PNHP

Are you one big illness away from bankruptcy?

Are you one big illness away from bankruptcy?

By Dean Calbreath
San Diego Union-Tribune
June 14, 2009

“The greatest health is wealth,” the classical Roman poet Virgil once said.

But to keep your health can cost you your wealth. In fact, it can drive you into bankruptcy.

A survey this month showed that in 2007, on the eve of the current recession, roughly two-thirds of bankruptcies in the United States involved people who were driven into insolvency because they could not keep up with their medical bills.

Although health care has been eclipsed by overdue mortgages and credit card debt as the primary cause of bankruptcy, it remains a potent driver of debt. And once the current wave of foreclosures abates, it could quickly regain its No. 1 status in the bankruptcy courts, unless something is done to fix the medical system first.

“Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy,” said David Himmelstein, an associate professor of medicine at Harvard.

“For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments and deductibles that illness can put you in the poorhouse,” Himmelstein said.

The study by Himmelstein and a team of researchers at Harvard Law School, Harvard Medical School and Ohio University shows that 62 percent of bankruptcies in 2007 were at least partly caused by problems involving health care. That’s up from 55 percent in 2001.

More than three-quarters of the people who were bankrupted for medical reasons had health insurance at the start of the “bankrupting illness,” according to the study, which will be published in The American Journal of Medicine in August. Most of them “were solidly middle class before financial disaster hit.” Two-thirds were homeowners, and three-fifths had gone to college.

“In many cases, high medical bills coincided with a loss of income as illness forced breadwinners to lose time from work,” the study reported. “Often illness led to job loss, and with it the loss of health insurance.”

Even filers who retained their insurance often faced high out-of-pocket medical costs, because of co-payments, deductibles and services that the insurers declined to cover.

Among the health-related bankruptcy cases, the medical debt averaged $17,749 for filers who retained their insurers; $22,568 for filers who initially had insurance coverage but lost it through the course of their illness; and $26,971 for the uninsured.

Hospital bills were the largest single expense for about half of all medically bankrupt families, according to the survey. Prescription drugs were the largest expense for 19 percent of those families.

Of course, if the Harvard researchers were to examine bankruptcy filings today, the results would be much different. These days, bankruptcy courts are crowded with real estate brokers, speculators and home-equity borrowers. But health care cases continue to show up in the bankruptcy system.

“Mortgage problems, job losses, credit card debt and health care bills can all be a part of the economic stew in a bankruptcy filing,” said Barry Lander, clerk at the U.S. Bankruptcy Court in San Diego. “Sometimes a person can handle two or three problems but not all at once, so that if you’re unemployed or facing credit card debt and then get sick, it can push you over the edge.”

Len Ackerman, who heads American Debt Relief, a law firm in downtown San Diego, said one of his clients was pushed into bankruptcy because of her bills from fighting a series of health-related problems. She was already in debt from treatment for diabetes and high blood pressure when she was diagnosed with breast cancer this spring.

“We had to postpone her bankruptcy filing because she was in surgery,” Ackerman said. “She’s been in the hospital for the past month.”

Mark Reed, a bankruptcy attorney in Kearny Mesa, tells of a client who filed for bankruptcy after incurring a couple hundred-thousand dollars in medical bills. Because of her medical problems, she could not find work. But because she was receiving spousal-support payments from her ex-husband, she was making too much money to qualify for government assistance.

“What I’ve seen is mostly people who don’t have insurance or people who have insurance but don’t have enough to cover their medical bills,” Reed said. He worries that the current rise in unemployment will lead to more health-related bankruptcies.

“A lot of people losing their jobs end up with no insurance,” Reed said. “Many can’t afford COBRA (a government-created program that allows laid-off workers to temporarily retain their former insurance at full cost). They end up paying for their health care on credit cards. A lot of the credit card bankruptcies we’re seeing these days include bills related to health care.”

A recent poll by the Deloitte Center for Health Solutions, part of the Deloitte LLP international consulting firm, shows that 94 percent of respondents believe health care costs are a threat to their personal financial security.

According to the poll, one of eight had serious problems paying or were unable to pay their medical bills. A similar percentage had to choose between paying for health care and paying for other essentials, such as food and rent. Nearly one household in four has a person who has postponed paying their medical bills by 90 days or more.

“The results of this study are conclusive: Consumers want better performance from their health care system,” said Paul Keckley, executive director of the Deloitte center.

“They think (the system) is wasteful, inefficient, complex and expensive,” Keckley said. “They want better value for the dollars they spend and believe fundamental changes are necessary to achieve these goals.”

These studies would seem to provide ammunition for forces in the White House and on Capitol Hill that are now pushing to reform the Medicare system.

But Steffie Woolhandler, a Harvard doctor who helped conduct the bankruptcy study, said that some of the proposed reforms – such as requiring uninsured people to pay for insurance or face a fine – might be worse than the current system.

Woolhandler notes that such a system, as currently envisioned, could include a monthly payment amounting to hundreds of dollars combined with deductions in the thousands of dollars – enough to push some patients into bankruptcy.

“With that kind of system, you may get the numbers of uninsured people down, but it won’t solve the affordability problems in health care,” she said.

Woolhandler, like many other members of the Harvard team, advocates a Canada-style single-payer system. That idea has not gained much traction on Capitol Hill, although Congress has recently begun discussing the idea.

Just last week, at a House subcommittee hearing on health affairs, San Diego registered nurse Geri Jenkins, co-president of the California Nurses Association/National Nurses Organizing Committee, was on a panel of speakers testifying on behalf of a single-payer system.

Regardless of what form the health care reform eventually takes, the Harvard study should inspire Congress to craft a program that will mean fewer people have to imperil their wealth in order to save their health.

http://www3.signonsandiego.com/stories/2009/jun/14/1b14dean211442-are-you-one-big-illness-away-bankru/

Insurance interests total 1/4 of Baucus' fundraising

By Mike Dennison
The Montana Standard
06/14/2009

HELENA — As Sen. Max Baucus has taken the lead on health-reform legislation in the U.S. Senate, he’s also become a leader in something else: Campaign money received from health- and insurance-industry interests.

In the past six years, nearly one-fourth of every dime raised by Baucus, D-Mont., and his political-action committee has come from groups and individuals associated with drug companies, insurers, hospitals, medical-supply firms, health-service companies and other health professionals.

These donations total about $3.4 million, or $1,500 a day, every day, from January 2003 through 2008.

Baucus, who chairs the Senate Finance Committee that is drafting a major health-care reform bill this month, insists this cavalcade of money is not unduly influencing his work.

“No matter the issue, Max always puts Montana first,” said his spokesman, Ty Matsdorf. “Max will continue to do what’s right for our state, and groups like SEIU (a union representing thousands of health-care workers) and AARP (a senior citizens’ group) wouldn’t line up in support of his health-care reform effort if this wasn’t true.” Baucus’ office also lists numerous examples of how his proposed reforms are challenging the health-care and insurance industries, such as requiring insurers to accept all customers, regardless of health condition.

Yet some reform activists and others who watch the political system say it’s foolish to think this money doesn’t hold some sway.

“When you spend so much of your time raising money, as members of Congress do, from those who have a compelling interest in the outcome of legislation, it has to change what you think about it, and the viewpoints that you have,” says David Donnelly, director of Campaign Money Watch, a Washington, D.C., group that tracks money in politics. “It’s just human nature. … and members of Congress are human.” Advocates of national, public health insurance for all — a proposal largely excluded from the health-reform debate — say their exclusion points to the power of moneyed interests in Congress.

“I’m convinced that this (money) has a profound influence,” says Quentin Young, national coordinator for Physicians for a National Health Program. “Otherwise, how could Baucus, an otherwise respected and wise politician, say categorically that single-payer (national health insurance) is off the table?” Since 2003, perhaps no other member of Congress has received more money from health and insurance interests than Baucus. Only his Republican counterpart on the Finance Committee, Sen. Charles Grassley of Iowa, rivals him in terms of percentage of funds from these business sectors.

The Lee Newspapers State Bureau examined fundraising data for Baucus, Grassley, Sen. Ted Kennedy (who chairs the Senate Health Committee, which is drafting health-reform legislation), the other two members of Montana’s congressional delegation, and President Barack Obama.

The data are compiled by the Center for Responsive Politics, a nonprofit group that tracks and sorts campaign donors by profession and industry. Here’s a summary of what the State Bureau discovered:

* From 2003-2008, the Baucus campaign and his Glacier PAC, which raises money and distributes it to other candidates, received 23 percent of their $14.8 million from health-care and insurance interests.

The $3.4 million from these sectors includes $853,000 from pharmaceutical and health-products, $851,000 from health professionals; $467,000 from hospitals and nursing homes, $466,000 from health-service and HMO interests, and $784,000 from insurance.

The insurance-sector money includes donations from all types of insurance-company interests, including health insurance.

* Five of the top 10 specific donor sources for Baucus were drug companies, health insurers or health-related firms. For example, employees of Schering-Plough Corp., a major drug firm, gave him $92,000 over the period, more than any other single source.

* Grassley, the highest-ranking Republican on the Finance Committee, received 23.5 percent of his funds from health and insurance interests, but a lesser dollar amount than Baucus ($2.3 million out of $9.8 million total funds).

* Sen. Kennedy, D-Mass, a longtime advocate of health-care reforms, received only 7.5 percent of his funds from health and insurance interests, or about $1.2 million.

* Sen. Jon Tester, D-Mont., and Rep. Denny Rehberg, R-Mont., had minimal contributions from the health and insurance sectors.

* President Obama, whose campaign raised a whopping $745 million in 2007 and 2008, received a relatively small share from health-care interests ($19 million, or 2.5 percent) and insurance interests ($2 million, or 0.3 percent).

Baucus has been leading the charge on health-care reform in the U.S. Senate since early 2008, holding numerous hearings and Finance Committee meetings on the issue. He released a lengthy “white paper” last November, outlining his reform ideas, and a major bill is expected to be introduced this month.

The general thrust of his proposals is to require all citizens to buy health insurance, while also forcing the private insurance industry to stop practices that make coverage unaffordable for many. He supports subsidies to those who may have trouble affording insurance.

However, on a reform bitterly opposed by the insurance industry and most health-care interests — a public, nonprofit insurance plan offered by the government — Baucus has been more ambivalent, saying he supports the idea, but declining to say in what form.

Baucus’s office supplied nearly 20 examples of stances he’s taken in direct opposition to drug, insurance and banking interests that have donated to his campaign funds.

For example, he has supported importing lower-cost prescription drugs from Canada, allowing the government to negotiate for lower drug prices for Medicare recipients, funding research that would show when generic drugs are a better deal than brand-name drugs and reducing Medicare payments to private insurers by $13 billion over five years.

His office also points to an April 2007 Wall Street Journal article in which Baucus was quoted as telling medical-industry contributors at a fundraiser that “You should worry about me coming after you.” Donnelly, the Campaign Money Watch director, says the proof on health-care reform will be in the final product — and that he’s not terribly optimistic.

Health and insurance interests are clearly targeting Baucus and his Finance Committee, which often have shown themselves to be receptive to their influence, he says.

“This debate on health care is a microcosm … that even after a ‘change’ election, how much the special interests view (Washington) as their fiefdom,” Donnelly says.

Supporters of national health insurance are even less optimistic, noting how Baucus, President Obama and leaders in Congress won’t even consider their proposal, which they believe would have broad public support.

“I can’t think of any reason other than fidelity to your donors, to explain why they would keep us out of the debate,” says Dr. Young of the physicians group. “Until we get campaign-finance reform, it will be very difficult to do anything to challenge the status quo (in health care), and the status quo had better be challenged, because it’s a very bad status quo.”

President Obama’s proposal to pay for reform

Paying for Health Care Reform

The White House
June 13, 2009

Health Care Reserve Fund ($ in billions – over 10 years)

$635 – FY 2010 Budget
$309 – Medicare and Medicaid Savings
$326 – Revenues

$313 – Additional Medicare and Medicaid Savings
$110 – Incorporate productivity adjustments into Medicare payment
$106 – Reduce hospital subsidies for treating the uninsured as coverage increases
$75 – Pay better prices for Medicare Part D drugs
$22 – Other

Total: $948

http://www.whitehouse.gov/MedicareFactSheetFinal/

Comment:

By Don McCanne, MD

What does President Obama mean when he says that this is how we’re going to pay for most of his health care reform proposals? Is he referring to savings in the actual costs of health care that would offset the increased spending that would result from expanding coverage? Or is he merely referring to a decrease in government spending that helps with government budgets, but doesn’t really have much impact on our total national health expenditures (NHE)?

Two-thirds of the proposed funding already appears in his FY 2010 budget. He would reduce overpayments to Medicare Advantage plans, reduce Medicare and Medicaid fraud (sure), reduce hospital readmissions (block the entrances?), and reduce Medicare hospital payments by measuring quality (hmmm). In this fact sheet, the only revenue increase mentioned is limiting the value of itemized deductions for families making over a quarter-million dollars a year, a proposal that has proven to be quite controversial.

The new proposals in this fact sheet include a reduction in spending based on improved productivity, extrapolating the improved productivity in the entire U.S. economy and applying it to health care (not exactly noted for assembly lines, displacing health care with information technology systems, etc.). It includes a reduction in payments to Disproportionate Share Hospitals (excess share of uninsured) which would be made possible by providing insurance to those currently uninsured. This is more of an accounting gimmick since it merely moves government spending from the hospitals to the insurance plans. Also proposed is a reduction in drug reimbursement for beneficiaries dually eligible for Medicare and Medicaid, a minute fraction of what could be saved by negotiating fair prices for all of us under a universal national health program.

Merely playing with numbers does not provide us with the comprehensive structural reform that we would need to accomplish our two primary goals: 1) health care for everyone, and 2) slowing health care cost escalation to sustainable levels. As long as the politicians can continue to distract us with cat fights over the public option, or whatever, we will never have what we really need: a new and improved Medicare for all.

Insurance interests total 1/4 of Baucus’ fundraising

By Mike Dennison
The Montana Standard
06/14/2009

HELENA — As Sen. Max Baucus has taken the lead on health-reform legislation in the U.S. Senate, he’s also become a leader in something else: Campaign money received from health- and insurance-industry interests.

In the past six years, nearly one-fourth of every dime raised by Baucus, D-Mont., and his political-action committee has come from groups and individuals associated with drug companies, insurers, hospitals, medical-supply firms, health-service companies and other health professionals.

These donations total about $3.4 million, or $1,500 a day, every day, from January 2003 through 2008.

Baucus, who chairs the Senate Finance Committee that is drafting a major health-care reform bill this month, insists this cavalcade of money is not unduly influencing his work.

“No matter the issue, Max always puts Montana first,” said his spokesman, Ty Matsdorf. “Max will continue to do what’s right for our state, and groups like SEIU (a union representing thousands of health-care workers) and AARP (a senior citizens’ group) wouldn’t line up in support of his health-care reform effort if this wasn’t true.” Baucus’ office also lists numerous examples of how his proposed reforms are challenging the health-care and insurance industries, such as requiring insurers to accept all customers, regardless of health condition.

Yet some reform activists and others who watch the political system say it’s foolish to think this money doesn’t hold some sway.

“When you spend so much of your time raising money, as members of Congress do, from those who have a compelling interest in the outcome of legislation, it has to change what you think about it, and the viewpoints that you have,” says David Donnelly, director of Campaign Money Watch, a Washington, D.C., group that tracks money in politics. “It’s just human nature. … and members of Congress are human.” Advocates of national, public health insurance for all — a proposal largely excluded from the health-reform debate — say their exclusion points to the power of moneyed interests in Congress.

“I’m convinced that this (money) has a profound influence,” says Quentin Young, national coordinator for Physicians for a National Health Program. “Otherwise, how could Baucus, an otherwise respected and wise politician, say categorically that single-payer (national health insurance) is off the table?” Since 2003, perhaps no other member of Congress has received more money from health and insurance interests than Baucus. Only his Republican counterpart on the Finance Committee, Sen. Charles Grassley of Iowa, rivals him in terms of percentage of funds from these business sectors.

The Lee Newspapers State Bureau examined fundraising data for Baucus, Grassley, Sen. Ted Kennedy (who chairs the Senate Health Committee, which is drafting health-reform legislation), the other two members of Montana’s congressional delegation, and President Barack Obama.

The data are compiled by the Center for Responsive Politics, a nonprofit group that tracks and sorts campaign donors by profession and industry. Here’s a summary of what the State Bureau discovered:

* From 2003-2008, the Baucus campaign and his Glacier PAC, which raises money and distributes it to other candidates, received 23 percent of their $14.8 million from health-care and insurance interests.

The $3.4 million from these sectors includes $853,000 from pharmaceutical and health-products, $851,000 from health professionals; $467,000 from hospitals and nursing homes, $466,000 from health-service and HMO interests, and $784,000 from insurance.

The insurance-sector money includes donations from all types of insurance-company interests, including health insurance.

* Five of the top 10 specific donor sources for Baucus were drug companies, health insurers or health-related firms. For example, employees of Schering-Plough Corp., a major drug firm, gave him $92,000 over the period, more than any other single source.

* Grassley, the highest-ranking Republican on the Finance Committee, received 23.5 percent of his funds from health and insurance interests, but a lesser dollar amount than Baucus ($2.3 million out of $9.8 million total funds).

* Sen. Kennedy, D-Mass, a longtime advocate of health-care reforms, received only 7.5 percent of his funds from health and insurance interests, or about $1.2 million.

* Sen. Jon Tester, D-Mont., and Rep. Denny Rehberg, R-Mont., had minimal contributions from the health and insurance sectors.

* President Obama, whose campaign raised a whopping $745 million in 2007 and 2008, received a relatively small share from health-care interests ($19 million, or 2.5 percent) and insurance interests ($2 million, or 0.3 percent).

Baucus has been leading the charge on health-care reform in the U.S. Senate since early 2008, holding numerous hearings and Finance Committee meetings on the issue. He released a lengthy “white paper” last November, outlining his reform ideas, and a major bill is expected to be introduced this month.

The general thrust of his proposals is to require all citizens to buy health insurance, while also forcing the private insurance industry to stop practices that make coverage unaffordable for many. He supports subsidies to those who may have trouble affording insurance.

However, on a reform bitterly opposed by the insurance industry and most health-care interests — a public, nonprofit insurance plan offered by the government — Baucus has been more ambivalent, saying he supports the idea, but declining to say in what form.

Baucus’s office supplied nearly 20 examples of stances he’s taken in direct opposition to drug, insurance and banking interests that have donated to his campaign funds.

For example, he has supported importing lower-cost prescription drugs from Canada, allowing the government to negotiate for lower drug prices for Medicare recipients, funding research that would show when generic drugs are a better deal than brand-name drugs and reducing Medicare payments to private insurers by $13 billion over five years.

His office also points to an April 2007 Wall Street Journal article in which Baucus was quoted as telling medical-industry contributors at a fundraiser that “You should worry about me coming after you.” Donnelly, the Campaign Money Watch director, says the proof on health-care reform will be in the final product — and that he’s not terribly optimistic.

Health and insurance interests are clearly targeting Baucus and his Finance Committee, which often have shown themselves to be receptive to their influence, he says.

“This debate on health care is a microcosm … that even after a ‘change’ election, how much the special interests view (Washington) as their fiefdom,” Donnelly says.

Supporters of national health insurance are even less optimistic, noting how Baucus, President Obama and leaders in Congress won’t even consider their proposal, which they believe would have broad public support.

“I can’t think of any reason other than fidelity to your donors, to explain why they would keep us out of the debate,” says Dr. Young of the physicians group. “Until we get campaign-finance reform, it will be very difficult to do anything to challenge the status quo (in health care), and the status quo had better be challenged, because it’s a very bad status quo.”

The view of those in the trenches supporting health care for all

Keynote: “Health Care Reform – What Has to Be Done”

By Don McCanne, M.D.
Health Care Council of Orange County
June 11, 2009
Annual Meeting
Opening questions directed to the audience:
How many here believe that it is probable – not certain, but probable – that Congress will pass health care reform and President Obama will sign it this year?
(Most individuals raised a hand)
How many believe that the legislation will provide insurance coverage to everyone or almost everyone?
(Not one hand went up)
How many believe that the legislation will be effective in slowing the rate of health care cost increases?
(Not one hand went up)
http://www.healthoc.com/

The Health Care Council of Orange County (California) has a mission of promoting access to improved health care for all Orange County residents through unified efforts to identify and address areas of need through research, collaboration, education and advocacy. The audience attending the annual meeting was composed of individuals who are quite well informed on the problems with our health care system, and they have been following the reform efforts taking place in Washington. Their opinions should matter to us.
For over half a century, the United States has struggled with a flawed health care financing system that leaves financial barriers in place for far too many of us. Most of the nation now agrees that something must be done to ensure that everyone has access to health care without having to face financial hardship or even bankruptcy.
But the goal of covering everyone has not been what has created the strong sense that health care is now facing a crisis. The concern that virtually everyone shares is that health care costs are no longer affordable. Too many individuals are no longer able to pay their insurance premiums, nor pay the out-of-pocket expenses not covered by insurance. Many businesses are no longer able to afford the costs of their employee health benefit programs. The federal and state governments are struggling with budget constraints aggravated by the high costs of public health programs.
Everyone agrees that it is critical that we do something now to slow the rate of increases in health care costs. While addressing costs, most of us also agree that we must bring everyone in under the umbrella of financial security when facing health care needs. Since neglect of these issues has created the crisis we face, you would think that Congress and the administration would be busy attempting to fix these problems.
Congress is busy all right. But no one at the Health Care Council has been fooled. We are going to end up with legislation that will be labeled “health reform,” but the twin crises of rising costs and inadequate insurance will still be with us. Congress and the President will walk away, pretending that they did something, and it will take years or decades of more suffering and hardship before our leaders revisit the problems and finally do the right thing.
Sheer madness!

The view of those in the trenches supporting health care for all

Keynote: "Health Care Reform - What Has to Be Done"

By Don McCanne, M.D.
Health Care Council of Orange County
June 11, 2009
Annual Meeting

Opening questions directed to the audience:

How many here believe that it is probable – not certain, but probable – that Congress will pass health care reform and President Obama will sign it this year?

(Most individuals raised a hand)

How many believe that the legislation will provide insurance coverage to everyone or almost everyone?

(Not one hand went up)

How many believe that the legislation will be effective in slowing the rate of health care cost increases?

(Not one hand went up)

http://www.healthoc.com/

Comment:

By Don McCanne, MD

The Health Care Council of Orange County (California) has a mission of promoting access to improved health care for all Orange County residents through unified efforts to identify and address areas of need through research, collaboration, education and advocacy. The audience attending the annual meeting was composed of individuals who are quite well informed on the problems with our health care system, and they have been following the reform efforts taking place in Washington. Their opinions should matter to us.

For over half a century, the United States has struggled with a flawed health care financing system that leaves financial barriers in place for far too many of us. Most of the nation now agrees that something must be done to ensure that everyone has access to health care without having to face financial hardship or even bankruptcy.

But the goal of covering everyone has not been what has created the strong sense that health care is now facing a crisis. The concern that virtually everyone shares is that health care costs are no longer affordable. Too many individuals are no longer able to pay their insurance premiums, nor pay the out-of-pocket expenses not covered by insurance. Many businesses are no longer able to afford the costs of their employee health benefit programs. The federal and state governments are struggling with budget constraints aggravated by the high costs of public health programs.

Everyone agrees that it is critical that we do something now to slow the rate of increases in health care costs. While addressing costs, most of us also agree that we must bring everyone in under the umbrella of financial security when facing health care needs. Since neglect of these issues has created the crisis we face, you would think that Congress and the administration would be busy attempting to fix these problems.

Congress is busy all right. But no one at the Health Care Council has been fooled. We are going to end up with legislation that will be labeled “health reform,” but the twin crises of rising costs and inadequate insurance will still be with us. Congress and the President will walk away, pretending that they did something, and it will take years or decades of more suffering and hardship before our leaders revisit the problems and finally do the right thing.

Sheer madness!

Single payer: bold, affordable, humane

[The following is the testimony of Dr. Walter Tsou to the House Subcommittee on Health, Employment, Labor and Pensions on June 10. The hearing was titled “Examining the single-payer health care option.”]

By Walter Tsou, M.D., M.P.H.

Congressman Andrews and members of the HELP subcommittee, my name is Dr. Walter Tsou. I am a public health physician and former Health Commissioner of Philadelphia.

If you believe that every American has the right to quality, affordable health care, then the only affordable means to achieve that goal is through a properly financed, single-payer national health insurance program.

Attempting to reconcile the dual imperatives of universal coverage and cost control through alternative methods besides single payer is an exercise in futility. It is clear that cost controls mean that someone’s ox gets gored, either the taxpayers’, physicians’ and hospitals’, or the private health insurance industry’s. When some Congressional leaders declare that “single payer is off the table,” they are, in effect, saying that insurers will be protected, leaving the pain to patients, taxpayers and health care providers.

Let’s examine each of these categories:

For the taxpayers, it is difficult to understand why we must endure an additional $1.5 trillion or more over the next decade in expenses at a time when our nation already spends 50 percent more per capita on health care than any other country in the world.

For physicians and hospitals, simply cutting reimbursements is counterproductive, especially at a time when we need to increase reimbursements for primary care and mental health services.

For the private insurance industry, they have dominated health care for the past 50 years, but it does not work. Despite a supposedly competitive marketplace, health care costs have skyrocketed, nearly 50 million are currently uninsured, and the quality of care for most Americans is “suboptimal,” in the words of the Agency for Healthcare Research and Quality. Choice is a total misnomer. Americans want to be able to choose their doctor and hospital, not their health plans.

A humane health care system should reinforce the safety net in the face of our nation’s worst recession since the Great Depression, but our profit-driven system kicks millions of Americans in the gut and leaves them both jobless and uninsured. We have saddled our nation with an inefficient and exorbitantly expensive health care system that drives jobs overseas where health benefit costs are low, and discourages entrepreneurs from striking out on their own for fear of losing their insurance coverage.

We need a far greater investment in community-based public health and preventive medicine, including home visitation for newborns and public health nurses doing chronic disease management in the community. But where will we get the funds?

Single payer is the only reform that can control health care costs. It does so by cutting insurance firms’ profits, streamlining the massive administrative apparatus that adds to the costs of hospital and doctors’ offices, using bulk purchasing, negotiating fee schedules with physicians, and putting hospitals on predictable, global budgets.

The $19 billion that has been set aside for health information technology is doomed to fail because it is dependent on a complex, fragmented health care financing system. In contrast, consider Taiwan, where everyone has a smart card. Your smart card carries your medical history and can be viewed by any doctor in Taiwan. Their national database allows them to identify the few outliers who try to abuse the system, rather than hassling millions of doctors and patients.

What the Internet has done to transform telecommunications across the world is what single payer will do to transform how we deliver health care in America. A national public health database would allow us to direct resources to areas of greatest need. We can change the incentives in reimbursement to advance our national health goals embodied in Healthy People 2020 and reward communities that help achieve those goals. This would encourage health professionals and hospitals to work together with local health departments to advance national health objectives.

President Obama has stated that if he were to start over again he would favor a single-payer system, but argues that moving to single payer is too radical.

Well, I come from Philadelphia where revolutionary ideas are celebrated not dismissed. Our most famous radical document begins with the words, “We the People,” not “We the Insurers.” “We the People of the United States, in order to form a more perfect union . . . to promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity do ordain and establish this Constitution for the United States of America.” This nation captured the world’s imagination with bold ideas that put the people first. It is time for our own generation’s revolution.

AMA and PNHP on public insurance

Doctors’ Group Opposes Public Insurance Plan

By Robert Pear
The New York Times
June 10, 2009
As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan, which President Obama and many other Democrats see as an essential element of legislation to remake the health care system.
… in comments submitted to the Senate Finance Committee, the American Medical Association said: “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”
The A.M.A., an umbrella group for 180 medical societies, does not speak for all doctors. One group, Physicians for a National Health Program, supports a single-payer system of insurance, in which a single public agency would pay for health services, but most care would still be delivered by private doctors and hospitals.
http://www.nytimes.com/2009/06/11/us/politics/11health.html?hp

In opposing a government-sponsored insurance plan, why would the AMA limit its objection to a public plan that would cover only non-disabled individuals under age 65? What about those over 65 and those with long-term disabilities? Of course, they are covered by Medicare, a plan that the AMA continues to lobby for, even though they were vehemently opposed to it before it was enacted.
We can only speculate as to why the AMA leadership would object to including everyone in an improved version of our very successful Medicare program. Some believe that the AMA House of Delegates is still dominated by right-wing reactionaries, as it was during the Medicare battles. A more likely explanation is that physicians, who are uniformly unhappy with both private and public insurance programs, may perceive a greater opportunity to bypass the third-party payers in the market of private sector plans that use high-deductibles, health savings accounts, and other payment innovations that would allow physicians to capture a greater portion of their often-unrealistic list fees.
Fortunately, many physicians believe that patients, all patients, are more important than wealth-creating opportunities. That’s what Physicians for a National Health Program is all about.

AMA and PNHP on public insurance

Doctors' Group Opposes Public Insurance Plan

By Robert Pear
The New York Times
June 10, 2009

As the health care debate heats up, the American Medical Association is letting Congress know that it will oppose creation of a government-sponsored insurance plan, which President Obama and many other Democrats see as an essential element of legislation to remake the health care system.

… in comments submitted to the Senate Finance Committee, the American Medical Association said: “The A.M.A. does not believe that creating a public health insurance option for non-disabled individuals under age 65 is the best way to expand health insurance coverage and lower costs. The introduction of a new public plan threatens to restrict patient choice by driving out private insurers, which currently provide coverage for nearly 70 percent of Americans.”

The A.M.A., an umbrella group for 180 medical societies, does not speak for all doctors. One group, Physicians for a National Health Program, supports a single-payer system of insurance, in which a single public agency would pay for health services, but most care would still be delivered by private doctors and hospitals.

http://www.nytimes.com/2009/06/11/us/politics/11health.html?hp

Comment:

By Don McCanne, MD

In opposing a government-sponsored insurance plan, why would the AMA limit its objection to a public plan that would cover only non-disabled individuals under age 65? What about those over 65 and those with long-term disabilities? Of course, they are covered by Medicare, a plan that the AMA continues to lobby for, even though they were vehemently opposed to it before it was enacted.

We can only speculate as to why the AMA leadership would object to including everyone in an improved version of our very successful Medicare program. Some believe that the AMA House of Delegates is still dominated by right-wing reactionaries, as it was during the Medicare battles. A more likely explanation is that physicians, who are uniformly unhappy with both private and public insurance programs, may perceive a greater opportunity to bypass the third-party payers in the market of private sector plans that use high-deductibles, health savings accounts, and other payment innovations that would allow physicians to capture a greater portion of their often-unrealistic list fees.

Fortunately, many physicians believe that patients, all patients, are more important than wealth-creating opportunities. That’s what Physicians for a National Health Program is all about.

House HELP Committee hearing on single payer

Examining the Single Payer Health Care Option

Health, Employment, Labor, and Pensions Subcommittee Hearing
U.S. House of Representatives
June 10, 2009
Marcia Angell, M.D.:
I want to mention one final and very important reason for enacting a nonprofit single-payer health program. We live in a country that tolerates enormous and growing disparities in income, material possessions, and social privilege. That may be an inevitable consequence of a free market economy. But those disparities should not extend to denying some of our citizens certain essential services because of their income or social status.
One of those services is health care. Others are education, clean water and air, equal justice, and protection from crime, all of which we already acknowledge are public responsibilities. We need to acknowledge the same thing for health care. Providing these essential services to all Americans, regardless of who they are, marks a decent and cohesive society. It says that when it comes to vital needs, we are one nation, not 300 million individuals competing with one another.
***
Walter Tsou, M.D., M.P.H.:
President Obama has stated that if he were to start over again he would favor a single-payer system, but argues that moving to single-payer is too radical.
Well, I come from Philadelphia where revolutionary ideas are celebrated not dismissed. Our most famous radical document begins with the words, “We the People”. Not “We the Insurers”. “We the People of the United States, in order to form a more perfect union . . . to promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity do ordain and establish this Constitution for the United States of America.” This nation captured the world’s imagination with bold ideas that put the people first. It is time for our own generation’s revolution.
***
David Gratzer, M.D.:
Critics of the American system note that it fails to provide universal coverage to its citizens. But Canada’s single-payer system also denies care; instead of denying insurance coverage, Canada’s public insurance plans simply limit the supply of costly medications and capital-intensive procedures.
These challenges appear in different forms across the single-payer world. Wait times, rationed care and inefficient public management is inevitable in single-payer systems because they all face the same health-care demands as the American system.
***
During the questioning by committee members:
Rep. Dennis Kucinich: Dr. Gratzer, you’ve tried to make the case for rationing in Canada – worse than it is in the U.S. Do you know what Statistics Canada – the analogue to the U.S. Census – says the median wait time is across Canada for elective surgery?
Dr. David Gratzer: Why don’t you inform us,sir?
Kucinich: It’s four weeks. And what does Statistics Canada say the median wait time for diagnostic imaging like MRIs is?
Gratzer: I could tell you the Ontario government recently looked at that for…
Kucinich: It’s three weeks.
Gratzer: … for cancers, was six months.
Kucinich: It’s three weeks. How many uninsured are there in Canada?
Gratzer: Probably relatively few.
Kucinich: That’s right, none or very few. How many medical bankruptcies are there in Canada?
Gratzer: Depends on how you define medical bank..
Kucinich: None or very few. How many insured Americans go without needed care due to high cost of health care which is due to health insurance companies?
Gratzer: (Pause) Am I allowed to answer, or are we just going to continue to…
Kucinich: If you have an answer, you can answer. But if you don’t, I’ll answer. What’s your answer?
Gratzer: Go for it, sir.
Kucinich: What’s your answer?
Gratzer: Why don’t you answer your question, sir?
Kucinich: What’s your answer?
Gratzer: My answer…
Kucinich: How many insured Americans go without needed care due to the high cost of health care which is due to health insurance companies?
Gratzer: (Silence)
Kucinich: The witness isn’t responding.
Gratzer: The witness is delighted to speak further on those statistics and other statistics, but you keep cutting me off, sir.
Kucinich: You respond, if you have an answer. You didn’t give an answer to the other one.
Gratzer: I don’t want to be led down a garden path. If you’d like to ask me a question, I’d be…
Kucinich: You’ve shown a garden here to members of this committee and to the audience. There’s another side to this picture you don’t seem to be aware of even though you want to be an expert on Canada. Can you provide us with an answer on this one about America?
Gratzer: My position is respectable, and I dislike your comment, sir.
Kucinich: Do you have an answer? How many insured Americans, insured, go without needed care due to high costs of health care due to health insurance companies?
Gratzer: (Silence)
Kucinich: He has no answer. Well what the answer is is that it’s one out of every four. So we’re trying to make a case here that somehow Canada is in a mess, but we’re not focusing on the fact that in the United States there are people who aren’t getting needed care, and this gentleman has expected us to believe that rationing is worse in Canada. I don’t know how we can buy that. Now if single payer is so bad, maybe the gentleman – the doctor – can explain to us why sixty percent of U.S. doctors want it according to the peer-reviewed Annals of Internal Medicine, April, 2008.
(off camera voice): Are you going to let him answer this one?
Kucinich: He can answer it, if he can answer it.
Gratzer: I would suggest that many physicians in the United States are unsatisfied with their system, and rightly so. I would suggest that many physicians are looking for reform, and rightly so. But I would suggest that many physicians are unaware of what really goes on single payer systems, perhaps illustrated well by some of the comments that you’ve already made…
http://edlabor.house.gov/hearings/2009/06/examining-the-single-payer-hea.shtml

Although there are many individual heroes in the single payer movement, joint citizen activism has played a crucial role in bringing the single payer message to a formal, official hearing before a committee of the House of Representatives – a hearing devoted exclusively to single payer.
Tomorrow, Sen. Kennedy’s Health, Education, Labor, and Pensions committee will hold a hearing on “Healthcare Reform.” At the top of the list of the twenty-four witnesses is one of our heroes, PNHP’s Margaret Flowers, M.D., who previously had asked Sen. Baucus to bring single payer to the table, shortly before her arrest.
There are many effective channels for citizen activism. In whatever form you choose, let’s have a whole lot more of it please.