By Rose Ann DeMoro
The Huffington Post
September 18, 2007

The pundits might have it right on this one. Hillary Clinton did learn a lesson from her 1994 fiasco on healthcare reform. Unfortunately for most of us who don’t have an Inc. after our name or a private jet to cart us around, it was the wrong lesson.

In the days leading up to the announcement of her latest, much anticipated health plan, Sen. Clinton threw around the word “consensus” a lot. In this case, the consensus she was seeking was with the same industry that so savaged her prior experience with healthcare.

This time, she apparently wants to soften them up in advance with a proposal that will generate hundreds of millions of dollars in additional profits for the insurance giants. It’s probably not a coincidence that she is also the top recipient of healthcare sector contributions to her presidential campaign.

Looking past the bells and whistles — which do at least include some good sound bites on retiree health and giving regular Americans the same health plan options as members of Congress — the Clinton plan seems to rest on three shaky legs:

1. Forcing all Americans, who do not have current coverage and do not qualify for public assistance, to buy and maintain insurance;

2. Mandating large employers to either provide health benefits or contribute to the cost of coverage

3. Tax credits for just about everyone

If the central elements here sound familiar, they should. The plan is a smorgasbord of the worst elements of what we’ve seen and heard from some other presidential candidates and the plans floating around several state Capitols.

Ironically, given the overheated reaction from Republican candidates, Clinton’s plan most closely resembles the approach of two Republicans — the Mitt Romney-crafted law in Massachusetts and the proposal by California Gov. Arnold Schwarzenegger.

That’s hardly a badge of honor. The Massachusetts model is working best for those with public subsidies, and Schwarzenegger’s plan is now buried in the minutia of a special legislative session while public support for it has been plummeting in the polls.

The biggest failing of this plan, like the Romney and Schwarzenegger schemes before it and like most of the other Democratic candidates’ proposals, is the abject failure to challenge healthcare industry price gouging and runaway costs.

Insurance premiums have climbed 87 percent the past decade, and though they have slowed a bit in the past year, the increase is still double the average increase in wages. That does not include, of course, the rising cost of deductibles, co-pays, prescription drug prices, hospital charges, and, the latest fad, annual doctor fees, like what many people are charged for the privilege of having a credit card or checking account.

This is only the biggest healthcare story of the year. One recent example. Consumer Reports last month reported that more than half of the “underinsured” postponed needed medical care due to cost and a third had to dig deep into their savings to pay for medical expenses. Another third of those over 50 said decisions about their retirement were adversely affected by healthcare costs, one quarter had outstanding medical debt, 38% postponed home or car maintenance repairs due to medical bills, and only 37% said they were prepared to financially handle unexpected major medical costs in the next year.

Throwing more Americans under the wheels of the insurance industry will not solve this problem any more than criminalizing the uninsured is humane or sound health policy.

Clinton’s solution is a combination of tax credits, unspecified encouragement to drug companies to “offer fair prices,” and promoting “consumer price consciousness in choosing health plans.”

But tax credits mostly benefit higher income Americans. And families grappling with skyrocketing prices, and no controls on costs, will likely choose the cheapest, high deductible plans that provide the worst coverage. The sad outcome may be seen in a report earlier this year by the American Academy of Pediatrics that families with high deductible health plans are far more likely to put off needed care, including immunizations and recommended treatment, due to the cost.

Sen. Clinton might have drawn an entirely different idea from her prior unpleasant history with the healthcare industry. She might have decided to cut them out of the business of profiting off pain, suffering and medical debt, and proposed a very different solution, such as expanding Medicare, Medicaid, or the State Children’s Health Program to cover everyone.

Accommodating the insurance behemoths, and effectively offering them massive public subsidies — using the considerable power of government to force everyone to become paying customers of the private insurers — is not the kind of leadership on healthcare we need.

Rose Ann DeMoro is executive director of the California Nurses Association/National Nurses Organizing Committee and a national vice president of the AFL-CIO

New York Times
Letters to the Editor

September 19, 2007

To the Editor

Re “Mayo Clinic Proposing a Universal Health Plan” ( Business Day, Sept. 15):

The Mayo Clinic proposal runs aground where most proposals for universal health care do — how to pay for it.

We have many urgent needs: to improve schools, make roads and bridges safe, meet the needs of veterans and their families. So there are no new sources of funding. “Taxes” is a dirty word, and proposals for subsidies and tax breaks would increase governmental deficits. They are nonstarters.

Our sole hope for funding is to make better use of over $2 trillion already being spent by business and governments. Medicare-for-all would save literally hundreds of billions of dollars on nonbenefit charges by simplifying the processing of billions of billings for insurers and health care providers.

Reducing provider conflicts of interest — which lead to enormous outlays determined by self-interest rather than health needs — could save billions more.

Medicare is marvelously efficient. We do not need to re-invent the wheel.

Merton C. Bernstein
St. Louis, Sept. 15, 2007

The writer served as principal consultant to the 1982-83 National Commission on Social Security Reform.

By Annette Fuentes
USA Today
September 19, 2007

When it comes to protecting our children’s health, where does the federal government’s role end and the responsibility of families begin?

Both houses of Congress want to expand health care coverage of low-income children under the State Children’s Health Insurance Program (SCHIP), which expires at the end of this month. Most members of Congress are concerned that more and more low-income children are falling into the growing pool of the USA’s uninsured, most recently estimated to be 47 million.

But President Bush says expanding the program could encourage families whose children are covered by private health insurance to opt for the government-paid program. Bush says he will veto any bill that would increase the number of children eligible because it would be another step toward a nationalized health care system.

But what’s wrong with such a system?

While the president and his supporters try to scare voters away from the idea of a national health care system, calling it “socialized medicine,” why shouldn’t all ideas be on the table for discussion?

The political skirmish over SCHIP is a microcosm of a larger debate this country needs to have over the direction of national health care reform as we head into the 2008 presidential election.

Put aside politics

Any discussion should begin by acknowledging that the USA already has a national health system: Medicare. The program has been an unqualified success as a government-subsidized and -administered health insurance system.

Ida Hellander, executive director of Physicians for a National Health Program, a non-profit that supports a single-payer approach, notes that Germany was the first to have a national health system early in the 20th century. U.S. conservatives in the post-World War I era attacked proposals for a U.S. national plan by linking it to the former enemy. “The way conservatives scared people off was to call national health ‘the Kaiser’s plan,’ ” Hellander says.

But two “allies” with national health care plans are worth noting:

* Great Britain guarantees all its citizens coverage, paid for by taxes and delivered by doctors employed by the health care system. According to the World Health Organization, the United Kingdom spends 6% of its economy on health care and ranks 18th out of 191 countries in health system performance. The United States spends 16% of its economy on ours, but we rank 37th, a step ahead of Cuba.

* Canada has a single-payer system that guarantees every Canadian coverage. It’s paid for by tax dollars. The government pays all claims, so there is no private insurance industry acting as middleman to administer the system. That’s where the big savings come. In Canada, administrative costs are less than 17% of all health spending, compared with 31% in the USA.

Longer waits

But the Canadian system does have one drawback: Its citizens face somewhat longer waits for some care — such as seeing specialists, receiving MRIs and non-emergency surgeries — than Americans.

In recognition of the high priority Americans place on health care reform, the leading U.S. presidential candidates have at least paid lip service to addressing their concerns, with the Democrats articulating more developed ideas.

On the Democratic side, only long-shot Rep. Dennis Kucinich of Ohio supports a single-payer system. Many use the term “universal health care,” which means that everyone would be covered in some fashion, including through public programs such as Medicare and SCHIP or private insurance plans. John Edwards would require employers to provide coverage or financial assistance, and he would expand public programs such as Medicaid and SCHIP. He also would create regional purchasing pools to make health insurance more affordable. Sen. Barack Obama, D-Ill., calls for a “new national health plan” with guaranteed eligibility and a federal subsidy for those who can’t afford to buy into the new plan. Sen. Hillary Clinton, D-N.Y., proposes a universal health care system that would cover all the uninsured, in part by expanding SCHIP, and that would make health insurance more affordable and protect coverage of those with chronic illness.

Of the Republican candidates, Rudy Giuliani proposes up to $15,000 in tax deductions for families to buy health insurance. Sen. John McCain, R-Ariz., has no plan other than to create “affordable” health insurance without added government spending. And Mitt Romney, who as Massachusetts governor implemented a mandatory universal health insurance plan, now opposes the same approach for the nation. Instead, he supports tax incentives and market reforms to lower costs.

There could be drawbacks to a single-payer system, but there are more good reasons to consider just such a system. We need an open, honest discussion of all possibilities without fearing the bogeyman of nationalized health care. With broad popular support for reform, maybe the debate will yield actual change when a new administration moves into the White House.

Annette Fuentes is an adjunct professor at the Columbia University Graduate School of Journalism and a member of USA TODAY’S board of contributors.

Sptember 14th, 2007 11:03 pm

Dear John,

My name is Julie Pierce. My husband was Tracy Pierce. I am featured in Michael Moore’s documentary ‘SiCKO.’ In the movie, I share my deceased husband’s story — his unsuccessful battle with our insurance company to receive what could have been life-saving treatments for kidney cancer.

I just read your Wall Street Journal article written on Sept. 13, 2007, titled “Sick Sob Stories.” You begin by talking about Tracy’s role in ‘SiCKO,’ and claim the bone marrow transplant denied by our insurer would not have saved him. You also accuse me of “sneering” over our situation.

In your ‘reporting’ of this story, you did not contact me, and you did not contact my husband’s doctors. I cannot believe that a publication like the Wall Street Journal would print such an accusation without talking to anyone involved — especially in such a personal matter, which resulted in the death of my 37-year-old husband and the father of my child.

If you had contacted me, I would have told you that bone marrow transplants became a last option, only after our insurer denied many other treatments again and again and again.

I would have shown you a letter from our doctors at the Blood and Marrow Transplant Program at the University of Kansas Hospital, in which they argued strongly for the bone marrow transplant, citing “strong evidence” supporting the past success of that treatment — they wrote that it could “give him a chance to achieve complete remission.” In fact, they called the bone marrow transplant “his only chance of survival.”

Instead of calling me up and doing real reporting, all you can do is throw around studies from 1999 about the supposed inefficiency of bone marrow transplants for breast cancer patients — even though Tracy didn’t have breasts. He had kidney cancer! I understand that you want to try to prove that private insurance in this country really isn’t that bad. And I can see that you won’t let the facts get in the way.

You go on to claim that Tracy wouldn’t have received his transplant in a country with socialized medicine, either. Where is the evidence? Not only are more bone marrow transplants performed every year in Canada, but they invented the technology! So much for your ridiculous claim that “profit is what has created the amazing scientific innovations that the U.S. offers to the world. If government takes over, innovation slows, health care is rationed.”

You are simply carrying water for the for-profit insurance industry that killed my husband. And then you have the nerve to accuse me of “sneering” about it. My husband has only been dead since January 18th, 2006. It is still fresh to me and my family, and comments like this are inhumane.

I have since tried to contact you via email, but you have not responded. I don’t expect an answer. People like you just write with an agenda, without coming to the source or getting any facts, because your main goal is to try to discredit Michael Moore and universal health care. I understand it’s a game — you did it without thinking about how you would hurt a family who have suffered — and are still suffering — such a tragic loss.

My family is not a “Sick Sob Story.” We are a normal, American family that has had a significant member die from a horrible cancer that ravaged his body due to repeated denials from a health insurance company. We will never know for sure what would have worked because Tracy was never given a fighting chance. Over 18,000 Americans die each year because they don’t have health insurance. I suppose theirs are “sob stories,” too.

I don’t want a hit-piece. I want answers. Why does our wonderful profit-driven system of medicine kill 18,000 Americans each year? Why do we pay far more for our health system than any other country, but have some of the lowest life expectancies and highest infant mortality rates in the Western world? Would you discredit the work of your late colleague Peter Jennings who, while suffering with lung cancer, did an excellent report titled “Breakdown: America’s Health Insurance Crisis”?

I hope you have answers, but I am not optimistic. I pray that you will never have to go through what we went through — if you did, you wouldn’t be so quick to cheerlead the system we were victimized by.

Julie Pierce
Mission, Kansas

New York Times
Letters to the Editor

September 19, 2007

To the Editor

Re “Mayo Clinic Proposing a Universal Health Plan” ( Business Day, Sept. 15):

The Mayo Clinic proposal runs aground where most proposals for universal health care do — how to pay for it.

We have many urgent needs: to improve schools, make roads and bridges safe, meet the needs of veterans and their families. So there are no new sources of funding. “Taxes” is a dirty word, and proposals for subsidies and tax breaks would increase governmental deficits. They are nonstarters.

Our sole hope for funding is to make better use of over $2 trillion already being spent by business and governments. Medicare-for-all would save literally hundreds of billions of dollars on nonbenefit charges by simplifying the processing of billions of billings for insurers and health care providers.

Reducing provider conflicts of interest — which lead to enormous outlays determined by self-interest rather than health needs — could save billions more.

Medicare is marvelously efficient. We do not need to re-invent the wheel.

Merton C. Bernstein
St. Louis, Sept. 15, 2007

The writer served as principal consultant to the 1982-83 National Commission on Social Security Reform.

by John Nichols
The Nation
Published on Tuesday, September 18, 2007

Would someone please ask Hillary Clinton to stop coming up with health care “reform” plans that are less attractive than the dysfunctional system she proposes to replace?

The former first lady, who snatched defeat from the jaws of victory in the 1990s by responding to the demand for a sane and humane system to deliver affordable medical care to all Americans with a plan to drown the ailing in a bureaucracy designed to augment the profits of the nation’s largest insurance companies, is back with an equally heavy-handed and unappealing “reform” proposal.

The senator from New York who has emerged as the frontrunner for the Democratic presidential nomination — based, in no small part, on romantic misrecollections of her last foray into the nation’s seemingly-endless health-care debate — wants to solve the crisis of the uninsured and the under-insured by requiring every American to obtain coverage.

Of course, the ridiculous Mitt Romney decries the Clinton campaign proposal as “European-style socialized medicine.”

But Romney knows so little about health care that he cannot even pick a smart site for a press conference on the issue — he derided the Clinton plan in front of St. Vincent’s Hospital in Manhattan, home of the Rudolph W. Giuliani Trauma Center. that is named for his chief rival in the Republican nomination race.

The reality is that the Clinton plan is about as socialistic as a Ronald Reagan corporate tax cut.

The Clinton plan maintains the current system of for-profit, insurance-industry defined health care delivery. The only real change is that, in return for minimal requirements regarding coverage of those with preexisting conditions, the government would pump hundreds of billions in federal dollars into the accounts of some of the country’s wealthiest corporations. The plan’s tax credit scheme would buy some more coverage for low-income families, which is good, but it would do so at a cost so immense that, ultimately, Clinton’s plan will be as tough a sell as the failed 1993 “Hillarycare” proposal.

America is ready for health care reform.

But it is not ready for more bureaucracy, more expense and more revenue for insurance companies.

Despite what Mitt Romney says, Clinton and the Democrats would have a far easier time selling “European-style socialized medicine” that what the senator from New York is peddling. And that does not even take into account the potential appeal of a uniquely American single-payer system that might intelligently combine the necessary efficiency of a publicly-funded and defined payment program for covering costs with the appealing prospect of allowing Americans to choose their own basic plans and doctors.

Clinton could have proposed such a system. Indeed, she could have modeled it on the plan she and other members of Congress now enjoy.

Instead, she chose to propose a scheme defined not by the needs or desires of the American people but by the demands of existing insurance firms and a dysfunctional for-profit health care industry.

If the senator is nominated and elected, and if she advances the initiative she unveiled Monday, there will be no health-care reform. And America’s uninsured and under-insured millions will be doomed to suffer for another decade or so because Hillary Clinton was incapable of extracting herself from the grip of the corporations that have made it so hard for the Americans to get the care they need.

John Nichols’ new book is The Genius of Impeachment: The Founders’ Cure for Royalism. Rolling Stone’s Tim Dickinson hails it as a “nervy, acerbic, passionately argued history-cum-polemic [that] combines a rich examination of the parliamentary roots and past use of the ‘heroic medicine’ that is impeachment with a call for Democratic leaders to ‘reclaim and reuse the most vital tool handed to us by the founders for the defense of our most basic liberties.'”

by John Nichols
The Nation
Published on Tuesday, September 18, 2007

Would someone please ask Hillary Clinton to stop coming up with health care “reform” plans that are less attractive than the dysfunctional system she proposes to replace?

The former first lady, who snatched defeat from the jaws of victory in the 1990s by responding to the demand for a sane and humane system to deliver affordable medical care to all Americans with a plan to drown the ailing in a bureaucracy designed to augment the profits of the nation’s largest insurance companies, is back with an equally heavy-handed and unappealing “reform” proposal.

The senator from New York who has emerged as the frontrunner for the Democratic presidential nomination — based, in no small part, on romantic misrecollections of her last foray into the nation’s seemingly-endless health-care debate — wants to solve the crisis of the uninsured and the under-insured by requiring every American to obtain coverage.

Of course, the ridiculous Mitt Romney decries the Clinton campaign proposal as “European-style socialized medicine.”

But Romney knows so little about health care that he cannot even pick a smart site for a press conference on the issue — he derided the Clinton plan in front of St. Vincent’s Hospital in Manhattan, home of the Rudolph W. Giuliani Trauma Center. that is named for his chief rival in the Republican nomination race.

The reality is that the Clinton plan is about as socialistic as a Ronald Reagan corporate tax cut.

The Clinton plan maintains the current system of for-profit, insurance-industry defined health care delivery. The only real change is that, in return for minimal requirements regarding coverage of those with preexisting conditions, the government would pump hundreds of billions in federal dollars into the accounts of some of the country’s wealthiest corporations. The plan’s tax credit scheme would buy some more coverage for low-income families, which is good, but it would do so at a cost so immense that, ultimately, Clinton’s plan will be as tough a sell as the failed 1993 “Hillarycare” proposal.

America is ready for health care reform.

But it is not ready for more bureaucracy, more expense and more revenue for insurance companies.

Despite what Mitt Romney says, Clinton and the Democrats would have a far easier time selling “European-style socialized medicine” that what the senator from New York is peddling. And that does not even take into account the potential appeal of a uniquely American single-payer system that might intelligently combine the necessary efficiency of a publicly-funded and defined payment program for covering costs with the appealing prospect of allowing Americans to choose their own basic plans and doctors.

Clinton could have proposed such a system. Indeed, she could have modeled it on the plan she and other members of Congress now enjoy.

Instead, she chose to propose a scheme defined not by the needs or desires of the American people but by the demands of existing insurance firms and a dysfunctional for-profit health care industry.

If the senator is nominated and elected, and if she advances the initiative she unveiled Monday, there will be no health-care reform. And America’s uninsured and under-insured millions will be doomed to suffer for another decade or so because Hillary Clinton was incapable of extracting herself from the grip of the corporations that have made it so hard for the Americans to get the care they need.

John Nichols’ new book is The Genius of Impeachment: The Founders’ Cure for Royalism. Rolling Stone’s Tim Dickinson hails it as a “nervy, acerbic, passionately argued history-cum-polemic [that] combines a rich examination of the parliamentary roots and past use of the ‘heroic medicine’ that is impeachment with a call for Democratic leaders to ‘reclaim and reuse the most vital tool handed to us by the founders for the defense of our most basic liberties.'”

By Steffie Woolhandler and David U. Himmelstein
The Boston Globe
September 17, 2007

IN 1966 – just before Medicare and Medicaid were launched – 47 million Americans were uninsured. By 1975, the United States had reached an all time low of 21 million without coverage. Now, according to the Census Bureau’s latest figures, we’re back where we started, with 47 million uninsured in 2006 – up 2.2 million since 2005. But this time, most of the uninsured are neither poor nor elderly.

The middle class is being priced out of healthcare. Virtually all of this year’s increase was among families with incomes above $50,000; in fact, two-thirds of the newly uncovered were in the above-$75,000 group. And full-time workers accounted for 56 percent of the increase, with their children making up much of the rest.

The new Census numbers are particularly disheartening for anyone hoping for a Massachusetts miracle. In the Commonwealth, 651,000 residents are uninsured, 65 percent more than the figure used by state leaders in planning for health reform. Their numbers came from a telephone survey done in English and Spanish. But that misses people who lack a land-line phone – 43.9 percent of phoneless adults are uninsured, according to other studies.

It also skips over the 523,000 non-English speakers in Massachusetts whose native language isn’t Spanish (e.g. Portuguese, Chinese, or Haitian-Creole), another group with a high uninsurance rate. In contrast, the Census Bureau goes door-to-door for its survey and has translators for almost every language. It gets a more complete picture.

In sum, Massachusetts health reform planners have been wishing away a quarter of a million uninsured people. Recent Patrick administration claims that health reform is succeeding are based on cooked books. According to the state’s figures, almost half of the previously uninsured gained coverage under the health reform bill by July 1. But according to the Census Bureau, the new sign-ups amount to less than one-quarter of the uninsured. Moreover, it’s likely that much of that gain has already been wiped out by shrinking job-based coverage – a longstanding and nationwide trend.

Why has progress been so meager? Because most of the promised new coverage is of the “buy it yourself” variety, with scant help offered to the struggling middle class. According to the Census Bureau, only 28 percent of Massachusetts uninsured have incomes low enough to qualify for free coverage. Thirty-four percent more can get partial subsidies – but the premiums and co-payments remain a barrier for many in this near-poor group.

And 244,000 of Massachusetts uninsured get zero assistance – just a stiff fine if they don’t buy coverage. A couple in their late 50s faces a minimum premium of $8,638 annually, for a policy with no drug coverage at all and a $2,000 deductible per person before insurance even kicks in. Such skimpy yet costly coverage is, in many cases, worse than no coverage at all. Illness will still bring crippling medical bills – but the $8,638 annual premium will empty their bank accounts even before the bills start arriving. Little wonder that barely 2 percent of those required to buy such coverage have thus far signed up.

While the middle class sinks, the health reform law has buoyed our state’s wealthiest health institutions. Hospitals like Massachusetts General are reporting record profits and enjoying rate increases tucked into the reform package. Blue Cross and other insurers that lobbied hard for the law stand to gain billions from the reform, which shrinks their contribution to the state’s free care pool and will force hundreds of thousands to purchase their defective products. Meanwhile, new rules for the free care pool will drastically cut funding for the hundreds of thousands who remain uninsured, and for the safety-net hospitals and clinics that care for them. (Disclosure – we’ve practiced for the past 25 years at a public hospital that is currently undergoing massive budget cuts.)

Health reform built on private insurance isn’t working and can’t work; it costs too much and delivers too little. At present, bureaucracy consumes 31 percent of each healthcare dollar. The Connector – the new state agency created to broker coverage under the reform law – is adding another 4.5 percent to the already sky-high overhead charged by private insurers. Administrative costs at Blue Cross are nearly five times higher than Medicare’s and 11 times those in Canada’s single payer system. Single payer reform could save $7.7 billion annually on paperwork and insurance profits in Massachusetts, enough to cover all of the uninsured and to upgrade coverage for the rest of us.

Of course, single payer reform is anathema to the health insurance industry. But breaking their stranglehold on our health system and our politicians is the only way for health reform to get beyond square one.

Dr. Steffie Woolhandler and Dr. David Himmelstein co-founded Physicians for a National Health Program and are primary care doctors at Cambridge Hospital.