This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.
Obama Vows Swift Overhaul As Chrysler Enters Bankruptcy
By Peter Whoriskey, Brady Dennis and Kendra Marr
The Washington Post
May 1, 2009
Chrysler, the nation’s third-largest automaker, filed for bankruptcy protection yesterday, with President Obama promising that court relief would give the company a “new lease on life.”
Now largely under government control, Chrysler will seek in court to strip itself of its overwhelming debts.
The new majority owner will be Chrysler’s union retiree health fund, which would receive a 55 percent stake in the new company. Fiat would get a 20 percent stake, with its share potentially rising to 35 percent over time based on performance. The United States would take 8 percent, while the Canadian government, which is also providing financing, would receive 2 percent.
Bondholders Propose an Alternative to G.M.’s Plan
By Cyrus Sanati
The New York Times
April 30, 2009
Under the proposal released Thursday, G.M.’s bondholders would receive 58 percent of the restructured company in exchange for tearing up their $27 billion in unsecured G.M. bonds.
The United Automobile Workers, through an entity known as a VEBA, which holds workers’ health care obligations, would get about 41 percent to offset the $20 billion G.M. owes the union. Current shareholders would receive 1 percent.
Under (another) proposal that G.M. made this week, bondholders would get 10 percent of the company for their unsecured debt, while the government would receive 50 percent in exchange for forgiving at least half of G.M.’s outstanding Treasury debt by June 1, which G.M. estimates would be about $10 billion. The VEBA would get 39 percent of the equity for giving up $10 billion of the $20 billion G.M. owes it, while current shareholders would get 1 percent.
UAW, Ford reach agreement on VEBA
By Brent Snavely
Detroit Free Press
February 23, 2009
The UAW said today it has reached a tentative agreement with Ford Motor Co. to modify the payment requirements for a retiree health care trust fund, and is likely to use the agreement as a template for talks with General Motors Corp. and Chrysler.
Ford said the tentative agreement gives it the option to use stock for up to 50% of its payments to fund the Voluntary Employee Beneficiary Association, or VEBA.
The UAW and each of the domestic automakers agreed to create a union-managed retiree health care trust fund during contract talks in 2007, and the UAW is scheduled to begin managing the fund in 2010.
Health Costs Soaring, Automakers Are to Begin Labor Talks
By Danny Hakim
The New York Times
July 15, 2003
Uwe Reinhardt, a Princeton University health care economist, calls the Big Three “a social insurance system that sells cars to finance itself.”
It was almost six years ago that Uwe Reinhardt called the Big Three “a social insurance system that sells cars to finance itself.” We have frequently quoted him, even though the statement was an exaggeration to make a point. But how prescient!
Saddled with legacy costs, each of the Big Three negotiated the transfer of their retiree health funds to the United Auto Workers (UAW) in the form of a voluntary employee beneficiary association (VEBA). With further deterioration in the auto industry’s financial status, the VEBAs are now accepting a major ownership position in these firms.
Thus Uwe Reinhardt was spot on. The VEBAs actually are “a social insurance system that sells cars to finance itself.”
Health care reform anyone?
This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.
Waiting-room death triggers review of Quebec private clinic rules
April 22, 2009
Quebec coroner Catherine Rudel-Tessier’s report released today on the death of Jean-Jacques Sauvageau, who died January 11, 2008, in the waiting room of a private Montreal urgent-care clinic, demands that the Collège des médecins du Québec refine its regulations on such clinics to better protect patients.
Ms Rudel-Tessier said the 2007 Collège guidelines on private clinic administration should be “more precise” on certain points and must help administrators “offer a safe environment to their patients and permit them to adequately deal with emergencies.”
The Collège’s president and CEO, Dr Yves Lamontagne, said the guidelines would be either revised or replaced, depending on the results of the Collège’s investigation of the incident. He said he expects two new measures will be incorporated into the guidelines. “One, every physician or nurse working in that type of clinic should follow a course on cardiopulmonary resuscitation. And two, all clinics should have equipment — a defibrillator.”
Ms Rudel-Tessier also recommended that the Collège investigate the doctor or doctors who attended to Mr Sauvageau.
Dr Jacques Chaoulli — the same crusading Jacques Chaoulli whose high-profile 2005 Supreme Court case against the government of Quebec forced the province to overturn some of its restrictions on private health insurance — examined Mr Sauvageau minutes after he stopped breathing and decided not to attempt resuscitation, instead leaving Mr Sauvageau’s body in his waiting room seat until an ambulance arrived. An autopsy later revealed that Mr Sauvageau died of massive bilateral pulmonary embolisms and would not have been saved by resuscitation but Ms Rudel-Tessier concluded that Dr Chaoulli could not have known that at the time and should have tried to save Mr Sauvageau.
Rapport d’enquête sur LE DÉCÈS DE M. JEAN-JACQUES SAUVAGEAU
In the Canadian Supreme Court case of Chaoulli v. Quebec, Justice Deschamps wrote, “The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care.”
This decision has resulted in intense efforts to privatize both the Canadian health insurance system and the Canadian health care delivery system. The outspoken proponents of privatization would have you believe that only the private sector is capable of saving lives that would be lost by neglect in the public sector.
Dr. Chaoulli’s patient did not die while on a waiting list for an elective orthopedic procedure. He collapsed and died in Dr. Chaoulli’s private waiting room. Dr. Chaoulli withheld cardiopulmonary resuscitation – a standard of care that surely would have been provided in any public health care facility – with questions over whether or not he had adequately trained staff and appropriate equipment to initiate such care. Dr. Chaoulli then asked his nurse to call 911 (to have the body removed), and he returned to his work. Only after the ambulance team arrived was cardiopulmonary resuscitation instituted.
The lesson of the tragic death of Jean-Jacques Sauvageau is simply that Crusader Dr. Jacques Chaoulli and the other privatizers have no credibility when they claim that the private system has a special capability of saving lives that the public system lacks.
About those deadly Canadian wait times
Andrew D. Coates, MD
“Pursuit of corporate profit and personal fortune have no place in caregiving. They create enormous waste and too often warp clinical decision making.”
Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance (JAMA 2003; 290:798-805)
In 2005 the Supreme Court of Canada ruled that the province of Quebec could not bar private health insurance from covering the same services as the province’s single payer system, if Canada’s Medicare made patients wait. The case was brought by Dr. Jacques Chaoulli on behalf of his patient who had waited one year for an elective hip replacement surgery.
A crusader for privatization of medical care, Dr. Chaoulli argued that the public system of health care financing caused Canadians to “suffer and die” while waiting for treatments. The Supreme Court of Canada found that waiting for surgery was a violation of the patient’s human rights. The province of Quebec, in turn, passed a law to allow the sale of private insurance to cover three specific elective surgeries that had wait lists: hip and knee replacement and cataract surgeries.
Thanks to his crusade against the Canadian single payer system Dr. Chaoulli became the darling of the insurance industry and well-funded ideologues hired to champion profiteering at the expense of the sick. He even inspired a few free-market fundamentalists to seek constitutional grounds to abolish Medicare in the United States. Other free-market enthusiasts also took up Dr. Chaoulli’s cry that Canadians would get seen more quickly and receive better care, if only they were allowed to pay privately.
Jean-Jacques Sauvageau died in the waiting room of a private clinic in Quebec in January 2008. The clinic advertised emergency care. The subsequent investigation has led the provincial coroner to urge the Quebec College of Physicians to issue guidelines to protect patient safety at private clinics.
The physician on duty at the private clinic was Dr. Jacques Chaoulli.
The clinic’s receptionist (who had no medical training) took identifying information and asked Mr. Sauvageau to take a seat. The coroner reported that Mr. Sauvageau then waited 20 to 60 minutes, blue and gasping, his shoulders heaving with each breath. In the Globe and Mail Ingrid Peritz described his death as “a scene that combined tragedy with Monty Python farce:”
…the increasingly alarmed fellow patients could see Mr. Sauvageau was unconscious and alerted the receptionist. Dr. Chaoulli came out, did a cursory examination and concluded the patient was already dead.
He left him sitting in the chair, and told the nurse to phone 911 to report the death.
But the 911 operator pleaded with the nurse to try to revive Mr. Sauvageau. Dr. Chaoulli got on the phone and tried to argue the patient was dead; however, the 911 operator insisted…
…Eventually, ambulance medics arrived and tried in vain to revive the patient.
An autopsy later revealed that Mr. Sauvageau died of a pulmonary embolism and would not have survived anyway. But the coroner said that Dr. Chaoulli had no way of knowing that, and should have tried to perform CPR.
Catherine Solyom reported in The Montreal Gazette:
It was Sarah Swain-Lagarde, 22, who called 911 for guidance on how to give the man CPR herself. She was told to lie him down. But when she tried, the nurses told her to stop – no one was to touch the man, they said.
“I’m not a doctor … but when someone is purple and having a hard time breathing he should be helped right away,” said Swain-Lagarde, who had brought her toddler to the clinic for a high fever. “He was in a waiting room surrounded by people. He just stayed on his chair. No one did anything for him.”
Jacques Chaoulli, the doctor who took Sauvageau’s pulse around 4 p.m., testified that he also spoke to Sauvageau, listened for a heartbeat and pinched him. He examined his eyes and his extremities, which were blue, while his face was now white.
But Chaoulli said he did not try to resuscitate him.
“I concluded that this patient must have been dead already a long enough time – I had no way of knowing how long – but long enough,” Chaoulli said.
Chaoulli told a nurse to call 911 so that they could declare him dead officially, he said.
As for why Chaoulli left the body there for what he says was another 10 minutes – he explained he felt the waiting room had become akin to “the scene of a crime.” The death in a public place would require an investigation, he explained, and “the police wouldn’t want us to touch the body.”
The Globe and Mail reported that the patient’s son “said the family was still appalled by his father’s treatment:”
“An animal at a veterinarian’s clinic gets better treatment than my father got,” Michel Sauvageau said.
This case has deepened the debate over the privatization of Canada’s Medicare, for the tragedy demonstrates why medical services cannot depend upon the ‘irrational exuberance’ of the “free market.”
One Canadian blogger, Mary Soderstrom, politely observed:
Certainly in this case it doesn’t look like Chaoulli’s clinic provided the kind of excellent health care proponents of privatization vaunt. Without a doubt members of the victim’s family must be asking what would have happened had he gone to a hospital emergency room where triage teams are trained to quickly size up a situation. It’s doubtful that a man turning blue would be told to sit and wait on a chair: while there’s no doubt that it can take hours for non-urgent cases to be seen, life-threatening cases are evaluated and treated quickly in hospitals, observers agree.
Mr. Sauvageau’s death reminds us that a person in acute distress, or a person in need of a surgery or care in general, is in no position to predict what care will be required. What kind of society would take the health and illness of human beings as an occasion to shop for a bargain — or a money-making moment for profiteers? Health policies and budgets are best set by the public. The effort to reduce waiting times is no exception.
When Ezra Klein examined wait times in the American Prospect in 2007 he wrote:
Sadly for those invested in this odd knock against the Canadian system, the wait times are largely hype. A 2003 study found that the median wait time for elective surgeries in Canada was a little more than four weeks, while diagnostic tests took about three (with no wait times to speak of for emergency surgeries). By contrast, Organisation for Economic Co-operation and Development data from 2001 found that 32 percent of American patients waited more than a month for elective surgery, and 5 percent waited more than four months. That, of course, doesn’t count the millions of Americans who never seek surgery, or even the basic care necessary for a diagnosis, because they lack health coverage. If you can’t see a doctor in the first place, you never have to wait for treatment.
Last week the Wall Street Journal reported that, thanks to layoffs, 9 million people have lost their employer-sponsored private health insurance in the United States in the last year. This week the Wall Street Journal reported that the economic crisis had caused an increase in those in the United States who, as Klein put it, “never seek surgery”:
While more uninsured patients strain hospital budgets, many hospitals report fewer inpatient admissions overall. For example, 41% of hospitals reported a moderate decrease in elective procedures, and 18% said the decrease was significant.
During the same period in Canada, including Quebec, waiting times for elective procedures have improved. Ironically, Chaoulli v. Quebec strengthened the single payer system. Dr. Randall White points out on the Canadian Doctors for Medicare blog, no one in Quebec has purchased the new private health insurance. Not one.
More than two years after Quebec legalized private medical coverage for select surgeries, the insurance industry says it has not sold a single policy.
Bill 33 was supposed to allow Quebecers to seek private insurance for faster knee and hip replacements, and cataract surgery.
Yves Millette, senior vice-president of the Canadian Life and Health Insurers’ Association, said no one is buying the policies because they are too expensive…
…Quebec Health Minister Yves Bolduc said the province has sped up wait times so much since the court ruling, it’s no wonder no one wants to pay for private coverage.
“We have such a good access to the surgeries in Quebec, that the industry knows they won’t be able to sell any insurance to anybody,” said Bolduc.
Imagine that. The province of Quebec, with its health system underfunded and in spite of a growing global economic crisis, has successfully shortened wait times for elective surgeries.
Meanwhile in the United States elective surgery is increasingly “off the table” for the uninsured and under-insured. In addition the New York Times reported in March 2009 that more than 85,000 people leave the United States each year, to travel to other countries for elective surgeries.
The waiting room tragedy that befell Mr. Sauvageau, and indeed Dr. Chaoulli, emphasizes our need for public decision-making, public financing and public health services. In the United States and Canada, as in every country, decisions over how best to share health resources belong in the public domain. In Canada we must defend Medicare against privatization. In the United States we need to enact a single payer national health program.
Single payer is not a perfect system, but it is so much better than the alternative, privatization and profiteering at the expense of the sick.
This entry is from Dr. McCanne's Quote of the Day, a daily health policy update on the single-payer health care reform movement. The QotD is archived on PNHP's website.
Bernie Sanders on the Need for a Single Payer Health Care System
April 28, 2009
(Clip courtesy of Video Cafe)
Bernie Sanders: … We can guarantee every man, woman and child health care with a single payer system.
Ed Schultz: Senator, that is what just boggles my mind. We have, right now, a political moment in this country. The president has high approval ratings; you have the people out there; town hall after town hall I hear it, they want single payer; you’re close to the super majority depending on how…
Sanders: Ed, what are you forgetting in that equation?
Schultz: Well, I’m forgetting the filibuster I guess.
Sanders: And you’re forgetting the power of the insurance companies…
Schultz: Yes. Right.
Sanders: The huge amounts of money they spend; the power of the drug companies, and if you think that every member of the Democratic caucus is prepared to stand up to those guys, you’re mistaken.
Sanders: But the bottom line here, Ed, is, you’re absolutely right; we have a Democratic president, a strong majority in the House, sixty votes in the Senate. If we can’t deliver on energy, on health care, on workers’ rights, then what’s the sense of it all. The answer is people have got to put pressure on Congress to have the guts to stand up to the insurance companies, the drug companies, the banks, the military-industrial complex.
Schultz: Well, who’s going to put pressure on them?
Sanders: We’re going to need a strong grassroots movement to make that happen.
Schultz: So you think the people can be heard on this.
Sanders: Absolutely. Absolutely they can.
Schultz: I think this is a real moment for the president. What if the president comes out tomorrow night at the press conference… I would love to hear President Obama come out and say, “Look, I don’t have all the answers, but everything is on the table.” And this idea that single payer is not politically achievable, Mr. President, respectfully, I think you’re wrong on that. I think it is politically achievable, because the people want it.
Video clip (7 minutes, 41 seconds):
When the people lead, Congress will follow.
Consumer Guide to HMOs
New York State Department of Insurance
Choices Available for Individual Coverage
Under New York State Insurance Law, New Yorkers purchasing health insurance on their own can choose either an HMO or an HMO/POS plan option at any time during the year. You cannot be denied coverage if you have health problems, but you may be subject to a waiting period of up to one year for certain pre-existing conditions.
HMOs deliver health care to members using provider networks, which are groups of doctors, hospitals and other health care providers that have agreed to serve members of a particular HMO. Health benefits are covered if the member uses providers that are in-network.
All New York HMOs also offer a point of service (POS) option that allows members to seek care from providers that are out-of-network. Services provided by out-of-network providers generally cost members more in out-of-pocket expenses.
Premium Rates for Standard Individual Health Plans
New York County
Monthly family premium rates for Point of Service Plans (POS)
$4450 – Aetna Health. Inc.
$3776 – Atlantis Health Plan, Inc.
$4066 – Empire BlueCross BlueShield HMO
$6824 – GHI HMO Select, Inc.
$4187 – Health Insurance Plan of Greater New York, Inc.
$3816 – Health Net of New York, Inc.
$3500 – Managed Health, Inc.
$4208 – Oxford Health Plans (NY), Inc.
HMO family rates for these same insurers range from $2266 to $5686
So in New York County, for a premium of about $50,000 per year, you can have a choice of physicians and hospitals for your family, although you will have to pay more in out-of-pocket expenses if you select out-of-network providers. If you don’t mind losing choice by staying within the HMO for all of your care, you can have your family covered for under $40,000 per year.
What is going on here? Why are the premiums so high?
Well, first of all, New York has addressed the problem of underinsurance by requiring, through regulation, that insurers provide adequate benefits. Also, they must accept anyone, regardless of health status (though they can enforce a waiting period to prevent individuals from waiting until they need care to apply for coverage). Innovative insurance products that keep premiums competitive by shifting significant costs to the insured are prohibited in New York. Health care is very expensive in the United States, so premiums that reflect the true costs will be quite high.
Per capita spending for health care is already at $8,100 per year. For a family of four, that would be about $32,000, but these numbers in New York are even higher. What explains that? If you had an income of $80,000 per year, and you and your family are healthy, and you are told that your insurance premium will be $50,000, what would you do? You really don’t have much choice; you’d wing it. If you had ongoing medical expenses of maybe $250,000 per year, what would you do? You would try to stay in the plan and somehow pay that $50,000.
This is the classic “death spiral” of health insurance. A ever increasing number of individuals who are healthy would leave the plan, leaving within the risk pool the very high cost patients. Premiums skyrocket and become unaffordable for most.
The private insurance industry has an answer for this. They are asking Congress to require everyone, through an individual mandate, to purchase insurance so that the risk pools remain diluted with the large numbers of people who are healthy. That might take care of the death spiral, but it glosses over a very important point.
In most states, plans in the individual market are underinsurance products, and true reform must bring an end to their underinsurance innovations, otherwise people who need medical care will continue to face financial hardship. The New York experiment has demonstrated that well regulated individual plans (which Congress promises us) are too expensive. Congress understands this so they say that we should be able to chose our plans through a “connector” so that we don’t have to pay broker fees. Come on! It’s health care costs that are breaking us!
At today’s costs, private plans that are adequate to prevent financial hardship in the face of medical need must have unaffordable premiums, whether or not in a connector. We need to eliminate this obsolete system of premiums tied to a private package of health benefits. We desperately need an equitable, efficient, single payer national health program. Each person pays his or her fair share, and everyone gets health care.
And what is Congress preparing for us behind those closed doors? Look again at the premiums for New York County. At least you will have a choice of plans with perhaps $40,000 premiums, and for another $10,000 plus out-of-pocket cost sharing, you can have your choice of providers as well.
You say that premiums won’t be that high if we eliminate the death spiral? President Obama has already said that you can’t mandate people to buy an insurance plan they can’t pay for. That keeps the death spiral in play.
Do Not Resuscitate: Why the Health Insurance Industry is Dying, and How We Must Replace It
By John Geyman, M.D.
Common Courage Press, 2008
Softcover, 251 pp., $18.95
(Special price of $10 from PNHP Store)
Book review by A.R. Strobeck Jr.
Dr. John Geyman, a longtime physician and professor emeritus of family medicine at the University of Washington, has written several books about health care. In his latest work, “Do Not Resuscitate,” he provides us with a highly informative and critical analysis of the U.S. private health insurance industry. Given the current health reform debate, it could not have come at a better time.
Geyman opens with a startling premise: the current debate of how to pay for health insurance ignores “a profoundly important fact: … the health insurance industry is dying.” Private health insurance, the historical cornerstone of U.S. health care financing, is quite simply “not sustainable and has failed the public interest.”
As evidence, he cites 50 million uninsured Americans; 18,000 deaths annually from lack of insurance; and tens of millions of underinsured persons who would face severe economic hardship were they to get sick. Medical bills contribute to more than half of all personal bankruptcies in the U.S. today; about three-fourths of those had insurance at the onset of their illness.
Meanwhile the cost of insurance premiums goes up and up. If the rate of increase continues, he says, premiums will consume all of an average family’s income by 2025. Yes, you read that right: all of family income.
Geyman has a knack for presenting statistical data in plain, accessible language, a trait he may have learned as a rural doctor. But make no mistake: his data is up-to-date and relies on the latest medical literature. The book is also heavily footnoted and amply illustrated with charts and tables.
The widespread consensus that health care is broken and in urgent need of repair is reflected in daily headlines and in recent pronouncements from the Obama administration. But Geyman points to a growing conviction among health policy experts that just any kind of reform will not do, that “incremental ‘reforms’ will not resolve the inequities, access, cost and quality problems of our unaccountable market-based system.”
Before outlining the kind of reform he says is needed, he traces the historical roots and evolution of the U.S. health insurance industry from the early decades of the last century. The industry started largely through the efforts of not-for-profit groups who controlled costs by spreading the risk over large groups of people.
Since the end of World War II, however, private health insurance “has been transformed from the quasi-public partnership in its pioneering years to an enormous industry on a corporate mission of profit over service.” Whereas private health insurance “once had a mission to serve the public interest,” today “the industry places its own self-interest above the public interest” and avoids risk rather than spreading it.
Geyman explains how today’s private health insurance companies – dominated by giants like Wellpoint, United Health and Aetna – strive to maximize profit through devising new ways to cut the quantity, quality and access to care.
Private insurers understand well that a relatively small proportion of persons account for a large proportion of health care spending, so the companies find ways of excluding those who need care from coverage, e.g. by invoking pre-existing condition clauses, re-underwriting policies with higher premiums for sick enrollees, denying claims and cancelling policies outright.
Much of the private insurance workforce and administrative overhead is dedicated to denying care and avoiding the payment of medical costs. An army of claim deniers has sprung up over the past three decades: the number of administrative personnel in the private insurance industry has grown 25 times more rapidly than the number of U.S. physicians.
The bulking up of these and other administrative costs – including marketing expenses, payouts to shareholders and CEOs, and the huge paperwork burden on doctors, hospitals and patients – has resulted in the intolerable situation where more than one-third of every health care dollar in the U.S. goes to wasteful bureaucracy.
Geyman effectively debunks many of the myths private insurers tout – that people are uninsured because they prefer to be, or that the uninsured usually find care anyhow. And as for those on the right who cry “Socialism!” every time national health care is mentioned, he reminds us that Teddy Roosevelt was attacked as a socialist in 1912 for advocating a national health insurance program.
Finally, Geyman describes the type of national health insurance program that he would support – single payer – similar in most aspects to that found in Canada. He believes that the transition from a for-profit system run by corporate stakeholders to a not-for-profit system “will eliminate much of the profiteering that goes on today.”
The new system will spread risk among the entire U.S. population. Care will be publicly funded, but privately delivered. People will go to the doctor and hospital of their choice. By eliminating the fragmentation and waste of our multi-payer system, the single-payer system will yield administrative cost savings – estimated at $350 billion annually – sufficient to provide comprehensive and quality care to everyone and to eliminate all co-pays and deductibles.
Geyman’s book is compelling. It’s also a must-read for anyone concerned about the future of health care in the United States.
A.R. Strobeck Jr. worked for many years in health care administration. He resides in Chicago.
Health care reform with no reform
By Marie Cocco
April 25, 2009
Maintaining what amounts to a monopoly on insurance for the working-age population has become a central goal of the insurance industry, which rightly fears that the government will provide more comprehensive coverage at a lower cost. This is, of course, the whole point of overhauling the insurance system. But never mind.
The industry worries that Americans will find out not only that government-supported health insurance isn’t a socialist catastrophe (see, for example, Medicare) but a fairer, lower cost and more efficient system than the expensive, inefficient – and failing – market-based system we have now.
Insurers have gone so far as to offer to stop charging people with existing medical conditions more for coverage, if only Congress and the Obama administration would continue to go along with a system more like the one we have now than the one that we actually need.
In essence, this is what the proponents of such a system want: a new and “reformed” health insurance system that works essentially like ours does today.
But the very reason we are again going down the politically treacherous path of attempting reform is that the system we have doesn’t work, not by any standard.
So far we have “reformed” the health insurance system by reinforcing precisely what’s wrong with it. To do this again would yield precisely the same result.
It wouldn’t be a reformed system. It would be just another way for the insurance industry to game the one we already have.
Everyone is in agreement that health care financing must be reformed. Most believe that the goal of reform should be to provide everyone with all necessary health care under a payment system that will prevent financial hardship for each one of us.
For the insurance industry, reform means expanding their successful business model to include more individuals in their plans while shifting the higher costs to the government (taxpayers). Most people do not want to be required to purchase health plans at premiums they cannot afford, and then be stuck with inadequate coverage designed to keep premiums from climbing even higher. Yet, as Marie Cocco makes clear, the insurance industry’s version of reform would reinforce precisely what is wrong with our health care financing.
So members of Congress continue to insist that a public insurance program that would achieve our goals is off the table, while they meet behind closed doors with representatives of the insurance industry, crafting reform that will cost much more but leave far too many of us without the protection we need.
Is complacency our problem?
complacency: “A feeling of contentment or self-satisfaction, especially when coupled with an unawareness of danger, trouble, or controversy.” (American Heritage Dictionary)
A Health Care Home Run
by Lisa Nilles, M.D.
April 26, 2009
It’s the bottom of the ninth inning in the 2009 Health Care World Series. Two outs. Team Single-Payer is down by three runs, and at bat. Their fans – the uninsured, the underinsured, the sick and the bankrupt – are cheering wildly. A window to victory is open.
The fans in the luxury box suites – supporters of Team Status Quo – act cool, but can’t celebrate just yet. It’s been a surprise to all, particularly to the baseball pundits, that Team Single-Payer, an under-funded team without corporate sponsorship, got this far. Surely they can’t win.
Batter up. As he takes a few practice swings, he thinks of his wife, who just lost her job and their health insurance. The pitch. The swing. A single.
The next batter wears a medal given to him by all the people excluded from health insurance because they have previously battled cancer. They are in his mind as he keeps his eye on the ball. He swings with all his might, all his anger, and all his skill. The ball soars into the sky, and then tumbles to the ground as the outfielders collide with each other. Runners on first and second.
The batter now up has just moved up from a long career in the minors. He never thought he would make it to this day, but long years of training, patience and perseverance pay off. He walks. Bases loaded.
The manager of Team Status Quo calls a time out, and consults with his players. They call on their ace, the one who has appeared in all their print, radio, and television ads. His mere appearance on the mound will intimidate Team Single-Payer.
The fans are on their feet. This is the moment they have been waiting for. The final standoff with the titans of Team Status Quo. The roar is deafening. The chant begins, “Home-run! Home run! Home-run!” They chant as if their jobs, homes, health, and lives depended on a win, for indeed they do.
The batter steps up. Bases loaded. The pitch is on the way . . .
Propaganda And Prejudice Distort The Health Reform Debate
By Merton Bernstein, the Walter D. Coles Professor of Law Emeritus at Washington University
Health Affairs Blog
April 22, 2009
Science does not permit ideology to foreclose inquiry; it requires facing facts and following where they and logic lead. Hence many cheered when President Barack Obama announced that science is back, that predisposition will no longer be permitted to trump reality…
… the Obama, Baucus, Grassley, CBO, and other playlists exclude consideration of Medicare-for-all. With rising discomfort with the price tag of recovery programs, those desiring comprehensive health care cannot afford to disregard a program with such enormous savings. If Medicare-for-all gets “on the table” before the Senate Finance and House Ways and Means committees, the CBO must report its vast savings and its greater efficiency and effectiveness compared with more expensive alternatives. Only by censorship — only by treating Medicare-for-all as nonexistent — can lesser alternatives be discussed with a straight face.
And censorship is not compatible with science.
Pelosi Pushes For Truth Commission
By Jennifer Skalka
April 22, 2009
Nancy Pelosi, during a Christian Science Monitor event:
“As our members came back from their recess, a great deal of what they heard out there was public options, public options, public options, public options. In our caucus, over and over again, we hear single payer, single payer, single payer. Well, it’s not going to be a single payer. … We had an opportunity for that awhile back, and it was not realized. And that’s not what it’s going to be. So we had to take people from a place that they see universal, affordable, quality health care available best in single payer and say this can be achieved in other ways.”
Whether you call it Medicare-for-all, or national health insurance, or single payer, Merton Bernstein describes well the irrational, unscientific effort to keep off the table the concept of a truly universal, efficient, publicly administered and publicly financed national health program.
Nancy Pelosi’s comments reveal just how determined the Congressional leadership is in keeping single payer off the table. Presumably her comment that “we had an opportunity for that awhile back” refers to the Clinton effort at reform, even though that was a process that quite explicitly excluded single payer as a reform model. The closest the nation has come to embracing the single payer model is the enactment of Medicare. Even though the program requires updating, it has been more effective and more efficient than any other program. A new and improved Medicare is precisely the reform that the nation needs.
For an administration and a Congress that advocates for using science in policy decisions, it is astounding that they would reject health policy science and leave us in the Dark Ages in health care reform.
Ways to Reduce the Cost of Health Insurance for Employers, Employees and their Families
Health, Employment, Labor, and Pensions Subcommittee Hearing
United States House of Representatives
Committee on Education and Labor
April 23, 2009
Testimony of David U. Himmelstein, M.D.
Mr. Chairman, members of the Committee. My name is David Himmelstein. I am a primary care doctor in Cambridge, Massachusetts and Associate Professor of Medicine at Harvard. I also serve as National Spokesperson for Physicians for a National Health Program. Our 15,000 physician members support non-profit, single payer national health insurance because of overwhelming evidence that lesser reforms will fail.
Health reform must address the cost crisis for insured as well as uninsured Americans. My research group found that illness and medical bills caused about half of all personal bankruptcies in 2001, and even more than that in 2007. Strikingly, three quarters of the medically bankrupt were insured. But their coverage was too skimpy to protect them from financial collapse.
A single payer reform would make care affordable through vast savings on bureaucracy and profits. As my colleagues and I have shown in research published in the New England Journal of Medicine, administration consumes 31% of health spending in the U.S., nearly double what Canada spends. In other words, if we cut our bureaucratic costs to Canadian levels, we’d save nearly $400 billion annually — more than enough to cover the uninsured and to eliminate copayments and deductibles for all Americans. By simplifying its payment system Canada has cut insurance overhead to 1% of premiums — one twentieth of Aetna’s overhead – and eliminated mounds of expensive paperwork for doctors and hospitals. In fact, while cutting insurance overhead could save us $131 billion annually, our insurers waste much more than that because of the useless paperwork they inflict on doctors and hospitals.
A Canadian hospital gets paid like a fire department does in the U.S. It negotiates a global budget with the single insurance plan in its province, and gets one check each month that covers virtually all costs. They don’t have to bill for each bandaid and aspirin tablet. At my hospital, we know our budget on January 1, but we collect it piecemeal in fights with hundreds of insurers over thousands of bills each day. The result is that hundreds of people work for Mass General’s billing department, while Toronto General employs only a handful — mostly to send bills to Americans who wander across the border. Altogether, U.S. hospitals could save about $120 billion annually on bureaucracy under a single payer system.
And doctors in the U.S. waste about $95 billion each year fighting with insurance companies and filling out useless paperwork.
Unfortunately, these massive potential savings on bureaucracy can only be achieved through a single payer reform. A health reform plan that includes a public plan option might realize some savings on insurance overhead. However, as long as multiple private plans coexist with the public plan, hospitals and doctors would have to maintain their costly billing and internal cost tracking apparatus. Indeed, my colleagues and I estimate that even if half of all privately insured Americans switched to a public plan with overhead at Medicare’s level, the administrative savings would amount to only 9% of the savings under single payer.
While administrative savings from a reform that includes a Medicare-like public plan option are modest, at least they’re real. In contrast, other widely touted cost control measures are completely illusory. A raft of studies shows that prevention saves lives, but usually costs money. The recently-completed Medicare demonstration project found no cost savings from chronic disease management programs. And the claim that computers will save money is based on pure conjecture. Indeed, in a study of 3000 U.S. hospitals that my colleagues and I have recently completed, the most computerized hospitals had, if anything, slightly higher costs.
My home state of Massachusetts recent experience with health reform illustrates the dangers of believing overly optimistic cost control claims. Before its passage, the reform’s backers made many of the same claims for savings that we’re hearing today in Washington. Prevention, disease management, computers, and a health insurance exchange were supposed to make reform affordable. Instead, costs have skyrocketed, rising 23% between 2005 and 2007, and the insurance exchange adds 4% for its own administrative costs on top of the already high overhead charged by private insurers. As a result, one in five Massachusetts residents went without care last year because they couldn’t afford it. Hundreds of thousands remain uninsured, and the state has drained money from safety net hospitals and clinics to kept the reform afloat.
In sum, a single payer reform would make universal, comprehensive coverage affordable by diverting hundreds of billions of dollars from bureaucracy to patient care. Lesser reforms — even those that include a public plan option — cannot realize such savings. While reforms that maintain a major role for private insurers may be politically attractive, they are economically and medically nonsensical.
The definitive legislation on health care reform that will be supported by the Democratic leadership in Congress has not yet been written. This important testimony by PNHP’s David Himmelstein confirms that single payer reform is still in play, in spite of dismissive comments by many of those involved.
Instead of sitting back and observing the process, it is imperative that we intensify our efforts to deliver the single payer message. The physical and financial health of the people of our nation depend on it.
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