Senator Bernie Sanders
June 16, 2009
For a quick and painless way to express your support for a single-payer Medicare-for-all program, click on this link to co-sign Senator Bernie Sanders’ petition to Congress, and then share this link with others who care.
http://sanders.senate.gov/petitions/index.cfm?uid=7fd59f2e-88e1-477a-8eaf-762a5b050809
By Don McCanne, M.D.
Let’s let Congress know how many of us there are who really care.
Editorial
Capital Times (Madison, WI)
6/10/2009
Dr. Linda Farley, the local physician and nationally recognized advocate for health care reform who died this week, had long championed the replacement of the current for-profit health care system with a single-payer plan. Such a plan would guarantee that all Americans have access to quality care while at the same time cutting costs associated with insurance and health care industry profiteering.
We have taken our counsel from Dr. Farley, and her husband, Dr. Gene Farley, on these issues for a number of years.
Our confidence in the experience and wisdom of these veteran physicians, who worked in a variety of public and private settings, has informed this newspaper’s commitment to the view that only a single-payer system will achieve the stated goals of President Barack Obama and congressional leaders. The Obama administration and Democrats and most Republicans in Congress say they want more and better care for all, with real flexibility for patients who want to keep the same doctor and genuine savings.
But we have also been informed over the years by Farley’s reminders that our current broken system does not merely make it harder for ailing Americans to get care and for healthy Americans to maintain their fitness. It also imposes incredible economic hardship on Americans who fall ill.
The extent of that hardship was revealed last week in a study that will be published this summer by the American Journal of Medicine. According to the study, medical problems contributed to almost 62.1 percent of all bankruptcies in 2007.
Worse yet, the data from the study show that, from 2001 to 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent.
That’s a particularly unsettling notion, as the current economic meltdown is all but sure to have caused an expansion of the crisis. Thus, as many as two-thirds of the 1.5 million Americans who are being forced into bankruptcy annually end up there because they made the “mistake” of getting sick.
And here is where things get downright scary. According to the study:
• Most of those bankrupted by medical problems had health insurance. More than three-quarters (77.9 percent) were insured at the start of the bankrupting illness.
• Most of the medically bankrupt fell into income categories that the authors of the study identify as “solidly middle class before financial disaster hit.” Two-thirds were homeowners, and three-fifths had gone to college.
• In a substantial number of instances, high medical bills coincided with a loss of income as illness forced breadwinners to lose time from work. Often illness led to job loss, and with it the loss of health insurance.
“Our findings are frightening,” says Dr. David Himmelstein, the lead author of the study and an associate professor of medicine at Harvard. “Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy. 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. And even the best job-based health insurance often vanishes when prolonged illness causes job loss — precisely when families need it most. Private health insurance is a defective product, akin to an umbrella that melts in the rain.”
Elizabeth Warren, the Leo Gottlieb professor of law at Harvard and one of the leading experts on personal bankruptcy, explains: “For many families, bankruptcy is a deeply shameful experience. People arrive at the bankruptcy courts exhausted — financially, physically and emotionally. For most, bankruptcy is a last choice to deal with unmanageable circumstances.”
And more often than not, notes Warren, a co-author of the report, they arrive because they fell ill or suffered from a chronic condition.
Thus bankruptcy is not for the most part a matter of personal responsibility — or the lack thereof. It is a matter of bad health and a broken health care system.
How should we respond at a point when the United States is preparing to enter into another national health care debate?
Not with the gimmicks that members of Congress on both sides of the aisle and the Obama administration have been proposing, which leave most Americans in the grip of insurance companies that don’t provide adequate or humane coverage when people need it the most.
“We need to rethink health reform,” says Dr. Steffie Woolhandler, an associate professor of medicine at Harvard and a primary care physician in Cambridge, Mass., who is another co-author of the study. “Covering the uninsured isn’t enough. Reform also needs to help families who already have insurance by upgrading their coverage and assuring that they never lose it. Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy. Unfortunately, Washington politicians seem ready to cave in to insurance firms and keep them and their counterfeit coverage at the core of our system. Reforms that expand phony insurance — stripped-down plans riddled with co-payments, deductibles and exclusions — won’t stem the rising tide of medical bankruptcy.”
Woolhandler is right.
Only the creation of a single-payer national health insurance system will address not just the health care crisis but the bankruptcy crisis.
As Dr. Linda Farley told us for years: “Single-payer is the cure.”
So how do we prescribe it?
The best way is by supporting the efforts of the group with which Farley was long associated: Physicians for a National Health Program, the real reform group that has won the support of more than 16,000 doctors nationwide.
To learn more about Physicians for a National Health Program, visit the group’s website at www.pnhp.org or call 312-782-6006.
By Robert Douglas
Tallahassee Democrat
My View
June 13, 2009
My first encounter with the U.S. health care system was in 1979. Thirty years later, it still haunts me and fuels my passion for supporting fundamental reform.
During a visit to a small hospital just outside Washington, D.C., I witnessed a scene that was utterly foreign to me as a recent immigrant from Canada. It involved a dispute between an unkempt young man in need of help and an officious clerk doing her best to deny it.
He had come into the hospital on a nonemergency basis to have stitches removed from a hand that had been injured weeks before on a nonunion construction site. The clerk told him that, until he produced proof of insurance or $60, he could not be seen by someone from the medical staff.
With his voice rising in frustration enough to prompt crying from the infant carried by his old-beyond-her-years wife who stood beside him, the man said as he started to leave: “I don’t have any insurance. I don’t have any money. The boss won’t let me back on the job until I get the stitches out. So I guess I’ll have to take them out myself.”
I left as well. But as a native Canadian who had never seen a doctor’s bill or been hassled at a hospital, I was shaken by this brutal show of how Americans treat those with no means but great needs.
With the typically understated smugness Canadians exude when they find something besides hockey where they outshine Americans, I chalked it up as another reason why my native country is a more civilized society than the one I was choosing to adopt.
But now that I’m a U.S. citizen, I’m no longer smug. And while I feel blessed to have adequate insurance myself, I’m angry that the injustice of our health care system persists.
But I’m also hopeful that fundamental reform finally has a chance here. And as the reform debate heats up, I feel obliged to share my perspective as someone who came of age Up North as Canada adopted its version of universal health care.
While progressive groups such as the Physicians for a National Health Program (PNHP) are backing legislation to create a Canadian-style system, in which government is the single payer of most health care costs, the health care establishment is cautioning against any reform that usurps its control and cuts into its profits. And now it seems that President Obama — pragmatist that he is — is listening, because he would rather achieve some incremental reform than no reform at all.
But that doesn’t mean we should take the Canadian model off the table, because it is the standard against which any progress here ultimately will be measured.
To be sure, the Canadian system of care is not perfect. And for every proponent of it you can find a detractor. But there are a few irrefutable facts. For instance:
* Per capita health care costs in Canada are about half of the comparable costs in the U.S., where 45 million remain uninsured — more than the entire 33.5 million population of Canada.
* Research suggests that medical outcomes in Canada are generally superior to those in the U.S.
* Most importantly, the specter that has haunted me for 30 years — of someone in need but without means being denied care — would not be shrugged off as routine in Canada as it too often is here.
Of course, Canadians had their share of struggles on their way to universal coverage — some of which have a familiar ring.
Socialism. Rationing. Long waits for inferior care. No choice. When reform talk here turns to the Canadian model, these are canards often used to strike fear in The Great Unwell. Much as they were in 1962, when the grandfather of actor Keifer Sutherland pioneered universal health care as premier in the sparsely populated prairie province of Saskatchewan.
The doctors in the province actually went on strike to protest changing the status quo. But Premier T.C. Douglas (no relation) would not be deterred. He successfully implemented a universal health care program in his own province and, by 1966, Canada’s federal government had adopted legislation calling for all provinces to create their own versions of a program guaranteeing that none of their citizens be denied care on the basis of their ability to pay for it.
Perhaps the biggest challenge to the Canadian system over the years has been keeping the system adequately funded. Just as Florida legislators are prone to cheat our children by underfunding education, some provincial legislators are prone to cheat the sick by underfunding health care.
But Canadians have always fought back to keep the “wonderful legacy” of universal health care that T.C. Douglas once told his grandson defines what makes Canadians special as much as their ability to endure harsh winters.
The grandson, who ironically has become an iconic American hero with his portrayal of terrorist-fighter Jack Bauer on television’s “24,” spoke passionately as a Canadian in defense of his grandfather’s legacy in 2000 at a rally in Edmonton called to protest another legislative effort to undermine universal health care.
Sutherland told a crowd of 8,000 that the universal health system his grandfather pioneered is “the envy of the rest of the world” because it shows Canadians have a way to “take responsibility for each other” by developing a platform for medical health for both the rich and poor, regardless of color or political bent. In Canada, he said, anyone can get the care he or she needs “because it is humane.”
“This is not a political issue,” he told the Canadians in a message that should resonate with Americans now. “It is an issue of humanity.”
I close my eyes and fantasize Sutherland’s Jack Bauer persona getting in the face of the clerk I saw 30 years ago denying care to the construction worker and, with his hallmark enhanced intensity, appealing to her sense of humanity.
Eyes wide open, I’m rooting for real-life champions of the reform that is in the spirit of Sutherland’s granddad.
“Single-payer is the health system that works for every other industrialized nation on earth.”
By Sylvia Hampton
East County Magazine, California
6/16/09
Supporters of real health care reform want a national expansion of the popular Medicare single payer program now covering every American over age 65. But they are being told that it is just not “politically feasible.” When one asks “Why?” there is double talk and a run-around. The facts are clear. Oxen will be gored–and the industry and some in Congress are circling the wagons to protect their own self interests. We have some blatant conflicts of interest here that would make an eight-year-old blush: Congress members who have stock holdings in the industry and get large campaign contributions from insurers. Imagine that.
The insurance industry competes by selling large group insurance to businesses employing young healthy people. Ca-ching! They get those contracts by promising low cost to the employer, so the employee “contribution” becomes a pay deduction. Then if an employee gets sick or in an accident, his co-pays can become so large as to cause him to go bankrupt. But hey–no skin off the insurance company’s nose! Ca-ching.
If the sickness or injury is bad enough to lose your job they don’t have to mess with you anymore. They just drop you if you live long enough (after they do everything in their power to deny the claims.) After all, they have stockholders to think about–they must, by law, make a profit. Ca-ching. And because the drug companies don’t want to have to negotiate with the big bad government on prices, they stick with the captains of this industry like two peas in a private money pot. That’s what makes health insurance hooked to employment so darn great–for insurers. The result is that they have so much money they can scare the pants off everyone in government. They will run an ad campaign so slick a good guy will look like Satan when they are done.
Who gets the money for all those campaigns to sell insurance, sell drugs, sell the negative campaign ads? The Media. Ca-ching. So don’t ask them to help you gore that ox. That money talks–big time.
Single-payer is the health system that works for every other industrialized nation on Earth. Single-payer results in health statistics better than ours, costs the people far less than ours, and at the same time covers everyone in their country. But it was not given consideration in Congress and is deemed an evil communist plot by 30% of our population. The other 70% have caught on after hard knocks in our system and now support single payer/Medicare for all. But that is not even what the president is asking for; he just wants a “public option” in addition to the private plans.
But no, the industry says that is not fair. Why? Too many employers and workers will grab it in a heartbeat. Why? Better, cheaper, faster, nicer and more complete–like what all of us over 65 have and love: Medicare. The modern robber barons are throwing so much money and weight around Washington D.C. right now that you ordinary people out here in the real world don’t have a chance.
There is only one way you young ‘uns will get what I have–and that is to take to the streets and demand it. Call your congressman, demonstrate in the street by his office, call the talk shows, and scream bloody murder. Because murder is what is happening to you right now. They are killing you. But as long as insurers, drug companies and legislators make a profit and you don’t pay attention, their life goes on.
Sylvia Hampton is the past director of Health Care for All CA and a current board member of San Diegans for Health Care Coverage.
The views expressed in this editorial reflect the views of the author and do not necessarily reflect the views of East County Magazine. If you wish to submit an editorial for consideration, contact editor@eastcountymagazine.org.
Letters
The Washington Post
Monday, June 15, 2009
Dana Milbank’s description of the recent congressional hearing on single-payer health care [“It’s Healthy to Vent,” June 11] was polemical.
First, many attendees were congressional staff members, not single-payer advocates.
Second, to describe the testimony of witnesses, which included Rep. John Conyers Jr., chairman of the House Judiciary Committee, as mere “venting” and “an exercise in blowing off steam” was offensive to the millions of Americans whose views they represent.
Third, Rep. Dennis Kucinich’s grilling of the Manhattan Institute’s David Gratzer was justified by Mr. Gratzer’s selective use of statistics to portray a falsely grim picture of the Canadian single-payer system. Certainly, a national system of health insurance that guarantees comprehensive access to needed care and eliminates profit is anathema to someone who cheerleads the intellectually and morally bankrupt “consumer-driven health care” movement.
Finally, to decry a national system of health-care financing that retains the private delivery of health care as socialism simply plays into the propaganda and fear-mongering of the right and the private insurance lobby, which opposes any challenge to its obscene profits.
Make no mistake: Single-payer advocates have much to be upset about, given our near-complete exclusion from the congressional debate on health reform.
But we are the only health-care reform movement with strong and growing grass-roots support, and we will be heard.
JAMES FLOYD
Washington
The writer, a physician and a health researcher for Public Citizen, which supports single-payer national health insurance, attended the hearing in question.
http://www.washingtonpost.com/wp-dyn/content/article/2009/06/14/AR2009061402388.html
By Philip Moeller
U.S. News and World Report
June 16, 2009
Health-care costs are the dominant cause of personal bankruptcies, according to a recent study based on detailed 2007 records and extensive interviews with people who filed for bankruptcy that year. The study was released for maximum impact amidst the Congressional debate over health-care reform, and it has been repeatedly cited as proof that the system needs fixing. While that may be a valuable outcome of the research, its underlying message will not be altered any time soon by reform efforts: health-care expenses are the largest uncontrollable expense that Americans face, and insurance does not make the problem go away. For seniors and those nearing traditional retirement age, setting aside funds for future health-care expenses simply must assume greater importance in financial plans.
More than 62 percent of personal bankruptcies in 2007 were related to medical expenses — up nearly 50 percent from 2001 — according to “Medical Bankruptcy in the United States, 2007.” Its authors, academics David U. Himmelstein, Deborah Thorne, Elizabeth Warren, and Steffie Woolhandler, said their work represented the first-ever national random survey of bankruptcy filers. The results were summarized in the American Journal of Medicine.
“Most medical debtors were well educated, owned homes, and had middle-class occupations,” the authors said, adding that nearly 80 percent of 2007 medical bankruptcies involved people who had health insurance at the time their medical problems began (60.3 percent with private insurance as their primary coverage, 10.2 percent with Medicare, 5.4 percent with Medicaid, and 2 percent with Veterans Affairs coverage).
Tougher bankruptcy rules were enacted several years ago; filings peaked in 2005 and then declined, the authors said. “Since then, filings have increased each quarter. They are likely to exceed one million households in 2008, representing about 2.7 million people.” According to Automated Access to Court Electronic Records, which tracks bankruptcies, personal filings have soared past the 6,000 per-day rate and may total 1.5 million this year.
In addition to being under-insured when their medical problems began, the 2007 study found that many people with private insurance coverage lost it after becoming ill. “Nationally, a quarter of firms cancel coverage immediately when an employee suffers a disabling illness; another quarter do so within a year,” the study said.
In planning for future medical expenses, the study said:
“Out-of-pocket medical costs averaged $17,943 for all medically bankrupt families: $26,971 for uninsured patients, $17,749 for those with private insurance at the outset, $14,633 for those with Medicaid, $12,021 for those with Medicare, and $6,545 for those with Veterans Affairs/military coverage. For patients who initially had private coverage but lost it, the family’s out-of-pocket expenses averaged $22,568.”
Hospital costs were the largest out-of-pocket expense for nearly half of the people filing for bankruptcy, followed by prescription drugs (19 percent), doctor’s bills (15 percent), and premiums (4 percent). Drugs were the major expense for patients with pulmonary, cardiac, or psychiatric illnesses. For a group of the most common medical conditions, the study found the highest out-of-pocket expenses were for non-stroke neurological illnesses such as multiple sclerosis ($34,167, expressed as a mean of expenses), followed by diabetes ($26,971), injuries ($25,096), stroke ($23,380), mental illnesses ($23,178), and heart disease ($21,955).
Senator Bernie Sanders
June 16, 2009
For a quick and painless way to express your support for a single-payer Medicare-for-all program, click on this link to co-sign Senator Bernie Sanders’ petition to Congress, and then share this link with others who care.
http://sanders.senate.gov/petitions/index.cfm?uid=7fd59f2e-88e1-477a-8eaf-762a5b050809
By Don McCanne, M.D.
Let’s let Congress know how many of us there are who really care.
Editorial
Capital Times (Madison, WI)
6/10/2009
Dr. Linda Farley, the local physician and nationally recognized advocate for health care reform who died this week, had long championed the replacement of the current for-profit health care system with a single-payer plan. Such a plan would guarantee that all Americans have access to quality care while at the same time cutting costs associated with insurance and health care industry profiteering.
We have taken our counsel from Dr. Farley, and her husband, Dr. Gene Farley, on these issues for a number of years.
Our confidence in the experience and wisdom of these veteran physicians, who worked in a variety of public and private settings, has informed this newspaper’s commitment to the view that only a single-payer system will achieve the stated goals of President Barack Obama and congressional leaders. The Obama administration and Democrats and most Republicans in Congress say they want more and better care for all, with real flexibility for patients who want to keep the same doctor and genuine savings.
But we have also been informed over the years by Farley’s reminders that our current broken system does not merely make it harder for ailing Americans to get care and for healthy Americans to maintain their fitness. It also imposes incredible economic hardship on Americans who fall ill.
The extent of that hardship was revealed last week in a study that will be published this summer by the American Journal of Medicine. According to the study, medical problems contributed to almost 62.1 percent of all bankruptcies in 2007.
Worse yet, the data from the study show that, from 2001 to 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent.
That’s a particularly unsettling notion, as the current economic meltdown is all but sure to have caused an expansion of the crisis. Thus, as many as two-thirds of the 1.5 million Americans who are being forced into bankruptcy annually end up there because they made the “mistake” of getting sick.
And here is where things get downright scary. According to the study:
• Most of those bankrupted by medical problems had health insurance. More than three-quarters (77.9 percent) were insured at the start of the bankrupting illness.
• Most of the medically bankrupt fell into income categories that the authors of the study identify as “solidly middle class before financial disaster hit.” Two-thirds were homeowners, and three-fifths had gone to college.
• In a substantial number of instances, high medical bills coincided with a loss of income as illness forced breadwinners to lose time from work. Often illness led to job loss, and with it the loss of health insurance.
“Our findings are frightening,” says Dr. David Himmelstein, the lead author of the study and an associate professor of medicine at Harvard. “Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy. 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. And even the best job-based health insurance often vanishes when prolonged illness causes job loss — precisely when families need it most. Private health insurance is a defective product, akin to an umbrella that melts in the rain.”
Elizabeth Warren, the Leo Gottlieb professor of law at Harvard and one of the leading experts on personal bankruptcy, explains: “For many families, bankruptcy is a deeply shameful experience. People arrive at the bankruptcy courts exhausted — financially, physically and emotionally. For most, bankruptcy is a last choice to deal with unmanageable circumstances.”
And more often than not, notes Warren, a co-author of the report, they arrive because they fell ill or suffered from a chronic condition.
Thus bankruptcy is not for the most part a matter of personal responsibility — or the lack thereof. It is a matter of bad health and a broken health care system.
How should we respond at a point when the United States is preparing to enter into another national health care debate?
Not with the gimmicks that members of Congress on both sides of the aisle and the Obama administration have been proposing, which leave most Americans in the grip of insurance companies that don’t provide adequate or humane coverage when people need it the most.
“We need to rethink health reform,” says Dr. Steffie Woolhandler, an associate professor of medicine at Harvard and a primary care physician in Cambridge, Mass., who is another co-author of the study. “Covering the uninsured isn’t enough. Reform also needs to help families who already have insurance by upgrading their coverage and assuring that they never lose it. Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy. Unfortunately, Washington politicians seem ready to cave in to insurance firms and keep them and their counterfeit coverage at the core of our system. Reforms that expand phony insurance — stripped-down plans riddled with co-payments, deductibles and exclusions — won’t stem the rising tide of medical bankruptcy.”
Woolhandler is right.
Only the creation of a single-payer national health insurance system will address not just the health care crisis but the bankruptcy crisis.
As Dr. Linda Farley told us for years: “Single-payer is the cure.”
So how do we prescribe it?
The best way is by supporting the efforts of the group with which Farley was long associated: Physicians for a National Health Program, the real reform group that has won the support of more than 16,000 doctors nationwide.
To learn more about Physicians for a National Health Program, visit the group’s website at www.pnhp.org or call 312-782-6006.
“Single-payer is the health system that works for every other industrialized nation on earth.”
By Sylvia Hampton
East County Magazine, California
6/16/09
Supporters of real health care reform want a national expansion of the popular Medicare single payer program now covering every American over age 65. But they are being told that it is just not “politically feasible.” When one asks “Why?” there is double talk and a run-around. The facts are clear. Oxen will be gored–and the industry and some in Congress are circling the wagons to protect their own self interests. We have some blatant conflicts of interest here that would make an eight-year-old blush: Congress members who have stock holdings in the industry and get large campaign contributions from insurers. Imagine that.
The insurance industry competes by selling large group insurance to businesses employing young healthy people. Ca-ching! They get those contracts by promising low cost to the employer, so the employee “contribution” becomes a pay deduction. Then if an employee gets sick or in an accident, his co-pays can become so large as to cause him to go bankrupt. But hey–no skin off the insurance company’s nose! Ca-ching.
If the sickness or injury is bad enough to lose your job they don’t have to mess with you anymore. They just drop you if you live long enough (after they do everything in their power to deny the claims.) After all, they have stockholders to think about–they must, by law, make a profit. Ca-ching. And because the drug companies don’t want to have to negotiate with the big bad government on prices, they stick with the captains of this industry like two peas in a private money pot. That’s what makes health insurance hooked to employment so darn great–for insurers. The result is that they have so much money they can scare the pants off everyone in government. They will run an ad campaign so slick a good guy will look like Satan when they are done.
Who gets the money for all those campaigns to sell insurance, sell drugs, sell the negative campaign ads? The Media. Ca-ching. So don’t ask them to help you gore that ox. That money talks–big time.
Single-payer is the health system that works for every other industrialized nation on Earth. Single-payer results in health statistics better than ours, costs the people far less than ours, and at the same time covers everyone in their country. But it was not given consideration in Congress and is deemed an evil communist plot by 30% of our population. The other 70% have caught on after hard knocks in our system and now support single payer/Medicare for all. But that is not even what the president is asking for; he just wants a “public option” in addition to the private plans.
But no, the industry says that is not fair. Why? Too many employers and workers will grab it in a heartbeat. Why? Better, cheaper, faster, nicer and more complete–like what all of us over 65 have and love: Medicare. The modern robber barons are throwing so much money and weight around Washington D.C. right now that you ordinary people out here in the real world don’t have a chance.
There is only one way you young ‘uns will get what I have–and that is to take to the streets and demand it. Call your congressman, demonstrate in the street by his office, call the talk shows, and scream bloody murder. Because murder is what is happening to you right now. They are killing you. But as long as insurers, drug companies and legislators make a profit and you don’t pay attention, their life goes on.
Sylvia Hampton is the past director of Health Care for All CA and a current board member of San Diegans for Health Care Coverage.
The views expressed in this editorial reflect the views of the author and do not necessarily reflect the views of East County Magazine. If you wish to submit an editorial for consideration, contact editor@eastcountymagazine.org.
Letter to Sen. Edward Kennedy, Chairman, Committee on Health, Education, Labor, and Pensions
From CBO Director Douglas Elmendorf
Congressional Budget Office
June 15, 2009
The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) have completed a preliminary analysis of the major provisions related to health insurance coverage that are contained in title I of draft legislation called the Affordable Health Choices Act, which was released by the Senate Committee on Health, Education, Labor, and Pensions (HELP) on June 9, 2009. Among other things, that draft legislation would establish insurance exchanges (called “gateways”) through which individuals and families could purchase coverage and would provide federal subsidies to substantially reduce the cost of that coverage for some enrollees.
Effects on Insurance Coverage.
According to the preliminary analysis, once the proposal was fully implemented, the number of people who are uninsured would decline to about 36 million or 37 million, representing about 13 percent of the nonelderly population.
Budgetary Impact of Insurance Coverage Provisions.
On a preliminary basis, CBO and the JCT staff estimate that the major provisions in title I of the Affordable Health Choices Act affecting health insurance coverage would result in a net increase in federal deficits of about $1.0 trillion for fiscal years 2010 through 2019. That estimate primarily reflects the subsidies that would be provided to purchase coverage through the new insurance exchanges, which would amount to nearly $1.3 trillion in that period.
Those costs would be partly offset by receipts or savings from three sources: increases in tax revenues stemming from the decline in employment-based coverage; payments of penalties by uninsured individuals; and reductions in outlays for Medicaid and CHIP (relative to current-law projections).
It is important to note, however, that those figures do not represent a formal or complete cost estimate for the draft legislation, for reasons outlined (in the letter). Moreover, because expanded eligibility for the Medicaid program may be added at a later date, those figures are not likely to represent the impact that more comprehensive proposals — which might include a significant expansion of Medicaid or other options for subsidizing coverage for those with income below 150 percent of the federal poverty level — would have both on the federal budget and on the extent of insurance coverage.
http://www.cbo.gov/ftpdocs/103xx/doc10310/06-15-HealthChoicesAct.pdf
Since the Affordable Health Choices Act and the CBO analysis of it are works in progress, the estimates of the net numbers who will gain insurance coverage and the net cost to the government are only preliminary and will likely change with refinements in the legislation and the analysis. What will not change are the fundamental implications of financing health care through government subsidized private health plans plus public programs.
The primary reform goals that most of us support include providing health insurance for everyone that is effective in preventing financial hardship, and controlling the rate of increase in our health care costs. What does the CBO response tell us about the potential of this legislation to meet these two goals?
Regarding the impact on our national health expenditures (NHE), the analysis tells us almost nothing. As with most reports of this nature, they looked primarily at government spending rather than total health care spending. Individuals, employers and the government are all concerned about health care costs. Tax and budget policies that satisfy fiscally conservative legislators by effectively capping government spending while shifting cost increases to individuals and employers do not help us, as a nation, to meet the challenges of run-away health care costs that are harming so many of us. Looking at government spending while ignoring private spending is of little value to us when we are trying to figure out how we are going to pay for health care.
CBO needs to provide us with an estimate of changes in our NHE since we are all paying that. Providing us, in addition, with estimates of government spending can be helpful in establishing tax policies that would help bring equity to health care financing. But let’s have transparency on our full health care spending, public and private.
Regarding the impact on the numbers who will become insured, analyses such as this can provide a ballpark figure. The fact that the policies outlined in the current draft of the legislation would leave 37 million people without coverage likely has Senate HELP Committee members scurrying to patch the holes in the legislation and to look for other refinements that would expand coverage to more individuals.
There is an inverse relationship between government subsidies and the numbers of individuals who are left uninsured. Increasing the number of individuals eligible for the subsidies and increasing the amounts of the subsidies reduce the numbers of individuals left out, but that number will never be zero. A policy of using government subsidies to purchase private plans will always fall short of universality. The only way to cover absolutely everyone is to make enrollment automatic, and to separate the financing by changing from premiums linked to individual plans to a global system financed through equitable tax policies.
Looking only at the numbers of individuals left without insurance skirts another crucial issue. The rate of underinsurance is exploding. Offering multiple tiers of different priced plans in an insurance exchange automatically results in an expansion of underinsurance. Even with subsidies, healthy individuals will select inadequate plans with the lowest premiums, sincerely believing that this is all they can afford. But what good is insurance if you can still be left bankrupt with medical bills?
This proposal leaves too many without health insurance, fails to control our escalating health care costs, and expands the market of underinsurance products. The staff members at CBO, JCT, the HELP Committee, the Finance Committee, and the House Committees will get busy introducing policy refinements for the legislative proposals. Then they will finally bring us a product that leaves too many without health insurance, fails to control our escalating health care costs, and expands the market of underinsurance products.
From CBO Director Douglas Elmendorf
Congressional Budget Office
June 15, 2009
The Congressional Budget Office (CBO) and the staff of the Joint Committee on Taxation (JCT) have completed a preliminary analysis of the major provisions related to health insurance coverage that are contained in title I of draft legislation called the Affordable Health Choices Act, which was released by the Senate Committee on Health, Education, Labor, and Pensions (HELP) on June 9, 2009. Among other things, that draft legislation would establish insurance exchanges (called “gateways”) through which individuals and families could purchase coverage and would provide federal subsidies to substantially reduce the cost of that coverage for some enrollees.
Effects on Insurance Coverage.
According to the preliminary analysis, once the proposal was fully implemented, the number of people who are uninsured would decline to about 36 million or 37 million, representing about 13 percent of the nonelderly population.
Budgetary Impact of Insurance Coverage Provisions.
On a preliminary basis, CBO and the JCT staff estimate that the major provisions in title I of the Affordable Health Choices Act affecting health insurance coverage would result in a net increase in federal deficits of about $1.0 trillion for fiscal years 2010 through 2019. That estimate primarily reflects the subsidies that would be provided to purchase coverage through the new insurance exchanges, which would amount to nearly $1.3 trillion in that period.
Those costs would be partly offset by receipts or savings from three sources: increases in tax revenues stemming from the decline in employment-based coverage; payments of penalties by uninsured individuals; and reductions in outlays for Medicaid and CHIP (relative to current-law projections).
It is important to note, however, that those figures do not represent a formal or complete cost estimate for the draft legislation, for reasons outlined (in the letter). Moreover, because expanded eligibility for the Medicaid program may be added at a later date, those figures are not likely to represent the impact that more comprehensive proposals — which might include a significant expansion of Medicaid or other options for subsidizing coverage for those with income below 150 percent of the federal poverty level — would have both on the federal budget and on the extent of insurance coverage.
http://www.cbo.gov/ftpdocs/103xx/doc10310/06-15-HealthChoicesAct.pdf
By Don McCanne, MD
Since the Affordable Health Choices Act and the CBO analysis of it are works in progress, the estimates of the net numbers who will gain insurance coverage and the net cost to the government are only preliminary and will likely change with refinements in the legislation and the analysis. What will not change are the fundamental implications of financing health care through government subsidized private health plans plus public programs.
The primary reform goals that most of us support include providing health insurance for everyone that is effective in preventing financial hardship, and controlling the rate of increase in our health care costs. What does the CBO response tell us about the potential of this legislation to meet these two goals?
Regarding the impact on our national health expenditures (NHE), the analysis tells us almost nothing. As with most reports of this nature, they looked primarily at government spending rather than total health care spending. Individuals, employers and the government are all concerned about health care costs. Tax and budget policies that satisfy fiscally conservative legislators by effectively capping government spending while shifting cost increases to individuals and employers do not help us, as a nation, to meet the challenges of run-away health care costs that are harming so many of us. Looking at government spending while ignoring private spending is of little value to us when we are trying to figure out how we are going to pay for health care.
CBO needs to provide us with an estimate of changes in our NHE since we are all paying that. Providing us, in addition, with estimates of government spending can be helpful in establishing tax policies that would help bring equity to health care financing. But let’s have transparency on our full health care spending, public and private.
Regarding the impact on the numbers who will become insured, analyses such as this can provide a ballpark figure. The fact that the policies outlined in the current draft of the legislation would leave 37 million people without coverage likely has Senate HELP Committee members scurrying to patch the holes in the legislation and to look for other refinements that would expand coverage to more individuals.
There is an inverse relationship between government subsidies and the numbers of individuals who are left uninsured. Increasing the number of individuals eligible for the subsidies and increasing the amounts of the subsidies reduce the numbers of individuals left out, but that number will never be zero. A policy of using government subsidies to purchase private plans will always fall short of universality. The only way to cover absolutely everyone is to make enrollment automatic, and to separate the financing by changing from premiums linked to individual plans to a global system financed through equitable tax policies.
Looking only at the numbers of individuals left without insurance skirts another crucial issue. The rate of underinsurance is exploding. Offering multiple tiers of different priced plans in an insurance exchange automatically results in an expansion of underinsurance. Even with subsidies, healthy individuals will select inadequate plans with the lowest premiums, sincerely believing that this is all they can afford. But what good is insurance if you can still be left bankrupt with medical bills?
This proposal leaves too many without health insurance, fails to control our escalating health care costs, and expands the market of underinsurance products. The staff members at CBO, JCT, the HELP Committee, the Finance Committee, and the House Committees will get busy introducing policy refinements for the legislative proposals. Then they will finally bring us a product that leaves too many without health insurance, fails to control our escalating health care costs, and expands the market of underinsurance products.
Dr. Margaret Flowers and Dr. Carol Paris
TruthDig
Jun 15, 2009
As the American Medical Association begins its annual convention in Chicago, we want to take this opportunity to make it clear to the American public, to the media, and to the president and members of Congress, that the AMA does not represent us. It is a common misconception that this organization speaks on behalf of most American physicians but that is a misconception with very serious consequences at such a critical time in the health care reform debate. So long as the public, the media and our elected officials lump all physicians together as “the AMA,” then we are guilty by association of a failure of our Hippocratic oath to “first, do no harm.”
In fact, the AMA represents less than one-third of America’s physicians, and half of those are retired. In fact, the American Medical Student Association endorses universal health care reform.
The AMA’s longstanding opposition to every effort to change health care financing, including Medicare in the 1960s, has resulted in decades of needless and countless morbidity and mortality. Sixty people die every day in this country simply for lack of access to health care. And instead of being an advocate for the only solution that accomplishes the goals of universal coverage and fiscal viability, the single-payer option, the AMA continues to be primarily a trade association looking out for the financial interests of its members.
But who, then, is looking out for the interests of patients? Certainly not Congress and the president. If that were so, the United States would long ago have relieved itself of the dubious distinction of being the only developed country in the world that does not have a universal system of health care. No, the evidence is clear that our Congress and our president are looking out for themselves and continuing the tradition of pay-to-play politics. How else would a reasonable person explain the fact that our elected officials, Democrats and Republicans combined, have accepted $12 million in campaign contributions since 1998 from the American Medical Association?
We would suggest that the American people, the media, President Obama, and the members of Congress need look no further than PNHP, Physicians for a National Health Program, if they want to consult an organization that represents the interests of patients and has been doing so for 22 years.
We are proud members of PNHP. We’re waiting and eager to be consulted. And our physicians are willing and able to continue to engage in acts of nonviolent civil disobedience. Health care reform is the civil rights issue of the decade.
The AMA does not represent us.
Dr. Margaret Flowers and Dr. Carol Paris are members of Physicians for a National Health Program.
