Speaker – Page 979

Medicare-for-all would keep everyone covered

Aaron E. Carroll, M.D.
The Indianapolis Star
Sunday, September 9 2007

One year ago, when the U.S. Census Bureau released its figures on Americans lacking health insurance in 2005, I wrote a piece here describing the sad state of the health care system in America. Recently, the 2006 numbers were released, and things have only gotten worse.

The number of uninsured Americans has jumped by 2.2 million to 47 million. This rise in the number of people without health insurance is the biggest jump reported by the Census Bureau since 1992. There are now more uninsured people in the United States than at any time since the passage of Medicare and Medicaid in the mid-1960s.

Amazingly, this deplorable situation has not been met with righteous anger or shock. It barely made a splash in the news. Yet, these numbers represent extraordinary suffering, unnecessary disability and premature deaths — at least 18,000 deaths per year, according to the Institute of Medicine.

Before we jump to conclusions about who is uninsured in America, some of the facts in the Census Bureau’s report deserve closer attention.

More than 90 percent of the newly uninsured are families with middle or high incomes. Some 1.4 million of the newly uninsured, accounting for 64 percent of the increase, are in families making more than $75,000 per year. An additional 633,000 new uninsured, 29 percent of the increase, are in families earning between $50,000 and $75,000. More than half the newly uninsured are full-time workers.

This divergence between poverty and uninsurance is relatively new and striking. Until now, as poverty went down, uninsurance fell. Now this has changed. Health insurance is so expensive (more than $11,000 for a family policy) that even middle-class families potentially face financial ruin along with illness and injury.

Do not be fooled into thinking any of the incremental changes we have been making are going to solve this problem. They are Band-aids on a gaping wound. In Massachusetts, often cited as a model for reform, the number of uninsured increased from 583,000 in 2005 to 657,000 in 2006. In Indiana, with a population less than that of Massachusetts, 12 percent, or 748,000 people, went a whole year without health insurance in 2006.

As those in Washington dither over the expansion of programs like State Children’s Health Insurance Program (SCHIP) to nip at the edges of this problem, the number of uninsured children rose by 611,000 between 2005 and 2006. As the president decries an SCHIP expansion as harmful to private insurers, the percentage of people covered by employment-based insurance actually decreased from 60.2 percent to 59.7 percent. As he claims that SCHIP expansion will encourage people to abandon private insurance for government programs, the number of Americans covered by such public programs actually decreased. Private health coverage is deteriorating rapidly, and the safety net, or what is left of it, cannot keep up.

In fact, the Bush administration wants to scale back the SCHIP program by insisting that states must enroll 95 percent of the lowest-income, and therefore eligible, children before more can be added. Nearly all state administrators have insisted that this goal is impossible to achieve. Make no mistake — this is an admission that incremental programs can never achieve universal coverage.

There is one sure-fire way to make these numbers come down. It worked for seniors in the 1960s and it still works for them today. You may hear politicians demonizing government-run health insurance, but you will hear none run on a platform of eradicating Medicare; nor will any turn it down for themselves when they turn 65. Call it whatever you want: National health insurance, Medicare-for-all, “single-payer” or socialized health insurance; it doesn’t matter. Research shows that Medicare-for-all could save enough on administrative waste ($350 billion) to cover all the 47 million uninsured and improve coverage for everyone else. A single-payer national health insurance system is the only way to drop the number of people lacking health insurance to zero.

Wouldn’t that be nice to read in next year’s Census statistics?

The Health Care America Wants

To the Editor:

David Brooks (“The New Social Contract,” column, Sept. 7) dismisses a single-payer health insurance system on the grounds that Americans “will not likely embrace a system that forces them to defer to the central government when it comes to making fundamental health care choices.”

Yet the federal government’s Medicare program has strong political support.

In 2003, even a conservative Republican president and Congress found it politically advantageous to expand Medicare significantly by adding prescription drug benefits.

Extending Medicare to cover all Americans would strengthen America’s economy in three ways.

It would reduce administrative expenses, replace costly emergency room visits for those now lacking insurance with more cost-effective preventive care, and improve the global competitiveness of American manufacturers, who now bear much higher health care costs than do their foreign rivals.

Gregory M. Saltzman
Ann Arbor, Mich., Sept. 7, 2007
The writer is a professor of economics and management at Albion College.

To the Editor:

According to David Brooks, single-payer health care is a bust, since Americans are too individualistic to embrace “a system that forces them to defer to the central government.”

But most Americans are now forced either to defer to the profit-seeking H.M.O. their employer chooses, or to switch jobs (which is certainly not as easy as switching brands of toothpaste) and be beholden to the H.M.O. one’s new employer has chosen.

Many other Americans are not lucky enough to be offered health insurance at work at all, and are forced to use the emergency room as their site of primary care. Hence, I doubt whether Americans, if there were a truly informative national discussion on the issue, would take the bogus threat of single-payer serfdom seriously, especially if the single-payer system is pitched as “Medicare for all.”

Craig Duncan
Ithaca, N.Y., Sept. 7, 2007

To the Editor:

David Brooks does not recognize that a single payer system based upon expanding Medicare, a proven system, to universal coverage does not mean “free” health care and would not place a burden on future generations.

Of course, premiums would be paid, perhaps adjusted for income.

The difference would be that the not-for-profit single payer system would be dedicated solely to using premiums for paying for medical treatment rather than a cash cow used to maximize profit through investment, limiting benefits and denying claims.

Medical providers and consumers as well as small and large businesses would all benefit from this approach. The system of relegating a nation’s health care to those interested only in profit is uncaring and in many ways, abusive.

Herb Wild
Punta Gorda, Fla., Sept. 7, 2007

To the Editor:

David Brooks seems favorably disposed to Stuart Butler’s health care reform plan for Americans.

While Mr. Butler’s plan may be an excellent plan, it is both innovative and untried. I propose a health care plan for all Americans that is in place and is presently in use and has a high satisfaction rating albeit slightly controversial because it is a single-payer program.

I am speaking of the health care package that the United States government provides our president, vice president, senators, members of the House, Supreme Court justices, secretaries of state, defense and so on.

I am confident that this health care package that our government offers to our leaders would be acceptable to the overwhelming majority of our citizens. It’s worth a try.

Isaac Comerchero
New York, Sept. 7, 2007

To the Editor:

David Brooks makes what he imagines to be two salient points explaining why single-payer health systems are not right for America: they are “European” and invariably centralized.

He is mistaken on both counts. Canada has just such a system but is distinctly North American.

Canadian health care, moreover, is delivered by 10 provincial and several territorial governments, not the government of Canada. Almost all of these jurisdictions use highly regionalized delivery systems.

There are, in fact, substantial variations in structure, procedures, coverage and financing, and these mirror and accommodate many local realities. Canadian health care already is the continent-spanning flexible web of networks Mr. Brooks so admires.

Ronald Hikel
Stratford, Ontario, Sept. 7, 2007
The writer was deputy minister of health for the province of Manitoba, 2000-1, and co-chairman of the federal-provincial council of deputy ministers of health.

To the Editor:

David Brooks espouses a new, complex health care plan redolent of the costly Medicare replacement plans in effect since the beginning of 2007. The federal government is now spending additional overhead to finance plans that are partly public and partly private and that have replaced, for some of us, traditional Medicare.

Two local medical groups my wife and I have tried to use this year will not accept our Medicare replacement insurance, even though both accept traditional Medicare.

Mr. Brooks writes that Americans “will not likely embrace a system that forces them to defer to the central government when it comes to making fundamental health care choices.”

He is manifestly wrong.

Millions find traditional Medicare more than satisfactory, and I lament that my wife and I are presently covered by an inadequate replacement plan rather than the excellent central government plan known as Medicare.

Robbins Winslow
Naples, Fla., Sept. 7, 2007

Age related burden of out-of-pocket health spending

The Burden of Out-of-Pocket Health Spending Among Older Versus Younger Adults: Analysis from the Consumer Expenditure Survey, 1998-2003

By Katherien A. Desmond, M.S., Thomas Rice, Ph.D., Juliette Cubanski, Ph.D. and Patricia Newman, Sc.D.
The Henry J. Kaiser Family Foundation
September 2007

Research has shown that older people spend more out of pocket on health care expenses than younger adults, but there have been only a few comparisons over the past 15 years of the magnitude of this difference or analyses of how the spending burden for younger and older adults may have changed over time. Understanding the extent to which younger and older adults are affected by rising out-of-pocket costs as a share of income may be important in the coming years as policymakers grapple with the challenge of maintaining or improving coverage for the rising numbers of younger adults without health insurance in the U.S., the rising number of people of all ages who are under-insured, and the challenge of making health care affordable for seniors on Medicare. In this paper, we analyze the extent to which health care spending as a share of income has differed among younger adults versus people ages 65 and older, both at a point in time (2003) and over the six-year period from 1998-2003.

Findings

The clear pattern that emerges in both sets of results is that people over age 65 spend far more of their income out of pocket on health care costs than younger adults. Older individuals, on average, spend over 12% of income, compared to only 2% for younger individuals. The pattern for households with two or more people is nearly identical, except that spending in relation to income is slightly higher — 14% for seniors and 3% for younger adults.

Among people age 65 and older, median out-of-pocket spending as a share of income rises with age. Those with Medigap to supplement Medicare spend more on health as a share of income than any other group of seniors, including those with no supplemental coverage at all, which may be driven by high premiums for private Medigap policies.

The figures show clearly that prescription drug spending was a relatively small portion of out-of-pocket health spending for younger and older adults alike. Thus, reductions in out-of-pocket spending that may occur among people over age 65 as a result of the Medicare drug benefit, although helpful, will do little to narrow the gap between the share of income spent out of pocket on health care costs for seniors versus younger people.

Discussion

Our findings document a persistent gap in financial burden between young and old which could have important implications for ongoing policy discussions in several areas, including the generosity of coverage for working age adults, rising health care costs, entitlements and more fundamental questions about the appropriateness of shifting more costs onto consumers.

If, in the future, out-of-pocket spending on health care continues to rise at a substantially faster rate than income, then the burden of health care spending will only increase over time, raising serious concerns about the affordability of medical care, particularly for seniors.

http://www.kff.org/medicare/upload/7686.pdf

Comment:

By Don McCanne, MD

The results of this study are intuitive. Older individuals with greater health care needs and lower incomes spend a greater percentage of their incomes on health care than do younger, healthier individuals with higher incomes. But there are a couple of other extrapolations from this study that are also important.

A significant part of the higher out-of-pocket spending for seniors is the premium paid for Medigap coverage. Medigap policies are perhaps the worst value in the private insurance market. Medical loss ratios (amount spent on health care) are typically 70 percent. Since out-of-pocket spending is a problem for seniors, it would be far better to fold the benefits offered by the Medigap plans into the Medicare program, saving that 30 percent lost to the private insurers. This would not change the incentives to use services since the total coverage would still be the same, except for the very few who have no supplemental coverage of any type. But it would have the benefit of reducing the out-of-pocket expenses which are clearly too high. This is particularly important for the half of the individuals above the median percentages reported in this study.

Also we should not be complacent because the median percent of out-of-pocket spending for younger individuals is relatively low. Most younger individuals are healthy and thus the median value would be expected to be quite low. The problem is that the median is not shifted by the very high skew of the costs of the unfortunate few with major medical problems. It is precisely those individuals with greater medical needs that are being battered by the high out-of-pocket costs in health care.

The out-of-pocket burden is a problem for individuals with significant health care needs, regardless of age. Why do we continue to listen to those who insist that the secret to controlling costs is to make people feel the pain by paying more out-of-pocket for the health care that they actually need? Out-of-pocket spending is already too high and will only get worse under current trends.

Guest Commentary: Get rid of the for-profits

Healthcare can no longer be a commodity for sale to those who can afford it

By Rep. Dennis Kucinich
Modern Healthcare
Sep 4, 2007

In a way and with an emphasis never before seen in political discourse and debate in the U.S., the issue of healthcare reform has taken center stage as one of the top priorities among Democratic presidential candidates.

At every debate and every forum, at every town hall meeting and union hall gathering, the question comes up: “What are your plans to reform our healthcare system?”

Not surprisingly, every candidate has a plan. The kindest observation that can be made regarding those plans is that they reflect an acknowledgement by the candidates that something is terribly wrong and that something needs to be done to solve the problem. For the most part, they define the problem in terms of the 47 million Americans who are uninsured, the estimated 50 million Americans who are underinsured or the millions of others who are at risk of losing whatever insurance they have because of circumstances beyond their control, such as job loss or changes in employer-paid benefits.

Those candidates are wrong. What they see as the problem is merely a sad, sometimes tragic, litany of symptoms. The real problem, I submit, is that healthcare in the U.S. is delivered by a system that is controlled and directed by for-profit insurance and pharmaceutical companies whose financial prosperity depends on providing as little healthcare as possible. We can no longer treat healthcare as a marketplace commodity for sale to those who can afford it. We must recognize that the U.S. stands alone among major industrialized nations in its failure to ensure adequate healthcare for its citizens is the problem.

There is only one “real” solution for the problem, and that solution is to remove “for-profit” from the healthcare equation. And I am the only candidate who has proposed that solution.

House Resolution 676, introduced in January and co-authored by Rep. John Conyers (D-Mich.) and myself, would establish a national, not-for-profit, single-payer insurance program that would cover all Americans for all necessary medical care. This bill, also known as the U.S. National Health Insurance Act, would provide coverage for prescription drugs, inpatient and outpatient care, primary and preventive care, emergency services, vision and dental care, mental health, home health, physical therapy, rehabilitation (including for substance abuse), chiropractic services and long-term care. There would be no premiums, no deductible and no copays.

The bill has 76 co-sponsors in the House of Representatives and has been endorsed by the California Nurses Association, National Nurses Organizing Committee, Physicians for a National Health Program, hundreds of labor union locals, and a number of local and state governmental bodies across the country. It also is the only healthcare plan endorsed by filmmaker Michael Moore, whose courageous, landmark documentary “Sicko” was a blistering expose of the for-profit healthcare system in America.

HR 676 represents a fundamental change, not only in how healthcare is financed and delivered, but in our national philosophical and moral definition of what healthcare is: a basic right of the people in an enlightened society, and a social and moral obligation of the government to its citizens.

And it is eminently affordable.

We spend more than $2.2 trillion a year on our current for-profit healthcare system. More than 30 cents of every dollar go to cover costs and expenses that have nothing to do with delivering healthcare: profits, dividends, executive salaries, stock options, bonuses, advertising, marketing, paperwork, and a host of duplicative and redundant services among legions of separate, independent, for-profit insurance and pharmaceutical companies. That’s more than $660 billion per year that doesn’t go directly to pay for healthcare.

Clearly, we are already paying for a national healthcare insurance system. We’re just not getting it. Instead, we’re paying for a ridiculously inefficient and scandalously discriminatory patchwork system that prospers more and more only when it provides less and less care. Physicians, nurses and other medical professionals who are in the best position to collaborate with patients to make healthcare decisions are at the mercy of insurance companies’ profit-driven decisions.

At the same time, while other candidates assert with seemingly zealous rhetoric that their plans will help those tens of millions of Americans who are being denied coverage or are paying too much for it, they propose no fundamental change in the current system. Rather than removing for-profit insurance companies from the system, they propose subsidizing those companies as a means of reducing premiums and costs. Some propose incentives (subsidies) to employers to help cover employees’ healthcare costs. Some propose more aggressive negotiations with insurance and pharmaceutical companies to make coverage more affordable for more people.

But the seldom-spoken reality is that every plan except mine would keep the for-profit companies in place and in control. Every plan except mine would still leave millions of Americans uninsured or underinsured. Every plan except mine reflects an unwillingness to challenge the politically and financially powerful insurance and pharmaceutical industries.

I am not afraid to challenge those interests. My campaign is not funded by them. My personal investment portfolio will not increase in value if the government begins pouring billions of dollars in subsidies into the for-profit healthcare industry. My loyalty and my commitment is to the American people. A universal, not-for-profit, single-payer health insurance plan for America is a moral and economic imperative. It is the No. 1 domestic policy issue, and reform requires more than rhetorical bandaging. It requires major surgery.

Rep. Dennis Kucinich of Ohio is a Democratic candidate for president.

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Taking care of our own: Health care in Spain has Lessons for the U.S.

By Pius Kamau
The Denver Post
9/5/07

We watched the running of the bulls in Pamplona from the safety of a balcony off a physician’s office. A crashing crowd of thousands and half a dozen bulls ran down the narrow street below us.

Then we saw a bull make an about-turn and attack several people, among them Lawrence and Michael Lenahan, brothers from Philadelphia. One suffered a deep wound to his buttocks; the other a less serious leg wound. Both required hospitalization.

I visited the ultra-modern University Hospital where the Lenahans were taken, a facility where heart and kidney transplants are routinely performed. I believe their care was as good as that offered in many American trauma centers.

Considering the current debate about health care reform in the U.S., I wondered what the Lenahans’ care would cost in Spain. All Spaniards’ health care is covered by Seguro Social, the state’s medical insurance, I learned. Hospital physicians told me that emergency care for all patients — regardless of citizenship — is provided without charge.

“Why would they do so?,” I asked. “Es lo justo,” I was told. It’s the right thing to do.

Until Francisco Franco’s death in 1975, fascist Spain was “the sick man” of Europe. After democracy and capitalism took root, the country’s economic fortunes reversed. Like other European countries, Spain has universal health care. Part of its success results from the fact that employers, industry and businesses are not shackled to their employees’ health care.

Most Spaniards I talked to are very happy that everyone is saved from being uninsured. They also were quick to point out that there is also private medical insurance for those who want it or can afford it. They consider our health care system a travesty and can’t understand why we can’t devise a system that works for all.

In Spain, France and the United Kingdom, illness condemns no one to penury. Every child is guaranteed immunization and basic health care. Every citizen in the European Union has the one thing 47 million Americans lack: universal health insurance. Contrary to what one hears, I found medical care in Europe to be as good as in the U.S.

In his book, “The United States of Europe,” T.R. Reid — a Colorado resident and former London bureau chief of The Washington Post — shows that health care in Europe is economically and socially a much better system than our own. Unburdened by a top-heavy health care system, Europe, he says, is bound to overtake the U.S. economically.

Americans don’t know that we can quite economically cover everyone without raising taxes or jeopardizing the quality of care. Furthermore, we can copy those parts of the Canadian and European systems that best suit us, to attain universal coverage.

What we need is a Medicare-like health care for all Americans, something similar to the federal system used by our senators and congressmen, a system divorced of the profit-seeking middlemen.

What’s abhorrent is the travesty of Americans losing their savings and livelihoods from illness because they are uninsured, of children dying from easily preventable conditions. The number of the uninsured in America has risen to 47 million as we argue about semantics, and our people are dying unnecessarily. Surely we can take care of our own citizens.

Pius Kamau of Aurora is a thoracic and general surgeon. He was born and raised in Kenya and immigrated to the U.S. in 1971.

Garamendi Stumps for Single-Payer Health Care System

Lt. Gov. John Garamendi (D) is touring California to gather support for a state-run, single-payer health care system, the Fresno Bee reports.

Garamendi on Monday stumped for universal health care in Los Angeles and Fresno. The lieutenant governor then was headed to Sacramento and Alameda to tout a single-payer, state-run health system similar to Medicare or the insurance plans provided to California teachers and federal employees.

Garamendi said health care legislation will be passed this year “but the question is what will it be.” He added, “If it’s for children only, that’s good, but it’s far and away from what needs to be done.”

He added, “We have seven days ahead of us to take a gigantic step forward for universal health care. We’ll either succeed or stall out, but the fight isn’t over” (Lloyd, Fresno Bee, 9/4).

Nuñez's unhealthy bill

No reform at all would be better than giving Schwarzenegger a political victory and leaving insurance companies in charge.

By Deborah Burger
Los Angeles Times
September 6, 2007

In alliance with Gov. Arnold Schwarzenegger, Democratic leaders of the state Legislature, led by Assembly Speaker Fabian Nuñez (“Healthcare reform — now,” Opinion, Aug. 28), are rushing to enact a substandard health reform plan that will not reduce the health insecurity of California families.

They’re apparently even willing to jeopardize Sen. Barbara Boxer and their own party’s slim hold on the United States Senate along the way.

Here’s the deal: Nuñez and some other Democrats are actively working with Schwarzenegger to put together a “compromise” healthcare package.

Schwarzenegger, the main architect of that plan, gets to claim credit for supposedly solving the state’s healthcare crisis using “bipartisan consensus.” As collateral damage to Democrats, Schwarzenegger can tout this deal to boost his candidacy against Boxer in 2010.

Nuñez could then get the governor’s support for extending his term as speaker.

This constellation of events may be dandy for a career politician or two, but it leaves behind a lot of other Californians, who will have to contend with a poor healthcare bill full of holes.

AB 8 does nothing to rein in rising insurance premiums — up 87% nationally this decade — or rising co-pays, deductibles and other health fees. Which means that costs, already unaffordable for far too many, would continue to spin out of control.

The bill fails to limit rising prescription drug costs, especially notable at a time when Schwarzenegger has just eliminated funding for his “voluntary” drug price restraints that were so ballyhooed last year by the governor and the authors of AB 8.

It is not universal, as many of the currently uninsured would remain without access to care. It fails to assure uniform, comprehensive benefits, and therefore perpetuates an increasingly multi-tiered health system based on the ability to pay.

It fails even to require insurance companies to provide insurance. They would not have to offer coverage to those with serious medical conditions — those people would instead be dumped into a publicly funded high-risk pool, earning big insurance companies millions in additional profits while bankrupting the public pool with the sickest, costliest patients.

The bill does not even protect patients’ choice of physicians, hospitals or other providers.

And, most critically, the plan reinforces and expands an insurance-based system — the source of much of the present crisis — thereby subverting real reform for years to come.

At the center of the plan is a mandate on businesses to either provide health coverage or pay taxes into a fund to buy it for their employees. The new tax would fall between the 7.5% of payroll costs favored by Nuñez and the 4% Schwarzenegger proposes.

No matter where the compromise figure ends up, it will be far less than many employers now pay for health benefits. One-fourth of all California businesses that provide health benefits currently pay more than 15% of their payroll for health premiums, according to the California Healthcare Foundation. As a result, businesses that now provide health coverage to employees would have an incentive to drop it.

Moreover, the mandate on employers is unlikely to survive a legal challenge; a similar Maryland bill was thrown out by the federal courts for violating federal benefits law.

Schwarzenegger continues to push his proposal to force most uninsured people to buy insurance or face severe penalties. So far, Democrats have resisted this proposal, but many expect them to accept some form of individual mandate as the final price for Schwarzenegger’s blessing for the term limits initiative.

Last year, Democrats united behind SB 840, a single-payer-style, enhanced “Medicare for all” bill that would have provided guaranteed healthcare for everyone, controlled costs, eliminated co-pays and deductibles, guaranteed choice of provider, and gotten the insurance companies out of the way.

Similar systems are succeeding in every other industrialized democracy — including Schwarzenegger’s homeland, Austria. If the politicians in Sacramento are concerned about patient care, they will not now settle for a bad healthcare bill that will further degrade our healthcare safety net. A bad healthcare bill is worse than no bill.

Deborah Burger, RN is president of the California Nurses Association.

MachinistsÂ’ Union (IAM) Ninth International to Endorse HR 676

The International Association of Machinists and Aerospace Workers (IAM) is the ninth international union to endorse HR 676, single payer healthcare legislation introduced by Congressman John Conyers (D-MI). The union represents 720,000 active and retired members.

In a letter conveying the endorsement, IAM Assistant Legislative Director, Hasan Solomon, said, Â“Â…we strongly endorse Congressman John ConyersÂ’ bill HR 676, Â‘Expanded and Improved Medicare for All.Â’Â” Solomon further states in his letter, Â“We have and will continue to urge members of Congress to support this much needed health care reform.Â”

The IAM joins the UAW, NEA, ILWU, NALC, UE, AFM, UA Plumbers & Pipefitters, and CNA/NNOC which have all endorsed HR 676.

Nuñez’s unhealthy bill