David Sirota
San Francisco Chronicle
Friday, May 15, 2009

The most stunning and least reported news about President Obama’s press conference with health industry executives this week wasn’t those executives’ willingness to negotiate with a Democrat. It was that Democrat’s eagerness to involve those executives in a discussion about health care reform even as they revealed their previous plans to pilfer $2 trillion from Americans.

That was the little-noticed message from the made-for-TV spectacle administration officials called a health care “game changer”: In saying they can voluntarily slash $200 billion a year from the country’s medical bills over the next decade and still preserve their profits, health care companies implicitly acknowledged they were plotting to fleece consumers, and have been fleecing them for years. With that acknowledgment came the tacit admission that the industry’s business is based not on respectable returns but on grotesque profiteering and waste – the kind that can give up $2 trillion and still guarantee huge margins.

Chief among the profiteers at the White House event were insurance companies, which have raised premiums by 119 percent since 1999, and one obvious question is why – why would Obama engage those particular thieves?

It’s a difficult query to answer, because Obama is a health care mystery, struggling to muster consistent positions on the issue.

Listening to a 2003 Obama speech, it’s hard to believe he has become such an enigma. Back then, he declared himself “a proponent of a single-payer universal health care program” – i.e., one eliminating private insurers and their overhead costs by having government finance health care. Obama’s position was as controversial then as today – which is to say, controversial among political elites, but not among the public. ABC’s 2003 poll showed almost two-thirds of Americans desiring a single-payer system “run by the government and financed by taxpayers,” just as CBS’ 2009 poll shows roughly the same percentage today.

In that speech six years ago, Obama said the only reason single-payer proponents should tolerate delay is “because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

This might explain why when Illinois contemplated a 2004 health care proposal raising insurance lobbyists’ “fears that it would result in a single-payer system,” those lobbyists “found a sympathetic ear in Obama, who amended (read: gutted) the bill more to their liking,” according to the Boston Globe. Maybe Obama didn’t think single payer was achievable without a Democratic Washington. And when, in a 2006 interview, he told me he was “not convinced that (single payer) is the best way to achieve universal health care,” perhaps he was following the same rationale, considering his insistence that he must “take into account what is possible.”

Of course, even as a senator aiming for the “possible” in a Republican Congress, Obama promised to never “shy away from a debate about single payer.” And after the 2008 election fulfilled his single-payer precondition of Democratic dominance, it was only logical to expect him to initiate that debate.

That’s why the White House’s current posture is so puzzling. As the Associated Press reports, Obama aides are trying to squelch any single-payer discussion, deploying their health care point-person, Sen. Max Baucus, D-Mont., to announce that “everything is on the table with the single exception of single-payer.”

So it’s back to why – why Obama’s insurance industry-coddling inconsistency? Is it a pol’s payback for campaign cash? Is it an overly cautious lawmaker’s paralysis? Is it a conciliator’s desire to appease powerful interests? Or is it something else?

For a president who spends so much time on camera answering questions, these have become the biggest unanswered questions.

David Sirota is a fellow at the Campaign for America’s Future. Find his blog at OpenLeft.com or e-mail him at ds@davidsirota.com.

This article appeared on page A – 13 of the San Francisco Chronicle
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/05/14/EDMF17KIVP.DTL

By Amy Goodman
Syndicated columnist
The Seattle Times
Thursday, May 14, 2009

Barack Obama appeared this week with health-industry bigwigs, proclaiming light at the end of the health-care tunnel. Among those gathered were executives from HMO giants Kaiser Foundation Health Plan and Health Net Inc., and the health-insurance lobbying group America’s Health Insurance Plans; from the American Hospital Association and the American Medical Association; from medical-device companies; and from the pharmaceutical industry, including the president and CEO of Merck and former Rep. Billy Tauzin, now president and CEO of PhRMA, the massive industry lobbying group. They have pledged to voluntarily shave some $2 trillion off U.S. health-care costs over 10 years. But these groups, which are heavily invested in the U.S. health-care status quo, have little incentive to actually make good on their promises.

This is beginning to look like a replay of the failed 1993 health-care reform efforts led by then-first lady Hillary Rodham Clinton. Back then, the business interests took a hard line and waged a PR campaign, headlined by a fictitious middle-class couple, Harry and Louise, who feared a government-run health-care bureaucracy.

Still absent from the debate are advocates for single-payer, often referred to as “Canadian-style” health care. Single-payer health care is not “socialized medicine.” According to Physicians for a National Health Program, single-payer means “the government pays for care that is delivered in the private (mostly not-for-profit) sector.”

A February CBS News poll found that 59 percent in the U.S. say the government should provide national health insurance.

Single-payer advocates have been protesting in Senate Finance Committee hearings, chaired by Democratic Montana Sen. Max Baucus. Last week, at a committee hearing with 15 industry speakers, not one represented the single-payer perspective. A group of single-payer advocates, including doctors and lawyers, filled the hearing room and, one by one, interrupted the proceedings.

Protester Adam Schneider yelled: “We need to have single-payer at the table. I have friends who have died, who don’t have health care, whose health care did not withstand their personal health emergencies. … Single-payer now!”

Baucus gaveled for order, guffawing, “We need more police.” The single-payer movement has taken his words as a rallying cry. At a hearing Tuesday, five more were arrested. They call themselves the “Baucus 13.”

One of the Baucus 13, Kevin Zeese, recently summarized Baucus’ career campaign contributions:

“… from the insurance industry, $1,170,313; from health professionals, $1,016,276; pharmaceuticals/health-products industry, $734,605; hospitals/nursing homes, $541,891; health services/HMOs, $439,700.”

That’s almost $4 million from the very industries that have the most to gain or lose from health-care reform.

Another of the Baucus 13, Russell Mokhiber, co-founder of SinglePayerAction.org, has been charged with “disruption of Congress.”

He was quick to respond: “I charge Baucus with disrupting Congress. It once was a democratic institution; now it’s corrupt, because of people like him. He takes money from the industry and does their bidding. He won’t even diffuse the situation by seating a single-payer advocate at the table.”

As I traveled through Montana recently, from Missoula to Helena to Bozeman, health-care activists kept referring to Baucus as the “money man.” Montana state Sen. Christine Kaufmann sponsored an amendment to the Montana Constitution, granting everyone in Montana “the right to quality health care regardless of ability to pay,” or health care as a human right. It died in committee.

Wisconsin Sen. Russ Feingold, a single-payer advocate, said his position will not likely prevail in Washington: “I don’t think there’s any possibility that that will come out of this Congress.” That’s if things remain business as usual.

Mario Savio led the Free Speech Movement on the UC Berkeley campus. In 1964, he said: “There comes a time when the operation of the machine becomes so odious, makes you so sick at heart, that you can’t take part, you can’t even passively take part, and you’ve got to put your bodies upon the gears and upon the wheels, upon all the apparatus, and you’ve got to make it stop. And you’ve got to indicate to the people who run it, the people who own it, that unless you’re free, the machine will be prevented from working at all.”

“Unless you’re free,” the Baucus 13 might add, “to speak.” The current official debate has locked single-payer options out of the discussion, but also escalated the movement — from Healthcare-NOW! to Single Payer Action — to shut down the orderly functioning of the debate, until single-payer gets a seat at the table.

Amy Goodman is the host of “Democracy Now!,” a daily international TV/radio news hour airing on more than 750 stations in North America. Denis Moynihan contributed research to this column.

By PAUL DeMARCO
Spartanburg (S.C.) Herald-Journal
Sunday, May 17, 2009

I live in a town with a population of 7,000. I own a pair of shotguns, and I know how to use them — a wood duck and a turkey are mounted on my office wall. I drive a 2001 Dodge Dakota pickup with 150,000 miles on it.

I wear a coat and tie every day to work. I’m in church each Sunday and am not embarrassed to tell you that Jesus is my Savior. I believe in chivalry; I open doors for women and expect my teenage daughter’s dates to come into the house when they visit.

My usual TV-watching dilemma is “The Andy Griffith Show” or “M*A*S*H.” I’m about as old-fashioned, square and conservative as they come.

So where do I get off backing a single-payer national health plan, a plan where everybody’s covered in one big risk pool and health care is publicly financed (but privately delivered)? Shouldn’t I be a rugged individualist, telling people that if they want good health insurance they can pay attention in class, go to college and get a good job with full benefits just like I did?

Well, part of me could do that. No country can survive unless individual responsibility is at the core of its ethos.

But to the other part of me, the go-it-alone attitude just sounds downright mean.

That puts me in about the same mind-set as a Midwestern farmer in the mid-19th century. Farmers then and now are often independent, self-sufficient

and hesitant to incur a debt. But when a neighboring family needed a barn raised, that was a different story. No matter how hearty the farmer, he couldn’t raise a barn alone. And there was a healthy dose of self-interest in the proposition. If I help raise your barn, then when mine needs repairs, I’ll have your help.

So I look at single-payer health care in that conservative light. I recognize that a significant portion of America’s chronic disease burden is self-induced (e.g., some people eat, drink or smoke too much and make themselves sick). But I also know that much of your health is beyond your control — it’s either in your genes or not significantly altered by lifestyle. Think breast cancer and many other malignancies, flu and many other infectious diseases, Alzheimer’s dementia or rheumatoid arthritis.

I don’t suspect that farmers of yore did any research on the family who they helped. Whether the family was industrious or lazy, a barn was built because everyone needed a barn. Without a place to store hay and protect animals in the upcoming winter, livestock would die and the family would soon follow. No farmer, no matter how stoic, would consign his neighbor to that fate.

I support single-payer health care in this tradition. A single-payer program, which would expand Medicare to all Americans (rather than just those 65 and over), would create one large barn-raising community, 300-million strong. We would all chip in our share so that all families could have health care. Almost all of us would end up paying less than we do now (there would be no co-pays or deductibles), and we could choose any doctor or hospital we wanted.

Under our present setup, it’s hit and miss. Money typically dictates who gets care and who doesn’t.

A carpenter who works for a big company with insurance may get care; another who works for a small one can only dream about it.

A woman with lupus loses her job and her insurance and then becomes uninsurable because of her pre-existing condition.

A 60-year-old man with a bad knee is laid off when a plant closes in his rural hometown. Lame and unskilled in a region with rising unemployment, he will limp for five years until he qualifies for Medicare and can have his knee replaced.

Barn-raising worked because it is was a nonprofit enterprise. A farming community bound itself in a social contract. Many countries have single-payer social contracts, including our neighbor Canada, to ensure the health of all their citizens. There are many ways to inject a profit motive into the process, but they all taint it. Until the 1960s, medicine was also primarily a nonprofit endeavor. In recent decades, the huge profits available to for-profit insurance companies and hospitals have often elevated shareholders above patients, resulting in higher costs and inferior care.

All my instincts call for problems to be solved by individuals operating in a free-market economy. But private enterprise cannot solve this one. We have 40 years of evidence of the free market’s failure to control costs or cover everyone.

The plain truth is that the public single-payer systems we already have (Medicare, Medicaid and the VA) provide better coverage with less overhead than private companies. I know that statement is hard for many, including me, to swallow, but it’s true.

Medicare for all will not be a perfect system, but it will be far better than the fragmented, profit-warped system we have.

When America was younger, we knew not to turn our backs on new neighbors in need of a barn. In this older — and I hope wiser — America, we should not turn our backs on those who need health care. Tell your representative and senators to put single payer on the table in Washington.

Paul DeMarco, MD is a general internist who lives in Marion. He is a member of Physicians for a National Health Program (www.pnhp.org).

By Uwe E. Reinhardt
New York Times
Economix Blog
May 8, 2009, 6:48 am

With another “national conversation” about health reform upon us — as it is every decade or so — we will hear a lot of derisive talk about the evils of “socialized medicine.”

The term is regularly confused with “social health insurance,” which is not at all the same concept. The chart below may be helpful in appreciating the distinction.

Socialized medicine refers to health system in which the government owns and operates both the financing of health care and its delivery. Cell A in the chart represents socialized medicine.

Social health insurance, on the other hand, refers to systems in which individuals transfer their financial risk of medical bills to a risk pool to which, as individuals, they contribute taxes or premiums based primarily on ability to pay, rather than on how healthy or sick they are.

Socialized medicine is one form of social insurance. More typically, however, social insurance is coupled on the health-care delivery side with a mixture of government-owned facilities (e.g., municipal hospitals), private nonprofit hospitals (roughly 90 percent of all American hospital beds) or private for-profit facilities (investor-owned hospitals, private medical practices, pharmacies and so on). It follows that one cannot simply treat social insurance as socialized medicine. In principle, one could have social insurance with 100 percent private for-profit delivery facilities.

Under private commercial insurance, individuals also transfer the financial risk of bills for health care to a risk pool, but the premium the individual contributes to the risk pool reflects that individual’s health status. These premiums are, as actuaries put it, “medically underwritten” and “actuarially fair.” The risk pools under private insurance can be operated by not-for-profit or for-profit insurers. And like social insurance, private insurance typically is coupled with a mixed private and public delivery system.

In the chart, cells A, B, C jointly represent single-payer social insurance — e.g., traditional Medicare. Cells D, E, F jointly represent multiple-payer social insurance — e.g., Medicaid Managed Care. Cells G to L jointly represent individually purchased private insurance with actuarially fair premiums. Finally, cells M, N and O represent the uninsured or the cost-sharing portion of insured persons.

In between these distinct systems falls employment-based health insurance.

Large employers typically self-insure and use private insurers only to procure health care on behalf of employees (e.g., negotiate fees with the providers of health care) and administer claims. Other employers do not self-insure and instead purchase so-called group health insurance policies for all their employees jointly, as if they were one large family. The premium for a group policy is “experience rated” over the covered group of employees, which means that they reflect the average actuarial cost of all of one company’s employees.

The individual employee’s own contribution toward his or her employment-based insurance, however, is divorced from the individual’s (or the attached family’s) health status. In this sense, then, employment-based insurance could be described as “private social insurance,” as distinct from “government-run social insurance.”

Former Mayor Rudolph Giuliani of New York has exemplified the perennial confusion in this country over socialized medicine. In his ill-fated presidential bid, and subsequently as a supporter of Senator John McCain’s bid for the presidency, Mr. Giuliani routinely decried as socialized medicine (or “socialist”) any proposal presented by Democratic candidates, because typically the latter advocated tax-financed subsidies toward the purchase of health private insurance or expansions of public insurance programs. But technically none of them advocated socialized medicine.

Perhaps Mr. Giuliani was unaware that Americans all along the ideological spectrum reserve the purest form of socialized medicine — the V.A. health system — for the nation’s veterans. I find this cognitive dissonance amusing. Indeed, if socialized medicine is so evil, why didn’t Republicans privatize the V.A. health system when they controlled both the White House and the Congress during 2001-06?

Mr. Giuliani also seems to forget that, in 1996, he found social health insurance a perfect solution to the financial problems faced by former Mayor John V. Lindsay, who fell on financially hard times during the 1990s as a result of chronic illness.

In a fit of compassion, then Mayor Giuliani rushed to his friend’s assistance with — you guessed it — taxpayers’ money, rather than with a private sector solution. He did so by appointing Mr. Lindsay to two no-show city jobs that came with tax-financed municipal health insurance and a tax-financed pension.

It seems fair, then, to ask Mr. Giuliani why it was perfectly fine to bail out a financially distressed man who had been wealthy enough in his younger years to provide adequately for his old age, when proposals to extend the same kind of assistance to hard-working, uninsured members of lower-income families are decried by him as “socialism.”

One can only hope that our members of Congress and the typical American voter can make the right distinctions.

Uwe E. Reinhardt is an economics professor at Princeton.