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TNR Editorial on Compromise

TNR Editorial on Compromise

Mr. Universe

by the Editors
The New Republic
January 29, 2007

For years, Republicans have attacked advocates of universal health insurance as “socialists.” But what are they going to call Arnold Schwarzenegger? Last Monday, the Republican governor announced that he wants to bring universal coverage to California–just as another Republican governor, Mitt Romney, recently did for Massachusetts.

When prominent Republicans start embracing universal coverage, it’s a sign that the next great debate about health care has begun.

But how will it end? A lot depends on how liberals react to proposals like Schwarzenegger’s. On the one hand, his plan represents a clear departure from the previous decade, when even Democrats limited themselves to incrementalism. It would give coverage to virtually every California citizen and would break some important political taboos along the way. The plan features extensive regulations of the insurance industry, so that it cannot exclude people with prior medical conditions. It also has higher taxes and requirements that employers contribute toward health insurance. There is even bigger government, in the form of expanded Medicaid.

Still, the plan has some serious drawbacks. For one thing, its minimum-benefits package seems meager, which could encourage employers who now offer more generous coverage to cut back. For another, its financing scheme makes some heroic assumptions about the savings that reform will produce.

But perhaps the biggest problem with Schwarzenegger’s plan is the danger that it could stall momentum for more sweeping changes–both in California and beyond. His proposal arrives on the heels of a measure he vetoed last year that would have created a single-payer system–the most comprehensive type of reform, in that it seeks to blow up the entire health care system and have government insure citizens directly. Yet even people who support single-payer may be tempted to rally around schemes like Schwarzenegger’s, which have more limited ambitions, because they might fear their preferred plans couldn’t pass.

But it’s not self-evident that moderate plans are so politically viable, either. Consider what happened to Bill Clinton, who tried desperately to blunt the opposition of special interest groups and get past Americans’ well-known skepticism of government.

At the very least, it’s premature for would-be reformers to “settle” on a plan that, like Schwarzenegger’s, has some major flaws. If this plan defines the outer limits of political acceptability, then whatever compromise it finally produces will likely have even greater deficiencies.

Yes, champions of universal coverage should welcome the likes of Schwarzenegger to their cause. But these common areas of belief should be the beginning of discussion, not the end. There is a time for compromise, and that time will come soon enough. But, right now, advocates of universal health care should speak openly and unabashedly about what they actually believe is right, even if that means proclaiming ambitions that defy conventional notions of the politically possible. That is how you stretch the boundaries of debate. And that is how reform, eventually, will happen.

http://www.tnr.com/doc.mhtml?i=20070129&s=editorial070129

Comment:

By Don McCanne, MD

The voices of compromise are very loud right now. Ours must be heard loud and clear above the din.

Proposal of the Health Coverage Coalition for the Uninsured

Expanding Health Care Coverage in the United States: A Historic Agreement

Health Coverage Coalition for the Uninsured
January 18, 2007

Signatory organizations:
AARP, America’s Health Insurance Plans, American Academy of Family Physicians, American Hospital Association, American Medical Association, American Public Health Association , BlueCross BlueShield Association, Catholic Health Association, Families USA, Federation of American Hospitals, Healthcare Leadership Council, Johnson & Johnson, Kaiser Permanente, Pfizer, UnitedHealth Group, U.S. Chamber of Commerce

A diverse group of 16 major national organizations with an abiding interest in accessibility to quality health care have reached a consensus on policy approaches to expand health coverage to as many people as possible as soon as possible.

Phase I: The “Kids First” Initiative and State Experimentation

Public Program Enrollment

…improve enrollment of children who are uninsured but currently eligible for SCHIP (State Children’s Health Insurance Program) and Medicaid.

Family Tax Credit

…creates a new family tax credit for the purchase of children’s health coverage…

State Demonstration Program

…establishes a state demonstration program giving states flexibility to experiment with new approaches that expand health coverage. Competitive grants would be provided to the states…

Phase II: Longer-Term Policy Recommendations

Public-Sector Proposals

…allow states to eliminate family status as an eligibility requirement and determine eligibility for Medicaid coverage based exclusively on financial need.

Private-Sector Proposals

Make… tax credits available for individuals and families with incomes between 100 and 300 percent of the federal poverty level for the purchase of health coverage. …graduated on a sliding scale based on income.

Provide federal grants to states in order to provide health coverage for high-risk populations.

Coalition’s home page:
http://www.coalitionfortheuninsured.org/

The “Historic Agreement:”
http://www.coalitionfortheuninsured.org/pdfs/agreement.pdf

Comment:

By Don McCanne, MD

What a tragedy. Health care coverage, affordability and access are rapidly deteriorating at an accelerated pace, and this is the best that this coalition of influential organizations can come up with.

They propose moving reform forward a couple of inches when we are sliding thousands of miles backwards.

You can cross this group off your list.

Marchers rally for single-payer health care

by Lorna Benson
Minnesota Public Radio
January 15, 2007

Single-payer health insurance advocates recalled the words of Dr. Martin Luther King on Monday as they made their case for health care reform during an annual Martin Luther King Jr. Day march in St. Paul. They also called on state lawmakers to take a bolder approach to fixing Minnesota’s health care system.

St. Paul, Minn. — Single-payer supporters say this is the first time they’ve paired their cause with St. Paul’s annual Martin Luther King Jr. Day march from Central High School to Concordia University. But the Minnesota Universal Health Care Coalition says the pairing actually makes perfect sense.

The organization’s vice chair, Dr. Jim Hart, says King was deeply troubled by health care inequality. To prove that point, single-payer marchers carried banners quoting King that said, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Hart says, like King, single-payer advocates believe that all Americans could and should have health care. But he says the U.S. will never achieve that goal with its current market-oriented system.

“We spend about 20-percent of our health care dollar on insurance functions, both at the insurance companies and at the clinics and hospitals that have to deal with this complicated system. So there would be ways to save but it would take a bolder approach than what we’re seeing so far,” he said.

Hart says single payer is that bolder approach. Often the mere mention of that model elicits groans from people who see it as leading to the rationing of health care. But fellow marcher Dr. Chris Reif says the definition of single payer is not necessarily what people assume.

“Single payer doesn’t mean it always happens the same way,” Reif said. “It just means that you try to get the economies of scale and try to get better care. Right now there’s a move, like in Utah, to have single application forms for insurance. That’s one step toward single payer. There’s also a move to have our electronic medical records be the same or talk to each other. That’s a move toward single payer.”

If those arguments don’t win over skeptics, single-payer advocates believe the eroding health insurance market will.

Eric Angell is with the Universal Health Care Action Network, another single payer organization that also marched at the King Day rally. Angel points to a recent vote by thousands of Twin Cities janitors who agreed to walk off the job if they don’t get a more affordable health-care package.

“This is not an anomaly,” according to Angell. “A lot of other unions have decided to go on strike for the exact same reason: the rising health care costs. Employers are not able to provide health care to their employees the way they once did and the obvious reason is the rising health care costs.”

Angell says he’s skeptical about lawmakers’ willingness to look seriously at a single-payer system. But Dr. Jim Hart says he’s impressed by at least one bill at the Capitol this session that would extend health care coverage to all children in Minnesota. Hart says the bill uses a single-payer approach to making health care affordable for kids.

Sen. John Marty, DFL-Roseville, who also participated in the march, says if lawmakers passing the “cover all kids” bill, it would be a huge step. But he says he’s already detecting some backtracking among people who originally supported the idea.

“It’s certainly a tough fight,” Marty said. “We’re not used to thinking this way. Much of the rest of the world does think that way but in the U.S. the health care industry is set up in a way that doesn’t cover people and I think there’s been a lack of vision in the political system.” Rep. Keith Ellison campaigned on a single-payer system before getting elected to Congress. He says he still believes in the approach and will push the idea in Washington. But he says Minnesota lawmakers need to do their part too.

“Everybody should do what they can do. We’re not putting the brakes on any effort,” Ellison said. “If we can get a single-payer program in the state of Minnesota, great. If we can do it at the federal level, great. Ultimately it has to be a nationwide thing. But maybe a step toward that goal is a statewide program.”

Ultimately single-payer advocates would like to see the state take over the way health care is financed. They admit there are plenty of obstacles to that goal. But they believe Minnesotans are more receptive to the idea now than they’ve ever been.

It's time for national program

By TERRY HAVENER
The Tribune-Democrat
January 16, 2007

As a citizen of this great nation, my health care should not be a privilege. It should be a right — not a handout but a true entitlement.

And not something I either pay for or beg for, but a given, no-questions-asked guarantee.

The time for national health care is now.

The United States is the only developed, industrialized country that does not provide national health care to its citizens.

Employment-related health care, where a person’s well-being is negotiated along with his or her wages, is becoming a casualty of a global market system that pits American workers against workers in third-world countries.

The current high cost of health care, when linked to global competitiveness, can be a deciding factor in the winning or losing of business opportunities.

More and more, companies are forcing employees to assume the cost of health care. Insurance co-pays and deductibles diminish the worth of workers’ paychecks, and are growing faster than most salaries or cost-of-living increases.

Many union-run health plans are being bankrupted or are being forced to restrict or eliminate coverage.

Meanwhile, the business of health care has become just that — big business. The cost of an individual’s health is based on profit margins, country-club memberships and the price of the most recent trendy luxury car.

Dr. Marcia Angell, a senior lecturer with the Department of Social Medicine at Harvard Medical School and a former editor-in-chief of the New England Journal of Medicine, said, “The underlying problem is that we treat health care like a market commodity instead of a social service.

“Health care is targeted not to medical need, but to the ability to pay. Markets are good for many things, but they are not a good way to distribute health care.”

Legislation proposed in the U.S. House of Representatives, HR 676, would establish a national health plan for all Americans — a Medicare- for-all type plan. Sponsored by Rep. John Conyers Jr. (D-Mich.), it now has 77 co-sponsors.

According to the All Unions Committee for Single Payer Health Care, based in Louisville, Ky., HR 676 has been endorsed by 192 union organizations, including 44 central labor councils and area labor federations, and 12 state AFL-CIOs , including Pennsylvania.

HR 676 is also endorsed by Physicians for a National Health Program. PNHP is a single-issue organization with more than 14,000 members. It advocates a universal, comprehensive, single-payer national health program.

So unless you are completely satisfied with your health-care plan and its delivery system, get involved.

Voice your concerns to your legislator and urge him or her to sign on to HR 676.

The health of our nation is too important for anyone to stand on the sidelines.

Hospitals cure bill ills with liens

Notice in mail surprises some patients

News-Journal
West Volusia edition

Tripping on the rug in his Port Orange home sent Glenn Hibbs on a financial odyssey he wishes he’d never been forced to take.

He broke his shoulder and before it was put back together, Halifax Medical Center had a $26,000 claim — a lien — on Hibbs’ home. The hospital insisted he sign financial responsibility forms before being admitted for treatment.

“I signed it with a broken shoulder,” said Hibbs, 50, who has no health insurance. “They told me I had to sign or there would be no surgery.”

Increasingly, three local hospitals — Halifax Medical Center, Florida Hospital DeLand and Florida Hospital Fish Memorial — are recording liens against patients with the Volusia County Clerk of Court when there’s been an accident, even when the patient has health insurance.

Since 1999, the number of liens Halifax has filed has more than quadrupled to 2,159 liens filed in 2005. And the stakes have skyrocketed: In September, Halifax Medical Center, the area’s largest hospital, filed $5.2 million in liens compared to the $840,469 in liens filed in September 1999.

At Florida Hospital DeLand, 14 liens were filed in 2001 — the first full year the West Volusia Division of the Adventist Health System operated the hospital — compared to the 349 that were filed in 2005. At Florida Hospital Fish Memorial in Orange City, no liens were filed in 2001, compared to the 125 filed last year. It’s part of a trend, nationwide.

It’s not because the patients haven’t paid or are ignoring notices — these liens are filed automatically, often before the patient leaves the hospital.

Hospital officials say — but some attorneys and property title closers disagree — the vast majority of these liens are not against the person or their property, but against the court or insurance settlement stemming from the accident that caused the hospitalization. The liens, which are allowed by statute in 21 of Florida’s 67 counties, including Volusia, help protect the hospital — and, in Halifax’s case, property taxpayers, hospital administrators say.

“We file liens to make sure that the person doesn’t take the insurance money without passing it to the hospital,” said Harry Reese, chief financial officer for the Halifax Community Health System.

Still, John Reynolds of DeLand said he was stunned to come home from his 16-day hospital stay after a motorcycle crash and discover notice of a registered letter from Halifax waiting in his stack of unopened mail. Medical bills aren’t covered in his motorcycle insurance, he said, so he’s waiting to see how the $122,424.55 hospital bill will be resolved with his health insurance.

“I’m in limbo,” said Reynolds, 52, who worked as a heavy-machine operator before he started receiving Social Security disability years ago.

Similarly, the Hepsworths of Deltona are not only coping with the Sept. 23 death of daughter Krystle Accardi, 14, in a car crash. They also have a lien of more than $92,000 against them from the hospital, resulting from her hospital stay of a little more than 24 hours.

“I don’t know if they can do that,” said Douglas Hepsworth, Krystle’s stepfather, about the lien. They are now waiting to see how much their health insurance will cover. “I think it’s a very questionable area that they are going into there.”

A 1953 legislative act enabled Volusia County hospitals to impose liens before the patient has a chance to pay. Florida Hospital West Volusia Division spokeswoman Stefanie Macfarlane said the number of liens that Florida Hospital DeLand and Fish Memorial are increasing as reimbursement for hospital services has become more difficult.

At Halifax Medical Center, Reese attributed the rise in the number of liens to a change in policy that occurred in November 2000 that meant liens were filed in the cases of all accidents, not just auto accidents. At the same time, the hospital started filing amended liens once the patient accumulated another $25,000 in charges after the initial $10,000.

A Boston-based health-care advocacy nonprofit organization says reports of the use of liens are increasing around the country.

“All hospitals are working to improve their revenue cycle management, which means they are being much more aggressive about collecting bills,” said Betsy Stoll, legal director at Community Catalyst, in an interview from her Boston office. “I think it’s a symptom of the growing number of people without insurance and more of a push onto the person who’s insured.”

Florida law prevents creditors from seizing homesteaded property. And, unless hospitals seek a judgment on outstanding liens, they don’t affect the debtor’s credit or property, officials from local hospitals say. But on this point, attorneys and property title closers disagree.

Debbi Kelley, marketing director and closer at Florida Venture Title, said medical liens are regarded much like outstanding child-support payments — and must be paid before the named person call sell property or refinance it.

“I have run across them in the past, and, for the most part, we have paid them at closing,” Kelley said.

But Daytona Beach Attorney Walter J. Snell said these liens in accidents essentially are uncollected bills — until the hospital decides to seek a judgment.

“The only time they sue is when they know a person owns property,” he said.

County and hospital records show that the number of lien releases is not keeping pace with the number of liens Halifax Medical Center is filing. But Arvin Lewis, vice president for patient business and financial services, said the hospital rarely files for judgment on its liens. The number of judgments the hospital sought has decreased from 175 in 2002 to 51 this year, he said.

“We truly don’t want to file claims against our patients in court,” he said.

Meanwhile, Hibbs’ shoulder has healed from the injury in February, but he’s still shocked at the treatment he received — which, he says, required him and his partner to make a $2,976 payment up front, even before he was diagnosed as needing surgery.

Hibbs, who has a $12-an-hour job at a real estate company, said he hasn’t begun to pay off the lien as he’s still juggling bills from anesthesiology and emergency room services.

The idea that Halifax Medical Center owns a piece of his house is a stinging reminder of his injury.

“We weren’t even given the option of making payments,” he said.

Doctor: Nation needs universal health care

By Chris Outcalt
coutcalt@seacoastonline.com
Portsmouth Herald
Thursday, January 18, 2007

PORTSMOUTH — Thomas Clairmont, a doctor at Portsmouth Regional Hospital, envisions a health care system without co-pays, deductibles or “pre-existing conditions.”

The program would be tier-free and provide health care coverage for everyone in the country. The way he sees it, having access to health care is not an option; it’s a right.

“The path we’re on now is not sustainable,” said Clairmont. “The link between health insurance and employment should be severed.”

Clairmont explained his vision of a national health care plan to a group of about 30 people Wednesday afternoon at the Portsmouth Public Library.

According to Clairmont, a member of Physicians for a National Health Program, something needs to be done to stop the rising number of uninsured people in New Hampshire and across the country.

Insurance costs are increasing at five times the rate of inflation, which has left more than 45 million Americans without health care, according to statistics from the U.S. Census Bureau.

In New Hampshire, 135,000 people, including 17,000 children, are without health insurance.

“With the number of uninsured rising each year and the number of businesses covering their employees steadily decreasing,” said Clairmont, “the time has come to move toward a national health plan.” A single health care plan would also eliminate the complications of choosing and understanding various plans, he said. “It’s dizzying. I can’t understand these plans myself; I don’t know how anybody else does.”

Clairmont urged those in attendance to take advantage of New Hampshire’s first-in-the-nation primary status to “grill” presidential candidates on national health care and write to representatives in support of the National Health Insurance Act.

“Anybody that comes to New Hampshire, we want these people under fire,” he said.

The national health insurance bill, HR 676, would create a publicly financed, privately delivered health care program available to all U.S. residents.

“We have a new opportunity with the Democrats in power,” he said. “We couldn’t have had this discussion a year ago.”

Medicare for All: The Only Sound Solution to Our Healthcare Crisis

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.

Guy T. Saperstein is a Democracy Alliance partner and past president of the Sierra Club Foundation; previously, he was one of the National Law JournalĆ¢ā‚¬ā„¢s “100 Most Influential Lawyers in America.”

Arnold-Care Is A Bad Deal

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.

Maria's hope

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.

Labor's Rx For Health Care

AFL-CIO Touts Single-Payer System

By JANICE PODSADA
Hartford Courant Staff Writer
January 13, 2007

The Connecticut AFL-CIO launched its lobbying effort Friday for a single-payer system for universal health care, which the labor group said would provide affordable health care to the 300,000 to 400,000 state residents currently without health coverage.

The AFL-CIO touted its plan as an enlightened alternative to the business-backed plan put forward by the Connecticut Health Insurance Policy Council earlier this week. Gov. M. Jodi Rell has also proposed a plan.

The single-payer system, the centerpiece of the AFL-CIO’s 2007 state legislative agenda, bucks a trend in Connecticut and other states in which business groups and advocates for broader health coverage have hammered out proposals that would use the state’s collective buying power, often subsidized by taxpayers, to buy health plans from private insurers.

The AFL-CIO plans to release a more detailed version of its single-payer health care plan in a few weeks, said the group’s secretary-treasurer, Lori Pelletier.

Under the AFL-CIO’s universal health care proposal, everyone would pay into a single health care fund – whether it’s a government agency or a trust – that would then pay private doctors and providers. The simple, streamlined system would eliminate the middlemen – insurance companies and their handsomely compensated CEOs – and thereby drastically reduce costs, AFL-CIO said.

“When Aetna and U.S. Healthcare merged several years ago, the CEO received $967 million and a corporate jet – how many MRIs is that?” Pelletier said. She was referring to U.S. Healthcare Inc.’s 1996 merger with Aetna Life & Casualty Co., in which Leonard Abramson, chief executive and founder of Pennsylvania-based U.S. Healthcare, a health maintenance organization company, received more than $967 million in cash, stock and the jet as a result of the $9 billion deal.

With just one organization handling the fund, administrative costs could be kept to about 3 percent, a reasonable goal because Medicare currently operates at 3 percent, she said.

Compare that with the current system, in which 30 percent of health care dollars go for paperwork, profits and other unrelated medical costs, Pelletier said. The insurance industry disputes that figure, putting their administrative costs at about 15 percent.

AFL-CIO leaders, including President John W. Olsen, blasted the business council’s recommendations, describing it as the same old clunker, shored up with a dash of window dressing.

“The business community’s plan is not much more than putting a new set of rims on a 1968 Corolla,” Pelletier said.

Earlier this week, the six-month old council, a coalition of health insurers, business groups and large employers, including United Technologies Corp., rolled out its plan.

Under the council’s plan, the uninsured would be allowed to purchase low-cost policies that would omit some state-mandated insurance benefits, employers would be encouraged to pay at least part of the premiums for part-time and temporary workers, and a new state agency dedicated to improving residents’ health would be established, among other features.

With those radically different plans now on the table, in addition to Rell’s plan, which also relies on private insurance, the legislative debate about health care should grow.

A single-payer system would save everyone money, from government to businesses to workers, Pelletier said.

“The employers’ piece would be half of what it is now,” she said – substantial savings for some small businesses, where as much as 25 percent of the payroll is health care costs. “They could save half,” Pelletier said.

Workers would also have their costs reduced. “An estimated $400 to $800 per year, per insured person, goes toward covering the costs of the uninsured,” Pelletier said.

Patients would be free to decide which doctor or hospital they want to visit. And doctors and medical providers would benefit. Often they can’t afford to hire additional clinical staff because they must first hire the necessary staff to process mountains of insurance forms.

“There are 1,500 national health care plans. Each has a CEO and a vice president. That’s a lot of redundancy,” Pelletier said.

AFL-CIO leaders said the council’s plan wags an accusatory finger at state residents for being “too fat and too lazy” and is a diversionary tactic aimed at glossing over the problems and keeping money flowing into the insurance carriers’ coffers.

A key component of the council’s plan is the creation of a new state agency whose mission would be to improve the health of the state’s residents, reducing health care costs. Employers would be asked to voluntarily weigh in with financial incentives for workers to lose weight, stop smoking and improve their general health.

The AFL-CIO’s 2007 legislative agenda, “A Blueprint for the Future,” focuses on safety, taxes, job creation and retention and the right to organize, Olsen said. Other proposals include a Worker Freedom Act, which would prohibit employers from firing or disciplining workers who don’t attend meetings that have no bearing on work, but are used to promote political or anti-union agendas; a proposal to limit outsourcing, which would require the state to purchase goods and services from Connecticut or American companies; and a tax reform plan to decrease the state’s dependence on the property tax.

Contact Janice Podsada at jpodsada@courant.com.

It’s time for national program

By TERRY HAVENER
The Tribune-Democrat
January 16, 2007

As a citizen of this great nation, my health care should not be a privilege. It should be a right — not a handout but a true entitlement.

And not something I either pay for or beg for, but a given, no-questions-asked guarantee.

The time for national health care is now.

The United States is the only developed, industrialized country that does not provide national health care to its citizens.

Employment-related health care, where a person’s well-being is negotiated along with his or her wages, is becoming a casualty of a global market system that pits American workers against workers in third-world countries.

The current high cost of health care, when linked to global competitiveness, can be a deciding factor in the winning or losing of business opportunities.

More and more, companies are forcing employees to assume the cost of health care. Insurance co-pays and deductibles diminish the worth of workers’ paychecks, and are growing faster than most salaries or cost-of-living increases.

Many union-run health plans are being bankrupted or are being forced to restrict or eliminate coverage.

Meanwhile, the business of health care has become just that — big business. The cost of an individual’s health is based on profit margins, country-club memberships and the price of the most recent trendy luxury car.

Dr. Marcia Angell, a senior lecturer with the Department of Social Medicine at Harvard Medical School and a former editor-in-chief of the New England Journal of Medicine, said, “The underlying problem is that we treat health care like a market commodity instead of a social service.

“Health care is targeted not to medical need, but to the ability to pay. Markets are good for many things, but they are not a good way to distribute health care.”

Legislation proposed in the U.S. House of Representatives, HR 676, would establish a national health plan for all Americans — a Medicare- for-all type plan. Sponsored by Rep. John Conyers Jr. (D-Mich.), it now has 77 co-sponsors.

According to the All Unions Committee for Single Payer Health Care, based in Louisville, Ky., HR 676 has been endorsed by 192 union organizations, including 44 central labor councils and area labor federations, and 12 state AFL-CIOs , including Pennsylvania.

HR 676 is also endorsed by Physicians for a National Health Program. PNHP is a single-issue organization with more than 14,000 members. It advocates a universal, comprehensive, single-payer national health program.

So unless you are completely satisfied with your health-care plan and its delivery system, get involved.

Voice your concerns to your legislator and urge him or her to sign on to HR 676.

The health of our nation is too important for anyone to stand on the sidelines.

Maria’s hope

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.