FRONTLINE's "Sick Around America"

Posted by on Friday, Apr 3, 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.

Sick Around America

March 31, 2009

Investigating the stories of Americans whose lives have become a quest to find and keep health insurance…

Join the Discussion


I am disappointed that this long-awaited special on healthcare did not address the single payer option. There were ample interviews with insurance company lobbyists but no discussion of this obvious choice. Our nation’s people are in crisis and the shameful greed displayed in other industries is replicated in the for profit hospital corporations, insurance companies and pharmceutical industries. We cannot afford profit in healthcare, as we will continue to have a chaotic, threadbare system riddled with donut holes and pitfalls for those who can least navigate: patients and their families. I’d like to see equal time — a Frontline on the single payer option.

Grace Gifford
Conway, SC

FRONTLINE’s editors respond:

Many viewers have written criticizing this report for not looking at solutions, in particular, a single payer system. Certainly, the topic is another important piece of any examination into the health care system and how it can be improved. And it would warrant a separate program of its own. We would like to point out that we did examine how the single payer system works in many European countries in our program last season, Sick Around the World. You can view this online.We believe that our report this week, Sick Around America, was equally of value in focusing on our current private health insurance system and showing how many Americans are only one or two events away from financial disaster or total ruin because they can’t afford this insurance, or because it offers inadequate coverage, or because it suddenly can be rescinded by the insurer for alleged omissions or errors. We also felt it important in this report to look at another major problem with the private insurance system: America’s for-profit medical system means that insurers have a fiscal duty to avoid risk and make profits for investors. Thus, insuring people who already have serious, chronic illnesses works against the interests of stockholders.

FRONTLINE: Sick Around America

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PNHP: “‘Sick Around America’ disappoints” – selected responses‘sick-around-america’-disappoints/

Columbia Journalism Review: “Sick Around America” by Trudy Lieberman

T.R. Reid had hosted FRONTLINE’s “Sick Around the World,” an important documentary describing successful health programs in several other nations that provide care for everyone at a fraction of the costs of our fragmented, inefficient health care system that leaves so many out.

We were looking forward to T.R. Reid’s sequel, “Sick Around America,” describing the problems with our private insurance system. Many of us were disappointed with the format of the program, believing that they missed a great opportunity to educate the nation on several health policies that would work well for all of us. Thus it was no surprise to us that T.R. Reid was not mentioned during the program, nor in the credits.

What happened? Reid left the show this February in a dispute with FRONTLINE. Trudy Lieberman of Columbia Journalism Review quotes Reid as saying, “When I saw it, I didn’t agree with it. It took a different view of health policy than I have.”

The program did use anecdotes effectively, demonstrating some of the problems with private insurance. Examples included medical underwriting, rescission, lapses in coverage, financial burdens due to underinsurance, and other deficiencies that most Americans now understand.

Watching this program, it is very clear that change is required. But the message for reform was outrageous. Throughout the program, many executives of the private insurance industry were featured, and they confirmed that these deficiencies were very real and needed to be addressed. That’s good. What was outrageous is that they were in no way contrite, but instead they implied that they would provide the leadership to make sure that private insurance will continue to manage the financing for health care in America, beginning with an individual mandate for every American to buy their lousy products.

We can only speculate on the motives of the producers. My opinion is that they wanted to provide support for the current efforts of the Democrats in Congress and in The White House to build reform based on private health plans. A publicly-administered and publicly-financed program would require a total restart on the reform process, and so it wasn’t offered as a potential solution. In deference to the insurance executives, the producers didn’t even promote a public Medicare-like option.

Remember, these insurance executives are not contrite. They can never provide the moral leadership that we need to create a health care system that serves all of us well.

‘Sick Around America’ disappoints

Posted by on Wednesday, Apr 1, 2009

“Sick Around America,” a Frontline documentary about the dysfunctional U.S. health care system, aired March 31 on PBS.

Billed as a sequel to the widely hailed “Sick Around the World,” a 2008 Frontline production featuring veteran Washington Post correspondent T.R. Reid, the new documentary was eagerly awaited by U.S. supporters of fundamental health reform.

In the first film, Reid gave an accurate portrayal of several single-payer health systems overseas. Many reform advocates hoped this new documentary would discuss single payer as an option for the United States, too, particularly given its popularity among the U.S. public.

Alas, that was not to be the case. Nor, incidentally, was Reid’s name to be found anywhere in the credits.

Instead, filmmaker Jon Palfreman, who also directed the first documentary, concentrates on telling dramatic patient stories that illustrate the utter failure of the present private-insurance-based system. But he offers little in the way of what to do about it.

To the extent that any reform proposal is cited as a possible pathway for change, it is the flawed, mandates-based Massachusetts model. While some of the serious problems of that faltering model are pointed out, viewers are nonetheless left with the impression that mandates may be the way to go. That’s certainly the point made by Karen Ignagni, president of America’s Health Insurance Plans, who makes multiple appearances in the film.

Frontline publishes a blog of viewer comments on its documentaries, and a number of PNHP members and other single-payer supporters were quick to express their disappointment. In fact, single-payer supporters from all over the country were heavily represented in the blog discussion during the first 12 hours after the film’s release. Below is a small sampling of their comments. You can join the discussion at


Americans are totally frustrated by our health care system and this documentary illustrates why the current health reform debate is moving in the wrong direction. Congress is about to force all Americans to buy private health insurance under the pretense of “universal health care” using the Massachusetts model. This is not what Americans want and to compel us to buy into the outrageous behavior of the private health insurance industry is totally disgusting.

We need single payer, national health insurance and begin with a totally different cultural orientation — everybody in, nobody out.

Walter Tsou, M.D.



Massachusetts — Election Day 2008. A ballot initiative put forward in 10 legislative districts read:

“Should the representative from this district be instructed to support legislation creating a cost-effective single payer health insurance system that is available to all residents, and oppose laws penalizing those who fail to obtain health insurance?”

73 percent of the 181,895 people voted YES.

Why oh why, from the very state where the health insurance “mandate” — a law criminalizing the uninsured — is held up as a model for the nation, in spite of its obvious failure?

Single payer national health insurance, H.R. 676, will SAVE hundreds of billions of dollars and COVER EVERYONE.

Health is a human right!

Andrew D. Coates, M.D.
Delmar, N.Y.



This program is heavy on interviews of insurance executives. Where are the voices for Single Payer, Medicare For All?

You stated that all other countries require all residents to buy health insurance. This is not true. Canada and UK cover everyone through taxes. Taiwan has a system like our Medicare.

If the US mandates insurance, the for-profit insurance industry will rake in tax payer money to support share holders, complex administration costs and excessive executive salaries and bonuses. This show is disappointing.

Karen Green Stone
Bloomington, Ind.

And …


Thank you, Frontline, for your inspiring programs first on health care around the world and now on health care in the U.S. We should draw three conclusions:

1. As Dr. Delbanco stated so eloquently, the first step is to provide health care to everyone. Only then, and at the same time, should we tackle the problems of cost and quality. If we wait to expand health coverage until we have succeeded in curtailing costs, we will wait forever and acquiesce in the suffering of those without access to the care they need.

2. If we truly want everyone to have health insurance, we need to provide it to them, i.e. to make signing up as automatic and easy as possible. Mandates to purchase health insurance are inefficient, expensive, incomplete, and unnecessary.

3. To make universal health care as efficient and inexpensive as possible, we need to institute a single payer system, i.e. to eliminate the hassle imposed on patients and providers by the private insurance system and eliminate the waste of health care dollars in marketing, claims processing, administrative salaries, and profits. The models are the single payer bills introduced by Representative Conyers in the House and by Senator Sanders in the Senate.

Thank you again, Frontline, for teaching us these lessons.

Paul Sorum, M.D.
Schenectady, N.Y.



Let me add my voice to the others who wish that this program had discussed the option of a single-payer system. Can America afford the continued existence of the private health insurance industry?

Oak Park, Ill.



Your “Sick Around America” show was excellent in all respects except one. Once again you held to the media standard of maintaining absolute blackout regarding the option of a “Single Payer” system. Most advanced countries provide superior care, far more efficiently, with less cost without the burden of insurance. Your coverage never included that possibility as proposed by HR 676. And, you stated that President Obama’s meeting included all the stakeholders without mentioning that Single Payer advocates were deliberately excluded. Such coverage withholds critical information from the public.

Jerry Reed
Grants Pass, Ore.

Views on IRAs and HSAs contrast sharply

Posted by on Wednesday, Apr 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.

Not the Next IRA: How Health Savings Accounts Shape Public Opinion

By Jason Barabas
Journal of Health Politics, Policy and Law
April 2009

This study has documented policy feedback effects of a personal nature. The central finding is that policy feedback effects occur, but they can be domain specific. That is, participation in investment accounts for retirement or health do not lead to uniformly conservative or liberal policy opinions. As expected, IRA owners tend to favor Social Security privatization, but that does not mean that investing always or unequivocally engenders support for investment account-based policy solutions. Participation in HSAs reduces public support for health care privatization. In particular, HSA owners, owing to their wildly different programmatic experiences, are much less likely to endorse individualized health care coverage. Thus, HSAs and related forms of consumer-driven health plans are not automatically designed to become “the next IRA.” The irony is that dissatisfaction with HSAs is greatest among those who have them.

Much has already been written about the wisdom, or lack thereof, of health savings accounts (HSAs) and the high-deductible health plans that are linked with them. By design, they benefit higher-income individuals who are able to take advantage of the regressive tax policies, and who remain healthy, allowing the savings to accumulate for use in their retirement years. But they don’t work for individuals with modest incomes who have significant health care needs.

You would think that HSAs would be dismissed from the current dialogue on reform, but no. Our politicians are struggling with how to pay for comprehensive reform. One goal is to reduce spending on insurance premiums, and that makes lower-cost, high-deductible plans more attractive to those attempting to make reform cost-neutral, for the government, that is.

As Congress plays games with the budgeting of health care reform, it is imperative that they understand that the “dissatisfaction with HSAs is greatest among those who have them,” whether conservative or liberal.

It is hoped that soon Congress will give up looking for magical solutions to pay for health care for everyone, and get serious about a solution that actually would work – a single payer national health program.

Time to play the single-payer card

Posted by on Tuesday, Mar 31, 2009

A health care reform bill out of Congress by the end of the summer? An end to our national nightmare within five months? The health insurance industry is banking on an Obama-Kennedy-Baucus bailout – “universal” health care, with taxpayer subsidies for those who can’t afford the unaffordable premiums.

Right now the insurance gang is controlling the debate, with big headlines about how they will give up a few of their most egregious behaviors and accept a modicum more government oversight as long as we mandate that everyone become their customer. And, most importantly, don’t let the Socialists have their way and allow a Medicare-like “public option.” They cry that it would be unfair competition to ask the for-profit insurance companies to go up against a government run plan.

If they think the government can do so much better than they can, why don’t we listen to them? Let’s go ahead and put everyone in a government plan!

The strategy from the industry and their Republican allies is obvious – appear to offer a series of compromises, but draw the line to prevent any government plan. Wrap it all up in a big package and proclaim that we’ve got a uniquely American solution to our problem: a huge system of taxpayer subsidies to the insurance industry, with no mechanism to control costs, because there are too many big money interests who don’t want to see real cost control. They are happy to expand access to insurance because it makes good business sense to create more customers.

The strategy of Obama, the Democrats, many labor leaders, and “progressive” groups like Health Care for America Now is equally clear. Let’s offer a compromise plan with many complex features, all of which need to be clarified and debated, and hope that we can get the whole thing through Congress intact, including the public option. This is a strategy for failure. The public option will be the part that gets compromised out.

Many prominent progressives like Paul Krugman and Jacob Hacker have argued that the public option is the key to the whole reform process. The public option will constrain the rapacious insurance companies. The public option will be popular and efficient. The public option will be, at its best, a slippery slope to a single-payer plan. Never mind that critics have pointed out that if the public plan is enacted, the insurance companies will find ways to game the system again. Never mind that the Right has recognized the slippery slope argument, and that is why they are so adamantly against it.

This calls for an obvious change in the Democrats’ strategy. Up to now they have tried hard to keep the voices for single payer out of the debate. They have reassured the Republicans that single payer isn’t even “on the table.” If they want to have a chance to get the public option through Congress, it’s time for a new strategy. Time to play the single-payer card.

Purely from a strategic perspective, the president should put single payer back on the table and start explaining to the people all the advantages of Medicare for All. Then, when the going gets tough in the trenches of Congress, they can compromise and settle for the public option, and a muscular enough public option that it could serve as a model (a slippery slope) for an eventual single-payer system.

Of course, maybe once the single-payer cat is out of the bag, the weight of logic and public support will just push the insurance gang right out of the way.

Insurers waste your dollars to invade your privacy and cheat you

Posted by on Tuesday, Mar 31, 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.

Insurers shun those taking certain meds

How health insurers secretly blacklist those with certain ailments.

By John Dorschner
The Miami Herald
March 28, 2009

Some insurers will automatically reject applicants who are using certain prescription drugs.

The medications, of course, are indications of specific health problems. To make sure that applicants are not lying, insurers hire a data-gathering service — Medical Information Bureau, Milliman’s Intelliscript or Ingenix Medpoint.

Intelliscript and Medpoint do computerized searches of a person’s drug use, gleaned from pharmacy benefits managers and other databases. The two companies say they comply with privacy laws. “Ingenix requires each Medpoint client to obtain the authorization of the individual applicant or insured person,” said Ingenix spokeswoman Karin Olson.

The health care financing systems in other nations are designed to assist patients in paying for their health care. Computerized searches of personal drug use as described in this article is yet one more example of how our private insurance industry adopts policies that are designed to avoid paying for the patients’ health care.

It is no surprise that UnitedHealth’s Ingenix is a player in this scheme to protect the insurers’ finances to the detriment of patients. They recently reached a settlement for cheating patients and physicians through another scheme to underpay for legitimate services, again protecting the insurers finances.

There are two issues here, about which we should all be concerned. First is that this is still another example of health care costs that are wasted on excessive administrative services. It is particularly egregious that these services, for which we are the payers, are detrimental rather than beneficial for the patients. That’s the opposite of what we should expect from our health care financing system.

The second concern is perhaps more ominous. Right now Congress and the administration are pushing the expansion of information technology (IT) systems when it is not at all clear that privacy and confidentiality issues are being adequately addressed. Pharmacy benefit managers (PBMs) are already using IT systems, and look at what is happening. Private insurers are doing computerized searches of your personal drug use gleaned from the PBM databases. Not only are they invading your privacy, but the intent is to defeat the purpose of insurance by denying you coverage.

Intelliscript (Milliman) and Medpoint (Ingenix/UnitedHealth) say that they comply with privacy laws, yet how many people in this gigantic private administrative bureaucracy have access to your personal information? The Fair Credit Reporting Act requires the companies to let you see your personal information if you so request, and how many more administrators are there to peek at your private records as the information is transmitted back to you? Merely passing laws against invasion of medical privacy is not enough. If invading your privacy in an IT system can be done, it will be done.

Isn’t there a theme here? We pay a whole lot of extra money to a private health care financing industry that uses our funds to cheat us out of the health care that we should have. And Congress and the administration are calling for an expansion of this very sick system of financing health care?

Congress should have the common sense, integrity, and decency to jettison the private insurance industry and provide us with our own public health care financing system that would save us money so it could be used where we want it to be used – on our health care. What is so difficult about this concept?

STAKEHOLDERS AGREE! (to block reform)

Posted by on Monday, Mar 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.

Health Reform Dialogue

March 27, 2009

A Time for Reform:

…several widely diverse, national organizations began a series of unique discussions six months ago to exchange ideas and see where their agreements and differences lay.

This health reform dialogue was never intended to cover every issue likely to arise as health reform is considered in the ensuing months. Some issues currently elude consensus.

Increasing coverage and access:

Regarding coverage, reform should build upon the key pillars of health care coverage today — employer-sponsored insurance and public safety-net programs for low-income people and families.

* Improve Medicaid and Children’s Health Insurance Program (CHIP) outreach and enrollment.

* Establish a nationwide floor for Medicaid eligibility for all adults no lower than 100 percent of the federal poverty level.

* Give individuals eligible for Medicaid and CHIP the option to utilize those dollars to purchase employer-sponsored insurance…

* Provide advanceable, refundable tax credits or other subsidies on a sliding scale for individuals and families to purchase adequate and affordable coverage…

* Provide subsidies for small businesses to provide health insurance for their employees.

* Enact reforms necessary so that all individuals will purchase or obtain quality, affordable health insurance.

Strengthening wellness and prevention:

The Centers for Disease Control and Prevention estimate that eliminating three risk factors — poor diet, inactivity, and tobacco use — would prevent 80 percent of heart disease and stroke, 80 percent of Type 2 diabetes, and 40 percent of cancer.

* Identify effective clinical preventive services.

* Encourage clinicians and providers to deliver effective clinical preventive services and follow-up treatment, as indicated.

* Ensure a sufficient primary care workforce through an ongoing, dynamic, national planning and development process.

* Continue to invest in health information technology (HIT) that supports wellness and prevention, both on the individual and community levels.

* Further encourage businesses to support healthy behaviors.

* Encourage communities to be healthy.

* Eliminate disparities in health.

* Help individuals improve their health.

Ensuring quality and value:

* Conduct comparative clinical effectiveness research (CER) studies via a public-private partnership to provide additional information that can help improve care decisions.

* Expand and accelerate the development of meaningful quality measures.

* Fund state demonstrations of alternative medical liability reform models.

* Improve billing efficiencies to reduce confusion and duplication for patients, clinicians, and providers.

* Reduce administrative costs.

* Work to reduce geographic, racial, ethnic, and gender disparities in health care delivery.

* Ensure an adequate health care delivery workforce, including funding for training and loan forgiveness programs and payment reforms directed at primary care, public health and nursing, and other high-priority areas facing imminent shortages.

Context for Financing Health Care:

* Cost efficiencies can be gained by improving health care delivery.

* Methodologies for quantifying long-term cost savings can be improved.

* To jumpstart health reform, additional investments in U.S. health care will be needed.

Enacting meaningful health reform requires a careful and balanced approach of fiscal prudence, accompanied by efforts to contain costs, increase savings, and enhance efficiencies. Such investments will enable transformational changes to be achieved — and those transformational changes will ultimately place the United States on a path toward greater financial and health care security.

Organizations endorsing this document include:

Advanced Medical Technology Association
America’s Health Insurance Plans
American Cancer Society Cancer Action Network
American College of Physicians
American Hospital Association
American Medical Association
American Nurses Association
American Public Health Association
Blue Cross and Blue Shield Association
Business Roundtable
Catholic Health Association of the United States
Families USA
Federation of American Hospitals
Healthcare Leadership Council
National Federation of Independent Business
Pharmaceutical Research and Manufacturers of America
U.S. Chamber of Commerce

This report, “Health Reform Dialogue,” contains a few modest but obvious recommendations that any reasonable reform effort must include. Much more important is that the primary theme of this report, as exemplified by the sampling of recommendations listed above, is that we should continue with the status quo, dumping more of our dollars into our dysfunctional, wasteful, inefficient, fragmented system of financing health care.

So why should we pay any attention at all to this worthless contribution to the national dialogue on health care reform? It is because it exposes the blatant lie that we are close to agreeing on reform that would bring affordable, high quality care to all residents of the United States.

This highly touted, closed door process has been taking place over the past half year. Theoretically all important stakeholders were included (except patients). They agreed that we have finally come to the time that reform is an absolute imperative. Through intensive negotiations behind closed doors in a (symbolically) smoke-filled room, they finally agreed… that smoking is bad for your health (and a couple of other points of less significance).

There is absolutely no mention of a single payer national health program, or Medicare for All. That option was discarded before anyone walked into the room.

The compromise position to which the progressives had agreed would be to offer a public, Medicare-like insurance program to compete in the market of private plans. “Health Reform Dialogue” remains silent on such an option.

In a decision to exclude the progressive community from playing any serious role in reform, moderates are now proposing a government-sponsored, managed care PPO program, insulated by a double firewall from the government, so that it must compete on a “fair playing field” with the private plans. “Health Reform Dialogue” even remains silent on the possibility of offering a government PPO that would be required to include the same perverse policies that are inherent features of the private health plan models.

Look again at the organizations that signed on to this report. Two organizations that participated in the process are conspicuously absent: American Federation of State, County and Municipal Employees (AFSCME) and the Service Employees International Union (SEIU). At the end of this process, they refused to sign on to a document that would have even less impact than a no smoking pledge.

Look again at the list and decide which organizations actually controlled the process. Yes, those are the same organizations that have an ownership position in the Congress of the United States.

Unless Americans are ready to march on Washington, both literally and figuratively, the reform process is dead. Yes, dead!

Sen. Bernie Sanders introduces single payer bill

Posted by on Friday, Mar 27, 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.

Single-payer health reform bill introduced in Senate

Press release
March 26, 2009

Challenging head-on the powerful private insurance and pharmaceutical industries, Vermont’s Sen. Bernie Sanders introduced a single-payer health reform bill, the American Health Security Act of 2009, in the U.S. Senate Wednesday.

The single-payer approach embodied in Sanders’ new bill stands in sharp contrast to the reform models being offered by the White House and by key lawmakers like Senators Max Baucus (D-Mont.) and Edward Kennedy (D-Mass.). Their plans would preserve a central role for the private insurance industry, sacrificing both universal coverage and cost containment during the worst economic crisis since the Depression.

In contrast, Sanders’ new legislation would cover all of the 46 million Americans who currently lack coverage and improve benefits for all Americans by eliminating co-pays and deductibles and restoring free choice of physician. The most fiscally conservative option for reform, single payer slashes private insurance overhead and bureaucracy in medical settings, saving over $400 billion annually that can be redirected into clinical care.

Highlights of the bill include the following:

  • Patients go to any doctor or hospital of their choice.
  • The program is paid for by combining current sources of government health spending into a single fund with modest new taxes amounting to less than what people now pay for insurance premiums and out-of-pocket expenses.
  • Comprehensive benefits, including coverage for dental, mental health, and prescription drugs.
  • While federally funded, the program is to be administered by the states.
  • By eliminating the high overhead and profits of the private, investor-owned insurance industry, along with the burdensome paperwork imposed on physicians, hospitals and other providers, the plan saves at least $400 billion annually – enough money to provide comprehensive, quality care to all.
  • Community health centers are fully funded, giving the 60 million Americans now living in rural and underserved areas access to care.
  • To address the critical shortage of primary care physicians and dentists, the bill provides resources for the National Health Service Corps to train an additional 24,000 health professionals.

Sanders, who serves on the Senate Committee on Health, Education, Labor, and Pensions, is a longtime advocate of fundamental health care reform. His new bill draws heavily upon the single-payer legislation introduced by the late Sen. Paul Wellstone (D-Minn.) in 1993, S. 491, and closely parallels similar legislation pending before the House, H.R. 1200, introduced by Rep. Jim McDermott (D-Wash.).

S.703 – American Health Security Act of 2009 – full text:

Thomas (S.703 is listed but the text has not yet been received from GPO):

At a rare time in our history when comprehensive reform may become a reality, it is important that the single payer model be represented in the legislative process. The House already has Rep. John Conyers’ H.R.676 and Rep. Jim McDermott’s H.R.1200, and now the Senate has Sen. Bernie Sanders’ S.703.

S.703 is very similar to H.R.1200, with two important additions regarding budgeting. Specified funds are budgeted for community health centers, and other specified funds are budgeted for the support of the National Health Service Corps, health professions education, and nursing education, including education of clinical nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, and physician assistants.

These additions in budgeting are not simple tweaks to the bill. They provide a remedy for both the deterioration in our primary care infrastructure and the impaired access to care in underserved regions. There is an urgent need to provide the professionals and the facilities that can help fill the most serious voids in our health care delivery system today.

S.703 has been referred to the Senate Finance Committee, chaired by Sen. Max Baucus, who is determined to join with Senators Ted Kennedy, Charles Grassley and Mike Enzi to enact reform this year. Sen. Sanders will have some input as a member of the Budget Committee and a member of Sen. Kennedy’s HELP Committee.

What happens now? Will Senators Baucus and Kennedy take a fresh look at single payer as a model that addresses many of the policy problems that they currently face with their model based on private plans? Or will they accept Sen. Sanders’ contribution emphasizing the importance of health centers and primary care professionals? Or will they look at his budgeted numbers and decide that they can’t add those to the deficits they already face with their unnecessarily over-priced model of reform? Will they simply say that they’ll have to deal with that later, after they fix the insurance problem (the later that never comes)?

It’s great that there is a single payer bill in the Senate, but now is not the time to sit back and watch the process unfold. We certainly support the emphasis on improving primary care access, but we need to support that within a financing framework that will make it happen – a single payer national health program.

The following is the speech that Dr. Ronald Lind intended to deliver at the March 23 White House-sponsored health forum in Des Moines, Iowa. Although he was not called upon (only one PNHP leader was able to speak from the floor), the force of his message is undiminished.

Don’t let special interests block single payer

By Ronald Lind, M.D.

My name is Ronald Lind. I’m an anesthesiologist and I’m currently working as an assistant professor at the University of Iowa. Prior to this academic appointment I spent 18 years working in community-based practice.

I’m here today representing Physicians For a National Health Program (PNHP), an organization of over 15,000 physicians nationwide committed to reforming health care through the implementation of single-payer national health insurance program — essentially an expansion of the Medicare program to cover everyone in the country.

We support the passage of legislation introduced in every legislative session by Rep. John Conyers Jr., H.R. 676, titled the U.S. National Health Care Act. Of all the proposed methods of effecting health care reform being considered in Congress, this legislation enjoys the most support with over 90 co-sponsors in the most recently concluded legislative session.

Multiple polls and studies also indicate the support of a solid majority of the American population and also physicians for this approach to health care reform. Single payer offers many advantages, including but not limited to universal coverage, portability and cost control.

And yet there are powerful and well-financed special interests that profit mightily from the status quo who are fighting vigorously to ensure that this proposal isn’t even under consideration at these health care forums or anywhere else that health care reform is officially discussed, like Congress.

They are concerned that their enormous profiteering will be curtailed with the passage of this legislation, and in fact it will. So these special interests spend millions of dollars annually in lobbying to ensure maintaining or only minimally tinkering with our current system of employment-based, for-profit health insurance. They want to make sure that they are the only ones at the table so that they don’t end up on the menu.

Well, we don’t have millions of dollars for lobbying or to attempt to buy influence. The only group that benefits from single-payer national health insurance is the American people, who don’t have a lobby. So we’re not paid lobbyists. We’re volunteers and we’re here today and at all the White House-sponsored regional health care forums to show our support for single-payer health care reform and to demand that this proposal is given at least the same consideration as other options by our government.

By any measure of health, every other Western nation in the world does a better job than we do, and at reduced cost. The one thing they all have in common is non-dependence on a for-profit health insurance model. Only single-payer national health insurance can solve our current predicament. Only single payer can provide universal coverage affordably. Only single payer can control the ever escalating costs of medical care that are slowly but steadily bankrupting the country. Please join us in supporting H.R. 676.

Lastly, every caring American physician can tell a tragic story about a patient without health insurance. Here’s mine. I was called upon to anesthetize a 58-year-old woman who traveled 150 miles to the university for a mastectomy, passing at least six hospitals on the way, several right here in Des Moines.

When I asked her why she traveled so far for a relatively routine procedure she told me it was due to a lack of health insurance. Did I mention that she’s a nurse? A year earlier her employer dropped health insurance coverage in a cost-cutting move. Since she couldn’t afford to buy health insurance on her salary, she rolled the dice, hoping she’d remain healthy until she qualified for Medicare.

Well, she lost her bet and developed breast cancer. What is tragic about this case is that she was a candidate for a more conservative treatment plan of limited surgery followed by a month of radiation treatments. But since no local hospital would treat her due to her insurance status, this would have required either a daily 300-mile commute or a month’s stay in Iowa City for the radiation treatments.

She didn’t feel she could miss that much work so she elected to have the more radical, more disfiguring surgery, thus allowing her to return to work in about a week. Because she was having the more radical procedure we offered her a nerve block for post-operative pain management. In addition to providing superior pain management there is some preliminary evidence that nerve blocks also reduce the chances of cancer recurrence in this setting.

After explaining these facts to her she told me, “That sounds great, but it also sounds expensive. And since I intend to pay these medical bills, I would appreciate it if you would do the anesthetic as cheaply as possible.”

Folks, this substandard care didn’t need to happen. And it won’t happen again if H.R. 676, single payer, is enacted. Please join us in supporting H.R. 676. Thank you.

Himmelstein and Woolhandler on a public plan option

Posted by on Thursday, Mar 26, 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.

Public Plan Option in a Market of Private Plans

By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.:

The “public plan option” won’t work to fix the health care system for two reasons.

1. It forgoes at least 84 percent of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer — not enough to make reform affordable.

2. A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan — which started as the single payer for seniors and has now become a funding mechanism for HMOs — and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.

The option to purchase a public plan within a market of private health insurance plans would merely provide one more player in our inefficient, dysfunctional, fragmented, multi-payer system of financing health care, that is if the public option even survives the political process. It would leave in place the deficiencies that have resulted in very high costs with the poorest health care value of all nations (i.e., overpriced mediocrity in health care).

Those who believe that the people of this nation would have the wisdom to drop their private plans and join the government program are ignoring history. When Congress authorized private plans to compete with our existing public program, Medicare, many enrollees did just the opposite. One-fifth have left the traditional Medicare program and joined the private plans.

So why should we care? Why shouldn’t they have the right to choose private plans if they want them? We know that those private plans are wasting money, both in their own costs and the administrative burden they place on the delivery system, but what all too many don’t realize is that we are all paying for that waste because of the inherent structural deficiencies in our financing system. Plus we are being deprived of the reforms needed in our health care delivery system that our own single payer monopsony would bring us.

Single payer activists, don’t give up. As President Obama said in his press conference this week, “persistence!”

Culling dependent coverage a great return on investment

Posted by on Wednesday, Mar 25, 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.

Employers getting more strict on health-care eligibility

By Steve Twedt
Pittsburgh Post-Gazette
March 25, 2009

Facing a difficult economy and running short of ways to reduce health-care costs, employers are becoming more aggressive about checking the eligibility of their workers’ dependents.

A Watson Wyatt survey of 489 employers this month for the National Business Group on Health found that audit reviews are the fastest growing change that companies are making to their health-care programs, well ahead of health risk appraisals or improving case management.

During an eligibility audit, employees are asked to document that family members on their health plans are eligible for coverage. They may be required to produce marriage certificates, proof of college enrollment or tax forms. Ex-spouses are not eligible. Nor are sickly uncles who live with the family. Stepchildren may not be eligible either, depending on the plan.

The appeal of eligibility audits is that they almost guarantee hard-dollar savings — with estimates of ineligible dependents typically in the 5 to 12 percent range — and they often can pay for themselves within a year.

“We have completed dependent eligibility audits for over 50 employers and we have yet to have a case where the employer did not receive a return on investment of over 300 percent within one year. Many times it is well over 1,000 percent,” said Michael Browning of Chapman Kelly, Inc., consultants in Jeffersonville, Ind.

Pittsburgh-based Daniel Priga, a principal with Mercer consulting, said the firm “conservatively” estimates a $1,900 savings per year for every ineligible dependent taken off the books. Such a return “is hard to find in today’s environment.”

Doing eligibility audits of dependents covered by employer-sponsored plans is yet one more example wherein our current dysfunctional system of financing health care actually promotes administrative waste. A rational system uses administrative services efficiently to pay for the health care that patients need. In the United States, much of the administrative cost of health care financing is due to efforts to avoid paying for health care.

Only in the United States do we consider that taking health insurance away from individuals to be a “return on investment.”

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