By PAUL KRUGMAN
Op-Ed Columnist
The New York Times
April 20, 2007

The plot against Social Security failed: President Bush’s attempt to privatize the system crashed and burned when the public realized what he was up to. But the plot against Medicare is faring better: the stealth privatization embedded in the Medicare Modernization Act, which Congress literally passed in the dead of night back in 2003, is proceeding apace.

Worse yet, the forces behind privatization not only continue to have the G.O.P. in their pocket, but they have also been finding useful idiots within the newly powerful Democratic coalition. And it’s not just politicians with an eye on campaign contributions. There’s no nice way to say it: the N.A.A.C.P. and the League of United Latin American Citizens have become patsies for the insurance industry.

To appreciate what’s going on, you need to know what has been happening to Medicare in the last few years.

The 2003 Medicare legislation created Part D, the drug benefit for seniors — but unlike the rest of Medicare, Part D isn’t provided directly by the government. Instead, you can get it only through a private drug plan, provided by an insurance company. At the same time, the bill sharply increased payments to Medicare Advantage plans, which also funnel Medicare funds through insurance companies.

As a result, Medicare — originally a system in which the government paid people’s medical bills — is becoming, instead, a system in which the government pays the insurance industry to provide coverage. And a lot of the money never makes it to the people Medicare is supposed to help.

In the case of the drug benefit, the private drug plans add an extra, costly layer of bureaucracy. Worse yet, they have much less ability to bargain for lower drug prices than government programs like Medicaid and the Veterans Health Administration. Reasonable estimates suggest that if Congress had eliminated the middlemen, it could have created a much better drug plan — one without the notorious “doughnut hole,” the gap in coverage once your annual expenses exceed $2,400 per year — at no higher cost.

Meanwhile, those Medicare Advantage plans cost taxpayers 12 percent more per recipient than standard Medicare. In the next five years that subsidy will cost more than $50 billion — about what it would cost to provide all children in America with health insurance. Some of that $50 billion will be passed on to seniors in extra benefits, but a lot of it will go to overhead, marketing expenses and profits.

With the Democratic victory last fall, you might have expected these things to change. But the political news over the last few days has been grim.

First, the Senate failed to end debate on a bill — in effect, killing it — that would have allowed Medicare to negotiate over drug prices. The bill was too weak to have allowed Medicare to get large discounts. Still, it would at least have established the principle of using government bargaining power to get a better deal. But in spite of overwhelming public support for price negotiation, 42 senators, all Republicans, voted no on allowing the bill to go forward.

If we can’t even establish the principle of negotiation, a true repair of the damage done in 2003 — which would require having Medicare offer seniors the option of getting their drug coverage directly, without involving the insurance companies — seems politically far out of reach.

At the same time, attempts to rein in those Medicare Advantage payments seem to be running aground. Everyone knew that reducing payments would be politically tough. What comes as a bitter surprise is the fact that minority advocacy groups are now part of the problem, with both the N.A.A.C.P. and the League of United Latin American Citizens sending letters to Congressional leaders opposing plans to scale back the subsidy.

What seems to have happened is that both groups have been taken in by insurance industry disinformation, which falsely claims that minorities benefit disproportionately from this subsidy. It’s a claim that has been thoroughly debunked in a study by the Center on Budget and Policy Priorities — but apparently the truth isn’t getting through.

Public opinion is strongly in favor of universal health care, and for good reason: fear of losing health insurance has become a constant anxiety of the middle class. Yet even as we talk about guaranteeing insurance to all, privatization is undermining Medicare — and people who should know better are aiding and abetting the process.

Saul Friedman
Newsday
April 21, 2007

As we’ve discussed, “Medicare for All” may seem the simplest and most logical path to universal health care. But the nation’s conservative traditions and the entrenched multizillion-dollar for-profit health care establishment will be formidable obstacles on that path.

It took 20 years of political struggle to get Medicare, and it passed only because an overwhelmingly elected Democratic president, Lyndon Johnson, had veto-proof majorities in both houses of Congress. Such one-party control is not the case now, nor will it be after 2008, unless there is a political earthquake.

Thus, any proposal for universal health care will have to reckon with the combined power of the nation’s richest and most powerful lobbies – the insurance industry and drug manufacturers, as well as medical professionals who make out well in the current system. People are easily fooled by misleading ads. Remember the insurance lobby’s “Harry and Louise”?

My mail shows that while most Americans say they favor publicly supported universal health care and social insurance, including Medicare and Social Security, a vocal minority strongly believes that would lead to socialism or worse. The minority will be aided by a network of right-wing think tanks that never supported Medicare but helped kill the Clinton plan in 1994.

Every Democratic presidential candidate favors one form or another of universal health care. Along with several Republican governors, they have proposed what they believe is a more politically palatable path than Medicare for All – a combination of public and private health insurance. They would mandate that individuals buy insurance and, if necessary, raise revenues to subsidize those purchases.

Most of the more pragmatic proposals reject the single-payer approach, fearing it would run afoul of lobbying campaigns against centralized government control of health care. The latest proposal, called AmeriCare, comes from one of the most liberal members of Congress, Rep. Pete Stark (D-Calif.). Like most others, it would depend on private, for-profit insurance companies to provide health care for the non-elderly.

Even AARP, which earned $379 million in royalties in 2005, mostly from health insurance sales, appears to favor universal public and private health care coverage. AARP endorsed and makes millions from Part D, which is based wholly on private coverage. Last month’s AARP Bulletin reported on various state schemes for universal private coverage, but made only passing mention of the Medicare for All proposals in Congress.

The most comprehensive public-private proposal favored by some liberal groups has come from Yale political scientist Jacob S. Hacker. Writing for the liberal Economic Policy Institute, Hacker said he seeks “to avoid the dismal fate of previous reform campaigns” that ran afoul of budget problems, public resistance to change and “the embedded realities of the present system.”

His proposal, Health Care for America, would “extend insurance to all non-elderly Americans through a new Medicare-like program and workplace health insurance…. Every legal resident of the U.S. who lacks access to Medicare or good workplace coverage would be able to buy into the ‘Health Care for America Plan,’ a new public insurance pool modeled after Medicare….Employers would be asked to either provide coverage as good as this new plan or make a relatively modest payroll-based contribution to Health Care for America.

“It would not eliminate private employment-based insurance….It is not single-payer – a vision that, for both political and budgetary reasons, is unlikely to be achieved in the near future. Nonetheless, Health Care for America does embody many of the key virtues of a universal Medicare-like program.”

Hacker’s plan would put private insurance in competition with a Medicare-type plan to provide coverage that would be guaranteed. “Health Care for America,” he writes, would provide “a generous package of benefits…greater choice.” (See epi.org for the full text of Hacker’s proposal.)

Diane Archer, former president of the New York-based Medicare Rights Center, applauded the proposal as a way to create competition between public and private insurers, and predicted that for-profit insurers would not compete because “they would still try as hard as possible to avoid insuring the people with the costliest conditions.”

President George W. Bush, who opposes government involvement in health care, says universal coverage should be provided only by private insurers. Under his recent proposal, government would grant people more tax incentives – greater deductions – to buy health insurance, perhaps through their employers.

But many of the 45 million workers who are uninsured don’t pay enough taxes to benefit from any deductions. Many cannot afford insurance for themselves and their families, and others can’t qualify because of adverse medical histories.

While the president opposes government health insurance for others, he and his immediate family, including his mother and father, have benefitted most of their lives from government-supplied, taxpayer supported health insurance. And they’ll never be without that coverage. They (as well as Vice President Dick Cheney and members of Congress) earned it with government service. If government coverage is good enough for them, what about the rest of us?

The most cogent criticism of the plans offered by Hacker and several governors came in an editorial by the Des Moines Register. It said that requiring the purchase of health insurance, called “individual mandates,” through employers or subsidies, “is far from simple, especially considering the government absolutely must ensure the coverage it makes people buy is adequate.”

Noting that a Register reader who bought an AARP-endorsed plan for $700 a month ended up with $200,000 in bills when he was treated for cancer, the editorial said, “Our greatest concern is that an individual mandate moves this country in the wrong direction by relying too heavily on the private sector to achieve universal coverage.”

Copyright 2007 Newsday Inc.

Jaime Torres
El Diario
OPINIóN – 04/24/2007

En toda la nación el tema de la crisis en nuestro sistema de salud está candente y la gente está demando a los políticos que la resuelvan. Hay 47 millones de personas sin cobertura médica — 14 millones son hispanos — y más de 50 millones con seguros inadecuados. El Instituto de Medicina reportó que cada año 18,000 personas mueren por falta de cobertura médica.

En salud, los EE.UU. gastan por persona más que cualquier otro país avanzado (casi el doble de Canadá y Francia). Aun así, tenemos la más alta mortalidad infantil y casi la más baja expectativa de vida del mundo desarrollado. Es muy claro que hay mucho sufrimiento y que las propuestas para “mejorarlo” en recientes años han tenido poco resultado.

En mis años como doctor he visto a un hombre perder una pierna porque no pudo pagar por antibióticos para curar una úlcera en un pie; he peleado con aseguradoras por denegar procedimientos necesarios, y he visto niños recibir cuidado deficiente porque tenían Medicaid–un seguro que muchos ven de segunda clase. Es increíble que en el país más rico del mundo haya tanta injusticia y dolor.

Pero los demás países desarrollados brindan atención de salud a todos. La única razón que no tenemos cobertura universal es la espectacular ineficiencia de nuestro sistema. Aunque los EE.UU. gastan $2 trillones en gastos de salud, $600 billones nunca llegan a la gente, pero se usan en gastos administrativos, y para pagar a accionistas y ejecutivos millonarios que nunca han cambiado un vendaje en sus vidas.

Es muy claro que el sistema necesita una cirugía radical. Eli Siegel, el gran filósofo y fundador de la educación Realismo Estético, demostró su falla central cuando explicó que un sistema de salud basado en lucro es inmoral porque está “basado en desprecio por la gente”. El explicó que tan pronto uno está en busca de lucrarse, uno no puede estar muy interesado en lo que otras personas se merecen, lo que sienten, ya que eso restringiría nuestra habilidad de ganar dinero de ellos.

Nuestro sistema no debe depender en que algunos se lucren de las desdichas de otros seres humanos. Cuando aseguradoras, hospitales o médicos ven a pacientes en término de cuánto dinero se puede hacer de ellos es puro desprecio, y es completamente opuesto a desear que se fortalezcan y que sean más saludables

Lo cierto es que podemos dar cobertura a todos en los EE.UU. si expandimos el plan federal Medicare a todas las personas que residan en el país, sin importar su estado migratorio, o su estado de salud. El Medicare es la aseguradora federal sin fines de lucro que ha cubierto eficientemente, y con cuidado de calidad, a nuestras personas mayores.

Esto se lograría pagado con un impuesto que representaría menos de lo que la mayoría de los empleados o de sus empleadores pagan hoy en seguros. Así, en un solo paso, se daría cobertura a los no asegurados, se bajarían significativamente los costos administrativos y se avanzaría en la prevención.

Es por eso que debemos educarnos y demandar a todos los que desean la presidencia de este país a que expandan el Medicare como el seguro médico nacional, donde todos estemos cubiertos, y cuyo único propósito sea mejorar nuestra salud y no obtener ganancias.

es fundador de Latinos por un Seguro Médico Nacional y un Asociado en la Fundación Realismo Estético en NY.

Saul Friedman
Newsday
April 21, 2007

As we’ve discussed, “Medicare for All” may seem the simplest and most logical path to universal health care. But the nation’s conservative traditions and the entrenched multizillion-dollar for-profit health care establishment will be formidable obstacles on that path.

It took 20 years of political struggle to get Medicare, and it passed only because an overwhelmingly elected Democratic president, Lyndon Johnson, had veto-proof majorities in both houses of Congress. Such one-party control is not the case now, nor will it be after 2008, unless there is a political earthquake.

Thus, any proposal for universal health care will have to reckon with the combined power of the nation’s richest and most powerful lobbies – the insurance industry and drug manufacturers, as well as medical professionals who make out well in the current system. People are easily fooled by misleading ads. Remember the insurance lobby’s “Harry and Louise”?

My mail shows that while most Americans say they favor publicly supported universal health care and social insurance, including Medicare and Social Security, a vocal minority strongly believes that would lead to socialism or worse. The minority will be aided by a network of right-wing think tanks that never supported Medicare but helped kill the Clinton plan in 1994.

Every Democratic presidential candidate favors one form or another of universal health care. Along with several Republican governors, they have proposed what they believe is a more politically palatable path than Medicare for All – a combination of public and private health insurance. They would mandate that individuals buy insurance and, if necessary, raise revenues to subsidize those purchases.

Most of the more pragmatic proposals reject the single-payer approach, fearing it would run afoul of lobbying campaigns against centralized government control of health care. The latest proposal, called AmeriCare, comes from one of the most liberal members of Congress, Rep. Pete Stark (D-Calif.). Like most others, it would depend on private, for-profit insurance companies to provide health care for the non-elderly.

Even AARP, which earned $379 million in royalties in 2005, mostly from health insurance sales, appears to favor universal public and private health care coverage. AARP endorsed and makes millions from Part D, which is based wholly on private coverage. Last month’s AARP Bulletin reported on various state schemes for universal private coverage, but made only passing mention of the Medicare for All proposals in Congress.

The most comprehensive public-private proposal favored by some liberal groups has come from Yale political scientist Jacob S. Hacker. Writing for the liberal Economic Policy Institute, Hacker said he seeks “to avoid the dismal fate of previous reform campaigns” that ran afoul of budget problems, public resistance to change and “the embedded realities of the present system.”

His proposal, Health Care for America, would “extend insurance to all non-elderly Americans through a new Medicare-like program and workplace health insurance…. Every legal resident of the U.S. who lacks access to Medicare or good workplace coverage would be able to buy into the ‘Health Care for America Plan,’ a new public insurance pool modeled after Medicare….Employers would be asked to either provide coverage as good as this new plan or make a relatively modest payroll-based contribution to Health Care for America.

“It would not eliminate private employment-based insurance….It is not single-payer – a vision that, for both political and budgetary reasons, is unlikely to be achieved in the near future. Nonetheless, Health Care for America does embody many of the key virtues of a universal Medicare-like program.”

Hacker’s plan would put private insurance in competition with a Medicare-type plan to provide coverage that would be guaranteed. “Health Care for America,” he writes, would provide “a generous package of benefits…greater choice.” (See epi.org for the full text of Hacker’s proposal.)

Diane Archer, former president of the New York-based Medicare Rights Center, applauded the proposal as a way to create competition between public and private insurers, and predicted that for-profit insurers would not compete because “they would still try as hard as possible to avoid insuring the people with the costliest conditions.”

President George W. Bush, who opposes government involvement in health care, says universal coverage should be provided only by private insurers. Under his recent proposal, government would grant people more tax incentives – greater deductions – to buy health insurance, perhaps through their employers.

But many of the 45 million workers who are uninsured don’t pay enough taxes to benefit from any deductions. Many cannot afford insurance for themselves and their families, and others can’t qualify because of adverse medical histories.

While the president opposes government health insurance for others, he and his immediate family, including his mother and father, have benefitted most of their lives from government-supplied, taxpayer supported health insurance. And they’ll never be without that coverage. They (as well as Vice President Dick Cheney and members of Congress) earned it with government service. If government coverage is good enough for them, what about the rest of us?

The most cogent criticism of the plans offered by Hacker and several governors came in an editorial by the Des Moines Register. It said that requiring the purchase of health insurance, called “individual mandates,” through employers or subsidies, “is far from simple, especially considering the government absolutely must ensure the coverage it makes people buy is adequate.”

Noting that a Register reader who bought an AARP-endorsed plan for $700 a month ended up with $200,000 in bills when he was treated for cancer, the editorial said, “Our greatest concern is that an individual mandate moves this country in the wrong direction by relying too heavily on the private sector to achieve universal coverage.”

Copyright 2007 Newsday Inc.

by Rose Ann DeMoro
The Huffington Post
04.11.2007

Listening to the purveyors of conventional wisdom, you might think only an incremental approach on healthcare reform is possible.

The most comprehensive reform, HR 676 in Congress, (and its state versions, such as SB 840 in California), providing guaranteed healthcare as an expanded and improved Medicare for all, is not politically feasible.

So, the pundits insist, settle for what we can get.

Lower the expectations and turn down the public heat, they advise. Gradualism – extending health coverage to some – is the mantra of the day, fawned over by some politicians and advocacy groups alike. The staged appearance of “bi-partisanship” or “strange bedfellows” for health reform is often the only purpose of grand pronouncements of support for universal health care. Whether the proposals actually solves the health care crisis is irrelevant or secondary to the hype.

Virtually all the gradual reforms being touted would reinforce a dysfunctional system with as many standards of care as there are dollars to purchase them. It would further lock us into a private insurance-based model that holds our health hostage to the HMOs and big insurance companies for years to come.

For the proponents of political expediency, the question remains who will be left behind while we wait?

Every year, 18,000 unnecessary deaths, the equivalent of six times the number who died in the September 11 attacks, are linked to lack of health coverage.

Among those un-covered, lung cancer patients are less likely to receive surgery, chemotherapy, or radiation treatment. Heart attack victims are less likely to receive angioplasty. People without pneumonia are less likely to receive X-rays or consultations. Those with colorectal cancer are 70% more likely to die within three years.

The uninsured receive less preventive care, are diagnosed at more advanced disease stages, and receive less therapeutic care (drugs and surgical interventions). Not only do they incur greater pain and suffering down the road, they also face increased cost, at a time when medical bills already account for half of all personal bankruptcies and one third of credit card debt.

The public is fed up, and they’re ahead of the politicians and policy wonks. A New York Times/CBS poll last month found that 64% said the government should guarantee health insurance for all, 55% identified it as the top domestic priority for Congress and the President.

As the polls show, we have the greatest opportunity in years to achieve fundamental reform. Yet the gradualist approaches would undercut the momentum and squander that opening.

Our most successful national health program, Medicare, provides one of the best arguments against incremental steps. When Medicare was enacted 42 years ago, following a broad grassroots campaign, many believed the dream of a full national health system was right around the corner.

Four decades later, Medicare has not been expanded. Most of the changes have been contractions – higher out of pocket costs for beneficiaries and repeated attempts at privatization by the healthcare industry and its champions in the White House and Congress.

Similarly, incremental healthcare reforms in Maine, Massachusetts, Minnesota, Washington, Vermont, and Tennessee, that were supposed to lead to universal coverage failed to produce any real reduction in the number of uninsured.

Moreover, by pushing further away the day of real reform, we open the door to some of the worst alternatives, from the Bush administration tax schemes to the current fad of forcing everyone to buy insurance.

Both of these schemes end up saddling people with high deductible insurance plans that more and more people are finding accelerate the healthcare crisis.

In January, a vice president of the Kaiser Family Foundation testified to Congress that one in six privately insured adults have “substantial problems paying their medical bills.” And, a new study this week by Harvard Medical School researchers in the Journal of General Internal Medicine documented that the financial burden of such plans is especially onerous for women who typically need more routine medical visits than men, and thus bear double the out-of-pocket costs.

It’s time to stop promoting inferior approaches and insist on real reform.

American history is filled with examples of fundamental, democratic change brought about by mass action and public pressure against the counseling of the go slow crowd. We can and must achieve that in healthcare as well.

Jaime Torres
El Diario
OPINIóN – 04/24/2007

En toda la nación el tema de la crisis en nuestro sistema de salud está candente y la gente está demando a los políticos que la resuelvan. Hay 47 millones de personas sin cobertura médica — 14 millones son hispanos — y más de 50 millones con seguros inadecuados. El Instituto de Medicina reportó que cada año 18,000 personas mueren por falta de cobertura médica.

En salud, los EE.UU. gastan por persona más que cualquier otro país avanzado (casi el doble de Canadá y Francia). Aun así, tenemos la más alta mortalidad infantil y casi la más baja expectativa de vida del mundo desarrollado. Es muy claro que hay mucho sufrimiento y que las propuestas para “mejorarlo” en recientes años han tenido poco resultado.

En mis años como doctor he visto a un hombre perder una pierna porque no pudo pagar por antibióticos para curar una úlcera en un pie; he peleado con aseguradoras por denegar procedimientos necesarios, y he visto niños recibir cuidado deficiente porque tenían Medicaid–un seguro que muchos ven de segunda clase. Es increíble que en el país más rico del mundo haya tanta injusticia y dolor.

Pero los demás países desarrollados brindan atención de salud a todos. La única razón que no tenemos cobertura universal es la espectacular ineficiencia de nuestro sistema. Aunque los EE.UU. gastan $2 trillones en gastos de salud, $600 billones nunca llegan a la gente, pero se usan en gastos administrativos, y para pagar a accionistas y ejecutivos millonarios que nunca han cambiado un vendaje en sus vidas.

Es muy claro que el sistema necesita una cirugía radical. Eli Siegel, el gran filósofo y fundador de la educación Realismo Estético, demostró su falla central cuando explicó que un sistema de salud basado en lucro es inmoral porque está “basado en desprecio por la gente”. El explicó que tan pronto uno está en busca de lucrarse, uno no puede estar muy interesado en lo que otras personas se merecen, lo que sienten, ya que eso restringiría nuestra habilidad de ganar dinero de ellos.

Nuestro sistema no debe depender en que algunos se lucren de las desdichas de otros seres humanos. Cuando aseguradoras, hospitales o médicos ven a pacientes en término de cuánto dinero se puede hacer de ellos es puro desprecio, y es completamente opuesto a desear que se fortalezcan y que sean más saludables

Lo cierto es que podemos dar cobertura a todos en los EE.UU. si expandimos el plan federal Medicare a todas las personas que residan en el país, sin importar su estado migratorio, o su estado de salud. El Medicare es la aseguradora federal sin fines de lucro que ha cubierto eficientemente, y con cuidado de calidad, a nuestras personas mayores.

Esto se lograría pagado con un impuesto que representaría menos de lo que la mayoría de los empleados o de sus empleadores pagan hoy en seguros. Así, en un solo paso, se daría cobertura a los no asegurados, se bajarían significativamente los costos administrativos y se avanzaría en la prevención.

Es por eso que debemos educarnos y demandar a todos los que desean la presidencia de este país a que expandan el Medicare como el seguro médico nacional, donde todos estemos cubiertos, y cuyo único propósito sea mejorar nuestra salud y no obtener ganancias.

es fundador de Latinos por un Seguro Médico Nacional y un Asociado en la Fundación Realismo Estético en NY.