PNHP

Hold out for single payer

Hold out for single payer

By Nick Skala

The following remarks were presented to the Congressional Progressive Caucus on June 4.

Today the Congressional Progressive Caucus faces a choice. That choice is whether Members should maintain their unflinching support for single-payer, or to accede to intense political pressure to support the plan currently being developed in Congress under the direction of President Obama: a mandate for Americans to purchase an insurance plan from a massive new regulatory “exchange,” with one plan potentially being a “public option.”

The difference between these choices could not be more stark: single-payer has at its core the elimination of U.S.-style private insurance, using huge administrative savings and inherent cost control mechanisms to provide comprehensive, sustainable universal coverage.

The “public option” preserves all of the systemic defects inherent in reliance on a patchwork of private insurance companies to finance health care, a system which has been a miserable failure both in providing health coverage and controlling costs.

Elimination of U.S.-style private insurance has been a prerequisite to the achievement of universal health care in every other industrialized country in the world. In contrast, public program expansions coupled with mandates have failed everywhere they’ve been tried, both domestically and internationally.

Many progressives accept that the “public option” is inferior to a single-payer system, yet support it because of its perceived political expedience. It is my aim today to convince you that the “public option” program currently being developed is not only bad health policy, but bad health politics.

On two separate occasions last month, physicians and nurses were dragged from the Senate Finance Committee in handcuffs for demanding that single-payer be considered in our nation’s health reform debate. These were American doctors and nurses, people who care for patients, people who want to practice medicine, not protest and disrupt Congress.

But these professionals risked their careers and their freedom. They did this not because they thought that the “public option” was “good” and single-payer “better.” They did it because they are firmly convinced, by well-established health policy science, that the so-called “public option” has no hope of remedying the systemic defects that cause their patients to suffer and die, sometimes before their very eyes.

Millions of dollars have been spent by political advocacy groups to commission polls and statistics “proving” that their health reform is “politically feasible.” Yet political winds do not make good health policy. Careful examination of science and experience do. And it is in the science and experience that we see that single-payer offers the only way to truly comprehensive, universal and sustainable health care, and that “public option” schemes offer only more of the same: tens of millions of uninsured, rapidly deteriorating coverage, an epidemic of medical bankruptcy, and skyrocketing costs that will eventually cripple the system.

First, because the “public option” is built around the retention of private insurance companies, it is unable – in contrast to single-payer – to recapture the $400 billion in administrative waste that private insurers currently generate in their drive to fight claims, issue denials and screen out the sick. A single-payer system would redirect these huge savings back into the system, requiring no net increase in health spending.

In contrast, the “public option” will require huge new sources of revenue, currently estimated at around $1 trillion over the next decade. Rather than cutting this bloat, the public option adds yet another layer of useless and complicated bureaucracy in the form of an “exchange,” which serves no useful function other than to police and broker private insurance companies.

Second, because the “public option” fails to contain the cost control mechanism inherent in single-payer, such as global budgeting, bulk purchasing and planned capital expenditures, any gains in coverage will quickly be erased as costs skyrocket and government is forced to choose between raising revenue and cutting benefits.

Third, because of this inability to control costs or realize administrative savings, the coverage and benefits that can be offered will be of the same type currently offered by private carriers, which cause millions of insured Americans to go without needed care due to costs and have led to an epidemic of medical bankruptcies.

Supporters of incremental reform once again promise us universal coverage without structural reform, but we’ve heard this promise dozens of times before.

Virtually all of the reforms being floated by President Obama and other centrist Democrats have been tried, and have failed repeatedly. Plans that combined mandates to purchase coverage with Medicaid expansions fell apart in Massachusetts (1988), Oregon (1992), and Washington state (1993); the latest iteration (Massachusetts, 2006) is already stumbling, with uninsurance again rising and costs soaring. Tennessee’s experiment with a massive Medicaid expansion and a public plan option worked – for one year, until rising costs sank it.

The Federal Employee Health Benefit Program (the model for a health insurance exchange) leaves hundreds of thousands of federal workers uninsured, and has proven unable to contain costs.

Negative results in a recent series of randomized trials explodes the hope that chronic disease management will cut costs. And the CBO has thrown a wet blanket on the notion that electronic medical records save money.

As Drs. David Himmelstein and Steffie Woolhandler, co-founders of Physicians for a National Health Program, have remarked, a public plan option does not lead toward single-payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan. A quarter-century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry-picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan – which started as a single-payer system for seniors and have now become a funding mechanism for HMOs – and a place to dump the unprofitably ill.

Progressive supporters of the “public option” readily concede that single-payer is a superior system. Indeed, their response to evidence that their plan won’t work is to commission more charts and graphs emphasizing its political feasibility.

The “public option” is truly the embodiment of health policy designed by sound bytes, cobbled together from snippets of information gathered from focus groups and public opinion polls, and centered around well-polling buzzwords such as “choice” and “shared responsibility.”

Such a plan may be enough to excite the political classes in Washington, who care more about what they think can pass the Congress than what will actually deliver universal, comprehensive health care for all. But doctors and nurses, the people who actually work in the health system, see right through it. They are going to jail because they know that this plan won’t work for their patients.

Nobody is going to jail for the “public option,” because the American people cannot be inspired by band-aids and half-measures it is impossible to believe in.

These doctors and nurses are the manifestation of a social movement, millions strong, that is waiting to be mobilized by the leadership of the Members in this room. Polls consistently show that two-thirds of the American people want single-payer. At a recent hearing in Montana convened by Sen. Max Baucus, only 10 people of three hundred said they were happy with the insurance they have. Sixty percent of physicians support single-payer, as do the U.S. Conference of Mayors and 39 state labor federations and hundreds of local unions across the country.

We’re told that holding out for single-payer is politically unwise, but to compromise and accept a bad plan at precisely the time when popular support and grassroots energy are on the side of true reform is the real political miscalculation.

The history of great social achievement is rife with instances in which the forces of institutionalized power told social movements – as they now tell this one – that what they wanted was too much, or too fast, or too soon. I think, of course, of the abolition of human slavery, the enfranchisement of women, the Civil Rights Movement, Social Security, the minimum wage, an end to child labor. In each of these instances, social movements held fast to their principles and soon discovered that they had been told was “politically unfeasible” one moment was political reality the next.

We currently have a better chance to pass single-payer than Lyndon Johnson had when he passed Medicare. Unlike the public option, single-payer – because it holds the potential to finally realize universal, equitable health care – can be a vehicle to inspire the American people for progressive change.

The voices of doctors and nurses can achieve extraordinary resonance when they speak selflessly in their patients’ interest. But your leadership is crucial to inspire the American people. It is my hope that you’ll see fit to provide it.

Click here for a printable version of the handout below.

The “Public Option” Fails as Health Politics:

  Single-Payer “Public Option”
Number Insured Universal Coverage Millions remain uninsured or underinsured
Coverage Coverage for all medically necessary services. Insurers continue to strip-down policies and increase patients’ co-payments and deductibles.
Cost Redirect $350 billion in administrative waste to care; no net increase in health spending. Increase health spending more than $1 trillion over 10 years.
Savings $350 billion in administrative waste. Further systemic savings achieved through negotiated fee schedule with physicians, global budgeting of hospitals, bulk purchasing of pharmaceuticals, rational planning of capital expenditures, etc. Add further layers of administrative bloat to our health system through the introduction of a regulator / broker “exchange.”
Sustainability Large scale cost controls (global budgeting, capital planning, etc.) ensure that benefits are sustainable over the long term. Uncontrolled costs ensure that any gains in coverage are quickly erased as government is forced to hike spending or slash benefits.

But Getting “Something” is Better than Getting “Nothing,” Isn’t It?

Not if that “something” makes it more difficult to reach a real solution and ensures temporary relief will be followed by prolonged suffering. The “public option” may allow some people to buy inadequate insurance products for a short time. But such a system will quickly be crushed by the weight of rising health care costs, as Medicaid, SCHIP and dozens of state initiatives have been.

In addition, expending political capital on reforms that we know will fail makes the public cynical and gives ammunition to those who say that the government cannot create effective programs. Hence, any attempt at real reform is delayed, usually by decades. The minor temporal relief that reformers might get by acquiescing to insurance industry demands is simply not worth the continued suffering of the American people.

But Such a System to Could be a “Step” Towards Universal Coverage, Right?

No. Enacting phony “universal coverage” has not brought any state closer to a single-payer system. Since the early 1990s, Minnesota, Oregon, Maine, Florida, Utah, Washington, California, Vermont and Massachusetts have been among the states that have attempted to “patch-up” their fundamentally fl awed systems while retaining a place for insurance companies. All have failed. Upon passage, incremental reforms in each of these states were hailed by politicians and the media as a “step toward universal coverage.” Yet despite all the claims of pragmatism, incremental reformers have been unable to shepherd through meaningful change in nearly four decades of trying. And while reformers in these states continue to wait for the next “step,” residents continue to suffer.

The definition of insanity is to repeat an action expecting a different result. This is exactly what we have done in continuing to advocate incremental reforms as “steps” toward single-payer. What Americans need is not more proposals for patchwork reforms. We need leaders willing to stand up for the only solution that will work.

Nick Skala is a member of Physicians for a National Health Program (www.pnhp.org).

Protesters want Baucus to consider single-payer system

By JOHN S. ADAMS
Great Falls Tribune
June 6, 2009

HELENA–Undeterred by Sen. Max Baucus’ steadfast refusal to inject single-payer into the congressional debate on health care reform, more than 100 proponents of a “Medicare-for-all” form of nationalized health insurance rallied for their cause on Friday.

Protesters in Helena, Great Falls, Missoula, Bozeman and Butte gathered at Baucus’ local field offices and demanded that Montana’s senior senator, and chairman of the powerful Senate Finance Committee, put single-payer back on the table.

Eric Feaver, president of the state’s largest labor union, MEA-MFT, addressed the crowd at the amphitheater at the Great Northern Town Center and said he doesn’t want to “trash” Baucus, but that Baucus is on the wrong path by ignoring single-payer.

“I think he has a very difficult job and he has 100 senators to work with that are not of one mind,” Feaver said. “But I am here to remind Sen. Baucus that MEA-MFT does have 18,000 members who live and work everywhere in this state and they all vote. And they have supported single-payer for many years.”

Though Baucus has been frigid to the idea of single-payer, he has said he’d consider supporting a public option in which the federal government would create an insurance plan that would compete with private insurance plans. However, Baucus also has floated the idea of taxing employer-provided health care benefits, a proposal MEA-MFT adamantly opposes, Feaver said.

“The working men and women of this state support health care reform, and they want the most comprehensive health care reform possible,” Feaver said.

Kim Abbott, lead organizer for the Montana Human Rights Network’s Right to Healthcare program, said affordable health care is not a privilege, but a human right.

“There is nothing more infuriating, or frustrating or sickening than knowing the answer but not having the political will to do the right thing,” Abbott said. “We all know the answer. What’s the answer?”

“Single payer!” the crowd responded.

Dr. Carol Paris, a Maryland psychiatrist who was twice arrested last month for protesting single-payer’s exclusion from two Senate Finance Committee hearings, also appeared at Friday’s rally.

Paris, who was introduced as a “hero” of the single-payer movement for her acts of civil disobedience, said single-payer advocates need to “keep the heat on Sen. Baucus.”

“The next 60 days truly are critical,” Paris said. “We need to keep the momentum going here and in Washington.”

Paris said single-payer advocates have three demands of Baucus.

* That he and Sen. Ted Kennedy, D-Mass., hold Senate hearings on the merits of single-payer health care.

* That Baucus order the Congressional Budget Office to study the costs of implementing the Senate and House versions of single payer bills that have already been introduced.

* That Baucus arrange a meeting between President Barack Obama and single-payer experts.

After the rally protesters walked to Baucus’ office around the corner. A Baucus staffer handed protesters a sheet of paper with Baucus’ position on single payer.

“For more than a year Sen. Baucus has been laying the ground work to enact comprehensive, meaningful health care reform,” the letter said in part.

It went on to say that Baucus and single-payer advocates “share the same goal.”

“Both Senator Baucus and single payer advocates believe that every Montanan should have quality, affordable health care,” the letter stated.

The two sides remain far from agreement on how to achieve that goal.

Kaiser Health Tracking Poll

Kaiser Health Tracking Poll

Kaiser Family Foundation
April 2-8, 2009
7. Now I’m going to read you some different ways to increase the number of Americans covered by health insurance. As I read each one, please tell me whether you would favor it or oppose it. Here’s the (first/next) one — (INSERT AND RANDOMIZE- ALWAYS ASK ITEMS d AND h LAST). Do you favor or oppose this? (Is that strongly favor/oppose or somewhat favor/oppose?)
Items b-d based on half sample (n=616)
Items e-h based on half sample (n=587)
a. Requiring employers to offer health insurance to their workers or pay money into a government fund that will pay to cover those without insurance
71% favor
25% oppose
b. Offering tax credits to help people buy private health insurance
67% favor
29% oppose
c. Expanding Medicare to cover people between the ages of 55 and 64 who do not have health
insurance
79% favor
18% oppose
d. Creating a government-administered public health insurance option similar to Medicare to compete with private health insurance plans
67% favor
29% oppose
e. Expanding state government programs for low-income people, such as Medicaid and the State Children’s Health Insurance Program
77% favor
20% oppose
f. Requiring all Americans to have health insurance, either from their employer or from another source, with financial help for those who can’t afford it
72% favor
25% oppose
g. Having a national health plan in which all Americans would get their insurance from a single government plan
49% favor
47% oppose
h. Creating a public health insurance option similar to Medicare to compete with private health insurance plans
67% favor
29% oppose
http://www.kff.org/kaiserpolls/upload/7892.pdf

Two-thirds to three-fourths of Americans support each of the reform options listed, except one. Americans are fairly evenly divided on “Having a national health plan in which all Americans would get their insurance from a single government plan.”
This is not a fluke. When the same survey was conducted in December, 2008 (minus the questions on public health insurance options), the results were very similar.
We could speculate as to why this poll seems to indicate less support for a single payer national health program than do other polls. Factors such as phrasing, context, demographics of the population polled, and so forth could explain the variation in the responses. If so, that would suggest that single payer support is quite malleable. That would mean that the threshold of a mandate for single payer reform has not yet been reached.
My opinion, which some may dispute, is that healthy Americans, who have good jobs and what they perceive to be adequate, employer-financed health care coverage, are not yet ready to trade that insurance in for an unknown government program which they assume they would have to pay for themselves, either through a premium or through higher taxes.
Pretending that the majority of Americans would risk their current health security for a more egalitarian system for everyone will not move the process for reform forward. Only when people understand that a single payer system would benefit them individually would they be willing to support reform that incidentally benefits everyone else as well.
We still have work to do.

Kaiser Health Tracking Poll

Kaiser Health Tracking Poll

Kaiser Family Foundation
April 2-8, 2009

7. Now I’m going to read you some different ways to increase the number of Americans covered by health insurance. As I read each one, please tell me whether you would favor it or oppose it. Here’s the (first/next) one — (INSERT AND RANDOMIZE- ALWAYS ASK ITEMS d AND h LAST). Do you favor or oppose this? (Is that strongly favor/oppose or somewhat favor/oppose?)

Items b-d based on half sample (n=616)
Items e-h based on half sample (n=587)

a. Requiring employers to offer health insurance to their workers or pay money into a government fund that will pay to cover those without insurance
71% favor
25% oppose

b. Offering tax credits to help people buy private health insurance
67% favor
29% oppose

c. Expanding Medicare to cover people between the ages of 55 and 64 who do not have health
insurance
79% favor
18% oppose

d. Creating a government-administered public health insurance option similar to Medicare to compete with private health insurance plans
67% favor
29% oppose

e. Expanding state government programs for low-income people, such as Medicaid and the State Children’s Health Insurance Program
77% favor
20% oppose

f. Requiring all Americans to have health insurance, either from their employer or from another source, with financial help for those who can’t afford it
72% favor
25% oppose

g. Having a national health plan in which all Americans would get their insurance from a single government plan
49% favor
47% oppose

h. Creating a public health insurance option similar to Medicare to compete with private health insurance plans
67% favor
29% oppose

http://www.kff.org/kaiserpolls/upload/7892.pdf

Comment:

By Don McCanne, MD

Two-thirds to three-fourths of Americans support each of the reform options listed, except one. Americans are fairly evenly divided on “Having a national health plan in which all Americans would get their insurance from a single government plan.”

This is not a fluke. When the same survey was conducted in December, 2008 (minus the questions on public health insurance options), the results were very similar.

We could speculate as to why this poll seems to indicate less support for a single payer national health program than do other polls. Factors such as phrasing, context, demographics of the population polled, and so forth could explain the variation in the responses. If so, that would suggest that single payer support is quite malleable. That would mean that the threshold of a mandate for single payer reform has not yet been reached.

My opinion, which some may dispute, is that healthy Americans, who have good jobs and what they perceive to be adequate, employer-financed health care coverage, are not yet ready to trade that insurance in for an unknown government program which they assume they would have to pay for themselves, either through a premium or through higher taxes.

Pretending that the majority of Americans would risk their current health security for a more egalitarian system for everyone will not move the process for reform forward. Only when people understand that a single payer system would benefit them individually would they be willing to support reform that incidentally benefits everyone else as well.

We still have work to do.

Concerns about conflict of interests apply to Grassley, too

By JESS FIEDOROWICZ
Des Moines Register
June 7, 2009

Over the last several years, Iowa Sen. Charles Grassley has aggressively campaigned against conflict of interests in academic medicine. He has criticized academics at dozens of institutions across the country, including but not limited to Harvard and Stanford universities. His primary targets are government-funded researchers who had undisclosed or inadequately disclosed ties to the pharmaceutical industry. The concern as detailed by Grassley in a letter to the chancellor of the University of Texas system is that “funding from pharmaceutical companies can influence scientific studies, continuing medical education, and the prescribing patterns of doctors.” Beyond disclosure of this conflict, Grassley demands an explanation of how “the interest has been managed, reduced, or eliminated.”

The disclosure and management of conflict of interests is indeed an important concern for those with an ethical and fiduciary responsibility to act in the best interests of others. Physicians have a responsibility to act in the best interests of their patients. Elected officials have a responsibility to act in the best interests of those they represent. We should be pleased Grassley has brought up this very timely, relevant issue.

The Senate Finance Committee, on which Grassley serves as the ranking member, has recently taken up the issue of health-care reform. While potential conflicts of interest for committee members have not been formally disclosed as part of the process, the data is publicly available. According to MAPLight.org, Grassley received $376,893 and $243,722 in campaign contributions from the insurance and pharmaceutical industries, respectively, from 2003-2008. During this time, Committee Chairman Sen. Max Baucus (D-Mont.) received $592,185 and $524,813, from the same respective industries. There does not appear to be any plan to reduce or eliminate these apparent conflicts of interests. Yet, any conflict may interfere with the ethical and fiduciary responsibility of our representatives, and the behavior of committee members suggests conflicting interests.

In several polls, the majority of Americans and physicians support national health insurance. A single-payer, national health-insurance system could save over $350 billion annually by reducing unnecessary overhead and bureaucracy and is the most affordable option to provide universal coverage. Advocates for single-payer, national health insurance, however, were denied a seat at the table in Senate Finance Committee hearings led by Baucus, who instead included industry “stakeholders.” Grassley has gone even further, opposing any public plan, arguing “that the government is an unfair competitor” to private insurers. The position of the private insurance industry appears to be well represented. Populist proposals such as single payer have been ignored in the setting of strong industry opposition.

Money and power have tremendous influence in Washington. Grassley’s crusade against conflict of interests in academic medicine may provide insight into how we can combat similar undue influence in Washington to protect our democracy. Our representatives need to not only disclose conflicts, but also take measures to reduce risk. This minimally requires open inclusion and serious consideration of proposals with proven effectiveness or popular support, such as single-payer, national health insurance. It further requires re-identification of the American public as the real “stakeholders.”

JESS FIEDOROWICZ is an academic psychiatrist. Contact: mkejess@yahoo.com

Doctor critical of Baucus promotes single-payer plan

By MIKE DENNISON
Billings Gazette
Saturday, June 06, 2009

HELENA – Maryland psychiatrist Carol Paris is calling herself one of the “Baucus 13” these days – in other words, one of the 13 doctors, nurses and activists arrested last month while protesting before a Washington, D.C., health reform hearing chaired by Sen. Max Baucus, D-Mont.

On Friday, Paris was in Montana, doing what got her arrested: urging Baucus, Congress and the president to consider a single-payer system of national health insurance that covers all citizens equally.

“The next 60 days are critical,” she told a rally of 150 single-payer supporters in Helena. “We need to keep the heat on Sen. Baucus (and Congress and the president).”

Single-payer advocates held rallies in six Montana cities on Friday.
Paris, 56, is a member of Physicians for a National Health Program, whose 16,000 members are pushing for a national, publicly funded insurance plan that would replace private health insurance. The group paid for her trip to Montana.

In an interview Friday with the Gazette State Bureau, Paris said she used to believe that the private health insurance market could be reformed to improve health care, and she spent several years lobbying the Maryland Legislature.

“After a few years, I came to the conclusion that it was just a phenomenal waste of time,” she said. “At that point, I just said, there has to be a better place for me to put my time and energy.”

That was just six months ago, when she joined PNHP, to push for a single-payer system.

But Paris and other Maryland-area members found themselves basically ignored by Congress. They planned to protest – and get arrested – at a Senate Finance Committee hearing on health reform, chaired by Baucus.

Paris and her colleagues showed up the morning of May 5, spread themselves among the gallery and, one by one, interrupted Baucus as he started the meeting.

“I interrupt this so-called public hearing to bring you the following unpaid political announcement: Put single-payer on the table,” Paris said before she was arrested. “My name is Dr. Carol Paris, and I approved this message.”

Capitol police arrested the protesters, who have been charged with disrupting Congress.

Baucus, a key senator in drafting health reform legislation, said last week that he’ll ask that the charges be dropped. He’s said repeatedly that a single-payer system won’t be considered as a reform and is backing changes that maintain private health insurance.

Baucus spokesman Ty Matsdorf said Friday that the senator and single-payer advocates have the same goal of providing “quality, affordable health care to every American,” and that Baucus is confident that Congress will pass meaningful reform to “make this goal a reality.”

Paris, however, said her experience in private practice has convinced her that true reform can happen only if private health insurance is replaced with national, public insurance for all.

No longer would physicians’ staff have to spend hours dealing with multiple insurers on billing, no longer would patients have to do the same, and no longer would patients have to worry about which doctor is “in network,” she said. “You can go to any doctor you want,” Paris said. “It’s the private insurance industry where you can’t go to any place you want.”

Paris’s arrest was covered prominently by her local newspaper but received little or no attention from national news outlets.

She said she’s not surprised: “The mainstream, national media have blacked us out as much as Congress has. … I would say they’re following the lead of the president and Congress and simply not giving us a voice.”

Yet Paris said the reaction from her patients, as well as many fellow physicians, has been overwhelmingly positive.

She said she hears “over and over and over again” how people are frustrated by the current system, particularly dealing with their insurer, and that as soon as they understand how single-payer would work, they usually support it.

“I think that the only thing that keeps this from happening is the lack of political will by the president and our Congress,” Paris said.

Debunking Canadian health care myths

By Rhonda Hackett
The Denver Post, June 7, 2009

As a Canadian living in the United States for the past 17 years, I am frequently asked by Americans and Canadians alike to declare one health care system as the better one.

Often I’ll avoid answering, regardless of the questioner’s nationality. To choose one or the other system usually translates into a heated discussion of each one’s merits, pitfalls, and an intense recitation of commonly cited statistical comparisons of the two systems.

Because if the only way we compared the two systems was with statistics, there is a clear victor. It is becoming increasingly more difficult to dispute the fact that Canada spends less money on health care to get better outcomes.

Yet, the debate rages on. Indeed, it has reached a fever pitch since President Barack Obama took office, with Americans either dreading or hoping for the dawn of a single-payer health care system. Opponents of such a system cite Canada as the best example of what not to do, while proponents laud that very same Canadian system as the answer to all of America’s health care problems. Frankly, both sides often get things wrong when trotting out Canada to further their respective arguments.

As America comes to grips with the reality that changes are desperately needed within its health care infrastructure, it might prove useful to first debunk some myths about the Canadian system.

Myth: Taxes in Canada are extremely high, mostly because of national health care.

In actuality, taxes are nearly equal on both sides of the border. Overall, Canada’s taxes are slightly higher than those in the U.S. However, Canadians are afforded many benefits for their tax dollars, even beyond health care (e.g., tax credits, family allowance, cheaper higher education), so the end result is a wash. At the end of the day, the average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.

Myth: Canada’s health care system is a cumbersome bureaucracy.

The U.S. has the most bureaucratic health care system in the world. More than 31 percent of every dollar spent on health care in the U.S. goes to paperwork, overhead, CEO salaries, profits, etc. The provincial single-payer system in Canada operates with just a 1 percent overhead. Think about it. It is not necessary to spend a huge amount of money to decide who gets care and who doesn’t when everybody is covered.

Myth: The Canadian system is significantly more expensive than that of the U.S.

Ten percent of Canada’s GDP is spent on health care for 100 percent of the population. The U.S. spends 17 percent of its GDP but 15 percent of its population has no coverage whatsoever and millions of others have inadequate coverage. In essence, the U.S. system is considerably more expensive than Canada’s. Part of the reason for this is uninsured and underinsured people in the U.S. still get sick and eventually seek care. People who cannot afford care wait until advanced stages of an illness to see a doctor and then do so through emergency rooms, which cost considerably more than primary care services.

What the American taxpayer may not realize is that such care costs about $45 billion per year, and someone has to pay it. This is why insurance premiums increase every year for insured patients while co-pays and deductibles also rise rapidly.

Myth: Canada’s government decides who gets health care and when they get it.

While HMOs and other private medical insurers in the U.S. do indeed make such decisions, the only people in Canada to do so are physicians. In Canada, the government has absolutely no say in who gets care or how they get it. Medical decisions are left entirely up to doctors, as they should be.

There are no requirements for pre-authorization whatsoever. If your family doctor says you need an MRI, you get one. In the U.S., if an insurance administrator says you are not getting an MRI, you don’t get one no matter what your doctor thinks — unless, of course, you have the money to cover the cost.

Myth: There are long waits for care, which compromise access to care.

There are no waits for urgent or primary care in Canada. There are reasonable waits for most specialists’ care, and much longer waits for elective surgery. Yes, there are those instances where a patient can wait up to a month for radiation therapy for breast cancer or prostate cancer, for example. However, the wait has nothing to do with money per se, but everything to do with the lack of radiation therapists. Despite such waits, however, it is noteworthy that Canada boasts lower incident and mortality rates than the U.S. for all cancers combined, according to the U.S. Cancer Statistics Working Group and the Canadian Cancer Society. Moreover, fewer Canadians (11.3 percent) than Americans (14.4 percent) admit unmet health care needs.

Myth: Canadians are paying out of pocket to come to the U.S. for medical care.

Most patients who come from Canada to the U.S. for health care are those whose costs are covered by the Canadian governments. If a Canadian goes outside of the country to get services that are deemed medically necessary, not experimental, and are not available at home for whatever reason (e.g., shortage or absence of high tech medical equipment; a longer wait for service than is medically prudent; or lack of physician expertise), the provincial government where you live fully funds your care. Those patients who do come to the U.S. for care and pay out of pocket are those who perceive their care to be more urgent than it likely is.

Myth: Canada is a socialized health care system in which the government runs hospitals and where doctors work for the government.

Princeton University health economist Uwe Reinhardt says single-payer systems are not “socialized medicine” but “social insurance” systems because doctors work in the private sector while their pay comes from a public source. Most physicians in Canada are self-employed. They are not employees of the government nor are they accountable to the government. Doctors are accountable to their patients only. More than 90 percent of physicians in Canada are paid on a fee-for-service basis. Claims are submitted to a single provincial health care plan for reimbursement, whereas in the U.S., claims are submitted to a multitude of insurance providers. Moreover, Canadian hospitals are controlled by private boards and/or regional health authorities rather than being part of or run by the government.

Myth: There aren’t enough doctors in Canada.

From a purely statistical standpoint, there are enough physicians in Canada to meet the health care needs of its people. But most doctors practice in large urban areas, leaving rural areas with bona fide shortages. This situation is no different than that being experienced in the U.S. Simply training and employing more doctors is not likely to have any significant impact on this specific problem. Whatever issues there are with having an adequate number of doctors in any one geographical area, they have nothing to do with the single-payer system.

And these are just some of the myths about the Canadian health care system. While emulating the Canadian system will likely not fix U.S. health care, it probably isn’t the big bad “socialist” bogeyman it has been made out to be.

It is not a perfect system, but it has its merits. For people like my 55-year-old Aunt Betty, who has been waiting for 14 months for knee-replacement surgery due to a long history of arthritis, it is the superior system. Her $35,000-plus surgery is finally scheduled for next month. She has been in pain, and her quality of life has been compromised. However, there is a li
ght at the end of the tunnel. Aunt Betty — who lives on a fixed income and could never afford private health insurance, much less the cost of the surgery and requisite follow-up care — will soon sport a new, high-tech knee. Waiting 14 months for the procedure is easy when the alternative is living in pain for the rest of your life.

Rhonda Hackett of Castle Rock is a clinical psychologist.

http://www.denverpost.com/opinion/ci_12523427

President Obama on the individual mandate

Letter from President Barack Obama to Senator Edward Kennedy and Senator Max Baucus

The White House
June 2, 2009
Excerpt
The meeting that we held today was very productive and I want to commend you for your leadership — and the hard work your Committees are doing on health care reform, one of the most urgent and important challenges confronting us as a Nation.
I understand the Committees are moving towards a principle of shared responsibility — making every American responsible for having health insurance coverage, and asking that employers share in the cost. I share the goal of ending lapses and gaps in coverage that make us less healthy and drive up everyone’s costs, and I am open to your ideas on shared responsibility. But I believe if we are going to make people responsible for owning health insurance, we must make health care affordable. If we do end up with a system where people are responsible for their own insurance, we need to provide a hardship waiver to exempt Americans who cannot afford it. In addition, while I believe that employers have a responsibility to support health insurance for their employees, small businesses face a number of special challenges in affording health benefits and should be exempted.
http://www.whitehouse.gov/blog/The-President-Spells-Out-His-Vision-on-Health-Care-Reform/

Numerous media reports are proclaiming that President Obama is now open to an individual mandate – a requirement that each uninsured individual purchase a basic health plan. But what did he really say?
He said that if we make people responsible for their own insurance (individual mandate), then we must grant a hardship waiver to exempt people who cannot afford it. But the primary reason that people have not purchased insurance in the individual market is that the plans are not affordable. Most of these individuals will be eligible for the hardship waiver and will remain uninsured.
What else did he say? He said that small businesses should be exempted from the responsibility of supporting health insurance for their employees since they face special challenges in affording health benefits. But for 80 percent of the uninsured, the head of the household is employed, predominantly by small businesses.
So President Obama has endorsed an individual mandate that would expand coverage to everyone – except those who cannot afford to pay for the coverage, and those whose jobs are in small businesses that cannot afford to provide employee health benefits. That is, we’ll cover everyone except most of those who are currently uninsured, nor those who will lose their health benefits as the rate of employer-sponsored coverage continues to decline, especially with a pessimistic job outlook.
The president’s letter is more than a personal communication to a couple of senators. It is a consensus statement, meant for public consumption, on the agreement between the administration and Congress on the most basic fundamentals of the reform legislation to be completed, as the president stated, in the “make-or-break window” before the August recess. Reading the full letter makes you realize how low the expectations are for the final reform product.
Sen. Baucus has expressed remorse for not giving single payer advocates an audience, but he has also stated that it is too late in the process to do so now. However, on June 10, the House Committee on Education and Labor will hold a hearing, “Examining the Single Payer Health Care Option.”
Although single payer legislation has already been introduced in both the House and the Senate, the logistics of lining up the political ducks before the August recess is nigh close to an impossibility. Nevertheless, do not let up on your efforts. In the next couple of months, while health reform is on the front burner, the flames must be stoked with our loud and clear message that we need reform that actually will accomplish the goal of affordable health care for all.
Though we may miss this one, the “make-or-break window” does not close with the August recess. The 2010 election process is already beginning. Individuals and organizations should begin immediately to use strategies and tactics to be certain that candidates understand that they will not be elected unless they support a single payer national health program. That should be the make-or-break litmus test for the 2010 elections.

President Obama on the individual mandate

Letter from President Barack Obama to Senator Edward Kennedy and Senator Max Baucus

The White House
June 2, 2009

Excerpt

The meeting that we held today was very productive and I want to commend you for your leadership — and the hard work your Committees are doing on health care reform, one of the most urgent and important challenges confronting us as a Nation.

I understand the Committees are moving towards a principle of shared responsibility — making every American responsible for having health insurance coverage, and asking that employers share in the cost. I share the goal of ending lapses and gaps in coverage that make us less healthy and drive up everyone’s costs, and I am open to your ideas on shared responsibility. But I believe if we are going to make people responsible for owning health insurance, we must make health care affordable. If we do end up with a system where people are responsible for their own insurance, we need to provide a hardship waiver to exempt Americans who cannot afford it. In addition, while I believe that employers have a responsibility to support health insurance for their employees, small businesses face a number of special challenges in affording health benefits and should be exempted.

http://www.whitehouse.gov/blog/The-President-Spells-Out-His-Vision-on-Health-Care-Reform/

Comment:

By Don McCanne, MD

Numerous media reports are proclaiming that President Obama is now open to an individual mandate – a requirement that each uninsured individual purchase a basic health plan. But what did he really say?

He said that if we make people responsible for their own insurance (individual mandate), then we must grant a hardship waiver to exempt people who cannot afford it. But the primary reason that people have not purchased insurance in the individual market is that the plans are not affordable. Most of these individuals will be eligible for the hardship waiver and will remain uninsured.

What else did he say? He said that small businesses should be exempted from the responsibility of supporting health insurance for their employees since they face special challenges in affording health benefits. But for 80 percent of the uninsured, the head of the household is employed, predominantly by small businesses.

So President Obama has endorsed an individual mandate that would expand coverage to everyone – except those who cannot afford to pay for the coverage, and those whose jobs are in small businesses that cannot afford to provide employee health benefits. That is, we’ll cover everyone except most of those who are currently uninsured, nor those who will lose their health benefits as the rate of employer-sponsored coverage continues to decline, especially with a pessimistic job outlook.

The president’s letter is more than a personal communication to a couple of senators. It is a consensus statement, meant for public consumption, on the agreement between the administration and Congress on the most basic fundamentals of the reform legislation to be completed, as the president stated, in the “make-or-break window” before the August recess. Reading the full letter makes you realize how low the expectations are for the final reform product.

Sen. Baucus has expressed remorse for not giving single payer advocates an audience, but he has also stated that it is too late in the process to do so now. However, on June 10, the House Committee on Education and Labor will hold a hearing, “Examining the Single Payer Health Care Option.”

Although single payer legislation has already been introduced in both the House and the Senate, the logistics of lining up the political ducks before the August recess is nigh close to an impossibility. Nevertheless, do not let up on your efforts. In the next couple of months, while health reform is on the front burner, the flames must be stoked with our loud and clear message that we need reform that actually will accomplish the goal of affordable health care for all.

Though we may miss this one, the “make-or-break window” does not close with the August recess. The 2010 election process is already beginning. Individuals and organizations should begin immediately to use strategies and tactics to be certain that candidates understand that they will not be elected unless they support a single payer national health program. That should be the make-or-break litmus test for the 2010 elections.

Medical Bills Cause Most Bankruptcies

By Tara Parker-Pope
New York Times blog
June 4, 2009

Nearly two out of three bankruptcies stem from medical bills, and even people with health insurance face financial disaster if they experience a serious illness, a new study shows.

The study data, published online Thursday in The American Journal of Medicine, likely understate the full scope of the problem because the data were collected before the current economic crisis. In 2007, medical problems contributed to 62.1 percent of all bankruptcies. Between 2001 and 2007, the proportion of all bankruptcies attributable to medical problems rose by about 50 percent.

“The U.S. health care financing system is broken, and not only for the poor and uninsured,” the study authors wrote. “Middle-class families frequently collapse under the strain of a health care system that treats physical wounds, but often inflicts fiscal ones.”

The data on medical bankruptcy, compiled by researchers at Harvard Law School, Harvard Medical School and Ohio University, is based on a survey of 2,314 randomly selected bankruptcy filers during early 2007.

Among families who were bankrupted by illness, those with private insurance reported average medical bills of $17,749 compared to those who were uninsured, who faced an average of $26,971 in medical costs. Those who had health insurance but lost it in the course of their illness reported average medical bills of $22,568.

Hospital costs accounted for about half the expenses (48 percent), followed by prescription drugs (18.6 percent), doctor’s bills (15.1 percent) and insurance premiums (4.1 percent). Medical equipment and nursing home care rounded out the list.

The health problems that left patients with the highest out-of-pocket expenses were ranked as follows:

Neurologic (i.e., multiple sclerosis): $34,167
Diabetes: $26,971
Injuries: 25,096
Stroke: $23,380
Mental illnesses: $23,178
Heart disease: $21,955

Regressive and Unaffordable

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/

Q&A with: Single-payer advocate Dr. Thomas Clairmont

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