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Insurance industry insider on Medicare vouchers
Medicare Voucher Costs
Letter, The New York Times, August 28, 2012
To the Editor:
Re “Truth and Lies About Medicare” (editorial, Aug. 19):
As a former chief executive and actuary of an insurance company that once sold both individual and group health insurance, I am particularly mystified by the effort to push Medicare participants into the individual health insurance market.
I thought that we wanted to reduce — or at least control — the cost of health insurance, but individual health insurance is by far the most expensive alternative.
Depending on the size of the vouchers, the government itself may save money, but the entire system will pay more. Someone has to pay for the costs of individual underwriting, marketing and so on, and those expenses will fall on the elderly themselves.
You are also correct in assuming that there is likely to be anti-selection, with the healthier people going to the insurance companies, leaving the sickest and most expensive people in the Medicare plan.
It is certainly true that health insurance needs reform and that President Obama is far from having all the answers, but the Romney-Ryan plan will increase the country’s health care bill with little or any of the increase going to more or better health care.
Stephen Brown
Brewster, Mass.
http://www.nytimes.com/2012/08/29/opinion/medicare-voucher-costs.html
Comment:
By Don McCanne, MD
Today’s message is important because it comes from an insider in the health insurance industry. Not only does he indicate that it is a terrible idea for Medicare beneficiaries to use vouchers to purchase private, individual plans, but, of even greater significance, is “that health insurance needs reform and that President Obama is far from having all the answers.”
For private insurance reform, nobody has all the answers. The nature of the beast is that when you try to fix one defect, others open up. Instead of moving Medicare beneficiaries into private insurance plans, we need to move private insurance victims into Medicare.
Shareholders urge WellPoint to oust CEO Angela Braly
Shareholders urge WellPoint to oust CEO Angela Braly
By Chad Terhune
Los Angeles Times, August 28, 2012
Investors in health insurance giant WellPoint Inc., which runs Anthem Blue Cross in California, are pressing for a change in top management as criticism intensifies about the company’s lagging stock, managerial missteps and disappointing earnings.
Shareholder complaints about WellPoint’s chairwoman and chief executive, Angela Braly, have grown louder since last month, when the Indianapolis company posted another anemic quarter and cut its full-year profit outlook as its enrollment fell again.
The investor unrest follows years of consumer fury that beset WellPoint as it repeatedly raised premiums on many families and small businesses by 10% or more.
A New York hedge fund, Royal Capital Management, sent a letter to WellPoint’s board last week saying that Braly has “failed miserably” as CEO and that “it is incumbent upon the board of directors to fulfill its fiduciary responsibility to shareholders by changing leadership.”
Other influential WellPoint shareholders, such as Leon Cooperman’s Omega Advisors hedge fund in New York, have expressed similar concerns about the company’s lackluster performance, particularly compared with its chief competitors’, and they have urged the board to replace Braly.
Thus far, WellPoint’s board has voiced strong support for Braly. “The board has been fully involved in the strategy WellPoint is pursuing and is supportive of the strategy and our management team,” Jacquelyn Ward, the company’s lead outside director, said in a statement last month after analysts began questioning management’s performance.
“Braly has presided over the most arbitrary and capricious health insurance rate hikes of our time,” said Jamie Court, president of Consumer Watchdog, an advocacy group in Santa Monica. “Now she is learning the rules of Wall Street: Cross policyholders all you want, but don’t step on the wallets of shareholders.”
http://www.latimes.com/business/la-fi-wellpoint-under-fire-20120828,0,4090962.story
Comment:
By Don McCanne, MD
Our politicians have left the private insurance industry in charge of our health care, but what is this industry really all about? As Jamie Court says, “Cross policyholders all you want, but don’t step on the wallets of shareholders.”
Addendum to today’s Quote of the Day on Angela Braly:
Angela Braly resigned today as president and CEO of WellPoint.
It would be a mistake to celebrate this action as some sort of elimination of an evil-doer. She will be replaced. From the perspective of patients, nothing changed.
The action that we need is from the President and Congress. They need to eliminate the private insurers and replace them with an improved Medicare for all. Hold the celebration until we can accomplish that goal.
Health Care Flaws
The New York Times, Letters, Aug. 27, 2012
To the Editor:
Re “A Reluctant Crash Course in Health Insurance 101” (The Agenda, Aug. 21): Suleika Jaouad’s dispassionate account of the added burdens imposed by our fragmented system of health insurance on those unfortunate individuals who become sick is powerful in its lack of sentimentality. With an unconscionable 45,000 excess deaths a year due to lack of health insurance, we remain the only country in the world where getting seriously ill or hurt, as if that weren’t bad enough, significantly increases one’s risk for financial ruin — even with health insurance. More than half of personal bankruptcies in the United States result from medical bills, and of those, 75 percent of the cases are people who had medical insurance when they got sick or injured.
Until the for-profit health insurance industry is replaced by a single-payer national health insurance program, Americans will continue to suffer and die for the sake of excessive corporate salaries and shareholder profits.
Elaine Fox, M.D.
Southampton, N.Y.
To the Editor:
Only in the United States would a young patient be burdened with tens of thousands of dollars of medical bills and a mother who should “be able to spend less time with my bills and more time with me” — while insurance companies bet billions on the increased profits they’re going to reap once the so-called Affordable Care Act brings them millions of new customers. While every other advanced country has achieved universal access to health care and removed from patients the burden of worrying about medical bills, we increasingly saddle patients with co-pays, deductibles and skimpy provider networks.
Medicare, which has largely removed these burdens from the elderly, while controlling costs better than the private sector, points the way. Until we expand and improve Medicare to cover everyone, patients will suffer while corporate stockholders smile all the way to the bank.
Leonard Rodberg
Flushing, N.Y.
The writer is research director for the New York chapter of Physicians for a National Health Program.
Ultra-conservatives offer no solutions on health care
By Pamella Gronemeyer, M.D.
Edwardsville (Ill.) Intelligencer, Letters, Aug. 1, 2012
Recently, I attended the Americans for Prosperity (AFP) event in Edwardsville entitled “Healthcare Freedom.” I am a Medicare for All advocate and a physician. I went to see how and what the AFP (the not-truly-a-grassroots organization but more the tentacle of the Koch Brothers) was selling.
The gist of the presentation was that Illinois should reject the federal money for expanding Medicaid and not set up health care exchanges putting our state in the same nihilistic class as Florida and Texas. Medicaid shouldn’t be expanded because it is broken. We should reject the Affordable Care Act (ACA) even though the presenter acknowledged that there is no other plan in the works to fix health care nor help cover the working poor who can’t afford health care now.
The story about the 12-year-old who died of dental disease because the family could not find a Medicaid provider was tragic. When asked what should have happened, there was no answer. The child’s death was inevitable (the speaker avoided answering the question). I agree that Medicaid’s payment rate is low and the checks are slow: however, ending Medicaid or shrinking it is not the answer.
Until we get single-payer health care, the ACA is the law of the land. If the AFP likes states’ rights then hopefully Vermont will get a waiver for state single payer and California will move forward. Most of the people in the room looked like they were Medicare age. None of them complained about their single-payer care.
Pamella Gronemeyer, M.D., is co-president for Southern Illinois of Physicians for a National Health Program-Illinois and a member of the board of the Illinois Single Payer Coalition. She resides in Glen Carbon, Ill.
Senator Kennedy’s Compromise
By Philip Caper, M.D.
The New York Review of Books, July 12, 2012
In Marcia Angell’s critique of Ronald Dworkin’s article about the Affordable Care Act’s mandate to buy health insurance, she advocates for replacing the ACA with a single-payer system [“Should Obama’s Health Care Be Opposed?” NYR, June 7]. In his rebuttal to her letter, Dworkin states that “even Senator Edward Kennedy, who was among the most powerful advocates of a single-payer system, long ago abandoned all hope of achieving it.” That is not quite correct.
I was the first physician Senator Kennedy hired as an adviser on health care. I served on his staff between 1971 and 1976 and continued to advise him on matters of health policy until his death in 2009. Although Senator Kennedy was acutely (and painfully) aware of the political obstacles that stood in the way of passing legislation expanding Medicare to eventually cover the entire American population, he nonetheless continued to believe it would be the best policy. On April 25, 2007, and over the objections of some on his staff at the time, he (together with Congressman John Dingell) introduced a bill that would do just that.
To the end, Senator Kennedy believed in going for the best.
Philip Caper, MD
Brooklin, Maine
Reply by Jeff Madrick, whom Ronald Dworkin cited as a source:
As Dr. Caper writes, Senator Kennedy always believed that a single-payer system was the best way to achieve adequate health care for all Americans. Not only did he sign onto the Dingell bill, he also reiterated his support of Medicare for all in his book, “America Back on Track,” which I helped write.
But in the political world, he had essentially backed off support for pure single-payer systems by the late 1970s. He realized the approach had too many powerful enemies. As Paul Starr points out in his book “Remedy and Reaction,” Kennedy proposed a plan for universal coverage in 1979 but that plan enabled Americans to buy insurance from Blue Cross, HMOs, or other private insurers. He wrote about his decision to compromise with the private health care industry in his last memoir.
Senator Kennedy was always a political pragmatist. Even in the early 1970s, he was willing to compromise on a full-fledged single-payer plan by requiring some payments by enrollees in opposition to the unions. And let us keep in mind that he supported President Obama’s less than perfect plan as well.
This does not mean Kennedy was not an idealist. His deep-felt idealism was his most admirable trait on issues across the political landscape. But he knew more about how to get legislation passed than almost any of his peers and certainly than anyone around today. It meant compromise, and it is why he accomplished so much. Many of us less-involved observers would not be good at that. But he was.
http://www.nybooks.com/articles/archives/2012/jul/12/senator-kennedys-compromise/
PNHP note: When Sen. Kennedy and Rep. Dingell introduced their “Medicare for All Act” in April 2007, Dr. Don McCanne, PNHP’s senior health policy fellow, assessed the legislation at his “Quote of the Day” blog, noting that it fell far short of the single-payer model by leaving the private health insurance industry in place and by perpetuating the administrative complexity of our current dysfunctional, multipayer system. At the same time, he saluted Kennedy and Dingell as longtime leaders in the effort to obtain comprehensive health care coverage for everyone. You can read McCanne’s assessment here.
Massachusetts leads on health care while Maine regresses
By Philip Caper, M.D.
Bangor Daily News, Aug. 23, 2012
Massachusetts, the first state that attempted to offer health care to all its residents and provided the template for national health reform, recently took the inevitable and much more difficult next step.
It passed a law intended to restrain future growth in total statewide health care costs. Once government has adopted a policy of achieving universal health care, it must then take steps to maintain affordability.
For the past 50 years, our national health care policy has been one of relentlessly expanding our system’s capacity. In the mid-1950s, the Internal Revenue Service made employer-provided health benefits tax exempt. In 1965, building on the legacies of Presidents Roosevelt, Truman and Kennedy, President Johnson prodded the Congress into enacting Medicare and Medicaid, thereby infusing billions of public dollars into our health care system for direct care of the poor and elderly.
During the following decades, under both Democratic and Republican administrations, Congress further expanded our health care system, creating community health and mental health centers, the national health service corps and expanding health benefits for federal workers, the military and their dependents, as well as veterans and Native Americans.
Congress also provided support to increase the numbers of doctors, nurses and other health care professionals and to construct hospitals and other health care facilities. Federal support for basic biomedical research was massively expanded through the National Institutes of Health.
That support subsequently spurred unprecedented innovation through the conversion of publicly funded scientific knowledge into commercially viable products and the capability to use them. With the help of sophisticated marketing techniques, these products and services are now being relentlessly promoted in an effort to increase demand.
So our public policy regarding health care has been to spend trillions of dollars to expand our capacity to provide services, personnel, facilities and innovation. These efforts have been hugely successful. Per-capita health care spending (in constant dollars) has increased by about six times since 1966, when Medicare was implemented, and we’re now at about twice the spending level of other wealthy countries.
But despite our high spending, we have the highest percentage of population without adequate access to health care, the poorest health outcomes and the least popular health care system of any advanced country.
The return on our public investment in health care has been disappointing. It is as though we have written a blank check to develop the world’s most powerful and technically sophisticated car, but now find it accelerating out of control, guzzling fuel at an unsustainable rate and lacking any controls.
We have been counseled by the experts to do everything we can to improve efficiency and reduce the demand for services by forcing people to become healthier; better managing treatment; reducing waste, fraud and abuse; increasing competition; making health care more “consumer directed” by requiring patients to pay more up front; and improving efficiency through more and better technology.
None of these ideas is new. All have been tried and, by themselves, failed.
If we look at evidence for what works from around the world, the results are clear. All other countries have been more successful than the U.S. at restraining costs and improving results. They have done so by constraining overall system capacity and managing the flow of health care facilities, personnel, technology and money into their systems. They have achieved better results at far less cost.
That is why the new Massachusetts law is so intriguing and so critically important. Despite the huge contribution of health care to that state’s economy, the Massachusetts Legislature has shown the political will to cap capacity and slow the growth of their total health care spending even as they are trying to increase access. Failure to do so threatens their goal of health care for all.
Of course, dramatically simplifying our byzantine and archaic system by replacing it with “Improved Medicare for All” on a state or national level would make this task much easier and would create a way to implement a health care budget that treats everyone fairly. If everybody has a stake in the same system, popular support to better manage and more effectively control its costs would be much stronger. That’s the way it works in most other countries.
Instead of fighting over who gets what, we would all support improvements in a system that benefits us all.
Winston Churchill once observed that “Americans will always do the right thing, once they’ve exhausted all alternatives.” Despite its flawed approach, Massachusetts now leads the way in its attempts to simultaneously improve access and control costs.
In contrast is Maine, which, with the insurance companies firmly in control of our legislature, is going backwards. Working together, people in Maine could change that.
Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be reached at pcpcaper21@gmail.com.
http://bangordailynews.com/2012/08/23/health/massachusetts-leads-on-health-care-while-maine-regresses/
Hospitals use physician practice acquisitions to pad fees
Same Doctor Visit, Double the Cost
By Anna Wilde Mathews
The Wall Street Journal, August 26, 2012
… hospitals are increasingly acquiring private physician practices.
Hospitals say the acquisitions will make health care more efficient. But the phenomenon, in some cases, also is having another effect: higher prices.
As physicians are subsumed into hospital systems, they can get paid for services at the systems’ rates, which are typically more generous than what insurers pay independent doctors. What’s more, some services that physicians previously performed at independent facilities, such as imaging scans, may start to be billed as hospital outpatient procedures, sometimes more than doubling the cost.
The result is that the same service, even sometimes provided in the same location, can cost more once a practice signs on with a hospital.
With private insurers, hospital systems with strong market heft can often negotiate higher rates for physician services than independent doctors get. The differential varies widely, anywhere from 5% or less to between 30% and 40%, industry officials say.
When Hartford Hospital, in Connecticut, bought Constitution Eye Surgery Center from its physician owners last year, it told regulators the center’s operating profit was about $3.9 million in fiscal 2009, before the sale. According to James M. Blazar, a senior vice president of the Hartford HealthCaresystem, the operating income at the center is expected to grow to nearly $8 million in fiscal 2012, the first full year of hospital ownership, though surgery volumes are likely to be fairly flat. Higher reimbursement is justified because the system made significant upgrades, he said. “We have not done this for a financial reason, we’ve done this for a quality reason,” he said of the deal.
http://online.wsj.com/article/SB10000872396390443713704577601113671007448.html
Comment:
By Don McCanne, MD
Much has been written about consolidation of health care providers and how that gives them leverage during contract negotiations with private insurers. This article provides further confirmation of that reality.
Medicare has been drawn into this in that they often pay more for services performed in a hospital facility, but we can be reassured that appropriate adjustments will be made once the full impact of this manipulation is defined. That cannot be said for private insurers that depend on market negotiations. Those with clout prevail.
This would be fixed by simply establishing our own public monopsony – a single payer national health program – which would ensure value for all of us in our health care purchasing.
Actuarial value may not predict your financial exposure
Choosing the “Best” Plan in a Health Insurance Exchange: Actuarial Value Tells Only Part of the Story
By Ryan Lore, Jon R. Gabel, Roland McDevitt, and Michael Slover
The Commonwealth Fund, August 2012
In the health insurance exchanges that will come online in 2014, consumers will be able to compare health plans with respect to actuarial value, or the percentage of health care costs that a plan would pay for a standard population. This analysis illustrates the out-of-pocket costs that might result from plans with various plan designs and actuarial values. We find that average out-of-pocket expense declines as actuarial values rise, but two plans with similar actuarial values can produce very different outcomes for a given person. The overall affordability of a plan also will be influenced by age rating, income-related premium subsidies, and out-of-pocket subsidies. Actuarial value is a useful starting point for selecting a plan, but it does not pinpoint which plan will produce the best overall value for a particular person.
Consumers anticipate some health care needs when choosing a plan, but many health care expenses are not predictable and some consumers are drawn to low cost-sharing plans because they prefer to minimize risk. Even when provided with information about the plans and their premiums, it can be hard for people to choose a plan that best meets their expected medical needs.
Although this analysis focuses on out-of-pocket expense, premiums, and affordability, it should be noted that there are other important considerations in judging the value of a plan. Health plans also differ in network access and quality of care. Exchanges are responsible for providing information to help consumers evaluate these dimensions, including the ability for consumers to search for particular providers in each plan’s network.
Comment:
By Don McCanne, MD
The important contribution of this study is that it shows that choosing an exchange plan based on its actuarial value (bonze, silver, gold, platinum) does not necessarily predict what out-of-pocket expenses may be. There are so many other variables that out-of-pocket expenses can be quite different for plans with the same actuarial value.
Some of the variables include the size of the deductible, whether or not some services are covered before the deductible is met, the amount of copayments, the amount of coinsurance, the maximum cost exposure, the age of the patient, income levels in qualifying for premium subsidies and for out-of-pocket subsidies, and, most important of all, how much medical care you require during the year, much of which may be totally unpredictable.
Under a properly designed single payer national health program – an improved Medicare for all – none of these variables would apply. You would not be forced to choose each year from plans that are unaffordable, or that underinsure, or both. Insurance would not be an issue. When you need health care, you get it. Period.
Global spending experiment in Massachusetts
Controlling Health Care Costs in Massachusetts With a Global Spending Target
By Robert Steinbrook, MD
JAMA, August 22, 2012
In July 2012, after years of consideration, Massachusetts enacted wide-ranging health care reform legislation that aims to control costs and improve quality. A signature feature of the act, signed into law by Deval Patrick, the state’s Democratic governor, on August 6, 2012, is the creation of an annual global spending target for total health care expenditures, which is tied to the growth rate of the state’s economy.
For 2013, the health care cost growth benchmark is set at 3.6%. For 2014 to 2017, the benchmark is set at the growth rate of potential gross state product, and for 2018 to 2022, it is set at the growth rate of gross state product minus 0.5%, with some provisions for adjustment. The state will not dictate how the annual benchmark is met.
The Health Policy Commission is to “establish procedures to assist health care entities to improve efficiency and reduce cost growth.” The commission may encourage, cajole, and, if needed, shame them into doing their part to control costs. Starting in 2016, the commission may require some to file and implement a “performance improvement plan” because they have exceeded the cost growth benchmark and have not adequately explained potential mitigating factors. Such an entity will be identified on the commission’s website until its plan is successfully completed.
There will be no way to know if this plan for Massachusetts is working until it has been in effect for at least several years. Until then, skepticism about the amount of projected savings is appropriate.
With a global spending target, health care in Massachusetts is still likely to be very expensive as compared with the United States and all other member countries of the Organisation for Economic Co-operation and Development. Health care may just not be quite as expensive as it could be without a spending target.
http://jama.jamanetwork.com/article.aspx?articleid=1352960
Comment:
By Don McCanne, MD
Recognizing that health care reform in Massachusetts enacted when Mitt Romney was governor has failed to control health care spending, Massachusetts has now enacted legislation supposedly designed to limit spending. One of the most important features is the introduction of global budgeting, an important economic tool long advocated by Physicians for a National Health Program. No, wait. It isn’t a global budget, but rather a global spending target, and that is the point of today’s message.
Massachusetts continues to finance care through a fragmented, dysfunctional system that can never be reined in. There is no state universal budget for health care, so there can be no global budgeting. Even hospitals cannot be globally budgeted because they have to interact with so many different payers. All this legislation does regarding global spending is to identify the various entities that exceed the targeted rate increases and them put them on a naughty boys’ list.
Be prepared. A few years from now, when we continue to teach that global budgeting is one of the more effective tools that we should be using to contain costs, we’ll have to respond to the claim that Massachusetts already tried that and it didn’t work. No they didn’t. Erecting targets on the sidelines has nothing in common with crafting a budget using real dollars.
Aetna Builds Empire: One Denial at A Time
By Donna Smith
MichaelMoore.com, August 22, 2012
It’s a business. It’s big business, and it’s all about the money. When plans for Aetna to purchase Coventry Health for $5.7 billion surfaced this week, all I could think about is where people like me – Aetna’s insured – figure in the business models. I’m not a patient in their calculations; I’m a medical loss. And it just happens to be a deadly serious business.
So, in all the gobbledygook of business economics, the articles announcing the big Aetna buys Coventry deal, and foreshadowing of the impact on Aetna’s bottom line, no one writes about the forbidden topic – what about the patients? What will Aetna do to make sure that other costs – like medical loss ratios – are kept in check while still abiding by federal regulations under the Patient Protection and Affordable Care Act (PPACA)?
How will the company keep its profits soaring and lower a leverage rate that this article says will rise in the wake of the Coventry Health deal?
From the article: “Aetna Inc. (AET)’s $5.7 billion purchase of Coventry Health Care Inc. (CVH) will take the insurer from about the bottom to the top of leverage among its peers as it seeks to cut $400 million of costs…
“…Chief Executive Officer Mark Bertolini has pledged to trim leverage, the purchase’s profitability depends on cuts to management and technology spending that may be difficult to achieve, according to CreditSights Inc. The three major credit- ratings firms lowered their outlooks for the Hartford, Connecticut-based insurer after it announced the deal Aug. 20 and said it would take on $2.5 billion of debt to finance it.”
Already, Aetna and other major insurers have been creative in finding ways to classify wellness programs – like the Aetna Connections program – as part of the medical loss expense. Disease management programs as well as some nurse hotlines provided by insurers were quickly reclassified as medical expenses following the ACA’s imposition of medical loss ratio requirements. Those reclassifications often mean the actual healthcare claims – for medications, services and treatment provided by physicians and other healthcare providers – may be denied more frequently. If the money can be kept “in house” by staffing an insurance company run disease management program or nurses hotline, fewer checks need to be sent outside the company. Profits are protected, and profits are enhanced.
Aetna’s willingness to leverage and to “risk” so much in order to close the Coventry deal tells us much about the profits they expect to gain from it: “In all, Coventry will add more than 5 million customers to the 26.7 million already on medical and prescription drug plans with Aetna, according to the companies’ quarterly reports.” And the company is especially interested in gaining the Medicaid and Medicare (government paid programs) business. Again, that’s cold, hard cash from outside the company.
So, in the short term, how does Aetna shore up the bottom line for investors? How about denying some claims for medications? Over the past three months, all three of the new medications my doctors ordered to help me with serious medical issues were initially denied. One denial was overturned last week on appeal, but two still remain outstanding. That’s a saving to Aetna of about $400 each month. And how does Aetna plan to cover the $2.5 billion in new debt they’ll take out to close the new business deal? As one dear friend of mine said to me recently, “One denial at a time.” It all adds up.
Hmmm, let’s do that math. Aetna could deny just $400 for just a quarter of its 26.7 million current “customers,” sign them up for $400 worth of disease management program support, and end up paying off that debt in no time at all as they’d retain far more of their premium dollars in house rather than paying those dollars out. $400 in profit times 6.5 million patients denied adds up to pay off that $2.5 billion debt.
In the books it would look like they were fully compliant with the medical loss ratios required in the ACA. But in the lives of patients, the pain and suffering could tell a much different story. I know it does in mine. That $400 denial causes me not just gut pain but consequences in my life that are far reaching beyond what needs to be listed here.
If you think your for-profit insurance company is very different from mine, think again. But it’s sure deceptive, isn’t it, when just a few people have to be really hurt to allow for such massive profits. It’s a business, folks. And until we finally decide a Medicare for all for life system would better serve us all, the deceptions will grow ever more complex and deadly.
http://www.michaelmoore.com/words/mike-friends-blog/aetna-builds-empire-one-denial-time
The politics of health care
By Sara Stalman, M.D.
Bangor Daily News, Aug. 22, 2012
To write about health care and politics is to write about the sacred and the profane.
Our word “health” has the same etymological root as our words “whole” and “holy.” It reflects ancient awareness that we are designed and guided by forces — sacred forces — that, although beyond human comprehension, we know to be greater than ourselves and to be good. “Health” has “the Sacred” at its very root.
“Politics,” on the other hand, refers to activities related to governance. Our present political realities foster the greatest disparity of wealth between rich and poor that our country has ever known. One in five Mainers do not seek medical care because they cannot afford it. Many have health insurance but, with high monthly payments and high deductibles, they see doctors only in emergencies.
At the same time Maine is hemorrhaging health care dollars to out-of-state insurance profiteers. In 2002, between 38 cents and 50 cents of every dollar spent on health insurance left Maine, never to return. It’s only gotten worse.
Working people pay for everybody’s health care. That’s the reality. In a single-payer health insurance system those monies would go into a single “pot” directly paying all health care costs: minimal overhead, no insurance company profiteers, direct purchase of medications for the cheapest negotiated price. Our veterans receive health care through a single-payer system. Minus the prescription-drug nonsense, Medicare, too, is a single-payer system.
In 2001, Maine was the first state to be standing within a hair’s breadth of legislatively passing a single-payer health insurance system. By a vote of 76-54, “single-payer” passed with strong bipartisan support in the House. With the Senate set to vote in favor along party lines (18-16) then-Gov. Angus King vowed to veto the bill. The final senate vote of 15-17 precluded the governor’s veto but in no way changed the fact of his position.
The tremendous economic impact a single-payer health insurance system would have for Maine can be seen in the results of a feasibility study funded in 2002. Maine is a small state with an aging population and high incidence of chronic disease. Even so, a single-payer healthcare “pot” composed of just 4 percent of Maine working people’s income and 7 percent of business payroll could pay for everyone’s healthcare (individual choice of doctor, preventive care, medical and surgical care, eye and dental care, prescription drugs, and home care) and save $350 million in the first year alone. Minimal copays assessed on a sliding scale would be required, but the maximum individual expense would be $1,000 per year, with no family paying more than $2,000. (With single-payer health insurance, businesses, of course, would no longer have to pay the health care costs of Workers’ Compensation Insurance.)
With Maine’s population of 1.35 million people, $350 million would mean that, for each of us, $260 currently unavailable now would be spent in the local economy — buying food, clothing, textbooks, whatever. Money would be changing hands, Mainers’ hands, improving our quality of life and increasing our local tax base. Moreover, local school budgets would no longer be burdened with the costs of employee health benefits.
Demonstrating we could afford a single-payer health insurance system (and could pass legislation to create that system) put Maine in the sights of those monied interests still working to undermine health care reform. In 2002, the National Heritage Foundation arrived in the guise of the Maine Heritage Policy Center. Pouring money from around the country into our state, those interests continue to dominate Maine electoral politics — underwriting, for example, the candidacy of now-Gov. LePage.
In writing the Declaration of Independence, our American founding fathers asserted that government should recognize “Life, Liberty and the Pursuit of Happiness” as inalienable (Sacred) rights of humankind. Our Democracy was the first modern government based on that principle. Because powers of wealth and economic violence have threatened its founding principle since our Country began, our American Democracy (honored worldwide by men and women trusting that principle) remains a work in progress. Today, that threat can be seen at its most dangerous in the political battle over health care reform.
True Democracy demands a healthy electorate. It demands an electorate able to experience the Sacred, trust the Sacred, and act on that trust. Those opposing quality health care and a single-payer insurance system are typically accused of acting from profit motive alone.
More profoundly, opposition to health care reform is opposition to true Democracy: Democracy of the People, by the People, and for the People. All the People.
Sara Stalman practiced neuropsychiatry for 18 years. Her clinical research investigating the relationship between early childhood experience and adult chronic depressive disorders is available to both lay persons and health care professionals on her website, bornforjoy.com.
http://bangordailynews.com/2012/08/22/opinion/the-politics-of-health-care/