PNHP

Harry and Louise:  The Missing Years

Harry and Louise:  The Missing Years

October 31, 2002
Harry and Louise:  The Missing Years
Steve Genova

As Oregon’s hotly contested single-payer initiative heads into the home stretch, it seemed like a good time to revisit my old pals Harry and Louise.  You remember them; they were the managed care industry’s mascots in the early ’90s and, according to industry observers, had more to do with sinking the 1994 Clinton health care proposal than all the rest of the negative campaigning combined.

Most people naturally assumed Harry and Louise were creatures of the PR and advertising industries.  They’re very much alive, however; they were friends of my parents from way back when.  They were frequent guests at our house when I was a kid and we at theirs.

They were always doing just a little bit better than my folks, so we gradually drifted apart the way people seem to when their fortunes head in opposite directions.

Still, I had stayed in touch with them over the years and, when they ended up in Oregon, I thought it might be time to check in with them again.  I hadn’t seen them since about 1997 and, at the time, things were going pretty well.  Their house was paid for, their stock portfolios were growing, Harry had been promoted to a regional management position, Louise had taken up quilting and golf, and Harry was making noises about retiring to a golf course community by 2004.

So you can imagine my shock when I looked them up at their new Oregon place a couple of months ago.  Gone were dreams of the bungalow on the seventh fairway.  They’d been replaced by a used doublewide in a squalid trailer park well within earshot of I-5.  Louise was at the doctor’s and Harry brought me up to speed. 

He’d been laid off from his job in early 2001, which not only cut his income to near zero, but cut off his and Louise’s health care coverage as well.  “My COBRA coverage ran out this June, but that’s not even the worst part,” he said.  “Louise has breast cancer.  She had a series of operations last December, while we still had coverage thank God, but she needs another operation and a round of chemo to stay in remission and I don’t see how we can afford it.  We’ve sold the house to raise cash, but I don’t even think that’s going to cover her expenses.  I honestly don’t know what the hell we’re going to do.”

Harry and Louise go Chapter 13
I picked up a copy of the local paper a few weeks ago and saw a brief news story describing how medical expenses drove Harry and Louise into bankruptcy court.  I called them up and they confirmed what I’d read.

I asked them if they knew medical expenses are the leading cause of bankruptcy in the US — and nowhere else in the civilized world.  They hadn’t heard that one, but they were less interested in stats than in where to come up with medical and legal fees. 

We rang off after a short conversation that I can only describe as surly and panicky — a drastic change from the usual. 

Harry and Louise Turn to Crime
The news just gets worse.  Harry has been busted for sales of controlled substances — in this case, Demerol, which Louise was using to try to control the pain from her untreated breast cancer. 

She and Harry agreed that they needed money more than pain relief, so Harry apparently joined the bangers and the mules on a well-known drug commerce corner.  The cops pulled a sweep and, of course, Harry was the only guy there who couldn’t do the 60-yard dash in less than seven seconds.  So the cops rousted him. 

His bail was insanely high, given his age and the reasons for his behavior.  So he stayed in the local lock-up for 10 days until his case finally came up.  He was sentenced to time served and a $10,000 fine (which of course he can’t possibly pay), and Harry and Louise were left wondering what the hell to do next.

Harry and Louise Found Dead in Apparent Murder-Suicide Pact
The end came abruptly but not unexpectedly.  Harry and Louise were always decent people with a profound sense of pride in the American system and their place in it.  When that very system boomeranged on them, they couldn’t handle it.  Nor could they envision an old age of poverty, untreated disease and constant pain.

The papers and local newscasts gave the story minimal, though dignified, coverage.  But the suicide note got the headlines.  With their last earthly acts, Harry and Louise went down swinging, rejecting an “unworkable, utopian” single-payer system and defiantly embracing the U.S. employment-based health care model. 

“At least we didn’t lose our choice of doctors or buy into a system that would have rationed health care, created an army of bureaucrats to make health care decisions and turned medical care over to the government,” the note read.  Just so.

Next time:  Harry and Louise go to hell.  As John Prine might have written, their Blue Cross cards won’t get them into heaven anymore.

# # #

The author is a freelance writer, communications consultant and member of the Portland Yes on Measure 23 steering committee.  Send comments to steveng@sonic.net

Big Three sign letters with Canadian Auto Workers Union on publicly funded health care

Canadian Auto Workers Union, Nov. 9, 2010

The Canadian Auto Workers Union reports that General Motors, Ford and DaimlerChrysler have all signed letters together with the CAW urging that Canada’s national health care system be “preserved and renewed.” The following joint GM-CAW letter is illustrative.

Joint GM-CAW letter on publicly funded health care

Canada’s publicly funded health care system provides essential and affordable health care services for all Canadians, regardless of their income. Publicly funded health care also enhances Canada’s economic performance in several important ways.

The auto industry is Canada’s most important export industry; it directly employs over 150,000 Canadians in high-wage jobs, supports hundreds of thousands of other spin-off jobs, produces $90 billion worth of shipments per year, and generates billions of dollars in tax revenues for all levels of government in Canada. The success of this industry has been crucial to Canada’s economic progress over the past decade. Canada’s health care system has been an important ingredient in the auto industry’s performance.

Workers in the auto industry, and in the many manufacturing and service industries which supply automakers, benefit directly from access to public health care services. Thanks to this system, they are healthier and more productive. Employers in the auto industry, meanwhile, enjoy significant total labour cost savings because most health care services are supplied through public programs (rather than through private insurance plans.)

The public health care system significantly reduces total labour costs for automobile manufacturing firms, compared to the cost of equivalent private insurance services purchased by U.S.-based automakers; these health insurance savings can amount to several dollars per hour of labour worked. Publicly funded health care thus accounts for a significant portion of Canada’s overall labour cost advantage in auto assembly, versus the U.S., which in turn has been a significant factor in maintaining and attracting new auto investment to Canada.

Canada’s publicly funded health care system is now facing demographic, technological, and fiscal pressures. The erosion of publicly funded health care – through measures such as the delisting of currently-covered services, the imposition of user fees, the failure of the public system to keep up with the changing nature of health care, and new costs such as prescription drugs and home-care, – will impose significant costs on automotive employers and undermine the attractiveness of Canada as a site for new automotive investment.

For both employers and workers in the auto industry, it is vitally important that the publicly funded health care system be preserved and renewed, on the existing principles of universality, accessibility, portability, comprehensiveness, and public administration. The system needs a secure multi-year funding base from government, and must be expanded to cover an updated range of services (including prescription drugs and home care services) that reflects both the evolving nature of medical science and the emerging needs of our population.

To this end, General Motors and CAW-Canada jointly urge the federal and provincial governments to take appropriate actions to preserve the public health care system, secure its funding base, and modernize the range of services which it covers. In addition to reinforcing the quality and accessibility of health care for Canadians, these measures would also help to ensure the long-run success of Canada’s auto industry.

http://www.caw.ca/en/campaigns-issues-past-campaigns-issues-big-three-auto-joint-letter-on-publicly-funded-health-care.htm

Economics at heart of Measure 23 debate

October 31, 2002
By Rebecca Merritt
The Bulletin

On the surface, Measure 23 looks to be a good deal for the average family struggling to keep up with escalating health insurance premiums.

If approved in Tuesday’s election, Oregonians would create a health plan that would cover everyone. Residents would receive a rich benefit package that includes everything from chiropractor visits to nursing home care to mental health counseling. To pay for it, residents would be taxed up to 8 percent of their incomes, and businesses would face a 3 percent to 11.5 percent payroll tax. Those figures would be in addition to current taxes.

But can Oregon afford such a bold plan?

The plan’s economics is at the heart of the debate over Measure 23. Supporters argue the system would save money by better controlling costs, while opponents point to a recent study that concludes the plan could increase health care expenditures in the state by as much as 30 percent.

For starters, the financial impact statement in the state voter’s pamphlet underestimates the measure’s potential cost, according to the state’s report on Measure 23’s fiscal impact.

The pamphlet states Measure 23 would cost the state not less than $1.7 billion per year while also taking in revenues of not less than $1.7 billion from income and payroll taxes.

The cost projection is based on the assumption of only covering the cost of about 460,000 people who are now on the Oregon Health Plan and another 420,000 Oregonians who have no health insurance.

But state budget analyst George Naughton said the state’s cost would increase to about $10 billion if those with private insurance drop their coverage to be part of the universal plan. And that’s likely to happen because people who pay for health insurance would be taxed for the new plan. Employers, faced with higher payroll taxes, would also almost be certain to terminate their employee health plans.

Naughton said the committee that puts together financial impact statements had their hands tied with Measure 23 because the committee cannot make assumptions about what may happen after a measure passes.

“We had to go with $1.7 billion because of what the measure says,” said Naughton, who wrote the state’s report. “The measure does not say people have to drop private insurance, but assuming they drop insurance would bring the cost up to $10 billion.”

With the income and payroll taxes set by the measure, Naughton said the state could generate enough revenues to cover the $10 billion cost. Increased income taxes could generate up to $4.7 billion while payroll taxes could generate to $6.1 billion for a total of $10.8 billion.

That means to cover that $10 billion, businesses and residents would likely be taxed close to the maximum limits set by the measure, depending on what happens with the economy between now and when the plan would take effect in 2005.

In addition, the measure would create a state board to oversee the plan and the board would have bonding authority to raise additional money. Because there is no way to predict what the board might do, there is no way to project how much debt the state would face because of bonds.

Supporters of the measure admit it is going to cost even more than the $10 billion to provide comprehensive health care to everyone in the state. Mark Lindgren, chairman for Health Care for All Oregon, said the total cost would be $19 billion per year. The rest of the money would come from shifting state and federal dollars to the plan, including Medicare and Medicaid dollars and workers compensation fees, he said. The plan would also begin collecting a 1 percent payroll tax in 2003, before the plan is implemented in 2005, to set up a reserve of funds.

Lindgren and campaign supporters say the plan is economically feasible because of cost savings that would come from lower administrative costs and global budgeting. By keeping administrative costs to 5 percent, the plan could save $1.5 billion. The plan would also save money by working with pharmaceutical companies and buying prescription drugs in bulk. Also, he said, the plan would encourage people to see doctors for preventative care, saving them more expensive trips to emergency rooms.

Opponents argue that there is reason to believe Measure 23 could cause a financial hardship for the state. A study conducted by the economics consulting firm LECG concluded that Measure 23 could increase health care expenditures in the state by as much as 30 percent. The study was commissioned by The American Association of Health Plans, an opponent of the plan who represents managed care companies across the nation.

According to the study, Oregon’s health care costs would rise by $2.2 billion to $6.5 billion once the plan is implemented. The study’s authors argue that the elimination of co-payments would increase the amount of services demanded by participants. Also, the plan’s comprehensive benefits and lack of a residency requirement may encourage people to move to Oregon for health care services.

The study concluded that increasing taxes to the plan’s limits would still leave the plan underfunded by $3.5 billion to $10.4 billion. Therefore, the study said that Oregon would have to raise more money.

Karen Ignagni, chief executive officer of the American Association of Health Plans, said the study shows the estimated costs presented before the public are too conservative.

“It demonstrates the burden that would be placed on households in Oregon,” Ignagni said.

“You would have an explosion of population in Oregon because of this,” she added. “Why wouldn’t people in surrounding states without health insurance and with a chronic disease move to Oregon?”

Supporters point to nine studies that say universal health care is economically feasible. One study, conducted by Boston University’s School of Public Health, showed that universal health care would lower the cost of health care in Massachusetts by savings in administrative costs and more appropriate use of hospital care. The study done in 2000 concluded that a universal plan could cut administrative costs by $3.6 billion and redirect $2.4 billion to providing more health care to more residents, resulting in an overall savings of $1 billion.

Deborah Socolar, author of the Boston study, said a state’s specific situation affects whether savings are achievable with universal health coverage. The uninsured population in Massachusetts is fairly low, and the government health spending per person is among the nation’s highest so saving money may be easier there.

In Oregon, she said, the uninsured are a greater share of the population and the state is among the 10 lowest in the nation for health spending per person. But Socolar said it’s encouraging for Oregon that a feasibility study showed universal health care coverage would save money in California, which has a higher number of uninsured residents and also has a lower spending per person.

Another study, supported by a grant from the U.S. Department of Health and Human Services, showed that Vermont would save $118.1 million in health spending with a single payer health system. The Vermont proposal, however, included a $10 co-payment for health services. Oregon’s plan has no co-payments, which can help control unnecessary visits to the doctor.

Regardless of the outcome of Tuesday’s election, Oregon is at the forefront of the debate over universal health care coverage. Six other states are working on similar proposals to offer single-payer health systems, said Rachel DeGolia, operations director for the Universal Health Care Action Network in Ohio.

“They’ve been successful in sparking a debate at a much higher level than you’ve had in the state,” she said. “It really has helped raise the level of debate of the nation.”

http://www.bendbulletin.com/news/story.cfm?story_no=8124

Oregonians Vote on Single Payer Health Care

Oregons are voting by mail from now until Nov 5, 2002 on Initiative 23, a measure to create a single payer system in the state.   Organizers are still doing last minute fundraising, and could use your support.  If you’d like to contribute to this historic effort, go to www.healthcareforalloregon.org.
       The full text of the measure, and both pro and con arguments, are on line at the state’s elections division at www.sos.state.or.us/elections/nov52002/guide/measures/m23.htm.
       In PNHP’s opinion Health Care for All Oregon has already won because of the tremendous job local activists – of all ages and from all walks of life – have done in educating Oregonians about reform.  More work may be needed to counter the influence of the powerful special interests, but Oregon is off to an incredible start, and could become the first state to implement a single payer system! 
       We look forward to working with activists in Oregon and all over the country until health care is a right all across the land.  Salud!

http://www.sos.state.or.us/elections/nov52002/guide/measures/m23fav.htm

Also see “Economics at heart of Measure 23 debate,” from the Bend Bulletin, and “Universal health care hinges on cost,” an article by the Courant.

Healthcare administration costs are greater than defense budget

Newsday
October 24, 2002
Bush Signs $355B Defense Bill

President George W. Bush signed into law yesterday the biggest military pending increase since Ronald Reagan’s administration – a $355.5-billion package giving the wartime Pentagon “every resource, every weapon and every tool they need.”

President George W. Bush (commenting on the scuttling of the Crusader artillery program):

“To have the willingness to say, ‘This program works and this one doesn’t,’ is important.”

http://www.newsday.com/news/nationworld/nation/ny-usbush242976429oct24,0,704917.story

Comment: 25% of our $1.55 trillion healthcare expenditures are consumed by
administrative functions, amounting to $387 billion, more than our entire United States military budget! Some would argue that both are a terrible waste of resources. But there is no dispute that the administrative waste in our healthcare system is particularly tragic considering the tremendous unmet healthcare needs in this nation.

The next time someone says that there would be no significant administrative savings by adopting a single, publicly-administered insurance program, remind them that our current healthcare administrative costs alone are more than our entire national defense budget! And the next time proponents of the status quo reject the single payer proposal as they tout our existing, egregiously-wasteful system of funding health care, remind them that President Bush said, “To have the willingness to say, ‘This program works and this one doesn’t,’ is important.”

(Note: We are revising our Quote of the Day list. If you no longer wish to be included on the list, please return this message with the instruction, “Unsubscribe.” Thanks.)

Paul Wellstone

United States Senate
July 19, 2000

Senator Paul Wellstone:

When I was first elected to the Senate and Bill Clinton was elected
president two years later, I believed the political winds and tides were
aligned for a decade of progressive change for America. I thought I had been
elected at just the right time to be a part of this change. When President
Clinton, in his State of the Union speech, announced he would veto any
health care legislation that did not provide universal coverage, that every
citizen must be covered, I jumped to my feet and cheered. This was why I
came to Washington, to make this kind of change, and this was a fight I
thought we could win.

But I had some quick learning to do. When I spoke about my interest in a
“single-payer” health care plan, similar to the Canadian system where
doctors and hospitals remain in the private sector, but where there is just
one insurer or payer, I was told by a senior colleague that my plan might be
the best proposal. “But it does not have a chance. The insurance industry
hates it and it will go nowhere. It is just not realistic.”

I was completely disillusioned. I could not accept then, and I do not accept
now, the proposition that even before the American people have the
opportunity to be informed or included, a good proposal is “dead on arrival”
because the insurance industry opposes it. That isn’t supposed to happen in
a representative democracy!

In spite of the advice, I did introduce the single payer plan with Jim
McDermott, a congressman and physician from the state of Washington. I
thought first you start with the most desirable, and later on in the process
you’ll find out what is politically feasible. I refused to admit defeat
before we had even begun to fight. And I was hoping that our legislation
would pull the debate in a more progressive direction.

What happened was just the opposite. The trillion dollar health care
industry, led by the insurance companies, went on the attack, not against
our plan which “wasn’t realistic” but against the President’s plan which
“was”. “Harry and Louise” ads cried out against the horrors of “government
medicine.” Intensive and expensive lobbying efforts expounded on the same
theme.

Media coverage, which should have been about the nuts and bolts of different
proposals shifted now to focus on strategy rather than substance and head
counts rather than hard information. So ordinary citizens no longer had a
source of knowledge to form opinions and inform their elected leaders.

But the problems were not limited to the insurance lobby and the media. The
only way we could have beaten the health care industry would have been with
dramatic and effective citizen politics. It never happened. Progressives
didn’t organize a constituency to fight for health care reform, and the
Administration didn’t have the political will to stand up to powerful
interests and therefore never asked the American people to take on this
fight. They tried to win with “inside politics,” cutting deals and making
compromises with different economic interests.

http://wellstone.senate.gov/On_the_Record/Floor_Statements/Floor_Statements_-_2000/hssafloor.htm

Comment: Paul… We failed you, and we failed America. But we won’t let it
happen again. This time we’ll win this fight, not just for you, but for all
of America. Thank you for lighting the beacon. Now we’ll do our part.

-=-=-=-=-=-=-=-=-=-=

E. Richard Brown, PhD, Director, UCLA Center for Health Policy Research:

Thank you, Don, for sending out Paul Wellstone’s speech on universal coverage from just two years ago. Paul and Sheila were such courageous people who selflessly fought for universal coverage, health insurance parity for mental illness, and social justice in all its forms. They inspired so many of us to persist even when we felt discouraged.

Marianne and I were very close friends with Paul and Sheila and we will miss them deeply. We spent the last weekend of September with them in Minnesota, at the height of Paul’s reelection campaign. Their remarkable personal qualities connected them to thousands of people in Minnesota. Whether it was his rousing speech to the statewide convention of the public employees union, ommunicating one-on-one through translation into sign with participants at a small conference of the deaf, speaking of the accomplishments of advocacy at the opening of a residential treatment home for young people with eating disorders, encouraging leaders of the Twin Cities’ Somali immigrant community, or conversing in the living rooms of ordinary working people, Paul was inspiring his constituents to political action to improve the conditions of their lives. The response to Paul was
the same in all these settings. People thanked him for his support that helped their own struggle for social justice, for particular things he had done to help them personally, or simply for being their voice and crusader in the Senate. The genuine love that people we encountered in living rooms and on the street obviously felt for him was something we have not seen in our own state.

We all feel this loss together. The nation will mourn our loss of Paul’s courageous and eloquent voice and his steadfast actions. But he would have told us that we need to struggle even harder and more effectively. He believed in “effective citizen politics” which he taught and practiced for two decades as a college professor/community organizer in Minnesota before the people of his state sent him to the Senate. He believed in us or he would not have spent his life inspiring us, encouraging us, and organizing us. He would expect us to believe in ourselves and what we can accomplish together.

Rick

Wellstone and Drug Industry

We are deeply grieved at the tragic death of Sen. Paul Wellstone, his wife, daughter, and members of his staff in a plane crash in Minnesota.  Sen. Wellstone was a longtime champion of single payer national health insurance in the Senate, and the lead sponsor of the Senate single payer bill, S. 491.  He will be sorely missed.

ELECTION 2002

Drug Industry Spending for Congressional Races Outpaces That of Liberal Groups

Access this story and related links online: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=14203

The number of “independent” political advertisements in support of Republicans has “overwhelm[ed]” ads from traditionally “big-spending” liberal groups in part because of increased campaign spending by the pharmaceutical industry, the Washington Post reports.  Ads sponsored by interest groups are not necessarily sanctioned by individual candidates or political parties, but analysts say the spots can “prove decisive in tight races,” the Post reports.  According to a study of political ads in 100 markets by the Campaign Media Analysis Group, pro-Republican, business-financed groups, such as the United Seniors Association, have outspent liberal groups by nearly three to one in House races, or $9.1 million compared with $3.3 million, respectively.  The United Seniors Association is running a $17 million ad campaign that praises House Republicans in close races for their stances on prescription drugs (Edsall, Washington Post, 10/23).  Democrats have alleged that the group is part of a “stealth campaign” by the drug industry to help Republicans win races.  They add that the campaign is “clearly misleading” because it does not mention that the group receives funding from the Pharmaceutical Research and Manufacturers of America or that the legislation referred to in the ads refer is the House-passed Medicare reform bill (HR 4954), which is supported by Republicans (Kaiser Daily Health Policy Report, 10/21).  The group’s officials say they have received funding from the pharmaceutical industry, but have declined to disclose the amount, the Post reports.  PhRMA said it has provided the group with “unrestricted educational grants” (Washington Post, 10/23).

Declining Ad Spending by Liberal Groups

In comparison to the senior group’s $17 million ad campaign, Planned Parenthood is spending about $2 million this election cycle on political advertisements, compared with $10 million during the last congressional election cycle, and the National Abortion and Reproductive Rights Action League is spending $3 million this cycle.  The Post reports the “pro-Republican trend” is a switch from 2000, when spending on independent advertising was about equal.  Part of the decline in support for Democratic groups is linked to the declining stock market, which has impacted the ability of “wealthy liberals with large portfolios” to support the political left, the Post reports (Edsall, Washington Post, 10/23).

Health care cost soar, coverage erodes: Troubling prognosis for state at annual health car forum

By Michelle Hillman
Wednesday, October 23, 2002

WALTHAM – Increases in health-care spending are in the double digits, insurance premiums are rising faster than the rate of inflation and there’s no solution on the horizon.

That sentiment was echoed by several health-care policy experts who spoke at the Massachusetts Medical Society here yesterday as part of the “State of the State’s Health Care” annual forum.

Drew E. Altman, president and CEO of the Kaiser Family Foundation in California, told 125 physicians and policymakers that health-care costs will continue to rise sharply while coverage erodes.

Total premiums this year rose 12.7 percent nationally. The average individual premium increased from $2,650 last year to $3,060 this year, and an average family premium increased by $901 this year to $7,954.

There are currently 41 million Americans without insurance coverage, a problem expected to get worse as many states, including Massachusetts, reduce Medicaid programs for the poor and disabled.

In Massachusetts, 50,000 residents stand to lose coverage under its version of the federal Medicaid program – MassHealth Basic – effective April 1, 2003.

Nancy Turnbull, director of educational programs at the Harvard School of Public Health, said pressure will continue to be put on MassHealth as the financial picture to erodes.

She said cutting eligibility will cause the ranks of the uninsured to rise, which will have a “tremendous” effect on hospitals and health-care providers left to care for the poor and disabled.

The cost of insurance is rising at a faster percentage rate than earnings for the first time in a decade, Altman said. He said rising insurance costs are creating problems for employers, but even bigger problems for employees who are being asked to pay more for fewer benefits.

In a national survey of firms with 200 or more workers this year, Altman said 78 percent said they would increase the amount employees pay for health insurance.

Health-care spending per capita was up 10 percent in 2001, which is the first double-digit increase since 1990, said Paul B. Ginsburg, president of the Center for Studying Health System Change in Washington, D.C.

Ginsburg said the elderly aren’t to blame for rising health-care costs. Increased hospital spending on wages and new technology is the culprit. He said in 2000, the average hourly wage for health-care workers increased by 3 percent, followed by a 6 percent hike last year.

Hospitals are spending more on wages because they are better paid by health plans. In the 1990s, many hospitals merged or consolidated giving them more leverage to negotiate higher prices for services with health plans.

Ginsburg said long-term drivers of health-care costs are physicians and patients’ penchant for the best technology medicine has to offer.

While technology can help reduce costs with faster and better ways to treat people, it also creates more volume because more people want the latest in treatments.

The “big ticket” problems in health-care spending are figuring out how to cover the uninsured and creating a prescription drug benefit for seniors. He said it was a “national shame” that seniors don’t have drug coverage, and people without insurance coverage are left to fend for themselves.

Altman said to cover 41 million uninsured people costs from $85 billion to $125 billion a year, and to provide a comprehensive drug plan for seniors would cost $350 billion to $800 billion over 10 years.

The problems will be addressed only when there is enough concern in the public, said health policy experts at yesterday’s event. When enough people become uninsured, or the cost of insurance increases beyond what people can afford, is when change will occur, Ginsburg said.

Letters in Support of Single Payer

In response to Marcia Angell’s Op-Ed piece on single payer, the New York Times received a number of supportive letters to the editor:

Prescriptions for an Ailing Patient

October 19, 2002

To the Editor:

Re “The Forgotten Domestic Crisis,” by Marcia Angell
(Op-Ed, Oct. 13):

The solution to the American health care crisis is a single-payer system. It is painfully clear that our health care system is a business run for profit and not for thebenefit of the patient. Few Americans now believe the myththat the market distributes health care in the most efficient or effective way.

If the Democrats want to regain their credibility and moral high ground, they should stop accepting money from any interest that might prevent them from speaking the truth about this. They could then fight forcefully for a single-payer system. High risk, high reward: Americans might wholeheartedly give them the White House in 2004.

JANET HEROUX
Princeton, N.J., Oct. 15, 2002

To the Editor:

Re “The Forgotten Domestic Crisis,” by Marcia Angell (Op-Ed, Oct. 13): As a psychotherapist with many patients in their 20’s, I can attest to the fact that not only do most of them not have any health insurance, but they also do not expect it as a condition of living in this country.

Dr. Angell is correct about the remedy, but I fear that we cannot rely on those who profit from the current system to redistribute the “profits.” Yet that is exactly what would have to happen if all of our citizens were given adequate
health insurance.

Don’t those who pay taxes and vote in this country deserve at least the minimum of essential services?

JUDITH GREENE
New York, Oct. 13, 2002

To the Editor:

Marcia Angell (Op-Ed, Oct. 13) is correct when she says the health care system “would be front and center in this fall’s political debate” were it not for national defense issues and a looming war with Iraq crowding political agendas. Why can’t we kill two birds with one stone? Why not have a quid pro quo health care system?

Instead of a national single-payment system as Dr. Angell proposes, provide free coverage for all health care needs in exchange for mandatory military or civil service. Not only would this save money, but it would also promote unity, nationalism and provide better health care coverage than many Americans already have.

PAUL LIEBESKIND
Dumont, N.J., Oct. 13, 2002

To the Editor:

Marcia Angell (Op-Ed, Oct. 13) recommends a single-payer system similar to those in Britain and Canada. This prefers a nationalized managed care collective over the dominant H.M.O.-managed care collectives.

Managed care fails for the same reason that nationalized industrial collectives failed in Western Europe. Ill-informed centralized authoritative decisions result in
poor-quality products, unhappy customers, inflation and erosion of infrastructure – problems that in varying degrees afflict the British, Canadian and the American
corporate-style managed health care collectives. There is a better way.

ROBERT W. GEIST, M.D.
St. Paul, Oct. 14, 2002

To the Editor:

Re “The Forgotten Domestic Crisis,” by Marcia Angell (Op-Ed, Oct. 13): In addition to placing health care increasingly out of the economic reach of individuals and businesses, our commodity approach guarantees that the pool of insurable individuals will continue to shrink, thereby undermining the very essence of affordable insurance.

Insurance works because a lot of people pay premiums and not everyone uses services. The more healthy people insured, the stronger the system. A single-payer, broadly financed health insurance system is hardly socialism; it is the only way health care can become universally accessible and even remotely cost-effective.

SUSAN POOR
San Francisco, Oct. 15,
2002

http://www.nytimes.com/2002/10/19/opinion/L19HEAL.html?ex=1036034356&ei=1&en=dc3b077de7e982ea

Experts decry health system

Speakers at SR forum call for universal care plan to replace present insurance

October 20, 2002

By JEREMY HAY
THE PRESS DEMOCRAT

Experts at a forum Saturday in Santa Rosa pronounced America’s health care system terminally ill and worse.

“It is a crazy and cruel system we are now struggling with,” said Jack Glaser, senior vice president of theology and ethics for St. Joseph’s Health Care System, the parent of Santa Rosa Memorial Hospital and Petaluma Valley Hospital.

Glaser was among two dozen speakers — physicians, nurses, public health administrators and educators — during a daylong forum at Santa Rosa Junior College. Though they differed on the formula, they overwhelmingly supported a universal health care system.

Past proposals — including a California ballot measure in 1994 and a Clinton administration plan a year earlier — have failed. But supporters of universal health care are closely watching Oregon, where voters next month will consider a proposal for the state to insure all of its residents.

“It’s a new political climate,” said Dr. Quentin Young of Chicago, national coordinator for the 10,000-member Physicians for a National Health Program, which advocates a single-payer government-financed system.

He said the present system’s woes — including 41.2 million Americans without health insurance, skyrocketing premiums for those who are insured, and soaring medical costs — are “fertile soil” for change.

“The people are ready,” said Mike Smith, a Sonoma Valley Health Care District board member and a lead organizer of the forum, “Health Care Crisis 2002: A Search for Solutions.”

The conference was co-sponsored by the junior college and nurses belonging to Service Employees International Union Local 707. Its urgent tone was underscored by the collapse of Health Plan of the Redwoods, which declared bankruptcy in June and closes its doors this month, leaving about 64,000 people to find other coverage.

Speakers cited a variety of strains on the system, including low reimbursement rates from insurers and the government, and a shortage of skilled workers that leaves many in the health care field feeling overworked and demoralized.

In Sonoma County, they said, lower pay scales and higher housing costs have contributed to doctors leaving and nurses choosing to work elsewhere.

Those who remain must contend with a population where 11 percent of children and 14 percent of adults under 65 are without health insurance, further taxing the system, said county Public Health Officer Mary Maddux-Gonzalez.

Without systemic changes, many expect the problems to get worse.

“The stress on the health care system within the next decade will demolish it; it’s an inexorable, inevitable demographic fact,” said Santa Rosa physician Robert Dozor, referring to when the first of the 76 million-strong baby-boom generation qualifies for Medicare benefits in 2011.

About 200 people, many of them medical professionals, attended the forum, and among the audience and panelists there was a broad sentiment that health maintenance organizations and private insurance plans should be replaced with a system along the lines of Medicare, which covers all citizens over age 65.

“We need some sort of national care system,” said Maria Angel of Sonoma, a government studies student at Sacramento State University who plans a career in public health policy.

Smith, from the Sonoma Valley Health Care District, said the time is ripe for change.

“The reason we don’t have universal health care is because we don’t have a broad-based movement to put fire under the politicians,” he said.

Others warned that without a firm sorting of priorities, any movement will suffer.

“You cannot have everything,” said Glaser. “If we cannot constrain ourselves to face that about health care … we will not see this in 50 years.”

You can reach Staff Writer Jeremy Hay at 521-5212 or jhay@pressdemocrat.com.

Universal Health Care Issue Regaining Saliency

October 17, 2002
By JOHN A. MacDONALD, Courant Staff Writer

WASHINGTON — Maine Rep. Scott W. Cowger was clear and concise when a newspaper asked his top priority if he is elected to a fourth term in the state legislature: “Providing affordable health care to all Mainers, not just low-income people. We must take aggressive action, including providing a single-payer universal health care system.”

Cowger is not alone. With insurance premiums rising and the number of uninsured Americans increasing, candidates across the nation are reviving the issue of the uninsured. The action is most concentrated in Oregon, where voters will decide Nov. 5 whether to become the first state in the nation to cover every resident through a government-financed health care system.

Dan Isaacson, campaign manager of Health Care for All Oregon, says one statistic makes the case for the ambitious change he is trying to pass. About 423,000 Oregon residents, 13 percent of the population, are not covered by health insurance. “People have a bad taste in their mouths for health insurance companies,” he said.

Still, the proposal appears to face long odds in Oregon and elsewhere. The only public poll in Oregon showed the issue trailing, 40 percent to 47 percent. The poll was conducted earlier this month by The Oregonian newspaper.

The proposal would end the system of private health insurance, which covers about 63 percent of Americans nationwide, and give the state government the responsibility for collecting taxes and paying medical bills. The goal – universal coverage – is the same one former President Clinton sought to achieve a decade ago. Clinton wanted to compel employers to provide health care, rejecting a government-financed system as exists in Canada because it was considered politically impossible.

The same conditions that prompted the Clinton proposal – multiple years of double-digit increases in health insurance costs and rising numbers of uninsured – are beginning to reappear. But that does not mean the public is ready for the kind of sweeping change proposed in Oregon and other places, experts said.

“The vast majority of Americans do not want a one-size-fits-all health insurance system,” said Len Nichols, who worked on the Clinton administration’s unsuccessful effort.

G. Lawrence Atkins, president of Health Policy Analysts, which advises Fortune 100 companies, said the nation’s private health care system is “on the verge of a meltdown.” But he is not ready to predict imminent wholesale change either.

Robert Blendon, a Harvard University expert on public attitudes on health care issues, said he sees little evidence health care is having a widespread effect on this fall’s elections, largely because there has been so much focus on terrorism and a possible war with Iraq. He also doubts the appeal of the single-payer approach.

Oregon’s Bold Plan

Mark Lindgren, who is working to pass the Oregon proposal, calls it an “audacious” plan. Opponents describe the proposal as an ill-conceived and ruinous tax increase.

Under the proposal, every man, woman and child in Oregon would receive health insurance with no co-payments and no deductibles. Any medical procedure approved by a doctor or registered medical professional would be covered under the plan, making it more comprehensive than most private insurance. The question is whether Oregonians would be willing to pay higher taxes to put the plan into effect.

The plan would be financed by a new payroll tax of up to 11.5 percent on businesses and an increase in personal income taxes. The top personal income tax rate would rise from its current 9 percent to as high as 17 percent. But employers and their workers no longer would pay premiums to insurers, estimated to be about $6,300 for family coverage next year.

Opponents said the plan would put Oregon’s economy at risk, result in huge job losses and threaten the quality of health care in the state. One of the more remarkable figures to emerge from the debate is that the universal coverage plan would cost $19 billion in its first year, about $3 billion more than the current state budget.

The Battle Elsewhere

On a recent Saturday, hundreds of people rallied in Montpelier, Vt., for a universal health care system similar to the one proposed in Oregon. “I speak for the people of America when I say this is a lead-in for national health care,” said Dr. Quentin Young, past president of Physicians for a National Health Program.

In addition to Vermont, candidates are pushing universal coverage in Maine, Washington state, California, Illinois, Massachusetts and New Mexico. This year, universal coverage proposals were introduced in at least 10 state legislatures, but all died because of tight budgets. Since 1994, single-payer system proposals have failed in Massachusetts, Florida and California.

A single-payer plan was introduced in the Connecticut legislature in 2001 but died without a hearing.

Despite repeated rejections, the idea refuses to go away. Edward F. Howard, executive vice president of the non-partisan Alliance for Health Reform, said the idea’s popularity is its apparent simplicity, equity and efficiency. “It does have some appeal,” Howard said.

But the appeal is far from universal. In Ohio, where prescription drug coverage is a hot item in the race for governor, the Columbus Dispatch took editorial note of the Oregon measure, commenting, “Oregon, a land where people are unafraid to take on some of the thorniest problems in health care, may become the nation’s crucible once again. … Better Oregon than Ohio.”

Voters eye health-care option

A November measure would create universal coverage.

SUSAN TOM
Statesman Journal
October 11, 2002

A sweeping initiative on the November ballot will test just how frustrated Oregonians are with the health care system.
Measure 23 would create a universal health care finance plan to provide medically necessary services to every Oregonian. If passed, Oregon will be the first state to offer free health care to all its residents. The measure would replace insurance premiums, copayments, deductibles and other out-of-pocket patient expenses with a single payer state system financed by payroll and personal income taxes.
Mark Lindgren, chairman of Health Care for All Oregon, the group backing the measure, said the initiative was deliberately written to be vague to avoid potential court challenges. A 15-member board would be created to set limits on health care services and to administer the program.
Laurie Sobel, attorney for Consumers Union, publisher of Consumer Reports, said the measure would reduce hidden costs and time wasted filing claims by cutting out the middle people, the insurance companies.
“We believe everyone has the right to health care,” Sobel said. “It makes for a healthier community and ultimately leads to lower costs.”
The measure sounds like an improvement over the current system, said Garth Keir of Salem, a former state worker retired on disability.
“It’s not just what you need now but what you may need,” said Keir, 56. “I always subscribe to the idea that we’re all in one big rowboat and we need to row together or sink together.”
But a growing number of opponents, including business, insurance, labor and medical groups like the Oregon Medical Association and Associated Oregon Industries, call the measure poorly written and financially unsustainable. They say it would force repeal of cost-saving worker compensation reforms and reduce money for schools. Estimates are that Measure 23 could cost up to $20 billion annually.
A coalition of health care insurers, including ODS Health Plans, Regence BlueCross BlueShield of Oregon, Kaiser Permanente, PacifiCare and Providence Health Plan, raised $402,692 so far to defeat the measure.
By comparison, Health Care for All Oregon raised $22,023, mostly from small donations.
David Fiskum, a lobbyist for Oregonians Against UnHealthy Taxes, said the measure not only would give the board unlimited power in issuing bonds and rationing health care, but will create another bureaucracy.
The timing also is bad given the state’s high unemployment rate and sagging economy.
An additional payroll tax will make Oregon a less attractive place for business, said Ken Rutledge, spokesman for the Oregon Association of Hospital and Health Systems.
“They’re being very naive to think there’s going to be adequate money to pay for all services,” Rutledge said.
Barbara Cummings, a Salem small business owner, said more people will abuse the system because there is no incentive to take personal responsibility for one’s health. She expects longer waits, more crowding and a lower quality of health care as a result.
“What happens when money runs out? Will I have to wait six weeks for an MRI?” Cummings said.
Rob Wagner, government relations director of the American Federation of Teachers-Oregon, said the measure is not an ideal fix, but it is a good first step toward.
“I see our members at the bargaining table having to choose between salary increases to keep up with the cost of living or picking up a greater portion of health care costs,” Wagner said.
Universal health supporters Oregon State Public Interest Research Group and Oregonians for Health Security are taking more conservative approaches because they say Oregonians aren’t ready to toss out the current system.
“We’re looking for smaller steps along the way and they’re looking for a leap,” said Rob Manning, spokesman for Oregonians for Health Security. “But if it were to pass, we would definitely be in support of it.”
The reason: more than 400,000 Oregonians don’t have health insurance. One in five lack prescription coverage.
Oregonians aren’t alone in their frustration with sharply rising premiums, lower reimbursements and reduced access. Fourteen states, including California and most recently Texas, are pursuing a single-payer system, according to the Universal Health Care Action Network in Cleveland, Ohio. Oregon could become the testing ground for a health care overhaul.
The problem isn’t new; the Clinton administration tried, but failed to expand health care coverage.
And Gov. John Kitzhaber’s promise of a more expansive system than the Oregon Health Plan to be financed in part by a business tax never materialized.
Critics say the current system provides too few services, costs too much, makes money off the young and healthy and dumps the sick and old.
Dr. Don McCanne, president of Physicians for a National Health Program, said the measure allows more efficient use of health care funds and establishes equity in finance and access.
“It provides more comprehensive services at a cost that is no greater than what Oregon is spending,” McCanne said.
But Dr. Colin Cave, OMA president-elect, said while the organization favors universal health care — it supported the Oregon Health Plan — it won’t back the measure because its approach is unreasonable.
Measure 23 has no limits on what type of health care is necessary, no incentive to coordinate access and no residency requirement.
There’s also no guarantee that 15 people have the necessary sophistication to deal with complex health care issues and manage a budget at least double that of Oregon’s general fund. Getting a federal waiver also is very unlikely.
“It’s very lopsided,” Cave said. “This is not the way to do it.”
But Hanteng Dai of Salem, a 38-year-old state employee, said he supports the measure despite its flaws because it’s the first step toward improving health care for society in the long run.
“Accept the concept first, improve the procedure later,” Dai said. “Don’t kill an idea in its infancy.”
Susan Tom can be reached at (503) 399-6744.