Health Care Reform: Draft Proposal

Posted by Ezra Klein
The Washington Post
June 18, 2009

Senate Finance Committee

Excerpts

Benefit Options – Actuarial value
Bronze = 65%
Silver = 73%
Gold = 81%
Platinum = 90%

Tax credit for individuals and families
Up to 300% federal poverty level (FPL)

Medicaid
Children and pregnant women – up to 133% FPL
Parents and childless adults – up to 100% FPL

Individual requirement – fine for non-compliance
Exempt from fine if lowest premium exceeds 15% of income
Exempt from fine if below 100% poverty

http://www.washingtonpost.com/wp-srv/politics/documents/health_care_reform_draft_proposal_061809.pdf

The Senate Finance Committee members were informed by the Congressional Budget Office that the impact their preliminary reform proposal would have on the federal budget would be much greater than a bipartisan consensus would permit. Before moving further forward with the legislative process, the committee is considering changes to reduce the amount of funds that would have to be budgeted. The draft proposal cited above is not a definitive recommendation but merely presents ideas for discussion.

Nevertheless, the process should alarm us. The committee members continue to steadfastly refuse to look at financing options that would be effective in providing affordable health care for everyone. They begin with the insistence that reform be built on the obsolete infrastructure of private health plans, even though they have just proven once again that this archaic model no longer works.

Look what happens when they try to cram reform into this model. They expect an individual or a family with an income of 300% of the federal poverty level to pay 15% of their income for the premium alone, and for that they receive a plan that covers only 65% of the actuarial value of their health care services. They would require Americans to pay to private insurers a premium that they can’t afford, to purchase an underinsurance product that would fail to prevent financial hardship should they need health care, and to fine them should they fail to comply.

So they say, wait, this isn’t final. Let’s work with these numbers so that we can find products with adequate benefits and affordable premiums that do not further burden our federal budget with excess subsidies. As long as our legislators rely on an infrastructure of private health plans, that game will never end. Those numbers do not exist.

There is a way we can do it. We can establish separately a single, equitably-funded, universal risk pool which would be affordable for everyone. We could then use those funds in a much more efficient, single health care purchasing system that would ensure that everyone receives the care that they need.

But you’ve heard this before. And so have the members of Congress. Yet they continue to craft policies that impair the health care finances and health care access of far too many of us merely to ensure the viability of the obsolete, dysfunctional insurance industry. Talk about perverse priorities!

If you haven’t yet co-signed Sen. Bernie Sanders’ Petition to Congress, please do so now, and ask others to do so as well:

http://sanders.senate.gov/petitions/index.cfm?uid=7fd59f2e-88e1-477a-8eaf-762a5b050809

Judge orders Scrushy to pay $2.8B to shareholders

By The Associated Press
The Washington Post
June 18, 2009

(An Alabama) state judge on Thursday ordered former HealthSouth CEO Richard Scrushy to pay about $2.8 billion to shareholders who sued over accounting fraud at the rehabilitation chain.

Circuit Judge Allwin E. Horn, who heard the case without a jury, ruled in favor of HealthSouth shareholders who filed a civil suit claiming Scrushy was involved in a massive fraud that nearly sent the company into bankruptcy.

The Alabama suit accused Scrushy of unethical dealings with the company while it was going broke and complicity in $2.6 billion in fraudulent earnings and asset reports it filed with regulators from 1996 to 2002. The amount shareholders sought included money they claimed he pocketed through sweetheart deals.

Five former HealthSouth finance chiefs gave testimony implicating Scrushy in a scheme to fraudulently inflate earnings. Scrushy, who hired all five when he ran the company, blamed them and described them as having personal weaknesses.

Scrushy wore a dark business suit in court, but his leg shackles jingled as he arrived for his first day of testimony.

During the lawsuit trial, an attorney for shareholders, John W. Haley, repeatedly confronted Scrushy over what Haley described as obvious conflicts of interest. Among them was HealthSouth’s purchase of 19 acres of land next to Scrushy’s suburban Birmingham estate for $1.9 million, then giving him the land three years later. Scrushy said he got the land instead of a bonus one year.

Haley, sounding incredulous, recounted how Scrushy took an $82 investment in a company that purchased property at a discount from HealthSouth and turned it into a personal profit of some $12 million in four years by leasing the property back to the corporation.

“That’s the way it works in America,” Scrushy said.

http://www.washingtonpost.com/wp-dyn/content/article/2009/06/18/AR2009061801985.html

“A Second Opinion,” by Arnold Relman, M.D.:
http://www.publicaffairsbooks.com/publicaffairsbooks-cgi-bin/display?book=9781586484811

In a landmark 1980 New England Journal of Medicine editorial, former Editor-in-Chief Arnold Relman warned us of the new “Medical-Industrial Complex,” referring to “a medical care system that had begun to attract investors, and in which business interests had started to reshape the behavior of doctors and health care facilities.”

Three decades later, he updated these views in his book, “A Second Opinion.” He writes, “market forces, investors, for-profit corporations, and entrepreneurs are now at the center of the U.S. system, and generation of income is a dominant consideration for most private providers of health care – including those that are not investor owned.” (Not-for-profits must adopt the same perverse behaviors of the for-profits to remain competitive with them.)

With the two great problems to address – 1) the uninsured and underinsured, and 2) skyrocketing health care costs, why should we concern ourselves now with the medical-industrial complex?

First, the medical-industrial complex seeks money, serving those with more money, and shunning those with less money. Theoretically, the private insurance industry would correct this problem by providing the medical-industrial complex with money that many individuals with health care needs simply don’t have. But we’ve all seen how this works. The private insurance industry takes the money from the largest, healthiest sector of our population, and then spends a significant amount of it on administrative services designed to ensure that they can keep as much of that money as possible. The medical-industrial complex has no motivation to try to defeat its money-seeking and money-retaining behavior by increasing the outflow of money to those with health care needs. Thus the problem of the uninsured and underinsured grows worse every year.

Second, the medical-industrial complex, in its drive to fulfill its money-seeking role, does everything that it possibly can to add booster rockets to our skyrocketing health care spending. The culture of the medical-industrial complex provides an economic environment in which the industry thrives, and patients and payers suffer.

Several members of the PNHP leadership have provided decades of well documented, peer review studies confirming that the medical-industrial complex has caused great damage to our health care system, resulting in financial hardship, physical suffering and even death. Although much of our recent advocacy has been around reforming our health care financing system, we have always supported a change from the medical-industrial culture to a culture of a caring health care delivery system that places patients first.

Listening to the national dialogue on reform, you would think that this problem is being ignored. It isn’t. Congressman John Conyers’ HR 676, “United States National Health Care Act or the Expanded and Improved Medicare for All Act,” includes the following language:

“No institution may be a participating provider unless it is a public or not-for-profit institution. Private physicians, private clinics, and private health care providers shall continue to operate as private entities, but are prohibited from being investor owned… For-profit providers of care opting to participate shall be required to convert to not-for-profit status.”

Richard Scrushy, an animal of the medical-industrial complex, now facing a $2.8 billion judgement against him, reminds us of the slogan of the medical industrial complex: “That’s the way it works in America.”

Let’s do all we can to see that it doesn’t work that way anymore.

Sebelius: Single-Payer Health Care Not In Plans

Morning Edition
NPR
June 16, 2009

Interviewer: What’s been the hardest thing for you to explain?

HHS Secretary Kathleen Sebelius: I think that the whole idea of the public option has been difficult, in part because I think some of the opposition has described it as a potential for a draconian scenario that was never part of the discussion in the first place. So disabusing people of what is not going to happen is often difficult because there is no tangible way to do that.

Interviewer: Can you say flat out it’s just never going to be single-payer health insurance, and we’re going to try to write it, if we can, so that it won’t ever be?

Secretary Sebelius: Oh I think that’s very much the case, and, again, if you want anybody to convince people of that, talk to the single-payer proponents who are furious that the single-payer idea is not part of the discussion.

http://www.npr.org/templates/story/story.php?storyId=105442888

The proposal to provide a government-run Medicare-like program as an option for purchase within an insurance exchange of private health plans is vehemently opposed by the insurance industry, the U.S. Chamber of Commerce, the AMA, all Republicans, a large bloc of conservative Democrats, and many others. No amount of negotiation can resuscitate a Medicare-like option. It’s dead.

To avoid losing the support of the progressives and many of the moderates in Congress, efforts are being made to create a new private program that has distinguishing features, primarily cosmetic, that will allow them to mislabel it as a public option. The fear of opponents is that this pseudo-public option could later be transformed into a government-run program. Thus it is imperative that the design of the option would lock it up as a private sector model with no possibility of transformation. Without that assurance, the pseudo-public option will have to be eliminated during markup in order to salvage other reform policies. The opponents will never ever sign on to single-payer-in-waiting.

Those in the progressive community who abandoned single payer to support a public Medicare-like option, believing that this was the politically feasible strategy for success, simply haven’t been paying attention if they still really believe that a government-run public option can survive. They can keep on wishing, but they would be wise to back up their position by signing Sen. Bernie Sanders’ Petition to Congress:

http://sanders.senate.gov/petitions/index.cfm?uid=7fd59f2e-88e1-477a-8eaf-762a5b050809

Letter to Sen. Edward Kennedy, Chairman, Committee on Health, Education, Labor, and Pensions

From CBO Director Douglas Elmendorf
Congressional Budget Office
June 15, 2009

The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) have completed a preliminary analysis of the major provisions related to health insurance coverage that are contained in title I of draft legislation called the Affordable Health Choices Act, which was released by the Senate Committee on Health, Education, Labor, and Pensions (HELP) on June 9, 2009. Among other things, that draft legislation would establish insurance exchanges (called “gateways”) through which individuals and families could purchase coverage and would provide federal subsidies to substantially reduce the cost of that coverage for some enrollees.

Effects on Insurance Coverage.

According to the preliminary analysis, once the proposal was fully implemented, the number of people who are uninsured would decline to about 36 million or 37 million, representing about 13 percent of the nonelderly population.

Budgetary Impact of Insurance Coverage Provisions.

On a preliminary basis, CBO and the JCT staff estimate that the major provisions in title I of the Affordable Health Choices Act affecting health insurance coverage would result in a net increase in federal deficits of about $1.0 trillion for fiscal years 2010 through 2019. That estimate primarily reflects the subsidies that would be provided to purchase coverage through the new insurance exchanges, which would amount to nearly $1.3 trillion in that period.

Those costs would be partly offset by receipts or savings from three sources: increases in tax revenues stemming from the decline in employment-based coverage; payments of penalties by uninsured individuals; and reductions in outlays for Medicaid and CHIP (relative to current-law projections).

It is important to note, however, that those figures do not represent a formal or complete cost estimate for the draft legislation, for reasons outlined (in the letter). Moreover, because expanded eligibility for the Medicaid program may be added at a later date, those figures are not likely to represent the impact that more comprehensive proposals — which might include a significant expansion of Medicaid or other options for subsidizing coverage for those with income below 150 percent of the federal poverty level — would have both on the federal budget and on the extent of insurance coverage.

http://www.cbo.gov/ftpdocs/103xx/doc10310/06-15-HealthChoicesAct.pdf

Since the Affordable Health Choices Act and the CBO analysis of it are works in progress, the estimates of the net numbers who will gain insurance coverage and the net cost to the government are only preliminary and will likely change with refinements in the legislation and the analysis. What will not change are the fundamental implications of financing health care through government subsidized private health plans plus public programs.

The primary reform goals that most of us support include providing health insurance for everyone that is effective in preventing financial hardship, and controlling the rate of increase in our health care costs. What does the CBO response tell us about the potential of this legislation to meet these two goals?

Regarding the impact on our national health expenditures (NHE), the analysis tells us almost nothing. As with most reports of this nature, they looked primarily at government spending rather than total health care spending. Individuals, employers and the government are all concerned about health care costs. Tax and budget policies that satisfy fiscally conservative legislators by effectively capping government spending while shifting cost increases to individuals and employers do not help us, as a nation, to meet the challenges of run-away health care costs that are harming so many of us. Looking at government spending while ignoring private spending is of little value to us when we are trying to figure out how we are going to pay for health care.

CBO needs to provide us with an estimate of changes in our NHE since we are all paying that. Providing us, in addition, with estimates of government spending can be helpful in establishing tax policies that would help bring equity to health care financing. But let’s have transparency on our full health care spending, public and private.

Regarding the impact on the numbers who will become insured, analyses such as this can provide a ballpark figure. The fact that the policies outlined in the current draft of the legislation would leave 37 million people without coverage likely has Senate HELP Committee members scurrying to patch the holes in the legislation and to look for other refinements that would expand coverage to more individuals.

There is an inverse relationship between government subsidies and the numbers of individuals who are left uninsured. Increasing the number of individuals eligible for the subsidies and increasing the amounts of the subsidies reduce the numbers of individuals left out, but that number will never be zero. A policy of using government subsidies to purchase private plans will always fall short of universality. The only way to cover absolutely everyone is to make enrollment automatic, and to separate the financing by changing from premiums linked to individual plans to a global system financed through equitable tax policies.

Looking only at the numbers of individuals left without insurance skirts another crucial issue. The rate of underinsurance is exploding. Offering multiple tiers of different priced plans in an insurance exchange automatically results in an expansion of underinsurance. Even with subsidies, healthy individuals will select inadequate plans with the lowest premiums, sincerely believing that this is all they can afford. But what good is insurance if you can still be left bankrupt with medical bills?

This proposal leaves too many without health insurance, fails to control our escalating health care costs, and expands the market of underinsurance products. The staff members at CBO, JCT, the HELP Committee, the Finance Committee, and the House Committees will get busy introducing policy refinements for the legislative proposals. Then they will finally bring us a product that leaves too many without health insurance, fails to control our escalating health care costs, and expands the market of underinsurance products.

Paying for Health Care Reform

The White House
June 13, 2009

Health Care Reserve Fund ($ in billions – over 10 years)

$635 – FY 2010 Budget
$309 – Medicare and Medicaid Savings
$326 – Revenues

$313 – Additional Medicare and Medicaid Savings
$110 – Incorporate productivity adjustments into Medicare payment
$106 – Reduce hospital subsidies for treating the uninsured as coverage increases
$75 – Pay better prices for Medicare Part D drugs
$22 – Other

Total: $948

http://www.whitehouse.gov/MedicareFactSheetFinal/

What does President Obama mean when he says that this is how we’re going to pay for most of his health care reform proposals? Is he referring to savings in the actual costs of health care that would offset the increased spending that would result from expanding coverage? Or is he merely referring to a decrease in government spending that helps with government budgets, but doesn’t really have much impact on our total national health expenditures (NHE)?

Two-thirds of the proposed funding already appears in his FY 2010 budget. He would reduce overpayments to Medicare Advantage plans, reduce Medicare and Medicaid fraud (sure), reduce hospital readmissions (block the entrances?), and reduce Medicare hospital payments by measuring quality (hmmm). In this fact sheet, the only revenue increase mentioned is limiting the value of itemized deductions for families making over a quarter-million dollars a year, a proposal that has proven to be quite controversial.

The new proposals in this fact sheet include a reduction in spending based on improved productivity, extrapolating the improved productivity in the entire U.S. economy and applying it to health care (not exactly noted for assembly lines, displacing health care with information technology systems, etc.). It includes a reduction in payments to Disproportionate Share Hospitals (excess share of uninsured) which would be made possible by providing insurance to those currently uninsured. This is more of an accounting gimmick since it merely moves government spending from the hospitals to the insurance plans. Also proposed is a reduction in drug reimbursement for beneficiaries dually eligible for Medicare and Medicaid, a minute fraction of what could be saved by negotiating fair prices for all of us under a universal national health program.

Merely playing with numbers does not provide us with the comprehensive structural reform that we would need to accomplish our two primary goals: 1) health care for everyone, and 2) slowing health care cost escalation to sustainable levels. As long as the politicians can continue to distract us with cat fights over the public option, or whatever, we will never have what we really need: a new and improved Medicare for all.

The following remarks were presented to the Congressional Progressive Caucus on June 4.

By Nick Skala

Today the Congressional Progressive Caucus faces a choice. That choice is whether Members should maintain their unflinching support for single-payer, or to accede to intense political pressure to support the plan currently being developed in Congress under the direction of President Obama: a mandate for Americans to purchase an insurance plan from a massive new regulatory “exchange,” with one plan potentially being a “public option.”

The difference between these choices could not be more stark: single-payer has at its core the elimination of U.S.-style private insurance, using huge administrative savings and inherent cost control mechanisms to provide comprehensive, sustainable universal coverage.

The “public option” preserves all of the systemic defects inherent in reliance on a patchwork of private insurance companies to finance health care, a system which has been a miserable failure both in providing health coverage and controlling costs.

Elimination of U.S.-style private insurance has been a prerequisite to the achievement of universal health care in every other industrialized country in the world. In contrast, public program expansions coupled with mandates have failed everywhere they’ve been tried, both domestically and internationally.

Many progressives accept that the “public option” is inferior to a single-payer system, yet support it because of its perceived political expedience. It is my aim today to convince you that the “public option” program currently being developed is not only bad health policy, but bad health politics.

On two separate occasions last month, physicians and nurses were dragged from the Senate Finance Committee in handcuffs for demanding that single-payer be considered in our nation’s health reform debate. These were American doctors and nurses, people who care for patients, people who want to practice medicine, not protest and disrupt Congress.

But these professionals risked their careers and their freedom. They did this not because they thought that the “public option” was “good” and single-payer “better.” They did it because they are firmly convinced, by well-established health policy science, that the so-called “public option” has no hope of remedying the systemic defects that cause their patients to suffer and die, sometimes before their very eyes.

Millions of dollars have been spent by political advocacy groups to commission polls and statistics “proving” that their health reform is “politically feasible.” Yet political winds do not make good health policy. Careful examination of science and experience do. And it is in the science and experience that we see that single-payer offers the only way to truly comprehensive, universal and sustainable health care, and that “public option” schemes offer only more of the same: tens of millions of uninsured, rapidly deteriorating coverage, an epidemic of medical bankruptcy, and skyrocketing costs that will eventually cripple the system.

First, because the “public option” is built around the retention of private insurance companies, it is unable – in contrast to single-payer – to recapture the $400 billion in administrative waste that private insurers currently generate in their drive to fight claims, issue denials and screen out the sick. A single-payer system would redirect these huge savings back into the system, requiring no net increase in health spending.

In contrast, the “public option” will require huge new sources of revenue, currently estimated at around $1 trillion over the next decade. Rather than cutting this bloat, the public option adds yet another layer of useless and complicated bureaucracy in the form of an “exchange,” which serves no useful function other than to police and broker private insurance companies.

Second, because the “public option” fails to contain the cost control mechanism inherent in single-payer, such as global budgeting, bulk purchasing and planned capital expenditures, any gains in coverage will quickly be erased as costs skyrocket and government is forced to choose between raising revenue and cutting benefits.

Third, because of this inability to control costs or realize administrative savings, the coverage and benefits that can be offered will be of the same type currently offered by private carriers, which cause millions of insured Americans to go without needed care due to costs and have led to an epidemic of medical bankruptcies.

Supporters of incremental reform once again promise us universal coverage without structural reform, but we’ve heard this promise dozens of times before.

Virtually all of the reforms being floated by President Obama and other centrist Democrats have been tried, and have failed repeatedly. Plans that combined mandates to purchase coverage with Medicaid expansions fell apart in Massachusetts (1988), Oregon (1992), and Washington state (1993); the latest iteration (Massachusetts, 2006) is already stumbling, with uninsurance again rising and costs soaring. Tennessee’s experiment with a massive Medicaid expansion and a public plan option worked – for one year, until rising costs sank it.

The Federal Employee Health Benefit Program (the model for a health insurance exchange) leaves hundreds of thousands of federal workers uninsured, and has proven unable to contain costs.

Negative results in a recent series of randomized trials explodes the hope that chronic disease management will cut costs. And the CBO has thrown a wet blanket on the notion that electronic medical records save money.

As Drs. David Himmelstein and Steffie Woolhandler, co-founders of Physicians for a National Health Program, have remarked, 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. 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 a single-payer system for seniors and have now become a funding mechanism for HMOs – and a place to dump the unprofitably ill.

Progressive supporters of the “public option” readily concede that single-payer is a superior system. Indeed, their response to evidence that their plan won’t work is to commission more charts and graphs emphasizing its political feasibility.

The “public option” is truly the embodiment of health policy designed by sound bytes, cobbled together from snippets of information gathered from focus groups and public opinion polls, and centered around well-polling buzzwords such as “choice” and “shared responsibility.”

Such a plan may be enough to excite the political classes in Washington, who care more about what they think can pass the Congress than what will actually deliver universal, comprehensive health care for all. But doctors and nurses, the people who actually work in the health system, see right through it. They are going to jail because they know that this plan won’t work for their patients.

Nobody is going to jail for the “public option,” because the American people cannot be inspired by band-aids and half-measures it is impossible to believe in.

These doctors and nurses are the manifestation of a social movement, millions strong, that is waiting to be mobilized by the leadership of the Members in this room. Polls consistently show that two-thirds of the American people want single-payer. At a recent hearing in Montana convened by Sen. Max Baucus, only 10 people of three hundred said they were happy with the insurance they have. Sixty percent of physicians support single-payer, as do the U.S. Conference of Mayors and 39 state labor federations and hundreds of local unions across the country.

We’re told that holding out for single-payer is politically unwise, but to compromise and accept a bad plan at precisely the time when popular support and grassroots energy are on the side of true reform is the real political miscalculation.

The history of great social achievement is rife with instances in which the forces of institutionalized power told social movements – as they now tell this one – that what they wanted was too much, or too fast, or too soon. I think, of course, of the abolition of human slavery, the enfranchisement of women, the Civil Rights Movement, Social Security, the minimum wage, an end to child labor. In each of these instances, social movements held fast to their principles and soon discovered that they had been told was “politically unfeasible” one moment was political reality the next.

We currently have a better chance to pass single-payer than Lyndon Johnson had when he passed Medicare. Unlike the public option, single-payer – because it holds the potential to finally realize universal, equitable health care – can be a vehicle to inspire the American people for progressive change.

The voices of doctors and nurses can achieve extraordinary resonance when they speak selflessly in their patients’ interest. But your leadership is crucial to inspire the American people. It is my hope that you’ll see fit to provide it.

Click here for a printable version of the handout below.

The “Public Option” Fails as Health Politics:

But Getting “Something” is Better than Getting “Nothing,” Isn’t It?

Not if that “something” makes it more difficult to reach a real solution and ensures temporary relief will be followed by prolonged suffering. The “public option” may allow some people to buy inadequate insurance products for a short time. But such a system will quickly be crushed by the weight of rising health care costs, as Medicaid, SCHIP and dozens of state initiatives have been.

In addition, expending political capital on reforms that we know will fail makes the public cynical and gives ammunition to those who say that the government cannot create effective programs. Hence, any attempt at real reform is delayed, usually by decades. The minor temporal relief that reformers might get by acquiescing to insurance industry demands is simply not worth the continued suffering of the American people.

But Such a System to Could be a “Step” Towards Universal Coverage, Right?

No. Enacting phony “universal coverage” has not brought any state closer to a single-payer system. Since the early 1990s, Minnesota, Oregon, Maine, Florida, Utah, Washington, California, Vermont and Massachusetts have been among the states that have attempted to “patch-up” their fundamentally fl awed systems while retaining a place for insurance companies. All have failed. Upon passage, incremental reforms in each of these states were hailed by politicians and the media as a “step toward universal coverage.” Yet despite all the claims of pragmatism, incremental reformers have been unable to shepherd through meaningful change in nearly four decades of trying. And while reformers in these states continue to wait for the next “step,” residents continue to suffer.

The definition of insanity is to repeat an action expecting a different result. This is exactly what we have done in continuing to advocate incremental reforms as “steps” toward single-payer. What Americans need is not more proposals for patchwork reforms. We need leaders willing to stand up for the only solution that will work.

Nick Skala is a member of Physicians for a National Health Program (www.pnhp.org).

Keynote: “Health Care Reform – What Has to Be Done”

By Don McCanne, M.D.
Health Care Council of Orange County
June 11, 2009
Annual Meeting

Opening questions directed to the audience:

How many here believe that it is probable – not certain, but probable – that Congress will pass health care reform and President Obama will sign it this year?

(Most individuals raised a hand)

How many believe that the legislation will provide insurance coverage to everyone or almost everyone?

(Not one hand went up)

How many believe that the legislation will be effective in slowing the rate of health care cost increases?

(Not one hand went up)

http://www.healthoc.com/

The Health Care Council of Orange County (California) has a mission of promoting access to improved health care for all Orange County residents through unified efforts to identify and address areas of need through research, collaboration, education and advocacy. The audience attending the annual meeting was composed of individuals who are quite well informed on the problems with our health care system, and they have been following the reform efforts taking place in Washington. Their opinions should matter to us.

For over half a century, the United States has struggled with a flawed health care financing system that leaves financial barriers in place for far too many of us. Most of the nation now agrees that something must be done to ensure that everyone has access to health care without having to face financial hardship or even bankruptcy.

But the goal of covering everyone has not been what has created the strong sense that health care is now facing a crisis. The concern that virtually everyone shares is that health care costs are no longer affordable. Too many individuals are no longer able to pay their insurance premiums, nor pay the out-of-pocket expenses not covered by insurance. Many businesses are no longer able to afford the costs of their employee health benefit programs. The federal and state governments are struggling with budget constraints aggravated by the high costs of public health programs.

Everyone agrees that it is critical that we do something now to slow the rate of increases in health care costs. While addressing costs, most of us also agree that we must bring everyone in under the umbrella of financial security when facing health care needs. Since neglect of these issues has created the crisis we face, you would think that Congress and the administration would be busy attempting to fix these problems.

Congress is busy all right. But no one at the Health Care Council has been fooled. We are going to end up with legislation that will be labeled “health reform,” but the twin crises of rising costs and inadequate insurance will still be with us. Congress and the President will walk away, pretending that they did something, and it will take years or decades of more suffering and hardship before our leaders revisit the problems and finally do the right thing.

Sheer madness!

Doctors’ Group Opposes Public Insurance Plan

By Robert Pear
The New York Times
June 10, 2009

As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan, which President Obama and many other Democrats see as an essential element of legislation to remake the health care system.

… in comments submitted to the Senate Finance Committee, the American Medical Association said: “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”

The A.M.A., an umbrella group for 180 medical societies, does not speak for all doctors. One group, Physicians for a National Health Program, supports a single-payer system of insurance, in which a single public agency would pay for health services, but most care would still be delivered by private doctors and hospitals.

http://www.nytimes.com/2009/06/11/us/politics/11health.html?hp

In opposing a government-sponsored insurance plan, why would the AMA limit its objection to a public plan that would cover only non-disabled individuals under age 65? What about those over 65 and those with long-term disabilities? Of course, they are covered by Medicare, a plan that the AMA continues to lobby for, even though they were vehemently opposed to it before it was enacted.

We can only speculate as to why the AMA leadership would object to including everyone in an improved version of our very successful Medicare program. Some believe that the AMA House of Delegates is still dominated by right-wing reactionaries, as it was during the Medicare battles. A more likely explanation is that physicians, who are uniformly unhappy with both private and public insurance programs, may perceive a greater opportunity to bypass the third-party payers in the market of private sector plans that use high-deductibles, health savings accounts, and other payment innovations that would allow physicians to capture a greater portion of their often-unrealistic list fees.

Fortunately, many physicians believe that patients, all patients, are more important than wealth-creating opportunities. That’s what Physicians for a National Health Program is all about.

Examining the Single Payer Health Care Option

Health, Employment, Labor, and Pensions Subcommittee Hearing
U.S. House of Representatives
June 10, 2009

Marcia Angell, M.D.:

I want to mention one final and very important reason for enacting a nonprofit single-payer health program. We live in a country that tolerates enormous and growing disparities in income, material possessions, and social privilege. That may be an inevitable consequence of a free market economy. But those disparities should not extend to denying some of our citizens certain essential services because of their income or social status.

One of those services is health care. Others are education, clean water and air, equal justice, and protection from crime, all of which we already acknowledge are public responsibilities. We need to acknowledge the same thing for health care. Providing these essential services to all Americans, regardless of who they are, marks a decent and cohesive society. It says that when it comes to vital needs, we are one nation, not 300 million individuals competing with one another.

***

Walter Tsou, M.D., M.P.H.:

President Obama has stated that if he were to start over again he would favor a single-payer system, but argues that moving to single-payer is too radical.

Well, I come from Philadelphia where revolutionary ideas are celebrated not dismissed. Our most famous radical document begins with the words, “We the People”. Not “We the Insurers”. “We the People of the United States, in order to form a more perfect union . . . to promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity do ordain and establish this Constitution for the United States of America.” This nation captured the world’s imagination with bold ideas that put the people first. It is time for our own generation’s revolution.

***

David Gratzer, M.D.:

Critics of the American system note that it fails to provide universal coverage to its citizens. But Canada’s single-payer system also denies care; instead of denying insurance coverage, Canada’s public insurance plans simply limit the supply of costly medications and capital-intensive procedures.

These challenges appear in different forms across the single-payer world. Wait times, rationed care and inefficient public management is inevitable in single-payer systems because they all face the same health-care demands as the American system.

***

During the questioning by committee members:

Rep. Dennis Kucinich: Dr. Gratzer, you’ve tried to make the case for rationing in Canada – worse than it is in the U.S. Do you know what Statistics Canada – the analogue to the U.S. Census – says the median wait time is across Canada for elective surgery?

Dr. David Gratzer: Why don’t you inform us,sir?

Kucinich: It’s four weeks. And what does Statistics Canada say the median wait time for diagnostic imaging like MRIs is?

Gratzer: I could tell you the Ontario government recently looked at that for…

Kucinich: It’s three weeks.

Gratzer: … for cancers, was six months.

Kucinich: It’s three weeks. How many uninsured are there in Canada?

Gratzer: Probably relatively few.

Kucinich: That’s right, none or very few. How many medical bankruptcies are there in Canada?

Gratzer: Depends on how you define medical bank..

Kucinich: None or very few. How many insured Americans go without needed care due to high cost of health care which is due to health insurance companies?

Gratzer: (Pause) Am I allowed to answer, or are we just going to continue to…

Kucinich: If you have an answer, you can answer. But if you don’t, I’ll answer. What’s your answer?

Gratzer: Go for it, sir.

Kucinich: What’s your answer?

Gratzer: Why don’t you answer your question, sir?

Kucinich: What’s your answer?

Gratzer: My answer…

Kucinich: How many insured Americans go without needed care due to the high cost of health care which is due to health insurance companies?

Gratzer: (Silence)

Kucinich: The witness isn’t responding.

Gratzer: The witness is delighted to speak further on those statistics and other statistics, but you keep cutting me off, sir.

Kucinich: You respond, if you have an answer. You didn’t give an answer to the other one.

Gratzer: I don’t want to be led down a garden path. If you’d like to ask me a question, I’d be…

Kucinich: You’ve shown a garden here to members of this committee and to the audience. There’s another side to this picture you don’t seem to be aware of even though you want to be an expert on Canada. Can you provide us with an answer on this one about America?

Gratzer: My position is respectable, and I dislike your comment, sir.

Kucinich: Do you have an answer? How many insured Americans, insured, go without needed care due to high costs of health care due to health insurance companies?

Gratzer: (Silence)

Kucinich: He has no answer. Well what the answer is is that it’s one out of every four. So we’re trying to make a case here that somehow Canada is in a mess, but we’re not focusing on the fact that in the United States there are people who aren’t getting needed care, and this gentleman has expected us to believe that rationing is worse in Canada. I don’t know how we can buy that. Now if single payer is so bad, maybe the gentleman – the doctor – can explain to us why sixty percent of U.S. doctors want it according to the peer-reviewed Annals of Internal Medicine, April, 2008.

(off camera voice): Are you going to let him answer this one?

Kucinich: He can answer it, if he can answer it.

Gratzer: I would suggest that many physicians in the United States are unsatisfied with their system, and rightly so. I would suggest that many physicians are looking for reform, and rightly so. But I would suggest that many physicians are unaware of what really goes on single payer systems, perhaps illustrated well by some of the comments that you’ve already made…

http://edlabor.house.gov/hearings/2009/06/examining-the-single-payer-hea.shtml

Although there are many individual heroes in the single payer movement, joint citizen activism has played a crucial role in bringing the single payer message to a formal, official hearing before a committee of the House of Representatives – a hearing devoted exclusively to single payer.

Tomorrow, Sen. Kennedy’s Health, Education, Labor, and Pensions committee will hold a hearing on “Healthcare Reform.” At the top of the list of the twenty-four witnesses is one of our heroes, PNHP’s Margaret Flowers, M.D., who previously had asked Sen. Baucus to bring single payer to the table, shortly before her arrest.

There are many effective channels for citizen activism. In whatever form you choose, let’s have a whole lot more of it please.

Kaiser Health Tracking Poll

Kaiser Family Foundation
April 2-8, 2009

7. Now I’m going to read you some different ways to increase the number of Americans covered by health insurance. As I read each one, please tell me whether you would favor it or oppose it. Here’s the (first/next) one — (INSERT AND RANDOMIZE- ALWAYS ASK ITEMS d AND h LAST). Do you favor or oppose this? (Is that strongly favor/oppose or somewhat favor/oppose?)

Items b-d based on half sample (n=616)
Items e-h based on half sample (n=587)

a. Requiring employers to offer health insurance to their workers or pay money into a government fund that will pay to cover those without insurance
71% favor
25% oppose

b. Offering tax credits to help people buy private health insurance
67% favor
29% oppose

c. Expanding Medicare to cover people between the ages of 55 and 64 who do not have health
insurance
79% favor
18% oppose

d. Creating a government-administered public health insurance option similar to Medicare to compete with private health insurance plans
67% favor
29% oppose

e. Expanding state government programs for low-income people, such as Medicaid and the State Children’s Health Insurance Program
77% favor
20% oppose

f. Requiring all Americans to have health insurance, either from their employer or from another source, with financial help for those who can’t afford it
72% favor
25% oppose

g. Having a national health plan in which all Americans would get their insurance from a single government plan
49% favor
47% oppose

h. Creating a public health insurance option similar to Medicare to compete with private health insurance plans
67% favor
29% oppose

http://www.kff.org/kaiserpolls/upload/7892.pdf

Two-thirds to three-fourths of Americans support each of the reform options listed, except one. Americans are fairly evenly divided on “Having a national health plan in which all Americans would get their insurance from a single government plan.”

This is not a fluke. When the same survey was conducted in December, 2008 (minus the questions on public health insurance options), the results were very similar.

We could speculate as to why this poll seems to indicate less support for a single payer national health program than do other polls. Factors such as phrasing, context, demographics of the population polled, and so forth could explain the variation in the responses. If so, that would suggest that single payer support is quite malleable. That would mean that the threshold of a mandate for single payer reform has not yet been reached.

My opinion, which some may dispute, is that healthy Americans, who have good jobs and what they perceive to be adequate, employer-financed health care coverage, are not yet ready to trade that insurance in for an unknown government program which they assume they would have to pay for themselves, either through a premium or through higher taxes.

Pretending that the majority of Americans would risk their current health security for a more egalitarian system for everyone will not move the process for reform forward. Only when people understand that a single payer system would benefit them individually would they be willing to support reform that incidentally benefits everyone else as well.

We still have work to do.