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Dixon, U.S. Conference of Mayors push single-payer health coverage

Archives for 2008

Dixon, U.S. Conference of Mayors push single-payer health coverage

by Sue Schultz
Baltimore Business Journal Staff
June 24, 2008

Baltimore Mayor Sheila Dixon is one of seven U.S. mayors to craft a bill supporting single-payer national health insurance, a proposal being pushed by the U.S. Conference of Mayors.

The resolution has been formally adopted by the U.S. Conference of Mayors, a national organization representing cities of more than 30,000, and is making its way through the U.S. Congress.

U.S. Rep. John Conyers, a Democrat representing Michigan, is the primary sponsor of the bill, which is backed by 90 other legislators. The universal health care approach would require all residents to have health insurance. Under the single-payer system, the program would be funded by one source such as the federal government. Canada’s health care system is a single-payer program.

“By taking this action, the mayors have put, in the boldest way, single-payer national health insurance on top of the domestic agenda, squarely in the middle of the legislative and presidential election,” said Dr. Quentin Young, national coordinator of Physicians for a National Health Program.

The Physicians for a National Health Program, a Chicago-based nonprofit representing about 15,000 physicians, helped the U.S. Conference of Mayors craft the resolution.

Media Miss Bigger Picture in Healthcare Debate

Ignoring 'mandate' plans' record of failure

By Roger Bybee
Fair & Accuracy in Reporting
Extra!
May/June 2008

In the 2008 Democratic primary campaign between Barack Obama and Hillary Clinton, each is offering a slightly different variant of individual mandate-based healthcare plans relying on the private insurance industry. Media coverage has magnified the slight variations while almost entirely ignoring the big picture: Both health plans are based on a model that has consistently failed to get off the ground in numerous states.

Most media analysis has focused on the political advantage provided by each proposal, rather than on the evidence that either plan would actually deliver quality, affordable care to all Americans.

Obama proposes that parents be mandated to buy private insurance for their children, with an individual mandate for adults to be imposed once “cost controls” drive down the cost of insurance–a highly optimistic scenario, given that he is not addressing insurers’ extremely high administrative costs. For her part, Clinton insists on an immediate and universal mandate for all to purchase private insurance. “As a practical matter, the difference between Senator Clinton’s and Senator Obama’s approaches comes down to timing and sequencing,” stated former Clinton Labor Secretary Robert Reich (American Prospect, 1/10/08).

Some health policy experts trace the roots of the Democratic candidates’ insurance-centered, mandate-based healthcare plans to Republican President Richard Nixon, who recognized the need for health reform but sought to protect private insurers and other powerful interests. In 1971, Nixon proposed mandating employers to cover their employees and requiring poorer Americans to pay reduced insurance premiums in an expanded Medicaid program. Over time, Nixon’s concept has devolved into an approach with less stress on employer payments and more emphasis on individual mandates to purchase private insurance.

The individual mandate essentially requires citizens to buy private insurance that is unaffordable for tens of millions. Consequently, it has been the rock upon which one “universal” state plan after another has crashed and splintered, as noted in a New York Times op-ed (12/15/07) by Harvard Medical School doctors Steffie Woolhandler and David Himmelstein.

Much-heralded plans passed in the late 1980s and early 1990s in Massachusetts, Oregon, Minnesota, Tennessee, Vermont and Washington all promised to provide universal coverage, most often based on a combination of employer and individual mandates. In each case, the mandate-based approach has failed to deliver any decreases in the number of uninsured; in several states there were substantial increases, as Himmelstein and Woolhandler detail.

The most recent experiment with mandates in Massachusetts appears to be sinking fast. The plan, signed into law in 2006 by Republican Gov. Mitt Romney, charges employers just $295 per year while forcing families earning as little as $29,400 a year to buy insurance without any subsidy, backed up with penalties as high as $4,000. While state officials claim progress, “according to the Census Bureau, the new sign-ups amount to less than one-quarter of the uninsured,” noted Himmelstein and Woolhandler (Boston Globe op-ed, 9/17/07). They pointed out that “244,000 of the Massachusetts uninsured get zero assistance–just a stiff fine if they don’t buy coverage.”

Essentially, healthcare plans have been configured to prevent a showdown with private health insurers over their unaffordable premiums, driven by astronomical U.S. administrative costs. As Woolhandler and Himmelstein observed in their New York Times op-ed (12/15/07):

The “mandate model” for healthcare rests on impeccable political logic: avoiding challenging insurance firms’ stranglehold on healthcare. But it is economic nonsense. The reliance on private insurers makes universal coverage unaffordable.

With an estimated excess administrative burden of $350 billion to $400 billion annually, it is impossible to envision effective cost controls under a system dominated by private insurance, at a time when per-person healthcare costs have reached $7,400 in the U.S. (New York Times, 3/3/08), virtually twice the cost of any other advanced nation.

Even when the individual mandate/private insurance approach is coupled with an option to choose a public insurance plan, as both Obama and Clinton have proposed, only a small portion of the excess insurance overhead can be eliminated, because providers and patients must contend with multiple insurers seeking to maximize profit. While some Democrats, like former candidate John Edwards, envisioned the public plan as the incubator for an evolving single-payer system (New York Times, 1/25/08), such an alternative system might also be transformed into the insurers’ dumping ground for patients who would likely diminish their profits by requiring more care.

The individual mandate approach is also weighed down by an unappealing political message, a point rarely mentioned in mainstream media. Rather than focusing on the benefits a new government program would confer on all Americans, the individual mandate puts the spotlight on the immediate burden of buying often-unaffordable insurance. As economist Robert Kuttner put it (American Prospect online, 1/30/08): “Universal social insurance signals government help. A mandate signals government coercion.”

Typifying the media analysis were New York Times reporter Kevin Sack’s pieces on the healthcare policy debate (12/25/07, 2/23/08). Sack pointed out (12/25/07) that the number of uninsured grew to 47 million in 2006, over 2 million more than the year before, and that employer-provided coverage now reaches only 60 percent of Americans, compared with 64 percent in 2000. Despite these mounting indicators of an increasingly crisis-wracked healthcare system, none of the “sweeping plans to restructure healthcare” in California, Illinois or Pennsylvania “will finish 2007 with a bill passed and signed.”

By way of explanation, Sack wrote, “In each state, the initiatives confronted entrenched opposition from insurance and other business lobbies that made it far more difficult to build a consensus than in the small New England states that acted in recent years.”

Such a statement is most notable for what it fails to illuminate. For one thing, the failures of the various New England mandate plans went unmentioned.

The candidates’ promised means of lowering insurance premiums also escaped any serious examination. “The difference is that Obama insists he will be able to lure all of the uninsured simply by dangling the carrot of low premiums; Mrs. Clinton believes there will always be some free riders who respond only to a government stick,” Sack wrote (New York Times, 2/23/08). While Sack cited cost-cutting proposals by Obama and Clinton for electronic record-keeping, preventive care and chronic disease management, he ignored the elephant in the room: the huge excess administrative costs in the U.S. imposed by private insurers. Overall, such costs account for 31 cents out of every U.S. dollar spent on healthcare (New England Journal of Medicine, 8/21/03; Health Affairs, 11-12/05).

Like much of the major media, Sack’s articles spotlighted relatively trivial procedural differences between Obama and Clinton while overlooking proven models of healthcare financing that deliver both universal coverage and effective cost controls through negotiations between provincial governments and providers. For example, neighboring Canada provides healthcare to every citizen for 52 percent of U.S. per-person costs, allows free choice of doctors, and produces far better health outcomes in terms of infant mortality, life expectancy and many other key indicators (Health Affairs, 1-2/08).

Yet many key policymakers and media commentators have utterly disqualified the single-payer plan from serious consideration. “If you want to get to universal coverage, then you have to do the individual mandate,” Urban Institute economist Joe Holahan told the Washington Post (2/24/08). “You can do it with a single-payer system, under which one entity, the government, would finance all healthcare,” he said. “But assuming that’s [politically] off the charts, then I think it [the individual mandate] is the only way to go.”

In the same vein, leading pundits like Ron Brownstein have pronounced (L.A. Times, 7/1/07):

For all the passion it evokes, the single-payer idea remains at the fringe of political viability. Though the cause energizes the left, the idea of the federal government completely replacing the private health insurance industry is so far outside the American experience that even the vast majority of health reform advocates consider it politically dead on arrival for the foreseeable future.

This viewpoint, while widely held among Washington, D.C. political and media insiders, overlooks the largely positive experience of over 40 million Americans with the Medicare and Veterans Administration systems that operate on a single-payer model.

Moreover, this exclusion reflects a vast gulf between Democratic leaders and the party’s constituency, as 70 percent of Democratic primary voters support a single-payer model of reform (Greenberg Quinlan Rosner Research, 5/4/07). This level of sentiment among Democratic voters was only slightly higher than that found among samples of all American citizens, as when CBS (9/14-16/07) found that 55 percent preferred “having one health insurance program covering all Americans that would be administered by the government and paid for by taxpayers,” vs. 29 percent who chose “keeping the current system where many people get their insurance from private employers and some have no insurance.”

But this overwhelming popular support for a single-payer system (both among the general public and increasingly doctors as well–Annals of Internal Medicine, 4/1/08) has rarely been found worthy of mention in influential media like the New York Times or Washington Post, where a search showed no record of articles on such polling over the last three years.

Meanwhile, a widely quoted New York Times poll (3/2/07) failed to even raise the single-payer issue, instead asking a much less revealing question about support for universal healthcare, a general goal supported by “nearly 8 in 10.” However, the ambiguous phrasing of possible alternatives–a list from which single-payer was omitted–produced predictably ambiguous responses from the public. Consequently, the accompanying story concluded by citing a Harvard expert predicting that public divisions would probably generate a “train wreck,” once more blocking reform. Such coverage reinforces the dubious notions that Americans resist large-scale healthcare reform and have no preferences on specific alternatives to the status quo.

Roger Bybee, a frequent contributor to Extra!, is a Milwaukee-based freelance writer and consultant who often writes about healthcare policy and corporate globalization.

U.S. Conference of Mayors Backs Single-Payer National Health Insurance

For immediate release
June 23, 2008

Contacts:
David Prensky, D.D.S., (561) 242-3424
Quentin Young, M.D., (312) 782-6006, info@pnhp.org
Alison Landes, (561) 488-0095, aslandes@aol.com

The U.S. Conference of Mayors, meeting in Miami, adopted a resolution this morning in support of single-payer national health insurance.

The assembly, in unanimous vote, backed a resolution calling for the enactment of the “United States National Health Insurance Act,” H.R. 676. The bill, which is also known as the “Improved and Expanded Medicare for All Act,” is sponsored by Rep. John Conyers of Michigan and 90 other members of Congress.

“This is a major achievement, a qualitative change in the movement for genuine health care reform,” said Dr. David Prensky, a retired dentist from Palm Beach, Fla., who helped promote the resolution. Prensky is a member of the Chicago-based Physicians for a National Health Program (PNHP).

“It shows that our country’s mayors now support the kind of approach that every other industrialized country has – an approach that guarantees health care for everyone at an affordable cost,” he said.

“Mayors, in a very real sense, are closer to the people than most elected officials,” Prensky continued. “They are closer to the grassroots, where their communities and constituents are suffering. Meanwhile their city budgets are being shattered by health costs for their own employees.”

Conyers’ bill would guarantee everyone care for all medically necessary services, contain costs by slashing the administrative waste and bureaucracy associated with the private insurance industry and assure patients their choice of doctor and hospital.

The resolution was introduced by Mayor Lois Frankel of West Palm Beach, Fla., and six other mayors from Baltimore to Santa Cruz, Calif. Frankel worked in cooperation with the statewide advocacy group Floridians for Health Care and the national group Healthcare-Now.

“By taking this action,” said Dr. Quentin Young, national coordinator of PNHP, “the mayors have put, in the boldest way, single-payer national health insurance on top of the domestic agenda, squarely in the middle of the legislative and presidential elections.”

The U.S. Conference of Mayors is a nonpartisan organization of mayors representing cities with a population of 30,000 or more. It currently has about 1,100 members.

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Physicians for a National Health Program (www.pnhp.org) is an organization of over 15,000 physicians advocating for non-profit national health insurance. PNHP has chapters and spokepersons across the country. For contacts, call 312-782-6006 or info@pnhp.org.

Text of Resolution adopted by the U.S. Conference of Mayors, June 23

Resolution in support of the United States National Health Insurance Act, H.R. 676

Submitted By:
The Honorable Lois J. Frankel, Mayor of West Palm Beach, Fla.
The Honorable Wayne J. Hall Sr., Mayor of Mayor of Hempstead, N.Y.
The Honorable Carolyn K. Peterson, Mayor of Ithaca, N.Y.
The Honorable John E. Marks, III, Mayor of Tallahassee, Fla.
The Honorable Sheila Dixon, Mayor of Baltimore, Md.
The Honorable Becky Tooley, Mayor of Coconut Creek, Fla.
The Honorable Ryan Coonerty, Mayor of Santa Cruz, Calif.

WHEREAS, every person deserves access to affordable quality health care; and

WHEREAS, the number of Americans without health insurance now exceeds 47 million; and

WHEREAS, millions with insurance have coverage so inadequate that a major illness would lead to financial ruin, and medical illness and bills contribute to one-half of all bankruptcies; and

WHEREAS, proposals for “consumer directed health care” such as Health Savings Accounts or Health Reimbursement Accounts (HRAs) would only worsen this situation by penalizing the sick, discouraging prevention and saddling many working families with huge medical bills; and

WHEREAS, managed care and other market-based reforms have failed to contain health care costs, which now threaten the international competitiveness of U.S. manufacturers; and

WHEREAS, administrative waste stemming from our reliance on private insurers consumes one-third of private health spending while the single payer Medicare system has administrative costs of less than 5 percent; and

WHEREAS, U.S. hospitals spend 24.3 percent of their budgets on billing and administration while hospitals under Canada’s single payer system spend only 12.9 percent; and

WHEREAS, Harvard researchers estimate that more than $300 billion could be recovered by replacing private insurance companies with a single public payer, enough to cover the uninsured and to improve coverage for all those who now have only partial coverage; and

WHEREAS, entrusting care to profit-oriented firms diverts billions of dollars to outrageous incomes for CEOs and threatens the quality of care; and

WHEREAS, The United States National Health Insurance Act (H.R. 676) would assure universal coverage of all medically necessary services, contain costs by slashing bureaucracy, protect the doctor patient relationship, assure patients a completely free choice of doctors, and allow physicians a free choice of practice settings; and

WHEREAS, most polls show that the majority of Americans support universal health care; and

WHEREAS, as of the date of this resolution, the majority of American physicians (59 percent) believe that Single Payer is the best method of securing universal health care; and

WHEREAS, The United States National Health Insurance Act (H.R. 676) will guarantee every mayor that all residents and employees of his/her city will be fully covered for health care and save millions of taxpayer dollars now spent on premiums to provide less than full health insurance coverage for government employees; and

NOW, THEREFORE,

BE IT RESOLVED, that the United States Conference of Mayors expresses its support for The United States National Health Insurance Act (H.R. 676), and calls upon federal legislators to work towards its immediate enactment and further urges the adoption of a process to insure that health care providers justify any increase in health care costs.

Private insurers take on women

Gender can cost you in individual health insurance

By David Lazarus
Los Angeles Times
June 22, 2008

When it comes to health insurance, Valencia resident Tova Hack’s first problem is that she works part time and thus needs an individual policy for medical coverage because her employer doesn’t offer one.

Her second problem is that she’s a woman. She just found out that the cost of her bare-bones, high-deductible insurance plan is going up 20%.

But the real surprise — which Blue Shield neglected to point out in its recent letters to individual policyholders but which was apparent from a close reading of an accompanying chart — is that men and women will now be charged different rates.

It’s not about pregnancy, though. Hack’s policy doesn’t even cover pregnancy and maternity care.

No, this is purely a matter of Blue Shield deciding that women, as a general rule, are more expensive to insure than men.

“We’ve done it because our competitors are doing it,” (Blue Shield spokesman Tom) Epstein said. “We don’t want to get a disproportionate share of high-risk people.”

By “high-risk people,” what he means is “women.”

And what Epstein is basically saying is that if women are indeed costlier to insure, and if Blue Shield doesn’t price its policies accordingly, more women will want to be insured by Blue Shield.

Can’t have that.

http://www.latimes.com/business/la-fi-lazarus22-2008jun22,1,3782851,full.column

And…

Health Policy Blog

By John Goodman
National Center for Policy Analysis

How many Americans are overinsured?…. Overinsured?…. Yes, overinsured.

Examples of overinsurance are: a male, or a female past menopause, paying for maternity coverage…

http://www.john-goodman-blog.com/worst-study-award/#more-252

Comment:

By Don McCanne, MD

Isn’t it really about providing all of us with the health care that we need? Doesn’t that mean that we should have an equitable system that removes financial barriers to care by pooling all risks and funding that pool based on ability to pay?

So if it’s about paying for health care, why do we keep talking about an arbitrary construct of private health plans in which premiums are manipulated based on how far we can go in fragmenting risk pools?

We’ve all observed the behavior of the private insurance industry. In order to keep their premiums competitive, they have continued to carve out risks so that those remaining in their insurance pools will have very low health care expenses.

Representatives of the insurance industry contend that they provide consumer value for their very high administrative costs. Foremost are the preventive services that they encourage. But pap smears and mammograms? Their actuarial studies confirm that women actually use those services, and, of course, it is unfair to make men pay for them.

And pregnancy? Men only place the order and receive a child in return, but they don’t go to the doctor for that. It’s women who are running up our health care tab by obtaining prenatal and obstetrical services. They should pay.

So let’s really refine our risk pools. Let’s establish pools more precisely defined by anticipated risks. Since each individual has his or her own risk profile, we should establish 304 million risk pools – one apiece.

Of course, the insurance industry would have much greater underwriting costs, so they would be entitled to maybe a 35 percent surcharge to our medical bills. And aren’t these administrative services worth three-quarters of a trillion dollars? After all, it costs money for the industry to make sure that each one of us pays for precisely the health care that we use.

Come on. Haven’t we had enough? The male-dominated Congress and administration aren’t going to do much based on the signals that we are receiving from Washington. But this time the insurance industry has taken on women.

Women, the guys are wimping out. The insurance industry has put it in your court. It’s your turn, and you can do it!

Having just served as a delegate to the national convention of the League of Women Voters, I am convinced that the women of this nation will bring us the reform that we desperately need. They voted unanimously at their convention to make advocacy for and education on health care reform a priority for the next two years. Watch out! The women are taking charge!

Single payer system is path to universal care

By Bill Roy
Topeka Capital-Journal
Saturday, June 21. 2008

At the end of a long presentation outlining new services, new doctors, new facilities and a growth in income this year at a rate greater than the growth of the economy, Dr. Kent Palmberg, the unusually savvy and successful senior vice-president and chief medical officer of Stormont Vail HealthCare, sighed and quietly said, “I’m not sure where all this is going, but we’ll probably end up with something like Medicare for all.”

He added, “I’m not sure that’s all bad. They pay promptly, predictably and adequately, with a minimum of paperwork. That beats costly fighting with scores of insurance companies, plus caring for the many uninsured.”

Palmberg’s audience was about 35 retired physicians, men and women who had provided good medical care for Kansans over some, or all, of the last 50 years, and who participated in the unprecedented growth of our profession.

I watched closely. None flinched, none shook his head or raised her hand to register an objection.

Their probable attitudes coincide with a 2007 study published in the Annals of Internal Medicine that found 59 percent of physicians in the U.S. support “government legislation to establish national health insurance,” up 10 percent in five years.

Palmberg, who oversees the nearly 170 physicians who provide care at 23 locations in Northeast Kansas, also was affirming the December 2007 endorsement by the American College of Physicians, medicine’s largest specialty society, of a single payer national health system as “one pathway” to universal coverage.

Dr. C. Anderson Hedberg, president emeritus of the 124,000 member ACP, was quoted as saying, “This new proposal by the ACP brings single payer into the mainstream. It’s the logical next step.”

Dr. Marcia Angell, former editor of the celebrated New England Journal of Medicine, came on stronger, “There’s only one choice for universal health care at a cost we can afford, and that’s single payer, Medicare for all.”

It has never been a secret that a single payer system is the most economic, efficient and fair way of providing universal care.

But Harry and Louise, the deceptive but effective 1993 television creation of the Health Insurance Association of America, so greatly intimidated legislators and their staffs that they crawled into a non-policy corner 14 years ago and have never come out.

During the fateful early 1990s when Hillary and Bill Clinton were fighting for universal care, the Journal of the American Medical Association under the courageous editorship of Dr. George D. Lundberg scored possible health care reforms by set criteria, and the single payer system was by far the best.

Lundberg kept his job, but the AMA did not buy the study results.

Closer to home, just last year the Kansas Health Policy Authority paid good money to the Schramm Raleigh Health Strategies to help them with ideas to present to the Legislature for health reform.

The Arizona firm provided cost estimates for several reform measures based on Kansas health expenditures of $8.228 billion in 2004-2005.

They calculated universal coverage using current payment mechanisms would cost $8.7 billion.

But a single payer system that eliminated insurance carriers could provide universal coverage for $7.4 billion.

The staff and board of KHPA chose not to present the Schramm and Raleigh single payer-universal coverage proposal to the 2008 Legislature, probably not wanting to embarrass their clients, the legislators and Gov. Kathleen Sebelius.

But pressure is building. Some day shifting public opinion and looming personal, business, state and federal bankruptcies will make elected officials consider a single payer-universal care system, which, in one form or another, has been adopted by every other industrial democracy, many of which have healthier populations that live longer. All spend substantially less.

Dr. Bill Roy is a retired physician and former member of Congress. He has a law degree and lives in Topeka. He may be reached at wirroy@aol.com.

The Experience of Exclusion: What Do We Do With People Like You?

By Donna Smith
Phoenix, Arizona
Thursday, June 12, 2008

Good morning. I can scarcely believe I have been asked to deliver this address to all of you, and I am so honored to be doing so. Thank you for including me in this experience and for helping bring me back from the depths of despair and exclusion.

For those of you who have seen Michael Moore’s movie, SiCKO, you know that my husband and I lost our home in South Dakota after suffering through years of healthcare related financial trauma and finding no way to hang on. We are filmed moving into our daughter’s small storage room or computer room or spare office or whatever you’d like to term it. And you see our youngest son confronting us about our situation. He asks us: “What Do We Do With People Like You?”

“What Do We Do With People Like You?”

The words seared my heart and my soul then and they still do now as I recall the fight to maintain what little dignity we had left at that point. You see the moments you see on the screen came only after many years of fighting and falling and fighting and crawling our way back again. Moving in with our daughter wasn’t our only homeless moment over the past 20 years of healthcare struggle, we had lived in a motel for a while after one of my husband’s surgeries, in a double-wide trailer house that we actually fought to keep as our last vestige of home owning freedom, and when we finally gave up the home you see in SiCKO, it was the deepest and darkest instant of that struggle when I heard the baby boy I brought into this world, the young man who I protected and loved and honored with my life’s work ask me, “What do we do with people like you?”

My own son excluded me from the people like him. Successful people. People with good jobs and good benefits. Healthy people. People with enough money to pay the rent, the utilities, the insurance premiums and all the rest of the things people like me could not. He believed that if I had just tried harder or worked smarter or reached deeper, I could have patterned for myself a different outcome. Being homeless was, in fact and in his mind, my fault. If only I had made other choices.

Yet, I knew somewhere in my heart he was simply expressing what we have created in our society. A attitude of exclusivity in which one group feels more worthy than another and in which those of us who cannot afford a home or healthcare or brand-name toothpaste are placed in a category outside of the mainstream. I grieved not for the loss of my home but for the cruelty even in my own family and felt deeply that as a mother I had not taught him that sometimes no matter how hard you try or how hard you work or how hard you believe, sometimes you cannot alone lift yourself from the depths.

Over the years prior to that moment, it is true we struggled up and down and in every way. Most of the time we did so quite privately, not admitting to anyone how bad things had become. Sometimes we tried borrowing money in ways that were not the wisest or in the only ways we could, and our situation simply got worse. We followed the pattern many, many families and individuals do in our nation — fighting to make it work somehow. But there we were. Standing in line at the food pantry every month, asking churches to help pay utility bills, selling anything we could to stay afloat — Did you know you can actually cook — well sort of — Ramen noodles in lukewarm motel room tap water? I’ll bet some of you do know that. And it’s sometimes 10 cents a package. That’s the way things were for a while.

After finally accepting the offer to move in with our daughter, we began the emotional and mental unraveling you saw on the screen in SiCKO. We begged people to know that we were trying hard to pull things out. It was so painful to have family and friends change their tone of voice when we’d call — they were terrified we were calling to ask for money. And sometimes we were. And I took an office job I hated just to get the benefits and earn enough for a security deposit, and first and last month’s rent to get an apartment again. And we moved into the place with a broken futon, some $5 lawn chairs from the evil empire — WalMart — and our clothes and the dog.

It seemed that everything we had worked to do in our lives was now distilled down to the measure of our financial failure and loss of our health. For me, having cancer was not a time when my diagnosis afforded me great support and love. I worried about losing time from work and spending money and losing benefits. Now in recent news reports, we all heard about this: we all want Sen. Ted Kennedy to win his battle with cancer, but I’ll guarantee you his first thought was not about finances. And he never wished to die quickly rather than bankrupt his spouse — like I did on that lonely August day when I heard the words, “You have cancer.”

So, how do we survive the exclusion and the pain and the anger and the withdrawal it takes to simply survive being viewed as a person with so little value? It seems to me that how I survived was a miracle. I am always acutely aware that more than 25,000 people who told their stories of health care horror to Michael Moore are not in the film… And those 24,988 people and families did not get to know the dignity that came along with simply having someone care enough to let us speak our truth.

But over the next several months after SiCKO was released, I have come to see another side of what it means to be “people like me.” Some of you know I spent two months this fall and early winter traveling on a 1980 school bus telling the healthcare reform message in 12 states and 17 Congressional districts. From Gary to Nashville — where I first met John — to Huntsville and down into New Orleans, from Florida and back up through the Carolina’s and on into Pittsburgh. I spent Thanksgiving in Birmingham, Alabama where other homeless people embraced me in ways I never knew I could be embraced. They thanked me and wished me a happy Thanksgiving.

They held my hand as they told me their health care stories and we cried together about the pain we are all suffering. I was finally with “people like me.” And I met veterans of our armed services who are most assuredly deserving of homes and healthcare, food and our deepest thanks and respect.

So, my young son asked, “What do we do with people like you?”

Well, after visiting 28 states and the District of Columbia this year speaking about healthcare reform, I can finally answer him.

We give people like me healthcare — always and freely.

We give people like me warm shelter and food.

We give people like me credit for having as brain and will power that did not break but enduring a system that did.

We give people like me the dignity to choose what they will do next in life with the tools we can together provide and that are given with joy.

We give people like me a voice — the way Michael Moore did for me and U.S. Rep. John Conyers, author of the National Health Insurance Act, HR676, did for me when he had me testify before a sub-committee in Congress, or the way the California Nurses Association and National Nurses Organizing Committee wrapped us in decency and welcomed us into their fight for single payer healthcare for all — and the way a civilized people do for one another.

We embrace people like me in the fight for a better nation — people like me are the people who built this nation and we are the people who will rebuild it into a more just and peaceful and compassionate society once again.

We will include people like me and we will call one another to task when any one of us is excluded — people like me are people like you.

Thank you so much.

A Presbyterian Minister Blogs for Single Payer

The Mystery of Opposition to Single Payer National Health Insurance

by David Bos
Louisville Letter
Published June 9th, 2008

Of course the cynics will say that there is no mystery to the fact that the Single Payer solution to our nation’s health care crisis doesn’t seem to be getting much traction. They will say that our legislators, our presidential candidates and our media are in the pocket of the health insurance companies — bought out by millions of dollars of contributions that come with implicit strings and pressured by hundreds of lobbyists who are paid at least partially with taxpayer monies that go to subsidize these companies rather than provide the health care that we are not getting. Indeed, they will say, even PBS’s Newshour uses Johnson and Johnson as their main consultant for health care issues — a pharmaceutical corporation that lobbies heavily against Single Payer solutions.

Yet, is it really possible that it just takes a lot of money to thwart the public will on an issue as important as this? Hillary Clinton said that she didn’t support Single Payer because it is not “practicable” Is this an admission that indeed the money calls the shots — from someone who took more money from the heath insurance industry than any other person in Washington except George Bush? Barak Obama says that he would have supported Single Payer if we were starting from scratch. Does he really not get the fact that we are starting from scratch? And John McCain says that Single Payer is socialized medicine without bothering to discuss the issue on its merits. Sooner or later a statement such as his will be recognized for what it is — a lie. Such irrationality? Maybe they are right. Maybe it is the money.

But, to me, Its still a mystery why we have 100,000,000 who are either uninsured or underinsured with the numbers and heart-rending stories growing day by day and millions of others with insurance who are just a serious illness away from backruptcy with apparently no political voice. Just think, polls show that over 60%, perhaps 70%, of the people want a Single Payer plan. The most recent polls show that a majority of doctors favor Single Payer. There are 90+ co-sponsors of Single Payer Bill HR 676 in the House of Representatives. Labor union locals are endorsing Single Payer at a rate of several a week. How can it be that these numbers represent no real decision-making power or influence in the political realm?

I wish someone would explain it. Are the party leaders and candidates so gutless that they won’t give the majority of people the time of day on this issue? Maybe it has something to do with the word “privitization”. Could it be that the Reagan/Bush administrations (and to no little extent the Clinton administration) have managed to persuade the people that privitizaton trumps all — so much so that we are willing to sacrifice tens of thousands of lives each year to lack of health care in the name of for-profit, privitized health insurance. Perhaps the people really want to put profits before patients even when those profits are supplied by taxpayer dollars and go to obscenely paid CEO’s and highly paid staffers whose job it is to figure out how not to give you and me the health care we need. Has the ideology of privitization captured the populace to this extent? If so, then the way is clear to privitize everything: the mail, the school, the water. Why not just do away with government by the people and admit that we would be ruled by nonaccountable businesses? I don’t know. As the song goes, “Its a mystery to me.”

Stories That Go Nowhere Because They're Ignored

By Saul Friedman
Nieman Watchdog blog
Posted at 10:39 am, June 22nd, 2008

I know, it’s a rule of the mainstream press. If the issue is not going anywhere, it’s not worth much of a story. Of course, if it’s not given much of a story, it’s not going anywhere. It’s like that old conundrum about the tree falling in the forest. Here are a couple of trees.

I’m thinking, first, of the June resolution by Rep. Dennis Kucinich, D-Ohio, calling for the impeachment of President Bush. I would venture to guess that most of the reporters who cover Washington, politics or national security probably agree that if any president deserves to be impeached, it’s Bush, for getting the nation into a war on false pretenses, for consenting to the torture of prisoners and innocents, for circumventing the Constitution’s guarantees against illegal searches, wiretaps and the right of habeas corpus.

But Kucinich’s speech introducing his resolution made six paragraphs inside the Washington Post. That was followed by a snotty column by Dana Milbank belittling Kucinich for the more than four hours he spent reading the resolution into the Congressional Record. Another Post blog suggested that his threat to press his resolution would go nowhere and was simply a “fantasy.” He got similar treatment in every other newspaper I read, and even less on television news. Only the British and French press reported it prominently.

But as far as I could see, no one bothered to read or quoted from any of the 35 counts of Kucinich’s resolution, or even tell readers where they might find it. It ran about 70 pages on my printer and I had to get it from the alternative media, like www.buzzflash.com. And it’s worth reading for Kucinich and his staff compiled solid, documented, evidence. Most of it is known, but it’s an impressive compilation, backing up many of the well-reported offenses committed by this president. Much more important than lying about sex.

Why is Bush getting away with it? The Democratic leadership, when it took control of this Congress last year, declared impeachment was “off the table.” And that declaration has remained in force even when new offenses have become known and the prospect of illegally attacking Iran has become possible. So, I wonder what came first, the indifference of the mainstream press, or the decision of the pols (and the president) who read the press?

This indifference and the resulting ignorance of the public, are haunting another issue–the prospect of single-payer, universal health care such as “Medicare for All.” Such a system is now supported by 56 percent of Americans, according to the Associated Press, and, for the first time, by 59 percent of the nation’s physicians. But you would not know that there is such a widely supported proposal awaiting congressional action, if you were reading the mainstream press accounts of a day-long health care forum staged by the Senate Finance Committee at the Library of Congress on June 16.

The Washington Post’s Lori Montgomery was among several reporters, who faithfully recorded the statements of the experts, all agreeing that health-care reform was necessary. But there was no agreement on the solution. Like other reporters, she recounted the possible proposals that were being drafted. By the usual suspects. But there was not a word about the most widely supported piece of legislation that would establish “Medicare for All,” HR 676, introduced early in this session by Judiciary Committee Chairman John Conyers, the veteran Michigan Democrat.

Conyers’ bill, the “U.S. National Health Insurance Act,” would provide health care for all Americans, modeled after Medicare, and would replace other government programs, such as Medicaid, the State Children’s Health Insurance Program, and end need for private insurance and its power over the American health care system. Recently the Conyers bill was endorsed in an overwhelming vote by the New York State Assembly, which has been grappling with health care issues to cover 2.6 million uninsured New Yorkers.

Conyers’ bill, which any reporter can find and read, has the backing of 90 house members, 430 labor unions, including 33 state chapters of the AFL-CIO, and thousands of doctors and nurses. But you wouldn’t know it from the mainstream media, for the possibility of single-payer universal health care, is like a tree that falls without a sound. Which is one reason it has little chance for passage.

Saul Friedman, a 1963 Nieman Fellow, is a former White House correspondent for Newsday and Knight Ridder newspapers and now writes a weekly column, “Gray Matters,” dealing with senior issues, for Newsday.

Stories That Go Nowhere Because They’re Ignored

By Saul Friedman
Nieman Watchdog blog
Posted at 10:39 am, June 22nd, 2008

I know, it’s a rule of the mainstream press. If the issue is not going anywhere, it’s not worth much of a story. Of course, if it’s not given much of a story, it’s not going anywhere. It’s like that old conundrum about the tree falling in the forest. Here are a couple of trees.

I’m thinking, first, of the June resolution by Rep. Dennis Kucinich, D-Ohio, calling for the impeachment of President Bush. I would venture to guess that most of the reporters who cover Washington, politics or national security probably agree that if any president deserves to be impeached, it’s Bush, for getting the nation into a war on false pretenses, for consenting to the torture of prisoners and innocents, for circumventing the Constitution’s guarantees against illegal searches, wiretaps and the right of habeas corpus.

But Kucinich’s speech introducing his resolution made six paragraphs inside the Washington Post. That was followed by a snotty column by Dana Milbank belittling Kucinich for the more than four hours he spent reading the resolution into the Congressional Record. Another Post blog suggested that his threat to press his resolution would go nowhere and was simply a “fantasy.” He got similar treatment in every other newspaper I read, and even less on television news. Only the British and French press reported it prominently.

But as far as I could see, no one bothered to read or quoted from any of the 35 counts of Kucinich’s resolution, or even tell readers where they might find it. It ran about 70 pages on my printer and I had to get it from the alternative media, like www.buzzflash.com. And it’s worth reading for Kucinich and his staff compiled solid, documented, evidence. Most of it is known, but it’s an impressive compilation, backing up many of the well-reported offenses committed by this president. Much more important than lying about sex.

Why is Bush getting away with it? The Democratic leadership, when it took control of this Congress last year, declared impeachment was “off the table.” And that declaration has remained in force even when new offenses have become known and the prospect of illegally attacking Iran has become possible. So, I wonder what came first, the indifference of the mainstream press, or the decision of the pols (and the president) who read the press?

This indifference and the resulting ignorance of the public, are haunting another issue–the prospect of single-payer, universal health care such as “Medicare for All.” Such a system is now supported by 56 percent of Americans, according to the Associated Press, and, for the first time, by 59 percent of the nation’s physicians. But you would not know that there is such a widely supported proposal awaiting congressional action, if you were reading the mainstream press accounts of a day-long health care forum staged by the Senate Finance Committee at the Library of Congress on June 16.

The Washington Post’s Lori Montgomery was among several reporters, who faithfully recorded the statements of the experts, all agreeing that health-care reform was necessary. But there was no agreement on the solution. Like other reporters, she recounted the possible proposals that were being drafted. By the usual suspects. But there was not a word about the most widely supported piece of legislation that would establish “Medicare for All,” HR 676, introduced early in this session by Judiciary Committee Chairman John Conyers, the veteran Michigan Democrat.

Conyers’ bill, the “U.S. National Health Insurance Act,” would provide health care for all Americans, modeled after Medicare, and would replace other government programs, such as Medicaid, the State Children’s Health Insurance Program, and end need for private insurance and its power over the American health care system. Recently the Conyers bill was endorsed in an overwhelming vote by the New York State Assembly, which has been grappling with health care issues to cover 2.6 million uninsured New Yorkers.

Conyers’ bill, which any reporter can find and read, has the backing of 90 house members, 430 labor unions, including 33 state chapters of the AFL-CIO, and thousands of doctors and nurses. But you wouldn’t know it from the mainstream media, for the possibility of single-payer universal health care, is like a tree that falls without a sound. Which is one reason it has little chance for passage.

Saul Friedman, a 1963 Nieman Fellow, is a former White House correspondent for Newsday and Knight Ridder newspapers and now writes a weekly column, “Gray Matters,” dealing with senior issues, for Newsday.

Taiwan: Surprising Lessons From a Small Island

By John Reichard
CQ HealthBeat Editor

[Excerpts] In the middle of May, two Taiwanese officials, Hou Sheng-Mou and Michael S. Chen, came to Washington facing a tough assignment: promote single payer health care in a city where it’s widely regarded as a non-starter in the debate over revamping the U.S. system.

Their visit didn’t command much attention from reporters covering that debate; countries like the Netherlands or Switzerland that have universal coverage based on strong private health care systems loom larger as potential models for a U.S. overhaul.

Adding to their challenge was that Drs. Hou and Chen hoped to influence U.S. policy in a forum unlikely to compel much attention by mainstream media — an event organized by Michigan House Democrat John Conyers, Jr., a lawmaker who isn’t widely perceived as specializing in health care issues and who, until recently, was regarded as little more than a fringe liberal by the mainstream media.

But to ignore the event meant missing a chance to consider a nation that has successfully grappled with the challenges the United States now faces — intolerable health cost increases and a large uninsured population.

It also meant missing a glimpse of the surprising power the single-payer idea still holds in parts of America’s own health policy community, and the role U.S. academics played in Taiwan’s adoption in 1995 of single-payer health care. The academics’ enthusiasm for the single-payer approach endures more than a dozen years later, despite the emphatic rejection by Congress in 1994 of government-run health care…

“In Taiwan, we have no waiting lists,” says Hou. “In Taiwan, the doctor works on Saturday. They operate on Saturday afternoon.” Moreover, the government does not tell its citizens where they must go for care, he said. Sophisticated information technology is a part of the health system. Each resident of the country carries a “smart card” to entitles them to health care.

“With the smart card you can go to any clinic at any time without an appointment,” Hou said. And there is no “gatekeeper” denying access to specialists, a frequent complaint among Americans about U.S. managed care companies.

This freedom of choice helps improve quality because providers must compete to attract patients, Hou says.

The smart card also contributes to the quality and efficiency of the system by giving doctors a medical profile of the patient and by automating payment. When a provider swipes the card, the patient’s medical history and medications show up on the computer screen and the government is billed for the provider’s services.

Under the Taiwanese system, “everyone is included and at a very reasonable cost,” Hou summarizes.

The climate now in Taiwan is a marked contrast with its situation before its adoption of a single-payer system of universal coverage in 1995. Only 59 percent of the population had health insurance at the time, and health costs were growing at double-digit rates. Now 99 percent of the Taiwan population is covered and health costs are growing between 4 and 5 percent annually.

Hou says the single payer approach is key to keeping costs generally affordable because everyone is in the same insurance pool. That means premium money left over because of the relatively low costs of healthy people can be used to pay for the care of sick people. In a system of multiple smaller insurers, sicker people have a hard time finding affordable coverage because insurers try to make money by appealing to good risks and avoiding bad ones.

Taiwan also relies on global budgets to keep costs under control. Payments are based on a point system that measures the level of health care resources being used. The payment rate per point drops if doctors are ordering so many appointments, tests, and procedures that the cap is likely to be exceeded. Points are recalibrated every three months and doctors respond to changes, seeing fewer patients if point values drop, Hou says. But payment rates for critical care are not adjusted based on utilization, he adds.

Having just one payer eases uniformity of billing and payment systems unlike a system in which multiple insurers compete for profits. Administrative costs average below two percent of all health spending in Taiwan. In the United States, however, administrative costs gobble up 15 to 30 cents of the health care dollar, analysts say…

But there is a missing ingredient in the United States when it comes to universal coverage. “What you do not have is political commitment.”

For single-payer advocates at least, there’s no question Capitol Hill is generally hostile terrain. Many analysts say single-payer systems are underfunded and that adopting one in the United States would choke off the profits needed to fund America’s position as the world’s leader in medical innovation.

Aside from philosophical and economic objections, drug and insurance companies happen to be the source of campaign donations that prop up the political careers of many lawmakers…

The term ‘singe payer’ by itself does not mean government-run. It simply means that all health care bills are paid by a single organization. That entity is usually the government, but the doctors and hospitals it pays may be in private practice or privately owned…

People might think the single-payer approach is bureaucratic and inefficient, but speakers at the forum extolled the efficiency of Taiwan’s system.

Only 1.6 percent of Taiwan’s health care spending goes to administrative costs, while those expenses consume 15 to 30 percent of health care spending in the United States, speakers said. “What is not spent on administration can be spent on other things,” noted Tsung-Mei Cheng, a Princeton University-based health policy analyst who helped design Taiwan’s single-payer plan. “It’s like night and day, or heaven and hell, pardon the word,” she said of the difference in administrative costs.

The nation’s health information system allows timely monitoring of medical conditions for which patients are seeking treatment, assisting efforts to counter threats to public health, speakers said…

A payroll tax of 4.5 percent helps fund the system but employees don’t pay it all; employers and the government also chip in to help pay it. A surcharge on tobacco and lottery revenues also helps fund the system.

And the switch to universal coverage hasn’t led to health care gobbling up a big share of Taiwan’s Gross Domestic Product. Health care accounted for 4.8 percent of GDP before universal coverage was adopted in 1995 and now stands at around 6 percent, Cheng said. In comparison, the United States spends 16 percent of its GDP on health care and has some 45 million uninsured people.

The lesson of Taiwan and other countries with single-payer systems is that “universal coverage is possible without breaking the bank,” said Gerard Anderson, a health policy professor at Johns Hopkins University who helped Taiwan plan its system. “We have our 45, 47, 48 million Americans without health insurance coverage and yet we spend twice as much per capita as most other industrialized countries.”

Countries with single-payer systems also “are able to control health care expenditures over a period of time” at growth rates the same or lower than that of the United States, Anderson added. “And when they go in and decide they are not spending enough money on health care compared to other industrialized countries, they can take action to do this.”

Laura Morlock , another health policy expert at Johns Hopkins University, said that health care is the most popular government service in Taiwan. But the system faces challenges as well, she noted.

“Perhaps the greatest challenge at the moment is their attempt to balance revenues and medical expenditures,” she said. Medical care expenditures are growing at about 5.5 percent while their revenues are growing at an average rate of 4.7 percent. “The shortfall is only about 10 days of their expenditures, still you don’t want that situation to increase.” To insulate those who set premium charges from political pressures, rate increases should be tied automatically to medical expenditure levels, she said…

The Michigan Democrat is the sponsor of legislation (HR 676) that would bring a single-payer system similar to Taiwan’s to the United States. The measure would provide health care to all individuals residing in the United States, virtually wipe out the for-profit health insurance industry and disqualify other for-profit providers from participating and create global budgets to control costs.

Despite American antipathy toward single payer systems, HR 676 boosters seemed upbeat that they could make the bill part of the emerging debate over overhauling U.S. health care.

Momentum is building for single payer health care, claimed Robert Zarr, president of the Washington, D.C. branch of Physicians for a National Health Program. “Let it be clear that there is growing support,” he said. Conyers’ measure has 90 Democratic co-sponsors. Citing a survey published March 31 in the Annals of Internal Medicine, Zarr said that 59 percent of doctors now support the creation of a national health insurance plan in the United States.

Physicians experience fewer hassles because they don’t have to deal with multiple insurance companies, and single-payer systems like Taiwan’s offer easy access to providers, advocates of the systems say.

Doctors in the U.S. may seem to have greater freedom to order tests like advanced medical imaging, but Zarr said some countries offer more MRI and CT scans. They also have higher ratios of nurses and doctors to patients, he said.

Advocates added that the single-payer concept is hardly foreign in America — Medicare is a single-payer system and is popular among seniors…

Asked whether the Taiwan model could be adopted in the United States, Hou noted that one key difference is that in Taiwan, the insurance industry was not particularly opposed to a single payer system, unlike the U.S insurance industry. Taiwanese insurers were more interesting in offering life insurance than health insurance, he said…

But to single-payer die-hards, such talk is beside the point. To them, the real issue is one of morality, the idea that a decent society simply does not permit millions of its citizens to go without adequate health care.

The right leadership is crucial, said one member of the audience who stood up to address the forum.

It turned out be none other than Uwe Reinhardt, the German-born Princeton professor who is perhaps academia’s most passionate advocate for single payer health care. Reinhardt, as it happens, is married to Taiwan-born Cheng, both of whom are now U.S. citizens…

Reinhardt said Americans “act more and more like a people sharing a geography. You don’t have the ethos that goes with being a nation. In Canada, in Taiwan, they view health care as the cement that makes a nation out of a group of people, rich or poor, when they are sick.

“The other thing we need to recover in this country is a sense of shame.

“All the details, the technical details, we can cover that … what we cannot do is get the politics straight. And the politics is just another name for moral tradeoffs,” Reinhardt said.

Hou made a similar point in his interview. In Taiwan, “the social value has it that the government must take care of the people, while Americans believe in self-reliance,” he said. Self-reliance is “respectable,” but the facts show “that it can not solve the problem of the uninsured.

“With strong political leadership, national health insurance is definitely not beyond reach, not so far-fetched,” Hou said.

Under the Taiwanese system, “everyone is included and at a very reasonable cost,” Hou summarizes.