By Marcia Angell
NYTimes
June 5, 2009

There would be no need for an individual mandate in a single-payer system, since everyone would be covered automatically and it would be paid for through their income and payroll taxes. So asking me, a supporter of a single-payer health system, about mandates is a little like asking someone whether he’s stopped beating his wife.

Only a single-payer system would stop the private insurance industry from holding us hostage.

But even within our current system, I’m troubled by the notion of an individual mandate. I live in Massachusetts, where we have one. It requires people to buy private insurance at whatever price the companies choose to charge. As might be expected, this is a windfall for the insurance industry. Premiums are rising much faster than income, benefit packages are getting skimpier, and deductibles and co-payments are going up.

Many people can’t afford the premiums for the best plans, and so have to choose bare-bones, low-premium plans with high deductibles and co-payments. They are then left with insurance that they might not be able to afford to use, but have to purchase anyway.

A mandate is also extremely regressive. In Massachusetts, mandated insurance and co-payments can amount to nearly a third of income. Income taxes apportion the costs of public services more fairly, and I see no reason not to adopt that approach in paying for health care. To be sure, President Obama has said he would exempt people from the mandate who couldn’t afford to purchase their own health insurance. But aren’t these precisely the people most in need of it? Massachusetts has exempted 62,000 people from the mandate for that reason.

I would hope the President and Congress would come up with something less regressive and truly universal, and stop holding the rest of us hostage to the private insurance industry.

Marcia Angell is a senior lecturer in social medicine at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine.

http://roomfordebate.blogs.nytimes.com/2009/06/04/should-health-insurance-be-mandatory/

By Michael McCord
New Hampshire Business Review
Friday, June 5, 2009

Portsmouth physician Thomas Clairmont — who has practiced medicine since 1977 and is a vocal member of Physicians for a National Health Program — considers the current health reform effort a dog-and-pony show.

As he watches the health-care reform debate in Washington — mostly with frustrated amusement — Dr. Thomas Clairmont, a primary care physician in Portsmouth, can offer his own diagnosis and prescription for what ails health care in this country in five minutes or less.

Clairmont, who has practiced medicine since 1977 and is a vocal member of Physicians for a National Health Program, considers the reform effort in Congress a dog-and-pony show produced by the health-care industry for public consumption.

“We aren’t having a debate right now. We’ve seen it before, and this usually leads to nothing significant happening,” said Clairmont, who advocates a government-run, single-payer solution — one that a bipartisan majority of politicians and President Obama are ignoring as best they can, he contends.

“Who is Senator (Max) Baucus (chair of the Senate Finance Committee, which is shepherding health-care legislation through the Senate) and how is that he will determine what kind of reform we will have?”

In May, a few PNHP doctors were arrested at a Senate hearing chaired by Baucus after they protested the exclusion of single-payer advocates from testifying. Clairmont said the Obama administration attempted a similar snub at its national health-care forum in March when it originally invited no single-payer supporters — even Rep. John Conyers, D-Mich., who has introduced single-payer legislation in Congress.

“I’m not a radical. I like taxes low and limited government spending, but health care should be a right and not a privilege,” Clairmont said. “We are hearing talk about reform and fears about socialized medicine or single-payer being politically unfeasible — but our plan is simple and it will save money because it focuses on health care and not making money for the insurance industry. And we are frustrated because it’s not being taken seriously.”

What’s at stake in health-care reform is a battle over money and how it will be allocated. According to the Centers for Medicare and Medicaid Services, health-care costs will total $2.5 trillion in 2009, or about 15.5 percent of the country’s gross domestic product. Health-care spending per person is estimated at $8,100 per person — while more than 47 million Americans have no health insurance, a statistic determined before the recession.

Clairmont concedes the fight isn’t easy but he says it’s necessary because if the latest reform effort plays out as he believes it will, they will be back to square one within the next three to five years.

Q. How long have you been a single-payer advocate?

A. In 1994, I attended the New Hampshire Medical Society meeting in which the then-AMA president from Maine debated Dr. David Himmelstein, the founder of PNHP. It wasn’t even close, as the facts Himmelstein presented were extremely persuasive and the AMA position — status quo, really — didn’t come anywhere near offering the comprehensive affordable portable coverage of single payer.

Q. How do you describe a single-payer system?

A. Usually I can explain it in seconds. It will cost 4.5 percent in taxes, and there will be no premiums, no pre-existing condition restriction and no tying health care to employment. Because we eliminate health insurance companies and the system is administered by the federal government, we can save $360 billion to $400 billion a year in administrative costs.

Q. How do you counter arguments that the single-payer approach is “socialized medicine?”

A. I have two responses to “socialized medicine.” The usual one that doctors are not employed by the government and the hospitals are independent as well. Also, patients have free choice in our system of doctor and hospital. And they can see doctors here in Portsmouth, go to a specialist in Boston, or if in Florida they can get care there by other private doctors.

Socialized systems employ doctors and they own the hospitals like the VA here or the U.K.

I often ask the question as to whether Medicare is socialized medicine, and the response is usually no. But if they say no, I ask why they wouldn’t want to expand such a wonderful system for seniors to everyone else. And I ask, can you imagine if Medicare didn’t exist today what would seniors do?

If they say yes, then I ask if they would propose eliminating such a ‘socialized’ system and replace it with something else — usually there is not much for them to say.

Q. As a physician, do you see any rationale need for health insurance companies as part of the health-care system?

A. No. People care about their health-care coverage and how much they are paying for it. They don’t care about their health insurance company.

What bothers me is listening to stories like I did at the 2007 Obama health-care forum in Portsmouth — or reading stories everywhere about patients not able to afford care, tests, medicines, or in severe debt because of medical problems.

I contrast that data with the exorbitant profits and multimillion-dollar salaries of some health-care system executives. I often contrast those salaries with the salary of Health and Human Services Secretary (Kathleen) Sibelius — $191,500, for taking care of over 40 million Medicare recipients and over 400,000 patients with renal failure (which makes anyone eligible for Medicare at any age) and anyone with Lou Gehrig’s disease — that is a lot of patients with serious illnesses.

One of the main questions I always come back to is this: Why are our premiums paying for the bonuses of health insurance industry executives? Also, I tell people we are heading for single-payer anyway, and what matters is if we want the government to administer it or for-profit insurance companies running the show, even more than they already are?

Q. What do you hope to accomplish?

A. We should be able to do side-by-side comparisons to see what’s best for the country. If our plan falls short, then fine, and at least we’ve had a debate. But so far Congress has mostly been doing the work of the health-care industry.

For example, a few weeks ago the health-care industry announced it could come up with $2 trillion in savings over 10 years. But a single-payer plan would conservatively save more than $3.5 trillion over 10 years. Why aren’t more politicians giving it (single-payer) further study if cost savings are a top priority?

We are seeing more support across the country as people become aware of what’s happening.

Q. What is your minimum hope for this round of health-care reform?

A. At a minimum, I would like to see Medicare expanded to cover the spouse of a person who is turning 65 and entering the Medicare system. Commonly, a spouse who is several years younger can have medical issues which do not allow them to buy into the individual market. I would give them the choice of buying into the Medicare program at that time of enrollment at the current per capita cost of Medicare. Retirement and a lifetime of savings can be quickly destroyed by a medical illness.

http://nhbr.com/apps/pbcs.dll/article?AID=/20090605/PEOPLE/906039958

By Lisa Girion
Los Angeles Times
June 4, 2009

President Obama’s push for healthcare reforms gets a boost today from a new study by Harvard University researchers that shows a sizable increase over six years in bankruptcies caused in part by ever-higher medical expenses.

The study found that medical bills, plus related problems such as lost wages for the ill and their caregivers, contributed to 62% of all bankruptcies filed in 2007. On the campaign trail last year and in the White House this year, Obama had cited an earlier study by the same authors showing that such expenses played a part in 55% of bankruptcies in 2001.

Medical insurance isn’t much help, either. About 78% of bankruptcy filers burdened by healthcare expenses were insured, according to the survey, to be published in the August issue of the American Journal of Medicine.

“Health insurance is not a guarantee that illness won’t bankrupt you,” said Steffie Woolhandler, one of the authors, a practicing physician and an associate medical professor at Harvard.

“Lots of health insurance comes with big co-payments, deductibles and uncovered services,” she said. “So you can be insured and still end up with big bills. At the same time, even if you have good insurance through your employer, you can lose it if you get sick and can’t work.”

Most people who filed medical-related bankruptcies “were solidly middle class before financial disaster hit,” the study says. Two-thirds were homeowners, and most had gone to college.

The study does not suggest that medical expenses were the sole cause for these bankruptcies, but it does identify them as a contributing factor. The increase in such filings occurred despite a 2005 law aimed at making it more difficult for individuals to seek court protection from creditors.

And the latest study probably understates the current burden of medical expenses because it is based on bankruptcies filed before the recession hit.

The findings by a team of Harvard researchers from the law and medical schools are expected to help fuel the debate over what type of healthcare system is right for the U.S.

In a letter Wednesday, Obama made another push for a healthcare overhaul, reiterating his concern about the financial burden the current system places on families and businesses.

“Soaring healthcare costs make our current course unsustainable,” he wrote in the letter to Sens. Edward M. Kennedy (D-Mass.) and Max Baucus (D-Mont.), who are leading efforts to develop healthcare legislation. “It is unsustainable for our families, whose spiraling premiums and out-of-pocket expenses are pushing them into bankruptcy and forcing them to go without the checkups and prescriptions they need.”

Momentum has been growing in Congress for healthcare reform. Such change can’t come soon enough for Mary McCurnin.

She and her husband, Ron, filed for bankruptcy and nearly lost their home near Sacramento after a series of medical crises, including her breast cancer and his open-heart surgery. Ron, 63, lost his insurance coverage when the company providing it lost its California license after paying 10% of his hospital bills. Mary, 59, managed to get on Medi-Cal after they “went broke.”

Despite the ordeal, she said, the self-employed illustrators feel fortunate that they survived and managed to hang on to their home. “The healthcare industry is killing people,” she said. “There’s no other way to put it. We just got lucky.”

Linda and Jeffrey Somach pay $800 a month for health insurance. But the Staten Island, N.Y., couple filed for bankruptcy a month ago when their out-of-pocket medical expenses surpassed $40,000.

Linda Somach, a psychologist, can earn $80,000 a year if she sees patients full time. But she had to scale back to care for Jeffrey, who has terminal brain cancer. That reduced their income. At the same time, she is constantly getting bills for out-of-network charges, deductibles and medical care that their insurance doesn’t cover.

“We put so much of the medical stuff on credit cards,” she said. “My patients do it too.”

The study suggests that such plights are routine.

Woolhandler is on the board of Physicians for a National Health Program, a group that advocates for a single-payer system, in which government, not private insurers, brokers healthcare. She said the study showed that private insurers had failed in their core mission: protecting consumers from financial ruin in the event of a medical crisis.

“We need to rethink health reform,” Woolhandler said. “Covering the uninsured isn’t enough. Reform also needs to help families who already have insurance by upgrading their coverage and assuring they never lose it.”

A spokesman for private insurers said the industry recognized that uncovered and expensive medical care imposed a burden on families and businesses. But he said that private insurers were in a better position to rein in spiraling medical costs and that the industry had a plan for protecting people from being forced into bankruptcy over medical expenses not covered by insurance.

“In fact, in our comprehensive reform proposal we recommended in December that Congress should look at an out-of-pocket spending cap and a system of tax credits for low-income people,” Robert Zirkelbach, a spokesman for America’s Health Insurance Plans, a Washington, D.C.-based trade group.

“If an individual’s health expenses reached a certain level, there could be tax credits or other assistance to help those individuals,” he said.

The study found that medical-related bankruptcy filers with private insurance reported average medical bills of $17,749. By comparison, people who filed for bankruptcy without insurance reported average medical expenses of $26,971.

Individuals with diabetes and neurological disorders, such as multiple sclerosis, had the highest medical bills, averaging $26,971 for those with insurance and $34,167 for those without. Hospital bills were the largest expense for about half the families that filed health-related bankruptcies.

By Errol Lewis
New York Daily News
Thursday, June 4th 2009, 4:00 AM

WASHINGTON – As the White House launches its bid to reform health care, the big questions bedeviling the activist base of the Democratic Party are how and when to nudge President Obama to the left on key issues.

The recent three-day conference of the Campaign for America’s Future – an amalgamation of hundreds of unions, advocacy groups, student organizations, liberal think tanks and anti-war organizations whose turnout helped elect Democrats from coast to coast – featured a vow to get behind Obama’s push to reform health care this year.

But the frenetic energy of last year’s conference and about 500 attendees were missing. So was a hoped-for cameo appearance by Obama, who as a candidate dazzled the crowd at past conferences.

Many progressives have concluded correctly that Obama’s penchant for compromise and consensus could lead to a complex, unworkable, hybrid public-private health care proposal that will be an easy target for pharmaceutical industry lobbyists and other entrenched interests to demonize, weaken and possibly kill.

The stakes could not be higher. Tens of millions of Americans lack coverage, and the cost of health care continues to soar by double-digit percentages, causing an estimated half of all personal bankruptcies.

Although polls suggest that a thin majority of Americans would support a single, Medicare-style health insurance plan that covers everybody, Obama is playing it safe politically by going for a hybrid proposal in which those who are happy with their current coverage could keep it without any changes. That option, according to the polls, brings public support to 77%.

That leaves single-payer supporters in the tricky position of wanting to put pressure on Obama without providing ammunition to his (and their) conservative adversaries.

There’s a fine art, and long history, of Presidents being pressured by the social movements that helped elect them. “Obama’s Challenge,” a book making the rounds in progressive circles for months, describes how movement pressure made Abraham Lincoln, Franklin Roosevelt, Lyndon Johnson and Ronald Reagan into great, transformational Presidents.

According to this reading of history, the abolitionists pushed Lincoln from the goal of saving the union to the more radical move of ending slavery. Labor activism moved FDR from halting the Depression to enacting the New Deal, and civil rights activism forced Johnson to pass the Civil Rights Act of 1964 and Voting Rights Act of 1965, breaking the back of legalized segregation.

Presidents need outside grass-roots heat to help move the national consensus. The dreaded scenario for progressives is the arm’s-length treatment the anti-abortion movement got from Reagan.

Every year, the anti-abortion forces would gather on the National Mall, and every year Reagan would address them via a phone link and promise action on a constitutional amendment to ban abortion that never got to first base.

“We’ve seen little evidence of a progressive movement that can challenge the limits of Obama’s agenda and rouse an aggrieved citizenry to open up the space for the President to act far more boldly,” is how Robert Borosage, co-director of the Campaign for America’s Future, put it in a recent blog post. “But anyone building that movement will have to understand that they might earn respect, but they won’t be loved in the White House.”

The question is whether progressive health care advocates want to make friends with Obama, or make history. We shall see.

Agence France-Presse (AFP)
June 4, 2009

WASHINGTON (AFP) — Major US, Canadian and British life and health insurance companies have billions of dollars invested in tobacco companies, a study published Wednesday in the New England Journal of Medicine said.

Wesley Boyd, the study’s lead author, found that at least 4.4 billion dollars in insurance company funds are invested in companies whose affiliates produce cigarettes, cigars and chewing tobacco.

“Despite calls upon the insurance industry to get out of the tobacco business by physicians and others, insurers continue to put their profits above people’s health,” said Boyd, a faculty member of Harvard Medical School.

“It’s clear their top priority is making money, not safeguarding people’s well-being,” he wrote.

Tobacco is considered the leading cause of lung cancer and a major risk factor for heart attack, stroke, pulmonary disease and cancer.

According to the World Health Organization, it is a contributing factor in 5.4 million deaths a year.

Researchers first revealed that health and life insurance companies had major investments in tobacco companies in 1995 in an article in the British medical journal Lancet.

“Although investing in tobacco while selling life or health insurance may seem self-defeating, insurance firms have figured out ways to profit from both,” Boyd wrote.

“Insurers exclude smokers from coverage or, more commonly, charge them higher premiums. Insurers profit — and smokers lose — twice over.”

According to the study, US insurer Prudential Financial Inc. has 264.3 million dollars invested among three US tobacco companies, including Reynolds America and Philip Morris.

Canadian insurer Sun Life Financial Inc., which sells life, disability and health insurance, has a stock portfolio with more than one billion dollars in two tobacco companies, including 890 million dollars in Philip Morris.

Prudential Plc, which sells health and disability insurance, has 1.38 billion dollars in two tobacco companies, including British American Tobacco.

The study also details the substantial tobacco investments of the US firms Northwestern Mutual and Massachusetts Mutual Life, and the Scottish firm Standard Life Plc.

Mike Penprase
News-Leader (Springfield, MO)
May 31, 2009

Dr. Judy Dasovich got national attention with her arrest during a recent Senate hearing in Washington, but she was more intent at a Saturday rally on getting attention paid to others.

Go talk to the family who had a mountain of medical bills that wasn’t covered by their insurance, the volunteer physician at The Kitchen told reporters during a “High Noon for National Health Care” rally.

The rally might have been impromptu and involved fewer than two dozen people, but Dasovich said she was pleased.

“We started organizing this in the middle of the week,” she said.

The Physicians for a National Health Program that Dasovich belongs to and other groups have advocated adoption of a single-payer or Medicare-for-all system, but Dasovich said she tells the curious there’s a simpler explanation.

Americans should pay for health insurance like they pay for interstate highways, she said.

Money that now goes for insurance premiums and co-payments should go to a nationwide tax that would support a health insurance system, she contends.

Instead of health insurance premiums going to insurance company profits and outright waste, the money would go for treating people, she said.

Dasovich said critics who contend such a system would be socialized medicine are mistaken because reform she wants to see would change the way money is spent and wouldn’t affect how doctors treat patients or how patients select doctors.

Anyone who has fought an insurance company over a bill or who has been forced to move from one physician to another because an employer changed health care coverage would understand, she said.

Her stance — and her trip to Washington that resulted in a misdemeanor arrest — didn’t come after one case of seeing someone needing health care who didn’t have insurance, she said.

Along with several other health insurance reform advocates, Dasovich was held for several hours after they demonstrated during a session of the Senate Finance Committee headed by Sen. Max Baucus.

“Charity care is not a solution,” she said. “I’ve seen that firsthand. This is the next step that needs to be taken.”

People attending the rally said they appreciate Dasovich’s commitment to reform.

“She’s wonderful,” Vicki Chapman said while holding baby daughter Kylie. “Judy is Kylie’s hero.”

As for her Washington arrest, Dasovich said she’s ready to deal with that soon.

Dasovich said she’s scheduled to return to Washington to respond the misdemeanor charge next week and expects a hearing to be held in another month.