Health Debate: Costs and Benefits

The New York Times
Letters
August 4, 2009

To the Editor:

Universal coverage and cost control are not conflicting aims.

Canada spends 10 percent of gross domestic product on health care, and everyone is covered. The United States spends 16 percent of G.D.P., but tens of millions lack coverage. The cost difference is almost entirely due to higher administrative costs and higher prices, which are directly related to the economics of a multi-payer system.

The lessons from Canada and other countries are clear. If you focus on cost control, you will fail. If you cover everyone because it’s decent and just, you will also achieve economic sustainability.

America, it’s time to do the right thing and then reap the rich rewards of moral public policy.

Michael M. Rachlis
Toronto, Aug. 2, 2009

The writer, a doctor, is a health policy consultant.

http://www.nytimes.com/2009/08/05/opinion/l05health.html?ref=opinion

And…

U.S. Health Spending Breaks From the Pack

By Catherine Rampel
Economixl
The New York Times
July 8, 2009

The following graph shows that the United States is the only nation that has failed to slow the growth in health care costs in spite of also being the only nation of those listed that has not provided universal coverage.

health spending per capita in US 2000 PPP dollars, OECD countries

If there is no image in this message, the graph can be accessed at this link:
http://economix.blogs.nytimes.com/2009/07/08/us-health-spending-breaks-from-the-pack/

And…

Senators Closer To Health Package

By Shailagh Murray and Lori Montgomery
The Washington Post
August 6, 2009

The emerging Finance Committee bill would shave about $100 billion off the projected trillion-dollar cost of the legislation over the next decade and eventually provide coverage to 94 percent of Americans, according to participants in the talks. It would expand Medicaid, crack down on insurers, abandon the government insurance option that President Obama is seeking and, for the first time, tax health-care benefits under the most generous plans. Backers say the bill would also offer the only concrete plan before Congress for reining in the skyrocketing cost of federal health programs over the long term.

Spurred by the CBO director’s startling assertion last month that measures drafted by other committees would not bend the “cost curve,” negotiators on the finance panel are also studying a plan to fine insurance companies that do not pay providers electronically, a plan to reduce payments to providers to force them to increase efficiency and a plan to study the comparative effectiveness of various medical treatments.

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/05/AR2009080503996.html?hpid=topnews

Once again. The stated goals of health care reform are 1) to cover everyone, and 2) to slow the growth in health care costs so that health care is affordable. So what is Congress doing?

The Senate Finance Committee now would leave 6 percent without coverage, and none of the other bills are truly universal either. Based on the policies contained in the bills, it is likely that the estimates of individuals that would be left out are very conservative, and many more will remain uninsured. So much for universal coverage.

What about bending the cost curve? Most of the legislative measures are aimed at controlling federal spending on health care. Very few of the policies would have any real impact on slowing the growth of our total national health expenditures. This means that more health care costs will be shifted from the government to individuals and employers. Bending the cost curve of the federal budget is of no value if the cost curve of our national health expenditures continues on its current trajectory.

Will private insurance reform slow cost increases? All Congress is asking of the insurance industry is that they guarantee the availability and renewability of insurance coverage. That can have no impact whatsoever on total health care costs, but it does increase health insurance premiums since those high-cost individuals who are currently shut out would then be allowed to purchase coverage in the private plan risk pools. Higher private insurance premiums is not exactly what most Americans want.

Michael Rachlis is right. Look at the curves. Every other nation has adopted health care financing systems – social insurance programs – which have allowed them to moderate the trajectory of health care spending, while providing universal coverage. The United States remains the outlier on both counts.

The members of Congress are diddling with policies that they wish would control costs, but at best will only sanitize the federal budget, while they insist in leaving in place our unique, American-style multi-payer system that can never provide affordable health care for all of us.

An improved Medicare-for-all program would bend our cost curve into the sustainable path shared by all other nations, and would take care of all of us. Let’s go for it!

Building a National Insurance Exchange: Lessons from California

California HealthCare Foundation
Issue Brief
July 2009

Among the deliberations now taking place in the nation’s capitol regarding federal approaches to expanding health coverage, virtually all incorporate the idea of an insurance exchange – an entity to which people can go to select a health plan from a broad range of offerings. Over the past 15 years, California gained extensive experience in designing and operating just such an exchange, an effort that ultimately proved unsustainable.

The California Exchange

The Expectation

1. Provide an easy to navigate single point of entry where people could go to choose among several health plans.

2. Reduce the cost of coverage, using three primary mechanisms:

* Reduce administrative costs by achieving economies of scale
* Command lower prices
* Foster market competition

3. Enhance portability of coverage

The Reality

The actual experience of the California exchange taught some hard lessons. It showed that none of theses objectives is easily achieved.

The Participation Problem

… as long as the exchange is not the exclusive source of coverage for some populations, health plans may be reluctant to participate…

Insurers do not particularly like the head-to-head competition that is a feature of the exchange concept… Insurers always prefer to insure whole groups directly rather than compete in the exchange.

The Elusiveness of Savings

* Few administrative efficiencies
* A lack of pricing power
* Exposure to adverse selection

People involved in the operations of the California exchange agreed that when there is competition for the same customers within and outside the exchange, the exchange is in “extreme peril” of becoming a victim of adverse selection… Eventually the exchange will fail.

Choosing the Right Model

But once individual choice is part of the exchange design, insurers will prefer to generate business outside of the exchange, as occurred in the California experience… The insurers will still have an incentive to direct higher-risk people to the exchange rather than insuring them directly, in hopes that they might pass off some of the “bad” risks to other insurers.

http://www.chcf.org/documents/insurance/BuildingANationalInsuranceExchange.pdf

For a description of the Health Insurance Exchange proposed in the House Tri-Committee bill, insert H.R.3200 in the Thomas search box and read Title II:
http://thomas.loc.gov/

Most progressive policy wonks observing the reform process taking place in Washington have been quite smug. As the battles take place over a public option, over taxing employer-sponsored plans, or over the eligibility thresholds for government subsidies, these wonks are complacent knowing that the really important reform taking place is the establishment of the Health Insurance Exchange. Or so they believe.

Within the Exchange the regulated private insurance industry will have to provide standard benefit packages, at affordable premiums made possible by competition, and without the intrusive perversities that currently permeate the industry and its products. What could be wrong with this?

President Obama and the Democrats in Congress are currently facing a barrage of criticism for supporting the government takeover of health care. To fend off this criticism, what are the very first words out of President Obama’s mouth? “You can keep the insurance you have!” So much for an insurance exchange market of comprehensive, affordable private health plans.

Why would a phenomenally successful private insurer ever want to compete with itself by offering a heavily regulated Health Insurance Exchange product that has unaffordable premiums because of adverse selection? Because of the requirement of risk adjustment within the Exchange, and because individuals and employers with high health care costs will seek relief in the Exchange, all products offered by the Exchange will be too expensive.

The Health Insurance Plan of California (later PacAdvantage) was designed not unlike the current federal proposals – an insurance exchange especially geared for small businesses. Because of adverse selection, it became a victim of the death spiral, and closed in 2006.

The only way a Health Insurance Exchange could work would be if we moved all existing private plans into the Exchange, and established a system that would effectively pool risk. Even then it would be very expensive, partly because of the profound administrative inefficiencies, and it would still fall short on universality and equity. And at that we would still have to address the problem of the very large sector of our population who would not qualify for subsidies but who still could not afford the high premiums and out-of-pocket expenses of private insurance.

The least expensive, most efficient, and most effective method of ensuring that everyone has affordable access to the health care that they need is a single payer, Medicare-for-all, national health program. There will be a lot of noise on health care reform during the August recess. Just make sure that our noise is the loudest!

Marilyn Clement’s Speech at Celebration Held in Her Honor

June 7, 2009

Closing comments of Marilyn Clement’s last speech:

Keep it up! We’re going to win single payer!

Video of speech (10 minutes):
http://www.healthcare-now.org/marilyn-clements-speech-at-celebration-held-in-her-honor/

Healthcare-NOW!
http://www.healthcare-now.org/

Marilyn never gave up, though she left us yesterday, August 3, 2009.

A Canadian doctor diagnoses U.S. healthcare

By Michael M. Rachlis
Los Angeles Times
August 3, 2009

Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians’ services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.

The U.S.’ and Canada’s different health insurance decisions make up the world’s largest health policy experiment. And the results?

On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.

On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.

Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.

Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.

Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.

The Canadian system does have its problems, and these also provide important lessons.

However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas.

On closer examination, most of these problems have little to do with public insurance or even overall resources.

Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.

U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada’s, or any other nation’s, experience than ever. Why?

American democracy runs on money.

Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our “socialized” system doesn’t let us choose our own doctors. In fact, Canadians have free choice of physicians. It’s Americans these days who are restricted to “in-plan” doctors.

Unfortunately, many Americans won’t get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.

(Michael M. Rachlis is a physician, health policy analyst and author in Toronto.)

http://www.latimes.com/news/opinion/la-oe-rachlis3-2009aug03,0,538126.story

August will be the month of sound bites on health care reform.

One of these sound bites is “unfair competition.” It is really a silly argument designed to suppress even the most feeble of reform efforts.

But the really unfair competition this month will be between those who can explain the relatively complex health policies that can benefit everyone (except those who are wasting our resources), and those who have at their command the very effective tool of simple sound bites. These sound bites relieve the listener of any responsibility to try to understand these complex issues.

Should the dialogue on reform move into discussions of effective health policies, the opponents will be ready with their sound bite diversions, including those based on the caricature of the Canadian experience suggesting that their government takeover of health care has caused Canadians to flee to the United States should they need health care – a lie supposedly “proven” by rare, bizarre anecdotes.

When the distortions and lies about Canada are brought up, interrupt (they do) with the response that Canada has a health care financing system that includes everyone and keeps health care affordable.

The United States needs the same. We need to include everyone in a system that is affordable. The problem for single payer advocates is that the program that the administration is trying to sell us will leave five percent of us out and make affordability even worse.

The real tragedy is that this war on health care financing reform will be settled by sound bites. On that war, the bad guys always win.

From Greg M. Silver, MD (Clearwater, FL)

Lots of activity in the Tampa Bay region. As the battle heats up, I have appeared on WEDU-TV, our local PBS affiliate, for a Special Roundtable presentation on Health Care Reform on 7/17, as well as the “Kathy Fountain Show” on WTVT 13 our local Fox affiliate on 7/29. Yesterday, I was interviewed on WTAN radio in Clearwater for a program focusing on reform efforts. I am also scheduled for another discussion at the University of South Florida in September. More to come as soon as I can take a breath!

(Video links below)

Last night as the House Energy and Commerce Committee completed its markup of HR 3200, the House health reform bill, Chairman Henry Waxman interrupted Representative Anthony Weiner of New York to say that House Speaker Nancy Pelosi had promised that single payer legislation, HR 676, The United States National Health Care Act would come before the entire House of Representatives. Chairman Waxman:

The Speaker has said that she will allow this to be brought up on the House floor, and debated, and voted on.

Representative Anthony Weiner (NY-9, Brooklyn/Queens) had placed an amendment before the Energy and Commerce Committee that would have replaced the text of HR 3200 with the text of HR 676, the United States National Health Care Act. He was joined by fellow Energy and Commerce committee members Peter Welch (VT, Vermont), Mike Doyle (PA-14, Pittsburgh), Tammy Baldwin, (WI-2, Madison), Jan Schakowsky (IL-9, Chicago), Bobby L. Rush (IL-1, Chicago), Eliot L. Engel (NY-17, Rockland/Westchester).

Chairman Waxman asked for the single payer amendment to be withdrawn from committee debate in exchange for a debate and vote on the House floor. Representative Weiner hailed this victory in a brief statement:

Single-payer is a better plan and now it is on center stage. Americans have a clear choice. Their Member of Congress will have a simpler, less expensive and smarter bill to choose. I am thrilled that the Speaker is giving us that choice.

On the Mouth of the Potomac blog, NY Daily News Washington Bureau journalist Michael McAuliff reported:

The Brooklyn-Queens Rep. looked a little surprised when Chairman Henry Waxman said Pelosi would allow that vote, and made Waxman repeat the deal to be sure it was clear and on the record. It’s an especially big deal for advocates of a single health care system — who see it as cheaper and simpler than the complicated measure being drawn up — because they have been complaining that they have not even been able to get an airing of their position.

And having the vote of the floor of the House will force members to declare a position, and bring much more attention to the idea.

Reporting for The Hill Mike Soraghan wrote:

Legislation creating a single-payer system would be expected to lose, but would allow liberal members to record their support for the proposal. It will also be a tough vote for some Democrats who will be wary of upsetting the liberal base.

Many liberal lawmakers feel that the controversial “public option” that would compete with private insurers is a compromise from single-payer.

Single payer advocates should not be surprised by this turn of events. Chairman Waxman himself was a co-sponsor of HR 676 in the 109th Congress. Speaker Pelosi has also supported single payer in the past. Only this spring, at an event sponsored by the Christian Science Monitor, the Speaker told the audience:

… over and over again, we hear single payer, single payer, single payer. Well, it’s not going to be a single payer. …

Just one day before the Energy and Commerce Committee meeting, on July 30th, over one thousand single payer supporters swarmed through the halls of Congress to celebrate Medicare’s 44th birthday. Congresspeople and staff told us over and over again that back home grassroots clamor for single payer continues to build. In other words, across the nation, representatives have had the same experiences as the Speaker of the House.

Anthony Weiner’s initiative has created a new opening for us to educate our colleagues, our patients, our elected representatives, indeed everyone, about the need for a single payer program of national health insurance. A strong single payer vote in the House will mark a turning point in history.

As we accumulate momentum, we find steady support and fresh creativity for our great cause. What a wonderful time to join Physicians for a National Health Program. We need your voice!

**************
Video links:

The full Weiner amendment discussion at the Energy and Commerce Committee can be viewed here. Look at the bottom on the screen. The session is 6 hours 5 minutes and 38 seconds long. The Weiner piece begins at 3 hours 15 minutes and 40 seconds and ends at 3:32:53.

Representative Weiner introduces the single payer amendment at the Energy and Commerce Committee.

Representative Tammy Baldwin (Madison, Wisconsin) speaks for single payer at Energy and Commerce Committee

Representative Eliot Engel (Westchester/Rockland, New York) speaks for single payer at Energy and Commerce Committee.

Chairman Waxman interrupts Representative Weiner to ask that the amendment be withdrawn because Speaker Pelosi has promised to allow single payer before the entire House of Representatives.

As the debate over health care reform becomes all-out warfare between parties and within the Democratic party, Congress will adjourn shortly for its August recess with many of the key questions unresolved.  However, the bill as shaped by two or three House committees (H. R. 3200, America’s Affordable Health Choices Act) gives a point of departure to consider the most that we might expect out of such a bill.

As described in our last three posts, this bill calls for both an individual and employer mandate as well as a small public option to be available to the uninsured and employees of small employers through a national insurance exchange.  Individuals would be subsidized by the government to offset their premium and out-of-pocket costs.  People with household incomes up to 400 percent of the federal poverty level (FPL) would be eligible for subsidies.  Tax credits would also be provided to small employers with fewer than 25 full-time workers, covering up to 50 percent of their premium costs.  These new subsidies, of course, are in addition to the many subsidies the government already provides to individuals and employers through long-standing tax-exemptions of  insurance costs.  H.R. 3200 also calls for expansion of Medicaid for all individuals with incomes up to 133 percent of the FPL (about $14,000 for an individual and $88,200 for a family of four).

The CBO projects the cost of H. R. 3200 to be about $1 trillion over 10 years, not including the increased costs of Medicaid, for which it lacks jurisdiction to score.  “Conservative” projections estimate that the bill will increase the U. S. budget deficit by $239 billion in 2019.  Governors have already weighed in against the increased costs of Medicaid expansion, pleading for an increased federal role in paying for it, and political opposition to the bill’s inflationary trends seems certain to spread beyond the Republicans and Blue Dog Democrats to others.  As the debate intensifies, we can expect that eligibility for subsidies will be tightened up.

Returning to the affordability of health insurance, the supposed reason for reform legislation, there is an obvious disconnect from the impacts of a deepening recession.  Much of the population, including the broad middle class, are in increasingly dire straits in their ability to pay for necessary health care.  Average annual health care costs for a family of four are now $16,771, including insurance premiums, deductibles and other out-of-pocket costs.  For a family of four with an income of $88,200 (four times the FPL and much more than the median U. S. median income), these average costs exceed 19 percent of family income, well above the 10 percent considered by the Commonwealth Fund as a hardship level.

We have to remember that the costs of health insurance often have little to do with the total costs of health care for individuals and families.  For those with significant health problems, their costs will be much higher.  And although the current proposals in Congress call for annual limits on out-of-pocket spending ($5,000 for individuals and $10,000 for families), insurance premiums and out-of-network charges are not counted against these limits.

This bad situation is getting worse. The unemployment rate is poised to soon rise above 10 percent, and the broader unemployment rate is already more than 20 percent in a number of states.  Tax revenues have fallen precipitously in many states, and 16 states are now paying for unemployment insurance in borrowed funds.  Draconian cuts are being made in safety net programs all across the country.

So it seems certain that federal payments for subsidies will far exceed any projections that are now being discussed. There are at least 100 million Americans less than 65 years of age with incomes below 400 percent of FPL.  If eligibility for federal subsidies is set at that level, the CBO projects that their cost will be about $773 billion between 2013 and 2019. Concerning Medicaid expansion, the CBO has also estimated that extending Medicaid to an additional group of Americans with incomes for a family of four up to $33,000 a year would cost about $500 billion over 10 years.

We can be sure that the Senate will restrict subsidies below these levels and that any final health care reform bill, if ever enacted, will further exacerbate the problems Americans face in paying for health care.  And to boot, federal law would mandate them to purchase health insurance, under penalty of fine, and an underinsurance product at that.  A working draft of the “actuarial value” of insurance coverage in the Senate Finance Committee last month stated that a policy of “bronze” or “silver” value would cover 65 and 73 percent of total health care costs, respectively — undercoverage by any standard.  A family of four with an income at 300 percent of FPL would pay 15 percent of their income on health care. So we would end up with a mandate for inadequate coverage which much of the population, as well as taxpayers, cannot afford.

The strong conservative challenge that is building against H. R. 3200 is largely due to its deficit-busting certainty as well as its increase in entitlement to health care without credible cost containment requirements.  As a progressive advocate of real health care reform, I can only agree with these concerns.  What is likely to emerge from Congress on health care reform this year, if anything, will not be real reform and will only add to our problems.

Although still very much under-recognized and fought against by the medical industrial complex and complicit corporate media, there is only one solution to cost containment of our runaway market-based health care system.   H. R. 676, coupled with a private delivery system, is a paygo alternative that assures universal coverage of necessary health care for all Americans.  It would save up to $400 billion a year and provide a structure within which to put in place other cost-saving efficiencies.

The private health insurance industry is an impediment to reform, not part of the solution.  It has survived to this time only through generous subsidies from the government, whether in the employer-based or individual markets or privatized Medicare and Medicaid programs.  Until we recognize this, all of our incremental approaches to build on our multi-payer system will be of no avail.

Adapted from Do Not Resuscitate: Why The Health Insurance Industry Is Dying, and How We Must Replace It, and The Cancer Generation: Baby Boomers Facing a Perfect Storm, with permission from the publisher, Common Courage Press.  Order link
1,096 words

John Geyman, M.D. is the author of The Cancer Generation and Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It, 2008 by John Geyman. With permission of the publisher, Common Courage Press

Buy John Geyman’s Books at: http://www.commoncouragepress.com

From Jeoffry Gordon, M.D., M.P.H. (San Diego, CA)

We had a good Medicare birthday rally on July 30th.

Next week is busy for me.
Sunday: Single payer presentation at Mission Hills United Church of Christ.
Tuesday: Medical Grand Rounds on Single Payer Reform at Sharp Coronado Hospital
Wednesday: I will represent PNHP and single payer on local PBS affiliate KPBS’s “These Days” show (you can get a podcast) which is presenting a four day series on problems with the health care and reform proposals.

From Wendy Ring, M.D., M.P.H. (Bayside, CA)

A group of us have been performing The Sound of Moolah, a show about health reform and why we need single payer, around southern Oregon and Northern CA recruiting new single payer activists wherever we go. There have been several newspaper articles and radio interviews.

From David A. Cimino, M.D. (St. Petersburg, FL)

I have had two letters to the editor published in the St. Petersburg Times in the past 4 months. The most recent was on July 22 and was a push for a Single Payer System. Tomorrow July 31 I have been asked to appear on a local news program on Channel 13 WTVT Fox News at 12:30 PM to discuss health care reform. I again will push for a Single Payer System as the only way to achieve affordable, quality health care for all. I am a semi-retired general pediatrician and for the past 20 years limited my practice to adolescents.

From Cynthia Haq, M.D. (Madison, WI)

Dr. Cindy Haq on Wisconsin Public Radio:
http://www.wpr.org/hereonearth/archive_090722k.cfm

Health Care Reform Rally 7/25/09 in Madison in Memory of Lindy Farley, MD

http://www.youtube.com/watch?v=TOc-2wwQYKk

Dr Jeff Patterson at the Farmer’s Market in Madison 6/28/09

http://www.youtube.com/watch?v=QaMU4-IYESc

Dr Gene Farley at the Farmer’s Market in Madison 6/28/09

http://www.youtube.com/watch?v=KeUjrW-UMZs

Farmer’s Market Madison 6/28/09
http://www.channel3000.com/health/19884995/detail.html

“American Values” — A Smoke Screen in the Debate on Health Care Reform

By Allan S. Brett, M.D.
The New England Journal of Medicine
July 29, 2009

Amid all the rhetoric about health care reform, one claim has emerged as a trump card designed to preserve the current patchwork of private and public insurance and to stop discussion of a government-sponsored single-payer system in its tracks: the claim that single-payer health care — a Canadian-style Medicare-for-all system — is antithetical to “American values.” The idea that American values dictate a particular approach to health care reform is often stated explicitly, and it is implicit in the generalization that “Americans want” a particular system. The underlying premise is that an identifiable set of American values point incontrovertibly to a health care system anchored by the private insurance industry. Remarkably, this premise has received very little scrutiny.

Americans have been misled by the rhetoric about choice. In contrast with the single-payer option, a system with multiple private insurers would continue to restrict one dimension of choice (selection of physicians) and perpetuate a choice most people would consider irrational (wasteful spending on administrative overhead).

A closely related rhetorical device — the idea that Americans or American values are “unique” — also deserves attention… What is relevant is whether a solution works, not whether it is unique. Indeed, the aspect of the current U.S. system that is truly unique among developed countries is its failure to cover everyone — hardly something to brag about.

Policymakers debating health care reform should stop hiding behind the smoke screen of “American values.” Discussions dominated by references to uniquely American individualism, uniquely American solutions, or narrowly defined conceptions of choice tell us more about the political and economic interests of the discussants than about the interests of the Americans they claim to represent. In an increasingly diverse country that has a widening gap between rich and poor, a more promising approach is to start with the questions that matter to everyone: Will the system care for us when we’re sick and help prevent illness when we’re well? Will we have access to medical care throughout our lives without risking financial ruin? Will we be able to navigate the system easily, without jumping through unnecessary hoops or encountering excessive red tape? Will health care spending be managed wisely? Health care reformers owe Americans a system that best addresses these questions — not one that merely pays lip service to ill-defined “American values.”

http://healthcarereform.nejm.org/?p=1245

Click on the link above now. At the bottom of this article you will find another link to the full PDF version (2 pages). Download it now. It will be a very important resource during the August recess when tens of millions of dollars will be spent to keep our thought processes suppressed by the poisonous rhetoric of carefully-crafted nice words – a process that has permeated our national dialogue on health reform. It is ideas, not words, that count.

Liberals will get single-payer vote on House floor

By Mike Soraghan
The Hill
July 31, 2009

Seeking to dampen liberal anger about deals cut with centrists, Energy and Commerce Committee Chairman Henry Waxman (D-Calif.) said House leaders have agreed to allow a floor vote on a government-run, single-payer system.

“A lot of members on our committee want a vote on that,” said Waxman said in an interview. “I believe their wishes will be accommodated.”

Rep. Anthony Weiner (D-N.Y.) offered a single-payer amendment in the Energy and Commerce Committee on Friday, but withdrew it after Waxman said House Speaker Nancy Pelosi (D-Calif.) had promised a floor vote.

http://thehill.com/leading-the-news/liberals-will-get-single-payer-vote-on-house-floor-2009-07-31.html

The Weiner single payer amendment:
http://energycommerce.house.gov/Press_111/20090731/hr3200_weiner_1.pdf

Call out the troops. We have work to do!