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.
Bill Clinton on Health Care Reform
CNN Larry King Live
March 11, 2009
Dr. Sanjay Gupta, CNN chief medical correspondent: Tonight, Bill Clinton exclusive on the nightmare that keeps 45 million Americans from seeing a doctor — the health care disaster.
GUPTA: All right. Let’s drill down specifically on something you said earlier. When it comes to sort of creating these silos of health care reform — you have sort of single payers and more governmental involvement on one send — one end, free market involvement solely on the other end. Single payer never has really caught traction politically. Is it politically unpalatable or is it a bad idea?
Bill CLINTON: Well, I think it’s more politically unpalatable than it is a bad idea, because single payer is not socialized medicine. Canada has a single payer system and a private health care provider system. Our single payer systems are Medicare and Medicaid.
CLINTON: And Medicare is quite popular.
The good thing about single payer is the administrative costs are quite low. We probably waste $200 billion a year between the insurance administrative costs, the doctors and other health care providers’ administrative costs and employers’ administrative costs in health care that we would not waste if we had any other country’s system.
On the other hand, if you look at the experience of Germany, France, Japan — that don’t have pure single payer systems, they have more mixed systems — their costs are actually slightly lower overall than Canada’s. So there’s something to be said for having a mixed system if you can get the administrative costs down, because then the systems have enough competition in them to try to restrain costs and it’s not all up to the political bodies.
In Canada, because it’s all financed through the government, it’s more difficult sometimes for the politicians to say no than for just the regular management of the health care system to cut the costs.
So I think you can have a mixed system. If you look at the French system, which scores very high on every international measure…
CLINTON: …it’s mostly publicly financed, but there’s enough private in there that there’s some tension that’s creative and positive.
GUPTA: Do you think there is a degradation quality of care with a single payer system? Is that a concern? Should that be a concern?
CLINTON: Well there’s no evidence of that in Canada that I’m aware of, except for excessive delays, which they always try to come to grips with. The British, you know, do have a completely government-run system, but they allow people who can afford it to get outside the system. And they’ve also started running hospitals almost like charter schools in America, that is, they have these trust hospitals that perform very well and therefore they’re given more control over setting their priorities, specializing and cutting delays.
There are all kinds of different ways to do it. But first, you do have to cover everybody. And then you have to stop people from gaming the system. There’s a lot of gaming going on now in the American system so that we spend more than anybody else and get loss for it.
I think that once you get the universal coverage, I think the health insurers then could play a more positive role than they do now, which is often involved in — you know, they make a lot of money through saying no and sort of the inordinate paperwork burdens that are put on doctors and hospitals and other providers.
GUPTA: What is it about the insurance industry that you just brought up? They tried to scuttle the health care reform plan of ’93. Now they’re saying we also believe in universal health care. A politically tactile question, I guess, are you buying it? Do you think they’re being honest?
CLINTON: I think some of them really do want it. Yes. If you look at their new organization, the person who heads it came out of a progressive background and favored, as a philosophical matter, coverage.
Secondly, I think they now understand that, in terms of the health of America and the well-being of our economy, we can’t go on basically giving them more and more dollars every year — the insurance industry — and getting people sicker and sicker and leaving more and more people behind.
I mean look at all the healthcare problems. The child obesity problem, which is my obsession, is the most glaring manifestation of a system that treats sick people and doesn’t keep people well. And that’s one where, I think, by the way, we can get broad bipartisan support on trying to — to do more on wellness. And that will save money.
I think the insurance industry realizes that they — a lot of the smarter ones realize that they could kill the goose that laid the golden egg here, that America can no longer go on spending more money and getting less for it and having all this money go to them and that they can make a lot of money and do well by making us healthier at a more affordable price.
Former President Bill Clinton makes two very important points here. (1) Single payer dramatically reduces administrative waste, and he implies that it would be popular, as is Medicare now. (2) The private insurers “make a lot of money through saying no,” and “we can’t go on basically giving them more and more dollars every year — the insurance industry — and getting people sicker and sicker and leaving more and more people behind.” Single payer is good; private insurers are bad.
In contrast, his comments suggesting that private insurers could play a beneficial role in a system of universal coverage are not supported by the facts.
He says that private plans in other nations provide competition which helps to lower costs below that of Canada. Wrong. First, our experience with the Medicare Advantage plans demonstrates that competing private plans increase costs instead of decreasing them. Second, there are many factors that influence health care spending besides the structure of the financing system.
According to the OECD, “Whatever the role played in a health system, private health insurance has added to total health expenditure.” According to the WHO, “Evidence shows that private sources of health care funding are often regressive and present financial barriers to access. They contribute little to efforts to contain costs and may actually encourage cost inflation.” Spending in the nations cited by President Clinton would be even lower if they had a pure single payer system. (qotd 8/21/07)
As for his optimism for a beneficial role of private insurers in our future, he had to take that one from his wish list. It’s been on all of our wish lists for decades. Isn’t it time to quit wishing, accept the fact that they’re incorrigible, and move on with our own single payer national health program?
The White House Press Secretary, late last week, had this exchange with a venerable member of the press corps:
Helen Thomas: Why is the President against single-payer?
Robert Gibbs: The President doesn’t believe that’s the best way to achieve the goal of cutting costs and increasing access.
Early this week President Obama, in remarks on the occasion of his reversal of the Bush Administration ban on embryonic stem cell research:
President Obama: Promoting science isn’t just about providing resources — it’s also about protecting free and open inquiry. It’s about letting scientists like those who are here today do their jobs, free from manipulation or coercion, and listening to what they tell us, even when it’s inconvenient — especially when it’s inconvenient. It is about ensuring that scientific data is never distorted or concealed to serve a political agenda — and that we make scientific decisions based on facts, not ideology. (Applause.)
When health policy researchers do their jobs, free from manipulation or coercion, they reveal a fact that many in Congress find especially inconvenient: private health insurance companies subtract enormous resources, and add nothing, when it comes to the care of patients. Single payer national health insurance will not only cut hundreds of billions of dollars in health costs annually but increase access more than any other proposal — it will include everyone.
The President and the Congress have launched a public discussion of health reform, in regional White House forums hosted by Governors, and also in congressional committees.
Mr. President: will you listen to the science, hear the facts — and rediscover single payer?
Attention Congress: our nation deserves a fair hearing of the evidence. Will you allow a comparison of single payer with every other proposal, in every committee of jurisdiction?
It is time for health reform based upon health policy science.
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.
Blog Debate: “An Obsolete Model”
By Tim Foley
March 12, 2009
This is the second day of a blog debate about what approach we should take on health care reform in 2009. Debaters are Dr. Don McCanne, a retired family physician now serving as Senior Health Policy Fellow for Physicians for a National Health Program, and Jason Rosenbaum, a writer and activist, and the Deputy Director of Online Campaigns for Health Care for America Now! Dr. McCanne will be presenting the “single-payer” point of view, and Mr. Rosenbaum will be presenting the “public competitor” point of view.
This is Dr. McCanne’s answer to the question: Is there anything valuable that private insurance brings to the table which, with far more muscular federal regulation, would enhance an American universal health care system?
Dr. McCanne: Everyone agrees that we need comprehensive reform of health care financing if we expect to slow the escalation of costs, while improving allocation of our resources. To achieve these goals, do we need to replace our dysfunctional financing system with an efficient public program, or can we simply use increased regulatory oversight to transform our private insurers into a better functioning system?
Systems using private plans that achieve near-universal coverage, such as Switzerland and Holland, are often cited as examples that we can emulate. These systems are more expensive, with greater administrative complexity, less equity, and fall short of true universality, though they satisfy those who ideologically prefer private to public administration. Some nations also use public programs for low-income individuals, comparable, in principle, to Medicaid in the United States. So how would it work if we were to regulate the private plans and then mandate the purchase of those plans?
There is a very fundamental difference between our private plans and theirs. Other nations that use private plans do so within a program of social insurance. Their plans are designed for the public good, assisting individuals in receiving the care they need without having to be concerned about the source of payment. They fulfill the insurance function by effectively pooling risks, whether through a single risk pool or though various methods of risk adjustment.
Our private plans are based on a business model designed to ensure success in the health care marketplace. Success is defined by the medical loss ratio, spending the least they can on health care. Much of their profound administrative waste is due to their elaborate efforts to avoid paying for care.
The plethora of private plans merely demonstrates the insurers’ innovations in restricting benefits — preventing payment for non-covered services; increasing deductibles and other forms of cost sharing — erecting financial barriers to care; contracting with limited lists of providers — penalizing patients who need care outside of the restricted lists; selective marketing to healthy populations — especially the healthy workforce and their young, healthy families; using underwriting and rescissions to avoid paying for essential care; and on and on. These are great business tools, ensuring success of the insurers, but they are anathema to the more egalitarian goals of social insurance systems. They defeat the insurance function of pooling risk by segregating out the low-cost healthy into their own market, and dumping the high-cost sick onto taxpayer funded programs.
Suppose we heavily regulate our private insurers and require guaranteed issue of plans that actually include all necessary services, and remove barriers to care such as restrictive lists of providers and unaffordable deductibles. This would require a massive, revolutionary transformation of the missions, goals, and administrative functions of our business-model private plans designed to prevent paying for care, into social insurance private plans designed to remove the financial system as a barrier to care.
Anyone who believes that this would be a simple transformation needs to have a conversation with insurance executives with their nine-figure compensation packages or with the large institutional investors who have fared extremely well under our market-based health care financing system.
As if that weren’t enough, there is one more unique problem in the United States. Our health care costs are much higher than in any other nation. If we were effective in covering everyone with a choice of private plans, whether with or without a public option, and if those plans covered the necessary care that people actually need, imagine the premium that would have to be charged.
The Milliman Medical Index has demonstrated that an average family of four with employer-sponsored coverage — a healthy sector — already pays $15,600 for their health care. That is only average; many pay more. With a typical household income of $60,000, that is no longer affordable. Now add into the pool the less healthy members of our population and just imagine what the premium would have to be. Financing our health care system through a specific premium assigned to an individual or family, based on an adequate package of benefits, has become an obsolete model of paying for health care.
We need a single, universal risk pool that is equitably funded. That would most easily be accomplished through progressive taxes. Once we do that, why would we continue to support the intrusion of the wasteful private insurers that do no more than take away our choice of hospitals, physicians and other professionals? Public administration is much more efficient, plus enrollment is a one-time event — absolutely everyone is covered for life.
For the full debate (in progress):
Members of Physicians for a National Health Program (PNHP) and supporters of the Health Care for America Now! coalition (HCAN) are all passionately dedicated to the goal of achieving reform that will provide affordable, high quality care for everyone. We are bothers and sisters in the cause. The ultimate goals of both organizations are the same, but the strategies are quite different.
The PNHP single payer concept has been around for a couple of decades, but Congress has failed to move on it. The HCAN leadership decided that reform will never occur unless the private insurance industry plays a major role in the future of health care financing, but that the insurers must be challenged with a competing, public Medicare-like option. In theory, the public option would be a better value, and the private plans would fade away as individuals opt to change to the new Medicare program.
There is massive, intense opposition to the public option by the same elements that have been successful in defeating reform in the past. AHIP, PhRMA, the U.S. Chamber of Commerce, the Republican members of Congress, and many others are all opposed to the Medicare-like option.
If the final legislation includes a well-designed public option (adequate benefit package, truly affordable premiums, no excessive cost sharing, the use of private insurer funds for risk adjustment, etc.) then there will be no comprehensive reform. The opponents are powerful enough to defeat it.
If the final legislation includes an emasculated public option, or leaves it out altogether, then reform will be based on a market of private plans.
Following the HCAN strategy, it is absolutely inevitable that private plans will continue to play a major role in financing health care, whether or not comprehensive reform is enacted. The reason that I selected my response on private insurance from our PNHP/HCAN blog debate is that everyone has to understand very clearly why private health plans are an obsolete method of financing an expensive health care system like we have in the United States. Once everyone understands that, we can reject the HCAN strategy and move forward with the program America needs: a single payer national health program.
You are encouraged to follow the debate this week (only four questions) and provide your comments (http://healthcare.change.org/). Tim, Jason and I are very interested in your thoughts, and hopefully the policymakers will be as well.
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.
No Reason to Demonize U.S. Single-Payer Health
Commentary by John F. Wasik
March 11, 2009
It’s time to stop kicking sand in the face of single-payer health care. It may be the strongest solution around to insure every American at a lower cost.
After decades of industry campaigns against this model — dubbed by its critics as “socialized” medicine — it’s important to stop whining and evaluate the many economic benefits. Health care is a fundamental human right.
If President Barack Obama wants real change in American health care, he will have to get over the fear of even mentioning single-payer concepts. At his health-care summit last week, only the threat of a demonstration garnered late invitations for Oliver Fein and Congressman John Conyers, two leading proponents of the single-payer plan.
Health-care costs have become a crippling personal-finance burden for 45 million uninsured and 25 million underinsured Americans. Those outside of the fractured employer-based system are only one illness away from financial ruin.
Lose your job and most likely your health coverage will disappear unless you want to pay exorbitant rates. And it’s getting worse. Because of the growing jobless rate, some 14,000 Americans are losing their coverage daily, according to the Center for American Progress Action Fund.
A single-payer plan would cover everybody regardless of employment situation and save money by cutting out middlemen.
(John F. Wasik, co-author of “iMoney,” is a Bloomberg News columnist. The opinions expressed are his own.)
Single payer should not only be back in the national dialogue on reform, it should be front and center as the golden standard by which all other options are compared.
A Broker’s Lament: We Brought This On Ourselves
By John Sinibaldi
The Health Care Blog
March 7, 2009
A huge segment of the American population is simply far too strapped to ever afford the premiums and costs associated with health insurance/health care as it is structured today.
It isn’t the employees of government (local, county, state or federal) who will demand immediate change. It isn’t the employees of institutional companies (the Motorolas, GEs, Microsofts of the country) who will demand change. It isn’t those on Medicare or Medicaid or the VA who will demand change. It isn’t the wealthy. It isn’t the poor. And, it isn’t the vast majority of health insurance agents who work with large group clients (because, while that market is becoming ever more difficult and the work more taxing, they’re still selling SOMETHING to these bigger businesses and government entities).
Why don’t these people see what I’m seeing? Simply because, while they are feeling the effects of the rise in health care/health insurance costs and the downturn in the economy, most of these businesses and their employees and dependents (and the affluent) have yet to have a clue about how expensive things really are (or in the case of the rich, they can still afford their out-of-pocket expenses). The agents who market to large employers are still making lots of money (I know, I rub elbows with them at my local Health Underwriters meetings once a month).
That leaves individuals and small businesses and the agents who work primarily in those markets – the very folks most beleaguered by the current situation. While the employee of a regional electric utility is complaining about monthly payroll deductions for his family that now exceed $500 or more on a $60,000 annual salary, the longtime employee of a local small electrician is looking at monthly payroll deductions for his family of $1,500 on a $35,000 annual salary. His apprentice is younger, and so is “fortunate” to have monthly deductions for his family of only $900 on a $20,000 annual salary. The electrician’s helper making $9/hr can’t afford even his half of the premium for just himself.
Individuals on personal health insurance policies are also feeling the “pinch.” Most of my individual clients see increases of 18-25% a year.
It is all of these folks (and there are tens of millions of them), coupled with those who have already been priced out of the market altogether, who will fuel the fire for radical reform. It is these folks who complain – long, loud and bitterly – that the American dream is leaving them behind. It is these folks to whom the politicians will ultimately listen, because they’re the ones making all the noise. It is these folks who will ultimately define what the next set of reforms looks like – and those reforms will NOT be confined only to the small group and individual markets – nor do these folks give a rat’s rear end if the insurance industry is involved. (After all, we’re doing such a wonderful job for them now.)
And, in my opinion, rightfully so. The health insurance industry (with lots of complicity from legislators, lobbyists and industry groups like ours) has let them down. Period. We have chased profits, chased commissions, swallowed every piece of spin the insurance industry has fed us, and generally ignored the growing number of folks who are beyond dissatisfied with the status quo. They’re mad, and they’re not going to take it any more.
We’re not talking about 5 million, or 15 million people. No, when you add together all small group employees and their dependents, with those who have individual coverage, and the 50 million or so who have no coverage, you’re talking about 100 million people or more.
We have brought this upon ourselves, because we (the industry, maybe not each of us individually) have ignored what folks want in favor of what WE want. The industry has ignored calls for more efficient claims and billing, lower bloat, curtailing outrageous CEO and executive salaries, and a more reasonable approach to return on investment. Our industry has ignored any attempt at out-of-the-box thinking to get reasonably priced health insurance to most low-wage Americans, instead focusing on mis-communications to get Americans to buy into what the industry wants (“High Deductible Health Plans are good for you. We don’t care if you can’t afford the deductible. Now accept that fact and shut up.”) Most of all, our industry has simply ignored an ever-louder clamor for us to get our act together. Instead of focusing on a long-term vision for the future of the industry (one that actually includes the very consumers to whom we sell products), the health insurance carriers have instead bellied up to the short-term trough of immediate reward (executive compensation, shareholder value, golden parachutes).
I’m normally not negative, either. I’ve always considered myself a realist. Yet here I am, watching every prediction I’ve made over the past 15 years on forums like this come true.
The saddest part is listening to all of the gnashing of teeth and screeching and wailing, mostly from the very folks who have repeatedly turned a deaf ear to the situation year after year because they were making gobs of money. (Yes, I’m talking about a lot of you on this very forum). In fact, some of you are still wearing your rose-colored glasses, and acting like if you just click your red-sequined shoes together, you’ll be able to get back home.
Well, you ain’t Dorothy, and this ain’t Oz.
Let’s see what the President and Congress come up with, and try to work with it – because it is inevitable that the reforms will be major, because we’ve waited too long to save our current system as we know it.
I will not apologize for the above, and I will probably not respond to the rants, flames and cacophony that are sure to ensue. We brought this upon ourselves, so now we’ll have to deal with it.
Note by Brian Klepper: John Sinibaldi is a St. Petersburg, FL-based health insurance agent – or as his industry association prefers to be called, “Health Underwriters” – catering primarily to small employer groups. He’s posted reality-based columns here in the past, including a particularly pithy one recently on small group coverage in Florida. The fiery comment above was written to colleagues on a national health care brokers’ forum.
John Sinibaldi has provided a consistent voice behind the scenes expressing many of the problems with our private insurance industry and the clear need for reform. His observations have been very helpful to me in providing insight to many of these issues, from the industry’s perspective.
In spite of his personal efforts, along with the efforts of many more of us, the problems grow worse. It has reached the threshold such that he now feels compelled to speak up quite frankly to his colleagues in their health care brokers’ forum.
John Sinibaldi really cares. He believes that health insurance should assist patients in receiving the health care that they need. The system fails far too many today. He sees no other option than to support comprehensive change that places patients first, even though that will be highly disruptive to his own business and that of his colleagues. We need to listen to him.
(For those who would like more of John Sinibaldi’s invaluable insight on brokering health insurance, access his commentary at the link above, and then scroll down to “Posted by: John Sinibaldi | Mar 9, 2009 7:21:02 AM” and read his comment above.)
The following report from the March 5 White House Health Care Summit was received today from Dr. Oliver Fein, president of Physicians for a National Health Program.
The White House health care summit
By Oliver Fein, M.D.
Thanks to many grassroots activists and physicians who called the White House and threatened to demonstrate outside its gates, I was at the Health Care Summit at the White House on March 5 along with Rep. John Conyers Jr. (D-Mich.). And it was good thing. It meant that the single-payer position was recognized as one pathway to health care reform. It also meant that one of our concerns was present: namely, that any health care reform that includes the for-profit, private health insurance companies will fail to provide universal coverage, will not be able to reduce heath care costs, and will increase the number of underinsured.
It’s important to note that there were others at the summit who are known to be sympathetic to single payer, including some past and present co-sponsors of H.R. 676 and Sen. Bernie Sanders of Vermont. (More on Sanders below.)
That said, it is true that the summit was carefully choreographed. The opening plenary featured Travis Ulerick, a 24-year-old firefighter from Dublin, Ind., who had sponsored a “health care community discussion” (house party) in his fire station in December. He read off the names of six other people who had hosted similar house parties who had been invited to participate in the summit.
Ulerick called attention to a booklet, “Report on Health Care Community Discussions,” which was distributed to all summit participants. It focuses on cost, access, quality and system performance as the major problems facing the American health care system. As solutions, it offers creation of a health insurance exchange, reducing prescription drug costs, research and standards to improve quality and efficiency, simplification and information technology, education for wellness and the promotion of healthy lifestyles.
Interestingly, in the middle of the report, there is a box labeled Single-Payer System, which states: “Over one-quarter (27 percent) of the groups discussed the merits of a single-payer system, and the majority of those groups supported this idea. These groups argue that this radical change was a necessary step for reform.”
President Obama then spoke about the urgency of the problem, focusing heavily on the need to rein in skyrocketing health care costs that are straining the budgets of families, businesses and federal and state governments. Health care reform is “not just a moral imperative, but also a fiscal imperative,” he said. He warned “special interests” not to stand in the way of reform and then dispatched the assembled group with “Let’s get to work.”
The approximately 150 participants were then split up into five breakout groups. I conferred with Rep. Conyers, author of H.R. 676, the major single-payer bill in the House of Representatives, about what we might be able to accomplish during the breakouts. He was assigned to Breakout Session One, chaired by Melody Barnes and Bob Kocher, the principal staffers who had organized the summit. I was assigned and attended Breakout Session Two, chaired by Valerie Jarrett, a senior adviser to the president, and Ezekiel Emanuel, an oncologist and former bioethicist for the NIH, now one of the chief health care advisers in the White House.
My panel had four senators: Robert Bennett (R-Utah), Christopher Dodd (D-Conn.), Bernie Sanders (I-Vt.) and Debbie Stabenow (D-Mich.); nine House reps: Roy Blunt (R-Mo.), Michael Burgess (R-Texas), Donna Christensen (D-VI), Nathan Deal (R-Ga.), Rosa DeLauro (D-Conn.), Steny Hoyer (D-Md.), Buck McKeon (R-Calif.), George Miller (D-Calif.), Tim Murphy (D-Pa.); and the following constituency representatives: John Engler (National Association of Manufacturers), Jeff Kindler (Pfizer), Chip Kahn (Federation of American Hospitals), Eric Whitaker (University of Chicago Medical School), Debra Ness (National partnership for Women and Families), Fredette West (Racial and Ethnic Disparities Coalition), Ed Coyle (Alliance for Retired Americans) and Scott Hersey Reed (PICO – a faith-based organization).
The discussion in my breakout group was relatively unfocused. Most agreed the time and circumstances were different from 1993-94, when the Clinton health plan was defeated by special interests. The opportunity for reform now was real. The major problem was high costs and access. Solutions ranged from community health centers to malpractice reform, physician payment reform, reduction of medical errors, wellness programs, comparative effectiveness research, and health information technology.
Because no one had yet mentioned for-profit, private health insurance companies as the source of our problems, I was preparing to speak. But at that moment Sen. Sanders burst in and pointed out that private health insurance added cost but no value. He then announced that he intends to introduce a bill in the Senate resembling the McDermott bill in the House, a national single-payer program administered through the states.
The only panel member who advocated for an existing bill was Sen. Bennett. He spoke on behalf of the Wyden-Bennett bill, which would remove the tax deduction that employers who sponsor private health insurance have, thrusting everyone into the individual market, which he claims would reduce costs through market competition. He had not heard of the “health insurance death spiral,” in which the healthy pay less for premiums and the sick pay more, although he understood the concept.
After an hour and half of discussion and without reaching consensus, we reconvened in the East Room of the White House, which had been reconfigured into a “theater in the round” with lectern in the middle for the president. The president had a list of names to call upon and started with Sen. Ted Kennedy (D-Mass.). He then proceeded to name the important Congressional committee chairs (Democrats) and their ranking members (Republicans). This gave each an opportunity to make a statement and/or ask the president a question.
It was clear that the main message that President Obama wanted to communicate was bipartisanship and transparency, since he avoided most of the truly contentious issues, such as an individual mandate to carry health insurance either for children and/or adults; an employer mandate to pay for coverage; a public plan to compete the private plans in a health insurance exchange; elimination of pre-existing conditions exclusions from private health insurance; taxation of health benefits offered by employers; or permitting Medicare to negotiate with pharmaceutical companies for drug prices. These are all issues left for discussion and resolution within Congress. While this is the opposite of the Clinton administration’s approach, the president may be seeking to lay a broad foundation for making hard choices in the future.
Besides the lawmakers, it is interesting to note which organizational leaders he called on to make statements. These included Karen Ignagni, president of America’s Health Insurance Plans; Dan Danner, president of the National Federation of Independent Businesses; and Ted Epperly, president of the American Academy of Family Physicians. A few other audience members were called on for statements, including Fredette West, president of Racial and Ethnic Disparities Health Coalition, and Irwin Redliner (a recently mentioned candidate for U.S. surgeon general) from National Center for Disaster Preparedness at the Columbia University Mailman School of Public Health.
What was my role in all of this? Despite my best efforts, I was unable to make a public statement at the meeting, although thanks to the PNHP staff in Chicago we were able distribute my prepared remarks to the media while the summit was under way. Our staff member in Washington, Danielle Alexander, also handed out hard copies to summit participants as they left the White House.
I took the opportunity to talk one-on-one with six senators and seven representatives and suggested that if their committees held hearings on health reform, at least one or two single-payer advocates should be included on the hearing panel. I also said that single-payer bills like H.R. 676 should be compared with all other proposals for health care reform by the Congressional Budget Office. There was considerable receptivity to these ideas among some of the Congress members. We will pursue these leads.
The media took great interest in the successful battle by Rep. Conyers and myself to get into the summit, with stories in the Congressional Quarterly, The Wall Street Journal, and The New York Times, among other places. We have also been able get the single-payer message out on radio, with myself and Drs. Walter Tsou, Steffie Woolhandler, David Himmelstein and Quentin Young, among others, being invited to appear on the air, often on programs with national reach. This was a plus.
In sum, I came out of the White House Health Care Summit with conviction that single payer – that is, publicly funded, privately delivered health care, which removes the wasteful for-profit, private health insurance companies as middlemen, remains the only solution that can guarantee access to comprehensive, quality health care with choice of doctor and hospital, and reduce overall cost. Single-payer, an improved and expanded Medicare-for-All, is the gold standard against which all other proposals for health care reform should be measured.
Advocates need to focus on Congress during the next few months. We need to make the case that co-sponsorship of H.R. 676 raises its legitimacy as a gold standard, and that single-payer advocates should be called to testify at congressional hearings.
Insurers’ commitment to healthcare reform is only skin-deep
The industry claims to have had a change of heart, but its position hasn’t changed at all.
By Michael Hiltzik
Los Angeles Times
March 9, 2009
In December, the industry’s trade group, AHIP (for America’s Health Insurance Plans) revealed that it had experienced an epiphany and decided for the first time to support the principle of universal healthcare — insuring everyone in America, regardless of health condition.
It described its change of heart as the product of three years of sedulous soul-searching by AHIP’s board of directors, who claimed to have “traveled the country and engaged in conversations about healthcare reform with people from all walks of life.”
As a connoisseur of health insurance lobbying practices, however, I withheld judgment until I could scan the fine print. What I found by reading AHIP’s 16-page policy brochure was that its position hadn’t changed at all. Its version of “reform” comprises the same wish list that the industry has been pushing for decades.
Briefly, the industry wants the government to assume the cost of treating the sickest, and therefore most expensive, Americans. It wants the government to clamp down hard on doctors’ and hospitals’ fees. And it wants permission to offer stripped-down, low-benefit policies freed from pesky state regulations limiting their premiums.
… AHIP Chief Executive Karen Ignagni (told) the Obama summit: “You have our commitment to play, to contribute and to help pass healthcare reform this year.”
Ignagni can afford to be gracious because no specific reform plan is yet on the table. But veterans of the last reform battle warn that the moment concrete proposals appear, the insurance industry will deploy in force to kill anything that threatens its profitability and freedom of movement, such as an expansion of public insurance programs or tighter federal regulations.
Veterans of earlier healthcare battles justly wonder if the industry is merely trying to get in front of the parade, the better to lead it into a dead end.
“It might be that they think reform is inevitable,” says (Jonathan Oberlander, a healthcare reform expert at the University of North Carolina), observing that the industry made very similar noises at the outset of the Clinton effort, before the slaughter started. “I’d say buyer beware. We’ve been there before with them.”
In Divide Over Health Care Overhaul, 2 Major Unions Withdraw From a Coalition
By Robert Pear
The New York Times
March 6, 2009
Two labor unions have pulled out of a broad coalition seeking agreement on major changes in the health care system. The action, by the American Federation of State, County and Municipal Employees and the Service Employees International Union, shows the seeds of discord behind the optimistic talk at a White House conference on health care this week.
The most active participants in the coalition include Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, and Billy Tauzin, president of the Pharmaceutical Research and Manufacturers of America, which represents drug companies.
In December, when America’s Health Insurance Plans (AHIP) released their new report indicating that they were fully committed to reform that would cover everyone, I responded in a Quote of the Day (12/4/08) with the following: “You could not possibly describe a proposal that would better serve the interests of the private insurance industry. They would create a standard of underinsurance, require all of us to purchase their products, and pretend to address affordability issues through tax credits.”
Michael Hiltzik has provided for us a great service by actually reading AHIP’s report – carefully. He confirmed that this industry, which has been so destructive to health care reform efforts in the past, hadn’t changed its position at all.
Yet Washington has rolled out the red carpet for Karen Ignagni, AHIP’s president. She appears at almost every forum on reform and is presented with the microphone with some fanfare, even if she was not scheduled in the agenda. The intensity of the efforts to keep the private insurance industry in control of the process might best be exemplified by President Obama’s Health Care Summit. In closing remarks, President Obama handed the microphone off to Karen Ignagni so that she could express for the national audience AHIP’s phony epiphany.
Robert Pear’s report on the split in a major coalition on reform exposes the sharp contrast between AHIP’s sick-sweet public rhetoric on cooperation, and its back-stabbing, cut-throat, behind-the-scenes negotiations on the specifics of reform.
AFSCME and SEIU, the two unions that pulled out of the negotiations, serve as a proxy that represents the only special interest that really matters – the patients. After half a year of intensive negotiations with AHIP, PhRMA, the United States Chamber of Commerce, and others, it was clear that the insurance industry would not compromise its business interests for the benefit of patients. AFSCME and SEIU had to walk out.
The coalition plans to issue recommendations later this month in a report that reflects “the lowest common denominator,” undoubtedly more sick-sweet rhetoric crafted by AHIP.
(Theoretically the consumers were represented by Ronald Pollack of Families USA, but he has lost all credibility because of his years of insistence that we follow a strange-bedfellows strategy – a process which tragically has only perpetuated health reform inertia. Jonathan Oberlander cautions that “we’ve been there before with them,” but Ronald Pollack’s learning curve is flat. )
Michael Hiltzik is to be praised for his leadership. We can only hope that other influential members of the media follow his example. All they need to do is carefully read AHIP’s own report on its change of heart, and see what it really says. (Hint: I couldn’t find a heart anywhere in the report.)
AHIP’s phony epiphany:
Report of Health Care Community Discussions
March 5, 2009
In December 2008, the Presidential Transition Team invited Americans to host and participate in Health Care Community Discussions to talk about how to reform health care in America.
IV. Solutions to the Problems in the U.S. Health Care System
B. Roles in a Reformed U.S. Health Care System
Role of Government v. Market
The real debate was over the balance of government versus the market in insuring Americans. Supporters of a single-payer system submitted numerous reports, in part due to the encouragement by advocacy groups to participate in Health Care Community Discussions. Under most versions of a single-payer system, the government would replace private insurers in organizing, financing, and paying for health care. Its specifics, and arguments for and against it, are described below (see Single-Payer System box).
That’s it. In this long report, this is the paragraph that expresses the ubiquitous single payer presence at these meetings. (The single payer box mentioned was not posted on this web version of the report.)
For those who were expecting a Quote of the Day on today’s White House Health Care Reform Summit, here is the the full discussion of single payer:
To quote Dr. Quentin Young, “It’s entirely heartening to fight for a just cause and, with remarkable speed, win.”
Only yesterday Dr. Ida Hellander sent out a PNHP Action Alert asking for calls to the White House to “Let Single Payer In” to tomorrow’s “forum” on health care. Then late today, Dr. Oliver Fein, PNHP President, was invited to attend. Earlier in the day, Chairman John Conyers had also been invited.
What gives? A deluge of calls and faxes and emails rained upon the White House.
As we celebrate, single-payer advocates also pause to take stock, of the task ahead of us.
DrSteveB at Daily Kos proposes:
Not just what Senator Baucus pre-determines to allow.
What are they afraid of?
Let there be a honest and open debate, comparing all the true total costs all proposals!
These are the next steps. And this small victory today shows us what we can we can do when we mobilize. It shows us to be confident, true to our convictions.
As we go forward we will need to keep the pressure on: Single payer in every Congressional hearing. Side-by-side comparison between single payer and every bill.
Yes we have a lot of work to do. Yes life “inside the beltway” does not reflect what we know of the rest of the nation, where a majority of physicians and patients want national health insurance.
And yes we can and will win single payer. To do so we will proudly join a social movement with the gravity and the momentum to win, – as we recognize that no one will do it for us.
Today helped show us what works. We can do it.
Thank you, PNHP!
Covering the Uninsured: Options for Reform
Kaiser Commission on Medicaid and the Uninsured
Alliance for Health Reform
March 2, 2009
Bradley Herring, Ph.D., Assistant Professor, The Johns Hopkins University, speaking on “Potential Complications with the Different Approaches to Health Reform”:
First off, single payer, HR 676. The underlying appeal of this is essentially that it is very elegant, and simple. You pay taxes into the system and in return you get the medical care that you need. And then also it’s universal. This is probably the only approach that’s actually going to get us to having no uninsured. That kind of notion of being universal – getting everyone covered. This is probably the only one that’s going to do it. But then moreover if you think about universal as having the system in which everybody essentially has got the same kind of coverage, and we’re all in the same boat together – single payer is really probably the only way we might get there. Another thing underlying the appeal about single payer is that there would be large reductions in the administrative costs. So Medicare has administrative costs between about 2 to 3 percent whereas private insurance varies considerably across different markets but averages about 14 to 15 percent.
Potential complications. Well, if you look at the description of single payer, and particularly on John Conyers’s website, it kind of seems like a health care utopia. You get the health care you need, cost sharing is reduced – right now there is pretty significant cost sharing in the Medicare program – and that is going to go away. But I think many of us might agree that somebody’s got to say no, right, that you can’t consume all of the health care that we’d like. Someone’s got to be in place to say no. There are certain treatments that we shouldn’t be receiving or certain patients that shouldn’t receive certain treatments.
Taxes is a big issue, right, so I don’t want to be hysterical. I actually think that taxes should kind of go up a little bit to address the fiscal situation we’re in in the U.S. But many people probably balk at the extent to which taxes have to go up to pay for a single payer. HR 676 includes payroll taxes, increasing from about 1.5 percent to 4.75 percent, on the employee side and the employer side. Repeal the Bush tax cuts. Get in line. Everyone’s targeting these Bush tax cuts – the single most popular pay-for in history. And then on top of that, the proposal would increase the marginal tax rates for the top 5 percent and the top 1 percent of income, an additional 5 percent or 10 percent respectively. And also include a tax on stock transactions.
The final thing I’ll say about single payer is that it most likely is going to result in lower payments to providers. If you look at the MedPAC data comparing private reimbursements and public reimbursements, they’re about 15 to 20 percent lower on the public side.
(Prof. Herring then discusses the three other models of reform: the Republican/McCain proposal, Obama/Baucus proposal, and the Wyden/Bennett proposal)
Q & A:
Audience member (from Center for Budget and Policy Priorities): Dr. Herring and the other panelists, I was wondering if you could discuss the ability of all of the various options to control costs of the health system. If health costs grow at their current rate, no insurance system, no matter how well designed, will be able to cover everyone because we won’t be able to afford it. Thank you.
Prof. Herring: So, off the top of my head, I would think that the single payer approach yields the most promise towards reducing health care costs because it can essentially happen by fiat, right. The government can say what we’re going to spend, and, if Congress is so willing to actually follow through on that, I mean, kind of decide what we’d want to spend. I think the Republican vision of tax reform and getting people into individual plans has a lot of promise for lowering the growth in spending in the sense that people would face strong incentives to purchase cheaper plans with higher deductibles, less access to costly technology, which will certainly, I think, reduce spending, but, taking a step away, we have to ask is that really appropriate? Is that where we want to go? I think the Wyden bill then, in turn, might probably rank third in terms of its ability to reduce the growth in spending. I think for some of these reasons alluded to in the more Republican approach in which there’s a system by which individuals are choosing, on cost, plans – in making decisions to purchase basic versus more comprehensive plans. And then finally I think with the Obama plan, and Baucus’s, the result is that, yes, we might get everybody covered but in a wildly fragmented system that it might be really hard to control costs moving forward with these different things, you know, to kind of plug (moves arms as if plugging multiple leaks in the system).
Should we care what Johns Hopkins Professor Bradley Herring has to say about single payer? Emphatically, yes. Prof. Herring is theoretically an academic purist, and has no relationship with the single payer community. Many of his policy studies on private health insurance have been done with Mark Pauly, of “moral hazard” fame. That would certainly place him outside of the single payer camp.
A recent Quote of the Day (2/6/09) covered the OECD working paper, “Health Care Reform in the United States.” My comment was quite critical because the paper ignored single payer while discussing the merits of private insurance reform, especially the work of Jonathan Gruber on the Massachusetts plan. The working paper was coauthored by two staff economists from OECD and, yes, Prof. Bradley Herring. In no way could he be considered to be a single payer ideologue.
Although I transcribed only his comments on single payer, you should listen to him on all four models (at the link above – a transcript will be available soon). He describes single payer as a system that actually gets everyone covered, that you get the medical care that you need, that there would be large reductions in administrative costs, and that “the single payer approach yields the most promise towards reducing health care costs.”
The other three models fall short on these goals, but look at what he says about how they control costs. Each model spends more money on administration in order to control costs by reducing benefits and by erecting financial barriers to care. As Prof. Herring asks, “Is that where we want to go?”
Tomorrow President Obama holds the White House summit on health care reform. A broad spectrum of special interests have been invited, but the single payer community has been explicitly excluded, except for Congressman John Conyers. Does that mean that they will search guests at the door to be certain that none of them bring in a copy of Prof. Herring’s comments? The turfs of the special interests would certainly be threatened by exposing the attendees to sound policy science.
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