PNHP

Portsmouth doctor: Obama hears my views on health care reform

Portsmouth doctor: Obama hears my views on health care reform

By Michael Mccord
Portsmouth Herald
March 6, 2009

PORTSMOUTH — Though he didn’t attend President Barack Obama’s health care forum in Washington on Thursday, Dr. Thomas Clairmont felt that he was heard — after fearing the health care reform proposal he supports would not be part of the discussion.

Clairmont, a Portsmouth primary care physician, contacted the Herald Tuesday and said he was concerned that the Obama administration would brush aside a government-managed, single-payer health care plan advocated by Clairmont and 15,000 other doctors and medical professionals through the Physicians for a National Health Program organization.


Dr. Thomas P. Clairmont, a Portsmouth primary
care physician, said, “I can explain our proposal
in 10 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.” Don Clark photo

But on Wednesday, the White House extended invitations to Rep. John Conyers, D-Mich., the most prominent sponsor of single-payer health care legislation in Congress, and Dr. Oliver Fein, PNHP president, to speak and make a single-payer presentation.

Clairmont believes the White House reacted correctly to the volume of letters, e-mails, blog posts and media coverage about the lack of single-payer representation at the White House Forum on Health Reform, which included members of Congress, medical professionals, hospital executives, health insurance and drug company representatives, and lobbyists from dozens of other business and consumer organizations.

“What we want is a fair hearing,” said Clairmont, who led a December health care forum in Portsmouth, one of 4,000 such forums held nationwide which sent findings to the Obama transition team. He said the Portsmouth gathering and many more across the country showed strong support for a single-payer solution to the health care crisis.

Clairmont said that single-payer is the best approach to deal with a health care system that, according to the Centers for Medicare and Medicaid Services, in 2009 will cost the country $2.5 trillion, 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.

“I can explain our proposal in 10 seconds,” Clairmont said. “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, we can save $360 billion a year in administrative costs. Why are our premiums paying for the bonuses of health insurance industry executives?”

Clairmont said that politics and ideology need to step aside to allow for a serious debate. “We should be able to do side by side comparisons to see what’s best for the country,” he said.

In his opening remarks at the summit, Obama said that health care reform can no longer be delayed because it has become a drag on the entire economy as health care premiums continue to rise for businesses and their employees.

“In this effort, every voice must be heard. Every idea must be considered. Every option must be on the table. There will be no sacred cows in this discussion,” Obama said. “Each of us must accept that none of us will get everything we want, and no proposal for reform will be perfect.”

Sen. Jeanne Shaheen, D-N.H., attended the forum and said that many ideas will come into play as the health care reform effort moves from the White House to lawmakers in Congress.

“I did meet last week in New Hampshire with supporters of the single-payer system,” Shaheen said during a conference call with reporters Thursday. “They have a very interesting proposal, and it will certainly be looked at. I think everything is going to be on the table.”

Rep. Chellie Pingree, D-Maine, is a co-sponsor of Conyers’ single-payer legislation, but one of Pingree’s ultimate goals, said spokesman Willy Ritch, “is to see the sort of reform that will lower the cost of health care for those who are already insured, improves the overall quality of care and provides guaranteed access for every family.”

A Canadian Comments on Experiences with Single Payer System in Canada

Posted By Chris Dinn
March 5, 2009

http://prospect.org/csnc/blogs/ezraklein_archive?month=03&year=2009&base_name=let_single_payer_free

As a Canadian who watched and helped his sister go through 5 years of elite treatment medical treatment for a rare brain tumor, I consider myself experienced with the single-payer approach and I have generally great things to say about it.

First things first, and this is a hugely important factor, Canada’s health care system is PROVINCIALLY RUN. That is to say, constitutionally, it’s not the purview of the federal government, it’s the explicit responsibility of the provinces. Over the years, various federal governments have issued transfers to the provinces explicitly for health care, but the responsibility for delivery remains with the provinces.

Additionally, as Ezra noted once upon a time in a review of international health care systems, the providers in a single payer system are private. This is an important distinction. Doctors in Canada are small business-people competing for customers. Canadians choose which doctor to visit and the doctor with the most visits gets better reimbursement from the province.

Get that? That’s provinces competing to do the best job on health care management (keeping costs down) with doctors and hospitals competing to get the most visitors, to keep business booming and government reimbursements coming.

The upside of this is that it promotes competition for efficiency of delivery. In fact, Canada’s entire system evolved that way, beginning as a Saskatewan program pioneered by Tommy Douglas.

Now, before you write off the single payer system (I’m looking at you wisewon), keep in mind that not only did Canadians recently vote Tommy Douglas the greatest Canadian in a recent CBC reality show (http://www.cbc.ca/greatest/), but he’s also Keifer Sutherland’s grandfather (no lie).

We should be honest about the downsides of a single-payer system. Despite the sundry downsides you may here from US commentators, criticisms in Canada come from mainly two areas.

First is equal access. In Canada it doesn’t really matter how rich you are or how much money you have to throw at your medical problems, you get treated in the same line as the poor farmer, the homeless guy and the suburban middle-class family who need the same treatment. To you, maybe, this is a bug. To me, it’s a feature. The idea that in Canada we treat our poor in the same order we treat the rich seems an impressive display of equality when it matters the most.

The second is for wait times. This is not a material concern to this discussion. If you want to know why read http://www.prospect.org/cs/articles?article=the_health_of_nations.

While there are some exceptions to these rules, such as Canada’s rare and controversial private clinics, the system generally works as advertised.

As an example, in 1996, when she was 10 years old my sister was diagnosed (in Newfoundland) with a rare brain tumor. She was treated in Newfoundland, but when a better treatment became available in Toronto the provincial government sent her to Toronto for the care and covered its cost. Had a better program existed in an American children’s hospital, she could’ve been treated there.

My family was middle class for our rural community, but would hardly qualify as rich. My parents had a combined income of under $100,000 yearly, but my sister received three rounds of neurosurgery, three rounds of chemotherapy and a three-weeks-in-isolation bone marrow transplant. All without my parents paying out of pocket for anything.

In the US people go bankrupt in situations like this. In Canada, they live through it. My parents are now happily in retirement and relatively well financed.

Meanwhile an exgirlfriend of mine from Wisconsin needed her wisdom teeth out. Her plan was to go get the treatment and stiff the hospital on the bill. She said future creditors would understand, since medical bills are often skipped out on.

I’m not an American, and I don’t know how typical or a-typical that is, but it definitely happened.

Are you still telling me the Canadian approach is completely the wrong solution? I’m sorry, but I just can’t take Americans with a straight face on that point.

AHIP’s phony epiphany

Insurers’ commitment to healthcare reform is only skin-deep

The industry claims to have had a change of heart, but its position hasn’t changed at all.

By Michael Hiltzik
Los Angeles Times
March 9, 2009

In December, the industry’s trade group, AHIP (for America’s Health Insurance Plans) revealed that it had experienced an epiphany and decided for the first time to support the principle of universal healthcare — insuring everyone in America, regardless of health condition.

It described its change of heart as the product of three years of sedulous soul-searching by AHIP’s board of directors, who claimed to have “traveled the country and engaged in conversations about healthcare reform with people from all walks of life.”

As a connoisseur of health insurance lobbying practices, however, I withheld judgment until I could scan the fine print. What I found by reading AHIP’s 16-page policy brochure was that its position hadn’t changed at all. Its version of “reform” comprises the same wish list that the industry has been pushing for decades.

Briefly, the industry wants the government to assume the cost of treating the sickest, and therefore most expensive, Americans. It wants the government to clamp down hard on doctors’ and hospitals’ fees. And it wants permission to offer stripped-down, low-benefit policies freed from pesky state regulations limiting their premiums.

… AHIP Chief Executive Karen Ignagni (told) the Obama summit: “You have our commitment to play, to contribute and to help pass healthcare reform this year.”

Ignagni can afford to be gracious because no specific reform plan is yet on the table. But veterans of the last reform battle warn that the moment concrete proposals appear, the insurance industry will deploy in force to kill anything that threatens its profitability and freedom of movement, such as an expansion of public insurance programs or tighter federal regulations.

Veterans of earlier healthcare battles justly wonder if the industry is merely trying to get in front of the parade, the better to lead it into a dead end.

“It might be that they think reform is inevitable,” says (Jonathan Oberlander, a healthcare reform expert at the University of North Carolina), observing that the industry made very similar noises at the outset of the Clinton effort, before the slaughter started. “I’d say buyer beware. We’ve been there before with them.”

http://www.latimes.com/business/la-fi-hiltzik9-2009mar09,0,4220704.column

And…

In Divide Over Health Care Overhaul, 2 Major Unions Withdraw From a Coalition

By Robert Pear
The New York Times
March 6, 2009

Two labor unions have pulled out of a broad coalition seeking agreement on major changes in the health care system. The action, by the American Federation of State, County and Municipal Employees and the Service Employees International Union, shows the seeds of discord behind the optimistic talk at a White House conference on health care this week.

The most active participants in the coalition include Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, and Billy Tauzin, president of the Pharmaceutical Research and Manufacturers of America, which represents drug companies.

http://www.nytimes.com/2009/03/07/us/politics/07health.html?ref=washington

Comment:

By Don McCanne, MD

In December, when America’s Health Insurance Plans (AHIP) released their new report indicating that they were fully committed to reform that would cover everyone, I responded in a Quote of the Day (12/4/08) with the following: “You could not possibly describe a proposal that would better serve the interests of the private insurance industry. They would create a standard of underinsurance, require all of us to purchase their products, and pretend to address affordability issues through tax credits.”

Michael Hiltzik has provided for us a great service by actually reading AHIP’s report – carefully. He confirmed that this industry, which has been so destructive to health care reform efforts in the past, hadn’t changed its position at all.

Yet Washington has rolled out the red carpet for Karen Ignagni, AHIP’s president. She appears at almost every forum on reform and is presented with the microphone with some fanfare, even if she was not scheduled in the agenda. The intensity of the efforts to keep the private insurance industry in control of the process might best be exemplified by President Obama’s Health Care Summit. In closing remarks, President Obama handed the microphone off to Karen Ignagni so that she could express for the national audience AHIP’s phony epiphany.

Robert Pear’s report on the split in a major coalition on reform exposes the sharp contrast between AHIP’s sick-sweet public rhetoric on cooperation, and its back-stabbing, cut-throat, behind-the-scenes negotiations on the specifics of reform.

AFSCME and SEIU, the two unions that pulled out of the negotiations, serve as a proxy that represents the only special interest that really matters – the patients. After half a year of intensive negotiations with AHIP, PhRMA, the United States Chamber of Commerce, and others, it was clear that the insurance industry would not compromise its business interests for the benefit of patients. AFSCME and SEIU had to walk out.

The coalition plans to issue recommendations later this month in a report that reflects “the lowest common denominator,” undoubtedly more sick-sweet rhetoric crafted by AHIP.

(Theoretically the consumers were represented by Ronald Pollack of Families USA, but he has lost all credibility because of his years of insistence that we follow a strange-bedfellows strategy – a process which tragically has only perpetuated health reform inertia. Jonathan Oberlander cautions that “we’ve been there before with them,” but Ronald Pollack’s learning curve is flat. )

Michael Hiltzik is to be praised for his leadership. We can only hope that other influential members of the media follow his example. All they need to do is carefully read AHIP’s own report on its change of heart, and see what it really says. (Hint: I couldn’t find a heart anywhere in the report.)

AHIP’s phony epiphany:
http://www.americanhealthsolution.org/assets/Uploads/healthcarereformproposal.pdf

A Victory For Single Payer?

Having initially excluded all advocates for single payer national healthcare from the White House Summit on Healthcare Reform, and after protest from activists, the Obama administration reconsidered and invited Rep John Conyers, author of HR 676 the single payer bill pending in Congress, and also a representative of Physicians for a National Health Care Program, to the summit attended by over 120 people Thursday.

Dr. Quentin Young, the founder and National Coordinator of Physicians for a National Health Program, explores Obama’s views on single payer and the battle for healthcare reform.

Report of Health Care Community Discussions

Report of Health Care Community Discussions

HealthReform.gov
March 5, 2009
In December 2008, the Presidential Transition Team invited Americans to host and participate in Health Care Community Discussions to talk about how to reform health care in America.
IV. Solutions to the Problems in the U.S. Health Care System
B. Roles in a Reformed U.S. Health Care System
Role of Government v. Market
The real debate was over the balance of government versus the market in insuring Americans. Supporters of a single-payer system submitted numerous reports, in part due to the encouragement by advocacy groups to participate in Health Care Community Discussions. Under most versions of a single-payer system, the government would replace private insurers in organizing, financing, and paying for health care. Its specifics, and arguments for and against it, are described below (see Single-Payer System box).
http://www.healthreform.gov/reports/index.html

That’s it. In this long report, this is the paragraph that expresses the ubiquitous single payer presence at these meetings. (The single payer box mentioned was not posted on this web version of the report.)
For those who were expecting a Quote of the Day on today’s White House Health Care Reform Summit, here is the the full discussion of single payer:

Report of Health Care Community Discussions

Report of Health Care Community Discussions

HealthReform.gov
March 5, 2009

In December 2008, the Presidential Transition Team invited Americans to host and participate in Health Care Community Discussions to talk about how to reform health care in America.

IV. Solutions to the Problems in the U.S. Health Care System

B. Roles in a Reformed U.S. Health Care System

Role of Government v. Market

The real debate was over the balance of government versus the market in insuring Americans. Supporters of a single-payer system submitted numerous reports, in part due to the encouragement by advocacy groups to participate in Health Care Community Discussions. Under most versions of a single-payer system, the government would replace private insurers in organizing, financing, and paying for health care. Its specifics, and arguments for and against it, are described below (see Single-Payer System box).

http://www.healthreform.gov/reports/index.html

Comment:

By Don McCanne, MD

That’s it. In this long report, this is the paragraph that expresses the ubiquitous single payer presence at these meetings. (The single payer box mentioned was not posted on this web version of the report.)

For those who were expecting a Quote of the Day on today’s White House Health Care Reform Summit, here is the the full discussion of single payer:

Single-payer isn't socialism

Letter to the Editor
Seattle Post-Intelligencer
February 27, 2008

As a long-time Seattle physician, I was pleased that the P-I supports health care reform toward a single-payer system (Opinion, Wednesday). Most Americans now fully understand that our health care delivery system is too expensive, too complex, too fragmented and overwhelmingly frustrating. Although some still believe that America has the best health care in the world, the truth is that our reimbursement system is killing us. The “health” of a country’s healthcare system can be inferred by looking at how we treat our most precious citizens: our children. International ranking of infant mortality by our own CIA now places the United States at 42 out of 222 countries, behind Hong Kong, Portugal, Korea, Macau, most of Europe and Cuba! In 1989, the United States was ranked at 19th. To allow this decline to continue is a moral outrage.

Many fear that a single-payer model is “Socialized Medicine.” In fact, a single simplified health care finance system is good for business. Our employment-linked health insurance system may have worked fine during the Cold War era, but today it is crippling American business. Businesses leaders and labor unions understand that shifting to a government-sponsored single-payer system isn’t a form of socialism. It is a more cost-effective, fair and universal system that can help restore our ability to compete in today’s international market place. This will preserve American business and American jobs.

Lastly, some fear universal healthcare would lead to rationing of benefits. But rationing is already being done by our insurance industry disguised under the euphemism of “medical necessity” or “covered service.” I am outraged when my patients tell me they can not get the medication or treatment they need because their insurance company will not cover it and they can not afford to pay out of pocket. It is time for our leaders to put aside fear and radically transform our healthcare finance system toward a single-payer system for our children and our future. It is economically and morally the healthy step to take.

B. Jason MacLurg, M.D.
Seattle, WA

Single-payer advocates win seats at White House health summit, remarks by Dr. Oliver Fein

Dr. Oliver Fein releases prepared remarks

FOR IMMEDIATE RELEASE
March 5, 2009

Contact:
Oliver Fein, M.D.
Don McCanne, M.D.
Steffie Woolhandler, M.D.
David Himmelstein, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

Two leading advocates of single-payer health reform, sometimes characterized as an improved Medicare for All, received last-minute invitations to attend the White House health care summit being held today. The invitations were greeted as a victory by single-payer supporters.

Rep. John Conyers Jr. (D-Mich.), chief sponsor of the single-payer U.S. National Health Care Act, H.R. 676, was invited to attend the meeting late in the day on Tuesday, and Dr. Oliver Fein, president of Physicians for a National Health Program, was invited on Wednesday afternoon.

The White House invitations were extended to the two leaders after intense grassroots lobbying efforts by single-payer supporters, who were concerned that no single-payer voices would be present at the meeting. The efforts included an outpouring of phone calls and e-mail messages to the White House, along with a threatened demonstration outside the White House gates by doctors and other health professionals wearing their white coats. The demonstration was called off when word arrived that Rep. Conyers and Dr. Fein had been invited.

In his prepared remarks, the full text of which follows, Dr. Fein says, “We are pleased to be here today and appreciate the implicit recognition of the majority support for single payer in our country. We hope this is the beginning of a serious dialogue on how to enact single-payer health reform and we look forward to working with [President Obama] and the Congress toward this end.”

Dr. Fein’s prepared remarks for the summit follow.

Prepared remarks by Dr. Oliver Fein

Mr. President, Physicians for a National Health Program agrees with your statement during your presidential campaign: health care should be a basic human right.

Physicians recommend an improved and expanded Medicare-for-All – that is, a single-payer national health insurance program, providing care that is publicly financed but largely privately delivered. This fundamental health reform – which enjoys solid majority support among physicians and the public – has become even more urgently needed in view of our severe economic recession.

Millions of people are losing their employer-sponsored health insurance, joining the 46 million who already lack coverage. Millions more, including those with insurance, are finding it harder to pay their co-pays and deductibles and are scrimping on their medications and doctor visits. Many go without care, risking their health and often their very lives.

Physicians find that private, for-profit health insurance companies add cost but no value to the health care system. The administrative waste associated with the private-insurance-based industry – enormous paperwork, marketing costs, and other costs that have nothing to do with delivering care – consumes 31 cents of every health care dollar.

As long as we rely on private health insurers, universal coverage will be unaffordable.

Mandates to buy private insurance are not the answer. Experience with mandate plans in Washington state (1993), Oregon (1992) and Massachusetts (1988 and today), shows they simply don’t work, achieving neither universal health care nor cost containment.

Some of these plans offer a Medicare-like, public option that people could buy into, but experience with Medicare shows that the private plans refuse to compete on a level playing field. They cherry-pick healthier patients and insist on more than their share of payment.

In contrast, single payer guarantees everyone access to comprehensive, quality health care and choice of their own doctor and hospital.

Single-payer health reform, an improved Medicare for All, is the only reform model that offers $400 billion in annual savings in administrative costs. It is the only approach that contains effective cost-containment provisions such as bulk purchasing and global budgeting.

Such economies would allow for expanding health coverage to everyone – with no co-pays or deductibles – with no overall increase in health care spending. In other words, it’s the only health reform proposal that pays for itself.

The single-payer model is the only fiscally prudent proposal available, an especially important consideration at a time of economic distress. And we know from our experience with Medicare and other single-payer systems that it will work.

With a single-payer national health insurance program we can assure lifelong, high quality, comprehensive and affordable coverage for everyone. Such a program will lift the heavy burden of crushing medical expenses off the shoulders of our population, expenses that often lead to personal bankruptcy. And we can save lives: the Institute of Medicine estimated in 2002 that more than 18,000 Americans die each year from lack of health insurance. That number is certainly higher today.

From the standpoint of what benefits our patients, single payer is the health policy model that best reflects their needs and values.

Support for single payer is extensive. In a peer-reviewed statistical study in the Annals of Internal Medicine, 59 percent of U.S. physicians said they would support government action to establish national health insurance. In a recent Associated Press poll, 65 percent of the respondents said, “The United State should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxes.”

Single-payer health reform is embodied in the U.S. National Health Care Act, H.R. 676, sponsored by Rep. John Conyers (D-Mich.). It had 93 co-sponsors in the 110th Congress, the most of any health reform legislation.

We are pleased to be here today and appreciate the implicit recognition of the majority support for single payer in our country. We hope this is the beginning of a serious dialogue on how to enact single-payer health reform and we look forward to working with you and the Congress toward this end.

****

A short biography of Dr. Fein is available here: https://pnhp.org/stateactions/new_york/

Physicians for a National Health Program (www.pnhp.org), a membership organization of over 15,000 physicians, supports a single-payer national health insurance program. To contact a physician-spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Single-payer isn’t socialism

Letter to the Editor
Seattle Post-Intelligencer
February 27, 2008

As a long-time Seattle physician, I was pleased that the P-I supports health care reform toward a single-payer system (Opinion, Wednesday). Most Americans now fully understand that our health care delivery system is too expensive, too complex, too fragmented and overwhelmingly frustrating. Although some still believe that America has the best health care in the world, the truth is that our reimbursement system is killing us. The “health” of a country’s healthcare system can be inferred by looking at how we treat our most precious citizens: our children. International ranking of infant mortality by our own CIA now places the United States at 42 out of 222 countries, behind Hong Kong, Portugal, Korea, Macau, most of Europe and Cuba! In 1989, the United States was ranked at 19th. To allow this decline to continue is a moral outrage.

Many fear that a single-payer model is “Socialized Medicine.” In fact, a single simplified health care finance system is good for business. Our employment-linked health insurance system may have worked fine during the Cold War era, but today it is crippling American business. Businesses leaders and labor unions understand that shifting to a government-sponsored single-payer system isn’t a form of socialism. It is a more cost-effective, fair and universal system that can help restore our ability to compete in today’s international market place. This will preserve American business and American jobs.

Lastly, some fear universal healthcare would lead to rationing of benefits. But rationing is already being done by our insurance industry disguised under the euphemism of “medical necessity” or “covered service.” I am outraged when my patients tell me they can not get the medication or treatment they need because their insurance company will not cover it and they can not afford to pay out of pocket. It is time for our leaders to put aside fear and radically transform our healthcare finance system toward a single-payer system for our children and our future. It is economically and morally the healthy step to take.

B. Jason MacLurg, M.D.
Seattle, WA

Professor Bradley Herring on single payer

Covering the Uninsured: Options for Reform

Kaiser Commission on Medicaid and the Uninsured
Alliance for Health Reform
March 2, 2009
Bradley Herring, Ph.D., Assistant Professor, The Johns Hopkins University, speaking on “Potential Complications with the Different Approaches to Health Reform”:
First off, single payer, HR 676. The underlying appeal of this is essentially that it is very elegant, and simple. You pay taxes into the system and in return you get the medical care that you need. And then also it’s universal. This is probably the only approach that’s actually going to get us to having no uninsured. That kind of notion of being universal – getting everyone covered. This is probably the only one that’s going to do it. But then moreover if you think about universal as having the system in which everybody essentially has got the same kind of coverage, and we’re all in the same boat together – single payer is really probably the only way we might get there. Another thing underlying the appeal about single payer is that there would be large reductions in the administrative costs. So Medicare has administrative costs between about 2 to 3 percent whereas private insurance varies considerably across different markets but averages about 14 to 15 percent.
Potential complications. Well, if you look at the description of single payer, and particularly on John Conyers’s website, it kind of seems like a health care utopia. You get the health care you need, cost sharing is reduced – right now there is pretty significant cost sharing in the Medicare program – and that is going to go away. But I think many of us might agree that somebody’s got to say no, right, that you can’t consume all of the health care that we’d like. Someone’s got to be in place to say no. There are certain treatments that we shouldn’t be receiving or certain patients that shouldn’t receive certain treatments.
Taxes is a big issue, right, so I don’t want to be hysterical. I actually think that taxes should kind of go up a little bit to address the fiscal situation we’re in in the U.S. But many people probably balk at the extent to which taxes have to go up to pay for a single payer. HR 676 includes payroll taxes, increasing from about 1.5 percent to 4.75 percent, on the employee side and the employer side. Repeal the Bush tax cuts. Get in line. Everyone’s targeting these Bush tax cuts – the single most popular pay-for in history. And then on top of that, the proposal would increase the marginal tax rates for the top 5 percent and the top 1 percent of income, an additional 5 percent or 10 percent respectively. And also include a tax on stock transactions.
The final thing I’ll say about single payer is that it most likely is going to result in lower payments to providers. If you look at the MedPAC data comparing private reimbursements and public reimbursements, they’re about 15 to 20 percent lower on the public side.
(Prof. Herring then discusses the three other models of reform: the Republican/McCain proposal, Obama/Baucus proposal, and the Wyden/Bennett proposal)
Q & A:
Audience member (from Center for Budget and Policy Priorities): Dr. Herring and the other panelists, I was wondering if you could discuss the ability of all of the various options to control costs of the health system. If health costs grow at their current rate, no insurance system, no matter how well designed, will be able to cover everyone because we won’t be able to afford it. Thank you.
Prof. Herring: So, off the top of my head, I would think that the single payer approach yields the most promise towards reducing health care costs because it can essentially happen by fiat, right. The government can say what we’re going to spend, and, if Congress is so willing to actually follow through on that, I mean, kind of decide what we’d want to spend. I think the Republican vision of tax reform and getting people into individual plans has a lot of promise for lowering the growth in spending in the sense that people would face strong incentives to purchase cheaper plans with higher deductibles, less access to costly technology, which will certainly, I think, reduce spending, but, taking a step away, we have to ask is that really appropriate? Is that where we want to go? I think the Wyden bill then, in turn, might probably rank third in terms of its ability to reduce the growth in spending. I think for some of these reasons alluded to in the more Republican approach in which there’s a system by which individuals are choosing, on cost, plans – in making decisions to purchase basic versus more comprehensive plans. And then finally I think with the Obama plan, and Baucus’s, the result is that, yes, we might get everybody covered but in a wildly fragmented system that it might be really hard to control costs moving forward with these different things, you know, to kind of plug (moves arms as if plugging multiple leaks in the system).
http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=3120

Should we care what Johns Hopkins Professor Bradley Herring has to say about single payer? Emphatically, yes. Prof. Herring is theoretically an academic purist, and has no relationship with the single payer community. Many of his policy studies on private health insurance have been done with Mark Pauly, of “moral hazard” fame. That would certainly place him outside of the single payer camp.
A recent Quote of the Day (2/6/09) covered the OECD working paper, “Health Care Reform in the United States.” My comment was quite critical because the paper ignored single payer while discussing the merits of private insurance reform, especially the work of Jonathan Gruber on the Massachusetts plan. The working paper was coauthored by two staff economists from OECD and, yes, Prof. Bradley Herring. In no way could he be considered to be a single payer ideologue.
Although I transcribed only his comments on single payer, you should listen to him on all four models (at the link above – a transcript will be available soon). He describes single payer as a system that actually gets everyone covered, that you get the medical care that you need, that there would be large reductions in administrative costs, and that “the single payer approach yields the most promise towards reducing health care costs.”
The other three models fall short on these goals, but look at what he says about how they control costs. Each model spends more money on administration in order to control costs by reducing benefits and by erecting financial barriers to care. As Prof. Herring asks, “Is that where we want to go?”
Tomorrow President Obama holds the White House summit on health care reform. A broad spectrum of special interests have been invited, but the single payer community has been explicitly excluded, except for Congressman John Conyers. Does that mean that they will search guests at the door to be certain that none of them bring in a copy of Prof. Herring’s comments? The turfs of the special interests would certainly be threatened by exposing the attendees to sound policy science.

Professor Bradley Herring on single payer

Covering the Uninsured: Options for Reform

Kaiser Commission on Medicaid and the Uninsured
Alliance for Health Reform
March 2, 2009

Bradley Herring, Ph.D., Assistant Professor, The Johns Hopkins University, speaking on “Potential Complications with the Different Approaches to Health Reform”:

First off, single payer, HR 676. The underlying appeal of this is essentially that it is very elegant, and simple. You pay taxes into the system and in return you get the medical care that you need. And then also it’s universal. This is probably the only approach that’s actually going to get us to having no uninsured. That kind of notion of being universal – getting everyone covered. This is probably the only one that’s going to do it. But then moreover if you think about universal as having the system in which everybody essentially has got the same kind of coverage, and we’re all in the same boat together – single payer is really probably the only way we might get there. Another thing underlying the appeal about single payer is that there would be large reductions in the administrative costs. So Medicare has administrative costs between about 2 to 3 percent whereas private insurance varies considerably across different markets but averages about 14 to 15 percent.

Potential complications. Well, if you look at the description of single payer, and particularly on John Conyers’s website, it kind of seems like a health care utopia. You get the health care you need, cost sharing is reduced – right now there is pretty significant cost sharing in the Medicare program – and that is going to go away. But I think many of us might agree that somebody’s got to say no, right, that you can’t consume all of the health care that we’d like. Someone’s got to be in place to say no. There are certain treatments that we shouldn’t be receiving or certain patients that shouldn’t receive certain treatments.

Taxes is a big issue, right, so I don’t want to be hysterical. I actually think that taxes should kind of go up a little bit to address the fiscal situation we’re in in the U.S. But many people probably balk at the extent to which taxes have to go up to pay for a single payer. HR 676 includes payroll taxes, increasing from about 1.5 percent to 4.75 percent, on the employee side and the employer side. Repeal the Bush tax cuts. Get in line. Everyone’s targeting these Bush tax cuts – the single most popular pay-for in history. And then on top of that, the proposal would increase the marginal tax rates for the top 5 percent and the top 1 percent of income, an additional 5 percent or 10 percent respectively. And also include a tax on stock transactions.

The final thing I’ll say about single payer is that it most likely is going to result in lower payments to providers. If you look at the MedPAC data comparing private reimbursements and public reimbursements, they’re about 15 to 20 percent lower on the public side.

(Prof. Herring then discusses the three other models of reform: the Republican/McCain proposal, Obama/Baucus proposal, and the Wyden/Bennett proposal)

Q & A:

Audience member (from Center for Budget and Policy Priorities): Dr. Herring and the other panelists, I was wondering if you could discuss the ability of all of the various options to control costs of the health system. If health costs grow at their current rate, no insurance system, no matter how well designed, will be able to cover everyone because we won’t be able to afford it. Thank you.

Prof. Herring: So, off the top of my head, I would think that the single payer approach yields the most promise towards reducing health care costs because it can essentially happen by fiat, right. The government can say what we’re going to spend, and, if Congress is so willing to actually follow through on that, I mean, kind of decide what we’d want to spend. I think the Republican vision of tax reform and getting people into individual plans has a lot of promise for lowering the growth in spending in the sense that people would face strong incentives to purchase cheaper plans with higher deductibles, less access to costly technology, which will certainly, I think, reduce spending, but, taking a step away, we have to ask is that really appropriate? Is that where we want to go? I think the Wyden bill then, in turn, might probably rank third in terms of its ability to reduce the growth in spending. I think for some of these reasons alluded to in the more Republican approach in which there’s a system by which individuals are choosing, on cost, plans – in making decisions to purchase basic versus more comprehensive plans. And then finally I think with the Obama plan, and Baucus’s, the result is that, yes, we might get everybody covered but in a wildly fragmented system that it might be really hard to control costs moving forward with these different things, you know, to kind of plug (moves arms as if plugging multiple leaks in the system).

http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=3120

Comment:

By Don McCanne, MD

Should we care what Johns Hopkins Professor Bradley Herring has to say about single payer? Emphatically, yes. Prof. Herring is theoretically an academic purist, and has no relationship with the single payer community. Many of his policy studies on private health insurance have been done with Mark Pauly, of “moral hazard” fame. That would certainly place him outside of the single payer camp.

A recent Quote of the Day (2/6/09) covered the OECD working paper, “Health Care Reform in the United States.” My comment was quite critical because the paper ignored single payer while discussing the merits of private insurance reform, especially the work of Jonathan Gruber on the Massachusetts plan. The working paper was coauthored by two staff economists from OECD and, yes, Prof. Bradley Herring. In no way could he be considered to be a single payer ideologue.

Although I transcribed only his comments on single payer, you should listen to him on all four models (at the link above – a transcript will be available soon). He describes single payer as a system that actually gets everyone covered, that you get the medical care that you need, that there would be large reductions in administrative costs, and that “the single payer approach yields the most promise towards reducing health care costs.”

The other three models fall short on these goals, but look at what he says about how they control costs. Each model spends more money on administration in order to control costs by reducing benefits and by erecting financial barriers to care. As Prof. Herring asks, “Is that where we want to go?”

Tomorrow President Obama holds the White House summit on health care reform. A broad spectrum of special interests have been invited, but the single payer community has been explicitly excluded, except for Congressman John Conyers. Does that mean that they will search guests at the door to be certain that none of them bring in a copy of Prof. Herring’s comments? The turfs of the special interests would certainly be threatened by exposing the attendees to sound policy science.