PNHP

Britain’s National Health Service: Simple, sensible and civilized

Britain’s National Health Service: Simple, sensible and civilized

A former NHS patient has some advice for Americans skeptical of single-payer, government-run healthcare: You’ll get over it

By Clancy Sigal
Opinion
Los Angeles Times
July 5, 2009

For the first couple of years I lived in Britain, I was an illegal immigrant from the United States, visaless with an expired passport and looking over my shoulder all the time. Even so, from the very first day I arrived at Victoria Station in London, suffering from bronchitis, I was accepted in the NHS — the national health scheme, we called it — no questions asked and no ID required.

After I’d become a legal resident, I asked my doctor why he had taken me, almost literally off the boat, with so little fuss. Weren’t foreigners a drain on his time and the National Health Service? He shrugged. “If you come here with a contagious disease, we don’t want you infecting the rest of us. So of course we give you medical care. Purely selfish on our part.”

For three decades I used and, being of a hypochondriacal nature, exploited the British medical system without paying a farthing except for the taxes taken out of my wages as a working journalist. And that single-payer, socialistic, government-run, bureaucratized, heavily used, nationalized health system served me — and 50 million others — very well. In need, I saw many doctors, with no money ever changing hands. There was nothing to sign, hardly any papers to shuffle. My primary-care physician ran his “surgery,” his office, with the help of only one receptionist whose job it was to arrange appointments.

My doctor’s waiting room in his storefront office was by American standards shockingly casual, even a trifle seedy. In what was then a rigid class society, the waiting room was also a lesson in democracy where duchesses and dustmen, old and young, rich and poor, waited their turn. It wasn’t perfect. There was the occasional misdiagnosis, crowded hospital ward, sleepy student nurse. But it worked.

It was all free, including specialists, and I came to believe that healthcare is a right, not an entitlement I had paid for. This “free” part sometimes puzzled my visiting American friends. When they got ill in London, I’d send them to my doctor, who would smile bemusedly when offered money. Did they appreciate this? Hardly. “Your doctors,” they’d say, “can’t be much good, can they?”

Is this too rosy a picture of single-payer, government-run healthcare? Maybe. Over the years, an underfunded, over-bureaucratized, increasingly privatized NHS has in some areas turned into a shadow of its former vibrant self.

Perhaps I was lucky to arrive so soon after World War II, when a traumatized, bomb-weary public was in no mood to revisit a prewar history of medical deprivation and the humiliation of means testing. Slowly, over time, by argument and debate, a consensus had been achieved, by Conservatives and Labor alike, that, in the words of Edward VIII as Prince of Wales when he first saw the grinding poverty of the unemployed, “something must be done.”

Recently, the American Medical Assn. responded with skepticism to President Obama’s plea for healthcare reform. In Britain, too, the massed ranks of the medical profession at first fought bitterly against a “socialized” service covering all from cradle to the grave. But Labor’s health minister, a firebrand from the mining valleys, Aneurin Bevan, brought them into line with a mixture of enticements and threats.

The NHS was, and is, a classically English compromise, in which individual doctors are independent contractors paid by the government according to the number of their patients. Doctors are free to remove patients from their list, and patients are free to go elsewhere. Once ideology was laid aside and the system got working, it was actually quite simple.

Once launched, in an astonishingly short time, a matter of a year or so, the NHS was accepted by even its worst enemies — the doctors and the Conservative Party — as indispensable and a civilized way of dealing with life, illness and death.

Does that sound so awful?

Clancy Sigal is a writer and former BBC broadcaster who lives in Los Angeles.

NHIS numbers, and building on what works

Town Hall on Health Care

President Obama
The White House
July 1, 2009
Here’s the problem, is that the way our health care system evolved in the United States, it evolved based on employers providing health insurance to their employees through private insurers. And so that’s still the way that the vast majority of you get your insurance. And for us to transition completely from an employer-based system of private insurance to a single-payer system could be hugely disruptive. And my attitude has been that we should be able to find a way to create a uniquely American solution to this problem that controls costs but preserves the innovation that is introduced in part with a free market system.
We want to build on what works about the system and fix what’s broken about the system.
http://www.whitehouse.gov/the_press_office/Remarks-of-the-President-in-an-Online-Town-Hall-on-Health-Care-Reform/

And…

Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2008

by Robin A. Cohen, Ph.D. and Michael E. Martinez, M.P.H., M.H.S.A.
CDC
In 2008, 60.2% of unemployed adults aged 18-64 years and 22.2% of employed adults in this age group had been uninsured for at least part of the past year.
Among persons under age 65 with private health insurance, 17% with employer-based coverage were enrolled in a HDHP, compared with almost 45% of those with a private plan that was directly purchased or obtained through means other than an employer.
http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur200906.pdf

Everywhere you turn those rejecting single payer, including President Obama, say that we want to build on what works and fix what’s broken. They say that what works is our employer-sponsored system of coverage. But does it?
Employer-sponsored plans fail to cover about one-fifth of the workforce. Of those who are covered many have been switched to high-deductible health plans (HDHP), a form of inadequate underinsurance that has been more characteristic of the individual insurance market.
Although the employer-sponsored system falls short for far too many of us, one of the most serious deficiencies is that it is dependent on employment. Well, of course. But that means that three-fifths of the unemployed remain without coverage. And of those insured who do not receive their coverage through their work, 45% have HDHP underinsurance products.
This is really a lousy insurance infrastructure that we are trying to prop up. And nobody in Washington is considering seriously the massive amount of tax subsidies that would be required to help everyone purchase plans with adequate benefits. Establishing an insurance exchange for employers and individuals is of little help if the subsidies won’t fill the gap of affordability. But adequate subsidies are off the table because they are budget busters.
How about dumping what’s broken, and building on a system that works – Medicare.

NHIS numbers, and building on what works

Town Hall on Health Care

President Obama
The White House
July 1, 2009

Here’s the problem, is that the way our health care system evolved in the United States, it evolved based on employers providing health insurance to their employees through private insurers. And so that’s still the way that the vast majority of you get your insurance. And for us to transition completely from an employer-based system of private insurance to a single-payer system could be hugely disruptive. And my attitude has been that we should be able to find a way to create a uniquely American solution to this problem that controls costs but preserves the innovation that is introduced in part with a free market system.

We want to build on what works about the system and fix what’s broken about the system.

http://www.whitehouse.gov/the_press_office/Remarks-of-the-President-in-an-Online-Town-Hall-on-Health-Care-Reform/

And…

Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2008

by Robin A. Cohen, Ph.D. and Michael E. Martinez, M.P.H., M.H.S.A.
CDC

In 2008, 60.2% of unemployed adults aged 18-64 years and 22.2% of employed adults in this age group had been uninsured for at least part of the past year.

Among persons under age 65 with private health insurance, 17% with employer-based coverage were enrolled in a HDHP, compared with almost 45% of those with a private plan that was directly purchased or obtained through means other than an employer.

http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur200906.pdf

Comment:

By Don McCanne, MD

Everywhere you turn those rejecting single payer, including President Obama, say that we want to build on what works and fix what’s broken. They say that what works is our employer-sponsored system of coverage. But does it?

Employer-sponsored plans fail to cover about one-fifth of the workforce. Of those who are covered many have been switched to high-deductible health plans (HDHP), a form of inadequate underinsurance that has been more characteristic of the individual insurance market.

Although the employer-sponsored system falls short for far too many of us, one of the most serious deficiencies is that it is dependent on employment. Well, of course. But that means that three-fifths of the unemployed remain without coverage. And of those insured who do not receive their coverage through their work, 45% have HDHP underinsurance products.

This is really a lousy insurance infrastructure that we are trying to prop up. And nobody in Washington is considering seriously the massive amount of tax subsidies that would be required to help everyone purchase plans with adequate benefits. Establishing an insurance exchange for employers and individuals is of little help if the subsidies won’t fill the gap of affordability. But adequate subsidies are off the table because they are budget busters.

How about dumping what’s broken, and building on a system that works – Medicare.

Middle class battles illness, medical bills

Middleton man has one goal: making sure his wife isn’t left penniless

BY COLLEEN LAMAY
Idaho Statesman
07/01/09

In the movies and in country music, spunky people dying of cancer take exotic vacations, jump out of airplanes, spend quality time with people they love – all the things they never had time to do before their diagnoses.

The reality is very different for growing numbers of middle-class families who lack health insurance or have skimpy coverage.

Take Richard Day, a Middleton man, 64, who lost his health insurance along with his management job at a Treasure Valley manufacturer last year as he neared retirement.

He claimed early retirement so he could receive Social Security and was working to start a small business but was having trouble paying the mortgage on his home. He gambled that he could go without health insurance until he turned 65 in December 2009. That’s the age at which most people become eligible for Medicare.

Then he was diagnosed with cancer. Not just any cancer, but lung cancer that had spread to his brain. Barring a miracle, he says now, he has four months to a year to live.

Day, the breadwinner for himself and his wife of 44 years, Shirley, now wants one thing only: to make sure medical bills do not leave her destitute after he dies.

“I’ve run my race,” Day said as he sat at his dining room table recently. “I am nearing the finish line.” He was quiet for a moment. “I just have to get through it.”

The mortgage on the couple’s retirement home – with three big bedrooms, a bonus room over the garage and large porches – hasn’t been paid in months. The house is six years old.

Bills are stacking up. The Days fear they will lose the house. Day is trying to stave off bankruptcy.

If he or his wife has to file for bankruptcy, he won’t be alone. Bankruptcies attributable to medical problems rose 50 percent from 2001 to 2007, according to a recent study of 2,314 bankruptcies nationwide. In 75 percent of the cases, the people filing were insured, and most were middle class, according to the study, published in The American Journal of Medicine. No Idaho-specific numbers are available.

Another recent study, by the nonprofit Kaiser Family Foundation, found cancer patients at the highest risk of financial ruin because of ever-escalating treatment costs.

Like millions of people, Day said, he made two mistakes he now admits readily.

First, he smoked for four decades. Hence the lung cancer.

Second, he took insurance for granted. He never worried about being without it.

So far, Day has received bills totaling at least $80,000 from doctors, his hospital, labs, imaging tests and other treatments. Exactly how large Day’s bills will be and where the money will come from are not yet known. Day’s cancer diagnosis is barely a month old.

Meanwhile, the Days owe $2,500 a month on their mortgage. Their sole income is $2,619 a month in combined Social Security benefits. They have no pension or 401(k) and no other significant source of income.

Agonizing about bills is no way for anyone to spend the last months of life, said Dr. Robert Vestal, an Idaho member of the Physicians for a National Health Program, which advocates for a single-payer health care plan – Medicare-style coverage for everyone. Vestal was a former research director at the Boise Veterans Administration Medical Center.

The Days have two grown children, both of whom have visited the parents to try to help. The oldest, Cathy Miller, came from her home in Louisiana to help her parents deal with the sheer volume of paperwork involved in applying for help. She stayed about three weeks and worked mainly with the Veterans Administration and the Canyon County indigent fund.

“It seemed like every time I turned around, I was hit in the face (with more paperwork),” Miller said.

Day was eligible to continue the health insurance his former employer offered at his own expense for up to 18 months under a federal law known as COBRA, but the couple said they didn’t know that. The federal economic-stimulus law passed last winter subsidizes that coverage for nine months. Day has since obtained COBRA coverage, but isn’t sure how much it will help.

When patients face potentially huge bills they may not be able to pay, hospitals – in this case St. Luke’s Meridian Medical Center – step in to pursue ways to get the bills paid, including government funding and charity.

“Cancer care puts an emotional and financial burden on nearly every patient, and we appreciate the difficulties Mr. Day is facing,” St. Luke’s spokesman Ken Dey said in an e-mail. “We have identified some significant resources to help offset the cost of care for Mr. Day, but it’s too early in his care to say that all expenses will be covered.”

St. Luke’s is helping the Days make their COBRA payments, Day said. Other possible sources of help include public health insurance plans such as Medicare disability, available to people before they turn 65; Medicaid, a state and federally funded program for the poor and disabled; the Veterans Administration, because Day is a veteran; and the hospital itself.

To cover all their bases, hospitals may send patients to county taxpayers for help. County indigent funds are supposed to be a last resort, and people must be indigent when they apply.

Indigent. Day was humiliated the first time he heard the word in the same sentence as his name. “I never had anybody say it to me before,” he said. “That hurt me more than anything.”

When the Days applied for help in Canyon County, the county put a lien on the couple’s home, its contents, his cars – things it could sell to pay Day’s bills, he said. If the Days get county money, the lien will put the county in line to get paid back when the house is sold, said Tony Poinelli, deputy director of the Idaho Association of Counties.

St. Luke’s cancer treatment centers — which go by the name Mountain States Tumor Institute – and its doctors receive only praise from Day, who says he has been treated like a king. He has hope that, with the help St. Luke’s is giving to find money, his wife will avoid poverty.

But Day appears tired as he and his wife sit at their dining room table, which looks out over a small hill with a walking path. The house, its contents – none of this “stuff” matters to Day any more. Just family and friends. And God. And Shirley.

“I have to get her situated with my daughter and get her a condo somewhere where she can survive because the medical (bills), even if I’m gone, are what is going to kill her,” Day said.

“How stupid was I not to look ahead and see that this was coming?” he asked, rubbing his neck. “Something happens like this, you are dead meat.”

http://www.idahostatesman.com/yourhealth/story/819855.html

Medical debt increasingly cited as factor in bankruptcies

Most people filing at least partly because of medical debt were insured, according to a report by single-payer advocates.

By Doug Trapp
AMNews
Posted June 30, 2009

Nearly two-thirds of bankruptcies in early 2007 were due in part to medical debt — an increase of more than 20% since 2001 — according to a national study of more than 2,000 cases.

Of those who filed for bankruptcy due in part to medical debt, 92% had debt of more than $5,000 or 10% of their income, according to “Medical Bankruptcy in the United States, 2007: Results of a National Study,” published in the May 18 issue of the American Journal of Medicine. The study is based on questionnaires returned by 2,314 debtors, plus court records and phone interviews.

The study is a follow-up to a similar 2001 analysis based on bankruptcy filings in five states. The earlier study found that medical problems contributed to at least 46.2% of bankruptcies in those states. The newer study — which required larger debts to label a bankruptcy as medically related — found that the bankruptcies of 62.1% of people who filed between Jan. 25 and April 11, 2007, were at least partly related to medical debt. Also, fewer than one-third of these debtors were uninsured when they filed.

“Most of us have policies with so many loopholes, co-payments and deductibles that illness can put you in the poorhouse. And even the best job-based health insurance often vanishes when prolonged illness causes job loss — precisely when families need it most,” said co-author David Himmelstein, MD, associate professor of medicine at Harvard University.

Dr. Himmelstein and another co-author — Steffie Woolhandler, MD, MPH — are members of Physicians for a National Health Program, which advocates for a single-payer health system. Dr. Woolhandler is also an associate professor of medicine at Harvard University.

Reasons for the bankruptcies examined in the study included the following:

* 38.2%: The debtor or spouse lost at least two weeks of income due to illness or became completely disabled.

* 34.7%: The debtor had medical bills of more than $5,000 or more than 10% of income.

* 32.1%: The debtor said medical problems of self or spouse led to the bankruptcy.

* 29%: Medical bills were the reason for the bankruptcy.

* 5.7%: The debtor mortgaged the home to pay medical bills.

The study is available online (download.journals.elsevierhealth.com/pdfs/journals/0002-9343/PIIS0002934309004045.pdf).

This content was published online only.
http://www.ama-assn.org/amednews/2009/06/29/gvse0630.htm

Single-payers crashing the gates

By Marcy Winograd
L.A. Progressive
June 30, 2009

One of the many frustrations for advocates of single-payer health care is the relentless drive to marginalize us, not only by conservatives but also by members of our own party.

Case in point: the accounting arm of Congress, the Congressional Budget Office, has yet to perform a financial analysis of the cost of implementing single payer, a system whereby taxpayers — businesses and individuals — pay into a single general fund which covers everyone’s health care for the rest of their lives, regardless of job or health status.

Studies in California and Colorado have shown that a single-payer system would save money for businesses, families, and government by eliminating private insurance overhead and creating enormous purchasing power that would drive down the costs of care.

I wanted to know why we don’t have federal government cost projections for single payer, so I called the Congressional Budget Office — and reached an answering machine.

Two days later, Melissa Merson, the communications director with the CBO, called me back and left a polite message, explaining that the CBO takes its orders from Congress, specifically the leadership (House Speaker and Senate Majority Leader), as well as the chairs of various committees:

– Finance (H-Barney Frank, D-Mass.; S-Max Baucus, D-Mont.)
– Health, Education, and Labor (S-Ted Kennedy, D-Mass.)
– Budget (H-John Spratt, D-S.C.; S-Kent Conrad, D-N.D.)
– Appropriations (H-David Obey, D-Wis.; S- Daniel Inouye, D-Hawaii)
– Ways and Means (H-Charles Rangel, D-N.Y.)
– Energy and Commerce (H-Waxman, D-Calif.)

“We are fully aware there are members of the public who would like us to provide a cost estimate of single payer,” said Merson, “but we are inundated with requests from committees of jurisdiction. The priorities are set for us by the Congress.”

Now single-payer activists, rallying behind Progressive Democrats of America and the California Nurses Association, are demanding the congressional leadership request a CBO analysis of single payer. Not projecting the costs is another way to marginalize the growing single-payer movement.

On the other hand, we do know the cost projections for the current proposal, the Affordable Choices Act, a hybrid concoction of private insurance and the so-called “public option” which funnels billions into private for-profit insurance companies. In a June 15th letter to Senator Kennedy, the primary sponsor of this legislative effort, Douglas Elmendorf, the director of the CBO, estimated the proposal would result in a trillion-dollar federal deficit over a 10-year period. And that amount could only be offset by increased taxes, payment penalties for the uninsured, and cuts in Medicaid — hardly the way toward health care for all.

Instead of taxpayer money paying for actual health care under the public option, most of it, according to the CBO letter, would pay insurance companies to pay for health care. To make matters worse, this subsidy to the insurance industry requires dramatic cuts in Medicare, a program that should be expanded, not curtailed.

But here’s the real kicker. At the end of the decade, in 2019, under a private insurance/public option proposal, 36 million Americans, as opposed to the current 45 million, would still be uninsured, according to the CBO.

Because the draft legislation includes an “individual responsibility” clause, anyone who couldn’t afford to pay for coverage could face steep fines. Much like mandated drivers’ insurance, this system would be a boon to private insurers reaping the benefits of the new law requiring everyone to get health coverage.

On top of that there would be more marginalization. Cancer patients who couldn’t get private insurance coverage on their own would be pushed onto the public rolls, thereby saddling taxpayers with having to subsidize insurance policies for the seriously ill.

In time, the public option, weighed down by this tax burden and unable to fully exercise bulk purchasing power, would collapse amidst a fiery congressional storm over the cost of the public option, thus legitimizing arguments that publicly funded health care is a failed idea.

Which begs the question, why is the health insurance industry pushing back if the public option would be such a bonanza? Is it because the insurance industry is scared of the unknown or is it because the industry would prefer to narrow the debate to two choices: the public option or business as usual?

I would argue the industry’s biggest fear is a frank and open discussion about the merits of single payer — a system that would put health insurers out of business. Hence, the insurance industry, in Academy-award winning style, paints the public option as the false bogeyman and bores in for the kill — the death of anything public.

Health Care for America Now (HCAN) television commercials pitching the public option urge Americans to embrace this hybrid solution — a moderate, reasoned approach –because others “would like the government to take over health care.” We know who those marginalized “others” are — the single payer advocates who can tell a snow job when they see one.

For those hoping the “public option” will be a vehicle for getting single payer, Health and Human Services Secretary Kathleen Sebelius recently set us straight.

From National Public Radio: “Asked if the administration’s program will be drafted specifically to prevent it from evolving into a single-payer plan, Sebelius says, ‘I think that’s very much the case and again, if you want anybody to convince people of that, talk to the single-payer proponents who are furious that the single-payer idea is not part of the discussion.'”

Fox News, the Republican Party, and the insurance industry charge the public option is an attempt to “socialize” health care.

Please.

Last time I checked we had publicly funded the fire department, police department, national parks, libraries, universities, and the highways of America. Though the government pays the bills for these services, fire departments are still free to purchase equipment made by private vendors; libraries purchase books from for-profit publishing houses. The same would be true under a single-payer system, which though funded by taxpayers would allow for individual choice: choose any doctor, hospital, lab, or clinic you wish. Ironically, a free-market approach in the delivery of health care.

So, let us not adopt the Republican Party’s talking points to marginalize the oracles; instead, we must marginalize those who make a killing off of health care.

If politicians in Washington pass a bill that precludes single payer on the federal level, so be it. If those same lawmakers, however, pass a bill that pre-empts the states from forming their own single-payer systems or multistate single-payer consortiums, then we’re in real trouble.

But we are not defeated. Losing patience with the congressional runaround, single-payer advocates are not just getting arrested in Washington, but also planning in-your-face actions in their districts.

“Wear your hospital gown and bring your gurney” protests in front of the Los Angeles office of Congressman Henry Waxman are planned for July 11th. Waxman, chair of the House Energy and Commerce Committee, was a previous co-sponsor of H.R. 676, Conyers’ bill for single payer, but has since reneged. A few weeks ago Waxman steadfastly refused to hold hearings on single payer, but that changed when Conyers called out Waxman publicly and single-payer activists crashed Waxman’s Health Care for America Now (HCAN) forum at UCLA on the public option. Since then, Waxman’s Energy and Commerce’s Subcommittee on Health held hearings with single- payer advocates, such as Congressman Conyers and representatives from Harvard Medical School and the Physicians for a National Health Program, testifying for a more comprehensive overhaul.

Politics, of course, is the art of compromise. So I call on Congressman Waxman — my former representative, Congresswoman Harman — my current representative and the one I am challenging in 2010, and Congressman Conyers — the sponsor of H.R. 676, to join forces to introduce a new health care bill that immediately enrolls every American in Medicare while allowing for those who prefer private insurance to opt out, pay their taxes, and cough up the added cost of boutique health care if they so choose.

One of the main reasons I am running for Congress is to get single-payer health care for all Americans. To push for it, I am running primetime cable ads round-the-clock on CNN and MSNBC, including spots on Keith Olbermann’s Countdown and the Rachel Maddow show, challenging my opponent, longtime incumbent Jane Harman (D-Calif.), to sign on to Congressman John Conyers’ bill, H.R. 676, for single payer.

Perhaps someone else, another primary candidate, will issue the same challenge in a different race, so that together, through district-targeted cable ads, we can amplify the message to not only put single payer on the table, but to make it the main course.

Marcy Winograd is a 2010 congressional candidate running to unseat Jane Harman in southern California’s 36th district, a 30-mile stretch that spans West Los Angeles to the harbor. For more on the campaign, visit www.winograd4congress.com or Marcy Winograd for Congress on Facebook.

http://www.laprogressive.com/2009/06/30/single-payers-crashing-the-gates/

Dr. Sidney Wolfe's Testimony before the House Committee on Energy and Commerce at Hearing on Health Insurance

June 24, 2009

Testimony of Sidney M. Wolfe MD
Acting President, Public Citizen and Director, Health Research Group at Public Citizen
Before the Subcommittee on Health
House Committee on Energy and Commerce
Hearing on Health Insurance

What if you picked up the morning paper tomorrow and saw the following headline: “50 People Died Yesterday Because they Lacked Health Insurance”? The next day, the same headline–and the next as well. This is the average number of people in the United States who, according to a 2004 report by the Institute of Medicine of the National Academy of Sciences, die each day–more than 18,000 a year–because they lack health insurance. How should we respond to this unacceptable and embarrassing finding?

Not by saying, as President Obama has said that if we were starting now from scratch, we would have a single-payer, but it’s too disruptive or, as the health insurance industry recently said, having the public option would be too “devastating”. What could be more disruptive and devastating than being one of 45+ million people who are uninsured, from whose ranks come 18,000 people who die each year because of this dangerous status?

The real question is why should we tolerate the fragmented, highly profitable, administratively wasting private health insurance industry any longer? In this regard, the public is way ahead of either President Obama or the Congress in its distrust of the health insurance industry.

A recent national Harris Poll (October, 2008) asked the following question: “Which of these industries do you think are generally honest and trustworthy — so that you normally believe a statement by a company in that industry?” Only one out of 14 people (7%) thought that the health insurance industry is honest and trustworthy. The only industries in the survey that were even more distrusted than the health insurance industry were HMO’s (7%), oil (4%) and tobacco (3%).

The Congress, on the other hand, trusts the health insurance industry and feels compelled to come up with a “solution” that avoids a big fight with them, not only writing them into the legislation but assuring further growth of that industry. The Congress wants to believe that the health insurance and pharmaceutical industries will be good citizens and voluntarily lower their prices to save some of the money that is necessary to fund health insurance. Several weeks ago, the collective forces of the health industry promised that they could voluntarily save two trillion dollars over the next 10 years

But the amount that can be saved over the next ten years by just eliminating the health insurance industry and the $400 billion of excessive administrative costs it causes each year is $4 trillion, in one fell swoop. This would be enough to finance health care for all without the additional revenues the Congress and the Administration is desperately seeking.

As an example of administrative waste, over the last 30 plus years there have been maybe two and a half, three times more doctors and nurses, in proportion with the growth in population. But over the same interval, there are 30 times more health administrators. These people are not doctors. They’re not nurses. They’re not pharmacists. They’re not providing care. Many of them are being paid to deny care. So, they are fighting with the doctors, with the hospitals to see how few bills can be paid. That’s how the insurance industry thrives by denying care, paying as little out as it can, getting the healthiest patients.

There is no question that we have a fragmented health insurance industry. And it thrives on being fragmented, avoiding any kind of serious centralized examination or control. The drug companies make much more money with this insurance fragmentation, because there’s no price control. The insurance companies make much more money because they can push away people who aren’t going to be profitable, let public programs take care of these patients who are “unprofitable”.

What the President and the Congress are really, realistically advocating–since there is absolutely no possibility of having enough money to cover all people in this country as long as the private, for-profit health insurance industry is allowed to exist –is more incremental reform, not National Health Insurance. It is now 44 years since Medicare and Medicaid came into existence. In the interim, there have been many experiments in this country and abroad to try to provide universal health coverage.

Other countries have uniformly rejected the private for-profit insurance industry and have adopted National Health Insurance. Is everyone else wrong and only the US is right?

A recent study by the international OECD (Organisation for Economic Co-operation and Development)[1] provided health insurance data from its 30 member countries (Europe, Korea, Japan, Mexico, Canada, the U.S. and others including Australia, New Zealand and Iceland). The latest data from those countries showed that 27 of the 30 had health insurance coverage for more than 96% of the population, with only Germany having any non-public coverage (10.3%). The other three were Mexico with 60.4% covered–all with public coverage, Turkey, with 67.2% covered, also with public coverage and the U.S. with 84.9% covered 57.5% with private and 27.4% with public coverage.

In Canada, back in 1970, they were spending the same percentage of their gross national product as we were on health. They also had millions of uninsured people and many of the same insurance companies such as Blue Cross, Blue Shield. They decided to just get rid of the health insurance industry. They had experimented with it in Saskatchewan ten years earlier and it had worked so well, they couldn’t wait to do it nationally. So, where there’s a will, there’s a way. There is no way we are ever going to get to having good health insurance for everyone, as long as there’s a health insurance industry, in the way, obstructing care.

Other more recent experiments abroad include Taiwan. In 1995, Taiwan had said, we don’t like the fact that 40 percent of our people are uninsured. They passed, essentially, single-payer plan and within a few years 90-95 percent of the people were covered.

In the U.S. we have had experiments as well with seven states having instituted various versions of the public/private combination that this legislation seeks to provide. In none of these states has this worked, once several years had elapsed, despite initial enthusiasm and short-lived decreases in the uninsured.

So as we consider what to do, which experiments do we follow? The ones that were successful, all of which, for all practical purposes eliminated the private for-profit insurance industry, or the failed U.S. state examples, all of which were built on this industry?

If instead of saying that a single payer program is not politically possible, the President and the Congress need to say, “It is not only politically possible, politically feasible, but it’s the only practical way national health insurance will ever happen. Anything short of that is essentially throwing tens of billions of dollars at the insurance industry. And if you’re afraid of the insurance industry, than you’re afraid of doing the right thing: Having everybody in, and nobody out of having health insurance.

[1]OECD Health Working Papers: Measuring Disparities in Health Status and Access and Use of Health Care in OECD Countries. 3/9/09

http://www.citizen.org/publications/release.cfm?ID=7672

Dr. Sidney Wolfe’s Testimony before the House Committee on Energy and Commerce at Hearing on Health Insurance

June 24, 2009

Testimony of Sidney M. Wolfe MD
Acting President, Public Citizen and Director, Health Research Group at Public Citizen
Before the Subcommittee on Health
House Committee on Energy and Commerce
Hearing on Health Insurance

What if you picked up the morning paper tomorrow and saw the following headline: “50 People Died Yesterday Because they Lacked Health Insurance”? The next day, the same headline–and the next as well. This is the average number of people in the United States who, according to a 2004 report by the Institute of Medicine of the National Academy of Sciences, die each day–more than 18,000 a year–because they lack health insurance. How should we respond to this unacceptable and embarrassing finding?

Not by saying, as President Obama has said that if we were starting now from scratch, we would have a single-payer, but it’s too disruptive or, as the health insurance industry recently said, having the public option would be too “devastating”. What could be more disruptive and devastating than being one of 45+ million people who are uninsured, from whose ranks come 18,000 people who die each year because of this dangerous status?

The real question is why should we tolerate the fragmented, highly profitable, administratively wasting private health insurance industry any longer? In this regard, the public is way ahead of either President Obama or the Congress in its distrust of the health insurance industry.

A recent national Harris Poll (October, 2008) asked the following question: “Which of these industries do you think are generally honest and trustworthy — so that you normally believe a statement by a company in that industry?” Only one out of 14 people (7%) thought that the health insurance industry is honest and trustworthy. The only industries in the survey that were even more distrusted than the health insurance industry were HMO’s (7%), oil (4%) and tobacco (3%).

The Congress, on the other hand, trusts the health insurance industry and feels compelled to come up with a “solution” that avoids a big fight with them, not only writing them into the legislation but assuring further growth of that industry. The Congress wants to believe that the health insurance and pharmaceutical industries will be good citizens and voluntarily lower their prices to save some of the money that is necessary to fund health insurance. Several weeks ago, the collective forces of the health industry promised that they could voluntarily save two trillion dollars over the next 10 years

But the amount that can be saved over the next ten years by just eliminating the health insurance industry and the $400 billion of excessive administrative costs it causes each year is $4 trillion, in one fell swoop. This would be enough to finance health care for all without the additional revenues the Congress and the Administration is desperately seeking.

As an example of administrative waste, over the last 30 plus years there have been maybe two and a half, three times more doctors and nurses, in proportion with the growth in population. But over the same interval, there are 30 times more health administrators. These people are not doctors. They’re not nurses. They’re not pharmacists. They’re not providing care. Many of them are being paid to deny care. So, they are fighting with the doctors, with the hospitals to see how few bills can be paid. That’s how the insurance industry thrives by denying care, paying as little out as it can, getting the healthiest patients.

There is no question that we have a fragmented health insurance industry. And it thrives on being fragmented, avoiding any kind of serious centralized examination or control. The drug companies make much more money with this insurance fragmentation, because there’s no price control. The insurance companies make much more money because they can push away people who aren’t going to be profitable, let public programs take care of these patients who are “unprofitable”.

What the President and the Congress are really, realistically advocating–since there is absolutely no possibility of having enough money to cover all people in this country as long as the private, for-profit health insurance industry is allowed to exist –is more incremental reform, not National Health Insurance. It is now 44 years since Medicare and Medicaid came into existence. In the interim, there have been many experiments in this country and abroad to try to provide universal health coverage.

Other countries have uniformly rejected the private for-profit insurance industry and have adopted National Health Insurance. Is everyone else wrong and only the US is right?

A recent study by the international OECD (Organisation for Economic Co-operation and Development)[1] provided health insurance data from its 30 member countries (Europe, Korea, Japan, Mexico, Canada, the U.S. and others including Australia, New Zealand and Iceland). The latest data from those countries showed that 27 of the 30 had health insurance coverage for more than 96% of the population, with only Germany having any non-public coverage (10.3%). The other three were Mexico with 60.4% covered–all with public coverage, Turkey, with 67.2% covered, also with public coverage and the U.S. with 84.9% covered 57.5% with private and 27.4% with public coverage.

In Canada, back in 1970, they were spending the same percentage of their gross national product as we were on health. They also had millions of uninsured people and many of the same insurance companies such as Blue Cross, Blue Shield. They decided to just get rid of the health insurance industry. They had experimented with it in Saskatchewan ten years earlier and it had worked so well, they couldn’t wait to do it nationally. So, where there’s a will, there’s a way. There is no way we are ever going to get to having good health insurance for everyone, as long as there’s a health insurance industry, in the way, obstructing care.

Other more recent experiments abroad include Taiwan. In 1995, Taiwan had said, we don’t like the fact that 40 percent of our people are uninsured. They passed, essentially, single-payer plan and within a few years 90-95 percent of the people were covered.

In the U.S. we have had experiments as well with seven states having instituted various versions of the public/private combination that this legislation seeks to provide. In none of these states has this worked, once several years had elapsed, despite initial enthusiasm and short-lived decreases in the uninsured.

So as we consider what to do, which experiments do we follow? The ones that were successful, all of which, for all practical purposes eliminated the private for-profit insurance industry, or the failed U.S. state examples, all of which were built on this industry?

If instead of saying that a single payer program is not politically possible, the President and the Congress need to say, “It is not only politically possible, politically feasible, but it’s the only practical way national health insurance will ever happen. Anything short of that is essentially throwing tens of billions of dollars at the insurance industry. And if you’re afraid of the insurance industry, than you’re afraid of doing the right thing: Having everybody in, and nobody out of having health insurance.

[1]OECD Health Working Papers: Measuring Disparities in Health Status and Access and Use of Health Care in OECD Countries. 3/9/09

http://www.citizen.org/publications/release.cfm?ID=7672

Medicare: Made In America

Rally and Lobby Day

Thursday, July 30th, 2009 | Washington, DC

Celebrate Medicare’s 44th Birthday by showing Congress and President Obama that unions, doctors, nurses, seniors, faith groups, and Americans of every stripe support national, single-payer healthcare.

The best way to save this system is to expand it and make it a truly single-payer system by removing the for-profit interests and guaranteeing healthcare as a right for all.

We’ll also be celebrating Rep. John Conyers, Jr. (D-MI) and his leadership on improving and expanding Medicare for all (HR 676).

Click here to download the flyer for this event

On Eve of Healthcare Rallies, Forums

Nurses, Progressive Democrats Seek Stepped Up Action for Real 'Robust' Reform--Single-payer, Medicare for All, as Best Solution to Crisis

For immediate release:

June 24, 2009
For more information contact:

Tim Carpenter, PDA Executive Director
Tim@pdamerica.org

Charles Idelson, CNA/NNOC Communications Director

WASHINGTON, DC–With action heating up in Washington for enactment of comprehensive healthcare reform, the nation’s largest RN union and professional association joined with progressive Democratic Party activists today in calling for the most “robust” reform of all to repair the nation’s healthcare crisis, by enacting a single-payer system in the form of expanded and updated Medicare for all.

In a joint statement, the National Nurses Organizing Committee/California Nurses Association and Progressive Democrats of America announced they are stepping up calls and other lobbying efforts to urge Congressional leaders to include discussion of the single-payer option in upcoming deliberations on the healthcare reform legislation now advancing in Congress.

As President Obama holds several public healthcare events, major committees in Congress unveiling legislation, and some liberal constituency groups set to rally in Washington Thursday, NNOC/CNA and PDA said that a single-payer/Medicare for all approach is “the best way to achieve goals of universality, effective cost controls, and improving the quality of care for all Americans.”

All other proposals, the groups said, suffer the same limitations. They:

* Leave the insurance industry, with its emphasis on generating profits and revenues rather than providing care, in control of our health.
* Fail to assure financial security of American families by not cracking down on insurance pricing practices.
* Avoid the strongest cost controls that are achieved in a single-payer system with one shared risk pool that covers everyone, eliminates the administrative waste associated with private insurers, and uses the power of the public entity to negotiate lower costs.
• Does not protect choice of doctor, hospital and other providers, as occurs in a single-payer system, because insurers can still limit choice to their own approved network of doctors and providers.

Even the public option favored by the President and leading Democrats would not achieve these goals, said NNOC/CNA and PDA. Private insurers would still be able to cherry pick healthier patients through their aggressive marketing techniques, with sicker patients likely being dumped into the public plan. The result is the public plan would face higher costs and the likelihood of having to cut or ration services to stay financially afloat.

PDA and NNOC/CNA are asking people to continue to call Congress and the White House to insist that single-payer healthcare, and the single-payer bills in Congress, HR 676 in the House and S 703 in the Senate, be given equal consideration in the legislative review process this summer.

The two organizations have worked together since early last year on a variety of healthcare projects, including passing an amendment to the Democratic National Party platform in “support of guaranteed health care for all” at the national convention in Denver, campaigns on behalf of single-payer candidates across the country in the fall, and rallies and forums in cities throughout the U.S.

“The time is ripe for real reform–for our personal well-being and for the sake of our great nation–now is the time to institute a real healthcare system instead of tweaking the patchwork of corporate non-care that now envelopes us,” said /CNA Co-President Geri Jenkins, RN.

Jenkins attended the ABC White House Town Hall meeting with President Obama on healthcare reform last night, along with Patty Eakin, RN, President of the Pennsylvania Association of Staff Nurses and Allied Professionals and a NNOC/CNA Board member.

“As long as a profit-motive is the centerpiece of our system, as it is and will be with healthcare corporations calling the shots, we entertain no notion that a public option will be the fix that so many Americans desperately need and want,” Jenkins said. “Medicare-for-all is the only solution to what ails us.”

“Regardless of the claims that the majority of people want a “public option,” what most people really want is a system of healthcare that covers everybody, and they believe the government can do a better job of it than the healthcare corporations can. It’s time for Congress to stop nibbling around the edges of reform and provide real leadership toward enacting healthcare reform for the people, instead of yet another windfall for wealthy corporations,” said Tim Carpenter national director of PDA.

The Healthcare NOT Warfare campaign presses forward with a “Week of Action for Medicare-for-All–H.R. 676.” Participating organizations will make calls to Congress asking representatives to provide leadership in the healthcare debate. On July 30, the 44th anniversary of Medicare will be celebrated with a rally and lobby day in Washington DC.

Does US Chamber soft talk hide their agenda?

Checking In With James Gelfand, U.S. Chamber of Commerce

By Jenny Gold
Kaiser Health News
July 1, 2009
The Chamber of Commerce is not mincing words. The senior manager of health policy for the Chamber, James P. Gelfand, says: “The problem is instead of focusing on the 90% of issues that everyone can agree on, we’re getting stuck on the 10% ideological, uncompromisable, unworkable provisions… like creating a government-run insurance plan, forcing employers to provide health insurance. That’s the kind of stuff that reads like a poison pill.”
Q: In congressional testimony, the Chamber’s senior vice president Randel Johnson said the [employer mandate] pay-or-play proposal “holds a Sword of Damocles over the necks of America’s job creators.” Do you believe it represents that kind of threat?
A: You [have to] pare this down to the simplest form — what does this employer mandate do? It makes people who don’t make a lot of money worth less to their employers. Say to yourself, I want to hire someone. I want them to do a simple task. It’s probably worth about $7 an hour. And then you realize, oh wait, because of a new law, I’m going to have to provide gold-plated health insurance. So instead of $7 an hour, it’s going to be more like $20 an hour. Let me tell you something, that person is not getting a job. So we’re just trying to make Congress understand this is a bad, bad policy. It’s gonna hurt the people they want to help.
Q: Many people say the plans on the table right now help lower income people the most. Why does the employer mandate hurt those people who are unable to get insurance?
A: Let’s look at the plan as a whole and what it’s going to do for people who don’t make a whole lot of money. If they’re lucky enough to keep their jobs, which many of them will not be — in fact, a model developed by the president’s own chair of the Council of Economic Advisers found that 4.7 million jobs would be lost based on this employer mandate — well, their benefits are going to be taxed. We’re going to tax them when they buy Coca-Cola. We’re gonna tax them when they buy alcohol. We’re going to force them, if they have a small health plan that they can afford and that appeals to them, to buy a big, rich, expensive health plan. Yeah, I think they’re getting the shaft here.
Q: So far, advertising on health care has been fairly restrained. At what point is it time to ramp up opposition? And what might it look like?
A: You don’t start a battle with nuclear weapons. First thing we’re going to do is try to work inside the system, try to work especially with Sen. Baucus to fix this thing. We don’t want to launch nukes. We don’t want to have a war. We want to support legislation. What will happen at the end of the day? Will Charlie Rangel work with us? I don’t know. I can tell you that at the hearing, he specifically, clearly said, we need the Chamber to get this done. He’s right. And I think as Congress slowly comes to the realization, oh wait, we can’t jam this down America’s throat, we can’t roll employers, we can’t roll the U.S. Chamber, I think the process is going to improve, and hopefully we won’t have to do any of these war tactics of buying air time and stuff like that. Just keep in mind, though, that we could if we had to. We have a massive grassroots network. We put out one e-mail asking people to write letters to Congress about the employer mandate and about the public plan, and we generate somewhere around 50,000 letters to Congress. So I think Congress is realizing that it’s gonna be trouble if they try to roll us.
We really do need reform, and I’m sorry that things have gotten to the point where we’re having to beat up on members of Congress who are proposing wacky schemes instead of pragmatic legislation.
http://www.kaiserhealthnews.org/Checking-In-With/Gelfand.aspx
Wal-Mart, SEIU, CAP letter to President Obama:
http://www.kaiserhealthnews.org/Daily-Reports/2009/June/30/~/media/Images/KHN%20Features/2009/June/30/CAPwalmartSEIU.ashx

“So I think Congress is realizing that it’s gonna be trouble if they try to roll us,” and “I’m sorry that things have gotten to the point where we’re having to beat up on members of Congress.” Was this guy nurtured on “The Sopranos,” or is he the real thing?
Regardless, are the owners of America’s businesses really as heartless as this jerk implies? Do they really believe that their workers would be “getting the shaft” by having health insurance with adequate benefits?
Even Wal-Mart can’t stomach this anymore. In a letter to President Obama yesterday, they stated, “We are for shared responsibility. Not every business can make the same contribution, but everyone must make some contribution. We are for an employer mandate which is fair and broad in its coverage, but any alternative to an employer mandate should not create barriers to hiring entry level employees. We look forward to working with the Administration and Congress to develop a requirement that is both sensible and equitable.”
Employer-mandated insurance is a primitive, inefficient and inequitable method of financing health care. Maybe Wal-Mart and the other business interests are ready to consider a model that is fair for all, efficient, and really does ensure that everyone has affordable access to health care. And if they walk away from the U.S. Chamber of Commerce, they will find advocates that can show them that they don’t even have to break any kneecaps to achieve that.

Does US Chamber soft talk hide their agenda?

Checking In With James Gelfand, U.S. Chamber of Commerce

By Jenny Gold
Kaiser Health News
July 1, 2009

The Chamber of Commerce is not mincing words. The senior manager of health policy for the Chamber, James P. Gelfand, says: “The problem is instead of focusing on the 90% of issues that everyone can agree on, we’re getting stuck on the 10% ideological, uncompromisable, unworkable provisions… like creating a government-run insurance plan, forcing employers to provide health insurance. That’s the kind of stuff that reads like a poison pill.”

Q: In congressional testimony, the Chamber’s senior vice president Randel Johnson said the [employer mandate] pay-or-play proposal “holds a Sword of Damocles over the necks of America’s job creators.” Do you believe it represents that kind of threat?

A: You [have to] pare this down to the simplest form — what does this employer mandate do? It makes people who don’t make a lot of money worth less to their employers. Say to yourself, I want to hire someone. I want them to do a simple task. It’s probably worth about $7 an hour. And then you realize, oh wait, because of a new law, I’m going to have to provide gold-plated health insurance. So instead of $7 an hour, it’s going to be more like $20 an hour. Let me tell you something, that person is not getting a job. So we’re just trying to make Congress understand this is a bad, bad policy. It’s gonna hurt the people they want to help.

Q: Many people say the plans on the table right now help lower income people the most. Why does the employer mandate hurt those people who are unable to get insurance?

A: Let’s look at the plan as a whole and what it’s going to do for people who don’t make a whole lot of money. If they’re lucky enough to keep their jobs, which many of them will not be — in fact, a model developed by the president’s own chair of the Council of Economic Advisers found that 4.7 million jobs would be lost based on this employer mandate — well, their benefits are going to be taxed. We’re going to tax them when they buy Coca-Cola. We’re gonna tax them when they buy alcohol. We’re going to force them, if they have a small health plan that they can afford and that appeals to them, to buy a big, rich, expensive health plan. Yeah, I think they’re getting the shaft here.

Q: So far, advertising on health care has been fairly restrained. At what point is it time to ramp up opposition? And what might it look like?

A: You don’t start a battle with nuclear weapons. First thing we’re going to do is try to work inside the system, try to work especially with Sen. Baucus to fix this thing. We don’t want to launch nukes. We don’t want to have a war. We want to support legislation. What will happen at the end of the day? Will Charlie Rangel work with us? I don’t know. I can tell you that at the hearing, he specifically, clearly said, we need the Chamber to get this done. He’s right. And I think as Congress slowly comes to the realization, oh wait, we can’t jam this down America’s throat, we can’t roll employers, we can’t roll the U.S. Chamber, I think the process is going to improve, and hopefully we won’t have to do any of these war tactics of buying air time and stuff like that. Just keep in mind, though, that we could if we had to. We have a massive grassroots network. We put out one e-mail asking people to write letters to Congress about the employer mandate and about the public plan, and we generate somewhere around 50,000 letters to Congress. So I think Congress is realizing that it’s gonna be trouble if they try to roll us.

We really do need reform, and I’m sorry that things have gotten to the point where we’re having to beat up on members of Congress who are proposing wacky schemes instead of pragmatic legislation.

http://www.kaiserhealthnews.org/Checking-In-With/Gelfand.aspx

Wal-Mart, SEIU, CAP letter to President Obama:
http://www.kaiserhealthnews.org/Daily-Reports/2009/June/30/~/media/Images/KHN%20Features/2009/June/30/CAPwalmartSEIU.ashx

Comment:

By Don McCanne, MD

“So I think Congress is realizing that it’s gonna be trouble if they try to roll us,” and “I’m sorry that things have gotten to the point where we’re having to beat up on members of Congress.” Was this guy nurtured on “The Sopranos,” or is he the real thing?

Regardless, are the owners of America’s businesses really as heartless as this jerk implies? Do they really believe that their workers would be “getting the shaft” by having health insurance with adequate benefits?

Even Wal-Mart can’t stomach this anymore. In a letter to President Obama yesterday, they stated, “We are for shared responsibility. Not every business can make the same contribution, but everyone must make some contribution. We are for an employer mandate which is fair and broad in its coverage, but any alternative to an employer mandate should not create barriers to hiring entry level employees. We look forward to working with the Administration and Congress to develop a requirement that is both sensible and equitable.”

Employer-mandated insurance is a primitive, inefficient and inequitable method of financing health care. Maybe Wal-Mart and the other business interests are ready to consider a model that is fair for all, efficient, and really does ensure that everyone has affordable access to health care. And if they walk away from the U.S. Chamber of Commerce, they will find advocates that can show them that they don’t even have to break any kneecaps to achieve that.