PNHP

Single-payer is only answer to health reform

Single-payer is only answer to health reform

By JOHNATHON ROSS
The Toledo (Ohio) Blade
Article published February 07, 2010

I care for low-income patients in an inner-city Toledo clinic. My work there convinces me that our country never will have high-quality, accessible, affordable health care as long as private insurers make the rules. The best policy solution would be a single-payer system, such as an improved and expanded “Medicare for All.”

Recently, I saw a young diabetic woman whose kidneys are failing. Arbitrarily assigned by Medicaid to a health-maintenance organization, she learned that the doctors who have cared for her for 15 years cannot see her anymore. She also faces losing her place on the local list for kidney transplants.

I called the number on her insurance card to protest. I reached a recording that told me I was the 35th caller in line. Two days and three calls later, I finally reached a nurse who told me that my patient may need to go to Cleveland Clinic for her care.

Later that day, I persuaded an insurer to cover two expensive medicines that are not on its formulary for a patient who needs them. My staff and I had contacted health insurance bureaucrats seven times over two weeks. They rejected the request six times before they let us win this game of “Mother, may I?”

Such waste of time and effort occurs daily at our clinic. Yet our frustrations pale in comparison with those of many patients of modest means who do not get health insurance at work and cannot afford the outrageous premiums for individual or family coverage. For them, bankruptcy is one big medical bill away.

The debate in Congress over health-care “reform” has offered the nauseating spectacle of blatant vote-buying, deal-cutting, and lawmakers’ catering to private special interests.

The current legislation would maintain or increase profits for HMOs, insurers, pill and bedpan makers, and the Wall Street bankers and stockholders who finance them – what I call the health-care mafia. The legislation would not control costs, cover all Americans, or adequately address serious problems with quality of care.

Rather, it would extend our present dysfunctional system to 30 million more Americans, while 20 million would remain uninsured. The newly insured, like other Americans, would find that their mandatory premiums cost too much and cover too little. Meanwhile, the crushing administrative nightmare of paperwork, bureaucracy, and insurers’ profit-taking would only expand.

The legislation would do some good things: expand Medicaid coverage, give more money to community clinics, and curtail some of the worst practices of private insurers. But the problems with its main provisions – especially the individual mandate, which would reinforce private insurers’ stranglehold on care — outweigh these benefits.

If you dislike your current employer-sponsored coverage, tough luck. You’ll have to keep it. If you’re uninsured, you’ll be forced by federal law to pay private insurers’ inflated premiums, often for coverage so skimpy that serious illness still could bankrupt you. Refuse, and you’ll pay a fine.

Insurance companies would get $476 billion in new public funds, ostensibly to help people buy their defective products. These handouts to for-profit insurers would strengthen their power and make future reform even harder.

In his State of the Union address last month, President Obama said: “If anyone from either party 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.” But the President already knows what that better approach is.

As a candidate, Mr. Obama said that if we were starting from scratch, a single-payer, health-care system would make sense. Indeed it would: Multiple studies confirm that such a system could cover everyone for what we spend now, and allow complete choice of doctors and hospitals.

There would be few or no co-payments because we would save hundreds of billions each year from the administrative efficiencies of a single, national, comprehensive health insurance program. An improved program of Medicare for all would free us from the tyranny of the health-care profiteers.

Americans need to let Congress know that the current health care legislation is unacceptable. That doesn’t mean joining the “just say no” chorus of Republican obstructionists.

Instead, lawmakers should immediately take up the single-payer approach. They need to make the improvement of our nation’s health a greater priority than the enhancement of private, profit-seeking interests.

Johnathon Ross, an associate clinical professor of internal medicine at the University of Toledo, is past president of Physicians for a National Health Program.

http://toledoblade.com/apps/pbcs.dll/article?AID=/20100207/OPINION04/2070302

Dr. Margaret Flowers on Medicare for All

Watch the video of Dr. Flowers here

Bill Moyers Journal
February 5, 2010

BILL MOYERS: Make me an offer I can’t refuse. That’s what President Obama said, when he talks about health care reform during his State of the Union last week.

PRESIDENT OBAMA: If anyone from either party 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. Let me know. Let me know. I’m eager to see it.

BILL MOYERS: Dr. Margaret Flowers took him at his word.

MALE VOICE: Can I help you?

DR. MARGARET FLOWERS: Well, last night the President gave his State of the Union address, and I’m a physician. I’m the Congressional Fellow with Physicians for National Health Program.

BILL MOYERS: The very next day she was outside the White House with a letter urging the President to revive the idea of single-payer healthcare. Medicare for all.

MALE VOICE: We can’t accept anything, so you’ll have to send it through the mail.

BILL MOYERS: The Secret Service turned Dr. Flowers away, but she didn’t give up. She tried again the next day in Baltimore, where once again, President Obama made his offer to hear ideas on health reform and once again, she tried to deliver her letter.

DR. MARGARET FLOWERS: Is there somebody here who’s in charge that can have somebody who’s a representative of the President, come and take this?

BILL MOYERS: This time, she and her colleague, Dr. Carol Paris, refused to move when security told them to, because Dr. Flowers said, “We didn’t want to continue to be excluded, marginalized and ignored.”

They were arrested.

DR. MARGARET FLOWERS: And we haven’t been heard. They continue to exclude us.

BILL MOYERS: When I saw pictures of Margaret Flowers being led away, I remembered those famous words attributed to another Margaret, the anthropologist Margaret Mead who said, “Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has.”

Dr. Flowers is with me now. A pediatrician from Maryland who worked at a rural hospital and in private practice, her full-time job is now the fight for single payer health insurance. She works on Capitol Hill for the organization, Physicians for a National Health Program. Welcome to the Journal.

DR. MARGARET FLOWERS: Thank you for having me.

BILL MOYERS: When you were arrested last Friday, were you taken to police headquarters?

DR. MARGARET FLOWERS: I was, with Dr. Paris.

BILL MOYERS: Were you handcuffed?

DR. MARGARET FLOWERS: We were.

BILL MOYERS: Were you interviewed independently by the Secret Service?

DR. MARGARET FLOWERS: Yes.

BILL MOYERS: What did they want to know?

DR. MARGARET FLOWERS: They wanted to make sure that we didn’t have a psychiatric history or did we wish the President any ill harm.

BILL MOYERS: What did you tell?

DR. MARGARET FLOWERS: That no, we don’t wish him any harm. In fact, if we passed a Medicare for all system, it would be a huge win, not just for the American people but for this administration. And that, in fact, we didn’t really want to have to go through this to have our voices heard. We’d much rather be working with Congress and the administration.

BILL MOYERS: I was watching that tape of your arrest. And I think I heard you say, you know, “Would you please-” to somebody. “Would you please call my husband?” Is it true he didn’t know you were out there and were going to get arrested?

DR. MARGARET FLOWERS: It’s true. Yeah.

BILL MOYERS: What did he think when he found out? Did somebody call him?

DR. MARGARET FLOWERS: Actually, his brother called him because he saw it on the news. And he said, “Do you know where your wife is right now?” And my husband said, “No.” Well, we weren’t sure. Dr. Paris and I weren’t sure what was going to happen that morning. We just knew that we would go down there with our banner and our letter and that hopefully, we could get our message across and that hopefully they would call a staffer to take our letter. And there came a point, though, when they kept saying, you know, “Go across the street and no, we’re not going to call anybody,” that we looked at each other. And without speaking, we both knew that, no, this is too important. We’re not going across the street.

BILL MOYERS: When you stood outside the White House last week, did you really think that the leader of the free world was going to respond to a petition from a single individual, standing outside his–

DR. MARGARET FLOWERS: I–

BILL MOYERS: –his gate?

DR. MARGARET FLOWERS: –did make the point that I was representing the majority of the public and the majority of physicians.

BILL MOYERS: How could you make that claim?

DR. MARGARET FLOWERS: Because numerous polls have shown that the majority of the American public want a national health system. When the poll actually describes what it is, you know, a system where everybody pays in and everybody can get the care that they need, people desire that. They favor that. And more and more doctors– well, we do have polls on doctors, but my experience also traveling around is the doctors support this.

BILL MOYERS: Had you taken him seriously when before his campaign, he was an advocate for single payer?

DR. MARGARET FLOWERS: I did. I even worked the polls on election day, and I knocked on doors to get people out. I guess I was naïve. I was kind of hopeful.

BILL MOYERS: You took him seriously.

DR. MARGARET FLOWERS: Well, we knew that he understood what single payer was. In the debates, he said that he understood health care was a human right. I know that he didn’t campaign on single payer or anything like it. But we felt it was an opportunity to, if we built the grassroots movement and showed that this is what the American people want, that he would actually, in some ways, include us. We saw the exact opposite. We saw that this whole process was very tightly scripted. And very exclusive. And he didn’t want us causing any trouble for, you know, trying to get some reform passed.

BILL MOYERS: If the President had sent a staff person out to invite you in for coffee last week, what would you have told him?

DR. MARGARET FLOWERS: I would have told him that the American people were expecting more from him, that there’s been such a huge amount of suffering in this country and preventable deaths. And that it’s completely unacceptable that we are the only industrialized nation that allows this to happen. And that, it doesn’t have to be this way, because we have the money. We’re already spending more than any other country, so it’s not an issue of whether we have the money. We have the resources to have one of the top health systems in the world. And
why wasn’t this debate about what is best for the people? Knowing that this is even, in terms of our economic recovery, this is vital, because our whole health system is a drag on our entire economic situation. So why is he excluding us? Why isn’t he letting us be at the table, when this makes complete sense from a public policy, public health policy, economic health policy standpoint?

BILL MOYERS: What made you such a passionate advocate for single payer?

DR. MARGARET FLOWERS: Why be– I went into medicine because I really do care about taking care of my patients and particularly, I chose pediatrics because I feel like if you give children a great start, a healthy start, they can carry that through them for the- with them through the rest of their lives and when I looked at what was going on and looked at what works in other places and what has worked here, what models have worked here, I saw that if we have a Medicare for all system, then really, doctors can practice medicine again, the art that we train to do.

BILL MOYERS: Why did you feel you weren’t able to do the medicine you wanted to do, because of the health care system?

DR. MARGARET FLOWERS: Well, it started when I was working in the rural hospital where I was. And when we would admit a patient to the hospital, the first person that would come to visit us was someone from utilization review, which is the group that interfaces with the insurance company. And they would say, “You have this many days to make this patient better. This is how many days they’ve been authorized for.” And what we often found is that didn’t match the number of days that we felt the patient needed to be in the hospital. So it puts you in a really uncomfortable position of, do you send a child home before they’re ready? And then in private practices it’s the same kind of thing, you see a patient, you determine what’s the best treatment, and then the insurance company says, ‘No they can’t have that test’ or can’t have that medicine. It didn’t make sense. It wasn’t based on what the patients need. It was based on what the insurance companies could get away with.

BILL MOYERS: Was there the eureka moment?

DR. MARGARET FLOWERS: It was a eureka moment when our office manager sat down with us in our practice and said, “Okay, if we want to keep in business, this is what you need to do. You can only see one well child a day, and the rest of the patients have to all be sick patients that you can churn through this many patients each hour.” And if your patient happens to bring up something else that’s bothering them, you have to ask them to reschedule and come back to talk about that other thing, which means they have to take, you know, more time off of work and continue to carry that worry with them, while they’re waiting for the next appointment. That just wasn’t why I went into medicine. I like the relationship that I have with patients. I want to take care of them. And when you build that relationship with your patient and you get to know them, you can provide the best care for them, not the way things are right now.

BILL MOYERS: But you know, you didn’t go into medicine to get arrested. And yet there you are, on the– out there being handcuffed and led away?

DR. MARGARET FLOWERS: Yeah, I never really dreamed that this was a path that I would go down. I mean, I’m a mother. Good citizen in my community. But it came to a point where that was the only way that we could have our voice heard. We were being completely excluded, when we tried the traditional avenues of having our voice heard. We were just put aside.

BILL MOYERS: Last May, before the Senate hearings at Max Baucus– Senator Max Baucus were conducted, it seemed like there might be a momentum behind this single payer Medicare for all movement. What happened?

DR. MARGARET FLOWERS: They actually did start inviting us in to have a seat at the table. Senator Kennedy’s committee contacted us. And I was the first person to testify in the Health Education and Labor and Pension Committee hearing. I sat next to the CEO of Aetna, which was a very interesting experience. And then when we went over to the House and spoke to the leadership there, they said, “We want your voice to be heard here.” And we testified there. And so we actually thought we were starting to get our foot in the door. And then we had some amendments that were introduced that were good amendments. They would have substituted a national single payer system for the legislation that was going through, so we were really pushing on that. And then we saw that all of that fell apart.

BILL MOYERS: And then?

DR. MARGARET FLOWERS: Well, what we learned through this process is there was a lot of control coming from the White House. And they did not- they wanted to pass something. They were putting everything off on passing something in health care reform. And they were concerned that if we let the single payer voice in, or if it was associated in any way with a legislation, that it would hurt their ability to pass that legislation. So they kind of put the kibosh on it.

BILL MOYERS: The White House.

DR. MARGARET FLOWERS: Yes, it really came down from the top. We tried to bring our viewpoint in this summer. We actually brought doctors and nurses in. That was a lot of what I was doing, to meet with staffers and meet with legislators and educate them about health policy, what makes good sense from a health standpoint, not an, you know, special interest standpoint. But when we tried to reach the White House and ask to be included there, we requested meetings with the president on numerous occasions. And they just said no.

BILL MOYERS: The health reform process is broken. It’s stalled, stymied. And many people think nothing is going to happen now. Do you think that’s a good thing?

DR. MARGARET FLOWERS: In some ways, it is. But what we were starting to see in December, as they got close to passing the Senate version, was they were already these huge proclamations of success. You know greatest thing since Social Security and Medicare, and look how great we are for passing this. And we knew that what they were passing was designed to fail. And– but that if it passed, it would take years for people to realize.

BILL MOYERS: The failure.

DR. MARGARET FLOWERS: Yes.

BILL MOYERS: And then–

DR. MARGARET FLOWERS: So–

BILL MOYERS: –it would be what, too late to–

DR. MARGARET FLOWERS: Well, then it would be, you know, if you look at the number of people that are dying in this country every year, and you say, “Okay, we’re going to wait four or five or six years to see whether this works or not,” when we already know from a health policy standpoint that it’s not going to work. It’s that many more people that are going to be lost during that period.

BILL MOYERS: What have you learned about our political process this last year?

DR. MARGARET FLOWERS: I didn’t realize how broken it was. I knew that there were special interests influencing the process. But I didn’t realize that the degree, the depth to which they’re involved in our political process.

BILL MOYERS: What was the most revealing moment that told you how strong and powerful the special interests, the industries are?

DR. MARGARET FLOWERS: That was really last Ma
y, when we decided that we needed to go to the Senate Finance Committee and stand up, because we had been working for months prior to that, meeting with members of Congress who would tell us, “Yes, it makes perfect sense that we should include your proposal along with what we’re putting together.” We just said, “Just compare them. Compare them on universality. Compare them on cost control. Just let’s have an honest debate about what’s really the best.” And when it came down to it, they just said, “Oh, no, we didn’t really mean what we said about that. And we’re not going to include you.” And when we heard that they weren’t going to allow us to have someone testify at that Senate Finance Committee, we just knew right then we have to do something different.

SEN. MAX BAUCUS (D-MT): The second of three roundtable discussions–

DR. MARGARET FLOWERS: Senator Baucus–

SEN. MAX BAUCUS (D-MT): –on healthcare in america. We order that we stand in recess until the police can restore order.

DR. MARGARET FLOWERS: My name is Margaret Flowers–

SEN. MAX BAUCUS (D-MT): We stand in recess until the police can restore order.

BILL MOYERS: And that was the first time you were arrested.

DR. MARGARET FLOWERS: Uh-huh.

BILL MOYERS: What was that experience like?

DR. MARGARET FLOWERS: It was terrifying. But I knew at that moment. I looked around the room, and I looked at the people who were sitting at the table, both from the senators to the people who had been invited to testify, who represented the industry. And in my mind, I juxtaposed that with the stories and the people that I’ve met, and the doctors I’ve talked to. And I felt like I was there on behalf of them. And I would do what I needed to do. And that I was ready for that.

BILL MOYERS: You still ready? You’re going to stay with this?

DR. MARGARET FLOWERS: Completely. Yeah. It’s too important.

BILL MOYERS: Dr. Margaret Flowers, thank you for being with me.

DR. MARGARET FLOWERS: Thank you.

DR. MARGARET FLOWERS: We’ve been cooperating and we haven’t been heard. They continue to exclude us! Phil, can you call Kevin?

MALE: Kevin? Yeah, ok.

DR. MARGARET FLOWERS: My husband doesn’t know.

MALE: Give him a call? Ok.

DR. MARGARET FLOWERS: And maybe if you can call Jill Carter, if you can be our lawyer that would be great…You know Delegate Carter.

MALE: Oh, Jill, yeah, ok.

Anthem Blue Cross dramatically raising rates for Californians with individual health policiesrates

Policyholders are incensed over rate hikes of as much as 39%, which they say come on top of similar increases last year. State insurance regulators say they’ll investigate

By Duke Helfand
Los Angeles Times
February 4, 2010

California’s largest for-profit health insurer is moving to dramatically raise rates for customers with individual policies, setting off a furor among policyholders and prompting state insurance regulators to investigate.

Anthem Blue Cross is telling many of its approximately 800,000 customers who buy individual coverage — people not covered by group rates — that its prices will go up March 1 and may be adjusted “more frequently” than its typical yearly increases.

The insurer declined to say how high it is increasing rates. But brokers who sell these policies say they are fielding numerous calls from customers incensed over premium increases of 30% to 39%, saying they come on the heels of similar jumps last year.

Many policyholders say the rate hikes are the largest they can remember, and they fear that subsequent premium growth will narrow their options — leaving them to buy policies with higher deductibles and less coverage or putting health insurance out of reach altogether.

“I’ve never seen anything like this,” said Mark Weiss, 63, a Century City podiatrist whose Anthem policy for himself and his wife will rise 35%. The couple’s annual insurance bill will jump to $27,336 from $20,184.

“I think it’s just unconscionable,” said Weiss, a member of Blue Cross for 30 years.

Woodland Hills-based Anthem declined to say how many individual policyholders will be affected or what a typical increase will be under the new pricing, which will vary from one individual to another. But the company defended its premiums, even as it tried to strike a sympathetic tone.

“We understand and strongly share our members’ concerns over the rising cost of healthcare services and the corresponding adverse impact on insurance premiums,” the company said in a statement.

“Unfortunately, the individual market premiums are merely the symptoms of a larger underlying problem in California’s individual market — rising healthcare costs.”

About 2.5 million Californians have individual insurance policies, accounting for a small portion of the state’s overall insurance market. By contrast, nearly 21 million people in California are covered by health maintenance organizations.

Individual policies are often the only option for those who are uninsured, self-employed or do not receive health coverage through employers.

Insurers are free to cherry-pick the healthiest customers in the lightly regulated individual market. They can raise rates at any time as long as they notify the state Department of Insurance and prove that they are spending at least 70% of premiums on medical care.

The size of the individual rate increases prompted state Insurance Commissioner Steve Poizner recently to call for a review of Anthem’s charges.

“Commissioner Poizner is very concerned by these large rate increases,” spokesman Darrel Ng said.

Poizner directed his department to retain an “independent outside actuary to examine Blue Cross’ rates” to ensure that the company spends at least 70% of the premiums on medical care, as required by state law, Ng said. Anthem said it had already hired an actuary who found that the rates were sound.

Anthem is not the only health insurer imposing double-digit rate increases. Competitors such as Blue Shield of California and Aetna also have raised premiums significantly in recent years, insurance brokers said. But they said the impending Anthem increases are the largest they have seen.

“Do they really think they are going to keep clients this way?” asked Bill Robinson, a Palm Springs broker who has informed his Anthem clients that they will face increases of as much as 39% on March 1.

Anthem sent letters to agents a few weeks ago informing them of the March 1 increases and followed up with similar notices to policyholders last week.

That’s when Mary Feller of San Rafael learned that the rate for herself and her husband will jump 39%, or $465 a month, driving the couple’s annual premium to $19,896 from $14,316.

Feller, 56, said the premium for her 26-year-old daughter also will rise 38%, costing the family an additional $1,572 a year.

As a result, starting March 1, the Fellers’ health insurance bill will surpass the family’s monthly mortgage payment on their home north of San Francisco.

“It’s breathtaking,” said Feller, an entertainment journalist. “We’re going to have to cut back somewhere else. This kind of stuff strikes fear in the heart.”

Feller said she was troubled by another part of the Anthem letter. Besides detailing the premium increase, it said: “Anthem Blue Cross will usually adjust rates every 12 months; however, we may adjust more frequently in accordance with the terms of your health benefit plan.”

She and others voiced anger about the increases as Anthem’s parent company, WellPoint Inc., sees big profits. Last week the company announced an eightfold increase in profit for the last three months of 2009, a surge attributed largely to the sale of subsidiaries.

Broker and insurance industry analysts said the California rate increases will leave individual policyholders with few good options: Anthem subscribers such as the Fellers can switch to a company plan with a higher deductible. Or they can try to switch insurers, a dicey proposition because carriers in the individual market can reject applicants who have preexisting medical conditions.

“It’s putting people’s backs up against the wall,” said Shana Alex Lavarreda, director of health insurance studies at the UCLA Center for Health Policy Research. “They are finding new ways to create new problems for consumers.”

The insurer said it had a team of workers to help customers balance costs and insurance.

“Anthem offers a variety of health benefit plans,” the company said, “and we are dedicated to working with our members to find health coverage plans that are the most appropriate and affordable for their needs.”

duke.helfand@latimes.com

Copyright © 2010, The Los Angeles Times

http://www.latimes.com/business/la-fi-insure-anthem5-2010feb05,0,3002094.story

Gov. Crist's lesson on unsound policies for health reform

Gov. Crist's victory for unaffordable underinsurance

Quote of the Day
May 23, 2008

From the Sun-Sentinel.com:

Delivering on Gov. Charlie Crist’s top election-year priority, the Florida Legislature on (May 2, 2008) approved a health insurance package to extend no-frills coverage to the state’s 3.8 million uninsured. Crist called the health-care package “historic legislation” that will be a model for the rest of the nation.

From the Comment (Don McCanne):

Some model. It would reduce insurance premiums by stripping down benefits through measures such as limiting hospitalization and specialized services and by capping payments. Since this “doesn’t cost taxpayers a dime,” the premiums would still be unaffordable for most individuals currently without coverage. Obviously this model will not work for individuals who have health care needs.

https://pnhp.org/news/2008/may/gov-crists-victory-for-unaffordable-underinsurance

And…

Florida’s health plan for the uninsured has few takers

By Doug Trapp
American Medical News
February 1, 2010

Florida Gov. Charlie Crist didn’t establish a specific enrollment goal for Cover Florida, the state’s unsubsidized private insurance program for the uninsured, when he announced the start of enrollment in January 2009. But in a state with approximately 3.8 million uninsured adults, the fact that only 5,246 people signed up for one of the 27 plans in the program’s first 11 months appears to have defied all expectations.

The authorizing legislation instructed participating insurers to offer at least two types of plans: one with catastrophic and emergency department coverage, and one without.

Plan subscribers… must wait 12 months before their preexisting conditions are covered. Also, insurers balance the risk of covering such conditions by setting benefit limits as low as $25,000 each year and $50,000 in a lifetime for catastrophic plans, for example.

United HealthGroup — one of the two companies offering statewide Cover Florida plans — does not know why plan enrollment has been low, said spokesman Roger Rollman. Blue Cross and Blue Shield of Florida — the other company offering a statewide plan — directed questions to the state.

http://www.ama-assn.org/amednews/2010/02/01/gvsd0201.htm

Comment: 

By Don McCanne, MD

Today’s message is not meant to be an “I told you so,” even if I did tell you. The point of the message is that health policy science has advanced to a level that the consequences of policies in various reform proposals are fully predictable. “Well, let’s try this and see how it goes” is no longer acceptable, especially for our entire $2.5 trillion health care industry.

Gov. Charlie Crist has provided us with a very valuable lesson with his “‘historic legislation’ that will be a model for the rest of the nation.” His “Cover Florida” program has left 99.9 percent of the uninsured without any coverage, while providing the other 0.1 percent with coverage that won’t work if you need health care.

This may an extreme example, but the cardinal principle is crucial. It is unsound to throw together a bunch of policies chosen based on political considerations, and then pretend that the flaws will be fixed later. You start with a core structure based on sound policies that have been proven to work.

The hybrid model before Congress, using private health insurance plans and public programs, is the most expensive model of reform, even though an important stated goal, when this process began, was to slow the increases in health care spending. The feeble measures included in the bill that allegedly would control costs do not pass basic tests of health policy science.

The hybrid model also was supposed to cover everyone, but health policy science has demonstrated that this model can’t do that. Tens of millions will be left without coverage, a number sure to increase with time.

Charlie Crist’s silly program may be an embarrassment, but that does not compare with the shame that members of Congress should be experiencing simply because they would bankrupt, maim, and kill people by walking away from sound health policy science, while they pursue what they believe will be a political victory. What a terrible, terrible shame.

Gov. Crist’s lesson on unsound policies for health reform

Gov. Crist’s victory for unaffordable underinsurance

Quote of the Day
May 23, 2008

From the Sun-Sentinel.com:

Delivering on Gov. Charlie Crist’s top election-year priority, the Florida Legislature on (May 2, 2008) approved a health insurance package to extend no-frills coverage to the state’s 3.8 million uninsured. Crist called the health-care package “historic legislation” that will be a model for the rest of the nation.

From the Comment (Don McCanne):

Some model. It would reduce insurance premiums by stripping down benefits through measures such as limiting hospitalization and specialized services and by capping payments. Since this “doesn’t cost taxpayers a dime,” the premiums would still be unaffordable for most individuals currently without coverage. Obviously this model will not work for individuals who have health care needs.

https://www.pnhp.org/news/2008/may/gov-crists-victory-for-unaffordable-underinsurance

And…

Florida’s health plan for the uninsured has few takers

By Doug Trapp
American Medical News
February 1, 2010

Florida Gov. Charlie Crist didn’t establish a specific enrollment goal for Cover Florida, the state’s unsubsidized private insurance program for the uninsured, when he announced the start of enrollment in January 2009. But in a state with approximately 3.8 million uninsured adults, the fact that only 5,246 people signed up for one of the 27 plans in the program’s first 11 months appears to have defied all expectations.

The authorizing legislation instructed participating insurers to offer at least two types of plans: one with catastrophic and emergency department coverage, and one without.

Plan subscribers… must wait 12 months before their preexisting conditions are covered. Also, insurers balance the risk of covering such conditions by setting benefit limits as low as $25,000 each year and $50,000 in a lifetime for catastrophic plans, for example.

United HealthGroup — one of the two companies offering statewide Cover Florida plans — does not know why plan enrollment has been low, said spokesman Roger Rollman. Blue Cross and Blue Shield of Florida — the other company offering a statewide plan — directed questions to the state.

http://www.ama-assn.org/amednews/2010/02/01/gvsd0201.htm

Comment: 

By Don McCanne, MD

Today’s message is not meant to be an “I told you so,” even if I did tell you. The point of the message is that health policy science has advanced to a level that the consequences of policies in various reform proposals are fully predictable. “Well, let’s try this and see how it goes” is no longer acceptable, especially for our entire $2.5 trillion health care industry.

Gov. Charlie Crist has provided us with a very valuable lesson with his “‘historic legislation’ that will be a model for the rest of the nation.” His “Cover Florida” program has left 99.9 percent of the uninsured without any coverage, while providing the other 0.1 percent with coverage that won’t work if you need health care.

This may an extreme example, but the cardinal principle is crucial. It is unsound to throw together a bunch of policies chosen based on political considerations, and then pretend that the flaws will be fixed later. You start with a core structure based on sound policies that have been proven to work.

The hybrid model before Congress, using private health insurance plans and public programs, is the most expensive model of reform, even though an important stated goal, when this process began, was to slow the increases in health care spending. The feeble measures included in the bill that allegedly would control costs do not pass basic tests of health policy science.

The hybrid model also was supposed to cover everyone, but health policy science has demonstrated that this model can’t do that. Tens of millions will be left without coverage, a number sure to increase with time.

Charlie Crist’s silly program may be an embarrassment, but that does not compare with the shame that members of Congress should be experiencing simply because they would bankrupt, maim, and kill people by walking away from sound health policy science, while they pursue what they believe will be a political victory. What a terrible, terrible shame.

Medicare model for health-bill fix

By Robert Stone
Journal Gazette (Fort Wayne, Ind.)
Published: February 4, 2010

“If anyone from either party 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.” In his State of the Union address Jan. 27, the president admitted that his plan for health care reform has run into trouble.

President Obama has often said, “If I were starting from scratch … I would go with a single-payer system.” Medicare, which takes care of our seniors, is such a system.

It is an American legacy that we can be proud of, running 3 percent overhead, as opposed to private insurance’s 20 percent.

Is it time to “start from scratch”? The Democrats surrendered in advance to the private insurers and drug companies that profit from our dysfunctional health financing system, and now the American people find themselves confused, frightened and frustrated.

Republicans have scorned bipartisanship and embraced obstructionism.

Back home in Indiana, Indianapolis-based Anthem/WellPoint reported fourth quarter profits of $2.7 billion – despite losing 1.4 million customers in 2009. Premiums were up, and the stock price has more than doubled since last March. There is something wrong with this picture.

WellPoint’s profits are soaring as they cover a million fewer people. They have spent tens of millions on lobbying this year, and now that the Supreme Court ruling eliminates limits on corporate spending, their huge pot of cash will buy even more influence.

A single-payer, improved Medicare-for-all reform would lower costs, cover the uninsured and upgrade coverage for most Americans. It would prove sustainable and hugely popular.

Under Medicare, patients have the freedom to choose their doctor and hospital and are free from the fear of financial catastrophe.

An easy way to start moving in that direction was suggested last month in the Senate – begin by expanding Medicare down to age 55. It’s a compelling argument.

The cost of doing nothing is too great. We know that rising premiums and the lagging economy will cause even more employers to drop health benefits.

As more of us become uninsured, research predicts that at least 45,000 will die this year from lack of access to medical care, and millions will go bankrupt.

Tell the president and Congress there is one national security issue, one economic security issue, that we must push forward on – quality, affordable health care for all.

The issues are not simple and the forces against reform are powerful, but we have come too far to turn back.

Dr. Robert Stone practices emergency medicine in Bloomington. He is director of Hoosiers for a Commonsense Health Plan and a member of Physicians for a National Health Program. He wrote this for Indiana newspapers.

PNHP Electronic Press Kit

Garrett Adams, M.D., M.P.H., Louisville, Ky.

Dr. Garrett Adams is president of PNHP. A pediatrician specializing in infectious disease and infectious disease epidemiology in Louisville, Ky., he received his undergraduate and master’s degrees from Vanderbilt University and medical degree from Wake Forest University. He completed his residency at Vanderbilt University Hospital and the Children’s Hospital of Los Angeles. He is retired from being a full-time faculty member at the University of Louisville School of Medicine, where he was chief of pediatric infectious diseases. He has also served as medical director of communicable diseases at the Louisville Metro Health Department. Since retiring, he has founded the Beersheba Springs Medical Clinic, a comprehensive ambulatory clinic in the underserved community of Beersheba Springs, Tenn. For 40 years Dr. Adams attended the health care needs of sick children and their young families. Video footage of his recent testimony before U.S. Senate subcommittee on the topic of poverty and health is available here (starting at the 40 second mark).

Olveen Carrasquillo, M.D., M.P.H., Miami, Fla.

Dr. Olveen Carrasquillo is a nationally recognized expert on health disparities. He is an associate professor of medicine and chief of the Division of General Internal Medicine at the University of Miami’s Miller School of Medicine. His research interests include minority health, health insurance, managed care and access to care, particularly among Latinos. Prior to his position in Miami, he was on the faculty of Columbia University’s College of Physicians and Surgeons for 12 years and directed their NIH-designated Center of Excellence in Health Disparities Research. Dr. Carrasquillo serves on the Advisory Committee of the HHS Office of Minority Health. He is available for interviews in English and Spanish.

Andrew D. Coates, M.D., Albany, N.Y.
Dr. Andy Coates is president-elect of PNHP. He is assistant professor of medicine and psychiatry at Albany Medical College. Board certified in internal medicine as well as hospice and palliative care medicine, he sees patients in a variety of clinical settings in the Albany area. Dr. Coates graduated from the Columbia University College of Physicians and Surgeons and completed a residency in primary care medicine and served as a traditional chief resident in medicine at the Mary Imogene Bassett Hospital in Cooperstown, N.Y. A national board member of PNHP and chair of the Capital District chapter of PNHP, helped found Single Payer New York, a statewide grassroots coalition of single-payer organizations and activists. Video footage of his remarks at a lobby day for single-payer health reform in New York is available here (at 6:16 mark).

Claudia Fegan, M.D., Chicago

Dr. Claudia Fegan is chief medical officer at John H. Stroger Hospital of Cook County Health and Hospitals System and past president of PNHP. An internist who has practice in both private settings and in large public systems, she has lectured extensively to both medical and lay audiences on health care reform across the United States. She is co-author of the book “Universal Health Care: What the United States Can Learn from Canada” and a contributor to another book, “10 Excellent Reasons for National Health Care.” The daughter of labor union organizer and a social worker, Dr. Fegan received her undergraduate degree from Fisk University and her M.D. from the University of Illinois College of Medicine. Clips from her recent appearance on MSNBC’s “Up with Chris Hayes” are available here.

Oliver Fein, M.D., New York City

Dr. Oliver Fein is immediate past president of PNHP. A general internist who is active in clinical practice, he is also professor of clinical medicine and clinical public health at Weill Medical College of Cornell University, where he serves as associate dean responsible for the Office of Affiliations and the Office of Global Health Education. Dr. Fein has advocated for an expanded role for primary care, for academic health centers in urban health care delivery systems, and for national health system reform. He was Robert Wood Johnson Health Policy Fellow during 1993-1994, when he worked in the office of Senate Democratic Majority Leader George Mitchell. He spent 17 years at the Columbia Presbyterian Medical Center developing community-based ambulatory care practices and the Division of General Medicine. He is chair of the N.Y. Metro chapter of PNHP and past vice president of the American Public Health Association. Dr. Fein participated in the 2009 White House Summit on Health Reform as a result of public pressure. Video footage of Dr. Fein on “Democracy Now” is available here (at the 32:50 mark).

David Himmelstein, M.D., New York City/Boston

Dr. David Himmelstein, a co-founder of PNHP, is professor at the CUNY School of Public Health at Hunter College and visiting professor of medicine at Harvard Medical School. As a practicing internist, he has also served as chief of the division of social and community medicine at Cambridge Hospital in Cambridge, Mass. He co-founded the Center for a National Health Program Studies at Harvard. Dr. Himmelstein co-edits PNHP’s newsletter and is a principal author of PNHP articles published in the JAMA, the New England Journal of Medicine and other professional journals. His research focuses on problems in access to care, administrative waste, and the advantages of a national health program. In 2009 he co-authored, with Dr. Steffie Woolhandler and others, a study published in the American Journal of Medicine showing that medical bills and illness are now linked to 62 percent of all personal bankruptcies, with 78 percent of those bankrupted having had insurance when they got sick.  In 2009 he testified before the House Subcommittee on Health, Education, Labor and Pensions, one of many occasions where he has spoken before Congress. Video footage of his appearance on PBS’s “Bill Moyers Journal” is available here (at the 7:40 mark).

David Scheiner, M.D., Chicago

Dr. David Scheiner, an internist, was President Barack Obama’s personal physician from 1987 till 2008 while the latter was based in Chicago. He is a member of PNHP and an outspoken advocate of single-payer health reform. Dr. Scheiner graduated from Princeton University and obtained his medical degree from Columbia University’s College of Physicians and Surgeons. He has practiced internal medicine in Chicago’s Hyde Park community for more than four decades. During the 2009 health reform debate, Dr. Scheiner appeared on numerous television and radio programs. Video footage of his appearance on CNN News is available here.

Paul Y. Song, M.D., Los Angeles

Paul Y. Song, M.D., is a board-certified radiation oncologist and board member of PNHP-California. He is on the faculty at the Samuel Oschin Cancer Center at Cedars Sinai Medical Center and an adjunct faculty member at the John Wayne Cancer Institute. Dr. Song graduated from the University of Chicago with honors and received his medical degree from George Washington University. He completed his residency in radiation oncology at University of Chicago Medical Center. Dr. Song was a frequent contributor to “Larry King Live” during the health care reform debate of 2009 and is a regular contributor to Extra TV for cancer-related topics. He is active in numerous civic organizations, including several that focus on issues facing Asian Americans. He resides in Santa Monica, Calif. Video footage of Dr. Song on CNN’s “Larry King Live” is available here (at the 2:56 mark).

Steffie Woolhandler, M.D., M.P.H., New York City/Boston

Dr. Steffie Woolhandler, a co-founder of PHNP, is professor at the CUNY School of Public Health at Hunter College and visiting professor of medicine at Harvard Medical School. She has served as co-director of Harvard’s General Internal Medicine Fellowship program, and worked for many years as a primary care physician at Cambridge Hospital in Cambridge, Mass. She served in 1990-91 as a Robert Wood Johnson Foundation health policy fellow at the Institute of Medicine and the U.S. Congress. Dr. Woolhandler is a frequent speaker and has written extensively on health policy. She is a principal author of many PNHP articles published in the JAMA, the New England Journal of Medicine and other professional journals. In 2009, she testified before the Health Subcommittee of the House Energy and Commerce Committee and to the House Judiciary Subcommittee on Commercial and Administrative Law about medical causes of bankruptcy. She also co-authored, with Dr. David Himmelstein and others, a recent study in the American Journal of Public Health showing that nearly 45,000 annual deaths are associated with lack of health insurance. A clip from a recent appearance on “Democracy Now” is available here (beginning at the 18:40 mark).

Quentin D. Young, M.D., Chicago

Dr. Quentin Young, an internist who recently retired from a decades-long practice in the Hyde Park community on Chicago’s South Side, is national coordinator of PNHP. He is clinical professor of preventive medicine and community health at the University of Illinois Medical Center. Dr. Young graduated from Northwestern Medical School and did his residency at Cook County Hospital in Chicago. During the 1970s and early 1980s, he served as chairman of the Department of Internal Medicine at Cook County, where he established the Department of Occupational Medicine. He has been a member of the American Medical Association since 1952. In addition distinguished career as a physician, Dr. Young has been a leader in public health policy and medical and social justice issues. He was Dr. Martin Luther King Jr.’s personal physician during Dr. King’s stays in Chicago. In 1998, he had the distinction of serving as president of the American Public Health Association and in 1997 was inducted as a master of the American College of Physicians. Audio and video footage of his recent appearance on TalkingStick TV in Washington state is available here (beginning at the 9:29 mark).

Gov. Crist's lesson on unsound policies for health reform

Gov. Crist’s victory for unaffordable underinsurance

Quote of the Day
May 23, 2008
From the Sun-Sentinel.com:
Delivering on Gov. Charlie Crist’s top election-year priority, the Florida Legislature on (May 2, 2008) approved a health insurance package to extend no-frills coverage to the state’s 3.8 million uninsured. Crist called the health-care package “historic legislation” that will be a model for the rest of the nation.
From the Comment (Don McCanne):
Some model. It would reduce insurance premiums by stripping down benefits through measures such as limiting hospitalization and specialized services and by capping payments. Since this “doesn’t cost taxpayers a dime,” the premiums would still be unaffordable for most individuals currently without coverage. Obviously this model will not work for individuals who have health care needs.
https://pnhp.org/news/2008/may/gov-crists-victory-for-unaffordable-underinsurance

And…

Florida’s health plan for the uninsured has few takers

By Doug Trapp
American Medical News
February 1, 2010
Florida Gov. Charlie Crist didn’t establish a specific enrollment goal for Cover Florida, the state’s unsubsidized private insurance program for the uninsured, when he announced the start of enrollment in January 2009. But in a state with approximately 3.8 million uninsured adults, the fact that only 5,246 people signed up for one of the 27 plans in the program’s first 11 months appears to have defied all expectations.
The authorizing legislation instructed participating insurers to offer at least two types of plans: one with catastrophic and emergency department coverage, and one without.
Plan subscribers… must wait 12 months before their preexisting conditions are covered. Also, insurers balance the risk of covering such conditions by setting benefit limits as low as $25,000 each year and $50,000 in a lifetime for catastrophic plans, for example.
United HealthGroup — one of the two companies offering statewide Cover Florida plans — does not know why plan enrollment has been low, said spokesman Roger Rollman. Blue Cross and Blue Shield of Florida — the other company offering a statewide plan — directed questions to the state.
http://www.ama-assn.org/amednews/2010/02/01/gvsd0201.htm

Today’s message is not meant to be an “I told you so,” even if I did tell you. The point of the message is that health policy science has advanced to a level that the consequences of policies in various reform proposals are fully predictable. “Well, let’s try this and see how it goes” is no longer acceptable, especially for our entire $2.5 trillion health care industry.
Gov. Charlie Crist has provided us with a very valuable lesson with his “‘historic legislation’ that will be a model for the rest of the nation.” His “Cover Florida” program has left 99.9 percent of the uninsured without any coverage, while providing the other 0.1 percent with coverage that won’t work if you need health care.
This may an extreme example, but the cardinal principle is crucial. It is unsound to throw together a bunch of policies chosen based on political considerations, and then pretend that the flaws will be fixed later. You start with a core structure based on sound policies that have been proven to work.
The hybrid model before Congress, using private health insurance plans and public programs, is the most expensive model of reform, even though an important stated goal, when this process began, was to slow the increases in health care spending. The feeble measures included in the bill that allegedly would control costs do not pass basic tests of health policy science.
The hybrid model also was supposed to cover everyone, but health policy science has demonstrated that this model can’t do that. Tens of millions will be left without coverage, a number sure to increase with time.
Charlie Crist’s silly program may be an embarrassment, but that does not compare with the shame that members of Congress should be experiencing simply because they would bankrupt, maim, and kill people by walking away from sound health policy science, while they pursue what they believe will be a political victory. What a terrible, terrible shame.

Gov. Crist’s lesson on unsound policies for health reform

Gov. Crist’s victory for unaffordable underinsurance

Quote of the Day
May 23, 2008

From the Sun-Sentinel.com:

Delivering on Gov. Charlie Crist’s top election-year priority, the Florida Legislature on (May 2, 2008) approved a health insurance package to extend no-frills coverage to the state’s 3.8 million uninsured. Crist called the health-care package “historic legislation” that will be a model for the rest of the nation.

From the Comment (Don McCanne):

Some model. It would reduce insurance premiums by stripping down benefits through measures such as limiting hospitalization and specialized services and by capping payments. Since this “doesn’t cost taxpayers a dime,” the premiums would still be unaffordable for most individuals currently without coverage. Obviously this model will not work for individuals who have health care needs.

https://pnhp.org/news/2008/may/gov-crists-victory-for-unaffordable-underinsurance

And…

Florida’s health plan for the uninsured has few takers

By Doug Trapp
American Medical News
February 1, 2010

Florida Gov. Charlie Crist didn’t establish a specific enrollment goal for Cover Florida, the state’s unsubsidized private insurance program for the uninsured, when he announced the start of enrollment in January 2009. But in a state with approximately 3.8 million uninsured adults, the fact that only 5,246 people signed up for one of the 27 plans in the program’s first 11 months appears to have defied all expectations.

The authorizing legislation instructed participating insurers to offer at least two types of plans: one with catastrophic and emergency department coverage, and one without.

Plan subscribers… must wait 12 months before their preexisting conditions are covered. Also, insurers balance the risk of covering such conditions by setting benefit limits as low as $25,000 each year and $50,000 in a lifetime for catastrophic plans, for example.

United HealthGroup — one of the two companies offering statewide Cover Florida plans — does not know why plan enrollment has been low, said spokesman Roger Rollman. Blue Cross and Blue Shield of Florida — the other company offering a statewide plan — directed questions to the state.

http://www.ama-assn.org/amednews/2010/02/01/gvsd0201.htm

Today’s message is not meant to be an “I told you so,” even if I did tell you. The point of the message is that health policy science has advanced to a level that the consequences of policies in various reform proposals are fully predictable. “Well, let’s try this and see how it goes” is no longer acceptable, especially for our entire $2.5 trillion health care industry.

Gov. Charlie Crist has provided us with a very valuable lesson with his “‘historic legislation’ that will be a model for the rest of the nation.” His “Cover Florida” program has left 99.9 percent of the uninsured without any coverage, while providing the other 0.1 percent with coverage that won’t work if you need health care.

This may an extreme example, but the cardinal principle is crucial. It is unsound to throw together a bunch of policies chosen based on political considerations, and then pretend that the flaws will be fixed later. You start with a core structure based on sound policies that have been proven to work.

The hybrid model before Congress, using private health insurance plans and public programs, is the most expensive model of reform, even though an important stated goal, when this process began, was to slow the increases in health care spending. The feeble measures included in the bill that allegedly would control costs do not pass basic tests of health policy science.

The hybrid model also was supposed to cover everyone, but health policy science has demonstrated that this model can’t do that. Tens of millions will be left without coverage, a number sure to increase with time.

Charlie Crist’s silly program may be an embarrassment, but that does not compare with the shame that members of Congress should be experiencing simply because they would bankrupt, maim, and kill people by walking away from sound health policy science, while they pursue what they believe will be a political victory. What a terrible, terrible shame.

CMS health spending projections

Health Spending Projections Through 2019: The Recession’s Impact Continues

From the Office of the Actuary, Centers for Medicare and Medicaid Services
Health Affairs
February 4, 2010

Projections for 2010:

National Health Expenditures (NHE): $2,569.6 billion

NHE per capita: $8,289.9

NHE as percent of GDP: 17.3%

NHE projected average annual growth, 2009-2019: 6.1%

Abstract:

The economic recession and rising unemployment—plus changing demographics and baby boomers aging into Medicare—are among the factors expected to influence health spending during 2009–2019. In 2009 the health share of gross domestic product (GDP) is expected to have increased 1.1 percentage points to 17.3 percent—the largest single-year increase since 1960. Average public spending growth rates for hospital, physician and clinical services, and prescription drugs are expected to exceed private spending growth in the first four years of the projections. As a result, public spending is projected to account for more than half of all U.S. health care spending by 2012.

http://content.healthaffairs.org/cgi/content/full/hlthaff.2009.1074v1

Woolhandler and Himmelstein: Paying For National Health Insurance — And Not Getting It (Health Affairs, July/August 2002):
https://pnhp.org/publications/payingnotgetting.pdf

Comment: 

By Don McCanne, MD

Same story every year. Health care spending continues to increase at rates well in excess of inflation, and health care continues to represent an increasing percentage of our gross domestic product.

One important technical point. The CMS authors report that public spending will soon account for more than half of all U.S. health care spending. But they leave out two important taxpayer sources of health care financing: 1) tax subsidies in the form of tax deductions for employer-sponsored plans, and 2) the purchase of health benefit programs for public employees. In their classic paper (link above), Woolhandler and Himmelstein demonstrated that this results in a figure of government spending about fifteen percentage points higher than the numbers reported in this annual CMS report.

Using a back-of-the-envelope update, the government is already using taxpayer funds to finance about two-thirds of our national health expenditures (NHE). In a financing system that only Americans would design, a significant portion of those funds, without much transparency, are funneled through to the inefficient, wasteful private insurance plans and recategorized as private spending.

Taxpayers should be outraged. We hold the stewards of our public funds to a higher standard for responsible spending than we do for those who are shuffling funds around in a market economy.

We should be receiving much greater value for our health care spending, but we won’t under the proposal before Congress. It has been designed to funnel even more taxpayer funds to the private insurance industry, with the guarantee that they can draw off for themselves fifteen to twenty percent of the funds they receive.

With that model of a financing system, we can anticipate that we will receive the same depressing report from CMS each year until finally our finances and our health are ruined by the imposition of the forces of Stein’s Law. With a single payer national health program – an improved Medicare for all – it doesn’t have to be that way.

CMS health spending projections

Health Spending Projections Through 2019: The Recession’s Impact Continues

From the Office of the Actuary, Centers for Medicare and Medicaid Services
Health Affairs
February 4, 2010
Projections for 2010:
National Health Expenditures (NHE): $2,569.6 billion
NHE per capita: $8,289.9
NHE as percent of GDP: 17.3%
NHE projected average annual growth, 2009-2019: 6.1%
Abstract:
The economic recession and rising unemployment—plus changing demographics and baby boomers aging into Medicare—are among the factors expected to influence health spending during 2009–2019. In 2009 the health share of gross domestic product (GDP) is expected to have increased 1.1 percentage points to 17.3 percent—the largest single-year increase since 1960. Average public spending growth rates for hospital, physician and clinical services, and prescription drugs are expected to exceed private spending growth in the first four years of the projections. As a result, public spending is projected to account for more than half of all U.S. health care spending by 2012.
http://content.healthaffairs.org/cgi/content/full/hlthaff.2009.1074v1
Woolhandler and Himmelstein: Paying For National Health Insurance — And Not Getting It (Health Affairs, July/August 2002):
https://pnhp.org/publications/payingnotgetting.pdf

Same story every year. Health care spending continues to increase at rates well in excess of inflation, and health care continues to represent an increasing percentage of our gross domestic product.
One important technical point. The CMS authors report that public spending will soon account for more than half of all U.S. health care spending. But they leave out two important taxpayer sources of health care financing: 1) tax subsidies in the form of tax deductions for employer-sponsored plans, and 2) the purchase of health benefit programs for public employees. In their classic paper (link above), Woolhandler and Himmelstein demonstrated that this results in a figure of government spending about fifteen percentage points higher than the numbers reported in this annual CMS report.
Using a back-of-the-envelope update, the government is already using taxpayer funds to finance about two-thirds of our national health expenditures (NHE). In a financing system that only Americans would design, a significant portion of those funds, without much transparency, are funneled through to the inefficient, wasteful private insurance plans and recategorized as private spending.
Taxpayers should be outraged. We hold the stewards of our public funds to a higher standard for responsible spending than we do for those who are shuffling funds around in a market economy.
We should be receiving much greater value for our health care spending, but we won’t under the proposal before Congress. It has been designed to funnel even more taxpayer funds to the private insurance industry, with the guarantee that they can draw off for themselves fifteen to twenty percent of the funds they receive.
With that model of a financing system, we can anticipate that we will receive the same depressing report from CMS each year until finally our finances and our health are ruined by the imposition of the forces of Stein’s Law. With a single payer national health program – an improved Medicare for all – it doesn’t have to be that way.

Labor Campaign for Single-Payer's Letter to President Obama

February 3, 2010

Dear President Obama,

The lives and livelihoods of a vast majority of Americans have been held hostage for decades by this country’s failure to provide an equitable, socially just health care system. Your Administration should be commended for identifying the need and pushing for a comprehensive solution to this uniquely American dilemma. But this year’s rancorous, special interest driven Congressional debate is now stalemated over differing House and Senate passed Bills, which do not meet the test of either equity or justice.

As grassroots representatives of millions of this country’s union members and in the interest of all working people, we respectfully submit that taking the single-payer solution off the table was both a strategic and tactical mistake. Medicare is an example of a successful single payer model and it is a very popular health care program. A “Medicare-for-All” system would be far more cost effective than any of the proposed current reforms based on the continuation of for-profit, market-based insurance. And it is a program that Americans are already familiar with–a solution right at our fingertips.

The rising cost of health care is one of the biggest issues in the collective bargaining process. Many working families have given up wage increases and are being asked to cover more of their health care costs. Others are losing their health care benefits altogether because more employers are dropping individual and family coverage. This is a crisis and a moral issue. People currently covered by private health insurance are understandably apprehensive when it is suggested that their only alternative to degrading that coverage is not to be covered at all–as is the current situation for approximately 50 million of our fellow citizens today.

Our current jobs crisis is further aggravated since the cost of health care in the U. S. is almost double that in other industrial countries, making our export sector increasingly uncompetitive and a major cause of the off-shoring of jobs.

At this past year’s AFL-CIO Convention in Pittsburgh, on the very day that you, Mr. President, addressed the Convention and were so warmly received, the delegates unanimously adopted a detailed resolution in support of a Single-Payer, “Medicare for All” system in America.

We welcome your call for a better approach that will “bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare and stop insurance company abuses.” We submit to you that a “Medicare-for-All” health care system accomplishes all of these worthy goals, contrary to the untruths that have been advanced by opponents of true health care reform.

The American people deserve better. We want our leaders to solve the health care crisis and to do so in a transparent way. No one in this country should have to fear losing their health care coverage or face bankruptcy. This is simply unacceptable for the United States of America. The time for single payer health care is now. We urge you to use this impasse as the time to put single payer health care on the table and into the health care reform discussions as the real solution.
Millions of working people and an overwhelming majority of unionists voted their confidence in your call for “change we can believe in.”

Respectfully Submitted,

The Labor Campaign for Single-Payer Health Care Steering Committee & Advisory Board

cc: Nancy Pelosi
Harry Reid