant of their expenses," Herloski said. "To be honest, I think it's good that more people are realizing what their medical costs really are."

Nancy Adams, executive director of the Monroe County Medical Society, said increased awareness of costs creates a double-edged sword.

"People should be more cost-conscious. One of the great disservices of the (health maintenance organization) system is it created the impression that health care costs $5 a visit," she said. But with the high deductible plans "unfortunately, some people are delaying care to lower their costs."

Adams cited a 2005 study by the Commonwealth Fund, a foundation working toward improved health care, that found about one-third of consumers in high-deductible plans said they delayed or avoided care. By comparison, 17 percent of consumers in comprehensive plans reported such delays.

"This has a lot of repercussions that concern us," she said.

For some workers, health-care benefits are as crucial as their pay.

Devery Reid-Holmes, a patient-care technician at Strong Memorial Hospital, doesn't pay any health-care premium under the contract she helped negotiate as an officer with the Service Employees International Union. So while her 3 percent raise adds just $16 week to her pay, she doesn't have to subtract any health-care expenses from that total.

"If I didn't have free health care, my paycheck would go to my car note, rent and health care," said Reid-Holmes, who is saving for a house. "We don't make a lot in wages, but at least we know we're guaranteed free health care for the next three years. That means a lot.

Controversial solutions

The rising cost of health care, with its subsidiary trends of high prescription-drug costs for the elderly, global competition with countries that provide socialized medicine, and a growing number of Americans living without health insurance, is driving a policy debate that's now decades old.

Leading presidential candidates have proposed health-care reform packages. And a bill to expand the number of children covered by the government-run health-care plan was recently vetoed by President Bush.

Wedig predicted health care will ultimately be rationed, with someone given the authority to determine when particular treatments are worth their cost to keep individual patients alive or well. Regardless of who's paying for it or how much it costs, consumers will always demand a product that keeps them alive.

"Everybody wants more time with their family members," he said.

To Save Counties

2007-11-06T19:25:00.000-05:00

Why a Single-payer Health Care System Would Be Good for Counties — Part One

by Paul Clay Sorum, MD
Professor of Medicine and Pediatrics
Albany Medical College, Albany, New York
and
Chair, New York Capital District Chapter of
Physicians for a National Health Program

published in NACA: The Journal of County Administration, October 2007

What can save counties from impending heath insurance-driven financial disaster? A single-payer health care system!

“The problem for counties is the soaring health care responsibilities and costs that already consume much of their budgets. County governments have a responsibility for the health of all their residents, especially for those at the margins. Many expend substantial taxpayer dollars on Medicaid, county hospitals, nursing homes, health departments, and other health costs. They provide health insurance for their current employees and retirees. All these costs are rising faster than people’s incomes and property values. County governments desperately need, therefore, a means of fulfilling their responsibilities without causing serious financial problems for county taxpayers.

The first step of a solution is to recognize the need to provide adequate health coverage to all residents of all counties. Almost all health reformers, interest groups, and politicians agree that everyone should have health insurance. If people do not have health insurance, they do not get preventive care, they do not get preventive care, they delay seeking treatment for illnesses, they use the emergency rooms more frequently than those with insurance, and counties end up paying in different ways for the unpaid and higher bills.(1) The cost of the health forgone because of uninsurance has been estimated at $65 to $130 billion.(2)

Not everyone is willing, however, to provide coverage sufficient for people’s health needs. The number of “underinsured” is rising as employers offer reduced coverage. The barebones basic packages envisioned by the Massachusetts reforms, the donut hole in Medicare part D, the high deductible policies increasingly offered to employees — all these leave millions of people underinsured, unable to pay all the co-payments on their medications, at risk of allowing their illnesses get worse, and of going bankrupt if they get seriously injured or sick. Consumer Reports reported that in May 2007 that ,“29 percent of people who had health insurance were ‘underinsured,’ with coverage so meager they often postponed medical care because of costs.”(3) Even the Reader’s Digest is alarmed: in its recent poll, “two-thirds of adults 21 and older said they feel they ‘can’t afford to be sick.’”(4)

The second step of a solution is to decide how to go about providing this adequate coverage. Reform plans fall into two categories, proposing either to utilize the private insurance companies — through tax credits or vouchers, individual mandates, employer mandates, and/or expansions of public programs for the poor — or to set up a “single-payer” system. In this issue, I will explain why private insurance companies cannot provide the solution and a single-payer system can. In the next issue, I will explain how a single-payer system would work and how it can be instituted.

Private insurers add enormous costs to our already skyrocketing medical expenditures. These include both insurers’ administrative costs — the salaries of their highly-paid executives and armies of employees, their marketing expenses, and (in the case of for-profit insurers) their profits — and the billing-related costs imposed on providers. In California, billing and insurance-related functions for insurers and providers represent 20-22 percent of privately insured spending in California acute care settings.(5) In the US, we spent in 2001 $351 per capita on administrative costs, while the Canadians spent only $54 and the French only $48.(6)

The health premiums charged by private insurers are soaring, owing in part to their administrative waste and profits. Premiums have increased 78 percent since 2001, while wages increased 19 percent and inflation was 17 percent. For employment-based insurance, they averaged $12,106 for a family of four in 2007 and $4,479 for a single person.(7) As a consequence, employers, especially small employers, are dropping health insurance benefits — 60 percent of companies offered them in 2007 versus 69 percent in 2000, and only 45 percent of companies with 3-9 employees in 2007 versus 57 percent in 2000 — and individuals have difficulty in paying on the open market for adequate insurance (especially since premiums are higher for non-employment-based insurance). Thus, in spite of the widespread conviction that people need health insurance, not only has the number of uninsured risen to nearly 47 million (15.8 percent of the population)(8), but the number who are inadequately insured is rising even faster.(9) So the counties’ health burdens are increasing. Even if counties self-insure for their own employees, they may buy health administrative services and pay for health care in markets inflated by the unneeded expenses of the private insurance companies that dominate these markets.

Private health insurers must, according to the logic of the free market, contribute to uninsurance and underinsurance. As long as health insurance is a market commodity, private insurers must promise prospective enrollees as much as possible, but also reduce costs as much as possible, i.e., must spend as little as possible of their premiums on actual health care. Even if individual medical directors and other employees are virtuous and well-meaning, they must avoid sick patients and deny care if their companies are to survive in the market.

Furthermore, private insurers cannot, unlike county governments, make the health of the population a top priority. They must, like other businesses, focus on short-term results, not on the long-term health of their enrollees (especially since these people are likely to change insurers and eventually switch to Medicare). In addition, in marketing their products to select groups, they fragment the population and undermine our already-fragile sense of social solidarity: they reinforce people’s short-sighted inclination to refuse to pay for those with more health needs, and fewer means, than themselves. They encourage healthy people to forget that they might one day suffer major illness and injury and that they, and the county as a whole, benefit if all county residents are as healthy as possible.

Private health insurers do not, therefore, provide the solution to the crisis in health expenses faced by county governments. But a public single-payer system, similar to but more inclusive than Medicare, is the solution with public financing but largely private delivery of health care.(10) All legal residents would have an insurance card entitling them to basic but comprehensive care, i.e., access to the health services that would provide significant benefit to them. The structure of the single-payer system will be discussed in the next issue. The counties would continue to play a role in delivering health care, through their clinics and hospitals, but would no longer be burdened with paying for this care.

Critics will argue, however, that a single-payer system, an expanded Medicare for All, would not be desirable. These criticisms are found not only in the distorted charges of political candidates, but also in the serious and reasoned arguments of single-payer opponents in scholarly articles and in public forums, such as in Albany, NY, the series of four forums on “The Pros and Cons of Medicare for All” sponsored by public radio WAMC in spring 2006.(11) It is necessary to address the three major criticisms.

First, opponents of a single-payer system assert that it would amount to “socialized medicine,” to “government-run medicine,” with health care decisions made by government bureaucrats rather than by physicians. This set of charges distorts the reality of what is proposed.

• Medicare for All is not socialized medicine. In socialized systems, the physicians and other providers are government employees; in Medicare for All, they would remain as they are now, mostly private practitioners, paid not by salary but by fee for service.

• Physicians and patients in countries with national health insurance have greater freedom of decision making than do physicians in the U.S.; in Medicare for All, medicine would be macro-managed; in current managed care, medicine is increasingly micro-managed, as insurance companies strive to reduce their own costs (and thereby increase the psychological as well as financial costs to patients and providers).

Second, opponents of a single-payer system point to Canada and the United Kingdom and charge that it will result in underfunding and waiting lists.

• In fact, single-payer systems do not necessarily result in waiting lists; they are not a problem in, for example, France and Japan.

• Even if they are a problem in Canada and the United Kingdom, the extreme cases are not typical (just as the cases in the U.S. documented in, for example, Michael Moore’s movie, SiCKO, are atypical); the waiting lists involve noncritical care; and lists are being reduced through government efforts to increase capacity, even as the number of Americans without health insurance increases.(12)

• Not only do those of us with health insurance often face delays to getting certain services, but those without insurance or money face uncalculated waiting times.

• Even if our own capacity is strained as health coverage becomes universal, the American public, the American voters (most of whom currently have insurance) will not put up with longer waiting lists and will insist on increasing our capacity.

Third, opponents charge that national health insurance will causes taxes to rise and will bankrupt the country by increasing health care expenses.

• What should interest individuals is not how much they pay for health care in income taxes, but how much they pay in all taxes—sales, property, payroll, and income—plus over-the-counter health expenses. The question is, therefore, what happens to overall costs.

• The only way to achieve universal access to comprehensive health care without increasing costs is to adopt a single-payer system. The reduction in administrative costs of insurers and providers and the elimination of marketing costs and insurance company profits would save far more money than would be spent on providing health coverage for the currently uninsured.

On the national level, Hadley and Holahan estimated in 2001 that the cost of the additional health services that would be used if the uninsured were provided insurance would be $33.9 to $68.7 billion.(13) Woolhandler, Campbell, and Himmelstein calculated in 1999 that reducing our administrative costs to those of Canada would have saved $209 billion.(14) In his critique, Henry Aaron argued for a lower figure, $159 billion, but still far more than the estimated additional costs.(15) On a state level, the Lewin Group has made estimates of the cost of various plans for universal coverage in numerous states from California to Mississippi; consistently, the single-payer plans save money, the others cost money.(16)

We must, however, be realistic. Even if having a single-payer health care system would seem beneficial to county governments and residents across America, what would it actually look like, and would it truly be possible to institute such a system? These are the questions to be addressed in the next issue.

Endnotes

(1) Ayanian JZ et al. Unmet health needs of uninsured adults in the United States. JAMA. 2000;284:2061-9. Institute of Medicine. A Shared Destiny: Community Effects of Uninsurance. Washington: National Academies Press, 2003. Ross JS, Bradley EH, Busch SH. Use of health care services by lower-income and higher-income uninsured adults. JAMA. 2006;295:2027-36. County-level estimates of uninsured in 2000 by the US Census Bureau, available at http://www.census.gov/hhes/www/sahie/statecntyest2000.html, accessed September 24, 2007.

(2) Miller W, Vigdor ER, Manning WG. Covering the uninsured: what is it worth? Health Aff. 2004.

(3) Are you really covered? Why 4 in 10 Americans can’t depend on their health insurance. Consumer Reports. August 2007. Available at http://www.consumerreports.org/cro/health-fitness/health-care/health-insurance-9-07/overview/0709_health_ov.htm, accessed September 24, 2007.

(4) Howley K. “I can’t afford to get sick”: Think your insurance has you covered? Just wait till you need it most. Reader’s Digest. April 2006: 57-70. Article and poll available at www.rd.com/healthcare, accessed September 24, 2007. A lower estimate of nearly 16 million people ages 19-64 underinsured in 2003 is given by the Commonwealth Fund: Schoen C, Doty MM, Collins SR, Holmgren Al. Insured but not protected: how many adults are underinsured? Health Aff. 2005;w5-289-302.

(5) Kahn JG, Kronick R, Kreger M, Gans DN. The cost of health insurance administration in California: estimates for insurers, physicians, and hospitals. Health Aff. 2005;24:1629-39.

(6) OECD Health Data. Accessed by David Himmelstein. [see also 1999 data referenced below published in the New England Journal of Medicine in 2003.]

(7) Kaiser Family Foundation. Employer Health Benefits 2007 Survey. Available at http://www.kff.org/insurance/7672/index.cfm, accessed September 24, 2007.

(8) US Census Bureau: http://www.census.gov/hhes/www/hlthins/hlthin06.html, accessed September 24, 2007.

(9) See the references in notes (3) and (4) above.

(10) The single-payer system most commonly proposed is described, with multiple links, on the website of the Physicians for a National Health Program: www.pnhp.org.

(11) Sorum PC. The pros and cons of “Medicare for All”: a series of public forums on health reform. Health Law Journal 2007;12: 24-37. Audio [of the forums] available at www.wamcarts.org (click on “Archives”).

(12) Canadian Institute on Health Affairs. Waiting for health care in Canada: What we know and what we do not know. 2006. Available at http://secure.cihi.ca/cihiweb/dispPage.jsp?cw_page=AR_1385_E&cw_topic=1385, accessed September 25, 2006. Statistics Canada. Access to health care services in Canada, January to December 2005. Ottawa: Minister of Industry, 2006. Available at http://cansim2.statcan.ca/cgi-Hadley win/cnsmcgi.pgm?Lang=E&SP_Action=Result&SP_ID=2967&SP_TYP=2&SP_Sort=-0, accessed September 24, 2007.

(13) Hadley J, Holahan J. Covering the uninsured: how much would it cost? Health
Aff. 2003;W3:250-65.

(14) Woolhandler S, Campbell T, Himmelstein DU. Costs of health care administration in the United States and Canada. N Engl J Med. 2003;349:768-75.

(15) Aaron HJ. The costs of health care administration in the United States and Canada—questionable answers to a questionable question. N Engl J Med. 2003;349:801-3.

(16) Available at http://www.lewin.com/NewsEvents/Publications/. Look in the category “uninsured & safety net.” Accessed September 16, 2007.

[lead article in the same issue of NACA: The Journal of County Administration]

Medicare: Cost Effective Capitalism
Editorial by Bob McEvoy, Managing Editor

My cardiologist gladly accepts Medicare. He is an entrepreneur, a capitalist, and you the patient, select him. Medicare, a very low cost single payer system for those 65 and older, does not tell him that he can only see you for seven minutes, like high cost for-profit HMO’s and insurance companies have done. The results of their actions are best described by the shocking statement of the 14,000 members of the Physicians for a National Health Program. The doctors said: “For physicians, the gratification of healing gave way to anger and alienation in a system which treats sick people as commodities and doctors as investors’ tools. In private practice we waste countless hours on billing and bureaucracy. For the uninsured, we avoid procedures, consultations, and costly medications. In HMO’s, we walk a tightrope between thrift and penuriousness, under the surveillance of bureaucrats who prod us to abdicate allegiance to patients, and to avoid the sickest, who may be unprofitable.”

Our doctors and nurses are heroes and we have not heard them. I listened more closely when I was invited to join a scholarly group at the Albany Medical Center and met a Gandhi-like physician. This humble practicing physician and Professor of Medicine and Pediatrics is a well researched spokesman for providing Medicare for all, similar to what the other major industrialized nations have done. I learned that the only thing exceeding his knowledge—he holds Ph.D. and M.D. degrees—is his devotion to the sick and their healing. I am particularly honored that he is sharing his wisdom with us as you will experience.

Extend Medicare to cover everyone

2007-11-04T17:02:00.000-05:00

By Alan A. Pfeffer, Attorney–at-Law, and Richard Propp, MD
Capital District Alliance For Universal Care, Inc.

Who can be surprised that all three leading contenders for the Democratic presidential nominations have based their proposals for health reform on private insurance? This, after all, is what the insurance industry is paying them for.

Unfortunately these unwise proposals are so far off the mark as to be bizarre. But we believe there is good news insofar as an increasing number of citizens understand that fact.

Imagine if they were enacted as proposed. If you have insurance, stay with it, even if the premiums are increasing 8% a year, even if the actual direct and indirect overhead is 35%, even if U.S. industry is becoming progressively less competitive, good jobs are evaporating, road and bridge infrastructure are failing, and public education outcomes are falling behind the rest of the world.

If you don't have insurance, you MUST buy it from a private insurance company. If you have a family of 4 and you make $60,000, your expendable income is $48,000. Health insurance will cost $12,000. That leaves you with $3,000 per month for food, housing, automobile, maintenance, clothing, property taxes, utilities, savings, miscellaneous. You do the math.

If you can't afford it, we taxpayers will subsidize it and subsidize the PROFITS of the private insurance company. (Remember, in order to get $1 worth of healthcare, you must pay $1.35)

None of these plans discusses the delivery side of medical care, possessing major and critical faults in our present system that lead to over-utilization, unwise care, poor patient safety, and excessive deaths.

A recent example of Republican thinking on the question can be found in David Brooks' article on health care reform “The New Social Contract” (OP-ED NY Times September 7). It is filled with the false framing of the arch-conservative. Phrases like "Americans are different from Europeans" ring hollow when it comes to the necessity of healthcare. Does he really believe we are that much different from our British cousins? Reminiscent of the fallacious corporate philosophy of rejecting any improvement not invented here, this kind of thinking also appears increasingly bizarre to most Americans.

Instead of either the Republican model of doing health care reform based on individualism and private enterprise or the Democratic idea of rescuing the private health insurance industry, we would like to see health care reform based on a Judeo/Christian model of a caring community taking care of one another through a single large risk pool.

U.S. Medicare is a remarkable government success run through private physicians and mostly nonprofit hospitals. Do you hear older Americans complaining about their Medicare social insurance which has an overhead of 3%?

Most thoughtful people realize that our 35% overhead private insurance system is driving our country into economic suicide. Just ask General Motors about its healthcare costs. The role of private for profit insurance companies in health care needs to be eliminated or minimized.

We suggest extending Medicare gradually to people of ages below 65 in five year increments, similar to the proposed HR676 bill of John Conyers. At the same time the federal/state health care programs for children, SCHIP, should be expanded in both scope of coverage and the age of eligibility. When an individual reaches 45 the two programs meet and people switch from SCHIP to Medicare.

Our basic premise is that health care is not an insurable risk. It is not the same as car insurance. In the case of car insurance there is a statistical probability of an accident occurring that the car owner insures against. There is no comparable risk equation for health.

Everyone needs preventive health care and at some point we all get sick. We now know that many illnesses are genetically based. If you have the gene you are going to get the illness or at least a predisposition for it. Under the right circumstances the illness is almost certain to occur.

If you have certain illnesses like cancer, in the absence of portability, you either can't buy health insurance or the price will be exorbitant. Insurance companies are not in the business of providing health care to society but are really running an extensive gambling operation, betting on the odds of an event not occurring. Insurance companies spend an enormous amount of administrative effort and cost in denying claims and in cleverly underwriting sick people out of their plans.

Society should be providing preventive health care through non profit social insurance like Medicare to help people avoid getting sick. In a preventive model. for example, people with diabetes can get preventive care to avoid the loss of a limb or a kidney. Under current insurance models no such care is provided. So the insurance company doesn’t pay for a diabetic to get toenails properly trimmed, but insurance will pay after gangrene sets in to have the foot removed.

The idea of rejecting a single payer system simply because it is financed by government is utter nonsense. Polls should be taken to see how many senior citizens have complaints against Medicare versus complaints against private insurance companies. We believe there will be far less complaints against Medicare.

If someone wants to buy private insurance for uncovered special items, they can. It will not be illegal and may be needed as a "wrap-around" for items that SCHIP and Medicare do not cover.

As to the fear of how America pays for it, we are already paying twice as much as other industrialized countries on a per capita basis.

America needs to get its priorities in order. We need a national debate on what is really important: farm subsidies to pay for crops that are not grown, insurance company profits for stockholders, space exploration, bridges to nowhere, foolish wars, or paying for health care so everyone can have a fair chance at life.

Single solution

2007-11-04T16:14:00.000-05:00

[The chairman of the Tompkins County (NY) Legislature explains what single-payer national health insurance would save counties.]

Single Solution:
One universal health care system answers all the questions

By TIM JOSEPH
First published: Sunday, November 4, 2007 in the Times Union

Gov. Eliot Spitzer has formed a task force to examine how to achieve universal health care access in New York. There are two fundamentally different approaches that can be taken to solve the problem.

One is to build on the current patchwork of employer-provided insurance, Medicare, Medicaid, Child Health Plus, Family Health Plus, individual pay as you go, indigent care provided by emergency rooms, etc. This approach involves making the health care system more complicated by adding patches to cover people currently left out.

The other approach is to replace the current system with a single government-managed health insurance system, sometimes called ``single payer'' or ``Medicare for all.''

As an elected county leader, I find that a tremendous amount of my time, and my county's budget, is devoted to one or another aspect of health care for some segment of our citizens. Nearly all of that time is devoted not to delivering health care, but to sorting out who will pay for it.

A big advantage of a single-payer system, compared with our current patchwork, is that it resolves this issue once and for all, and thus offers substantial savings in administrative costs.

Every estimate I've seen of those savings overlooks the myriad hidden costs associated with our current system. Here are just a few of those costs I encounter every day:

My county, like every county in the state, has an Office for the Aging. We have a 10-person staff. The largest part of their work consists of helping seniors navigate the health care system, find programs available to help them, and plan how they will manage health care costs now and in the future.

Our personnel department includes a full-time benefits manager who is mostly occupied with assisting employees in dealing with the health insurance program. Those employees lose productive work time consulting with the benefits manager and fighting insurance company denials, which can take hours from the workday.

When we negotiate with our employee unions, health care is always the biggest topic. We have a health care consultant on retainer to help us examine and cost out plan changes that we present to our unions in an attempt to control costs. At least two-thirds of the staff time devoted to collective bargaining is spent on health care issues.

We devoted hundreds of hours of staff time to developing and publicizing a discount prescription card available to all county residents to reduce drug costs for those without insurance.

We have a $400,000 state grant to form a health insurance consortium among local governments to purchase employee health care as a larger group. We will hire a consultant to help us form that consortium and find a suitable plan. Various county staff devotes substantial time to this project.

We have staff in our mental health, public health and social services departments devoted to collecting fees from private insurers to reduce the public cost of programs that deliver various health services.

We have people waiting in jail whom judges are prepared to release to drug or alcohol treatment programs as soon as we can assure payment to the treatment center. Staff in local agencies and our Department of Social Services work on getting these inmates into health care programs, mainly Medicaid, that will cover treatment. Meanwhile, we pay the cost of incarceration.

Our economic development staff encounters aspiring entrepreneurs who would like to start their own businesses, but are tied to a job by the health insurance benefits. Meanwhile, new businesses often have trouble attracting the employees they need, because they cannot yet offer a health plan.

We have staff who don't like their jobs and perform at less than the desired level, but who remain because they need the health insurance.

Nurses and other health care professionals routinely leave direct service to take jobs in insurance companies, contributing to our severe shortage of nurses and physicians.

This is just a partial list of the many ways county government and local economies spend time and money dealing with the question of who will pay for health care.

None of these costs are ever included in comparisons between single-payer and other health care systems, but every one of them would go away if there was a single, simple and consistent answer to the question, ``Who will pay?''

Only a single-payer system will accomplish that.

Tim Joseph in chairman of the Tompkins County Legislature.

1.8 Million Veterans Lack Health Coverage

2007-10-31T22:13:00.000-04:00

Contacts:
Steffie Woolhandler, MD, MPH
Jeffrey Scavron, MD
Ida Hellander, MD (312) 782-6006

Harvard Study Finds Sharp Increase Since 2000

Nearly 6 Million Uninsured Americans are Veterans or their Families

Of the 47 million uninsured Americans, one in every eight (12.2 percent) is a veteran or member of a veteran’s household, according to a study by Harvard Medical School researchers published in the December, 2007 issue of the American Journal of Public Health (galley version available here). 1.8 million Veterans (12.7 percent of non-elderly veterans) were uninsured in 2004, up 290,000 since 2000, the study found. An addition 3.8 million members of their households were also uninsured and ineligible for VA care.

The study is based on detailed analyses of government surveys released between 1988 and 2005. Veterans were only classified as uninsured if they neither had health insurance nor received ongoing care at Veterans Health Administration (VA) hospitals or clinics. A preliminary review by the study’s authors of 2006 data released last month (while this study was in press) shows little change in the number of uninsured veterans since 2004.

“Like other uninsured Americans, most uninsured vets are working people - too poor to afford private coverage but not poor enough to qualify for Medicaid or means-tested VA care,” said Dr. Steffie Woolhandler, an Associate Professor at Harvard Medical School who testified before Congress about the problem earlier this year. “As a result, veterans and their family members delay or forgo needed health care every day in the U.S. It’s a disgrace.”

Other findings of the study include:

* The number of uninsured veterans has increased by 290,000 since 2000, when 9.9% of non-elderly veterans were uninsured, a figure which rose to 12.7% in 2004.

* Of the 1.768 million uninsured, 645,628 were Vietnam-era veterans while 1,105,891 were veterans who served during “other eras” (including the Iraq and Gulf Wars).

* Of uninsured veterans, 56.5% were older than 44.

* Uninsured veterans had as much trouble getting medical care as other uninsured persons. 26.5% of uninsured veterans reported that they had failed to get needed care due to costs; 31.2% had delayed care due to costs; 49.1% had not seen a doctor within the past year; and two-thirds failed to receive preventive care.

* Nearly two-thirds of uninsured veterans were employed.

Many uninsured veterans are barred from VA care because of a 2003 Bush Administration order that halted enrollment of most middle income veterans. Others are unable to obtain VA care due to waiting lists at some VA facilities, unaffordable co-payments for VA specialty care, or the lack of VA facilities in their communities.

“Since President Bush took office the number of uninsured vets has skyrocketed, and he’s cut eligibility, barring hundreds of thousands of veterans from care. This administration has put troops in harm’s way overseas and abandoned them and their families once they got home,” said Dr. David Himmelstein, co-author of the study and co-founder of Physicians for a National Health Program. “We need a solution that works for veterans, their families, and all Americans - single payer national health insurance.”

“I see uninsured vets in my clinic every week,” said Dr. Jeffrey Scavron, a former Navy physician now practicing in Springfield, Massachusetts. “In many cases, they’re too sick to work, but not yet sick enough for full disability which would qualify them for Medicare. Only the government can put men and woman into military service and only the government can guarantee that they are covered after they serve.” Dr. Scavron is a founding member and former president of Physicians for a National Health Program.

#

Physicians for a National Health Program is a national organization with 14,000 physician members that supports single payer national health insurance. PNHP has chapters and spokespeople across the U.S. For local contact information, write info@pnhp.org or call 312-782-6006.

Himmelstein, Woolhandler et al. “Lack of Health Insurance Coverage Among U.S. Veterans from 1987 to 2004” American Journal of Public Health, December 2007.

Leadership training held in Albany

2007-10-21T09:09:00.000-04:00

The campaign for president and the impending failure of recent state-based health reform efforts like the one in Massachusetts have brought a new focus and forum for advocates for national health insurance. Michael Moore's documentary "SiCKO!" further enlightens the debate. With plans for continuing grassroots efforts and anticipating the DVD release of the movie, activists in Albany, New York met to make plans to win new supporters for single-payer national health insurance.

Over 40 single payer advocates attended a leadership training session titled "From Sicko to Single-Payer, Learning to Speak Out for National Health Insurance" on Saturday, October 13, in Hyuck Auditorium at Albany Medical Center. The meeting was hosted by the Capital District Chapter of Physicians for a National Health Program (PNHP) and co-sponsored by Albany Medical College Student Perspectives in Activism, the New York State League of Women Voters, the Capital District Alliance for Universal Healthcare and Albany Medical College student chapter of PNHP. In attendance were medical students, labor union leaders and activists, pastors, physicians, nurses, therapists and other health workers, retirees and others.

The meeting developed from summer activities at a local theater run of Michael Moore's movie "SiCKO!" including the distribution of some 14,000 leaflets at movie showings. When the movie came out the New York State Nurses Association organized a preview of "SiCKO!", and a few days later, when the movie opened at the Spectrum Theater in Albany, about 50 medical students, invited by the Albany Medical Student chapter of PNHP, attended the film wearing white coats. The New York chapter of the American College of Physicians subsequently hosted a special showing of the film for its members. An ad hoc coalition then decided to arrange the leadership training at Albany Medical Center.

During the five-hour workshop PNHP leaders Paul Sorum and Andy Coates made presentations on how to speak out for national insurance. Lively and spontaneous discussions emerged among participants all day long and the meeting found an extensive exploration of the issues. Mark Dunlea of the Hunger Action Network presented advice about talking to politicians. The session culminated with 31 of the participants getting up individually in front of the room to give their own unscripted answers to a selection of challenging questions commonly asked of single payer advocates. Participants took home a dense and comprehensive information packet put together for each participant by Euthemia Matsoukas and Paul Winkeller.

The workshop graduates are now prepared to argue for single payer in a variety of venues around the Capital District. They are ready to talk to any groups you can identify, including home parties to discuss SiCKO. Please email us to set up speaking engagements, would like one of our information packets or would like to be part of our online discussion forum.

Letters to the editor of the New York Times

2007-09-25T05:52:00.000-04:00

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

•

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

•

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

•

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

•

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

•

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.

•

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.

•

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

Woolhandler and Himmelstein in the Boston Globe

2007-09-20T23:32:00.000-04:00

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.

Testimony in Glens Falls (part 2): Matt Funicello

2007-09-07T22:22:00.000-04:00

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.

Testimony in Glens Falls (part 1): Paul Winkeller

2007-09-06T23:55:00.000-04:00

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.

See SICKO! And Learn about Private Health Insurance

2007-08-01T21:41:00.000-04:00

Published July 29, 2007 in the Daily Gazette (Schenectady, NY), page F1

by Paul Sorum, MD

You should see Michael Moore’s SICKO. You will both laugh and cry. You will feel disgusted both with our health care system and with Moore. It is, in Moore’s typical style, outrageous, one-sided, and contrived.

But its fundamental message—that the private health insurance industry is dangerous to our health—will resonate loudly with patients and physicians. Here is why:

• Private insurers impose on medical practitioners and their patients a huge financial and psychological burden of rules, paperwork, delays, and denials. Even their attempts to improve “quality” scores increase this burden.

• Private insurers add enormous extra costs to our already skyrocketing medical expenditures. These include both insurers’ administrative costs--the salaries of their highly-paid executives and armies of employees, their marketing expenses, and (in the case of for-profit insurers) their profits—and the billing-related costs imposed on providers. In 2001, we spent $351 per capita on administrative costs, while the Canadians spent only $54 and the French only $48.

• Soaring health premiums—caused in part by private insurers’ administrative waste—are causing employers to reduce or drop health insurance benefits and preventing individuals from purchasing adequate insurance. Not only are 47 million (15% of the population) currently uninsured and many more millions inadequately insured, but these numbers are rising inexorably.

• As long as health insurance is a market commodity, private insurers must reduce their costs as much as possible, i.e., must spend as little as possible of their premiums on actual health care. Even if individual medical directors and other employees are virtuous and well-meaning, they must avoid sick patients and deny care if their companies are to survive in the market.

• Private insurers cannot make the health of the population their top priority. They must, like other businesses, focus on short-term results, not on the long-term health of their enrollees (especially since these people are likely to change insurers and eventually switch to Medicare). Moreover, in marketing their products to select groups, they fragment the population and undermine our already-fragile sense of social solidarity: they reinforce people’s short-sighted inclination to refuse to pay for those with more health needs, and fewer means, than themselves. They encourage healthy people to forget that they might one day suffer major illness and injury and that they and society as a whole benefit if all people are as healthy as possible.

So what does Moore offer us as a solution? He takes us to other developed countries—Canada, Britain, France—where private insurers have greatly reduced roles. These countries have, of course, more problems than Moore shows us; no system can be perfect. But they provide high-quality health care to all residents, at half our cost. They have high levels of patient satisfaction (yes, in spite of complaints in Canada and Britain about waiting lines). They interfere in patient-physician decision-making less than do US managed care companies. Their health systems are based on the principle that all residents should have the health care they need.

But would a publicly-financed system be, in some way, un-American? As Moore points out, we already use public funding for other social goods like schools and fire protection. And we already have in this country a health program that is publicly funded, liked by patients, and efficient: Medicare. Recently, for-profit Blues spent 26.5% of premiums on administrative costs, commercial carriers 19.9%, not-for-profit Blues 16.3%, and Medicare only 3.1%. If we expand Medicare to provide comprehensive coverage for everyone, we will, therefore, not only improve the health of our population and eliminate the scandal of the uninsured, but also end up saving money!

What then should you do? See SICKO and bring our elected officials with you. Convince them that Americans’ health is too important to leave in the hands of the private insurance industry. Convince them that, like the Canadians, British, and French, we should provide our people with the health care they need, not what they can pay for.

Paul Sorum lives in Schenectady, is a primary care physician in Latham, and chairs the Capital District chapter of Physicians for a National Health Program.

Subsidizing private health insurance doesn't work

2007-07-18T22:44:00.000-04:00

The following is a press release from the Rand Corporation. At his excellent "Quote of the Day" Don McCanne made this comment: "Amazing. Using government subsidies to cut health insurance premiums in half would reduce the numbers of uninsured by only 3 percent if participation were voluntary. The initial experience in Massachusetts also indicates that mandating participation, even with government subsidies and penalties for non-compliance, also fails to achieve universal health insurance coverage."

News Release
OFFICE OF MEDIA RELATIONS
703-413-1100 x5117
and 310-451-6913
media@rand.org

FOR RELEASE
Monday
July 16, 2007

RAND STUDY FINDS HEALTH INSURANCE SUBSIDIES WON'T SIGNFIICANTLY CUT NUMBER OF THE UNINSURED

Government subsidies that cut health insurance premium prices in half for people without insurance would reduce the number of uninsured Americans by just 3 percent, according to a RAND Corporation study issued today.

The study by the nonprofit research organization contradicts suggestions by some that large numbers of people without health insurance would sign up for coverage if government provided subsidies or tax credits to reduce the cost of health insurance.

An estimated 45 million Americans don't have health insurance. Most of these people are in low- and moderate-income families where no one gets the insurance from his or her job, but family income is too high to qualify for Medicaid, the health insurance program for the poor.

Insurance policy prices aren't going to be the tool that solves the problem of the uninsured,” said M. Susan Marquis, senior economist with RAND and one of the study's authors. “Price is not the only barrier people face in deciding whether to purchase insurance. A lot of people who don't have insurance are young and healthy and would rather spend their money on something else.

People surveyed for the RAND Health study cited numerous other factors that influenced whether they purchased individual health insurance policies, including personal attitudes toward risk, whether they believe they can get good health care without insurance, perceived difficulty in selecting a health care plan, and even a concern that insurance companies require too much personal information for individual plans compared with group insurance plans.

One implication of our findings is that if you really do want to get to universal health insurance coverage, voluntary solutions that rely on financial incentives aren't going to get you there,” Marquis said. “Government is probably going to have to mandate it

The study found that among people who decide to buy non-group health insurance, price is an important factor in their decision to choose one policy over another.

Researchers found that people who buy health insurance prefer policies with more benefits and lower deductibles, even if they have to pay higher premiums. Those in poor health are particularly willing to pay a higher price for a low deductible, and are more likely to prefer insurance plans that feature mental health and prescription drug benefits.

People prefer better benefits, even if they have to pay a little bit more,” Marquis said. “It's evidence of risk aversion. People would rather pay a little more now and reduce their risk of having a bigger loss in the future. If that weren't true, you probably wouldn't buy insurance.

Researchers concluded that newer types of individual plans with very high deductibles may be attractive to healthy people, but are unlikely to help reduce the total number of people without health insurance.

The study is titled "The Role of Product Design in Consumers' Choices in the Individual Insurance Market." It will be published in a future issue of Health Services Research and has been posed online by the journal.

Marquis and her RAND colleagues looked at nearly 19,500 new individual health care policy subscribers from January 1997 through the fall of 2001. The new subscribers enrolled with the three largest non-group insurers in California, which provide approximately 80 percent of the individual policies in the state.

Researchers also examined U.S. Census Bureau survey data on the uninsured and purchasers of individual health plans in California. In addition, researchers conducted telephone surveys in California with nearly 4,000 individual health plan subscribers and 400 families with an uninsured adult in 2002 and 2003.

The data is currently relevant – even though the types of individual health insurance plans available today have changed – because the underlying behavior of consumers has remained consistent, Marquis said.

In addition to Marquis, the other authors of the study include Melinda Beeuwkes Buntin, of RAND; Jose J. Escarce, of the David Geffen School of Medicine at UCLA; and Kanika Kapur, of the School of Economics, University College, Dublin. Both Escarce and Kapur also are affiliated with RAND. The study was funded by a grant from the California HealthCare Foundation.

RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care quality, costs and delivery, among other topics.

The RAND Corporation is a nonprofit research organization providing objective analysis and effective solutions that address the challenges facing the public and private sectors around the world.

Rescue plan

2007-07-01T08:13:00.000-04:00

First published: Sunday, July 1, 2007 in the Albany Times Union

Single-payer system is the answer to health insurance woes
By ANDREW D. COATES

Michael Moore's documentary "Sicko" indicts private health insurance and calls for its abolition. "Sicko" joins an American tradition that includes Lewis Hine's photographs of child laborers (1908) and Harriet Beecher Stowe's antislavery novel "Uncle Tom's Cabin" (1852), two examples among many. But can Moore's theme change our nation in 2007?

Private health insurance, usually obtained if our employers offer it, has dominated access to American medical care for three generations.

Two generations ago, when employer-based private health insurance definitively failed to provide for the elderly and the poor, Medicare and Medicaid were enacted.

As the most recent generation of Americans has grown up, the failures of private health insurance have come to touch each of us in some personal way.

Private health insurance has failed to:

Remain affordable. Premiums, co-pays and deductibles mushroom, and employers pass their costs on to employees. Health care benefits present a sticking point in nearly every union contract.

Cover those who have it. Health care costs related to illness are the main cause of bankruptcies in America, according to a 2005 study by Harvard professors. Astonishingly, of those who were bankrupt because of medical bills, three out of four had health insurance at the outset of their illness.

Protect the patient-physician relationship. Insurance company interference in decisions that should be made between doctor and patient has become routine. Insurance rules delay and deny payment for diagnostic tests as well as treatments and very often control where a patient may seek care.

Contain spending. Health costs soar, both per capita and as a percent of gross domestic product.

Improve quality. The United States lags far behind all other developed nations on a broad index of health outcomes.

Reverse health disparities. Consider appalling data from the Centers for Disease Control that the ratio of black to white mortality among newborn babies has worsened in recent decades. A study by former Surgeon General David Satcher showed not only that blacks continue to die sooner than whites but that the overall ratio of black to white mortality changed very little between 1960 and 2000.

Cover the uninsured. Census Bureau data show that more than one in five Americans lack insurance for part of the year and more than one in six have no health insurance for 12 consecutive months or more.

A few years ago, the Journal of the American Medical Association ran a memorable article about the personal suffering and death of victims of our hodgepodge arrangement of access to medical care. The author, a Texas physician, lamented "the system of no system."

Michael Moore calls it "Sicko."

But mainstream politicians recoil from the suggestion that private health insurance has no legitimate role in society, though they repeat the word universal as if in a delirium. Recent state legislation, with the exception of California's single-payer bill, has aimed to rescue private health insurance from a crisis of its own making.

Look at Massachusetts, which this year required individuals to purchase private health insurance. With confusing, expensive and limited-coverage plans, bloated bureaucracy, thousands remaining uninsured and costs continually rising, the bipartisan-supported "Massachusetts miracle" already stumbles toward failure.

Americans know from personal experience that private health insurance ties up an enormous amount of resources in administrative costs and profits at least $350 billion annually, according to an article in the New England Journal of Medicine. American and Canadian Medicare both have proven for decades that very low overhead costs are feasible in a public health program.

The resources wasted by private health insurance on administration and profit could be used instead to cover all necessary medical care, for everyone -- primary care, specialty care, hospital care, dental care, mental health care, home care, rehabilitation, nursing home care and prescription drugs.

Earlier this year, in a New York Times/CBS News poll, 64 percent of those asked agreed that "the federal government should guarantee health insurance to every American."

To share risks, to control costs, to protect the doctor-patient relationship and to reverse shameful disparities, a single-payer system of public health insurance, with everybody in and nobody out, presents the only proposal that is both practical and just.

This is the idea behind a bill in Congress, H.R. 676: "The United States National Health Insurance Act." Among its 78 co-sponsors are Reps. Michael McNulty of Green Island and Maurice Hinchey of Saugerties.

Michael Moore hopes to convince America that our sick-o system of no system, based upon private health insurance, is a disgrace. Can a film move us to embrace a national health program?

See you at the theater!

CounterSpin Don McCanne on 'SiCKO' & single payer, Stuart Ewen on health care propaganda

2007-06-30T11:17:00.000-04:00

Counterspin (6/29/07-7/5/07)

This week on CounterSpin: Michael Moore's new film SiCKO is premiering around the country, delivering a blunt message: the U.S. health care system is broken. But Moore doesn't just want to fill movie theaters; he wants to spur a debate about health care policy—namely, getting rid of the private health care system in favor of a public, government-financed one. That'll be a tough sell to the mainstream media; we'll talk to Don McCanne of Physicians for a National Health Program about SiCKO and the debate over health care.

Also on CounterSpin today, why doesn't the United States have publicly-financed health care? Some in the media say Americans are just different; but of course there's more to it than that. We'll look at the propaganda effort to defeat national health care just after World War II, when policies supported by the president, congress and the American people succumbed to a corporate right propaganda blitz. We'll talk to Professor Stuart Ewen of the CUNY Graduate Center and Hunter College.

Listen to an mp3
RealAudio link at Counterspin (6/29/07-7/5/07)

Healthcare professionals, union leaders, consumer activists attend preview of "SiCKO" in Albany

2007-06-27T23:20:00.000-04:00

Albany, N.Y. – June 27, 2007 – Nearly 200 registered nurses, doctors, and leaders from both the labor and consumer advocacy community attended a special advance screening of Michael Moore’s new film, SiCKO, this evening at the Spectrum Theatre.

The invitation-only event was designed to build grassroots support for a national healthcare program and was arranged by Michael Moore and the Weinstein Company at the request of the New York State Nurses Association (NYSNA). The sponsoring organizations support a single-payer, national healthcare financing system, sometimes called “expanded and improved Medicare for all.”

That proposal is before Congress in the form of Bill HR676, which has 74 cosponsors in the House of Representatives.

“Health care is a basic human right,” said Tina Gerardi, RN, NYSNA chief executive officer. “To make sure that every American has access to care, we must abandon a system controlled by for-profit, private insurance companies. We need a single-payer plan that covers everyone.”

“Private health insurance, which usually is obtained only if employers offer it, has dominated access to American medical care for three generations – and this system has failed,” said Andrew Coates, MD, secretary of the Capital Region Chapter of Physicians for a National Health Program. “The resources wasted on supporting private, profit-driven health insurance companies could be used to cover all necessary medical care for everyone – primary care, specialty care, hospital care, dental care, mental health care, home care, rehabilitation, nursing home care and prescription drugs. A single-payer national health program is the only proposal that is both practical and just.”

“The American healthcare system is not safe. The Institute of Medicine estimates that 18,000 Americans die each year because they can’t afford health insurance,” said Richard Propp, MD, chair of the Capital District Alliance for Universal Healthcare. “The system also is financially unsafe. Each year 500,000 people declare bankruptcy due to medical bills. Premium costs are skyrocketing, producing record profits for private insurance companies. We need to create a healthcare system where patients, not profits, come first.”

“As is documented in SiCKO, private health insurance is at the heart of what is wrong with the American health care system,” stated Mark Dunlea, associate director of Hunger Action Network of New York State.
– more –

“Providing quality health care for all while controlling costs starts by ending – not expanding – our wasteful system of private health insurance. We need Senators Clinton and Schumer to join many New York Congressional members like Michael McNulty in sponsoring a Medicare for All national health care system. We also need Governor Spitzer to incorporate a single-payer approach into the universal health care proposal for New York that he expects to release next spring,”
This year’s state budget includes $200,000 for a cost-benefit analysis of various approaches to a state universal healthcare system, including single payer. High health care bills are one of the major reasons why more than 2 million New Yorkers annually utilize emergency food programs. Upstate, 58% of bankruptcies are related to high health care bills.

“The cost of health insurance has become problematic for many working Americans and a major stumbling block in settling union contract negotiations,” said Mike Keenan, president of the Troy Area Labor Council and a vice president of the Capital District Area Labor Federation, AFL-CIO. “HR 676 would save billions of dollars by eliminating the high overhead and profits of the private health insurance industry and HMOs. The transition to single-payer national health care would apply these savings to expanded and improved coverage for all.” The Capital District Area Labor Federation has unanimously endorsed HR676.

Additional sponsors of the SiCKO event include Healthcare-Now and the Solidarity Committee of the Capital District.

Industrial union leader reviews "SiCKO"

2007-06-25T22:04:00.000-04:00

Review of Michael Moore’s New Film,”SiCKO”

By United Steel Workers International President Leo W. Gerard

Michael Moore, the activist author and filmmaker, has given every union member in the United States a great tool of advocacy for our health care agenda with his new movie, “SiCKO.” We should return that favor by attending the premiere of his movie June 29. Wear your USW gold and blue when you go.

With a compelling combination of humor and pathos, “SiCKO” documents how medical insurance companies act like cancer on this country’s health care system. This is what we want to eliminate with a national health care system.

Moore begins “SiCKO” by subjecting his viewers to excruciatingly painful insurance system failure scenes. They include an injured worker suturing up his own lacerated knee because he is one of the 47 million Americans without health insurance; a couple moving into a spare room in their daughter’s home after medical insurance co-payments for the husband’s three heart attacks and the wife’s cancer forced them into bankruptcy, the most common cause for personal bankruptcy today; and a young woman recounting the death of her 18-month-old baby because an ambulance took the critically ill girl to a hospital that refused to treat her because her insurance would not pay for services there.

Those disquieting scenes are thankfully interspersed with Moore’s often-comical antics in four countries with national health care: Canada, Britain, France and Cuba.

In Canada, he tools around in a golf cart with a conservative, who endorses the country’s national system of medicine and describes its creator, Tommy C. Douglas, as a Canadian hero, akin to George Washington or Abe Lincoln.

How could a conservative support socialized medicine, Moore asks the man. The conservative says it’s because not everyone can afford the medical services they need. The conservative, like Michael Moore and most of us, recognizes that health care is a human right, not some kind of privilege bestowed only on the rich or the lucky.

On his trip to Britain to investigate their national health care system, begun after World War II, Michael Moore searches a hospital for some department that will bill a patient. Finally, after numerous workers laugh at him, Moore discovers a cashier’s window. It turns out, however, money is dispensed from the window to patients, reimbursing them for public transit to the hospital.

Moore reports that his research shows that Canadian, British and French citizens live longer, healthier lives than Americans, and their infants are more likely to survive. The overhead costs for these health care systems are far less than America’s. In fact, the overhead for the one, already national system in America, Medicare, is 3 percent. It’s 30 percent for the insurance system. Apparently, Moore says, the government can do something right.

Moore ends up in Cuba after trying to take some American patients, including two 9-11 first responders who suffered lung injuries, to Guantanamo Bay to get some of that free health care American is dispensing to accused al Qaida war criminals imprisoned there.

After being refused entrance to the American portion of the island, Moore takes his patients to a Cuban hospital which provided free treatment to the foreigners, under the same procedures and circumstances that it gives care to Cuban citizens. The idea, again, was that medical treatment is a right of all humans, regardless of nationality, or religion or politics.

A Cuban firehouse conducted a ceremony to honor the first responders before they left because, the firemen said, they were all brothers and sisters. The Cubans said they wished they could have aided with the rescue on 9-11.

This kind of solidarity is essential for us to win a better health care system. The film advocates radical surgery on the American system to excise the insurance companies, which profit by denying coverage, treatments and pharmaceuticals, and by rescinding payments once made.

Michael Moore argues in “SiCKO” that this is not representative of American behavior. We show solidarity in crises. We rush to aid each other when there’s a tornado, a Katrina, a Virginia Tech. We bring food, build houses, give blood and clothes. We are generous. We are not the people of a stingy health care system. We have the right, the power and the opportunity to deliberately plan and build a health care system that would be fair and equitable and cover everyone as a human right. Let’s stand in solidarity for that.

We all know from our bargaining experiences how crucial it is to get health care off the table. That would eliminate much of the contentiousness in negotiations and make it much easier for American companies to compete in the global economy against nations that already provide national health care, including all of those in Western industrialized countries. We should act to radically reform the existing health care system that has resulted in 47 million uninsured Americans.

Make no mistake. Moore’s film advances our cause. It’s to our benefit to advance his film, which will play in only about 1,000 theaters its first weekend. The more people who clamor to get into those doors that first weekend, the more movie screens it will appear on the following week, and so on. The more popular the film, the more clear it will be to politicians that this issue must be addressed.

Again, I encourage you to go see the movie on opening night. Put on your USW cap or shirt when you go. Take your family and friends and neighbors. And take action outside the theatre, too. Stand in solidarity with your union brothers and sisters and Michael Moore to cure our SiCKO health care system.

What's the One Thing Big Business and the Left Have in Common?

2007-04-20T21:18:00.000-04:00

Letter to the Editor
New York Times Magazine
April 15, 2007

Is this what our country has come to? Leading C.E.O.’s, despairing of their ability to limit rising health-care costs and unwilling to bear these costs themselves any longer, will now back legislation that would place every individual and family at the mercy of private insurance companies like UnitedHealth, Wellpoint and the other insurance giants. Do they think John and Jane Doe can achieve what Safeway and General Motors cannot, namely, affordable health care for all of us?

Instead of moving backward to the time before there was employer-based or group health insurance, when people were on their own to get health care any way they could, we should be moving forward, recognizing that health care is a necessary public good that should be treated as a public responsibility. We should be expanding and improving the Medicare program, which we know provides reliable, cost-effective coverage and has been doing so for more than 40 years. Public Medicare-for-All, not private for-profit insurance, is the only path to a future that will truly provide access to health care for all Americans.

Oliver Fein, M.D.
New York
Leonard Rodberg
Flushing, N.Y.

(The authors are, respectively, chairman and research director of the New York chapter of Physicians for a National Health Program)

The New Massachusetts Health Reform: Half a Step Forward and Three Steps Back

2007-01-25T21:04:00.000-05:00

by Steffie Wooldhandler and David U. Himmelstein

Massachusetts runs in regular cycles. Every eighty-six years our Red Sox win the World Series. Once a decade Harvard hires a seior woman scientiest. And every twenty years our legislature passes a universal health care bill that the governor hopes to use as a springboard to the White House.

Unfortunately, Governor Mitt Romney’s stab at universal coverage looks set to repeat the flop of Michael Dukakis’s bill two decades ago. Then as now, our governor crowed about “Health Care for All” in the statehouse rotunda. But Dukakis’s plan imploded within two years, and today 250,000 more people are uninsured in Massachusetts than on the day it was signed.

The Structure of the New Bill

The new bill includes two provisions meant to expand coverage. First, it will modestly expand Medicaid eligibility. Second, it requires people with incomes above 100 percent of the poverty line to purchase a private insurance policy. The state will offer partial subsidies for the purchase of this private coverage to families with incomes below 300 percent of the poverty line (about $30,000 for a single person or $60,000 for a family of four). Those above three times the poverty line will have to pay the full cost of their own coverage.

To help make coverage more affordable, a new state agency called “the Connector” will connect people with the private insurance plans that sell the coverage. The Connector is also supposed to help design affordable plans. Massachusetts citizens will be allowed to use pre-tax dollars to purchase coverage (although this tax break mostly helps affluent taxpayers in high tax brackets).

Businesses that employ more than ten people and fail to provide health insurance will be assessed a token fee (not more than $295 annually—about fifteen cents per hour of labor) to help subsidize care. Additionally, hospitals won a rate hike assuring them better payments from state programs, and several provisions were included that are meant to attract additional federal funding to help pay for the Medicaid expansion.

The new plan is half a step forward for Massachusetts. One positive element in it is that all legal Massachusetts residents with incomes below 100 percent of the poverty line will now get publicly paid coverage. However, less than 17 percent of uninsured people in the state have incomes that low. Moreover, new federal Medicaid regulations that require proof of legal status will disenroll undocumented immigrants, as well as some African-Americans who lack birth certificates because they were born at home in the rural south. The bill also includes funds to help a few safety net hospitals keep their doors open. (Disclosure: We work at one such hospital.) However, it phases out the state’s free-care pool, which has sustained safety net hospitals and covered many undocumented immigrants.

Unfortunately, the bill also takes three steps back. First, the contention that the bill will generate universal coverage is based on extremely fuzzy math. The politicians assumed that only about 500,000 people in Massachusetts are uninsured. The Census Bureau says that 748,000 are uninsured. Why the difference? The 500,000 figure came from a telephone survey conducted in English and Spanish. Anyone who did not have a telephone or who spoke another language (roughly one-third of immigrant families in Massachusetts) was, in effect, counted as insured—a dubious assumption since nationally 43.9 percent of phoneless adults are uninsured (1) and many non-English speaking immigrants lack coverage. The Census Bureau’s 748,000 figure comes from a much more thorough survey, the Current Population Survey, which is carried out in person, door-to-door, with surveyors who speak multiple languages (including Portuguese and Haitian Creole, common in Massachusetts). In sum, the calculations behind the reform plan overlook everyone who lacks a phone or does not speak English or Spanish, nearly half of whom are likely to be uninsured. Hence, the level of funding in the bill for insurance subsidies and Medicaid expansion is grossly inadequate to cover the actual costs.

Second, 83 percent of the new coverage is of the “buy it yourself” variety. The linchpin of the bill is an individual mandate that forces near-poor and middle-income uninsured people to purchase coverage (or suffer tax penalties). Unfortunately, few of the uninsured can actually afford adequate coverage. Currently, a reasonably comprehensive health insurance policy in Massachusetts costs about $6,000 annually for an individual or $14,000 for a family. A wealthy uninsured person could afford that—but few of the uninsured are wealthy. Only 23 percent of those without coverage make more than five times the poverty level.

Third, the legislation promises that the Connector will help the uninsured find comprehensive and affordable private health plans, but that’s like promising delicious chocolate chip cookies with no fat, sugar, or calories. While officials have projected that the mandatory policy will cost only $300 per month for an individual plan and $600 for a family, the only way to get private plans that cheap is to strip down the coverage: boost copayments and deductibles and exclude important services from coverage altogether. Such stripped-down coverage may let politicians claim they’ve done something useful, but it provides neither adequate access to care nor real financial protection. In the RAND Health Insurance Experiment (the only randomized controlled trial comparing highdeductible plans to comprehensive coverage), high deductibles caused a 17 percent fall in toddler immunizations and swelled the number of children failing to see a doctor in the course of a year from 15 percent to 32 percent among school-aged children and from 5 percent to 18 percent among infants and toddlers. (2) While high deductibles reduced children’s use of “rarely effective care” by 33 percent, they also reduced “highly effective care” by 28 percent. Adults in the RAND Experiment also used less preventive and primary care, and had higher blood pressure and higher risks of dying, when high deductibles were placed on their insurance coverage.

Stripped-down plans like those that the Massachusetts uninsured will be forced to buy also do little to protect people against financial catastrophe due to illness. In our own work on medical bankruptcy, 76 percent of those bankrupted by medical problems had insurance at the onset of the illness that bankrupted them; many were ruined by copayments, deductibles, and uncovered expenses such as physical therapy.

Covert, Regressive Taxes Rather than Cost Containment

The individual mandate will force working families to make bitter choices: pay premiums they cannot afford or buy stripped-down policies—or both. The vast majority of the new money in the bill comes from the mandated premium payments of low-to-middle-income families who are now uninsured. While families will pay these premiums to private insurance companies rather than to the government, they are in fact a highly regressive new tax: the wealthy contribute virtually no new money to the system, while the near-poor who were previously uninsured foot the bill.

Moreover, the legislation will do nothing at all to contain the skyrocketing costs of care in Massachusetts. With costs 30 percent above the national average, Massachusetts already has the highest per capita health care costs in the world. Predictably, rising costs will force more and more employers to drop coverage, while state coffers will be drained by the continuing cost increases in Medicaid and the private insurance subsidies for the near-poor. When the next recession hits, tax revenues will fall just as newly unemployed people flood the Medicaid program or apply for the insurance subsidies promised in the reform legislation. The program is simply not sustainable over the long—or even medium—term.

What Are the Alternatives?

In announcing the new bill, Governor Romney proclaimed that the bill marked the demise of the movement for singlepayer national health insurance. Yet single-payer contains two elements lacking in the Massachusetts bill: universal coverage and cost control.

A simple single-payer plan would make coverage affordable by eliminating the multiple, competing insurers that generate our massive health administrative costs, currently at least 31 percent of total health spending. (3) For instance, Massachusetts Blue Cross spends only 86 percent of premiums paying for care. It spends the rest— more than $700 million annually—on billing, marketing, and other administrative costs. Harvard Pilgrim and Tufts Health Plan—Massachusetts’s other largest insurers—are little better; each collected about $300 million more in premiums than it paid out in benefits. That’s ten times as much overhead per enrollee as Canada’s national health insurance program. And our hospitals and doctors spent billions more fighting with insurers over payments for each bandaid and aspirin tablet. Overall, Massachusetts residents will spend $13.3 billion on health care bureaucracy in 2006. If we cut bureaucracy to Canada’s levels we could save $9.4 billion annually, enough to cover all of the 748,000 uninsured in Massachusetts and improve coverage for the millions more who are now under-insured.

A broad spectrum of researchers have concluded that single-payer is the only reform option that can expand coverage without increasing costs. Back in the 1980s, the Congressional Budget Office and the General Accounting Office estimated that universal coverage under single-payer was a break-even proposition because administrative savings would offset new clinical costs. More recently, a raft of studies by the Lewin Group—a fairly conservative consulting firm—evaluated proposed state single-payer plans and reached the same conclusion. Another consulting firm engaged by the Massachusetts Medical Society estimated that a single-payer plan could actually decrease spending while covering everyone in Massachusetts.

A broad spectrum of researchers have concluded that single-payer is the only reform option that can expand coverage without increasing costs. Back in the 1980s, the Congressional Budget Office and the General Accounting Office estimated that universal coverage under single-payer was a break-even proposition because administrative savings would offset new clinical costs. More recently, a raft of studies by the Lewin option, and tens of millions of dollars lobbying politicians to keep single-payer off the table, it remains popular. Nearly two-thirds of Massachusetts physicians support it (4), along with the Massachusetts Nurses Association and dozens of other labor and consumer groups and seniors organizations. Nationally, 62 percent of Americans favor “a universal health insurance program, in which everyone is covered under a program like Medicare that’s run by the government and financed by taxpayers.” (5)

The Massachusetts legislation raises ethical and policy issues that go far beyond health care. Has our democracy become incapable of enacting reforms, like single-payer, that benefit the vast majority of Americans but threaten the multi-million dollar paychecks of executives and the outrageous profits of private firms? Must every initiative to help the poor also further enrich the wealthy? Must we slash the estate tax if we hope to raise the minimum wage?

The Massachusetts legislature has answered: Yes. Their bill will generate huge new revenues for private insurers, vastly increase payments to already flush hospitals, excuse the wealthy from sharing the burden of covering the uninsured, and saddle working families with huge bills for nearly useless coverage.

Our patients and our democracy deserve better.

(1) S.J. Blumberg, J.V. Luke, and M.L. Cynamon, “Telephone Coverage and Health Survey Estimates: Evaluating the Need for Concern about Wireless Substitution, American Journal of Public Health 96 (2006): 926-31.

(2) J.P. Newhouse and the Insurance Experiment Group, Free for all? Lessons from the Rand Health Insurance Experiment (Cambridge, Mass.: Harvard University Press, 1993).

(3) S. Woolhandler, T. Campbell, and D.U. Himmelstein, “Health Care Administration Costs in the U.S. and Canada,” New England Journal of Medicine 349 (2003): 768-75.

(4) D. McCromick et al., “Single-payer National Health Insurance: Physicians’ Views,” Archives of Internal Medicine 164 (2004): 300-304.

(5) Washington Post-ABC News Poll: Health Care, October 20, 2003. Single-payer plans contain two elements lacking in the Massachusetts bill: universal coverage and cost control.

The Insurance Companies' Plan for Covering the Uninsured

2006-11-16T09:51:00.000-05:00

by Marilyn Clement, National Coordinator, Healthcare-NOW

In a plan revealed November 13th, less than a week after the historic election of a new Congress, America’s Health Insurance Plans (AHIP) called for more hundreds of billions of dollars to be provided by the federal government to pay for the uninsured – and to pay for them in ways that would continue to line their own pockets. They call it “Hope for Millions.”

Here are some of the questions that were not addressed. Why would the insurance companies who are raking in hundreds of billions of dollars in excess profits and basically standing in the way of a national non-profit healthcare program for all create a new plan to cover the uninsured? Why haven’t they done it before? What do they stand to gain? What do they stand to lose?

The follow-up story should explore the fact that a national healthcare program is the number one domestic priority of the voters. According to some statistics, 83% of the people want such a program and recognize that we are the only industrialized country in the world that doesn’t have such a program. People expect Congress to take decisive action to provide a national healthcare system.

Most of the people want such a program because the healthcare crisis isn’t primarily about the uninsured. We are all close to being uninsured, and even when we are insured we face the growing costs of insurance policies, the co-pays and deductibles, the potential of losing our job, and worst of all, the fact that insurance companies cancel insurance policies when people get really sick.

It doesn’t have to be that way.

Reporters ought to talk with Congressman John Conyers whose bill, the United States National Health Insurance Act, H.R. 676, was introduced during the last Congress and has 78 co-sponsors on it. There is a growing constituency of millions of people who understand and support this bill. It would provide comprehensive, quality healthcare for all residents of the United States including payment for all physicians and hospital costs, dental, optical, mental health, prescription drugs for all and long-term care, among other benefits. You would never receive another healthcare bill. There would be no co-pays, deductibles, or denials. There would never be any more bankruptcies caused by healthcare costs.

Congressman Conyers has jurisdiction over bankruptcy as a part of his Judiciary Committee duties. About 50% of the bankruptcies in the U.S. are caused by healthcare crises. People are losing their homes and their jobs and their livelihood, children are missing a college education, and businesses are going bankrupt and/or cutting out healthcare coverage entirely because of the rising cost of insurance.

It would be good for reporters to check out Conyers’ bill and see how it would be financed by all of us, employers and employees, paying a small premium based on our income, and that all of us except 5%, the ultra rich, would be spending less money than we are now paying for healthcare.

The cost of high-priced insurance companies would be eliminated because we wouldn’t need them. They don’t provide any healthcare at all. This would save almost $300 billion each year. Insurance companies just take the money, make a huge profit, and pay out a reduced amount, too little for the healthcare of the people. They are money-managers, not healthcare professionals. They even invest our money in tobacco and other detrimental corporations. They control the doctors, the Congress, and our healthcare at the moment. They want to keep that control. So they are scurrying about to try to get their own survival plan firmly entrenched in Congress.

President Bush’s Health Savings Accounts and ownership plans are also promoted in the AHIP plan. These would provide money to managers and put more money into Wall Street. The affluent who would then get tax breaks for saving money for future healthcare needs. Because of their tax-breaks, government money sorely needed for a healthy society would be used to further enrich the money managers. People would be urged to pay as much as possible out of pocket into the system before accessing their Health Savings Accounts.

Healthcare-NOW is a national movement made up of hundreds of organizations challenging this kind of continuing government subsidy for the health insurance industry. We need healthcare – not insurance companies. AHIP represents those 1300 insurance companies that would be replaced by a single payer such as an improved Medicare for All. At present, they benefit from the increasing privatization of Medicare Part D and Medicaid and Medicare reimbursements for their management costs. That’s why they are proposing to “help the uninsured” by providing more tax money to Medicare and Medicaid.

The uninsured must be covered. It is a mandate. But the rest of us need a good healthcare system too. It could be so simple and so beneficial if we went for a single payer national non-profit healthcare system instead of more money to the insurance companies.

If you would like more information, please check our website.

Marilyn Clement, National Coordinator
Healthcare-NOW

Healthcare-NOW Co-Chairs:
Leo Gerard, President of the United Steelworkers (largest industrial union in North America)
Jim Winkler, General Secretary of the United Methodist Board of Church and Society
Dr. Quentin Young, National Coordinator of Physicians for a National Health Program

Pace Poll: New Yorkers favor a government-run health insurance plan

2006-10-30T21:56:00.000-05:00

This via the Brian Lehrer show on WNYC.

A new poll by Pace University/New York Magazine/WCBS 2 News/WNYC asked New Yorkers to compare single-payer health insurance with an individual mandate to purchase private insurance, along the lines of the Massachusetts plan. Evidently, Mr. Lehrer himself put forward the idea for the question.

This morning during his "Pacing Politics" segment Brian Lehrer struck a note of astonishment that 48% of New Yorkers support the abolition of private health insurance in favor of a solitary publicly financed government-run plan, while 35% supported a statewide mandate that individuals purchase private health insurance.

The overall poll sought to gauge public opinion on a variety of candidates and issues on the eve of the elections; there was only one question on health care.

The results do not add up to 100% - at this point we only have the data via the link above.

The actual question -- as it appeared for the pollsters to ask:

Question 43:

Now I'm going to read you some statements about health insurance, which helps people pay doctors' bills and other medical expenses. When I am done, please tell me which one you agree with more.
[ROTATE]

Statement A:
Some/Other people say that New York State should require people without health insurance to buy it and that the government should help people pay for health insurance if they can't affort it. They say that many unisured people are young, healthy, and financially well-off, so their failure to buy health insurance forces the rest of us to pay more than our fait share of the high cost of caring for the sick.

Statement B:
Some/Other people say that New York State should create a government-run health insurance program to replace private health insurance companies and provide health insurance to everyone. They say that the private insurance companies drive up the cost of health care by acting as useless middlemen between doctors and patients, and they say that people in other countries spend less money on health care while enjoying better health because they don't waste money on insurance
companies.

Which statement do you agree with more?

Results:

22% strongly agree with A
13% somewhat agree with A
29% strongly agree with B
19% somewhat agree with B

Overall (by 48% to 35%) New Yorkers favor a "government-run health insurance program" to a plan that would "require people without health insurance to buy it."

Medicare for All is a smart decision for business world

2006-10-25T00:01:00.000-04:00

By DR. RICHARD PROPP
First published: Sunday, October 22, 2006

Every day across New York, doctors, their employees and hospital workers spend much valuable time anxiously dealing with health insurance company employees. And every day, businesses begin the multimonth process of evaluating old and new insurance plans, investing more and more to provide decent health insurance in an attempt to retain good employees and keep them healthy. Increasingly, businesses give up providing health insurance because they can't afford it.

The United States is the last country in the industrial world without a universal health care system. We spend more per capita ($6,102) yet cover a smaller proportion of the population than Canada ($3,165), France ($3,159), Germany ($3,005) or the United Kingdom ($2,546). At least 47 million Americans lack health insurance. Our outcomes for infant mortality and life span are worse than in these other countries, the Organization for Economic Cooperation and Development reported this year.

The universal health care movement seeks a practical way to solve the health care needs of all Americans. Because the business of America is business, and with apologies to the Letterman staff, here are the top five reasons the business community should care about expanding the federal Medicare program for seniors and those who are disabled to provide Medicare for All: (5) More capable employees: Fully insured part-time and full-time employees mean improved wellness, less absenteeism and better retention. (4) Reduced auto, truck and business insurance costs: Businesses will pay less for upfront insurance because most of the medical portion of bodily injury or chronic disability care needs of an injured party will be covered by Medicare For All. (3) Reduced administrative responsibilities. Expansion of Medicare to cover all citizens, financed by the government but run privately, would eliminate costly employer time and energy to explain benefits each time a new plan is purchased or an old plan is changed. All bills would be paid from a single pool, eliminating time spent dealing with multiple bills from multiple vendors of multiple services using multiple forms. Improved employee morale would follow and labor management expenses would decrease as negotiations on health care benefits would be off the table. Providers and consumers on a payment council would negotiate fair and affordable reimbursements. (2) New money for investments and payroll. The money that responsible large and small businesses pay for health care costs represents a substantial portion of their annual overhead. The modest tax increases that would be required to cover Medicare For All will leave substantial savings in annual overhead costs. Where will businesses spend that windfall? On better wages? Investment in new equipment to be more competitive in the global economy? To create better working conditions?

And the No. 1 reason small and large businesses will benefit from universal health care: (1) Reduced workers' compensation costs. Workers' compensation is a huge cost for businesses because of high rates that cover long-term health care costs. Medicare For All would include high quality standard coverage for illnesses or injuries, work related or not, thus eliminating the portion of premiums that pays for special health care under Workers' Compensation.

The Medicare system is in place. It has a low and reasonable 3 percent overhead for administration. It is essentially nonprofit. Remuneration decisions are politically negotiable; witness the rollback of planned fee cuts for 2006 that would have decreased physician participation. Medicare quality initiatives are active and Medicare quality data are available on the New York state Health Department Web site.

It is time to end the procrastination and to expand Medicare to all citizens. Citizens are in favor of this. A recent Zogby International poll of 1,200 New York residents found 62 percent would prefer a universal health care system like Medicare. An October 2003 Washington Post/ABC poll found by a 2-to-1 ratio Americans preferred a universal system that would provide coverage to everyone under a government program as opposed to the current employer-based system. We challenge the politicians and business community to act now.

Dr. Richard Propp is chairman of the Capital District Alliance for Universal Healthcare Inc.

Hear Steffie Woolhandler on Friday October 13th

2006-10-07T13:59:00.000-04:00

Steffie Woolhandler, MD, MPH, co-founder of Physicians for a National Health Program, will speak at two locations in the Albany area on Friday, October 13. Below is a synopsis of her planned remarks. These events, part of the Capital Region Social Forum, are free and open to the public.

The first will be a talk by Dr. Woolhandler at the University at Albany Uptown Campus, Humanities Building, Room 132, from 4 - 5:30 p.m.

The second is a presentation by Dr. Woolhandler followed by a panel discussion at Siena College: "Health Care in Crisis: Toward Universal Coverage" at 7:30 p.m. in the Key Auditorium in Roger Bacon Hall. Contact: 518-783-2398. Panelists: Dr. Duane Matcha, Siena College; Dr. Blanca Ramos, University at Albany; and Dr. Andy Coates, physician and local PNHP member.

Dr. Woolhandler is an Associate Professor of Medicine at Harvard and co-director of the Harvard Medical School General Internal Medicine Fellowship program. She worked in 1990-91 as a Robert Wood Johnson Foundation health policy fellow at the Institute of Medicine and the U.S. Congress. Dr. Woolhandler is a frequent speaker and has written extensively on health policy. A co-founder of Physicians for a National Health Program (PNHP) and current PNHP Board member, she co-edits PNHP’s Newsletter and is a principal author of PNHP articles published in the JAMA and the New England Journal of Medicine. She is also principal author of articles in Health Affairs, including the most-widely read Health Affairs article of 2005 - the investigation of the role of health care costs in American personal bankruptcies.

She has appeared on CounterSpin, Democracy Now!, Bill O'Reilly, and elsewhere.

Steffie Woolhandler is a compelling speaker as well as a national leader. Her understanding of American health care and her clear voice for change are crucial for all of us. Please attend one of these meetings!

Summary of Presentation
Steffie Woolhandler, M.D., M.P.H.

More Americans lack health insurance today than at any time since the start of Medicare and Medicaid in the mid 1960s. Meanwhile, workers are paying a higher share of premiums (and larger co-payments and deductibles) as firms shift costs onto employees. Seniors have also faced rising out-of-pocket costs. While the uninsured face the gravest problems, few Americans have adequate coverage. Most who need long term nursing home care pay out-of-pocket until they are impoverished and qualify for Medicaid; private insurance covers only 7% of nursing home costs. About half of all bankruptcies involve illness or medical debts.

Lack of coverage, insurance hassles, and other problems paying for care endanger the health of millions. Many of those with no, or poor, coverage forego care for potentially life threatening symptoms such as chest pain or a breast lump. HMOs often erect barriers to care, even in emergencies. For terminally ill patients and their families the burden of illness is often compounded by financial suffering. Women frequently delay prenatal care because they're uninsured or unable to pay.

While millions of Americans are denied needed care, hospital beds lie empty every day and millions of Americans are subjected to unnecessary and even harmful tests and procedures. Meanwhile a growing army of health bureaucrats struggles to keep sick patients away from idle health care resources and personnel.

Recent health policies have encouraged market-based strategies - an expanded role for investor-owned firms, reliance on competition to control costs and streamline care, and the erosion of insurance coverage that is supposed to force patients to shop wisely for care.

Contrary to widespread perceptions, Medicare's costs have risen less than those of private insurers (where managed care has predominated). While market enthusiasts push Medicare to enroll seniors in HMOs, an AARP study shows that few seniors could make informed HMO choices; the sickest and frailest are most vulnerable to being duped.

As managed care came to dominate health insurance, for-profit HMOs eclipsed non-profit plans. Yet the non-profit plans that are losing out in the marketplace rank higher on every quality measure collected by the National Committee for Quality Assurance.

Some do well under our current health care system - notably the CEOs of large health care firms. Yet their firms have demonstrated a flexible sense of morality. For instance, the two largest investor-owned hospital chains have admitted to illegal schemes to pad their revenues. But even when not engaged in unlawful behavior, for-profit hospitals cost more and provide worse care. In communities whose medical market in dominated by investor-owned hospitals, health costs are higher and rising faster than in areas dominated by non-profits. Much of the excess costs of for-profit hospitals are due to higher administrative costs; expenditures on clinical personnel are actually lower than at non-profits. Death rates at for-profit hospitals are 7% higher than at comparable non-profit hospitals, and have been for at least a decade.

Poor quality has also been endemic among other types of for-profit health facilities, e.g. nursing homes and dialysis.

Drug companies are the largest for-profit health care firms. In the past decade drug costs have soared. In the U.S., where firms have escaped the price regulations prevalent in other nations, drug prices are outrageous, fueling drug firm profits that outstrip any other industry.

International experience proves that universal coverage is feasible and improves health. Every other developed nation assures health coverage for the entire population. Our infant mortality rate, among the lowest in the world in 1950, is now disturbingly high. We trail other nations on life expectancy, and score poorly on measures of premature death. Meanwhile, our health costs per capita are nearly double those of any other nation, and rising more rapidly. Indeed, GOVERNMENT spending on health care in the U.S. exceeds TOTAL health spending in any other nation.

Yet Americans have fewer physician visits and lower hospital use per capita than other nations. Surveys of English-speaking countries show that Americans face the greatest barriers to care.

As the U.S. was implementing Medicare and Medicaid in the mid 1960s, Canada was putting in place national health insurance. Despite waits for some specialized care, studies continue to find that quality of care for Canadians is at least as good as the care received by INSURED Americans (though Canada spends far less. And national health insurance has effectively contained costs in Canada - perhaps too effectively. Canada's single payer system greatly simplifies administration, cutting insurance overhead to about 1% (vs. 15% of premiums in the U.S.) and reducing bureaucratic costs for hospitals and doctors. Overall, Canada saves about $857 per capita annually on bureaucracy alone.

Surveys have consistently shown wide popular support for universal coverage, though political leaders' views reflect the more conservative convictions of the business community. Indeed, most medical school facutly and deans now favor single payer national health insurance. Yet Congress and most state legislatures are swayed by the massive donations that come largely from the wealthiest Americans. As a result, policy debate is dominated by options that protect insurers and the drug industry.

Chapter Begins Physician Recruiting Campaign

2006-10-07T09:11:00.000-04:00

Thanks to a very generous donation from a prominent member of the Capital Region business community, our chapter will sponsor a series of receptions and dinners this fall and winter.

We hope to bring physicians together at convenient times and in convenient places to discuss the work of our chapter. We will make the case for a universal health care system through a single payer funding mechanism. We hope to create a place where physicians can explore their concerns surrounding such a transformation. We are confident we can inspire further interest and commitment to our cause.

This is a critical moment for our crumbling and expensive health care system. In light of recent events in California, and with a new New York Governor arriving in just few months, there is no doubt that health care will rise to the top of issues facing a new administration.

We need to grow.

There is strength in numbers and our local benefactor - an individual who not only believes that every American ought to have decent affordable health care but also would like to help American business compete with other industrialized countries that pay far less per capita on health care costs - has challenged the local physician community to join PNHP and get involved.

If you have any ideas about this major initiative - individual physicians to whom we should reach out, ideal venues (e.g., lunch time meetings or presentations at subspecialty chapter meetings, restaurant owners interested in our work,) please email or call us ASAP if you have any suggestions. Please help us set up meetings with your colleagues and friends.

Paul Winkeller

Capital District PNHP applies for grants

2006-09-19T19:18:00.000-04:00

September 2006 – Our chapter plays a central role in two grants submitted to NYS Health Foundation. The first grant, in collaboration with the Hunger Action Network of New York State, Metro NY PNHP and Rekindling Reform, requests funding for a Lewin Group study of a potential single payer funding mechanism in order to provide health care for all New Yorkers, along with a set of before and after public hearings to best shape the study. The second grant, in collaboration with the State University at Albany, will develop a feasibility study for implementing a single payer system in the Capital District. (Submitted by Paul Winkeller)

Our Annual Chapter Meeting

2006-09-14T08:02:00.000-04:00

Please attend our upcoming annual meeting, where we will review the many accomplishments of our new PNHP chapter and set a course for another year of progress toward achieving our common goal of health care for all New Yorkers!

PNHP NY Capital District Annual Chapter Meeting
Sunday, September 17, 2006
Location: Latham Med-Ped office, 724 Watervliet-Shaker Road, Latham, NY 12110, a few yards west of exit 5 (Latham) of the Northway..

Agenda
2:30-3:00 Refreshments and conversation
3:00-4:15 Business meeting
Introductions
Treasurer's report (Beatrice Kovasznay)
Executive Director's report on 2005-6 (Paul Winkeller)
Election of new Executive Committee
Plans for 2006-7
4:15-4:30 Break
4:30-5:30 Discussion of health reform (based on Len Rodberg's PowerPoint slides)

If you plan on coming, please RSVP via email to Paul Winkeller.

Capital District PNHP – Highlight of Recent Activities

2006-08-02T09:08:00.000-04:00

July 15, 2006 – Health Care Summer Advocacy Camp: organized by second year Albany Medical College Student Katherine Baerwald and featuring Len Rodberg and Wink Dillaway from the Metro NY chapter, this one day event included over 50 participants, some traveling from as far as NYC. The Camp provided area physicians and medical students, along with interested citizens and community leaders, with training, techniques and general discussion in helping to accelerate the transition to a Medicare For All health care system.

March-April 2006 – Four Part Public Forum Series on WAMC-Northeast Public Radio titled “Reforming our Health Care System: The Pros and Cons of Medicare For All.” This series, now available on CD and featuring several members of the Metro NY chapter of PNHP, brought together a diverse group of leaders and experts in health care, business, and politics to discuss the challenge of providing comprehensive, high-quality health care to all citizens. The title of the four forums were 1) What Is Wrong With The Current System; 2) What Lessons Can We Learn From Other Countries; 3) What Would An Expanded Medicare For All Look Like; and 4) Can We Institute Medicare For All In A Single State, Namely New York?

Ongoing - Meetings, Presentations, Debates. Led by Capital District Chapter Chair and Secretary, respectively Dr. Paul Sorum and Dr. Andrew Coates, we have represented and advocated a Medicare For All type position in numerous settings, ranging from the University of Buffalo Medical School to area County Medical Societies and the offices of local County Executives to local and regional labor councils.

Ongoing - NYS Legislative Commission on Health Care Coverage. Working in concert with a large statewide alliance of organizations (led at least in part by Mark Dunlea of the Hunger Action Network of New York State) chapter representatives have met with members of the Legislature to support this initiative, which would fund a Lewin type study of various approaches to provide universal access to care in New York State.

(submitted by Paul Winkeller)

Susanna Rodell: Good health care, Aussie-style

2006-07-06T22:40:00.000-04:00

Thursday, July 6, 2006
The Providence Journal

HOBART, Tasmania

WHENEVER the lament goes up about the awful health-care system in America, there's a predictable response: Yes, we have our problems, but this country still has the best health care in the world. To those who still think this is true, I'd like to introduce Billy Badger, of the Australian state of Tasmania.

Dr. Badger (a Ph.D., not a medical doctor) inhabits the office next to mine at the University of Tasmania. He is a professor of German. He is also the brand-new father of a baby girl.

Billy has no private health insurance. He and his wife, Christina, have relied entirely on the public system for prenatal care, for the birth, and for postnatal care of baby and mother. I asked him to describe the experience.

"We had no idea what to expect," he told me. Both parents were healthy and had never as adults set foot in a hospital. Upon finding out they were expecting a baby, they went to a doctor, who directed them to the maternity ward at the Royal Hobart Hospital.

At the Royal, Hobart's big public hospital, they were given the choice of three systems: 1) They could go to a birthing center, run entirely by midwives. 2) They could go to a doctor at the hospital. 3) Or they could stay in the hospital and use a system called KYM, which stands for Know Your Midwife: At prenatal visits they would meet all the hospital's midwives, so that whoever was on duty when the time came, it would be someone familiar. Christina and Billy chose the KYM system.

At first monthly, they visited the hospital's maternity unit and had checkups with midwives. As the pregnancy advanced, the intervals between visits were shorter, becoming weekly in the last month. They saw an obstetrician at their first visit and at the 20th and 36th weeks. If the midwives had seen any problems, the couple would have seen a doctor more often.

"We were never kept waiting at any of these appointments for more than five minutes," Billy said. "There were five or six midwives in all, and they were all pretty good. It was like a family; you had a community feeling."

On the day that Christina went into labor, she and Billy went to the hospital, at first to a PAC, or Pregnancy Assessment Center. This was a two-bed hospital room with a bathroom attached, where Christina was monitored until the staff judged her to be fully in labor. Then they went to the birthing suite.

The suite consisted of a large room with a double bed, a table and chairs, and its own adjoining bathroom. "It was comfortable," said Billy. "It was clean enough in a hospital sense, but also homey enough."

Here the midwives kept an eye on the couple but also tried to stay out of the way unless they were needed. The birth was straightforward. Emergency equipment was available, just in case, and a doctor was also present, but a midwife eased the baby into the world as Billy stayed in bed with Christina.

"You didn't necessarily get the feeling you were being watched or intruded on," Billy said. "It was more like we were doing it, and they were there to help." For example, after the birth a midwife lifted the baby's legs and said, "Have a look and see what you've got" -- rather than telling them the child's sex.

"After that they left us pretty much alone," Billy said. "The baby was obviously all right, so they just left us for about an hour." Any time they needed help, it was nearby.

Billy, Christina, and the baby stayed together in the suite for five days, just getting to know each other and calling on the staff when they needed a little help with establishing breast-feeding and giving the baby her first bath.

"We could have stayed for up to two weeks if we had wanted," Billy recalled with wonderment. The food was good, too -- a special menu, since the couple are vegetarians.

When they decided to go home, the staff encouraged them to stay another night if they felt at all unsure. The staff also said that the new family could come back and stay a few more nights, if needed, up to the two-week limit.

When the family left, they took with them free diapers and baby wipes. Whatever was needed, said Billy, "if you didn't have it, you got it."

After the family was home, midwives visited every day for three days. A child-health-service nurse also visited, giving Christina and Billy phone numbers they could call at any time of day or night with any problem.

Christina made an appointment with a postnatal physical therapist, who spent 45 minutes with her, coaching her on exercises to get her body back in shape. In six weeks she will be able to go to postnatal-exercise classes with her baby.

How much, I asked Billy, did all this cost the couple?

Nothing, said Billy. Not the prenatal care, not the hospital, not the supplies, not the postnatal care, not the physical therapy. He and Christina have not spent a penny.

And there's more. In the next few weeks, the couple will receive a check from the government for $3,500, to help with the expenses of a new child.

How does Australia pay for all this? With a flat 1.5-percent levy on everyone's income, plus a 1-percent surcharge on people with higher incomes ($50,000 for an individual, $100,000 for a family). So if your taxable income is $45,000, you pay $675 a year.

Still think we in America have the world's best health-care system?

Susanna Rodell, editorial-page editor of The Charleston (W.Va.) Gazette, is teaching journalism at the University of Tasmania (srodellwvgazette.com).

Health Care Advocacy Summer Camp

2006-06-29T08:21:00.000-04:00

All welcome!

Please RSVP if you would like to attend.

Capital District Physicians For A National Health Program will host a one day Health Care Advocacy Summer Camp on July 15, 2006 at Albany Medical College. We hope to provide area physicians and medical students, along with interested citizens and community leaders, with training and techniques in helping to accelerate the transition to a Medicare For All health care system.

The camp is being organized and led by Katherine Baerwald, PNHP chapter member and second year medical student at the Albany Medical College.  Schedule of events --

9 am Saturday July 15th
Albany Medical College
Huyck Auditorium
Registration, with light refreshment provided

9:45 am – Keynote: “Who Needs Insurance Companies Anyway” – presented by Leonard Rodberg, PhD, Treasurer of the Metro NY Chapter of PNHP, founding member of PNHP
       45 min slide presentation
       45 min Q&A

Leonard Rodberg received a PhD in theoretical physics from MIT in 1957. He began his health care reform activities in 1974 when he led the development of the Dellums Health Service Act. Along with his late wife Joanne Lukomnik, he was one of the founders of Physicians for a National Health Program. He has served on the Board of the NY Metro Chapter of PNHP for a number of years and has been Treasurer and chair of the Finance Committee of the Chapter for the past four years. He is Co-Editor of the Chapter's Forum Reports and Issue Papers and Co-Coordinator of the Chapter's Health Reform Study Group. He teaches Urban Studies at Queens College and directs the Infoshare Community Data Service .

11:15 am - break and informal networking

Noon – Working Lunch (provided): Presentation: Ten Challenges In American Medicine – presented by Erick Cheung, third year medical student at Albany Medical College and leader of the National Organization of Student Representatives.

1:00-4:00 pm – Four sessions, with one break at 2:30

Topic A: Local advocacy and activism: Andrew Coates, MD, Secretary, Capital District PNHP
Topic B: Organizing Students and Physicians at the state level: Withrop C. Dillaway, MD, PNHP New Jersey Chapter
Topic C: The AMSA Vision: Networking With Students: Vanessa Calderon, American Medical Student Association Jack Rutlege Fellow and National Chair for Universal Healthcare
Topic D: The State of Healthcare Reform in New York: Mark Dunlea, Associate Director of the Hunger Action Network of New York State

4:00-5:00 pm – Panel Discussion including all Camp presenters, moderated by Andrew Coates

Suggested Contribution = $25.  Free for medical students, students, PNHP members with scholarships available.

Registration Deadline – July 8, 2006.  Please email us to reserve your spot today.

Catamount Health offers little in the way of reform

2006-05-28T07:21:00.000-04:00

MARVIN MALEK, MD
From the May 21, 2006
Times Argus

Observers of the lovefest at the state capital over the recently passed Catamount Health reform bill might think we'd found the Holy Grail or invented an improved wheel. Unfortunately just because a Republican governor and Democratic Legislature can agree on a bill does not mean that good legislation lies ahead.

As an internist in Barre, I frequently undertake the difficult task of providing care to people who have no health insurance — those the Catamount health bill is designed to help. So I want to believe that the Catamount Health bill will really serve as the "historic reform" that Sen. Jim Leddy called it in a commentary on these pages on April 30.

But I'm really worried about the bill. As a cost-control measure, improving the care of those with chronic illnesses is completely unproven. The research supporting it is dubious. The Democrats' consultant, Ken Thorpe, has grossly overstated the ability of chronic care programs to reduce the cost of medical care. He ignores the findings of a thorough review conducted by the Congressional Budget Office, and also research conducted by Kaiser-Permanente, the country's largest nonprofit health plan, which indicated there is no evidence chronic care management programs lead to cost savings.

In fact, far from allowing an expansion of public coverage to a new population, I worry that the growth of Medicaid costs will be unsustainable if the chronic care initiative fails to meet the most optimistic projections. The Medicaid program will be under sustained pressure because it serves as the bottom of the safety net. The sickest — and most expensive people to insure – end up insured through the Medicaid program when they become too ill to work and exhaust their savings.

While you're adding a new population for the state to insure by not taking on the insurance and pharmaceutical industries, you are leaving aside the best tactic to reduce costs. The current system of multiple private health insurance companies adds enormous amounts of administrative expense. I see it every day as we contend with complex insurance company policies which attempt to avoid paying any and every medical bill, and I can only imagine the parallel expense taking place at the other end of the phone line at the insurance company. And by not consolidating into one large insurer for the entire population, we fragment our ability to get serious about negotiating down the prices of medical supplies and prescription drugs — and to create a better coordinated system of care for those with chronic illnesses.

It's clear that Gov. James Douglas' close-minded insistence on preserving the privileged position of the private health insurers has set the limits on the legislation. So we're instead stuck with modest, band-aid reform – with no secure funding for the bill, and no action to do something meaningful about the ongoing meltdown of our health care system. Here is a snapshot of just a few of the problems the new reform bill does not address:

The Medicaid deficit;

Labor strikes over health benefits;

Poor access to primary care as middle class and poorer families contend with ever-increasing deductibles before their insurance coverage kicks in;

Big businesses continuing to relocate to Canada and other countries where they can fulfill the promise of health insurance to their employees at far lower cost;

Small businesses struggling to find affordable health insurance for their employees;

Massively higher administrative costs in the United States compared to other countries. H.861 actually adds to our administrative burden, especially since the governor succeeded in insisting that multiple private insurance companies administer the program.

What does that mean to me? Yet more sets of rules for our practice to contend with. And I can only imagine the administrative burden the chronic care initiative will place on primary care practices.

Worse yet, I fear the passage of the Catamount bill will sideline the push for more meaningful health reform. We'll all be asked to give the new program a chance to work, likely putting the brakes on effective health reform for at least three, and maybe four or five years. Meanwhile, there will be ever more underinsured patients, ever higher health costs, ever greater Medicaid deficits.

It is inappropriate for Sen. Leddy and other legislators to portray this bill as a major, landmark achievement. Believe me, it is anything but that. You would do better to portray it as a small step that will have some immediate beneficiaries, but a bill that cannot provide long-term health security for the citizens of Vermont.

Every legislator asking for our vote should be obliged to come up with a coherent answer to the question: Why does every other developed country have universal health insurance and vastly superior health outcomes while spending only 50 percent to 60 percent of what Americans spend on health care? Our legislators — and our governor — ought to show enough curiosity to really grapple with this fact.

Vermonters should expect the same health security that citizens of every other developed country have come to expect. In all these countries, every citizen has full health coverage that is stable and stays with them throughout their lives — no matter what.

By contrast, the Catamount bill is a small, tenuous step that is dependent on an infusion of extra Medicaid dollars in the next two years and relatively good tax revenues that have gone along with the current favorable phase of the economic cycle.

Beyond two or three years, we can expect the new Catamount plan and the Medicaid program to both face enormous deficits — and we'll probably be forced to cut back on both programs.

Dr. Marvin Malek is an internist in Barre and a member of Physicians for a National Health Program.

"What will it take to achieve real health care reform?"

2006-05-17T20:31:00.000-04:00

Richard Kirsch, Executive Director of Citizen Action of New York has written an insightful, detailed analysis "If Wishes Were Horses: The False Promise of the Massachusetts Health Plan." Especially because the Massachusetts legislation was widely hailed across the country as a 'miracle' and a 'model' of bipartisan cooperation, as well as 'universal health care' and a 'solution,' etc., thoughtful criticism of the plan helps us all; I hope people take time to read it closely.

Kirsch dissects the Massachusetts plan thoroughly. He identifies the provisions that will help the poor, aspects we should celebrate, and also exposes the roots of the "false promise." He places the plan in contemporary context and reviews the history of similar efforts as well his own efforts in New York. He offers his honest reflections and recommendations.

Yet Kirsch discounts, rather than returning to embrace, the single payer national health insurance proposal. He resurrects the phrase that single-payer is not "politically feasible," which is by now an old saw. But where this once sufficed to dispense with the idea, and thus ignore it, discussion of a public national health insurance system can be dismissed no longer. We see this when Kirsch asks:

"If the fundamental flaw in the Massachusetts plan is that it maintains the private insurance system and accelerates the pressure toward consumer driven health care, does that mean that the only solution is a national health insurance plan?"

Significantly, he answers his question by striking a reluctant, not dismissive, chord: "Not necessarily." Kirsch elaborates:

"The advantages of single-payer are clear and go well beyond the elimination of excess administrative costs that is too often the prime rallying point of single-payer advocates. National health insurance provides the basic structure for universal coverage: everyone is automatically covered in one large pool. It provides the tools for systemic affordability: setting prices; controlling supply; limiting out of pocket costs; directing funds towards high quality care. But these goals, all of which stem from the concept that health care is a public good rather than a private commodity, can be achieved in various measures with systemic changes that don't require a single-payer system."

And yet, while Kirsch acknowledges crucial strengths of the single payer proposal, he retreats to a position in defense of private health insurance:

"So in proposing a public program that fits the American experience, and therefore has some chance of becoming law, I recommend a system that utilizes Medicare and regulates private insurance. Under such a system every American would be guaranteed health care from Medicare or private insurance."

Is this really how we might avoid "more false promises" like the ones in Massachusetts? Even in the best case scenario, won't the preservation of our private health insurance corporations lead to more health care injustice, with inequalities of care accelerating, polarizing and ultimately crystallized in a two-tier system? Can the American profit-driven health insurance industry really be regulated into treating health care as a "public good?" If that were to happen, wouldn't that industry, at least as we know it, cease to exist?

In other words, if one sees, as Kirsch does, that selling health care as a private commodity is a fundamental flaw for social policy, as it is in the Massachusetts plan, then it really is time to come back to single-payer. There is no right way to do a wrong thing.

Kirsch suggests that one can find examples of developed nations where private health insurance coexists happily alongside public health insurance, thanks to heavy government regulation of the health insurance industry. Besides the question of whether it might be "politically feasible" for American insurers to be regulated into changing their spots -- or perhaps their souls -- this idea seems, at best, lost in translation.

Mostly, "private" insurance companies in other countries are actually non-profit firms which are not only highly regulated but which exist only because government finds it advantageous, and efficient, to work through them. They are not politically powerful agents, as are insurance companies in this country. In countries like France private insurers are sidelined. In a few nations, like Switzerland, regulation means that the government has the power to dictate how much each insurer may charge for premiums as well as the amount of profit it may make on basic coverage -- none. In Britain, parallel private insurance spurs the underfunding of the NHS, undermining it. In Canada lately there is a lawn sign that sums it up: "Don't Privatize Medicare!" With Medicare "Part D" - D for debacle - those signs apply just as well here in the US. Like Medicare Part D, and just as Kirsch finds in the Massachusetts plan, for most developed nations, treating health care like a private commodity remains the germ of the problems.

This gets back to the point about what is "politically feasible." Consider what we're up against this way -- a profitable, powerful private insurance industry, alongside behemoth pharmaceutical and medical technology industries -- a three-headed Cerberus. Kirsch identifies what nourishes the monster (health care as a private commodity) as the source of our ills. He identifies basic health insurance coverage for all as the necessary next step toward reorganizing the American health care system along the lines of a public good. He then proposes, like Hercules at his twelfth labor, that if we keep private health insurance, there is a way to tame the beast and harvest from it the public interest. Well, OK -- but a great myth.

If Kirsch's recommendation seems logically contradictory, even more curiously, he contemplates the Herculean social force that it will take to change the American health care system in order to organize it around the best interests of its patients. Surely that force would be capable of delivering single payer reform. Even further in line with the single payer demand, he wants to see sweeping change, real strides instead of baby steps. Kirsch concludes transcendently, reiterating the theme of health care as a public good:

"What will it take to achieve real health care reform? It will take a major shift in the nation's politics. As long as our political agenda is dominated by the champions of privatization and the opponents of government regulation, we will have no chance of enacting reforms that realize the objectives of universal coverage and systemic affordability. Instead, we will get more false promises like that of Massachusetts, a law that has some positive provisions based on the concept that health care is a public good, but is flawed and doomed to failure by its core assumption that health care is a private commodity."

Ultimately, working my way through Kirsch's analysis seemed a bit like observing a dramatic exploratory surgery -- the sick patient rushed to the OR after failing medical treatments -- where the surgeon masterfully dissects, keenly exposes the malignancy, proposes the instruments to resect the tumor ... and then hesitates, wishing he could give the medications one more chance. Nevertheless Kirsch's closing words return to his deep conviction that the patient can be saved:

"There are no shortcuts. Wishing won't make it so. Winning real health care reform requires a clear vision, a persistent, strategic energy and a belief in the miracle of change."

A major shift in American politics is well underway. We should see the Massachusetts plan as a result of its shift, as well as a driver. Not a "miracle in Massachusetts" but a measure of a struggle in which real reform can be won -- a process that has the power to yield the "miracle of change." Massachusetts gives us a measure of acceptance of the idea that health care is a public good. That idea is winning the day. Yet Massachusetts also shows us that the insurers retain the capacity to hijack that idea, co-opt it and use it to reinforce the status quo.

The demand for single payer national health insurance -- which leaves no role for private insurance companies to treat health care as a private commodity -- is the clear vision with the strategic power to realize the change we all need.

Richard Kirsch, please come back.

Andrew D. Coates, MD

Download our WAMC Forums

2006-05-08T07:03:00.000-04:00

All four forums in our series "Reforming Our Health Care System: The Pros and Cons of Medicare for All" can be heard via the internet at the WAMC Performing Arts Studio archive page.

Capital District Physicians for a National Health Program would like to thank all who participated in the forums as well as our co-sponsors -- the League of Women Voters and especially WAMC, Capital District Alliance for Universal Healthcare, Hunger Action Network of NY State, the Labor-Religion Coalition, Albany Medical Center, Albany Law School, the MBA Program in Healthcare Management of the Graduate College of Union University, the Medical Society of Albany County, the New York State Nurses Association and Rekindling Reform.

Marcia Angell, MD on the Massachusetts plan

2006-04-17T18:44:00.000-04:00

Healthcare plan needs dose of common sense
Boston Globe op-ed
By Marcia Angell | April 17, 2006

IF GOVERNOR Romney thinks the state's new plan for universal health coverage will carry him to the White House, he should think again. This Rube Goldberg contraption won't even get him off the ground because it doesn't touch the underlying problem -- our reliance on multiple private insurance companies.

Private insurers compete not by offering better healthcare, but by avoiding high-risk individuals, limiting services for those they do cover, and, whenever possible, shifting costs to other payers or to individuals in the form of high deductibles and copayments. It's a chaotic and fragmented system that requires a mountain of paperwork, which is one reason premiums are so high. Those employers who still offer health benefits react by capping their contributions, so that workers pay more out of pocket and bear the full brunt of premium increases. Massachusetts does better than most states, but healthcare in Massachusetts is also the most expensive in the nation.

If this system is left essentially intact, as it is under the new plan, expanding coverage will inevitably increase costs. That is common sense: Coverage and costs have to move in tandem if the system stays the same. Furthermore, the plan does nothing to keep costs from growing. For years, premiums have been rising much faster than the consumer price index. At current rates, even if the state were able to cover its proposed contributions to the plan at launch, it wouldn't be able to keep up with soaring prices.

But already it's clear that the governor and legislators don't know how to pay for it even at launch. One legislator told Boston Globe columnist Joan Vennochi: ''We don't yet know what it's really going to cost us or where we're going to get the money from. To some extent you might call it a Hail Mary pass." The essence of this faith-based plan is to squeeze employers and individuals, with a relatively small state contribution. But employers who don't offer health insurance can get away with paying a penalty of only $295 per employee per year -- in a state where health insurance for individuals costs about $7,200 per year.

Individuals not covered by employers and whose income is at least 300 percent of the federal poverty level (now about $30,000) will have to buy their insurance or pay income tax penalties. Romney thinks premiums can be held to $2,400 a year with a cap of $2,100 on deductibles, but that is wildly implausible. If premiums are higher than that and continue to escalate faster than income, this will amount to fining people because they can't afford health insurance, which, in effect, will punish them twice -- an unsavory prospect.

Those individuals whose income is less than 300 percent of poverty level would receive state subsidies. That will require an enormous bureaucracy to determine what insurance is adequate and ''affordable" and who can really afford it, and there will be incessant legal and regulatory wrangling. The legislation calls for a new state agency, the Commonwealth Health Insurance Connector, to oversee insurance plans, and that is just the beginning.

Like the Medicare prescription drug benefit, the Massachusetts healthcare plan is a complicated morass that might limp along for a while, but will never cover all the people it is meant to cover, and will become increasingly unaffordable. Most likely, it will meet the same fate as the much celebrated 1988 legislation to provide universal coverage in Massachusetts, which shriveled and died with scarcely a whimper.

The only answer is to change the system entirely, so that we can expand coverage while controlling costs. Romney said, ''The old single-payer canard is gone." No, it isn't. Sooner or later, that is exactly what we'll need if we're really serious about universal healthcare. There's no other way.

Dr. Marcia Angell is a senior lecturer in social medicine at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine.

Approaches to Health Care for All

2006-04-12T07:50:00.000-04:00

Press Release
April 10, 2006
Mark Dunlea
Associate Director, Hunger Action Network of New York State
518 434-7371, ext 1

New York Needs a Commission to Develop Cost-Effective Approaches to Health Care for All

New Massachusetts Health Care Plan is Seriously Flawed

Universal health care advocates said today that New York should followed the lead of the State of Massachusetts in taking action to provide quality, affordable health care coverage to all its residents.

The groups however said that the Massachusetts program is seriously flawed, focusing more on increasing payments to hospitals and insurance companies rather than on ensuring universal access to quality, affordable health care.

The groups called on NYS to join half a dozen other states in creating a Commission on Health Care Coverage to do independent cost-benefit analysis of the various ways NY could provide health care to all New Yorkers.

“Health care for all is an essential goal. We can not afford to spend one of out six dollars in our economy to prop up a patchwork, inadequate health care system that excludes tens of millions of America from coverage. Every other industrial country has already figured in out. America should be able to figure out how to put the public good ahead of campaign contributions from special interests. And with Congress stalling, individual states have to step forward to create their own universal health care plans to protect taxpayers and consumers,” stated Mark Dunlea of the Hunger Action Network of New York.

The Commission, endorsed by more than 250 organizations, would evaluate proposals such as Medicare for All (single payer); the new Massachusetts program; employer mandates; Medical Savings Accounts; and tax credits. This commission process was used in Maine to develop its proposal to provide health care to all residents.

Many of the groups support the proposal by the Physicians for a National Health Program to expand Medicare to cover all Americans. Such a single payer system would save hundreds of billion of dollars, starting with a major reduction in administrative costs. A recent study by the Lewin group estimated that a single payer system just for California would save $38 billion annually.

Dr. David Himmelstein, the national cofounder of PNHP, said that the recent Massachusetts proposal fell far short of providing quality affordable health care for all.

“The linchpin of the plan is the false assumption that uninsured people will be able to find affordable health plans,” observed Dr. Himmelstein. A typical group policy in Massachusetts costs about $4500 annually for an individual and more than $11,000 for family coverage. According to Census Bureau figures, only 12.4% of the 748,000 uninsured in Massachusetts are both young enough to qualify for low-premium plans (under age 35) and affluent enough (incomes greater than 499% of poverty) to readily afford them. Yet even this 12.4% figure may be too high if insurers are allowed to charge higher premiums for persons with health problems.”

“The legislation promises that the uninsured will be offered comprehensive, affordable private health plans. But that’s like promising chocolate chip cookies with no fat, sugar or calories. The only way to get cheaper plans is to strip down the coverage – boost co-payments,, deductibles, uncovered services etc. Hence, the requirement that most of the uninsured purchase coverage will either require them to pay money they don’t have, or buy nearly worthless stripped down policies that represent coverage in name only,”Himmelstein added.

“Finally, the legislation will do nothing to contain the skyrocketing costs of care in Massachusetts – already the highest in the world. Indeed, it gives new infusions of cash to hospitals and private insurers. Predictably, rising costs will force more and more employers to drop coverage, while state coffers will be drained by the continuing cost increases in Medicaid. Moreover, when the next recession hits, tax revenues will fall just as a flood of newly unemployed people join the Medicaid program or apply for the insurance subsidies promised in the reform legislation. The program is simply not sustainable over the long – or even medium – term,” he concluded.

“Access to health care is a matter of human dignity. It is about the stewardship of our resources. Our elected representatives must listen to the voices of all New Yorkers, especially those who have no access to decent medical care, whose voices are marginalized. These are the people whom we all have a special responsibility to support and protect. Enacting the Commission and the process of open hearings and public studies is an important step in ensuring that the best interests of all the people is our priority,” stated Rev. Cass Shaw, General Presbyter for the Albany Presbytery.

“Despite the fact that health care is now half of the state budget, the Governor and Legislature have failed to embrace comprehensive approaches to controlling costs while providing quality, affordable health care to all. The fact that millions of New Yorkers - as many as one in three during any one year – lack adequate health care coverage is a huge factor in causing financial problems both for Medicaid and hospitals, yet state lawmakers refuse to tackle the problem due to the power of the insurance and drug companies. Instead, they continue to offer incremental changes in coverage while the overcall cost of health care continues to skyrocket,” said Mark Dunlea, Associate Director of the Hunger Action Network of New York State.

Legislation to establish such a commission has been introduced in New York by Assemblymember Richard Gottfried (A6575) and Senator John Marchi (S 4928), among others. In Illinois, the Legislature is required to adopt a universal health care program within a year after the Commissions studies are completed. Advocates want NY to adopt a similar model, with the commission to start on January 1, 2007 to meet objections by Senator Hannon that the Hospital Closing Commission should first finish its work. The groups agree with Senator Marchi that the Governor should appoint the Chairperson of the Commission.

“One of our main concerns in patient safety. What kind of patient safety do you have if you lack health insurance? 3 million people in New York State lack health insurance and patient safety. They have documented excess illness and deaths. Their preventive care is nil. Serious illness is unsafe for a family’s finances. Costly and inefficient healthcare is unsafe for the competitivensss of our economy. Society as a whole would benefit from a universal healthcare financing system that includes all citizens. The needs of patients and healthcare professionals must come first. A legislative commission is needed to study and act on our worsening healthcare non-system, concluded Richard Propp, MD, Chairperson, Capital District Alliance for Universal Healthcare.