By Margaret Flowers, M.D.

On May 5, eight health care advocates, including myself and two other physicians, stood up to Sen. Max Baucus (D-Mont.) and the Senate Finance Committee during a “public roundtable discussion” with a simple question: Will you allow an advocate for a single-payer national health plan to have a seat at the table?

The answer was a loud, “Get more police!” And we were arrested and hauled off to jail.

The fact that a national health insurance program is supported by the majority of the public, doctors and nurses apparently means nothing to Sen. Baucus. The fact that thousands of people in America are dying every year because they can’t get health care means nothing. The fact that over 1 million Americans go into bankruptcy every year due to medical debt – even though most of them had insurance when they got sick – means nothing.

And so, as the May 5 meeting approached, we prepared for another one of the highly scripted, well-protected events that are supposed to make up the “health care debate” using standard tools of advocacy. We organized call-in days and faxes to the members of the committee requesting the presence of one single-payer advocate at the table of 15. Despite thousands of calls and faxes, the only reply – received on the day before the event – was, “Sorry, but no more invitations will be issued.”

We knew that this couldn’t be correct. We had heard Sen. Baucus say on that very same day that “all options were on the table.” And so, the next day, we donned our suits and traveled to Washington. We had many knowledgeable single-payer advocates in our group. And as the meeting started, one of us, Mr. Russell Mokhiber, stood up to say that we were here and we were ready to take a seat. And he was promptly removed from the room.

In that moment, it all became so clear. We could write letters, phone staffers, and fax until the machines fell apart, but we would never get our seat at the table.

The senators understand that most people want a national health system and that an improved Medicare for All would include everybody and provide better health care at a lower cost. These facts mean nothing to most of them because they respond to only one standard tool of advocacy: money, and lots of it.

The people seated at the table represented the corporate interests: private health insurers and big business and those who support their agenda. The people whose voices were heard all represented organizations which pay huge sums of money to political campaigns. These interests profit greatly from the current health care industry and do not want changes that will hurt their large, personal pocketbooks.

And so, we have entered a new phase in the movement for health care as a human right: acts of civil disobedience. It is time to directly challenge corporate interests. History has shown that in order to gain human rights, we must be willing to speak out and risk arrest. We must engage in actions that expose corporate fraud and corruption. We must make our presence known.

And that is why the eight of us, knowledgeable health care advocates and providers, most of us parents, some of us grandparents, spoke out one-by-one at the Senate Finance Committee. And it is why we will continue to speak out and encourage others to do the same. Our voices must be strong enough to drown out the influence of corporate dollars.

Health care must become the civil rights movement of this decade. The opportunity is here. And we can create a single-payer national health care system.

Yes, we can.

Dr. Margaret Flowers is a pediatrician in Baltimore and co-chair of the Maryland chapter of Physicians for a National Health Program (PNHP). Her statement was co-signed by Mark Dudzic, Labor Campaign for Single Payer; Russell Mokhiber, Single Payer Action; Carol Paris, M.D., PNHP; Katie Robbins, Healthcare-NOW!; Pat Salomon, M.D., PNHP; Adam Schneider, B’more Housing for All; and Kevin Zeese,

Ed Schultz interviews Dr. Margaret Flowers

Posted by on Friday, May 8, 2009

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.

Arrested for fighting for healthcare reform

The Ed Show
May 7, 2009

Ed Schultz interviews Dr. Margaret Flowers:

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Frank Luntz's "The Language of Healthcare 2009"

Posted by on Thursday, May 7, 2009

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.


By Dr. Frank I. Luntz

This document is based on polling results and Instant Response dial sessions conducted in April 2009. It captures not just what Americans want to see but exactly what they want to hear. The Words That Work boxes that follow are already being used by a few Congressional and Senatorial Republicans. From today forward, they should be used by everyone.

You simply MUST be vocally and passionately on the side of reform. The status quo is no longer acceptable. If the dynamic becomes “President Obama is on the side of reform and Republicans are against it,” then the battle is lost and every word in this document is useless. Republicans must be for the right kind of reform that protects the quality of healthcare for all Americans. And you must establish your support of reform early in your presentation.


(1) Humanize your approach.

(2) Acknowledge the “crisis” or suffer the consequences.

(3) “Time” is the government healthcare killer.

(4) The arguments against the Democrats’ healthcare plan must center around “politicians,” “bureaucrats,” and “Washington” … not the free market, tax incentives, or competition.

(5) The healthcare denial horror stories from Canada & Co. do resonate, but you have to humanize them.

(6) Healthcare quality = “getting the treatment you need, when you need it.”

7) “One-size-does-NOT-fit-all.”

(8) WASTE, FRAUD, and ABUSE are your best targets for how to bring down costs.

(9) Americans will expect the government to look out for those who truly can’t afford healthcare.

(10) It’s not enough to just say what you’re against. You have to tell them what you’re for.

This is an important document. It is Frank Luntz’s recommendation to the Republican politicians on how to frame the debate over health care reform. If you have been listening to the Republicans speak on reform, you have already heard some of the rhetoric, and you will recognize it as you read this report.

This is not a report on health policy. If you read it as if it were a policy paper, you will likely become angered over the liberties that Luntz takes with policy concepts. You will recognize a great many distortions and, worse, many instances in which his statements are not supported by the facts (i.e., “lies” in common parlance).

This is a report on political framing of the debate. It is designed to provide Republicans with political rhetoric that theoretically would shift support to the Republican positions for reform, and away from the Democratic positions. As you read it, you will see that there is a very strong emphasis on the latter, and very little on the former since the Republicans have almost nothing to offer in the way of substantial reform.

A note of caution: As you read the report, you will tend to fall into the trap of responding based on their framing of the issues. Do not do that. Always address the issues within our own framing structure. When you identify rhetoric that is blatantly untrue, you will tend to say, “That’s a lie.” Such ’tis so/’tis not debates are never productive and tend to favor the smooth talkers (predominantly Republicans). Instead, respond with highly credible facts that use the framing from our own arena.

Another word about lies. You will see that Frank Luntz does not have an issue with this. What counts is a strong message that appears to be credible, regardless of whether or not it is. On our side, we must never lie, nor even distort our message. We have established unblemished credibility with our message, and we must never do anything that might impair that credibility. That makes our task more difficult because we must be very careful that anything we say is supported by sound health policy science. But it also makes the Republicans vulnerable since they tend to concentrate on sound bites that are not based on sound policies. That risks exposing them as charlatans; we can do that with our carefully framed messages.

Some parts of the report actually provide good advice not only for the Republicans, but for the Democrats as well. In fact, you will identify some recommendations that have been lifted from our camp. We can continue to use these, and we should not attack them when they use the same rhetoric. Only when they twist it unfairly should we counter with our rhetoric describing the beneficial impacts of our policies.

Look at this example from the report: “What Americans are looking for in healthcare that your ‘solution’ will provide is, in a word, more: ‘more access to more treatments and more doctors…with less interference from insurance companies and Washington politicians and special interests.'”

What Luntz left unsaid is that these are features that more closely describe the progressive position. Most of the Republican policies would make these worse. Again, you wouldn’t respond by saying, “That’s not true.” You would respond by providing accurate sound bites on how the single payer proposal provides improved access by eliminating financial barriers to care, and single payer would eliminate the private insurance industry so it could no longer interfere with your care.

Wait. Progressive? Single payer? Isn’t my comment supposed to be talking about the framing to be used the Democrats? Well, we have a problem here.

Look at another example from Luntz’s report: “We suggest ratcheting up the rhetoric against insurance companies to almost the same degree as you do against Washington bureaucracy. Call the Democratic plan a ‘bailout for the insurance industry’ — both because it is, and because it will build lasting credibility by going after the two things the American people hate most: Washington bureaucracy and insurer greed.”

Wow! Luntz is right! The Democratic plan IS a “bailout for the insurance industry.” In fact, the Democrats have lost all credibility on this one when they have AHIP’s Karen Ignagni front and center at every hearing, every forum, every summit, and her operatives providing input to the closed-door sessions, while they have excluded from the process those who most vigorously attack the insurance companies – the single payer advocates.

Read Luntz’s report. Be prepared to respond using our framing. Attack their credibility when they provide us with obvious openings.

What is sobering is that we have to use the truth to attack both the Republican and the Democratic politicians. And this was to have been our great opening to provide high quality care for everyone.

But don’t give up. The Democrats’ plan won’t work. They’ll still need us to fix our system when their failure becomes painfully obvious.

Sen. Schumer kills reform

Posted by on Wednesday, May 6, 2009

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.

Schumer Offers Middle Ground on Health Care

By Robert Pear
The New York Times
May 5, 2009

In an effort to defuse the most explosive issue in the debate over comprehensive health care legislation, a top Senate Democrat has proposed that any new government-run insurance program comply with all the rules and standards that apply to private insurance.

The proposal was made Monday by Senator Charles E. Schumer of New York, the third-ranking member of the Senate Democratic leadership, in a bid to address fears that a public program would drive private insurers from the market.

Democrats in Congress hope to shift the debate from the question of whether to create a public health insurance plan to the question of how it would work.

“The public plan,” Mr. Schumer said Monday, “must be subject to the same regulations and requirements as all other plans” in the insurance market.

The chairman of the Senate Finance Committee, Max Baucus, Democrat of Montana, asked Mr. Schumer to seek a solution. In his response, Mr. Schumer set forth these principles:

* The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

* The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

* The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

* To prevent the government from serving as both “player and umpire,” the officials who manage a public plan should be different from those who regulate the insurance market.

In addition, Mr. Schumer said, the public plan should be required to establish a reserve fund, just as private insurers must maintain reserves for the payment of anticipated claims. And he said the public plan should be required to provide the same minimum benefits as private insurers.

Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, said, “We are very, very grateful that members of Congress have been thoughtfully looking at our concerns.” But she said she still saw no need for a public plan “if you have much more aggressive regulation of insurance,” which the industry has agreed to support.

The success of the effort to reform health care seemed to be threatened by the disagreement over whether or not a public insurance option should be offered to compete with private health plans. All Republicans have expressed opposition to the public option, indicating that it would be a deal breaker if included. The Progressive Caucus in the House, which actually wants single payer, has taken a position that leaving the public option out of the reform legislation would be a deal breaker.

To prevent gridlock, Sen. Charles Schumer offers the simple solution of “public option light” so that it would not be a deal breaker for either side. The progressives would have a government-sponsored plan in the mix of private plans, and the Republicans would have government-sponsored plan that is indistinguishable from private plans, creating a level playing field. Thus each side could move forward with reform without having to implement their deal-breaking rhetoric.

This is not simply Sen. Schumer’s personal effort defuse this bomb. His public option compromise was prepared at the request of Sen. Max Baucus who has been working closely with Sen. Charles Grassley to craft truly bipartisan reform legislation. In fact, at yesterday’s Senate Finance Committee hearing on expanding health care coverage, in addition to the fifteen scheduled witnesses, Sen. Baucus called on committee member Schumer to present the public option compromise.

Look at the history of what has happened here. The progressives were told by the moderates that the votes for single payer were not there. So negotiations began from a position that single payer was off the table. The progressive community then decided to concede that the Republicans and the insurance industry could have their market of private plans, and that the compromise position that all could accept would be the addition of a public insurance option.

In the compromise process, the Republicans and the insurance industry finally made their move. That was, “drop dead.” The Progressive Caucus responded with, “we’ve already come more than half way, so now you drop dead.” So now we have the Schumer compromise of public option light, which now has been blessed as the current, official Democratic position, even though it moves even closer to the Republican position.

What have the Republicans conceded so far? Nothing. What is the insurance industry’s position on a competing public plan that looks just like their private plans? Karen Ignagni of AHIP says that she still sees “no need for a public plan.” No concession.

The Democrats have already conceded on an effective public plan option. They have conceded that universal coverage is not possible so we should merely “aim for universal.” They have admitted that they have not figured out a way to pay for plans with adequate benefits for working families. They have abandoned support of policies that would improve value while controlling costs.

The Democrats have already given away all major policies for reform, and the Republicans haven’t had to budge the least. Why should they when the Democrats are rushing in their direction?

It is ironic that yesterday, at the Senate Finance hearing, one by one, eight individuals, including physicians from PNHP, stood up and offered to present policies that would work.

One of them stated, “… single payer national health care; we want a seat at the table.”

Sen. Baucus responded, “We want police,” and he got them. Each was arrested in turn.

That allowed enough time for Sen. Baucus to add Sen. Schumer as an additional pseudo-witness so that they could kill the last, but all-too-feeble effort at real reform – the public option.

Sen. Baucus respects our views

Posted by on Tuesday, May 5, 2009

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.

Hearing on “Expanding Health Care Coverage”

Senate Committee on Finance
May 5, 2009

The opening of the hearing was disrupted by a passionate protest from the audience…

Person from audience: (at end of the protest)… We need health care now! Put single payer on the table now!

Sen. John Kerry: Is there anyone in the audience who didn’t come to…


Sen Max Baucus: Let me say this. I think I speak for everybody on the committee and everybody in the Congress… deeply, deeply respect the views of all members of the audience and of all Americans who feel deeply about health care reform, especially those who are worried about single pay system, public option, who really do fervently believe that is the proper result. That is a view that many people have. It’s a view which I respect. There are other approaches to health care reform which also I respect. The whole point of this hearing and other hearings is to try to determine the best route, the best option, in determining how to best reform our country’s health care system. So for those of you who remain in the audience who may be inclined to stand up and, out of order, to state your views, I encourage you to not do so, because I want you to know that I personally care deeply about your views. I deeply respect your views. I hear what you say. I talk to a lot of people in my home state of Montana who have the exact same views. I represent 900,000 of the world’s best bosses, Montanans, and many of them have the very same view. But we aren’t going to get the best result here… the more we can have an orderly discussion of how we should best reform the health care system. So I want to say to everyone, especially those of you who might be inclined to stand up, that I urge you not to so we can proceed with the hearing holding your views also deeply in mind as we proceed. Thank you. (includes the list of witnesses and their testimonies)

Apparently the single payer views must have been held very deeply, hidden in the minds of the Senators and the witnesses, since at no time during the hearing was single payer discussed as an option for reform.

It is one thing to respect the views of those who support a model of reform that actually would provide all necessary health care for everyone and make it affordable for each and every individual, but it is quite something else to restrict the discussion to options that cannot ever achieve those goals.

This hearing represents the the framework of reform that is being crafted behind closed doors. The tragedy is that any bill that results from this process will delay further the reform that we desperately need. In the meantime, tens of millions or more will face unnecessary physical suffering and financial hardship, and many will die.


Medical student debt and specialty selection

Posted by on Monday, May 4, 2009

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.

Where Did All the Doctors Go?

The New York Times
May 3, 2009

To the Editor:

Re “Shortage of Doctors Proves Obstacle to Obama Goals” (front page, April 27), about a lack of primary care providers :

As those of us responsible for delivering health care know, the battle between specialists and primary care doctors has been going on for years, and one side has been winning.

The marketplace has rewarded specialists financially, and like any other special interests, they are amply financed for this conflict. Still, I don’t fault them. They have studied and worked hard, and are responding to market incentives, like good red-blooded Americans.

What we really need is a European-style single-payer system, with primary care doctors who emerge from their training with European-style debt loads: zero.

Georganne Chapin
Tarrytown, N.Y.

The writer is president and chief executive of the Hudson Health Plan, a not-for-profit managed care organization.


Subject: Graduate Medical Education: Trends in Training and Student Debt

GAO (Government Accountability Office)
May 4, 2009

In summary, we found that medical students prefer surgical and procedural specialties, and physician subspecialization is increasing. Relative to the number of available residency positions, more medical students have preferred surgical and procedural specialties over primary care specialties since 1999, according to national data.

Some factors may also lead students to pursue certain specialties while avoiding others. For example, the desire for a controllable lifestyle — a predictable schedule and fewer on-call hours — and high salary may lead students to pursue procedural specialties such as anesthesiology, and avoid other specialties such as primary care.

Medical school tuition and fees have increased significantly since 1998. Medical students can borrow up to $40,500 per year through the federal Stafford loan program with additional funding available through other federal loan programs; these loan programs can cover the full cost of medical school. The median amount of educational debt for indebted medical students graduating in 2008 was $155,000 — a 53 percent increase since 1998, controlling for inflation. Once out of medical school, residents earn stipends — on average about $3,729 a month for a 1st year resident. With $155,000 in debt, a resident’s monthly loan payment could reach over $1,700 (about 48 percent of pretax income). However, residents have repayment options that can reduce their monthly debt payment until they complete postgraduate training.

This statement from a highly respected executive of a not-for-profit managed care organization, and this new GAO report, both further confirm what we already knew. Medical students are graduating with excessive debt, and this is likely contributing to the decline in the numbers choosing the primary care specialties.

Without increasing total health care spending, a few policies could be adopted which would realign incentives to improve our primary care infrastructure, while relieving students of the necessity of accumulating debt. That would be much easier to accomplish through a single payer monopsony than through a dysfunctional, fragmented, multi-payer, health care financing system.

Uwe Reinhardt's prescience on the auto industry

Posted by on Friday, May 1, 2009

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?

Dr. Chaoulli's private clinic waiting room death

Posted by on Thursday, Apr 30, 2009

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

Canadian Medicine
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.


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.

Akin to "the scene of a crime"

Posted by on Thursday, Apr 30, 2009

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.

If only.

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.

As CBC News reported:

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.

Ed Show: Bernie Sanders on single payer

Posted by on Wednesday, Apr 29, 2009

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

Ed Show
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.

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