Health Care Takes a Hit in New Commission Plan

By Drew Altman
The Fiscal Times
November 12, 2010

Three national commissions are hammering out recommendations for reducing the debt and reining in entitlement spending, putting two giant health programs that serve the elderly, disabled and low-income Americans, Medicaid and Medicare, as well as Social Security, in the crosshairs of a new policy debate.

The discussion of these issues is framed almost always in terms of “hard choices” to reduce spending, increase taxes, or both. In general, Democrats will resist cuts in these programs and Republicans will resist any new taxes.

But these choices are also hard on legitimate policy grounds, especially when it comes to Medicare.  And the most important reason they are hard is that so many seniors and disabled people on Medicare have low incomes and already pay a significant share of those incomes for their health care today.  It will be difficult if not impossible to ask the majority of beneficiaries ––to pay more or make do with less.  That has been the missing element in the entitlement/deficit reduction debate: Warren Buffet is not the typical Medicare beneficiary.  Instead the prototype is an older woman with multiple chronic illnesses living on an income of less than $25,000 who spends more than 15 percent of her income on health care.  It is the people on these programs and the realities of their lives that have been left out of the discussion.

http://www.thefiscaltimes.com/Issues/Health-Care/2010/11/12/Health-Care-Takes-a-Hit-in-New-Commission-Plan.aspx

Medicare is already an inadequate program for our seniors and for individuals with long term disabilities. The commissioners are making an egregious mistake in framing the problem as a budget deficit that needs “hard choices” to reduce federal spending by shifting more costs to Medicare beneficiaries.

Medicare does need to be improved, not by cutting benefits, but rather by expanding benefits and by eliminating financial barriers to care. Then Medicare would be a much more suitable program, not only for current beneficiaries, but for everyone else as well.

It is true that the federal budget spending would increase, but the federal budget deficit would be reduced by financing Medicare through equitable taxes, and wasn’t this supposed to be all about reducing the federal budget deficit in the first place? Further, our entire national health expenditures, public and private, finally would be brought under control. As both patients and taxpayers, we couldn’t ask for a better deal.

By Ida Hellander, M.D.

There’s actually some good news for single-payer health reform in the midst of the generally negative midterm election news.

The good news:

* Peter Shumlin won in Vermont, so the state has a pro-single-payer governor on top of a large grassroots movement. Sen. Patrick Leahy was re-elected to office and is pro-single-payer; the same holds for Rep. Peter Welch, a co-sponsor of Rep. Conyers’ single-payer bill in Congress, H.R. 676. Sen. Bernie Sanders, of course, is a very outspoken supporter of single-payer Medicare for all.

* Jerry Brown won in California so that state also has a pro-single payer governor and a large movement (twice passing a single-payer bill through the state’s Legislature).

* Neil Abercrombie, who was a co-sponsor of H.R. 676 while he was in Congress, was elected governor of Hawaii. Many of Hawaii’s lawmakers have shown support for single payer.

* With 14 of 14 districts reporting, the ballot question for single payer in Massachusetts swept all of them, including some of the most conservative districts in the state and several that went for Republican Sen. Scott Brown in last year’s special election. The text of the ballot question reads as follows:

“Shall the representative from this district be instructed to support legislation that would establish health care as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?”

* Only one of 87 co-sponsors of H.R. 676 was defeated in the general election by a Republican, Rep. Phil Hare of Illinois. (We lost seven other co-sponsors to death, resignation, defeat in the primary or retirement. Just one of those, Rep. Eric Massa’s old seat, went to a Republican.)

The bad news (a partial list):

* Sen. Russ Feingold, who ran on his support for the Obama health plan but is also a single-payer supporter, lost his Senate race in Wisconsin to a Republican.

* “Freedom of choice” and anti-mandate ballot initiatives passed in Arizona and Oklahoma (but was rejected in Colorado). An excellent article explains how these initiatives are anti-single payer measures.

* The Minnesota single-payer movement was set back by a Republican takeover of the state Legislature. The governor’s race, which includes a pro-single-payer candidate, is still too close to call and is undergoing a recount.

* Rick Scott of Columbia/HCA fame, which paid a $1 billion fine for Medicare fraud, won the governor’s race in Florida.

Is the Deficit Commission Serious?

By Kevin Drum
Mother Jones
November 10, 2010

So this report matters (the “chairman’s mark” of the deficit commission report), even though it’s really nothing more than the opinion of Alan Simpson and Erskine Bowles. So here’s what I think of it, all contained in one handy chart from the Congressional Budget Office:

(If the chart is not transmitted by this email, it can be accessed at the link below.)

Here’s what the chart means:

*  Discretionary spending (the light blue bottom chunk) isn’t a long-term deficit problem. It takes up about 10% of GDP forever. What’s more, pretending that it can be capped is just game playing: anything one Congress can do, another can undo. So if you want to recommend a few discretionary cuts, that’s fine. Beyond that, though, the discretionary budget should be left to Congress since it can be cut or expanded easily via the ordinary political process. That’s why it’s called “discretionary.”

*  Social Security (the dark blue middle chunk) isn’t a long-term deficit problem. It goes up very slightly between now and 2030 and then flattens out forever. If Republicans were willing to get serious and knock off their puerile anti-tax jihad, it could be fixed easily with a combination of tiny tax increases and tiny benefit cuts phased in over 20 years that the public would barely notice. It deserves about a week of deliberation.

*  Medicare, and healthcare in general, is a huge problem. It is, in fact, our only real long-term spending problem.

To put this more succinctly: any serious long-term deficit plan will spend about 1% of its time on the discretionary budget, 1% on Social Security, and 98% on healthcare. Any proposal that doesn’t maintain approximately that ratio shouldn’t be considered serious. The Simpson-Bowles plan, conversely, goes into loving detail about cuts to the discretionary budget and Social Security but turns suddenly vague and cramped when it gets to Medicare. That’s not serious.

There are other reasons the Simpson-Bowles plan isn’t serious. Capping revenue at 21% of GDP, for example. The plain fact is that over the next few decades Social Security will need a little more money and healthcare will need a lot more. That will be true even if we implement the greatest healthcare cost containment plan in the world. Pretending that we can nonetheless cap revenues at 2000 levels isn’t serious.

And their tax proposal? As part of a deficit reduction plan they want to cut taxes on the rich and make the federal tax system more regressive? That’s not serious either.

Bottom line: this document isn’t really aimed at deficit reduction. It’s aimed at keeping government small. There’s nothing wrong with that if you’re a conservative think tank and that’s what you’re dedicated to selling. But it should be called by its right name. This document is a paean to cutting the federal government, not cutting the federal deficit.

http://motherjones.com/kevin-drum/2010/11/deficit-commission-serious

After reading Kevin Drum’s explanation of the federal deficit, it becomes even more obvious that all we have to do is improve Medicare, provide it for everyone, and then use its power as a monopsony serving the public good to bring the growth of health care costs to a manageable level. Compared to this, the other budget issues are a piece of cake.


by Andy Coates

Peter Shumlin was elected Governor of Vermont on his plans to close down Entergy’s aging, unsafe Vermont Yankee Nuclear Power Plant, to transition to green energy and to increase passenger rail, to reduce prison spending, his strong pro-choice stance, and, of course, single-payer healthcare for every Vermonter.

PNHP has already posted the VPR news story that excerpts an interview by Bob Kinzel. But you can also listen to the full interview with Governor-elect Shumlin.

Here is my own transcript. At about 10 minutes into the interview the Governor-elect talks about health spending briefly:

Big picture. I have a dual task. The first is to manage this 112, 115 million dollar hole. But the second is simultaneously, in managing this budget, we’ve got to start managing the infrastructure. We’ve got to put the pieces in place that I believe will do two things. The first is grow jobs and grow economic opportunities that I’m incredibly optimistic about for Vermont. And the second is, at the same time, we wil be solving our own budget problems.

Now, where is the money? We know that the first and the fastest area of growth in the state budget is health care. It’s killing us just like it’s killing Vermont’s families and small businesses. So we need to be putting the infrastructure changes in place, putting a team together that’s going to work with Dr. Hsaio and others to come with a plan, to pass a single payer health care plan that can contain costs and save Vermont from ourselves as we spend a million dollars more a day than we spent the day before.

And then a second area that I’ve talked so much about is corrections. It’s the second area of growth in the state budget. It is not sustainable…

At 33 minutes the Governor-elect returns to single payer:

Welcome back to Vermont Edition. I’m Bob Kinzel. Our guest today is Governor-elect Peter Shumlin. Our phone number is [...] Governor-elect I see you’re going to the White House in early December as part of a contingent of new governors meeting with the President. So do I understand that you may use this as an opportunity to try to pitch the idea that Vermont needs some “waivers” from the federal government, particularly in the area of health care?

Yes. I had the privilege of talking to the President of the United States earlier today. He called me from Air Force One. A lot of bizarre things have happened to me in the last five days, but that’s one of them. You pick up the phone and there’s the President at the other end of the line. It was a real honor.

But I mentioned two things to him. That I was looking for three waivers. And then I also said there’s a famous photograph of our current Governor, Jim Douglas, moving a couch down at the White House. I just told him that I was a little bit younger than Jim Douglas, nothing personal, but if he had any furniture to move, I’d come right down, just let me know when they needed things moved around down there.

But the answer is yes. We’re looking forward to working with the President and the Congressional delegation to get three waivers that I really want.

Looking at the health care one, supposedly it’s going to be at least until 2014 before any state can get a waiver. Who knows what’s going to happen to that health care law in the next two years, with Republican gains in Congress. Do you really think you can move it up from 2014 to 2012?

You know Bob this was tough to say during the campaign because it’s often hard to change the dialogue during the campaign: The “waivers” is the easy part.

The hard part is designing a single payer health care system that works and that delivers quality health care, gets insurers off our, our providers backs, has a reimbursement system that makes sense. You know we’re losing our primary care doctors. We’re going to lose our hospitals if we keep up this crazy system where they get paid 40 cents for one customer, 60 cents for another. They’re awash in a sea of paper and bureaucracy. They have insurers second-guessing them on everything that they do. The list goes on and on. So the challenge for us is not the waivers. I get that the waivers are a small challenge.

The bigger challenge is to say, to sit down with the plans that we’re going to be given. To bring together the health care community, the business community, families, consumers, providers, insurers, and design the system that does three things. Delivers quality health care to all Vermonters where health care is a right and not a privilege. Second, is affordable. The current system is going to drown us. It will bankrupt us. We can’t spend a million dollars more a day than we did the day before. Third, provide outcomes-based medicine, so that providers are reimbursed for keeping us healthy, not the number of tests they drive us through or put us through. And finally fourth, and perhaps most important, using technology to deliver health care the way all other businesses have utilized technology to deliver a product that allows them to be profitable.

If you designed the current system in Vermont from scratch and brought it in and said “we want a health care system and here it is,” people would think that you had lost your mind. It’s easy to criticize the existing system. It’s much harder to design a new one. That is a much bigger challenge than getting the waivers we need from Washington.

I believe if we design that system we can sell it. And I’m going to start working on that immediately, bringing people together to start the hard work to get it done. If we succeed, and if we also can design a system where health care is not a requirement of the employer, as well as the individual — it’s a huge job creator. It’s a huge national example of how to do health care right.

I think we have a real opportunity here. You know I was criticized during the campaign on this for making promises on this that I can’t keep. This is not a promise. It’s a commitment to a plan and we’re going to fight really hard to deliver on it.

Governor-elect Shumlin says the waivers are the easy part. Designing a single payer system is indeed hard work, particularly when we need to consider the transition from the multi-payer, money-driven, all-day disaster we have now.

But another part of the hard work is to see how our educational mission can help the people of Vermont. As the Governor-elect suggests, we find a welcome opportunity to set an “example of how to do health care right.”

Critique of the co-chairs’ health care proposals for the National Commission on Fiscal Responsibility and Reform

The projected increases in Medicare spending are of concern to all of us. Although we need to slow the rate of growth in spending, we should do so not only without impairing the program, but by actually enhancing the benefits.

The co-chairmen have advanced proposals that address federal budget deficits related to Medicare, but unfortunately they have done so to the detriment of the Medicare beneficiaries. I spoke to this briefly in my Quote of the Day yesterday.

They propose an increase in Medicare cost sharing to promote greater consumer sensitivity to health care costs. Medicare is already a relatively Spartan program, paying roughly only half of health care costs for our seniors and those with long-term disabilities. Medicare beneficiaries face significant financial barriers to care, sometimes preventing them from receiving essential health care services. Some with greater health care needs even face bankruptcy because of the high out-of-pocket costs. Shifting more costs from the federal government to patients might reduce the federal budget, but it plays havoc with personal budgets. Cost sharing is merely a polite term for what it really is — cost shifting onto the backs of patients.

Because of the potential financial burden, many Medicare beneficiaries purchase Medigap plans. They provide one of the lousiest values in health insurance, having very high premiums for very modest benefits. The co-chairmen propose that the benefits be reduced further by requiring deductibles, again to create greater consumer sensitivity to costs. If they were really interested in saving money, they would recommend folding the Medigap benefits into the traditional Medicare program, thereby saving the profound administrative waste that characterizes these private Medigap plans. Although that improves patients’ budgets without changing the federal budget, policies should be designed to benefit the patients rather than the anti-government ideologues.

In many areas of the country physicians are concerned about their relatively low Medicare payment rates, and the lack of a “doc fix” is a very real threat for patients. Our primary care infrastructure is already crumbling, and imposition of the scheduled fee reductions will cause many more physicians to exit the Medicare program. The recommendation to prevent the fee reductions for physicians by imposing fee reductions on physicians is truly disingenuous. Physicians understand simple math when it comes to their paychecks. Patients also understand what it means when physicians’ practices are closed to new Medicare patients.

The co-chairmen propose strengthening the pending Independent Payment Advisory Board (IPAB). The board is being given the task of reducing payments in the traditional fee-for-service Medicare program, and has been provided with considerable leverage to impose those changes. Reducing fees in the Medicare program without changing fees paid by private insurers will surely motivate physicians to drop Medicare patients in favor of those privately insured. Strengthening IPAB will only compound this differential. We do need an IPAB that has a mission, not to simply reduce payments, but rather to set payments based on value. But, to be effective, an IPAB would have to have influence over the entire health care delivery system. That would be possible only with a single payer system, but not with our current fragmented system of financing health care.

Another disingenuous recommendation is to reward physicians for meeting spending targets by reducing their rates further. Disgruntled physicians lack incentives for high quality performance. A “back-up-sequester” to increase premiums or reduce provider payments is punitive to both patients and physicians and could further impair patients’ access to care.

The proposed premium support system for Medicare is strictly another manifestation of the great risk shift – an assault on individuals and families (Hacker). It defeats the solidarity behind social insurance programs.

Although the deficit commission is fixated on the federal budget, what really matters in health care is that our total spending is brought under control – both private and public combined. If we are paying a reasonable amount for all health care combined, then it really doesn’t matter that most of it would appear in the federal budget. It’s still our money whether we pay it directly or pay it as taxpayers.

It would be much more efficient and equitable if our national health expenditures were funded through progressive tax policies. We could do that very easily if we simply improved Medicare and then provided it for everyone. At least we would have stabilized the health care component of our federal budget.

Co-Chairs’ Proposal (Draft Document)

National Commission on Fiscal Responsibility and Reform
November 10, 2010

Reducing Health Care Costs (page 31)

## Medium Term: Fully offset the cost of the “Doc Fix” by asking doctors and other health providers, lawyers, and individuals to take responsibility for slowing health care cost growth. Offsets include:
* Pay doctors and other providers less, improve efficiency, and reward quality by speeding up payment reforms and increasing drug rebates
* Pay lawyers less and reduce the cost of defensive medicine by adopting comprehensive tort reform
* Expand cost-sharing in Medicare to promote informed consumer health  choices and spending
* Expand successful cost containment demonstrations
* Strengthen IPAB
* Recommend additional health savings (illustrative examples to follow)
## Long Term: Contain growth in total federal health spending to GDP+1% after 2020 by establishing a process to regularly evaluate cost growth, and take additional steps as needed if projected savings do not materialize

Paying for the “Doc Fix” (page 32)

## Pay doctors, other health providers, and drug companies less and improve efficiency and quality
* Replace cuts required by SGR through 2015 with modest reductions while directing CMS to establish a new payment system, beginning in 2015, to reduce costs and improve quality.
* Require rebates for brand-name drugs as a condition of participating in Medicare Part D.
## Increase cost-sharing in Medicare
* Eliminate first-dollar coverage in Medigap plans.
* Replace existing cost-sharing rules with universal deductible, single coinsurance rate, and catastrophic cap for Medicare Part A and Part B.
## Pay lawyers less and reduce the cost of defensive medicine
* Enact comprehensive medical malpractice liability reform to cap non-economic and punitive damages and make other changes in tort law.

Savings Beyond the Doc Fix (page 34)

## Expand Successful Cost-Containment Demonstration Projects by 2015
## Identify an additional $200 billion savings in federal health spending
## Strengthen the Independent Payment Advisory Board (IPAB)
* Include all providers (no carve-outs) and recommendations on benefit design and cost-sharing.
* Improve savings targets to 1.5% starting in 2015.
* Eliminate the trigger that could turn off IPAB in 2019.
* Allow cost-savings recommendations even when spending does not exceed the target growth rate.
* Allow proposals that apply reforms to health plans in the exchange.
* Require affirmative Congressional approval of recommendations or alternative savings, with a “back-up sequester” increasing premiums and reducing provider payments if IPAB recommendations (or equivalent savings) are not adopted.

Long-Term Health Care Savings (page 36)

## Set global target for total federal health expenditures after 2020 (Medicare, Medicaid, CHIP, exchange subsidies, employer health exclusion), and review costs every 2 years. Keep growth to GDP+1%.
## If costs have grown faster than targets (on average of previous 5 years), require President to submit and Congress to consider reforms to lower spending, such as:
* Increase premiums (or further increase cost-sharing)
* Overhaul the fee-for-service system
* Develop a premium support system for Medicare
* Add a robust public option and/or all-payer system in the exchange
* Further expand authority of IPAB

http://www.fiscalcommission.gov/sites/fiscalcommission.gov/files/documents/CoChair_Draft.pdf

Today, behind closed doors, the chairmen of President’s Obama’s deficit commission, Erskine Bowles and Alan Simpson, presented to the other members of the commission their draft proposal for reform. The selections above, from their report, apply to health care.

The reception by the committee members is expressed well by Lori Montgomery of The Washington Post:

“Commission members, who include a dozen sitting members of Congress, emerged from the morning session in a Capitol Hill hearing room praising the seriousness of the effort but voicing deep reservations about the details.”

http://www.washingtonpost.com/wp-dyn/content/article/2010/11/10/AR2010111004029.html

Obviously, some of these proposals are very deleterious. It is not as if the commission didn’t receive suggestions for far better policies to address costs while actually improving our health care system, though they have chosen to ignore them. Following is a quote from the testimony of Margaret Flowers, M.D. of Physicians for a National Health Program:

“The alternative scenario of a national improved Medicare for All will save lives and save money. National improved Medicare for All will place our nation on the path of becoming one of the best health systems in the world – something of which we can all be proud. This commission has the ability to recommend creating a financially sustainable universal health system. I urge the members of this commission to recommend addressing the deficit through adopting this most popular approach: national improved Medicare for All. Don’t cut Medicare. Protect it, improve it and expand it to cover everyone.”

http://www.fiscalcommission.gov/meetings/public-forum/6/Margaret_Flowers_6_30_2010.pdf

Video version (in 6 of 7 at 27:30):
http://www.fiscalcommission.gov/meetings/public-forum/

Central Utah children on CHIP face doctor shortage

By Kirsten Stewar
The Salt Lake Tribune
November 8, 2010

Privatizing Utah’s Children’s Health Insurance Program (CHIP) is supposed to save money and improve services.

But with no proof yet of any savings reaped, the experiment has been tripped up by service breakdowns.

The latest: Complaints from some of the 379 CHIP families in Carbon and Emery counties who say their children no longer have access to pediatric care. That’s because Intermountain Healthcare’s SelectHealth, which inherited some CHIP patients on July 1, has no primary care doctors in that region.

“Now, after 10 years with our local family doctor, we need to find a new one,” said Jason Chambers of Wellington.

Chambers said his doctor applied to become a SelectHealth provider months ago and gave up after receiving no response.

Chambers phoned the toll-free number on his CHIP card and was told his only option was to drive over the mountain to an in-network doctor in Spanish Fork. “That’s 65 miles away — four hours round trip,” to keep an appointment, said Chambers.

Legislation to privatize the CHIP program was backed by the insurance industry and sponsored in 2008 by Taylorsville Republican and insurance broker Rep. Jim Dunnigan… He said he sponsored his bill not as a favor to the insurance industry but to save taxpayer dollars and improve care through market forces.

http://www.sltrib.com/sltrib/home/50606756-76/chip-chambers-selecthealth-doctor.html.csp

The drive to divert the administration of publicly-financed health insurance programs to the private sector can be described at best as irrational fanaticism. The claim that private administration of public insurance programs uses market forces to improve quality and reduce costs has been disproven repeatedly. Costs of private administration are always higher, so any reductions in net spending are the result of curtailment of services.

Utah’s Children’s Health Insurance Program is one of the latest victims of this fanaticism. Requiring a four hour round trip to a primary care physician might save money by decreasing utilization, but it certainly fails on the quality measure of access.

If Utah had a publicly-administered universal health program, this wouldn’t even be an issue. Mr. Chambers’ children could continue to go to their own family physician.

Imagine with such a system in place – say a single payer national health program – if someone said that we are turning the program over to a private entity that requires you to travel to a distant community for your routine care, what would be your response? After the expletives, then what would you say?

The irrational fanatics are swarming. How long are we going to tolerate being stung?

President Barack Obama

60 Minutes
November 4, 2010

President Barack Obama: … I think there were some that argued, “Well, you should just stop and let people digest all these changes. And so, you shouldn’t take on something as big as health care.” And I’ll be honest with you, Steve, at the time, we knew that it probably wasn’t great politics.

Steve Kroft: You were told that by your aides.

President Obama: Absolutely… So, ultimately, I had to make a decision: do I put all that aside, because it’s gonna be bad politics? Or do I go ahead and try to do it because it will ultimately benefit the country? I made the decision to go ahead and do it. And it proved as costly politically as we expected. Probably actually a little more costly than we expected, politically.

Kroft: In what ways?

President Obama: Well, partly because I couldn’t get the kind of cooperation from Republicans that I had hoped for. We thought that if we shaped a bill that wasn’t that different from bills that had previously been introduced by Republicans — including a Republican governor in Massachusetts who’s now running for President — that, you know, we would be able to find some common ground there. And we just couldn’t.

http://www.cbsnews.com/stories/2010/11/07/60minutes/main7032276_page4.shtml

President Obama now confirms what was obvious all along. A political decision was made to introduce the Republican model of health care reform, with the presumption that the Republicans would cooperate. The tragedy is not that it proved to be so costly politically, but rather that we are locked into a very expensive and quite ineffective model – the version that has now been abandoned by the Republicans.

Those “secret negotiations behind closed doors” were not so secret. Senators Grassley and Enzi were cooperating in their respective committees to try to build reform on what was really the Republican model, drafted by a recruited WellPoint executive. During negotiations the basic model was not modified, and the disputed differences in policy were negligible. Only after it became evident that the health care reform effort could be used to discredit the Democrats did Grassley and Enzi yield to the Republican leadership by agreeing to become opponents of the effort. This has been a tremendous lesson in the pitfalls of placing politics before policy.

Yes, the Democrats did pass a bill, but can you call that a success? The bill will not control spending, it will not insure everyone, and it will establish under-insurance as the norm, exposing individuals and families with health care needs to financial hardship.

Simply stated, this was yet another political failure in our nearly century-long quest for health care for all.

No effective bill can possibly be passed in the next two years because of the current political climate, but that does not mean that we should wait it out until the politics are right. Quite the contrary.

Many in the nation still do not understand that an improved Medicare that would cover everyone is a vastly superior option. It is imperative that we greatly intensify our efforts to be sure that they do understand. If we wait until we like the partisan ratios in the House and Senate, it will be far too late for us to have any real impact.

Get to work.

By Benjamin Day

Massachusetts voters have, for the second straight election, overwhelmingly affirmed their support for single payer health reform by turning in majority ‘Yes’ votes in all fourteen districts where local single payer ballot questions appeared on November 2. The ballots spanned 80 different cities and towns in a state of 351 municipalities, winning in every city and town reporting results so far except two. Five of the districts backing single payer reform voted for Scott Brown in last year’s special senate election, which was largely seen as a referendum on national health reform, showing that the goal of improved and expanded Medicare for All is supported by a diverse range of communities across the state. It is also striking that in a year of political change, and in a year of drawn-out economic suffering, residents recognize that single payer health reform offers the promise of a more just and humanitarian health care system, which would actually cost us less as a society and lift the burden of sky-rocketing health costs from thousands of households, employers, and taxpayers.

Similar local referendum questions passed overwhelmingly in ten representative districts in 2008, and we look forward to building momentum for the state’s single payer bill even further this coming legislative session, which begins in January 2011.

Mass-Care wants to extend congratulations to all of the hard-working volunteers who collected signatures to put these questions on the ballot, got the word out to their local media, worked on public education with community organizations in their districts, and spoke one-on-one with residents of the district on the streets, holding signs, and standing outside of polling places.

Mass-Care also wants to extend its congratulations to the Vermont single payer movement. Peter Shumlin was elected Governor of Vermont running on a single payer platform. This is incredibly exciting as the Vermont legislature recently commissioned Dr. William Hsiao, the designer of Taiwan’s single payer health care system, to draft an implementation and impact study for a potential single payer plan in Vermont.

Not every precinct has yet reported results to the state, but we include partial results in a table below. Official results for every district will be posted on the Boston Globe web-site and on this page when they become available.

* Results from Suffolk district are unofficial.

Benjamin Day is executive director of Mass-Care: The Massachusetts Campaign for Single Payer Health Care.

http://masscare.org/announcements/single-payer-ballot-questions-pass-in-all-fourteen-massachusetts-districts/

By Jennifer Katzenberg

After listening to Dr. Rob Stone’s talk at the satellite “Rally to Restore Sanity/Keep Fear Alive” in Chicago’s Grant Park this past Saturday, I was impressed by his ability to succinctly explain the problems with the current state of health care and health reform in this country.

Stone began by saying, “I went to medical school so I could take care of people.” He talked about his years of experience as an emergency room doctor in rural Indiana where he sees everyone who comes in – insured, poorly insured or uninsured.

Appealing to the “fear” aspect of the rally, Stone shared the shameful statistic that “50 million, or 1 in 6 Americans, are uninsured” and said that “no other civilized country leaves 50 million people without coverage.”

He then asked how many people either know someone who is uninsured or are uninsured themselves. Shouts of “Yes!” erupted and hands flew up across the large crowd.

He then referred to President Obama’s interview on Jon Stewart’s “The Daily Show” last week, highlighting Stewart’s remark that some people think the new health law is too “timid.” It is clear that Stone, along with many others, feels the health bill was indeed timid because “Congress is afraid of big corporations.”

“We try to get health insurance in this country mostly from for-profit, Wall Street-driven companies,” he said. “Wall Street has taken over health insurance,” and it’s a big problem that the new law “keeps private insurance as a major centerpiece.”

“We have to speak up for what the people need and not what the corporations need,” Stone said. The audience cheered in response.

Speaking of the private insurers, Stone said, “We’ve got to find a way to move them aside and just make one big pool of all of us where we’re all covered. … That’s what we call single payer, that’s what we call an expanded and improved Medicare.”

Stone said single-payer health reform is what is “sane,” and the crowd clearly agreed. Who could argue with that? How could anyone honestly believe in keeping people uninsured or poorly uninsured?

As Stone walked off stage, he had the crowd chanting, “Everybody in, Nobody out!”

More Americans need to hear people like Stone talk about health care so that Medicare-for-All has a chance.

Jennifer Katzenberg is an intern at Physicians for a National Health Program (www.pnhp.org).