PNHP's Official Blog » Rob Stone MD

The Continuing Debate – Is This Bill Better Than Nothing?

Rob Stone MD — Fri, 20 Nov 2009 15:12:55 +0000

One of my professors years ago was a round little man who liked to warn us, with a twinkle in his eye, “Making predictions is very difficult, especially predictions about the future.” Will a bill pass, in what form, and then what will the long term implications be? It’s hard to predict.

The incomparable Dr John Geyman, former president of PNHP, makes a strong case in Tikkun “The Affordable Health Care for America Act (HR 3962) :Enough Reform to Succeed?” His argument is that whatever bill this Congress is able to pass will likely set the cause of single payer healthcare back because it “would leave in place an inefficient, exploitive insurance industry that is dying by its own hand, even as [the bill] props [the industry] up with enormous future profits through subsidized individual and employer mandates.” His comments follow up on those of Marcia Angell on the Huffington Post “Is the House Health Care Bill Better than Nothing?” and others that readers on this site have seen.

Not everyone on the Left agrees. Sam Stein’s piece in the Huffington Post is called “Goldman To Private Insurers: No Health Care Reform At All Is Best.” Goldman’s analysis for the health insurance behemoths is that no reform would benefit them the most, and if we end up with a version close to the House bill, that would cause the industry the most financial difficulty. Jonathan Cohn in The New Republic asks “The House Bill Is “Worse Than Nothing”? Really?”

Sorting all this out is tough and can be frustrating because there is so much wishful, non-reality-based thinking going on. It is clear that many of the supporters and opponents of the bills, both in Congress and the general public, are clearly deluded, and single payer is what has them flummoxed.

On the Left I keep talking to supporters of the public option who claim to be “single payer at heart”, and they believe that whatever passes will be the camel’s nose under the tent, the slippery slope to single payer. Seems delusional. If only they are right….

Speaking of the Right, many of them also believe that any bill this Democratic Congress will pass will become the same camel’s nose, the same slippery slope to socialism. Could they be right, too?

There is still work to do. The handwriting was on the wall Saturday 10/31 when anti-abortion Democrats had enough political oomph to get their Stupid Amendment debated and passed while the Progressive Caucus couldn’t muster enough support to bring either the Kucinich or Weiner Amendments to the floor.

No matter what happens, one thing is certain: we have to continue to build our movement. Next time around we have to get all those Representatives and Senators who plan to vote for reform this time, to vote for real single payer reform. And that would prove the delusional ones were right after all.

Links: HCHP Blog http://hchp.wordpress.com/ HCHP website: http://hchp.wordpress.com/

People Get Ready

Rob Stone MD — Fri, 29 May 2009 16:09:17 +0000

“People get ready, there’s a train a’comin’, Don’t need no ticket, you just get on board.”
- Curtis Mayfield

“If not now, If not now, tell me when?”
- Carrie Newcomer

….The closing songs sung by Carrie Newcomer at the Affordable Healthcare For All Rally on Monument Circle, across from WellPoint’s headquarters, May 20, 2009

Jim Mitchiner from PNHP Michigan arranged for me to speak to the House of Delegates at the annual meeting of the Michigan State Medical Society this April. There I met David Share, a physician working for Blue Cross of Michigan, which is still an independent non-profit insurance company like all the Blues were less than 20 years ago. They can’t turn down anyone with a pre-existing condition. Their board is made up of consumers and providers whose average annual compensation is under $50 thousand a year, compared with over $300 thousand per year on the WellPoint board. They support 42 free clinics throughout the state. It’s what the Blue Cross brand used to stand for. The idea of calling for WellPoint to re-mutualize was born.

Think globally and act locally. Some years ago I realized that we could do both by taking our message to one of the state’s largest employers, WellPoint based in Indianapolis. Starting as a non-profit state-based Blue Cross program like all the others, Blue Cross of Indiana de-mutualized in the 90’s. It went from non-profit to for-profit, raised a ton of money with a Wall Street stock offering, and started a rampage of mergers and acquisitions. In 2003 they merged with WellPoint, better known as Blue Cross of California, and became the largest health insurer in the country. For closing that deal, CEO Larry Glascock got a $42.5 million bonus. The HQ remained in Indiana, but WellPoint stayed as the name of the new company.

My wife Karen and I bought 5 shares (WLP, currently about $45 a share) a few years ago just so we could go to the annual meeting. Other members of our PNHP affiliate Hoosiers for a Commonsense Health Plan had stock as well, and a tradition was born. We have annually harangued them about recission, Medicare Advantage, Ingenex,and many other scandals – they are an easy target.

We needed something new this year in order to keep their attention and that of the media. I wrote an Op-Ed for the Indianapolis Star published 5 days before the meeting/rally with my critique of the company, including my dismay that our shareholder dollars were being spent trying to influence the healthcare reform debate. I noted “Last month the Sacramento Bee reported that in California WellPoint was making 3 million computer generated phone calls a week to try to influence the debate on reform. BusinessWeek magazine‘s headline called them ‘Robo-Calls.’ In 2007 the company spent $2 million on a publicity campaign to sink Governor Schwarzenneger’s proposal for a state universal care system.”

I concluded with:

“I fear that the for-profit insurance industry in America is the biggest barrier to achieving affordable universal coverage.

“With that in mind, I have a proposal for the board to consider – For the good of the company and the good of the country, I propose that WellPoint re-mutualize. That WellPoint return to its not-for-profit Blue Cross roots and spin back off all the state Blues that it acquired over the last 15 years.

“Give up this grand effort to become a behemoth astraddle the insurance market – you have only become a dinosaur.”

Having that published in the state’s largest newspaper, the stage was set for May 20. At 8 AM five of us were seated in the meeting room, and when the time came, I read my statement. Other members of thegroup shared their concerns, most notably that Susan Bayh’s position on the board, with her husband Evan in the Senate as it considers healthcare legislation, has the appearance of a huge conflict of interest. No one outside of our group spoke, except, of course, for the talking heads of the CEO and Chairman of the Board.

At 11 AM, under a clear blue sky in the center of town, Monument Circle, we opened our rally with folk singer Carrie Newcomer. We had 150 people decked out with signs and our blue Medicare For All T-shirts. My comments focused on the for-profit insurance gang being the biggest threat to meaningful reform. We closed with more music, and then 75 of us marched to Senator Bayh’s office a block away. The march made for particularly good TV footage. Thirty of us were able to get into his office and spent a surprisingly good hour with his chief of staff, as the Senator was in DC.

Should WellPoint return to non-profit status and is that part of our PNHP mission and message? In Indiana it’s an effective way to put our local insurance behemoth on the spot, and to get the media to spread our message that the insurance giants are the real enemy of healthcare reform. For those of you in Minnesota (United Health), Kentucky (Humana), Connecticut (Cigna and Aetna), California (HealthNet), Maryland (Coventry), or wherever, the strategy will be different. Confronting the local face of the for-profit health insurance industry has been a successful approach to raising awareness in our state, motivating our supporters, and putting the insurance gang on the defensive.

We’ll be back at WellPoint again next year. We’re all looking forward to it.

People Get Ready, performed by Carrie Newcomer 5/20/09

If Not Now, Tell Me When, written and performed by Carrie Newcomer

Time to play the single-payer card

Rob Stone MD — Tue, 31 Mar 2009 17:51:56 +0000

A health care reform bill out of Congress by the end of the summer? An end to our national nightmare within five months? The health insurance industry is banking on an Obama-Kennedy-Baucus bailout – “universal” health care, with taxpayer subsidies for those who can’t afford the unaffordable premiums.

Right now the insurance gang is controlling the debate, with big headlines about how they will give up a few of their most egregious behaviors and accept a modicum more government oversight as long as we mandate that everyone become their customer. And, most importantly, don’t let the Socialists have their way and allow a Medicare-like “public option.” They cry that it would be unfair competition to ask the for-profit insurance companies to go up against a government run plan.

If they think the government can do so much better than they can, why don’t we listen to them? Let’s go ahead and put everyone in a government plan!

The strategy from the industry and their Republican allies is obvious – appear to offer a series of compromises, but draw the line to prevent any government plan. Wrap it all up in a big package and proclaim that we’ve got a uniquely American solution to our problem: a huge system of taxpayer subsidies to the insurance industry, with no mechanism to control costs, because there are too many big money interests who don’t want to see real cost control. They are happy to expand access to insurance because it makes good business sense to create more customers.

The strategy of Obama, the Democrats, many labor leaders, and “progressive” groups like Health Care for America Now is equally clear. Let’s offer a compromise plan with many complex features, all of which need to be clarified and debated, and hope that we can get the whole thing through Congress intact, including the public option. This is a strategy for failure. The public option will be the part that gets compromised out.

Many prominent progressives like Paul Krugman and Jacob Hacker have argued that the public option is the key to the whole reform process. The public option will constrain the rapacious insurance companies. The public option will be popular and efficient. The public option will be, at its best, a slippery slope to a single-payer plan. Never mind that critics have pointed out that if the public plan is enacted, the insurance companies will find ways to game the system again. Never mind that the Right has recognized the slippery slope argument, and that is why they are so adamantly against it.

This calls for an obvious change in the Democrats’ strategy. Up to now they have tried hard to keep the voices for single payer out of the debate. They have reassured the Republicans that single payer isn’t even “on the table.” If they want to have a chance to get the public option through Congress, it’s time for a new strategy. Time to play the single-payer card.

Purely from a strategic perspective, the president should put single payer back on the table and start explaining to the people all the advantages of Medicare for All. Then, when the going gets tough in the trenches of Congress, they can compromise and settle for the public option, and a muscular enough public option that it could serve as a model (a slippery slope) for an eventual single-payer system.

Of course, maybe once the single-payer cat is out of the bag, the weight of logic and public support will just push the insurance gang right out of the way.