PNHP

Why Pennsylvania should opt for single-payer health system

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Why Pennsylvania should opt for single-payer health system

By David Steil
Erie Times-News, July 6, 2012

When asked, almost all Americans will say that access to health care is of major concern to them. But access means different things to different people. For some who have chronic illnesses, it is how to pay for the continuing costs of treating the illness. That may mean paying for health care insurance and its deductibles and co-pays, or it may mean having the ability to acquire health care insurance even if cost is not an issue. For others it may mean having the ability to manage one’s own health care along with their medical professionals and not having to subject themselves to the dictates of the health insurance carrier.

Those who do not have health care insurance and do not have the financial ability to pay for it must live in the constant fear of injury or illness, which would devastate their personal finances and potentially destroy the economic future of themselves and their family.

There is no question that this country has the finest medical care in the world. Our ability to identify, manage and treat injury and disease is without peer. But, all of that is valueless if one does not have access to the system. While it is true that everyone will ultimately be treated, even if they do not have health care insurance, it is not free. Someone has to absorb the cost. That normally means that doctors, hospitals, government and insurance carriers (through higher premium costs for their policy holders) all share the costs in some proportion.

In March 2010 Congress passed the Patient Protection and Affordable Care Act. This landmark legislation addressed some health care issues, but also left many questions and legal challenges. The U.S. Supreme Court has upheld the constitutionality of the act which means that the various provisions will continue to be implemented, mostly by 2014 but also continuing through the end of the decade. One provision is that states may propose their own innovations in health care, provided that those innovations do not fall below the requirements of the PPACA. As the law is written, this cannot occur until 2017.

In Pennsylvania citizens from all walks of life have banded together in an organization known as Health Care 4 All PA. We believe that resolution of the health care issue begins with allowing the states to adopt health care programs tailored to the needs of their residents. Moreover we believe that a single-payer system is the most cost-effective and economical method of delivering that health care. Research data and economic analysis supports that conclusion. Huge costs of the present health care system are eliminated through reducing or eliminating extensive administrative, marketing and management costs.

Single-payer means, simply, that every Pennsylvania citizen would be provided health care with the expectation that every citizen and every business would contribute to its cost. It is clear that those costs would be significantly less in total than the costs of the current system, which leaves many Pennsylvanians without health care protection.

Our organization is committed to moving forward with a single-payer model and to be prepared to join other states including Vermont, Hawaii, Montana and Washington by 2017 with the implementation of the proposal.

Legislation has already been introduced in the Pennsylvania House (HB 1660) and Senate (SB 400). Even though PPACA is now the law of the land, it still leaves many Americans and many Pennsylvanians unprotected. Therefore, now is the time for new efforts and new ideas to ensure that all of our citizens have the comfort of knowing they will be able to utilize the best health care system in the world when they need it.

But it will not happen until and unless the people of Pennsylvania make it happen. Learn about the single-payer option. Study the alternatives and then decide what works best for you and your family. Finally, contact your state representatives and state senators and ask them for their ideas. Remember that this is an election year. They will listen. Ask them to support and fight for the health care solutions that will benefit every Pennsylvanian.

David Steil, of Yardley, is president of Health Care 4 All PA and owner of a manufacturing business. A Republican, his 27 years of experience in government includes serving as township planning commission, a township supervisor and in the Pennsylvania House of Representatives.

http://www.goerie.com/article/20120706/OPINION09/307069993/Why-Pennsylvania-should-opt-for-single-payer-health-system

Single-payer system better

By Kay Tillow
Courier-Journal (Louisville, Ky.), June 29, 2012

The Supreme Court, in declaring the Affordable Care Act (ACA) constitutional, has endorsed a flawed attempt to solve the nation’s health care problem. Moreover, the court’s decision will only prolong many of our current health care issues.

This is the opinion of Kentuckians for Single Payer Healthcare (KSPH). The decision has saved the individual mandate which requires many uncovered persons to buy a private health insurance policy. KSPH is not about to weigh in with an opinion one way or the other on the constitutionality of mandated purchases. However, we do believe that the ACA is still deeply flawed — no matter that it has some good features — because it includes the private, for-profit health insurance industry at the center of its system.

Not only does this industry not provide an answer to many of the medical problems, it is a major problem itself. The insurance industry is responsible for extracting up to 31 cents of the American health dollar without providing any direct medical benefits.

A single-payer system would basically be an expanded and improved version of Medicare, but it would cover every age, every person. This system would negate the need for profit-driven insurance companies. And it would be a major jump-start in controlling soaring medical costs.

We think the Affordable Care Act will ironically become not affordable because the insurance industry is already finding ways to limit the coverage while charging more, and the bulk of the ACA doesn’t even kick in until 2014. Higher deductibles and higher premiums and skimpy under-coverage are on the horizon for most patients following the court’s decision. Skyrocketing medical costs will continue because the ACA doesn’t have effective controls.

In sum, the court threw a life buoy to a law that needed a rescue boat. The real remedy would be H.R. 676, the bill that would expand and improve Medicare, a type of system that every other developed nation has in place. This means that citizen activists must start right now to bring it to pass.

Kay Tillow is chair of  Kentuckians for Single Payer Healthcare. She resides in Louisville.

Employers considering defined contribution for health care

With health care law upheld, employers weigh shift to defined contribution insurance plan

By Peter Frost
Chicago Tribune, July 3, 2012

Many Chicago-area employers have remained on the sidelines with their employee health plans, waiting for the U.S. Supreme Court to determine whether the 2010 health care overhaul passed constitutional muster.

But with the court’s decision last week to uphold most of the law, companies may pursue a historic change.

Many employers are quietly considering a move away from traditional defined benefit plans and toward defined contribution plans, which set aside a fixed amount of money each year for employees to use toward health care costs.

Under the structure of defined contribution plans, companies hand an employee a set amount — say $9,000 — and employees use that money to buy or help pay for a health insurance plan they choose themselves.

At the heart of the shift is a desire of companies to reduce their exposure to health care costs by shifting the risk of unpredictable expenses to their workers.

Few employers, particularly large companies, are eager to discuss their internal deliberations on the issue because they don’t want to raise concerns among employees before final decisions are made, said Paul Keckley, executive director of the Deloitte Center for Health Solutions, the health care research arm of consulting firm Deloitte LLP.

“The only thing that’s certain right now is (companies are) doing everything that’s legal to shift cost to employees,” Keckley said.

Employees of companies that pursue the defined contribution route may be funneled into so-called corporate health care exchanges, which function in much the same way as state-run exchanges.

The private exchange market “is really emerging and growing, largely because of all the interest in the state exchanges,” said Michael Thompson, a principal in PricewaterhouseCoopers LLC’s global human resources practice.

Inside the exchanges, employees will be offered more choices on what types of coverage they desire — and how much they’re willing to pay.

“If you value broad access and you’re willing to pay for it, that’s fine,” Thompson said. “If you’re willing to live with a narrower network (of providers) and possibly a higher deductible, you would have the ability to save significant money on your premiums.”

On private exchange GoHealth.com, consumers can shop and ask for advice. Michael Mahoney, GoHealth’s vice president of marketing, said the company has explored a corporate health care exchange for its employees, but it will continue offering its “traditional and robust” health insurance plan for the time being.

His reason? “If you give control to the employees, they could choose to save money and possibly choose something where they’re not completely covered, so they end up in a pinch. Right now, we’re going to overspend on our employees and give them more than they want so they’re always covered.”

http://articles.chicagotribune.com/2012-07-03/business/ct-biz-0703-corp-exchanges–20120703_1_health-care-health-insurance-deloitte-center

Comment: 

By Don McCanne, MD

Just as they did with employee pension plans, employers are now gearing up to convert employee health benefit programs from defined benefit to defined contribution. What does that mean?

Over the past few decades, employers passed on the risks of their pension plans to their employees by switching from a defined benefit (a guaranteed dollar amount that employees would receive monthly in retirement) to a defined contribution such as 401(k) plans (a set dollar amount contributed to the pension account, but with no guarantee of the amount received in retirement – the employee thus bearing the full risk of the uncertain investment returns on the pension funds).

Now many employers plan to do the same with their health benefit programs. They intend to pay a set dollar amount for the premiums, whereas the employees will have to bear the the costs of health care inflation plus the costs of any benefits in excess of the basic program to be offered  by the employer.

This will be disastrous. Employees are already being stuck with higher deductibles in order to slow the rate of premium increases for the employer. With defined contribution, premiums can be contained further by limiting the benefits covered, by further increasing the out-of-pocket cost sharing of deductibles, copayments and coinsurance, by tiering cost sharing of different levels of products and services, and by further restricting the panels of approved health professionals and institutions.

When the employee uses the defined dollar amount to purchase plans from the choices offered, but must pay the full balance of the premium, most will choose lower cost plans that place them at very high risk for out-of-pocket expenses should they or their family members need health care. This is the disaster that is pending. Employees will not be able to afford the care that they or their families need, in spite of being nominally insured by their employers.

From a policy perspective, we can understand why employers would want to control their overhead expenses, in this case by protecting themselves from health care inflation, but we can’t understand why policymakers would want to keep employers in charge of health care financing for the majority of Americans, and then add further insult by perpetuating regressive tax policies that favor wealthier employees over those with lower incomes.

With this defined contribution threat looming, we should once and for all remove the employer from the equation. Let’s replace our health care financing system with a much more sensible and equitable single payer national health program, which would remove from employers the burden of having the responsibility of supervising health benefit programs.

Vermonters respond to Supreme Court ruling on ACA

By the editor
Vtdigger.org, June 28, 2012

The following is an excerpt of a roundup of reactions by prominent individuals and organization in Vermont to the Supreme Court’s ruling on the Affordable Care Act. For the full article, click on the link at the end.

Vermont Physicians for a National Health Program

The U.S. Supreme Court has upheld the bulk of the Patient Protection and Affordable Care Act, including the individual mandate. They affirmed that health care may be financed through taxation. The worst insurance abuses are being curtailed. Americans will benefit from reforms Vermont has enjoyed for years. Many people without insurance, especially young adults and people with low incomes, will gain health care coverage.

Unfortunately, the PPACA institutionalizes “unaffordable underinsurance” at taxpayer expense. Millions will have to buy overpriced policies with limited coverage and high deductibles and copayments. Ignoring the root of the problem—private health insurance—this legislation hands them an estimated $557 billion in taxpayer money through 2020, strengthening their ability to block future reform. And over 26 million people will remain uninsured.

Insurance companies currently add cost to the health care system: more than ten percent in direct costs and additional millions due to administrative burdens on Vermont patients and providers. Green Mountain Care will replace them with a single, non-profit payer. Health planning, resource allocation, care coordination, new payment methodologies, and drug price negotiation may all help to control costs. Vermonters will get the care they need without risking bankruptcy. Business, town, school, and state budgets will find relief.

In contrast to the PPACA, there was never any debate over the constitutionality of Medicare. In its 47 years, this publicly funded system has allowed millions of seniors and people with disabilities to access health care that would otherwise have been unaffordable. What we need is a Medicare expansion, not the Medicaid expansion of the PPACA. We urge Congress to extend Medicare coverage to every American, regardless of age. And Congress should support state innovation like Vermont’s.

The Affordable Care Act provides some funding for Vermont’s health reform effort. Like other single-payer systems, Green Mountain Care will provide universal coverage, improve access, and control costs. Patients will choose which clinicians will care for them; medical decisions will be in the hands of patients and clinicians. On the downside, without the PPACA, Vermont could have done a single-payer system at its own pace; now we must delay up to six years.

The members of Vermont PNHP know that a system dominated by private insurers and Big Pharma—as envisioned by the PPACA—cannot be universal and affordable. Polls have repeatedly shown that a solid majority of Vermonters and Americans favors single-payer. Our federal representatives should continue their efforts to gain appropriate waivers so that Vermont’s vision of Green Mountain Care can be realized as soon as possible. And Congress should extend improved Medicare coverage to every American.

http://vtdigger.org/2012/06/28/supreme-court-decision-everyones-got-something-to-say/

A ‘greater good’

By Elizabeth Frost, M.D.
The Pioneer Press (St. Paul, Minn.), Letters, June 30, 2012

I think it is interesting that the Supreme Court has upheld the idea that the individual mandate as a tax is constitutional. What does this mean? First of all, it means that we as a nation have decided that health care is a “greater good” — that everybody deserves health care. Second, we have decided that everyone pays in to health care. We have already decided to do this in Medicare, but now we are extending the concept to everyone.

The next step as a society is to decide how best to meet everyone’s health care needs. Unfortunately, the Affordable Care Act does not do that well; it leaves 25 million Americans, at least, without health care and many more paying too much. It turns out that our for-profit, inefficient system based on private insurance is not a good way to provide health care for all, and that Medicare is much more efficient. What if we tried Medicare for All in a state first? That way a state could be a “laboratory” for more comprehensive reform. Of course, Medicare for All would be constitutional, as it is also a tax.

We need to keep moving beyond the Affordable Care Act and work to establish a just, equitable and universal health system; maybe Minnesota will lead the way.

Dr. Elizabeth Frost of Minneapolis is a physician at Hennepin County Medical Center.

http://www.twincities.com/opinion/ci_20974425/greater-good

Single-payer health care system would ensure ‘necessary service for everyone’

By Michael Novinson
Times Herald-Record (Monroe, N.Y.), June 29, 2012

MONROE — While the Supreme Court spent months pondering whether or not Obama’s health care plan went too far, Joseph Birnbaum maintains that the reforms didn’t go far enough.

The Monroe optometrist backs a single-payer system where the government would finance health care for all.

Birnbaum insists this is the best way to provide all Americans with consistently good care.

“Health care is a necessary service for everyone,” said Birnbaum, who’s been practicing for 57 years. “It’s not a gift, it’s not an entitlement.”

The current health care marketplace has only resulted in users paying higher premiums, Birnbaum said, as insurance companies fight one another for the fattest bottom line.

Eliminating the middleman means the public would no longer have to bankroll the insurance industry. Birnbaum said this would drive down costs across the health care system.

To those who see single-payer as a departure from the capitalist system, Birnbaum points to the exceeding popularity of Medicare, a social insurance program for senior citizens.

Single-payer would only extend the virtues of Medicare to all Americans, Birnbaum said.

“The only ones benefiting (from the current system) are the CEOs of those (insurance) companies,” Birnbaum said.

http://www.recordonline.com/apps/pbcs.dll/article?AID=/20120629/NEWS/120629691/-1/SITEMAP

U.S. needs single-payer health care

By Hedda Haning, M.D. 
The Charleston (W.Va.) Gazette, June 29, 2012

Now that the U.S. Supreme Court has essentially approved the Affordable Care Act, including the individual mandate, what affect will it have?

It will make practically no difference at all. So take a big breath and settle down. We will still have an inadequate health-care system that costs too much and covers too little. We will still have people going without care or going underwater, even bankrupt, to obtain necessary care. We do not have the best health-care system in the world, and the law won’t change that.

Skimpy health insurance policies will consume at least 9.5 percent of family income, but leave patients unable to access care due to high deductibles, co-payments, co-insurance and other out-of-pocket costs. Nationally, 78 percent of those bankrupted by illness or injury are insured at the start of their illness, including 60.3 percent who had private coverage.

That is because the health-care industry will still be in the hands of the private industry that makes its profit by collecting premiums and denying care. Private insurance also tells you which physicians and which hospitals you can use. Big Pharma provides our drugs with absolutely no limits at all on charges. The pharmaceutical industry uses federally supported research to develop new patented drugs that often provide little improvement over those already available but cost orders of magnitude more.

The act was modeled on Massachusetts’ law. Six years after the Massachusetts law went into effect, the people are not happy. A June 11 poll in Massachusetts found 78 percent of patients say the cost of care in Massachusetts is a serious problem, and 63 percent say it has gotten worse. Patients report longer waits, higher premiums, higher co-payment and less satisfaction with care. That is private insurance, private health care. The number of bankruptcies due to medical illness and costs has continued to increase in Massachusetts.

Design of the act reflects political considerations, not sound health policy. As physicians, we cannot accept this inversion of priorities.

Instead of eliminating the root of the problem – the profit-driven, private health insurance industry – this legislation hands them $557 billion in taxpayer money through 2020. The total windfall to private insurers from the Affordable Care Act, including tax subsidies, consumers’ share of premiums and overhead and profits on Medicaid managed care plans, is well over $1 trillion, according to a Bloomberg Government study.

The American people desperately need a universal health system that delivers comprehensive, equitable, compassionate and high-quality care, with free choice of provider and no financial barriers to access. Polls have repeatedly shown an improved Medicare for All, which meets these criteria, is the remedy preferred by two-thirds of the population. A solid majority of the medical profession now favors such an approach, as well.

How do we know it will work? We know because it works for the rest of the developed world, which pays much less, and gets much more.

By replacing the private insurers with a streamlined system of public financing, our nation could save $400 billion annually because unnecessary wasteful administrative costs will drop, going from 31 percent to 5 percent of our health-care expenditures. That’s enough to cover all the uninsured and to upgrade everyone else’s coverage without having to increase overall U.S. health spending by one penny. There is legislation before Congress (H.R. 676), the “Expanded and Improved Medicare for All Act,” which would do precisely that.

There is no question that the government can tax individuals to provide services. That approach is clearly constitutional. Medicare is constitutional. That is why we physicians signed on to the amicus brief to say there is an alternative to the Affordable Care Act mandate.

Only a single-payer Medicare for All system offers effective tools for cost control like bulk purchasing, negotiated fees, global hospital budgeting and capital planning. And in a single-payer system, you pick your own caregivers. The government is the single payer, not the single provider. Think about plain Medicare and drop two words – “over 65.”

For more information about single-payer health-care reform, see Physicians for a National Health Program (pnhp.org.) and get active.

Dr. Hedda Haning, a retired physician in Charleston, is active with Physicians for a National Health Program and a signer of a friend-of-the-court brief in the Affordable Care Act case that was before the U.S. Supreme Court. 

Can we learn from Rawanda?

In Rwanda, Health Care Coverage That Eludes the U.S.

By Tina Rosenberg
The New York Times, July 3, 2012

Last week’s Supreme Court decision upholding of the constitutionality of President Obama’s health care law moves the United States closer to the goal of health coverage for all. All other developed countries have it. But so do some developing nations — Brazil, Thailand, Chile. These countries are mostly middle income. But one country on the list is among the poorest of the poor: Rwanda.

The point is not that Americans should envy Rwanda’s health system — far from it. But Rwanda’s experience illustrates the value of universal health insurance.  “Its health gains in the last decade are among the most dramatic the world has seen in the last 50 years,” said Peter Drobac, the director in Rwanda for the Boston-based Partners in Health, which works extensively with the Rwandan health system.

It couldn’t have happened without health insurance.

Rwanda is known, of course, for the 1994 genocide that killed 800,000 Tutsi and moderate Hutu. Since 1994, the country has been ruled by Paul Kagame, at first as de facto leader and, since 2000, as president.  Kagame runs a repressive regime that equates criticism with treason; opposition journalists or politicians in Rwanda have disappeared or died mysteriously.

But Kagame is also widely admired as the most effective leader in Africa. A country in ashes 18 years ago is now safe and clean. It is one of the least corrupt countries in Africa. Per capita income has tripled — although the fact that it is now only $550 a year tells you how destitute Rwanda was.

Its most impressive gains, however, have been in health. AIDS has been cutting life expectancies in Africa and is widespread in Rwanda. Yet life expectancy at birth in Rwanda has increased from 48 to 58 — in the last 10 years. Deaths of children under 5 have dropped by half in five years; malaria deaths have dropped by roughly two-thirds. “Of all countries in Africa Rwanda is probably getting the closest to having health for all, health access for all,” said Josh Ruxin, a longtime resident of Rwanda who is the founder of the Access Project, a Rwandan-run health program.

One key reason that Rwandans are so much healthier today is the spread of health insurance.  In 1999, Rwanda’s health facilities sat unused, as the vast majority of people couldn’t afford them.   In response, the Health Ministry began a pilot project of health insurance in three districts.   In 2004, the program began to spread across the nation.   Now health insurance — called Mutuelle de Santé — is nearly universal. Andrew Makaka, who manages the health financing unit at the Ministry of Health, said that only 4 percent of Rwandans are uninsured. 

In most poor countries — and in the United States — health disasters are a leading cause of a family’s decline into poverty, but not for Rwandans. “It gives relief to people knowing that if you get sick, you don’t need to have a lot of money,” said Dr. Agnes Binagwaho, Rwanda’s health minister. “It gives you psychological stability so you can concentrate on something else. The money can be used for other things — this is very important in trying to stimulate economic development.”

“You can bring on all the diagnostic services, new technologies and specialties,” said Drobac. “But if those things can’t reach people in need, what’s the point?”

We could ask the same thing in the United States.  Rwanda, starting from nothing, decided to build a health system that includes everyone.  And it found economic value, alongside human value, in doing so.  Now we can get started.

http://opinionator.blogs.nytimes.com/2012/07/03/rwandas-health-care-miracle/

Comment:  

By Don McCanne, MD

Rawanda, one of the poorest nations in the world, has seen a dramatic improvement in the health of their people since the establishment of their near-universal health insurance program, Mutuelle de Santé, covering all but 4 percent of their population.

After the Affordable Care Act is fully implemented in the United States, over 8 percent of our population will still be uninsured – over twice the percentage of Rawanda’s uninsured. Shouldn’t we be ashamed? We know how to do better than that; we just have to do it.

Canada's medicare at 50 years: It's part of us

By Roy Romanow
Globe and Mail, July 2, 2012

July 1, the birthdate of our great nation, is also the birthdate of Canada’s emblematic health-care system. And this weekend we celebrated the 50th anniversary of the introduction of medicare in Saskatchewan. Now often referred to as unsustainable, this milestone provides an opportunity to reflect on the hard fought accomplishments of the past, to re-evaluate today’s system and to consider the growing debate about its future.

Until 50 years ago, Canada’s health-care system was based on the private, for-profit model. Patients individually paid for the services of medical professionals and hospitals. Often, those who could not afford health care did not receive it, and even some who could did so by deferring treatment, hoping to save their family budget. Since then we have built a national system, lauded around the world, that allows us all access to high-quality care.

The achievement of universal health care took a long, acrimonious and protracted road. It is no surprise to me that Saskatchewan was at the forefront of this journey. The province’s citizens learned many hard lessons during the desperation of the Great Depression and the sacrifices of the Second World War. They learned about generosity, about hardship and fairness, about boom and bust. They learned about the imperative for co-operative action. They came to understand that the notion of shared destiny was key to our existence.

And so it is with other regions in Canada, where geography and demographics may vary, where many waves of immigration began with an initial sense of isolation, but where we all learned to see survival and progress as a test of our ongoing ability to come together and to remain united around shared values.

Canada’s history offers a strong and rich legacy of success that has forged our country. It is this legacy of a shared destiny that is key to understanding our young but dynamic history. Today, as we find ourselves living in complicated times, I believe it is this same legacy that remains the road map to our future, at home and abroad.

Before we give in to despair around the present-day mantra that our system is unsustainable, there are a few things we must consider. First, a universal, single-payer, public insurance model is both less costly and produces better population health outcomes than multipayer systems like the one that exists in the United States. This has been proven time and time again by study after study. Questions of sustainability can never be successfully addressed by moving incrementally backward to a private, for-profit model, at least not the sustainability of a system that remains accessible to all of us.

Second, if our political leaders are genuine in their desire to rein in health costs while maintaining a system for all of us, our task is clear, if not without difficulties. We must lay the groundwork for including catastrophic drug costs and bringing aspects of home care, long-term care and access to advanced diagnostic services into our not-for-profit system. Otherwise, costs will continue to escalate – without restraint and with relentless abandonment of those in need.

Third, we must also recognize that the well-being of our citizenry goes beyond health care; it is dependent on preventing illness and tackling the more fundamental barriers to good health, including social, economic and environmental factors. How we treat the environment has a direct impact on our health and the longevity of a sustainable economy. The growing gap between the rich and poor directly affects our health and the fiscal demands on our health-care system.

Every day, Canada faces new challenges that prompt key questions about what kind of people we are and what kind of future we wish to shape.

As we celebrate the birth of our nation and of medicare, we must ask ourselves: What kind of Canada do we want? Because, as I see it, the choice Canadians make about health care is fundamentally intertwined with our values and future.

Roy J. Romanow is co-chair of the Canadian Index of Wellbeing advisory board and a former commissioner of the Royal Commission on the Future of Health Care in Canada.

http://www.theglobeandmail.com/commentary/medicare-is-part-of-us/article4380858/

Canada’s medicare at 50 years: It’s part of us

By Roy Romanow
Globe and Mail, July 2, 2012

July 1, the birthdate of our great nation, is also the birthdate of Canada’s emblematic health-care system. And this weekend we celebrated the 50th anniversary of the introduction of medicare in Saskatchewan. Now often referred to as unsustainable, this milestone provides an opportunity to reflect on the hard fought accomplishments of the past, to re-evaluate today’s system and to consider the growing debate about its future.

Until 50 years ago, Canada’s health-care system was based on the private, for-profit model. Patients individually paid for the services of medical professionals and hospitals. Often, those who could not afford health care did not receive it, and even some who could did so by deferring treatment, hoping to save their family budget. Since then we have built a national system, lauded around the world, that allows us all access to high-quality care.

The achievement of universal health care took a long, acrimonious and protracted road. It is no surprise to me that Saskatchewan was at the forefront of this journey. The province’s citizens learned many hard lessons during the desperation of the Great Depression and the sacrifices of the Second World War. They learned about generosity, about hardship and fairness, about boom and bust. They learned about the imperative for co-operative action. They came to understand that the notion of shared destiny was key to our existence.

And so it is with other regions in Canada, where geography and demographics may vary, where many waves of immigration began with an initial sense of isolation, but where we all learned to see survival and progress as a test of our ongoing ability to come together and to remain united around shared values.

Canada’s history offers a strong and rich legacy of success that has forged our country. It is this legacy of a shared destiny that is key to understanding our young but dynamic history. Today, as we find ourselves living in complicated times, I believe it is this same legacy that remains the road map to our future, at home and abroad.

Before we give in to despair around the present-day mantra that our system is unsustainable, there are a few things we must consider. First, a universal, single-payer, public insurance model is both less costly and produces better population health outcomes than multipayer systems like the one that exists in the United States. This has been proven time and time again by study after study. Questions of sustainability can never be successfully addressed by moving incrementally backward to a private, for-profit model, at least not the sustainability of a system that remains accessible to all of us.

Second, if our political leaders are genuine in their desire to rein in health costs while maintaining a system for all of us, our task is clear, if not without difficulties. We must lay the groundwork for including catastrophic drug costs and bringing aspects of home care, long-term care and access to advanced diagnostic services into our not-for-profit system. Otherwise, costs will continue to escalate – without restraint and with relentless abandonment of those in need.

Third, we must also recognize that the well-being of our citizenry goes beyond health care; it is dependent on preventing illness and tackling the more fundamental barriers to good health, including social, economic and environmental factors. How we treat the environment has a direct impact on our health and the longevity of a sustainable economy. The growing gap between the rich and poor directly affects our health and the fiscal demands on our health-care system.

Every day, Canada faces new challenges that prompt key questions about what kind of people we are and what kind of future we wish to shape.

As we celebrate the birth of our nation and of medicare, we must ask ourselves: What kind of Canada do we want? Because, as I see it, the choice Canadians make about health care is fundamentally intertwined with our values and future.

Roy J. Romanow is co-chair of the Canadian Index of Wellbeing advisory board and a former commissioner of the Royal Commission on the Future of Health Care in Canada.

http://www.theglobeandmail.com/commentary/medicare-is-part-of-us/article4380858/

Translating the insurance industry's feel-good rhetoric

By Wendell Potter
iWatch News, July 2, 2012

Health insurers avoided their worst case scenario last week — the prospect of the Supreme Court striking down the individual mandate but letting the rest of the health care law, especially profit-threatening consumer protections, go forward. Now the industry can focus on a goal it has had all along: getting rid of those pesky consumer protections.

That goal was clear to me from the reaction statement issued by America’s Health Insurance Plans. The statement was jam-packed with feel-good phrases like “secure and affordable,” “peace of mind,” and “choice and competition.” Allow me to provide an interpretation of what AHIP, the industry’s biggest PR and lobbying group, was really saying and really planning. After twenty years as an industry PR guy, I’m all too familiar with prose written to obscure intentions.

Sentence by sentence, here’s what AHIP’s communications people crafted as soon as they realized the industry would not have to go nuclear to wipe out ObamaCare — that instead, it could conduct a stealth ground war to get rid of everything in the law that might threaten profits.

“Individuals and families need secure, affordable coverage choices. Maintaining the link between market reforms and universal coverage is essential to avoiding significant cost increases and loss of choice for consumers and employers.”

Translation: “Whew! Thank you, Chief Justice Roberts. We can now shelve the campaign we were poised to launch to convince people why the consumer protections in the law won’t work without the mandate. We won’t have to squander resources on that effort. Now we can devote our war chest to helping elect candidates willing to use our talking points and vote the way we tell them to vote — and to persuading people to believe the consumer protections are not in their best interests after all. The mandate will work best for us when they’re all gone.”

Next sentence: “As the reform law is implemented, health plans will continue to focus on promoting affordability and peace of mind for their beneficiaries.”

Translation: “We are masters at stringing together words that test especially well in focus groups, even if they have little or nothing to do with the way we really conduct business. ‘Affordability and peace of mind’ sound great, don’t they? So trust us. Just don’t look at our track record.”

And so on: “The law expands coverage to millions of Americans, a goal health plans have long supported, but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed.”

Translation: “First off, we want you to suspend disbelief for a moment and forget that if health plans really cared a whit about expanding coverage, they would have ended their routine practices of refusing to sell coverage to people with preexisting conditions and charging exorbitant rates years ago. That’s why 50 million Americans are uninsured. As for that premium tax, even though we stand to gain billions every year because of the individual mandate and the subsidies the government will provide to help low-income families pay their premiums, we don’t want to give up a dime of those billions to help the government pay for the expanded coverage we’ve been in favor of for so long. So we’ll have a campaign designed to mislead people into thinking that their premiums will have to increase and that their coverage might somehow have to be disrupted as a result of the tax. We’d love to be able to say that we are so grateful for the billions in new revenue that we will agree not to pass the tax along to our customers. We’d love to say that, we’d even consider doing it — if only our shareholders would let us.”

Wait, there’s more: “Health plans will continue to work with policymakers on both sides of the aisle to make coverage more affordable, give families and employers peace of mind, and promote choice and competition. Health plans also will continue to lead efforts to reform the payment and delivery system to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care.”

Translation: “We have Democrats as well as Republicans in our pocket. And look how we’ve worked in ‘affordable’ and ‘peace of mind’ into our little statement again. Aren’t we good at this? And we know ‘choice’ and ‘competition’ are two words that test especially well. So well, in fact, that we and our allies named one of the front groups we set up a few months ago, the one we’re using to try to control how the state health insurance exchanges operate, the ‘Choice and Competition Coalition.’ And instead of focusing on how we can — and do — get between you and your doctor whenever we want to, please suspend disbelief once again and just think of us as your doctor’s helper. Doctors don’t know best, silly. We do. So trust us.”

Expect to hear all of these buzzwords and phrases coming out of the mouths of the industry’s friends in politics, business and the media in the coming months — over and over and over again. The coming war will be a war of words, a war of messaging.

Next week I’ll provide a more detailed list of the other provisions of the law the insurers have their sights on, along with some of the talking points they’ll be deploying to try to take them out.

Wendell Potter is a former CIGNA executive-turned-whistleblower who writes about the health care industry and the ongoing battle for health reform. He is the author of “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans.”

http://www.iwatchnews.org/2012/07/02/9249/opinion-translating-insurance-industrys-feel-good-rhetoric

Translating the insurance industry’s feel-good rhetoric

By Wendell Potter
iWatch News, July 2, 2012

Health insurers avoided their worst case scenario last week — the prospect of the Supreme Court striking down the individual mandate but letting the rest of the health care law, especially profit-threatening consumer protections, go forward. Now the industry can focus on a goal it has had all along: getting rid of those pesky consumer protections.

That goal was clear to me from the reaction statement issued by America’s Health Insurance Plans. The statement was jam-packed with feel-good phrases like “secure and affordable,” “peace of mind,” and “choice and competition.” Allow me to provide an interpretation of what AHIP, the industry’s biggest PR and lobbying group, was really saying and really planning. After twenty years as an industry PR guy, I’m all too familiar with prose written to obscure intentions.

Sentence by sentence, here’s what AHIP’s communications people crafted as soon as they realized the industry would not have to go nuclear to wipe out ObamaCare — that instead, it could conduct a stealth ground war to get rid of everything in the law that might threaten profits.

“Individuals and families need secure, affordable coverage choices. Maintaining the link between market reforms and universal coverage is essential to avoiding significant cost increases and loss of choice for consumers and employers.”

Translation: “Whew! Thank you, Chief Justice Roberts. We can now shelve the campaign we were poised to launch to convince people why the consumer protections in the law won’t work without the mandate. We won’t have to squander resources on that effort. Now we can devote our war chest to helping elect candidates willing to use our talking points and vote the way we tell them to vote — and to persuading people to believe the consumer protections are not in their best interests after all. The mandate will work best for us when they’re all gone.”

Next sentence: “As the reform law is implemented, health plans will continue to focus on promoting affordability and peace of mind for their beneficiaries.”

Translation: “We are masters at stringing together words that test especially well in focus groups, even if they have little or nothing to do with the way we really conduct business. ‘Affordability and peace of mind’ sound great, don’t they? So trust us. Just don’t look at our track record.”

And so on: “The law expands coverage to millions of Americans, a goal health plans have long supported, but major provisions, such as the premium tax, will have the unintended consequences of raising costs and disrupting coverage unless they are addressed.”

Translation: “First off, we want you to suspend disbelief for a moment and forget that if health plans really cared a whit about expanding coverage, they would have ended their routine practices of refusing to sell coverage to people with preexisting conditions and charging exorbitant rates years ago. That’s why 50 million Americans are uninsured. As for that premium tax, even though we stand to gain billions every year because of the individual mandate and the subsidies the government will provide to help low-income families pay their premiums, we don’t want to give up a dime of those billions to help the government pay for the expanded coverage we’ve been in favor of for so long. So we’ll have a campaign designed to mislead people into thinking that their premiums will have to increase and that their coverage might somehow have to be disrupted as a result of the tax. We’d love to be able to say that we are so grateful for the billions in new revenue that we will agree not to pass the tax along to our customers. We’d love to say that, we’d even consider doing it — if only our shareholders would let us.”

Wait, there’s more: “Health plans will continue to work with policymakers on both sides of the aisle to make coverage more affordable, give families and employers peace of mind, and promote choice and competition. Health plans also will continue to lead efforts to reform the payment and delivery system to promote prevention and wellness, help patients and physicians manage chronic disease, and reward quality care.”

Translation: “We have Democrats as well as Republicans in our pocket. And look how we’ve worked in ‘affordable’ and ‘peace of mind’ into our little statement again. Aren’t we good at this? And we know ‘choice’ and ‘competition’ are two words that test especially well. So well, in fact, that we and our allies named one of the front groups we set up a few months ago, the one we’re using to try to control how the state health insurance exchanges operate, the ‘Choice and Competition Coalition.’ And instead of focusing on how we can — and do — get between you and your doctor whenever we want to, please suspend disbelief once again and just think of us as your doctor’s helper. Doctors don’t know best, silly. We do. So trust us.”

Expect to hear all of these buzzwords and phrases coming out of the mouths of the industry’s friends in politics, business and the media in the coming months — over and over and over again. The coming war will be a war of words, a war of messaging.

Next week I’ll provide a more detailed list of the other provisions of the law the insurers have their sights on, along with some of the talking points they’ll be deploying to try to take them out.

Wendell Potter is a former CIGNA executive-turned-whistleblower who writes about the health care industry and the ongoing battle for health reform. He is the author of “Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans.”

http://www.iwatchnews.org/2012/07/02/9249/opinion-translating-insurance-industrys-feel-good-rhetoric