The Institute of Medicine (IOM) has just released recommendations for the “essential benefits” of the health insurance coverage mandated under the Affordable Care Act (the 2010 federal health reform law). The IOM is the health arm of the National Academy of Sciences, described on their website as “an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public.”

“Skimpy coverage” is the best description for the “essential benefits” package the IOM panel has recommended. These bare-bones policies come with unaffordable deductibles and co-payments, as well as uncovered services. Rather than endorsing the more comprehensive coverage plans of large employers, the panel chose coverage similar to that offered by small employers, making these skimpy plans the new standard.

This inadequate coverage will shift costs from corporate and government payers onto families, which will lead to delaying care. Millions of Americans are already underinsured with skimpy insurance policies, and as a result, forego necessary medical care or fail to fill prescriptions they need. Of course, delaying care eventually leads to higher medical costs when patients finally receive treatment, because they are sicker.

Rising deductibles and co-payments over the past two decades have not stopped medical inflation. Costs keep going up, and more and more people suffer financial ruin when they have serious illnesses.

A new study has just been released, by Masscare and Massachusetts Physicians for a National Health Program, about the outcome of our state health reform law four years after its full implementation. This is an important study because the Affordable Care Act is based on the Massachusetts Health Reform Law, which was enacted in 2006. The study finds that the number of uninsured people in Massachusetts decreased by one-half to two thirds. However, most of the gains have come from expansions in publicly subsidized insurance, shifting patients from the previous Free Care Pool, which compensated hospitals directly, to private insurance plans, which are a more expensive way to provide coverage.

In addition, cost-shifting to patients has accelerated due to skimpy coverage in employer-sponsored insurance, especially for policies for small business employees. Since the reform, the use of high-deductible plans more than tripled for Massachusetts residents with private insurance.

Reform has not reduced the burden of medical bills and medical bankruptcy in Massachusetts. The federal Affordable Care Act, like health reform in Massachusetts, will probably have similar mixed outcomes, expanding coverage to the uninsured, but doing this through inadequate insurance policies purchased through private insurance companies, who will reap big profits even as the cost of policies become unaffordable.

As you might suspect, the panel from the IOM who made these recommendations for the federal health reform law is “riddled with conflicts of interest,” according to a protest letter signed by 2,400 doctors, nurses, and health advocates. The IOM panel members include Sam Ho, executive vice president of United Healthcare, and Leonard Schaeffer, a former CEO of Wellpoint, two of the largest health insurance companies.

Last year, a journalist at the Los Angeles Times wrote, “Leaders of Cigna, Humana, UnitedHealth, WellPoint and Aetna received nearly $200 million in compensation in 2009, according to a report, while the companies sought rate increases as high as 39 percent” for insurance premiums. Other members of the IOM panel with conflicts of interest include executives from 3M Health Information Systems, a medical supplier; Milliman, Inc., an actuarial consulting firm with close ties to the insurance industry; and The Blackstone Group, a private equity firm with major health care interests. These health industry ties violate a 2009 recommendation from the IOM itself that those with industry conflicts should be excluded from such panels.

Of course, the IOM panel recommendations were lauded by insurance industry leaders. Health insurance companies, who stand to gain by issuing skimpy insurance policies that patients will avoid using until they are very sick, have attempted to undermine real health reform all along the way. The Lancet, one of the oldest and most respected medical journals has stated: “Corporate influence renders the U.S. government incapable of making policy on the basis of evidence and the public interest.”

No wonder the Occupy Wall Street movement has the support of increasing numbers of American people who are awakening to the effects of corporate influence on our lives. Health insurance policies are just one example.

Single-payer health insurance, an improved and expanded Medicare plan for everyone, would remove corporate influence and greed from our health care insurance system, be cost-effective, and provide comprehensive health care coverage for everyone. Unlike the skimpy coverage suggested by the IOM, a single-payer health care system would actually pay for care when we are sick.

Dr. Susanne King is a Lenox-based practitioner.

Writing about the Massachusetts health care reform program in a 2009 issue of the Wall Street Journal, Governor Deval Patrick stated, “Because of our reform, families are less likely to be forced into bankruptcy by medical costs.” Both Governor Patrick and President Obama have used the benchmark of medical bankruptcy as a key measure to prove the success of their health insurance reforms.

Unfortunately, according to a study this month from Harvard University by Dr. David Himmelstein and associates, the absolute number of medical bankruptcies in Massachusetts increased between 2007 and 2009, the years after health care reform had been enacted. Dr. Himmelstein commented, “Massachusetts health reform, like the national law modeled after it, takes many of the uninsured and makes them under-insured, typically giving them a skimpy defective policy that’s like an umbrella that melts in the rain. The protection’s not there when you need it.”

For example, in Boston, the least expensive individual coverage available to a 56-year-old carries an annual premium of $5,616 and a deductible of $2,000, and even then only covers 80 percent of the next $15,000 cost for covered services. Therefore, someone with a chronic condition like diabetes could have to pay $10,000 annually out of pocket, in addition to the premium.

The current Massachusetts heath care reform, on which President Obama has based his national reform legislation, is not adequate. Massachusetts reform has not ended medical bankruptcies in our state, a finding that strongly suggests that national reform won’t reduce medical bankruptcies nationwide.

While individuals, small businesses and towns struggle to pay for inadequate health care insurance, CEOs of non-profit health insurance companies continue to walk away with obscene amounts of our hard-earned dollars. Blue Cross /Blue Shield’s former chief executive, Cleve L. Killingsworth recently received an $11 million payout, while Blue Cross board members individually received up to $89,000 to rubber stamp Killingsworth’s compensation.

As many states and congressional Republicans look for ways to roll back President Obama’s signature health care law, Vermont is moving in a different direction. During his inaugural address, Governor Peter Shumlin proposed guaranteeing health insurance to all Vermonters, noting that current health care costs “[represent] an enormous hidden tax on families and small businesses across our state. If left untethered, the rising cost of health insurance will cripple us.” Shumlin has proposed the creation of a single-payer system for Vermont in which private delivery of healthcare would continue, but the government would act as everyone’s health insurer.

This “Expanded and Improved Medicare-for-all” option was barred from the national health reform debate by special interest groups. By choosing a single-payer program, Vermonters would divorce health insurance coverage from employment, and eliminate the administrative waste of private insurance companies, including outrageous CEO salaries.

Dr. William Hsiao, an international expert on health care reform at the Harvard School of Public Health, was commissioned by the Vermont Legislature to conduct a study about the best way to provide universal coverage, reduce the rate of cost increases, and create a primary care-focused, integrated delivery system. Hsiao stated, “The system capable of producing the greatest potential savings and achieving universal coverage was a single-payer system — one insurance fund that covers everyone with a standard benefit package, paying uniform rates to all providers through a single payment mechanism and claims-processing system. Our analysis showed that Vermont could quickly save almost 8 percent in health care expenditures through administrative simplification and consolidation, plus another 5 percent by reducing fraud and abuse. . . All told, we estimated that Vermont could save 25 percent in health care expenditures over 10 years.”

In the national health reform debate, Vermont, not Massachusetts, now leads the way.

Susanne L. King, M.D., is a Lenox-based practitioner.

Let me pose two riddles I will answer at the end of this column. Which health care reform program for Massachusetts won a non-binding referendum last November? Which health care reform legislation is co-sponsored by all five Berkshire County legislators?

We are now at the time of year when businesses, towns and families are faced with sticker shock as they pay their health insurance premiums for 2011. Town employees find they will have to pay a larger percentage of their health insurance as municipalities deal with escalating costs and limited budgets. There is a push for towns to join the GIC (the Group Insurance Commission) to attempt to reduce town expenses by limiting the choice of private insurance policies and increasing out-of pocket costs for employees.

Businesses are also being forced to require increased cost sharing from their employees. Individuals have to buy insurance plans that cover less even as they cost more, for high deductible plans with larger co-payments for both medical services and prescription drugs.

But there is a solution to these runaway costs: a single-payer health insurance program. In Massachusetts, single-payer legislation, the “Medicare for All Massachusetts Bill,” has been filed for 2011. This legislation guarantees first class, comprehensive coverage for every Massachusetts resident, while reducing costs to the state, towns, businesses and individuals.

Under this legislation, residents of Massachusetts would have a health insurance card to present whenever they received medical care, dental care or prescription drugs. They would pay nothing out-of-pocket, and receive no medical bills.

Businesses would pay a stable payroll tax of 7.5-8 percent instead of rising premiums. Towns would pay the same payroll tax for their employees. Middle and low-income employees would pay a 2.5 percent payroll tax, and take home 7.3-15 percent more income than with their current health insurance program.

In addition to saving money for businesses, towns and families, a single-payer health care program would save money for the state, money needed for other services like education, police and fire protection. Insurance companies, with their high profits and administrative costs, would be supplanted by a “single-payer” that would administer the health care money at a much lower cost than the many private insurance companies. By eliminating the insurance middlemen who provide no health care services, Massachusetts would save $9.7 billion per year. Administrative costs would also decrease for doctors and hospitals with a single-payer program.

The covered benefits would include:

* Prevention, diagnosis and treatment of medical injury and illness, both inpatient and outpatient, laboratory and radiology services, mental health care, dental care, acupuncture, physical therapy, and chiropractic and podiatric services.

* Rehabilitation treatment

* Prenatal and maternity services.

* Home health care.

* Long term care.

* Hospice care.

* Medical transportation.

* Vision and hearing treatment.

* Medical equipment.

* Prescription drugs.

There would be no deductibles, co-payments or co-insurance. Patients would have free choice of health care providers. And an added benefit would be the long term care insurance, especially important for baby boomers now coming of an age where they may need that benefit.

The current Massachusetts health care bill has not been able to control costs, nor do private health insurance policies provide adequate coverage for health care. People want health care reform that works.

So here are the answers to the riddles.

Fourteen districts in Massachusetts voted in favor of a non-binding referendum for a single payer health program in the November election.

All five state legislators in the Berkshires have signed on to co-sponsor the Medicare for All Massachusetts Bill. We praise their leadership, vision, commitment and caring: Senator Benjamin Downing and Representatives Gail Cariddi, Paul Mark, “Smitty” Pignatelli and Chris Speranzo. Our Berkshire delegation is leading the way: no other county in Massachusetts has the support of all their legislators for single-payer health care.

It is time for everyone who supports the Medicare for All Massachusetts Bill to become even more active for the establishment of a state health insurance program that works for everyone, at a cost that is affordable for the state, towns, businesses and families.

Call or write our governor. In his heart, he may be a secret single-payer supporter.

Susanne L. King, M.D. is a Lenox-based practitioner.

On Nov. 2, you will be able to vote for “single-payer” health care if you live in the 2nd or 4th districts of Berkshire County. This referendum is non-binding, but will send a strong message to our legislators and governor.

A single-payer health care program would be an expanded and improved Medicare system for everyone, not just senior citizens. The government would be the only administrator of the health care funds (the “single payer”), rather than the hundreds of for-profit health insurance companies which currently administer our health care dollars.

The insurance companies add to the enormous cost of health care by keeping 20-30 percent of our health care dollars for their administration, profits and exorbitant CEO salaries. In contrast, Medicare uses less than 1.5 percent of our health care funds for administration. “Single payer” refers only to the administration of health care dollars, not to the delivery of care, which would remain in the hands of health care providers.

Who will benefit from a single-payer system?

First, patients will experience cost-savings and better access to care. Rather than paying insurance premiums that increase in price each year for policies that provide less coverage with higher deductibles and co-payments, everyone will pay a modest income tax that will cost less than current premiums for health care insurance. Plus, patients will be able to choose their own doctors.

Second, doctors and hospitals will benefit, because they will no longer have to hire legions of office workers for administrative tasks. Doctors will be relieved of the onerous paperwork demands from multiple insurance companies, freeing them to spend more time with their patients.

A majority of doctors support single-payer health care. The annual study by the Massachusetts Medical Society found doctor shortages throughout our state, especially in the Berkshires, and especially in primary care. Doctors were asked about their preferences for a health care system: they picked single-payer health reform over a public option, over high-deductible plans, and over the Massachusetts health reform — in short, over every other option presented. The current Massachusetts health reform was least favored.

Third, business will benefit, especially small business owners who view rising health insurance costs for their employees as their greatest concern. If everyone were covered by a single-payer program, payment for health care would no longer be tied to employment, and business owners would be freed from an expensive, complicated responsibility.

Fourth, towns and cities will benefit because they will not need to provide health insurance for their active and retired employees; instead, that money can be used to improve other services such as education.

Fifth, our state will benefit. The recent health care legislation that extended health insurance to 97% of our state population has required enormous infusions of cash to provide subsidies for those unable to afford health insurance policies. As a result, we have filled the coffers of the private health insurance industry, while seriously straining the state budget.

Sixth, even though the Massachusetts referendum is not a national vote, the United States would benefit from a single-payer national health program by saving $400 billion per year in administrative costs alone; a serious consideration for a financially-strapped country. The legislation just passed by President Obama and Congress, the Patient Protection and Affordable Care Act (PPACA), makes only minor improvements to an unsustainable for-profit health insurance system. Similar to the Massachusetts legislation in its laudable attempt to provide universal coverage, this legislation is not cost-effective.

Our government will subsidize private insurance premiums for the “near poor,” channeling $447 billion of taxpayer dollars to private insurers over the next decade. As Drs. Steffi Woolhandler and David Himmelstein (founders of Physicians for a National Health Program) have written, “Morphine has been dispensed for the treatment of cancer — the reform (PPACA) may offer a bit of temporary relief, but it is certainly no cure.”

Another physician, Dr. Edward Ehlinger, wrote, “Insurance is a strange model for health care . (Insurance) is meant for life’s uncertainties, but illness is a pretty sure thing ” That’s why we don’t use the insurance model for fire and police protection or for education. Health care should also be in the category of essential services we will all need someday.

The only loser after single-payer health care is enacted will be the health insurance industry, the middlemen who provide no medical care and siphon our hard earned premiums into their own exorbitant profits.

If you are in favor of a single-payer health care system for Massachusetts, I urge you to vote “Yes” on Question 4 on Tuesday, Nov. 2.

Susanne L. King, M.D. is a Lenox-based practitioner.

“Employers pushed costs for health on workers,” The New York Times revealed this month, citing a survey released by the Kaiser Family Foundation, a non-profit research group. Although the cost of an average insurance policy rose 3 percent, the worker’s share of the cost of a family policy jumped 14 percent. Workers are absorbing more of the costs of health insurance premiums as well as facing higher deductibles, thus paying a larger share of their overall health care costs.

Helen Darling, president of the National Business Group, says that companies expect their costs to go up more under the new health care law, the Patient Protection and Affordable Care Act (PPACA), which requires them to provide more benefits. She says businesses “can’t afford to subsidize what’s happening.” Meanwhile, in 2009, profits increased 56 percent for the nation’s five largest health insurers to $12.2 billion. Insurance company CEO compensation keeps rising as well. Stephen Helmsley, CEO of United Health Group, received an income of $107.5 million last year.

Not only are health insurance companies squandering our hard-earned health care premiums on profits, they are often doing so illegally. The California Department of Insurance is seeking fines from PacifiCare, a subsidiary of United Health Group, for nearly one million violations of state law from 2006-2008. The attorney for the Department of Insurance stated, “It’s a story of intense corporate greed.”

With the passage of the new health care law (PPACA), health insurers can only spend 15 percent of premiums from large groups, and 20 percent of premiums from individual policies on administrative expenses. As might be expected, health insurers are gaming the system by pushing as many of their administrative expenses as possible to the medical side so they can preserve CEO salaries and profits, while beleaguered businesses and struggling workers continue to fill the coffers of the health insurance industry.

The for-profit private insurance system, with its multiple insurance plans and micro-management, creates an additional administrative burden for providers of health care, consuming another 12 percent of the premium dollars, which brings total administrative costs up to 32 percent of insurance premiums. Doctors spend hours on paperwork every day.

A national single-payer health insurance program, like an improved Medicare system for everyone, would save $400 billion a year by eliminating the private health insurance industry. According to a recent report from the U.S. House Committee on Energy and Commerce, Medicare administrative expenses are less than 1.5 percent, which means that 98.5 percent of premiums are actually spent on health care. Businesses would be freed from paying rising health insurance costs or passing them on to their workers, because health insurance coverage would not be tied to employment. Everyone would have health insurance coverage, paid for by a modest payroll tax, which would be less than current health care premiums.

In 2009, President Obama stated, “I want to cover everybody. Now the truth is unless you have a single-payer system in which everyone’s automatically covered, you’re probably not going to reach every single individual.” He’s right. Official estimates this week from the Census Bureau show a dramatic spike in the number of Americans without health insurance in 2009 to a record 50.7 million. The rise in the number of uninsured was almost entirely due to a sharp decline in the number of people with employer-based coverage, which has declined for the ninth consecutive year.

In 2014, when PPACA is finally implemented, 23 million Americans will remain uninsured. In Massachusetts, 295,000 citizens still do not have insurance four years after the passage of our own state reform bill. Health insurance must be divorced from employment, and a single-payer program established to cover everyone in a cost-effective manner.

In Massachusetts, there will be a non-binding referendum on the ballot in 14 districts in November, including districts 2 and 4 in the Berkshires. Question 4 reads, “Shall the representative from this district be instructed to support legislation that would establish health care as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?”

By voting “yes” on question 4, voters will send a clear message to our state government, proclaiming their support for single-payer health care reform.

Susanne L. King, M. D., is a Lenox-based practitioner.

Say “Happy Birthday” to Medicare, signed into law by President Lyndon Johnson 45 years ago, on July 30, 1965.

This national program provides health insurance coverage for everyone 65 years and older, regardless of income or health status, as well as covering people with disabilities. Our senior citizens love Medicare, which, along with Social Security, has substantially lowered poverty among the elderly, providing a secure safety net for our most vulnerable citizens.

Medicare is an example of a “single payer” health insurance program, in which health care dollars are administered by only one payer, the federal government. Medicare patients love the program for a number of reasons. Their premiums, deductibles and co-payments are reasonably priced. No one 65 and older can be denied coverage due to pre-existing conditions. Patients have their choice of doctors and hospitals, and are able to make decisions with their doctors about the care they need.

This safety net is now being threatened. President Obama has appointed a committee, the “National Commission on Fiscal Responsibility and Reform,” to make recommendations to Congress for reducing our federal deficit. Unfortunately, some members of this commission are already considering cuts to Medicare and Social Security benefits. Other solutions for reducing the deficit, like cutting the military budget, taxing the rich, negotiating drug costs, and eliminating the waste of the private health insurance industry by enacting a single-payer health insurance program, are not being considered. The commission is expected to make its recommendations to the House of Representatives after the fall elections, with a vote anticipated in December during a lame duck period of Congress.

Instead of cutting Medicare benefits, a better solution is to eliminate the failed and very costly for-profit “multiple payer” model, that includes hundreds of private health insurance companies with their high administrative costs and exorbitant CEO salaries, as well as their intrusion into the doctor-patient relationship. A much more cost-effective insurance approach would be to improve and expand Medicare to include everyone. At a time when our nation faces high unemployment, and fiscal crises, an expanded Medicare program would be a boon for individuals, small businesses, towns and states.

How would such a program produce savings and control health care costs? First, with Medicare, administrative costs are much lower than for private insurance companies. Administrative savings would be about $400 billion/year, enough money to provide coverage for everyone. Second, prescription drug prices would be negotiated, and drug costs could be lowered by 40 percent, bringing U.S prices in line with other developed countries. Third, an expanded Medicare system could establish global budgets for health care facilities.

The majority of Americans support Medicare and an expansion of this program to provide single-payer health insurance for everyone. Last week this was demonstrated again when participants in town meetings sponsored by “America Speaks” demanded single-payer as the option to solve the health care crisis, and 71 percent voted to not cut Medicare and Medicaid.

Our public and private dollars are flowing into the coffers of the private health insurance industry. These insurance companies continue to squeeze patients and health care providers financially, while paying their executives enormous salaries and bonuses. In 2009, the United Health Group, one of the biggest health insurance companies, paid CEO Stephen Helmsley a compensation package of over $107. 5 million. A recent conference of health economists in Chicago concluded that increasing consolidation in the health insurance industry has led to higher premiums, fewer jobs for health care workers, and reduced physician earnings.

Obama’s commission should not recommend cutting Medicare benefits. Write to your senators and representatives, and let them know how you feel about preserving, and expanding Medicare. Ask them to improve and strengthen Medicare by making it available to everyone, so that in coming years we will all be able to enjoy and celebrate the birthday of this life-saving health insurance program.

Susanne L. King, M. D., is a Lenox-based practitioner.

The passage of the “health insurance” bill has been a huge political success for President Obama and the Democrats and has been compared to the historic passage of Medicare and Social Security. Unfortunately, this bill is not in the same league as those successful programs, which provide medical and financial security to every elderly and disabled American. This is not a “health care” bill; it is a “health insurance” bill, which will hand out $447 billion in taxpayer money to insurance companies as subsidies to purchase inadequate insurance products. And the bill will require millions of Americans to buy these substandard products. The insurance companies are the big winners in this legislation.

We did not need to create this scenario to obtain the useful measures in the bill, like additional funding for community health centers, expansion of Medicaid, reduction of the “donut hole” in prescription drug coverage for Medicare patients, and allowing young adults to stay on their parents’ health insurance plans until age 26. These fixes could have been done separately. Instead, they were inserted into a 2,000-page bill that will further enrich and empower the insurance industry.

Sen. Max Baucus recently praised his aide, Elizabeth Fowler, former vice president of the giant health insurer Wellpoint, for her pivotal role in crafting this legislation. While middle class families were struggling to pay their escalating health insurance premiums, rising deductibles and co-payments, Wellpoint’s profits increased by $2.3 billion in 2009, 91 percent more than the previous year. Not content with this level of profiteering, Wellpoint’s subsidiary, Anthem Blue Cross of California, seeks to increase profits even more by raising its premiums by an astounding 39 percent this year.

Wall Street loves the law. Mutual fund analysts say it is beneficial for health industry stocks, particularly for pharmaceutical and medical equipment companies, because there are no “onerous cost controls.” Health insurance company stocks continue their upward trend, and CEO salaries remain astronomical.

In addition to the bill’s handout to the insurance industry, this legislation has many shortcomings:

* Twenty three million people will remain uninsured, which translates into 23,000 unnecessary deaths every year.

* Millions of middle-income people will have to buy health insurance policies, costing up to 9.5 percent of their income, but covering an average of only 70 percent of their medical expenses, because of high deductibles and co-payments.

* People with employer-based coverage will still not be able to choose their doctors and hospitals, and eventually face steep taxes on their benefits as the cost of insurance grows.

* Health care costs will continue to skyrocket, as we have seen here in Massachusetts after the passage of Chapter 58, which did nothing to contain costs.

* The insurance regulations are riddled with loopholes, as one might expect when insurers helped to craft the bill. For example, older people will be charged three times more than their younger counterparts, and large companies that have more female workers will continue to pay higher rates until 2017.

The American people did not have to be saddled with an expensive package of individual mandates, taxes on workers’ health plans, sweetheart deals with insurers and Big Pharma, and a perpetuation of our current dysfunctional and unsustainable system. President Obama did not seize his chance to inherit the mantles of Presidents Roosevelt and Johnson, with their historic fashioning of legislation for Social Security and Medicare. This bill’s passage reflects political considerations, not sound health care policy.

Sooner or later, our nation will have to adopt a single-payer national insurance program, an improved Medicare for all. We could save $400 billion annually in administrative costs, enough to provide comprehensive coverage for everyone. And only a single-payer system provides the tools for cost control, like bulk purchasing, negotiated fees, global hospital budgeting, and capital planning.

Polls show that almost two-thirds of the American public supports this approach, and a recent survey shows that 59 percent of U.S. doctors do as well. Inevitable price increases by the insurance industry will expand the popularity of the single-payer movement. Ultimately we will have a national health insurance program. Single-payer health care is the only coverage that is universal, comprehensive, and affordable.

Susanne L. King, M.D. is a Lenox, Mass.-based practitioner.

Aetna, Cigna, Humana, United Health, and Wellpoint scored record profits totaling $12.2 billion. In 2008, Ron Williams, CEO of Aetna, received over $24 million in compensation, about $450,000 per week. His weekly compensation would be enough to pay the yearly salary of three family doctors, whose median income in the United States is $159,000 per year.

While middle class families were struggling to pay their escalating health insurance premiums, rising deductibles and co-payments, Wellpoint’s profits increased by 91 percent in 2009, $2.3 billion over the previous year. Not content with this level of profiteering, Wellpoint’s subsidiary, Anthem Blue Cross of California, seeks to raise its premiums for some by an astounding 39 percent this year.

A study in the Journal of the American Medical Association last week reports that physician fees, adjusted for inflation, decreased by 25 percent between 1996 and 2006. This coincided with a decrease of 5.7 percent in the number of hours that doctors worked per week, a reduction that amounts to the equivalent of a loss of 36,000 doctors from the work force, had the hours per physician not changed.The authors’ suggested “the possibility that economic factors such as lower fees and increased market pressure on physicians may have contributed, at least in part, to the recent decrease in physician hours. Further reductions in fees and increased market pressure on physicians may therefore contribute to continued decreases in physician work hours in the future.”

Will President Obama’s health reform proposal, crafted to gain bipartisan support from a Congress that has been lobbied by the Big Five with $16. 8 million last year, actually reform health care? Not a chance, because the proposal preserves a central role for the for-profit insurance industry. This leads to several problems.

First, his plan will give subsidies to people who are unable to afford insurance policies. While more people would have insurance coverage, this is the equivalent of giving billions of taxpayer dollars to the private health insurance industry.

Second, the individual mandate he proposes will force millions of middle class Americans to buy inadequate insurance products, which have rapidly escalating premiums, and high deductibles and co-payments. This will contribute to financial hardship and medical bankruptcy for those who suffer serious illnesses, and actually need to use their insurance.

And, third, at least 23 million people will remain uninsured.

Dr. Quentin Young, speaking for Physicians for a National Health Program, said, “This proposal is an insurance company bonanza, not good, evidence-based reform. The president would do better by abandoning the insurance and drug companies and instead taking up the single-payer approach . . . By building on and improving the already popular Medicare program, we could put our patients’ interests first. Were Obama to do so, he would meet with strong public support, including from the medical community.”

Obama’s proposal supports the health insurance industry to the detriment of the American people. Private health insurance companies have been given our health care dollars in order to pay doctors and hospitals: they are robbing the coffers, with their exorbitant compensation packages for CEOs and profits for their investors. An improved “Medicare for All” would cover everyone, and provide payment for care people need when they are ill: that is the health care reform Americans need and want.

Susanne L. King, M. D., is a Lenox-based practitioner.

Everyone is talking about health care reform and trying to decipher the differences between the bills in the House and the Senate. The “public option” is praised by some and derided by others. Politicians are influenced by the financial support of various interest groups who are lobbying furiously to retain or extend their turf.

Regardless of the legislation Congress passes, the health insurance industry is primed to expand its consumption of U.S. health care dollars by selling more insurance policies to people who are currently uninsured. And American taxpayers are going to subsidize many of these policies, a windfall profit for private insurance companies.

In a statement about why he voted against the House Bill (H.R. 3962) passed this weekend, Rep. Dennis Kucinich said, “In H.R. 3962, the government is requiring at least 21 million Americans to buy private health insurance from the very industry that causes costs to be so high, which will result in at least $70 billion in new annual revenue, much of which is coming from taxpayers. This inevitably will lead to even more costs, more subsidies and higher profits for insurance companies — a bailout under a blue cross.”

Few others in power are discussing the important question, “Is all of this legislation real reform or phantom reform?” Universal coverage is important, but what are the other necessary components of health care reform that American people desire? There are four other important elements beyond universal coverage: choice, adequate coverage, security, and cost-effectiveness.

First, phantom reform does give you choice, but it is the choice between many HMOs and other private, for-profit insurance plans. Real reform would give patients the choice they actually want, which is to choose their doctors and hospitals. Americans don’t want a choice of insurance company bureaucrats; they want a choice of health care providers.

Second, phantom reform does give you insurance coverage, but with deductibles and co-pays, as well as exclusions for various services. Real reform would provide coverage with no out-of-pocket costs; i.e., comprehensive care for all medically necessary services, as decided by you and your doctor, not a faceless bureaucrat in an insurance company intent on maximizing its profits.

Third, phantom reform provides illusory security. Sure, you get an insurance policy, but if you can’t work or pay, you lose your insurance. Real reform would provide security for everyone, for as long as they needed care, just as Medicare does now for those over 65.

Fourth, phantom reform saves money by providing less care. “Medical loss” is the term insurance companies use for the dollars they pay out to health care providers and hospitals for their services, at times resorting to criminal means to hold on to the money patients have paid for insurance to cover the health care services they need . Real reform would save $400 billion per year by eliminating private, for profit health insurance, if the government were the non-profit single payer of the health care funds.

Real reform is a single-payer national health insurance program that would be comprehensive, universal, and cost-effective. Phantom reform is what Congress is now hotly debating, and the public option is a red herring in the pursuit of real reform.

According to Dr. Steffie Woolhandler of Harvard Medical School, who has studied the financing of health care reform, the public option would deliver very little of the administrative savings possible in a single-payer program. There would be no savings on hospital billing or the administrative bureaucracies of nursing homes and doctors’ offices. In reality, the public option would save only a fraction (1/7th) of the $400 billion savings available through a single-payer program, even if half of the privately insured were to switch to a public option.

In addition, our experience with Medicare HMOs shows that private insurance plans avoid patients who are seriously ill and have high medical costs. Despite regulations, private insurance companies undermine fair competition. There is no reason to believe the public option would fare any better in this arena.

Unlike politicians, the American people know real reform when they see it. In 2009, a CBS News/ New York Times poll showed that 59 percent of Americans support national health insurance, up from 40 percent in 1979. And Americans know that we have what it takes in the United States to deliver top-notch care: excellent hospitals, well-trained professionals, and superb research.

We already spend at least twice as much per person for health care as other wealthy countries. Even our public spending is greater than the total spending in other nations. We have the money for health care for everyone. The money just needs to be spent on health care delivery, rather than bureaucracy and profits for insurance companies.

If you cannot afford insurance, or your health insurance premiums keep rising, along with your out-of-pocket costs, consider our neighbor to the north. Canada has Medicare for all, a single-payer national health program that provides universal, comprehensive coverage. Canadians also have a life expectancy two years longer than Americans, infant deaths 25 percent lower, more doctor visits and hospital care per person, and a quality of health care equivalent to that of insured Americans. Canada spends half the amount per person that we spend on health care. Now that is real reform.

The disruptions at town meetings in August were not just the work of conservative hecklers and their corporate backers. The wave of anger also revealed that many Americans feel left out during the current recession. It is not just the 50 million people who are left out because they don’t have health insurance, or the tens of millions who are left out because they have inadequate health insurance, or even the many people who have been bankrupted by their medical bills (the most common cause of bankruptcy in the United States).

Millions of other Americans also feel left out and angry, frustrated by the bailouts for Wall Street and other corporations which profit from the tax dollars of struggling Americans.

The current health insurance reform bill being created in Congress is looking like just another bailout – this time for health insurance and pharmaceutical companies. With their lobbying dollars and influence, these companies are crafting health insurance legislation to expand their profits and power.

A proposed individual mandate to force 47 million citizens to buy health insurance will be a windfall for private health insurance companies, and will be partially paid for with taxpayer dollars for subsidies to support premiums for people who can’t afford health insurance.

And the drug companies pulled a real coup. President Obama agreed to a promise of $80 billion from the pharmaceutical companies over ten years in exchange for an agreement with the government to not bargain down medication prices for Medicare, and to not allow people to buy cheaper drugs from Canada. The drug companies did not give the government $80 billion, nor agree to cut prices, but only to reduce the amount they would otherwise have raised prices. $80 billion over ten years translates into savings of only 2 percent of the projected U.S. spending on prescription drugs. What was Obama thinking?

What ordinary people seem to be thinking is, “We’ve given enough bailouts to the private sector, and we are sick of our government continuing to subsidize private corporations.”

At a “Community Meeting for Healthcare” in New Hampshire during his campaign for president in 2007, Barack Obama talked with 200-plus people about health care reform. He said, “I want to be held accountable for establishing a universal health care plan by the end of my first term, but I have to insist on the voters rallying for this change. When I take office I have to feel I have a mandate for change.”

According to the Associated Press, his audience at the community meeting was “almost single-mindedly focused on a single-payer system.” What we know from polls is that 59 percent of Americans support a single payer national health insurance program, an improved “Medicare for All.” So why have our president and Congress abandoned single payer health care when the majority of Americans support it?

Representatives John Conyers and Dennis Kucinich are sponsoring HR 676, the single-payer, not-for-profit health insurance bill in the house, along with 85 other representatives. Kucinich says, “Insurance companies will stop at nothing to hold on to the American people’s wallet when it comes to health insurance.” He believes that health care reform needs to come from public input, not the special interest groups who are driving the legislation in Congress.

He recommends that we step back and start over on health care reform, and that congressmen should go back to the people and listen to their stories. They need to talk to all their constituents, not just those who scream the loudest. They need to hold town meetings where civil discourse prevails.

For those of us who support single payer health care, we can make it clear to our representatives in Congress that this will be an important issue in their re-election as we go to vote next year.

Since health insurance lobbyists have effectively squelched discussion of single payer bill HR 676 as an option for health care reform in Congress at this time, Rep. Anthony Weiner, a single payer supporter, has filed an amendment to the health reform legislation recently created in the House, HR 3200. Weiner’s amendment would effectively change HR 3200 into a single payer bill.

Speaker Nancy Pelosi has promised an up or down vote on this amendment in September. If you support single payer health care, please call your representative, or go to www.pnhp.org and send an email asking him to support the Weiner amendment to HR 3200.

If we had an improved “Medicare for All” program, everyone would have comprehensive coverage, including medical and dental care, prescription drugs, and long term care, all without deductibles and co-payments. This approach would not add to our burgeoning national deficit, but would save $400 billion in administrative costs alone by eliminating for-profit health insurance companies.

The current Medicare program is financially threatened: Medicare viability would be enhanced by including everyone in the system, rather than siphoning off healthy workers to the for-profit insurance industry. Only with a single payer national health program will we have “everybody in and nobody out.”

There is a moral imperative to providing comprehensive health care to everyone. Health care should be a human right, not a market good. As Senator Teddy Kennedy said, “For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.”

Susanne L. King is a Lenox-based practitioner.