PNHP

President Obama: the Answer is Medicare for All

President Obama: the Answer is Medicare for All

By Healthcare-NOW!
February 17, 2010

Once again the president and congress are not including any discussion of the only real solution to America’s health care problems – expanding and improving Medicare to cover everyone in America.

Medicare for All would meet each of the goals President Obama set for health reform in his State of the Union Address, “But if anyone…has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.”

The President’s goals and our responses:

1. Expand coverage and provide more Americans health care – Improved Medicare for All will provide comprehensive medical, mental, dental, vision and prescription coverage to all people (everybody in, nobody out) living in the United States from birth to death without gaps. No system based on private insurance can make the same guarantee.

2. End insurance company abuses – Improved Medicare for All will remove the expensive and bloated private insurance bureaucracy from our health care system and effectively end their profit-driven practices of denying and restricting coverage. All people in America will enjoy the same sense of security that those with traditional Medicare currently feel in knowing that necessary care will be covered and that their coverage cannot be taken away. Medicare is accountable to the public, rather than to investors.

3. Control health care costs – Improved Medicare for All is the only solution with built-in cost controls. There will be immediate savings of $400 billion per year simply by removing the high administrative and marketing costs that come with having over 1,300 different private insurance plans. Additional savings will arise through negotiations for fair pharmaceutical prices as Walmart does now.

4. Decrease the deficit – Improved Medicare for All is the only solution which will put the brakes on our health care costs which are spiraling out of control. Further positive effects on the economy will occur as businesses are relieved of the financial burden of paying for health benefits allowing them to focus on building their business, raising wages and competing in the global market. Having less volatility in health care prices will allow businesses to hire more employees, thereby spurring job growth.

5. Stabilize Medicare – Improved Medicare for All will finally relieve the financial stress which is placed on Medicare from providing coverage for those who have the greatest health care needs – those who are disabled or who are 65 years of age and older. Everybody, healthy and ill, will contribute to the Medicare fund throughout their lives knowing that Medicare will be there for them when they need it.

Single-payer insurance needed now

By Mark Leno
San Francisco Chronicle
Tuesday, February 16, 2010

As outraged families and small businesses react to the latest health insurance premium increases, Californians are forced to face the fact that insurance companies are not in business to provide health care to people who need it. Premium increases are just part of the concerns – pre-existing condition denials, overturned doctors’ decisions, coverage rescissions and other insurance industry abuses are sadly commonplace.

It is impossible to make a profit serving customers who are likely to cost the insurer more than the premiums they pay. This means that if any one of us gets seriously sick or injured, we become an undesirable customer to health insurers. That’s the message Anthem Blue Cross sent to millions of Californians when it increased premiums by up to 39 percent. The insurer clearly doesn’t care if it loses these customers.

Health insurance companies are defending the rate increases by blaming rising health care costs – but health care costs have increased about 6 percent a year on top of similar increases last year – not 39 percent.

It is outrageous that insurance companies blame their rate increases on consumers who are dropping coverage because they can no longer afford it. In this economy, another increase in health premiums will be the last straw for many Californians. We know health insurance companies increase premiums each year because they can. They do it because it is in their best financial interests to do so, even when some increases stifle economic growth and threaten our middle-class standard of living. Everything we buy or use has health care costs embedded in it – from the food we eat to the dry cleaning service we select. Our current health insurance system is failing us. The California Universal Health Care Act, a single-payer reform plan that I introduced last year, provides every Californian with comprehensive health care and is fully funded with money that California already spends on health care.

Senate Bill 810 builds on our current system of privately delivered health care but is funded by a single, comprehensive health insurance plan that cuts out the private insurance middle man in order to simplify administration. It puts doctors and hospitals back in charge of our health care system.

SB810 works by creating a trust fund to pool money that government, employers and individuals spend on health care each year. Instead of paying premiums to private insurers, Californians would pay into the fund, which would guarantee coverage to all Californians. Patients would be free to choose their private doctors and hospitals.

SB810 would provide relief to consumers and to California businesses, which are struggling to pay rising employee health benefits.

Americans already pay per capita for health care twice what residents of other industrialized countries pay. The United States ranks 37th among nations in health care outcomes, according to the World Health Organization.

Californians want and deserve the state-of-the-art, single-payer health-care system envisioned by SB810. Visit CaliforniaOneCare.org to learn more.

Democrat Mark Leno represents Marin and parts of San Francisco and Sonoma counties in the state Senate.

http://sfgate.com/cgi-bin/article.cgi?f=/c/a/2010/02/16/EDLL1C0UA9.DTL

This article appeared on page A – 10 of the San Francisco Chronicle

Is Medicare "close enough" to universal?

Measuring Coverage for Seniors in Medicare Part A and Estimating the Cost of Making It Universal

By Michael Birnbaum and Elizabeth M. Patchias
Journal of Health Politics, Policy and Law
February 2010
Medicare’s Part A Coverage Gap in the Context of National Health Care Reform
The fact that 1.6 million seniors in the United States — 5 percent of the elderly population — are without full federal Part A coverage is a significant policy issue. While Medicare is widely understood to cover the entire elderly U.S. population, this is at best a substantial exaggeration of Medicare’s reach and perhaps a mischaracterization whose broad acceptance preempts a national debate about Medicare eligibility policy and clouds the existing debate on universal coverage.
Will a national discussion on Medicare eligibility get at least a little traction? At this point it seems unlikely because of a powerful counterargument that Medicare is close enough to universal and that seniors without the full federal Part A benefit have other public programs and sources of government funding to support their health care needs, with some ultimately gaining Medicare Part A through their state Medicaid programs. This argument is valid and empirically strong, but it hangs on a normative question: when we are dealing with Medicare eligibility policy in the context of a national discussion about universal coverage, should we settle for “close enough” and accept that, when people fall through the cracks of Medicare’s eligibility framework, Medicaid and the states will be there as a last resort?
http://jhppl.dukejournals.org/cgi/content/abstract/35/1/49?etoc

And…

Projected Impact of Senate Health Reform Bill; Estimates of Alternative Designs

RAND
February 16, 2010
The (RAND) study finds that health care legislation passed by the Senate in December would cut the number of uninsured Americans to 25 million by 2019 (a 53 percent decrease).
http://www.rand.org/news/press/2010/02/16/

At what level do we say that the rate of coverage under a universal program is “close enough”? For Medicare Part A, we’ve already answered that question. Covering 95 percent of those over age 65 is “close enough,” leaving 1.6 million seniors out of the Part A program (primarily hospital care).
We now hear from our politicians that the Senate reform bill awaiting approval in the House is “close enough” to universal coverage, cutting the number of uninsured in half, leaving only 25 million without coverage, according to this new RAND report.
Many suggest that we abandon the term “single payer” and use “Medicare for All” instead. Universal coverage under single payer means 100 percent – everyone is included automatically, not 95 percent like Medicare Part A.
When we choose to use the Medicare rhetoric because it would resonate better with some audiences, we should refer to it as “improved Medicare for All.” That’s simply code language for replacing Medicare’s numerous flawed policies with a bona fide single payer program – a program that removes financial barriers to health care for absolutely everyone.
During the health reform dialogue, when someone says, “close enough,” you know that person is supporting flawed policies. Jump in immediately, protesting that “close enough” isn’t good enough when we have better policies that will get all of us all the way there.

Is Medicare “close enough” to universal?

Measuring Coverage for Seniors in Medicare Part A and Estimating the Cost of Making It Universal

By Michael Birnbaum and Elizabeth M. Patchias
Journal of Health Politics, Policy and Law
February 2010

Medicare’s Part A Coverage Gap in the Context of National Health Care Reform

The fact that 1.6 million seniors in the United States — 5 percent of the elderly population — are without full federal Part A coverage is a significant policy issue. While Medicare is widely understood to cover the entire elderly U.S. population, this is at best a substantial exaggeration of Medicare’s reach and perhaps a mischaracterization whose broad acceptance preempts a national debate about Medicare eligibility policy and clouds the existing debate on universal coverage.

Will a national discussion on Medicare eligibility get at least a little traction? At this point it seems unlikely because of a powerful counterargument that Medicare is close enough to universal and that seniors without the full federal Part A benefit have other public programs and sources of government funding to support their health care needs, with some ultimately gaining Medicare Part A through their state Medicaid programs. This argument is valid and empirically strong, but it hangs on a normative question: when we are dealing with Medicare eligibility policy in the context of a national discussion about universal coverage, should we settle for “close enough” and accept that, when people fall through the cracks of Medicare’s eligibility framework, Medicaid and the states will be there as a last resort?

http://jhppl.dukejournals.org/cgi/content/abstract/35/1/49?etoc

And…

Projected Impact of Senate Health Reform Bill; Estimates of Alternative Designs

RAND
February 16, 2010

The (RAND) study finds that health care legislation passed by the Senate in December would cut the number of uninsured Americans to 25 million by 2019 (a 53 percent decrease).

http://www.rand.org/news/press/2010/02/16/

At what level do we say that the rate of coverage under a universal program is “close enough”? For Medicare Part A, we’ve already answered that question. Covering 95 percent of those over age 65 is “close enough,” leaving 1.6 million seniors out of the Part A program (primarily hospital care).

We now hear from our politicians that the Senate reform bill awaiting approval in the House is “close enough” to universal coverage, cutting the number of uninsured in half, leaving only 25 million without coverage, according to this new RAND report.

Many suggest that we abandon the term “single payer” and use “Medicare for All” instead. Universal coverage under single payer means 100 percent – everyone is included automatically, not 95 percent like Medicare Part A.

When we choose to use the Medicare rhetoric because it would resonate better with some audiences, we should refer to it as “improved Medicare for All.” That’s simply code language for replacing Medicare’s numerous flawed policies with a bona fide single payer program – a program that removes financial barriers to health care for absolutely everyone.

During the health reform dialogue, when someone says, “close enough,” you know that person is supporting flawed policies. Jump in immediately, protesting that “close enough” isn’t good enough when we have better policies that will get all of us all the way there.

Proper health care requires everybody in the same boat

By George Jolly
The Saratogian (Saratoga Springs, N.Y.)
Sunday, February 14, 2010

Health care reform has derailed and is sitting beside the tracks.

The proposals that came out of Congress are patchworks of policies which try to alleviate some of the most egregious failures of our present healthcare “non-system,” such as limiting the power of insurance companies to refuse to cover those with pre-existing conditions.

But those stalled efforts fell far short of what is needed:  Twenty-million people would remain uninsured. The system would be more complex than ever. These reforms would cost an extra trillion dollars over the next 10 years and contain no effective means of reducing the rapid rate of growth of health care expenditure. More middle-class families would face financial disaster as insurance companies issue policies inadequate in serious illness. The mandate to buy insurance would push huge sums into the hands of the already powerful private insurers.

What should be the essential features of the future American health care finance system?

– We need to have everybody participate. That is the way insurance works — you spread the risk of illness across as many people as possible.

– We need simplicity, ease of administration, ease of enrollment and a system not affected by changing jobs or being laid off.

– It should cover all necessary medical care.

– It should allow choice of physician and of hospital.

– We need to curtail rising costs. The greatest waste in the system right now is created by enormous bureaucratic complexity. Future rises in costs should be managed system wide, with input from providers and the public. It is crazy to let Congress micro-manage health care expenditure.

It should be financed through a graduated income tax, because illness doesn’t check to see if you are wealthy or poor, employed or unemployed.

Such a system already exists in our traditional Medicare.

As a citizen, I know I’m automatically included at age 65. The paperwork is minimal. I can use any doctor or hospital. It is clear what is covered and what is not. It runs with an overhead of 5 percent instead of the 15 to 25 percent of commercial insurance. Payment policy is controlled by a federal agency under a budget set by Congress.

Medicare is costly, paying for care of the oldest and sickest people in society. We have caused that by allowing private insurance to “cherrypick” the healthiest, lowest-cost working people. Every healthy person brought into “Medicare for all” will reduce the per-patient cost. Elimination of the multiplicity of insurance companies and the use of global budgeting of institutions like hospitals will result in an estimated savings of $400 billion yearly, enough to pay for all the uninsured, and improve the quality of coverage for both present and new Medicare enrollees.

Shouldn’t we expect more from our elected representatives, the Congress and the president? Shouldn’t we insist that they place the interests of the American people ahead of the special interests of insurance companies and drug companies? A workable solution won’t emerge unless each of us makes it clear to our elected officials that we want a system based on the principles listed above.

So, if no reform comes out of Washington this year, we may have been given a chance to do it right. Our first consideration ought to be a “single-payer” Medicare for all.

George Jolly is a geriatrician with Saratoga Medical Associates in Saratoga Springs.

http://www.saratogian.com/articles/2010/02/14/opinion/doc4b777ba10f13a031529704.txt

Health Insurers Break Profit Records as 2.7 Million Americans Lose Coverage

From Health Care for American Now

The five largest U.S. health insurance companies sailed through the worst economic downturn since the Great Depression to set new industry profit records in 2009, a feat accomplished by leaving behind 2.7 million Americans who had been in private health plans. For customers who kept their benefits, the insurers raised rates and cost-sharing, and cut the share of premiums spent on medical care.1 Executives and shareholders of the five biggest for-profit health insurers, UnitedHealth Group Inc., WellPoint Inc., Aetna Inc., Humana Inc., and Cigna Corp., enjoyed combined profit of $12.2 billion in 2009, up 56 percent from the previous year. It was the best year ever for Big Insurance.

Click here for the fact sheet.

'We can do better'

Single-payer plan is the best option, one local doctor says

By LORETTA SWORD
The Pueblo Chieftain (Colo.), Feb. 15, 2010

Proponents of a national health plan are disappointed that bills that emerged last year from the U.S. Senate and House didn’t include a national health plan.

Critics of the measures are optimistic that both will be buried in political haggling.

But most on both sides of the debate agree that efforts to reform the nation’s health care system, stalled for now by partisan politics, is critical.

They may even agree that now is the time to take a longer, harder look at what the problems are and how they can best be solved.

They see the current stalemate as a chance to start over and do it right, even if they don’t agree on what is “right.”   Dr. Anne Courtright, a local board member of Health Care for All Colorado, said she was deeply disappointed in the bills that came out of House and Senate committees and now await some sort of melding process, or a slow death.

During his campaign and through most of the past year, President Barack Obama repeatedly said the only way to provide medical care for all Americans is through a single-payer system “and that if he were starting a new system from scratch, that is the way he would go,”  Courtright said.

She and others hope he’ll be more insistent in the second go-round.

“At the very beginning of the discussion about health reform bills, it was stated, basically, that ‘single-payer is off the table.’ While it has never officially been on the table, they have never really been able to get it totally off of the table. My question is, if single-payer is such an awful idea, why are they scared to have it publicly discussed? The obvious answer to me, of course is, is that it is the only plan that meets every one of President Obama’s criteria.”

Aside from Republican resistance to an Obama victory on health care, and outlandish lies about single-payer proposals from the Tea Party movement and other detractors, she said, there was tremendous pressure from the insurance industry not to consider a single-payer plan, or even a public option that would compete with private insurance.

The voice of single-payer proponents eventually was drowned out in the clamor, but are determined to be part of the debate now.

“The reality is that you cannot provide economical health coverage for all with for-profit insurance companies providing insurance coverage,” Courtright said.

“You can do it with an individual mandate and non-profit insurance companies which are tightly controlled and told to offer uniform policies with the government picking up the tab for those who cannot afford to buy a policy.

“You can do it with a socialized  plan in which the government owns the hospitals, nursing homes, etc. and hires the providers.

“Or you can do it with a ‘Medicare for all’ system, in which the government collects the money and puts it in a trust fund and care is provided privately, and the providers are privately owned but non-profit. Providers would bill the trust fund, which would pay the bills.”

  With a single-payer system, Courtright added, “it would be easier to see what is working well and what is not, and also much easier to spot potential fraud or misuse of the system. It is also easier to enforce best practices and patient safety protocols.

  “Yes, decisions have to be made about what is covered. But let’s make those decisions with a doctor/patient/ hospital administrator board, not a for-profit insurance company focused on making a profit. This is what they have to focus on, or they will go out of business.”

The best thing to come out of last summers rancorous public debates and the ugly wrangling in Congress, Courtright said, is that “the principle on which all of the debate has been based is: ‘How do we get everyone covered in an economical manner?’ ” may mean something a bit different to different political groups, but it’s the core of the problem.

“The first decision that we as a country have to make is, do we believe that everyone should be covered? Is health care is a right? We say everyone has a right to life, liberty and the pursuit of happiness. Don’t people deserve health care just as much as they deserve police and fire protection and basic education?

“Every other industrialized democracy has made the decision that they believe everyone should have the same quality health care coverage. That is what the single payer movement believes and that is what we are fighting for. That is what repeated polls have shown the majority of the American people believe.

“I think that is why the majority of the American people are opposed to the current House and Senate health care bills, which are seen, I believe, as a sellout to the insurance companies and offer no relief to the rising cost of health care for the American people.”

Courtright said it is unimaginable that, despite having many of the world’s best doctors and medical schools, and the latest technology and research, Americans die every day of treatable diseases — and survivors lose their homes in medical bankruptcies.

“We have excellent medical care available, but too many of us cannot afford to access that excellent care. I don’t like being told that our health care system ranks 37th worldwide. We can do better if we get our priorities right,” she said.

‘We can do better’

Single-payer plan is the best option, one local doctor says

By LORETTA SWORD
The Pueblo Chieftain (Colo.), Feb. 15, 2010

Proponents of a national health plan are disappointed that bills that emerged last year from the U.S. Senate and House didn’t include a national health plan.

Critics of the measures are optimistic that both will be buried in political haggling.

But most on both sides of the debate agree that efforts to reform the nation’s health care system, stalled for now by partisan politics, is critical.

They may even agree that now is the time to take a longer, harder look at what the problems are and how they can best be solved.

They see the current stalemate as a chance to start over and do it right, even if they don’t agree on what is “right.”   Dr. Anne Courtright, a local board member of Health Care for All Colorado, said she was deeply disappointed in the bills that came out of House and Senate committees and now await some sort of melding process, or a slow death.

During his campaign and through most of the past year, President Barack Obama repeatedly said the only way to provide medical care for all Americans is through a single-payer system “and that if he were starting a new system from scratch, that is the way he would go,”  Courtright said.

She and others hope he’ll be more insistent in the second go-round.

“At the very beginning of the discussion about health reform bills, it was stated, basically, that ‘single-payer is off the table.’ While it has never officially been on the table, they have never really been able to get it totally off of the table. My question is, if single-payer is such an awful idea, why are they scared to have it publicly discussed? The obvious answer to me, of course is, is that it is the only plan that meets every one of President Obama’s criteria.”

Aside from Republican resistance to an Obama victory on health care, and outlandish lies about single-payer proposals from the Tea Party movement and other detractors, she said, there was tremendous pressure from the insurance industry not to consider a single-payer plan, or even a public option that would compete with private insurance.

The voice of single-payer proponents eventually was drowned out in the clamor, but are determined to be part of the debate now.

“The reality is that you cannot provide economical health coverage for all with for-profit insurance companies providing insurance coverage,” Courtright said.

“You can do it with an individual mandate and non-profit insurance companies which are tightly controlled and told to offer uniform policies with the government picking up the tab for those who cannot afford to buy a policy.

“You can do it with a socialized  plan in which the government owns the hospitals, nursing homes, etc. and hires the providers.

“Or you can do it with a ‘Medicare for all’ system, in which the government collects the money and puts it in a trust fund and care is provided privately, and the providers are privately owned but non-profit. Providers would bill the trust fund, which would pay the bills.”

  With a single-payer system, Courtright added, “it would be easier to see what is working well and what is not, and also much easier to spot potential fraud or misuse of the system. It is also easier to enforce best practices and patient safety protocols.

  “Yes, decisions have to be made about what is covered. But let’s make those decisions with a doctor/patient/ hospital administrator board, not a for-profit insurance company focused on making a profit. This is what they have to focus on, or they will go out of business.”

The best thing to come out of last summers rancorous public debates and the ugly wrangling in Congress, Courtright said, is that “the principle on which all of the debate has been based is: ‘How do we get everyone covered in an economical manner?’ ” may mean something a bit different to different political groups, but it’s the core of the problem.

“The first decision that we as a country have to make is, do we believe that everyone should be covered? Is health care is a right? We say everyone has a right to life, liberty and the pursuit of happiness. Don’t people deserve health care just as much as they deserve police and fire protection and basic education?

“Every other industrialized democracy has made the decision that they believe everyone should have the same quality health care coverage. That is what the single payer movement believes and that is what we are fighting for. That is what repeated polls have shown the majority of the American people believe.

“I think that is why the majority of the American people are opposed to the current House and Senate health care bills, which are seen, I believe, as a sellout to the insurance companies and offer no relief to the rising cost of health care for the American people.”

Courtright said it is unimaginable that, despite having many of the world’s best doctors and medical schools, and the latest technology and research, Americans die every day of treatable diseases — and survivors lose their homes in medical bankruptcies.

“We have excellent medical care available, but too many of us cannot afford to access that excellent care. I don’t like being told that our health care system ranks 37th worldwide. We can do better if we get our priorities right,” she said.

Mark Pauly didn't move; the center did

Republicans Spurn Once-Favored Health Mandate

By Julie Rovner
NPR
February 15, 2010

For Republicans, the idea of requiring every American to have health insurance is one of the most abhorrent provisions of the Democrats’ health overhaul bills.

“Congress has never crossed the line between regulating what people choose to do and ordering them to do it,” said Sen. Orrin Hatch (R-UT). “The difference between regulating and requiring is liberty.”

But Hatch’s opposition is ironic, or some would say, politically motivated. The last time Congress debated a health overhaul, when Bill Clinton was president, Hatch and several other senators who now oppose the so-called individual mandate actually supported a bill that would have required it.

In fact, says Len Nichols of the New America Foundation, the individual mandate was originally a Republican idea. “It was invented by Mark Pauly to give to George Bush Sr. back in the day, as a competition to the employer mandate focus of the Democrats at the time.”

Pauly, a conservative health economist at the University of Pennsylvania’s Wharton School, says it wasn’t just his idea. Back in the late 1980s — when Democrats were pushing not just a requirement for employers to provide insurance, but also the possibility of a government-sponsored single-payer system — “a group of economists and health policy people, market-oriented, sat down and said, ‘Let’s see if we can come up with a health reform proposal that would preserve a role for markets but would also achieve universal coverage.’ “

The idea of the individual mandate was about the only logical way to get there, Pauly says. That’s because even with the most generous subsidies or enticements, “there would always be some Evel Knievels of health insurance, who would decline coverage even if the subsidies were very generous, and even if they could afford it, quote unquote, so if you really wanted to close the gap, that’s the step you’d have to take.”

One reason the individual mandate appealed to conservatives is because it called for individual responsibility to address what economists call the “free-rider effect.” That’s the fact that if a person is in an accident or comes down with a dread disease, that person is going to get medical care, and someone is going to pay for it.

“We called this responsible national health insurance,” says Pauly. “There was a kind of an ethical and moral support for the notion that people shouldn’t be allowed to free-ride on the charity of fellow citizens.”

So while President Clinton was pushing for employers to cover their workers in his 1993 bill, John Chafee of Rhode Island, along with 20 other GOP senators and Rep. Bill Thomas of California, introduced legislation that instead featured an individual mandate. Four of those Republican co-sponsors — Hatch, Charles Grassley of Iowa, Robert Bennett of Utah and Christopher Bond of Missouri — remain in the Senate today.

But the summary of the Republican bill from the Clinton era and the Democratic bills that passed the House and Senate over the past few months are startlingly alike.

Beyond the requirement that everyone have insurance, both call for purchasing pools and standardized insurance plans. Both call for a ban on insurers denying coverage or raising premiums because a person has been sick in the past. Both even call for increased federal research into the effectiveness of medical treatments — something else that used to have strong bipartisan support, but that Republicans have been backing away from recently.

And how does economist Pauly feel about the GOP’s retreat from the individual mandate they used to promote? “That’s not something that makes me particularly happy,” he says.

http://www.npr.org/templates/story/story.php?storyId=123670612

And…

Chafee’s political prescriptions – Republican Senator John Chaffee has his own proposals for health care reform

By Rich Lowry
National Review
January 24, 1994

Senate Minority Leader Robert Dole tapped (Sen. John) Chafee, a long-time student of health care, to craft the principles that 23 Republicans signed last fall as a buffer against the Clinton onslaught.

Chafee’s plan then looked, as critics said, like “Clinton Lite”: no price controls or employer mandates, but, universal coverage, a comprehensive benefits package, a National Health Board, and purchasing alliances. Before long Hillary Clinton, eager for Republican cooperation, was calling him her “counselor and advisor.”

In October Chafee’s bill was redrafted under pressure from conservatives and Dole. It went from having mandatory purchasing alliances–the linch-pin of the Clinton plan–to voluntary ones. “This is night and day,” says Don Devine, head of Citizens against Rationing Health, a group supported by the American Conservative Union. The plan now includes medical savings accounts–an essential feature of the conservative John Goodman plan. And Chafee puts off universal coverage to 2005, promising to extend coverage only as savings are realized.

Newt Gingrich delivered perhaps his sharpest attack on the Clinton proposal yet in a speech to Empower America December 14. And, significantly, in a December 16 news conference Dole said, “I don’t think there’s a [health-care] crisis.” He went on to endorse incremental reforms: “When we’ve got some areas we agree on, why not just go ahead and pass those early next year?” Administrative simplification, coverage for people with pre-existing conditions, malpractice reform, insurance portability–the list goes on–would improve the system without scrapping it.

http://findarticles.com/p/articles/mi_m1282/is_n1_v46/ai_14809418/

Comment: 

By Don McCanne, MD

In perhaps the greatest irony of the reform process, President Obama has scheduled a bipartisan health care summit in which the Democrats will submit a right-wing proposal similar to that crafted by conservative economist Mark Pauly and his market-oriented colleagues. The Republicans will offer nominal proposals that would provide no significant benefit in correcting the problems that we face with our health care system.

When President and Mrs. Clinton began their reform efforts, they understood the superiority of the single payer model, but they anticipated that it would be rejected as being a left-wing government program. They decided to stake out a position that they perceived to be in the middle, when in fact it was a market-oriented proposal that would have appeal more to those on the right except for the level of regulatory oversight.

Although with the Clintons already negotiating to the right of center, the conservatives moved the fulcrum of the negotiations further to the right by offering a counter-proposal for mandatory purchasing alliances – “a health reform proposal that would preserve a role for markets but would also achieve universal coverage.” The conservatives then again pulled up stakes and moved even further to the right by making them voluntary. The process ended with Sen. Robert Dole saying that all we needed was some incremental reforms. We all know what’s happened to our health care system since then.

President Obama clearly understands the superiority of the single payer model and has stated so on several occasions, going so far as to say that we would adopt single payer if we were starting from scratch. But the position he eventually staked out was far to the right, even further to the right than the initial Republican counter-proposal offered in 1993. He campaigned against an individual mandate to purchase private plans since they were not affordable to middle-income individuals a
nd families. Although a pseudo-mandate has been included in the Democrat’s proposal, it would still leave tens of millions without coverage, falling short of the goal that conservative economist Mark Pauly likely envisioned.

This bipartisan process began on the right. Over the past couple of decades it has been pulled further and further to the right until it has deteriorated into a process in which we are looking for those reforms, all in right-wing territory, that we can agree on. We’re only one step away from returning to Bob Dole’s incrementalism – a path that leads ever downward into despair.

It’s not too late. We can start over with single payer – an improved Medicare that covers everyone. That would end our despair.

Mark Pauly didn’t move; the center did

Republicans Spurn Once-Favored Health Mandate

By Julie Rovner
NPR
February 15, 2010

For Republicans, the idea of requiring every American to have health insurance is one of the most abhorrent provisions of the Democrats’ health overhaul bills.

“Congress has never crossed the line between regulating what people choose to do and ordering them to do it,” said Sen. Orrin Hatch (R-UT). “The difference between regulating and requiring is liberty.”

But Hatch’s opposition is ironic, or some would say, politically motivated. The last time Congress debated a health overhaul, when Bill Clinton was president, Hatch and several other senators who now oppose the so-called individual mandate actually supported a bill that would have required it.

In fact, says Len Nichols of the New America Foundation, the individual mandate was originally a Republican idea. “It was invented by Mark Pauly to give to George Bush Sr. back in the day, as a competition to the employer mandate focus of the Democrats at the time.”

Pauly, a conservative health economist at the University of Pennsylvania’s Wharton School, says it wasn’t just his idea. Back in the late 1980s — when Democrats were pushing not just a requirement for employers to provide insurance, but also the possibility of a government-sponsored single-payer system — “a group of economists and health policy people, market-oriented, sat down and said, ‘Let’s see if we can come up with a health reform proposal that would preserve a role for markets but would also achieve universal coverage.’ “

The idea of the individual mandate was about the only logical way to get there, Pauly says. That’s because even with the most generous subsidies or enticements, “there would always be some Evel Knievels of health insurance, who would decline coverage even if the subsidies were very generous, and even if they could afford it, quote unquote, so if you really wanted to close the gap, that’s the step you’d have to take.”

One reason the individual mandate appealed to conservatives is because it called for individual responsibility to address what economists call the “free-rider effect.” That’s the fact that if a person is in an accident or comes down with a dread disease, that person is going to get medical care, and someone is going to pay for it.

“We called this responsible national health insurance,” says Pauly. “There was a kind of an ethical and moral support for the notion that people shouldn’t be allowed to free-ride on the charity of fellow citizens.”

So while President Clinton was pushing for employers to cover their workers in his 1993 bill, John Chafee of Rhode Island, along with 20 other GOP senators and Rep. Bill Thomas of California, introduced legislation that instead featured an individual mandate. Four of those Republican co-sponsors — Hatch, Charles Grassley of Iowa, Robert Bennett of Utah and Christopher Bond of Missouri — remain in the Senate today.

But the summary of the Republican bill from the Clinton era and the Democratic bills that passed the House and Senate over the past few months are startlingly alike.

Beyond the requirement that everyone have insurance, both call for purchasing pools and standardized insurance plans. Both call for a ban on insurers denying coverage or raising premiums because a person has been sick in the past. Both even call for increased federal research into the effectiveness of medical treatments — something else that used to have strong bipartisan support, but that Republicans have been backing away from recently.

And how does economist Pauly feel about the GOP’s retreat from the individual mandate they used to promote? “That’s not something that makes me particularly happy,” he says.

http://www.npr.org/templates/story/story.php?storyId=123670612

And…

Chafee’s political prescriptions – Republican Senator John Chaffee has his own proposals for health care reform

By Rich Lowry
National Review
January 24, 1994

Senate Minority Leader Robert Dole tapped (Sen. John) Chafee, a long-time student of health care, to craft the principles that 23 Republicans signed last fall as a buffer against the Clinton onslaught.

Chafee’s plan then looked, as critics said, like “Clinton Lite”: no price controls or employer mandates, but, universal coverage, a comprehensive benefits package, a National Health Board, and purchasing alliances. Before long Hillary Clinton, eager for Republican cooperation, was calling him her “counselor and advisor.”

In October Chafee’s bill was redrafted under pressure from conservatives and Dole. It went from having mandatory purchasing alliances–the linch-pin of the Clinton plan–to voluntary ones. “This is night and day,” says Don Devine, head of Citizens against Rationing Health, a group supported by the American Conservative Union. The plan now includes medical savings accounts–an essential feature of the conservative John Goodman plan. And Chafee puts off universal coverage to 2005, promising to extend coverage only as savings are realized.

Newt Gingrich delivered perhaps his sharpest attack on the Clinton proposal yet in a speech to Empower America December 14. And, significantly, in a December 16 news conference Dole said, “I don’t think there’s a [health-care] crisis.” He went on to endorse incremental reforms: “When we’ve got some areas we agree on, why not just go ahead and pass those early next year?” Administrative simplification, coverage for people with pre-existing conditions, malpractice reform, insurance portability–the list goes on–would improve the system without scrapping it.

http://findarticles.com/p/articles/mi_m1282/is_n1_v46/ai_14809418/

Comment: 

By Don McCanne, MD

In perhaps the greatest irony of the reform process, President Obama has scheduled a bipartisan health care summit in which the Democrats will submit a right-wing proposal similar to that crafted by conservative economist Mark Pauly and his market-oriented colleagues. The Republicans will offer nominal proposals that would provide no significant benefit in correcting the problems that we face with our health care system.

When President and Mrs. Clinton began their reform efforts, they understood the superiority of the single payer model, but they anticipated that it would be rejected as being a left-wing government program. They decided to stake out a position that they perceived to be in the middle, when in fact it was a market-oriented proposal that would have appeal more to those on the right except for the level of regulatory oversight.

Although with the Clintons already negotiating to the right of center, the conservatives moved the fulcrum of the negotiations further to the right by offering a counter-proposal for mandatory purchasing alliances – “a health reform proposal that would preserve a role for markets but would also achieve universal coverage.” The conservatives then again pulled up stakes and moved even further to the right by making them voluntary. The process ended with Sen. Robert Dole saying that all we needed was some incremental reforms. We all know what’s happened to our health care system since then.

President Obama clearly understands the superiority of the single payer model and has stated so on several occasions, going so far as to say that we would adopt single payer if we were starting from scratch. But the position he eventually staked out was far to the right, even further to the right than the initial Republican counter-proposal offered in 1993. He campaigned against an individual mandate to purchase private plans since they were not affordable to middle-income individuals and families. Although a pseudo-mandate has been included in the Democrat’s proposal, it would still leave tens of millions without coverage, falling short of the goal that conservative economist Mark Pauly likely envisioned.

This bipartisan process began on the right. Over the past couple of decades it has been pulled further and further to the right until it has deteriorated into a process in which we are looking for those reforms, all in right-wing territory, that we can agree on. We’re only one step away from returning to Bob Dole’s incrementalism – a path that leads ever downward into despair.

It’s not too late. We can start over with single payer – an improved Medicare that covers everyone. That would end our despair.

Mark Pauly didn't move; the center did

Republicans Spurn Once-Favored Health Mandate

By Julie Rovner
NPR
February 15, 2010
For Republicans, the idea of requiring every American to have health insurance is one of the most abhorrent provisions of the Democrats’ health overhaul bills.
“Congress has never crossed the line between regulating what people choose to do and ordering them to do it,” said Sen. Orrin Hatch (R-UT). “The difference between regulating and requiring is liberty.”
But Hatch’s opposition is ironic, or some would say, politically motivated. The last time Congress debated a health overhaul, when Bill Clinton was president, Hatch and several other senators who now oppose the so-called individual mandate actually supported a bill that would have required it.
In fact, says Len Nichols of the New America Foundation, the individual mandate was originally a Republican idea. “It was invented by Mark Pauly to give to George Bush Sr. back in the day, as a competition to the employer mandate focus of the Democrats at the time.”
Pauly, a conservative health economist at the University of Pennsylvania’s Wharton School, says it wasn’t just his idea. Back in the late 1980s — when Democrats were pushing not just a requirement for employers to provide insurance, but also the possibility of a government-sponsored single-payer system — “a group of economists and health policy people, market-oriented, sat down and said, ‘Let’s see if we can come up with a health reform proposal that would preserve a role for markets but would also achieve universal coverage.’ ”
The idea of the individual mandate was about the only logical way to get there, Pauly says. That’s because even with the most generous subsidies or enticements, “there would always be some Evel Knievels of health insurance, who would decline coverage even if the subsidies were very generous, and even if they could afford it, quote unquote, so if you really wanted to close the gap, that’s the step you’d have to take.”
One reason the individual mandate appealed to conservatives is because it called for individual responsibility to address what economists call the “free-rider effect.” That’s the fact that if a person is in an accident or comes down with a dread disease, that person is going to get medical care, and someone is going to pay for it.
“We called this responsible national health insurance,” says Pauly. “There was a kind of an ethical and moral support for the notion that people shouldn’t be allowed to free-ride on the charity of fellow citizens.”
So while President Clinton was pushing for employers to cover their workers in his 1993 bill, John Chafee of Rhode Island, along with 20 other GOP senators and Rep. Bill Thomas of California, introduced legislation that instead featured an individual mandate. Four of those Republican co-sponsors — Hatch, Charles Grassley of Iowa, Robert Bennett of Utah and Christopher Bond of Missouri — remain in the Senate today.
But the summary of the Republican bill from the Clinton era and the Democratic bills that passed the House and Senate over the past few months are startlingly alike.
Beyond the requirement that everyone have insurance, both call for purchasing pools and standardized insurance plans. Both call for a ban on insurers denying coverage or raising premiums because a person has been sick in the past. Both even call for increased federal research into the effectiveness of medical treatments — something else that used to have strong bipartisan support, but that Republicans have been backing away from recently.
And how does economist Pauly feel about the GOP’s retreat from the individual mandate they used to promote? “That’s not something that makes me particularly happy,” he says.
http://www.npr.org/templates/story/story.php?storyId=123670612

And…

Chafee’s political prescriptions – Republican Senator John Chaffee has his own proposals for health care reform

By Rich Lowry
National Review
January 24, 1994
Senate Minority Leader Robert Dole tapped (Sen. John) Chafee, a long-time student of health care, to craft the principles that 23 Republicans signed last fall as a buffer against the Clinton onslaught.
Chafee’s plan then looked, as critics said, like “Clinton Lite”: no price controls or employer mandates, but, universal coverage, a comprehensive benefits package, a National Health Board, and purchasing alliances. Before long Hillary Clinton, eager for Republican cooperation, was calling him her “counselor and advisor.”
In October Chafee’s bill was redrafted under pressure from conservatives and Dole. It went from having mandatory purchasing alliances–the linch-pin of the Clinton plan–to voluntary ones. “This is night and day,” says Don Devine, head of Citizens against Rationing Health, a group supported by the American Conservative Union. The plan now includes medical savings accounts–an essential feature of the conservative John Goodman plan. And Chafee puts off universal coverage to 2005, promising to extend coverage only as savings are realized.
Newt Gingrich delivered perhaps his sharpest attack on the Clinton proposal yet in a speech to Empower America December 14. And, significantly, in a December 16 news conference Dole said, “I don’t think there’s a [health-care] crisis.” He went on to endorse incremental reforms: “When we’ve got some areas we agree on, why not just go ahead and pass those early next year?” Administrative simplification, coverage for people with pre-existing conditions, malpractice reform, insurance portability–the list goes on–would improve the system without scrapping it.
http://findarticles.com/p/articles/mi_m1282/is_n1_v46/ai_14809418/

In perhaps the greatest irony of the reform process, President Obama has scheduled a bipartisan health care summit in which the Democrats will submit a right-wing proposal similar to that crafted by conservative economist Mark Pauly and his market-oriented colleagues. The Republicans will offer nominal proposals that would provide no significant benefit in correcting the problems that we face with our health care system.
When President and Mrs. Clinton began their reform efforts, they understood the superiority of the single payer model, but they anticipated that it would be rejected as being a left-wing government program. They decided to stake out a position that they perceived to be in the middle, when in fact it was a market-oriented proposal that would have appeal more to those on the right except for the level of regulatory oversight.
Although with the Clintons already negotiating to the right of center, the conservatives moved the fulcrum of the negotiations further to the right by offering a counter-proposal for mandatory purchasing alliances – “a health reform proposal that would preserve a role for markets but would also achieve universal coverage.” The conservatives then again pulled up stakes and moved even further to the right by making them voluntary. The process ended with Sen. Robert Dole saying that all we needed was some incremental reforms. We all know what’s happened to our health care system since then.
President Obama clearly understands the superiority of the single payer model and has stated so on several occasions, going so far as to say that we would adopt single payer if we were starting from scratch. But the position he eventually staked out was far to the right, even further to the right than the initial Republican counter-proposal offered in 1993. He campaigned against an individual mandate to purchase private plans since they were not affordable to middle-income individuals and families. Although a pseudo-mandate has been included in the Democrat’s proposal, it would still leave tens of millions without coverage, falling short of the goal that conservative economist Mark Pauly likely envisioned.
This bipartisan process began on the right. Over the past couple of decades it has been pulled further and further to the right until it has deteriorated into a process in which we are looking for those reforms, all in right-wing territory, that we can agree on. We’re only one step away from returning to Bob Dole’s incrementalism – a path that leads ever downward into despair.
It’s not too late. We can start over with single payer – an improved Medicare that covers everyone. That would end our despair.