WILLIAM CONNOLLY, Columnist
The Evansville Courier & Press
Sunday, January 21, 2007

According to a recent Parade Magazine article by David Wallechinsky, patriotic sentiments notwithstanding, while the United States is still No. 1 in some respects – Nobel prize winners, billionaires and armed forces stationed in other countries – we lag far behind in other categories that more accurately assess social well-being. We lag behind other countries when it comes to health care. Thirty-three countries, including Cuba, have lower infant death rates; 43 have more physicians per capita, including France, Switzerland, Mongolia and Lebanon; and 49 have more hospital beds per capita, including England, Italy and Ireland.

We rank 29th in maternal death rate, 30th in life expectancy for women and 28th for men. All this despite our spending more per capita on health care ($5,700) and as a percentage of gross domestic product (more than 15 percent), higher than any other country.

So why don’t we do better? Perhaps this is a matter of lifestyle. We consume too many calories – we’re No. 1 in obesity. Despite being obsessed with sports, most of the time we are only spectators, not participants. We are inactive at all ages. We have the 15th highest murder rate.

The data also reflect an ailing health-care system, afflicted with confusing, conflicting and inefficient ways of financing care. Most comes from private insurance tied to employment. That system leaves more than 45 million Americans uninsured.

Because the system is composed primarily of the working poor, they end up served by inadequately funded public assistance. They postpone treatment and rely on more expensive emergency care, funded indirectly by the insured. This indirectly increases their costs. As the U.S auto industries have learned, the costs further harm their global competitiveness.

But there is some good news on the horizon. While Washington has provided little leadership, states are beginning to explore alternatives. California Gov. Arnold Schwarzenegger recently promoted an ambitious plan to provide coverage for all Californians. His goal is commendable because his plan promises universal coverage, requiring all to buy health insurance.

Those who cannot afford it will be provided financial assistance. Insurance companies are required to sell insurance to everyone at the same price. It would enable people to obtain preventive care rather than wait for more expensive emergency care. Since insurers have to provide coverage to everyone, they would not waste resources trying to deny coverage. This would allow for more spending on actual care. Furthermore, insurers would have to spend at least 85 percent of premiums on health care, which is quite the improvement.

The program will, however, result in substantial government intrusion to ensure that people buy insurance. It will also determine who will receive assistance and police insurers, guaranteeing their compliance. All of this seems necessary to keep insurance companies in the game. This may make Schwarzenegger’s proposal more politically appealing to insurance companies that plan to do well in this program. However, this complex interplay of private insurers and government killed the Clinton proposals in the early 1990s.

Why not eliminate the middleman and opt for a single-payer system similar to Medicare, contributed to by everyone, including employers? It would be simpler – and cheaper – for employers and health-care providers.

This is a worthwhile debate. While I believe a single-payer system would be better, Schwarzenegger deserves credit for bringing the issue to the table.

http://www.courierpress.com/news/2007/jan/21/us-should-focus-on-finding-cure-to-health-care/?printer=1/

(c) 2006 The Evansville Courier Co.

By Guy T. Saperstein
AlterNet
Posted January 16, 2007

Our $2 trillion healthcare industry is not only unhealthy, it is unsustainable. Why universal Medicare is the way to get universal healthcare without collapsing the system.

We all know that America’s healthcare system is collapsing. Andy Stern has written that America’s employer-based health insurance system is “dead.” Auto executives troop to the White House complaining that they are not competitive with foreign automakers because they pay $1,500 per car for health insurance. Some of the biggest laughs in movies come when America’s healthcare system is ridiculed. Politicians, even Republicans, are offering solutions.

In the Greenberg Quinlin poll of November 2006 voters, 22 percent ranked healthcare as the most important issue; likewise, MoveOn.org recently polled its members, received over 100,000 responses, and healthcare ranked as the No. 1 concern

To add substance to these observations, consider the following: Not only are 47 million Americans uninsured (approximately 18.5 percent of the insurable market), 41 percent of Americans with incomes of $20,000 to $40,000 did not have health insurance for at least part of 2005, up from 28 percent in 2001; 53 percent with incomes under $20,000 lack health insurance.

The number of people without health insurance rose 16.6 percent from 2001 to 2005; average health insurance premiums for a family of four are $10,880, which exceeds the annual gross income of $10,712 for a full-time, minimum-wage worker; lack of insurance causes 18,000 excess deaths a year; people without health insurance have 25 percent higher mortality rates; and, 59 percent of uninsured people with chronic conditions such as asthma or diabetes skip medicine or go without care.

There are additional costs to the haphazard U.S. healthcare system: More than 50 percent of the U.S. population has medical debt problems; between 1981 and 2001, medical-related bankruptcies increased an astounding 2,200 percent and 55 percent of personal bankruptcies are now caused by illness or medical debts, despite the fact that over 75 percent of the bankrupts had health insurance at the onset of bankruptcy and illness.

Contrary to popular conceptions, the average medical bankrupt was a 41-year old woman with children, some college education; over half owned homes and over 80 percent were in the middle or working classes.

But for the insured, the United States has the best quality healthcare in the world, right? Wrong.

A Second-Rate System

The World Health Organization ranks healthcare systems based on objective measures of medical outcomes: The United States’ healthcare system currently ranks 37th in the world, behind Colombia and Portugal; the United States ranks 44th in the world in infant mortality, behind many impoverished Latin American countries. While infant mortality in the United States is skewed toward poor people, who have rates double the wealthy, the top quintile of the U.S. population has infant mortality rates higher than Canadians in the lowest quintile of wealth.

Out of 30 developed nations, life expectancy in the United States ranks 21st; life expectancy in the United States is 4.6 years less than Japan, 2.1 years less than France and 2.6 years less than Canada. The United States has fewer physicians, nurses and hospital beds than most developed nations. In the United States, 28 percent say it is “difficult to get care”; in most European countries, Japan, Australia and New Zealand, 15 percent say that. In terms of continuity of care (i.e., five-plus years with the same doctor), the United States is the worst of all developed nations. By every objective measure, the United States has a second-rate healthcare system.

OK, the U.S. healthcare system is not performing very well, but that must be a funding problem, right? Wrong.

The Truth About Healthcare Costs

The United States has the most expensive healthcare system on the planet. Even including the 47 million uninsured, the U.S. healthcare system costs almost double per capita what single-payer systems in Europe, Japan and Canada cost; in the United States, healthcare costs were $5,635 per person in 2005.

By contrast, in Japan, with life expectancy 4.6 years more than the United States (presumably a cost-increasing factor), healthcare costs were $2,139 per person; in the United Kingdom, $2,232; Sweden (the ultimate “welfare state”), $2,520; France, $2,903; and, Canada, $3,001.

And, this is not just an individual problem; this is a national problem. Healthcare system costs in the United States are 16 percent of GNP (and currently increasing 14 percent per year); no other country in the world has healthcare costs which exceed 11 percent of GNP and the average among developed nations is 9 percent. As noted above, these high costs are making the U.S. uncompetitive in many areas.

Why is the U.S. healthcare system so expensive? Administrative costs, marketing and profits account for 22 to 31 percent of the U.S. healthcare dollar (I recently heard Edward Kennedy say these costs were 33 percent, but I have not seen documentation of that number). By contrast, overhead costs in single-payer systems (including Medicare) typically are 3 percent.

In America’s for-profit private insurance healthcare system, medical technicians must contend with hundreds of different forms, billing procedures, regulations and requirements from hundreds of insurance companies; U.S. healthcare companies spend money for advertising and marketing; and, the U.S. healthcare system is based on profit. Since 1970, the number of medical doctors in the United States has increased 40 percent, while the number of medical administrators has increased almost 3,000 percent.

We are paying for a massive, inefficient bureaucracy. The increasing cost of prescription drugs also is increasing the healthcare bill, and U.S. drug costs are the highest in the world; Americans pay 30 percent to 80 percent more for prescription drugs than citizens of any other country.

You might think that this excess money goes into developing new drugs, but you would be wrong: Only 13 percent of drug costs go to research and development, and little of that goes for pioneering new drugs to deal with life-threatening conditions; 51 percent goes to marketing, administration and profits.

Recently, one of my adult sons went to a medical office for testing. On completing the tests, he was handed a bill. The bill had two prices: One was the insurance price, $969.25, the second was the “cash pay price,” $678.00 — exactly 30 percent less than the insurance price. What more do you need to know about the excessive cost and inefficiency of the American private health insurance system than that it costs 30 percent more than the underlying medical services are worth?

The public understands this. In the California Field Poll released on Jan. 3, 2007, California voters were asked why healthcare costs are increasing: The No. 1 reason given by voters was “high profits” (65 percent); the number two reason was “waste, fraud and inefficiencies in the current system” (60 percent).

The answer to this problem is not simply “universal health insurance.” “Universal healthcare” that does nothing more than bring more people into the most expensive and inefficient private insurance-based healthcare system on the planet would accelerate the total collapse of the system for everyone.

No credible economist thinks America can sustain healthcare costs exceeding 20 percent of GNP (itself a gigantic burden and drag on economic growth) and adding 47 million more people to the current decrepit system would bring the United States to the 20 percent threshold. Since the costs of our private insurance system currently are rising at the rate of 14 percent per year, the system is unsustainable, by any rational economic analysis.

Single-Payer Solutions

Howard Dean recently identified healthcare as an emerging top-tier political issue and endorsed single-payer, saying at a Democracy Alliance conference in Miami, “It is obvious we are going to need to work toward some form of single-payer system, just like every other industrialized nation. In the next two years, we should expand Medicare and Medicaid to cover every uninsured person under 25.” Dean is an M.D., by the way.

Surely the healthcare system which every other industrialized nation in the world relies on, which is both less expensive and offers improved medical outcomes, and which many think is the only viable and sustainable healthcare system, deserves serious consideration by American progressives and the public, but, to date, single-payer is not being researched and evaluated in America.

I am not arguing that the perfect must be the enemy of the good; there may be intermediate steps that could be taken, rather than proposing that America swallow the big enchilada in one bite. Clearly, Howard Dean’s proposal to cover everyone under 25 is a step down the incremental path, and, as he suggested, probably not even a very expensive one.

What is unacceptable would be to have a political debate which could change healthcare in America for the next 20-30 years, or more — in the process helping to decide elections — without sound progressive ideas and input and without serious consideration of single-payer.

The biggest objection to single-payer I have heard from Democrats is not that single-payer is not a good system, or even the best system, but that it will be attacked as socialized medicine and therefore is not politically viable. Of course, a single-payer system is not socialized medicine.

Medicare is a single-payer system — a very popular one, by the way — and single-payer systems such as Medicare do not employ any doctors or own any hospitals or medical facilities, let alone create bureaucracies approximating the bloated, inefficient bureaucracy the private insurance model has created in America.

Rather than hundreds of payers (insurance companies) and thousands of different forms, regulations and procedures, there would be one payer and one set of forms and procedures. Single-payer also would offer more choice of medical providers; unlike the current system, where patients are limited to panels of providers, in a single-payer system, patients go to any doctor they want, submit a national health insurance card and the government pays — just like Medicare.

Single-payer is the simplest, most efficient, system of all. While single-payer is a government-paid program, American taxpayers already pay more than 60 percent of healthcare costs in America (including tax subsidies). With that much money invested, can’t we demand a system that covers everyone at reasonable cost and with improved performance? Why should we continue to allow 22 percent to 31 percent of healthcare costs to be swallowed by bureaucratic inefficiencies, marketing and profit?

John Garamendi, formerly California’s insurance commissioner and now lieutenant governor, campaigned in favor of single-payer and said repeatedly on the stump: “Are you aware that for 40 years, the United States has had a universal single-payer healthcare system that allows every participant to choose their own doctor, its administrative cost is one-tenth the cost of private insurance and people do everything possible to get into the system (i.e., live to 65). It is Medicare, and no one calls it socialized medicine.”

Insurance Industry Wrath

Of course, the real reason people back away from a single-payer system is fear of insurance industry wrath. We all remember the “Harry and Louise” ad campaign the health insurance industry unleashed on HillaryCare 12 years ago. So, is anyone not afraid of the insurance industry? Is anyone willing to challenge insurance industry profits?

The answer, surprisingly, not only is yes, but the person apparently willing to take on the big ugly bear is a pro-business Republican — The Terminator.

On Jan. 8, California Gov. Arnold Schwarzenegger unveiled his plan to insure all Californians, and while the proposal itself continues to rely on the private insurance model, it provides that insurance companies would be required to spend 85 percent of their revenues on medical services; in other words, insurance company overhead, marketing, administrative costs and profits, would be capped at 15 percent — roughly half of what they currently are.

Does anyone think the insurance industry is not going to fight this incursion on its profits with all its might? Of course it will, and it will fight a halving of its profits just as vigorously as it will fight a single-payer system.

So, if a Republican, pro-business governor of a major state is willing to take on the insurance industry, should progressives be any less courageous in pursuit of real healthcare reform? In short, a very gifted Republican politician has made a calculated decision that fighting the insurance industry not only is not going to hurt him politically, it is going to get him elected to the United States Senate in 2010. It is good politics.

The other political objection to single-payer I have heard is that it is simply too big an idea and too big a proposal.

While this objection is debatable, single-payer need not be adopted whole in one bite; it can be adopted and implemented piece-meal, just as Howard Dean suggested when he said in the next two years we should work to cover the uninsured under age 25 in an expanded Medicare.

There are other inclusions which could be adopted incrementally, such as expanding Medicare to include everyone with incomes under $20,000 per year, then increasing income thresholds until everyone is covered; or, it would be possible to work in age-based increments by expanding Medicare into ever-younger categories of Americans. Conservatives understand the power and effectiveness of “slippery slope” proposals (banning partial birth abortion is one such “slippery slope”).

Let’s put the healthcare agenda on the “slippery slope” to Medicare for all, not work toward more private insurance and inevitable healthcare system insolvency — where most current healthcare proposals (including Democratic) are headed.

Before leaving the subject of political viability, let me briefly address the healthcare proposal put out by the Center for American Progress, which threatens to become the Democratic Party proposal. In general, CAP’s proposal would provide coverage for the uninsured through the existing private insurance system, funded by a national ad valorem (i.e., sales) tax. I had a long conversation with CAP’s CEO, John Podesta, shortly after it was published, and while John is intellectually honest enough to recognize the advantages of single-payer, his advocacy of the CAP plan was more based on political viability than operational efficiency or effectiveness.

In any case, trying to impose a regressive national sales tax to fund insurance for 47 million people through an expensive, inefficient system not only makes no economic sense, I fail to see how it would be politically attractive, or even politically possible. It would make Democrats look like your daddy’s Democratic Party — you already can hear the Republicans, “Here they go again, another big, costly Democratic welfare program.”

By contrast, a single-payer system could cover everyone, including the 47 million uninsured, at a net cost-savings, as the savings obtained by cutting overhead from 22-31 percent down to 3 percent would more than pay for providing coverage for the 47 million currently uncovered. It makes far more sense to approach healthcare reform as an issue which affects everyone, than it does approaching it as an issue that affects only the poor, to be solved by another welfare program, funded by more taxes — in this case, a regressive tax.

America’s current healthcare system works well for no one, and it would be better to seek a genuine progressive fix on the basis that we’re all in this together and need to find solutions that work for everyone, rather than special pleading for some at the expense of others. The uninsured have to be covered, to be sure, but let’s do it in the context of solving the real problems of American healthcare, not exacerbating the structural problems of the current system.

A System in Collapse

Healthcare is a $2 trillion industry in America, and we are fast approaching a “perfect storm,” where individual consumers, voters, business and the government are beginning to realize the current healthcare system not only is not healthy, it is unsustainable. Is the range of discussion of “serious” healthcare proposals limited to proposals that offer only variations on the failed private insurance model? Howard Dean apparently doesn’t think so.

If progressives are going to project progressive solutions and be part of this debate, they will need to do so quickly because the system is fast-collapsing and decisions are going to be made with or without us.

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Guy T. Saperstein is a Democracy Alliance partner and past president of the Sierra Club Foundation; previously, he was one of the National Law Journal’s “100 Most Influential Lawyers in America.”

Rose Ann DeMoro
TomPaine.com
January 16, 2007

Rose Ann DeMoro is executive director of the California Nurses Association.

Sparked by the embarrassment of nearly 47 million uninsured Americans and, more notably, the growing agony of even large business that are staggering under intolerable premium costs, our long national health care scandal is finally beginning to prod our political leaders into action.

Unfortunately, many of the proposals being promoted with such fanfare may well exacerbate the crisis and simply prolong the disgrace.

The latest example comes from California Gov. Arnold Schwarzenegger, who has pledged to achieve “universal” coverage for all the state’s residents with a smorgasbord of every scheme floating around the national policy debate–with the exception of the only one that would actually work: some form of a national health care program or single-payer system, the course taken by every other industrialized country.

Like the Massachusetts law before it, on which it is largely modeled, the Schwarzenegger plan has produced fawning editorials across the country and calls from some politicians in state capitals and on Capitol Hill to use it as a blueprint for other states and Washington.

It has as its centerpiece a mandate forcing every individual buy health insurance or face penalties, along with state subsidies for the low income to buy insurance, a limited tax on businesses who fail to provide health benefits and promotion of health savings accounts.

All the components have a common theme: reinforcement and expansion of the role of the market in health care, the very same market that created the current mess by placing the pursuit of increased revenues and profits ahead of increased access, affordable care and enhanced quality.

Nothing better symbolizes the ascendancy of the market than the mandate on individuals to buy insurance. It stands the central premise of health care on its head–to help people, not to criminalize them. And the Schwarzenegger plan goes beyond Massachusetts, which simply sets tax penalties, by proposing that health insurance become a pre-requisite to getting a job or enrolling your children in school.

Individual mandates shift all the risk from insurers or government onto the back of individuals. Neither the Massachusetts nor the California plan includes limits on premiums or standards to assure the plans have comprehensive or uniform benefits.

With ever-escalating premiums, it’s a safe bet that the average family not eligible for the low-income subsidies will opt for the bare bones plan which, Schwarzenegger has recommended, would specify deductibles of up to $10,000.

Most would thus end up paying for most, if not all, of the health care services they actually use, in addition to the premiums the law would force them to buy. Further, many would simply gamble with their health by limiting medical visits and the prevention that is critical to reducing greater pain and suffering and higher overall healthcare costs down the road.

Someone is making a killing here, and you probably guessed who: California insurers would reap hundreds of millions in profits from the 6.5 million new customers marched into their offices at gunpoint by the state. No wonder Blue Shield of California CEO Bruce Bodaken says of the plan, “There’s a lot to like.”

It reflects a neoconservative political ideology that individuals are solely responsible for their health status, ignoring corporate and commercial factors, from cancer-causing pollution to contaminated agriculture to fast food.

California’s model also undermines the social structure of pooled insurance–that healthier and younger individuals help pay the health costs for the less healthy through collective insurance pools. These would ultimately help everyone who will eventually need coverage, while reducing overall health care costs that mount when large numbers don’t have or don’t use health services.

Another stellar example of that free market fundamentalist philosophy is health savings accounts, a side product of the Bush administration’s 2003 Medicare drug benefit fiasco.

HSAs are tax-free savings accounts to be used solely for out-of-pocket medical expenses, typically used in combination with a low-cost, high deductible catastrophic health insurance plan, in most cases offered by an employer as a cheaper alternative to the health benefits they currently provide. Like the Bush tax cuts, they ultimately look like another tax break for the wealthy.

HSAs bear strong similarities to individual mandates in encouraging the user to play Russian roulette with their health and discouraging the use of preventive care–hence the euphemism “consumer-driven care,” which could also be termed “lack of meaningful insurance” or “no care.”

And, like individual mandates, HSAs do nothing to control rising costs or to reduce administrative waste. In fact, HSAs add a new layer of bureaucracy and profit to yet another well-heeled industry that will of course operate and manage the accounts–the financiers. The banks are scrambling to get into this booming new market and expecting $20 billion in HSA accounts by 2010.

There’s a better way. The opportunity has never been greater to mount a national campaign for real reform for a single payer system, as is embodied in H.R. 676 in Congress or S.B. 840 in California.

Single-payer plans, like Medicare, have everything the market-based plans lack:

Americans will be covered with one high standard of benefits and care–as opposed to good care for the wealthy only–and portable. They assure choice of physician and other providers. By removing financial roadblocks to care, they emphasize prevention.

Single-payer plans reduce administrative waste (about three percent in Medicare, vs. over 30 percent with most private insurance), thus producing cost savings. They allow for common sense budgeting in which care, not profit is the primary focus, and they end the disgraceful insurance industry interference with care. And, they are accountable through public oversight.

H.R. 676, introduced by Rep. John Conyers, D-Mich., now has 78 congressional co-sponsors, and should get a hearing in the new Congress. California’s SB 840 was vetoed by Schwarzenegger last fall but will be re-introduced.

It’s time we joined the rest of the world in achieving this basic humanitarian right.

By Joe Conason
Salon.com
Jan. 12, 2007

Sometime during the hours before the advent of the new year, alone in a modest apartment in Arlington, Va., a woman named Maria Leavey died of heart failure. Had she lived until the morning of Jan. 1, 2007, she would have been able to celebrate her 53rd birthday.

Though very few of those now reading this column have ever heard of her, Maria was a highly effective advocate of progressive causes, a consultant and confidant to important Democratic political leaders, and an encouraging mentor to many young activists and writers on the left. Over the past two weeks, on the Huffington Post and many other sites small and large in the progressive blogosphere, as well as on private e-mail lists, her mourning admirers and acquaintances have poured out memories of an extraordinary person who really cared more about social progress than personal ambition.

An old joke about left-wingers is that they love humankind with all their hearts but just don’t like people all that much. Maria confounded that stereotype with startling acts of kindness to people she had never even met. Born in Pisa, Italy, where her father was then stationed in the U.S. Army, and raised in an Irish Catholic clan in Queens, N.Y., she was old-fashioned in the best sense. She baked cookies, worried a lot about other people, and was appalled by the crass and the selfish.

In those ways, she certainly stood out from the pack of Beltway consultants and other hustlers who make a very good living in the orbit of the Democratic Party. Whip-smart but polite and soft-spoken, she didn’t fit in among the self-important loudmouths who have banked millions of dollars while losing for their clients one election after another.

She would never consider selling her talents to lobby for a tobacco company, a software monopoly, a foreign despot or an insurance corporation, as so many of her “progressive” peers have done to supplement their enormous incomes. (Those tend to be the famous Democratic “strategists” who appear on cable TV.) She preferred to work on her own rather than in a firm or a partnership. She could be quirky and difficult, but she also had enormous integrity.

I know all this because for the past nine years, she was also a good friend of mine.

While Maria led an exemplary life in many respects, however, there is also something to be learned from her early death. As the Washington Post noted in a sensitive obituary on Jan. 6, she managed to connect with important figures on Capitol Hill, including Senate Majority Leader Harry Reid and Speaker Nancy Pelosi, in addition to her media contacts, despite the fact that she “had no money to spread around.” And as the Post obit also mentioned, as someone who worked independently, “she had no health insurance.”

She had no health insurance — which meant that the hereditary heart condition that killed her probably went undiagnosed and untreated. That almost certainly killed her, as the lack of regular care prematurely kills thousands of other Americans every year. And while she was acutely aware of how that problem affected her fellow citizens, and worked hard every day to change that injustice, she was unable, like so many who work freelance and in small business, to help herself.

If her many friends among the great and the good in Congress need any further motivation to fight for universal healthcare, then Maria’s untimely and perhaps unnecessary death should be enough. She had no illusions about the Democrats, but she toiled for years to return them to power in the hope that they would fulfill such promises.

Meanwhile, what happened to her ought to chasten the progressive community, such as it is. She often worked for free — or got stiffed on her very reasonable bills — while the nonprofit executives and politicos who exploited her talents took down big salaries. Laboring behind the scenes, frazzled and distracted by her many commitments, and too proud to complain publicly, she wasn’t very good at fighting on her own behalf.

The larger issue is an enduring mind-set on the left that values programs over people and expects everyone (except the donors and those at the top of the career ladder) to live like monks. This is stupid as well as mean. The irony is that conservative groups, whose leaders are often stereotyped as stingy and heartless, tend to provide far better conditions for their troops than progressive organizations do. The right may or may not have more money, but it has used what it has to provide a living for the people who build its institutions, which have thrived as a result.

Maria deserved much better — and so do the many like her who accept low wages to uphold their ideals. Being able to pay the rent, get health insurance and even take a vacation would not corrupt them.