Letter to the Editor
Salt Lake Tribune
07/17/2009

Because I am a physician and attorney with many years of experience in both fields, I can say unequivocally that the best way to solve the escalating cost in health care is also the best way to reduce medical errors and nearly eliminate medical malpractice lawsuits. It is also the simplest solution and it pays for itself without resorting to budgetary tricks.

The solution I refer to is single-payer Medicare for all, embodied in Rep. John Conyers’ bill, HR676. Simply put, single-payer Medicare for all eliminates health insurance companies as the middleman. Health care that is publicly financed and privately delivered returns health decisions to their proper place — solely between the doctor and the patient.

People who don’t have to worry about paying for their future medical care are much less likely to sue, even when injured by negligence. Doctors who don’t have to spend 30 percent of their time and income dealing with bills to 1,200 different insurance companies, and with unjustified denials or limitations of care, will have more time to treat their patients carefully and adequately.

Single-payer Medicare for all is a simple solution that already works for seniors, and it will work for all of us.

Clark Newhall
Salt Lake City

By Alicia C. Shepard
NPR ombudsman
July 17, 2009

The dilemma is a classic for all news organizations covering government or elections.

The news media doesn’t cover a proposal or political candidate because the media doesn’t think either has a chance of success. But without news coverage, how will either get enough attention to make a difference?

In this case, it’s the single-payer approach to the current national debate over paying for health care.

More than 300 listeners have complained that NPR is ignoring the single-payer movement in covering Congress’s overhaul of health care. NPR says it’s just being practical.

A single-payer medical system would be similar to a broadened Medicare, with doctors, hospitals and health-care facilities run privately but the government paying the bills with taxpayer money.

Supporters consider it the best solution to a crumbling health care system. Often they cite polls indicating broad public support. For example, an April 2009 CBS/New York Times poll said 57 percent of respondents were “willing to pay higher taxes so that all Americans have health insurance.”

“The majority of Americans want single payer,” wrote Selma Goldberg of Crofton, MD. “It is the health care of choice for almost all other industrialized nations. There is no question it is superior in every way to alternatives. Why are you opting to exclude coverage of this system? I am unhappy with the way you cover the news, bowing as you do to commercial interests.”

But here’s the reality. NPR says it is not avoiding coverage because it is beholden to the health insurers or big Pharma — as claimed by an “NPR Watch” piece for Counterpunch, a political newsletter.

“Revenue in the pharmaceutical category represents only 3 percent of total underwriting revenue,” said John King, operations manager for NPR Sponsorship.

The decision not to devote a lot of attention to single-payer, I’m told, is based on pragmatism.

“This issue is not getting a lot of attention from NPR because it’s simply not on the table in Congress,” said Julie Rovner, NPR’s lead reporter covering the health care overhaul. “I think the reason that single-payer is not on the table is because it’s too big a change.”

There are two major bills in the House and Senate to provide health care to all Americans. H.R. 676, introduced by Rep. John Conyers (D-MI) has 85 co-sponsors and endorsements from 550 labor organizations, according to the Thomas database for the Library of Congress. Senate bill S. 703 introduced by Sen. Bernie Sanders (I-VT) has no co-sponsors. The California state legislature twice passed a single-payer bill. Gov. Arnold Schwarzenegger vetoed both.

NPR’s most recent story solely on single-payer was Dec. 24, 2008 on All Things Considered. It explored the political prospects (not good) for a single-payer system. Last summer, NPR did a series that explored national health plans (each with similarities to a single-payer system) in France, Germany, Great Britain, The Netherlands and Switzerland.

Since late February, the single-payer approach has been mentioned or discussed in broader health care stories at least 25 times. All NPR healthcare stories are aggregated here. On July 8, Talk of the Nation, looked at the politics behind health care for 20 minutes and single-payer was discussed.

“NPR’s coverage is not much different than other media in that it tends to dismiss the single-payer alternative as a marginal phenomenon and discount it as a legitimate solution to the health care crisis,” said Mark Almberg, communications director for Physicians for a National Health Program, a 16,000-member group supporting the concept. “Such discounting excludes us from the political process.”

Rovner said that 160 million Americans now get employer-provided health insurance. “There are enough people who are satisfied with what they have now and it would be too big a shock to do such a massive change,” she said. “All the experts I talk to say this doesn’t have a chance because it would mean getting rid of employer-provided insurance.”
She pointed out that “most polls that offer a wide range of choices show that a good 30 percent of the public is for single-payer.”

“The problem is it’s not a majority,” Rovner said. “I feel like I’m one of the few reporters that has recognized from the beginning that the single-payer supporters are an important element in this debate.” Rovner is one of the most experienced and widely respected reporters covering health care policy in the U.S.

One reality for NPR is that there are dozens of aspects of the health care debate to cover.

“We are giving single-payer as much attention as it needs given the discussion in the nation’s capital about overhauling health care,” said Anne Gudenkauf, who heads the science desk. “We need to give them [the listeners] information about what’s on the table. Not what’s not.”

Rovner did several news spots in May for newscasts when single-payer advocates, upset they weren’t invited to testify, disrupted several health care hearings. Thirteen were arrested at one.

“We haven’t done a stand-alone single payer story since last year, but as you’ll note in the sheaf of stories I handed you,” said Rovner, “I have gone out of my way to include the single-payer viewpoint in nearly a dozen stories I’ve done this year. I think that’s far more than most of the mainstream media can claim.”

Rovner’s correct about including single-payer views. But I think NPR could have done a few stories directly on the single-payer concept — especially because by Rovner’s own statement, polls show 30 percent of the public supports it.

Shortly before posting this, Rovner stopped by to say that she intends to do a piece next week on single-payer and another long-shot health care proposal that are both noteworthy but won’t pass because they would eliminate employer-provided health insurance. She said it’s been on her list of stories to do for weeks.

PNHP editor’s note: According to a recent poll, 59 percent or more of Americans support national health insurance, not “30 percent” as claimed by NPR’s Julie Rovner. (CBS News/New York Times, Jan 15, 2009).

http://edlabor.house.gov/documents/111/pdf/markup/FC/HR3200-AmericasAffordableHealthChoicesActof2009/KucinichERISA.pdf

By Drs. Steffie Woolhandler and David Himmelstein
The Progressive
July 22, 2009

Once Congress finishes mandating that we all buy private health insurance, it can move on to requiring Americans to purchase other defective products.

A Ford Pinto in every garage?

Lead-painted toys for every child?

Melamine-laced chow for every puppy?

Private health insurance doesn’t work.

Even middle-class families with supposedly good coverage are just one serious illness away from financial ruin.

Illness and medical bills contribute to 62 percent of personal bankruptcies — a 50 percent increase since 2001. And three-quarters of the medically bankrupt had insurance, at least when they first got sick.

Coverage that families bought in good faith failed to protect them. Some were bankrupted by co-payments, deductibles, and loopholes. Others got too sick to work, leaving them unemployed and uninsured.

Now Congress plans to make it a federal offence not to purchase such faulty insurance.

On top of that, it’s threatening to tax workers’ health benefits to meet the costs of simultaneously covering the poor and keeping private insurers in business.

President Obama’s plan would finance reform by draining funds from hospitals that serve the neediest patients. His other funding plans aren’t harmful, just illusory. He’s gotten unenforceable pledges from hospitals, insurers and the American Medical Association to rein in costs, a replay of promises they made (and broke) to Presidents Nixon and Carter. And Obama trumpets savings from computerized medical records and better care management, savings the Congressional Budget Office has dismissed as wishful thinking.

The president’s health plan can’t make universal, comprehensive coverage affordable.

Only single-payer health reform — Medicare for All — can achieve that goal.

Single-payer national health care could realize about $400 billion in savings annually — enough to cover the uninsured and to upgrade coverage for all Americans. But the vast majority of these savings aren’t available unless we go all the way to single payer.

A public plan option might cut into private insurers’ profits. That’s why they hate it. But their profits — roughly $10 billion annually — are dwarfed by the money they waste in search of profit. They spend vast sums for marketing (to attract the healthy); demarketing (to avoid the sick); billing their ever-shifting roster of enrollees; fighting with providers over bills; and lobbying politicians. And doctors and hospitals spend billions more meeting insurers’ demands for documentation.

A single-payer plan would eliminate most insurance overhead, as well as these other paperwork expenses. Hospitals could be paid like a fire department, receiving a single monthly check for their entire budget. Physicians’ billing could be similarly simplified.

With a public insurance option, by contrast, hospitals and doctors would still need elaborate billing and cost-tracking systems. And overhead for even the most efficient competitive public option would be far higher than for traditional Medicare, which is efficient precisely because it doesn’t compete. It automatically enrolls seniors at 65 and deducts their premiums through the social security system, contracts with any willing provider, and does no marketing.

Health insurers compete by NOT paying for care: by seeking out the healthy and avoiding the sick; by denying payment and shifting costs onto patients; and by lobbying for unfair public subsidies (as under the Medicare HMO program). A kinder, gentler public plan that failed to emulate these behaviors would soon be saddled with the sickest, costliest patients and the highest payouts, driving premiums to uncompetitive levels. To compete successfully, a public plan would have to copy private plans.

Decades of experience teach that private insurers cannot control costs or provide families with the coverage they need. And a government-run clone of private insurers cannot fix these flaws.

Drs. Steffie Woolhandler and David Himmelstein are associate professors at Harvard Medical School. They co-founded Physicians for a National Health Program, a nonprofit research and education organization of 16,000 physicians, medical students, and health professionals who support single-payer national health insurance. For more about the group, go to www.pnhp.org. This piece was distributed by the Progressive Media Project, an affiliate of The Progressive magazine.

Letter to the Editor
San Francisco Chronicle
Wednesday, July 22, 2009

If congressional leaders are disturbed by the Congressional Budget Office report that their proposed health reform legislation will deepen “the already staggering national debt” (“Fiscal conservatives grumble over tab for reform,” July 20), they need to ask the question: How would the cost of a single-payer program compare?

Many health policy authorities believe that the “Medicare for all” bills introduced by Rep. John Conyers, D-Mich., and Sen. Bernie Sanders, independent-Vt., are the most fiscally prudent and affordable approach to universal, comprehensive, high-quality health care.

It’s time for the president and congressional leaders to stop ignoring reality: The United States can afford national health insurance if the government administers a single-payer program. But what we cannot afford is to continue squandering $400 billion annually on the current dysfunctional patchwork of for-profit private insurance plans.

By adopting a single-payer system, that amount could be plowed back into providing expanded services for the entire population at no additional cost to the country.

LI-HSIA WANG, M.D.
HENRY L. ABRONS, M.D.
Berkeley

By Drs. Steffie Woolhandler and David Himmelstein
The Progressive
July 22, 2009

Once Congress finishes mandating that we all buy private health insurance, it can move on to requiring Americans to purchase other defective products.

A Ford Pinto in every garage?

Lead-painted toys for every child?

Melamine-laced chow for every puppy?

Private health insurance doesn’t work.

Even middle-class families with supposedly good coverage are just one serious illness away from financial ruin.

Illness and medical bills contribute to 62 percent of personal bankruptcies — a 50 percent increase since 2001. And three-quarters of the medically bankrupt had insurance, at least when they first got sick.

Coverage that families bought in good faith failed to protect them. Some were bankrupted by co-payments, deductibles, and loopholes. Others got too sick to work, leaving them unemployed and uninsured.

Now Congress plans to make it a federal offence not to purchase such faulty insurance.

On top of that, it’s threatening to tax workers’ health benefits to meet the costs of simultaneously covering the poor and keeping private insurers in business.

President Obama’s plan would finance reform by draining funds from hospitals that serve the neediest patients. His other funding plans aren’t harmful, just illusory. He’s gotten unenforceable pledges from hospitals, insurers and the American Medical Association to rein in costs, a replay of promises they made (and broke) to Presidents Nixon and Carter. And Obama trumpets savings from computerized medical records and better care management, savings the Congressional Budget Office has dismissed as wishful thinking.

The president’s health plan can’t make universal, comprehensive coverage affordable.

Only single-payer health reform — Medicare for All — can achieve that goal.

Single-payer national health care could realize about $400 billion in savings annually — enough to cover the uninsured and to upgrade coverage for all Americans. But the vast majority of these savings aren’t available unless we go all the way to single payer.

A public plan option might cut into private insurers’ profits. That’s why they hate it. But their profits — roughly $10 billion annually — are dwarfed by the money they waste in search of profit. They spend vast sums for marketing (to attract the healthy); demarketing (to avoid the sick); billing their ever-shifting roster of enrollees; fighting with providers over bills; and lobbying politicians. And doctors and hospitals spend billions more meeting insurers’ demands for documentation.

A single-payer plan would eliminate most insurance overhead, as well as these other paperwork expenses. Hospitals could be paid like a fire department, receiving a single monthly check for their entire budget. Physicians’ billing could be similarly simplified.

With a public insurance option, by contrast, hospitals and doctors would still need elaborate billing and cost-tracking systems. And overhead for even the most efficient competitive public option would be far higher than for traditional Medicare, which is efficient precisely because it doesn’t compete. It automatically enrolls seniors at 65 and deducts their premiums through the social security system, contracts with any willing provider, and does no marketing.

Health insurers compete by NOT paying for care: by seeking out the healthy and avoiding the sick; by denying payment and shifting costs onto patients; and by lobbying for unfair public subsidies (as under the Medicare HMO program). A kinder, gentler public plan that failed to emulate these behaviors would soon be saddled with the sickest, costliest patients and the highest payouts, driving premiums to uncompetitive levels. To compete successfully, a public plan would have to copy private plans.

Decades of experience teach that private insurers cannot control costs or provide families with the coverage they need. And a government-run clone of private insurers cannot fix these flaws.

Drs. Steffie Woolhandler and David Himmelstein are associate professors at Harvard Medical School. They co-founded Physicians for a National Health Program, a nonprofit research and education organization of 16,000 physicians, medical students, and health professionals who support single-payer national health insurance. For more about the group, go to www.pnhp.org. This piece was distributed by the Progressive Media Project, an affiliate of The Progressive magazine.