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The battle for Vermont's health

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The battle for Vermont's health

Insurance firms seeking to sow doubt about proposed single-payer system

By Wendell Potter
iWatch News, Feb. 6, 2012

MONTPELIER, Vt. — You can’t see them. They’re hidden from view and probably always will be. But the health insurance industry’s big guns are in place and pointed directly at the citizens of Vermont.

Health insurers were not able to stop the state’s drive last year toward a single-payer health care system, which insurers have spent millions to scare Americans into believing would be the worst thing ever. Despite the ceaseless spin, Vermont lawmakers last May demonstrated they could not be bought nor intimidated when they became the first in the nation to pass a bill that will probably establish a single-payer beachhead in the U.S.

When he signed Act 48 into law on May 27, surrounded by dozens of state residents who worked for many years to achieve universal coverage, Governor Peter Shumlin expressed great pride in what had been accomplished.

“We gather here today to launch the first single payer system in America, to do in Vermont what has taken too long—to have a health care (system) that is the best in the world, that treats health care as a right and not a privilege, where health care follows the individual, not the employer,” Shumlin said.

The problem for Shumlin and his allies is this: it will take five years before Vermont can fully implement its new system, partly because the federal health care reform law prohibits states from undertaking more far-reaching reforms until 2017 unless granted waivers from the feds to do so. And though Vermont’s Congressional delegation is on board to pursue a waiver that would let the state set up a single payer system two years from now, the insurance industry’s friends in Washington are not keen to let that happen. That’s because they want to use those five years to persuade Vermonters that they really don’t want to go the single payer route after all.

During my 20 years as a health insurance PR executive, I was involved in numerous efforts to make the very term “single payer” toxic to most Americans. We even spent hundreds of thousands of premium dollars in 2007 to help finance the operation of a front group, called Health Care America, for the sole purpose of trashing a movie — Michael Moore’s “Sicko” — that put single payer systems abroad in a favorable light. You can rest assured that the industry will spend much, much more to make sure that Vermont does not succeed.

I have observed in Vermont over the past several days just how the invisible hand of the insurance industry is working. Insurers know their efforts will be more effective if they can get others — third party advocates, they call them — to carry out them out. I recognized the campaign because the tactics are the same as those used in previous attempts to kill reforms insurers don’t like.

Part of the strategy is to get key groups of individuals to begin raising doubts, to get Vermonters to second-guess themselves. Among the first groups the insurers have targeted are those most easily spooked — certain business owners and physicians, especially specialists who thrive in the current system.

Last Wednesday, legislators got a sampling of what they’re in for. At a hearing on creation of the state’s health care exchange, or marketplace — mandated by the federal reform law — employers worried about losing the ability to choose from numerous competing insurers. And they worried too about not being able to shift their employees into benefit plans with high deductibles. Insurers and employers have been collaborating for the past several years in a mutually beneficial effort to shift more of us into high-deductible policies. The higher the deductible, the less insurers and employers have to pay for our care. This collaboration has been so successful that increasing numbers of American families filing for bankruptcy are, at least theoretically, insured.

At a hearing a few days earlier in Rutland, this one for health care providers, several physicians were, wittingly or not, using some of the same industry talking points I used to write for insurers’ allies.

Dermatologist Dan McCauliffe was one of several doctors there who suggested that patients needed to pay more — not less — out of their own pocket for care. Ironically, this skin doctor joined other physician specialists in arguing that health care costs would never stabilize until patients had “more skin in the game,” a term my former colleagues used frequently as we tried to spin the “advantages” of high-deductible plans. According to statistics from the American Medical Association, dermatologists are among the highest paid specialists, making on average more than $230,000. 

So why do insurers care so much about Vermont? Even though Vermont is a small state where most for-profit insurers have little business, the insurers don’t want a single state to go single payer. Just last week, single payer advocates in California fell just a few votes short of getting a bill to the floor of the Senate for a vote. If Vermont succeeds, California lawmakers might actually get the votes they need. 

Health insurers make enormous amounts of money off of us, something they cannot do so effectively in other countries, especially Canada. The four largest insurers, United, WellPoint, Aetna and CIGNA, reported earning a combined $11 billion on nearly $220 billion in revenues last year. For years insurers have been successful in persuading Americans to believe something that is at best debatable — that they play a useful role in the U.S. health care system. They are nervous that if Vermont proves to the rest of the country that health insurers are about as useful as teats on a boar, they might have to figure out another way to make a few billion bucks.

Former CIGNA executive-turned-whistleblower Wendell Potter writes about the health care industry and the ongoing battle for health reform. Potter 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/2012/02/06/8094/analysis-battle-vermonts-health

The battle for Vermont’s health

Insurance firms seeking to sow doubt about proposed single-payer system

By Wendell Potter
iWatch News, Feb. 6, 2012

MONTPELIER, Vt. — You can’t see them. They’re hidden from view and probably always will be. But the health insurance industry’s big guns are in place and pointed directly at the citizens of Vermont.

Health insurers were not able to stop the state’s drive last year toward a single-payer health care system, which insurers have spent millions to scare Americans into believing would be the worst thing ever. Despite the ceaseless spin, Vermont lawmakers last May demonstrated they could not be bought nor intimidated when they became the first in the nation to pass a bill that will probably establish a single-payer beachhead in the U.S.

When he signed Act 48 into law on May 27, surrounded by dozens of state residents who worked for many years to achieve universal coverage, Governor Peter Shumlin expressed great pride in what had been accomplished.

“We gather here today to launch the first single payer system in America, to do in Vermont what has taken too long—to have a health care (system) that is the best in the world, that treats health care as a right and not a privilege, where health care follows the individual, not the employer,” Shumlin said.

The problem for Shumlin and his allies is this: it will take five years before Vermont can fully implement its new system, partly because the federal health care reform law prohibits states from undertaking more far-reaching reforms until 2017 unless granted waivers from the feds to do so. And though Vermont’s Congressional delegation is on board to pursue a waiver that would let the state set up a single payer system two years from now, the insurance industry’s friends in Washington are not keen to let that happen. That’s because they want to use those five years to persuade Vermonters that they really don’t want to go the single payer route after all.

During my 20 years as a health insurance PR executive, I was involved in numerous efforts to make the very term “single payer” toxic to most Americans. We even spent hundreds of thousands of premium dollars in 2007 to help finance the operation of a front group, called Health Care America, for the sole purpose of trashing a movie — Michael Moore’s “Sicko” — that put single payer systems abroad in a favorable light. You can rest assured that the industry will spend much, much more to make sure that Vermont does not succeed.

I have observed in Vermont over the past several days just how the invisible hand of the insurance industry is working. Insurers know their efforts will be more effective if they can get others — third party advocates, they call them — to carry out them out. I recognized the campaign because the tactics are the same as those used in previous attempts to kill reforms insurers don’t like.

Part of the strategy is to get key groups of individuals to begin raising doubts, to get Vermonters to second-guess themselves. Among the first groups the insurers have targeted are those most easily spooked — certain business owners and physicians, especially specialists who thrive in the current system.

Last Wednesday, legislators got a sampling of what they’re in for. At a hearing on creation of the state’s health care exchange, or marketplace — mandated by the federal reform law — employers worried about losing the ability to choose from numerous competing insurers. And they worried too about not being able to shift their employees into benefit plans with high deductibles. Insurers and employers have been collaborating for the past several years in a mutually beneficial effort to shift more of us into high-deductible policies. The higher the deductible, the less insurers and employers have to pay for our care. This collaboration has been so successful that increasing numbers of American families filing for bankruptcy are, at least theoretically, insured.

At a hearing a few days earlier in Rutland, this one for health care providers, several physicians were, wittingly or not, using some of the same industry talking points I used to write for insurers’ allies.

Dermatologist Dan McCauliffe was one of several doctors there who suggested that patients needed to pay more — not less — out of their own pocket for care. Ironically, this skin doctor joined other physician specialists in arguing that health care costs would never stabilize until patients had “more skin in the game,” a term my former colleagues used frequently as we tried to spin the “advantages” of high-deductible plans. According to statistics from the American Medical Association, dermatologists are among the highest paid specialists, making on average more than $230,000. 

So why do insurers care so much about Vermont? Even though Vermont is a small state where most for-profit insurers have little business, the insurers don’t want a single state to go single payer. Just last week, single payer advocates in California fell just a few votes short of getting a bill to the floor of the Senate for a vote. If Vermont succeeds, California lawmakers might actually get the votes they need. 

Health insurers make enormous amounts of money off of us, something they cannot do so effectively in other countries, especially Canada. The four largest insurers, United, WellPoint, Aetna and CIGNA, reported earning a combined $11 billion on nearly $220 billion in revenues last year. For years insurers have been successful in persuading Americans to believe something that is at best debatable — that they play a useful role in the U.S. health care system. They are nervous that if Vermont proves to the rest of the country that health insurers are about as useful as teats on a boar, they might have to figure out another way to make a few billion bucks.

Former CIGNA executive-turned-whistleblower Wendell Potter writes about the health care industry and the ongoing battle for health reform. Potter 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/2012/02/06/8094/analysis-battle-vermonts-health

A word about the Susan G. Komen Foundation

A Painful Betrayal

Editorial
The New York Times, February 2, 2012

With its roster of corporate sponsors and the pink ribbons that lend a halo to almost any kind of product you can think of, the Susan G. Komen for the Cure foundation has a longstanding reputation as a staunch protector of women’s health. That reputation suffered a grievous, perhaps mortal, wound this week from the news that Komen, the world’s largest breast cancer organization, decided to betray that mission. It threw itself into the middle of one of America’s nastiest political battles, on the side of hard-right forces working to demonize Planned Parenthood and undermine women’s health and freedom.

The Associated Press reported on Tuesday that the foundation is cutting off its financing of breast cancer screening and education programs run by Planned Parenthood affiliates. That means nearly $700,000 less for Planned Parenthood, which performed 750,000 such screenings last year, many thousands of them with money from the Komen foundation.

http://www.nytimes.com/2012/02/03/opinion/a-painful-betrayal.html

And…

Consolidated Statements of Functional Expenses

The Susan G. Komen Breast Cancer Foundation, Inc.
Year Ended March 31, 2011

Public support and revenue – $471,750,158

Program services
Research – $75,301,537
Public health education – $181,092,283
Health Screening Services – $54,089,036
Treatment services – $23,251,563
Total program services – $333,734,419

http://ww5.komen.org/uploadedFiles/Content/AboutUs/Financial/2011%20Komen%20Financial%20Statements%20FINAL(3).pdf

Comment: 

By Don McCanne, MD

Nothing further needs to be said about how unwise it was for the Susan G. Komen Foundation to cut off funds for breast cancer services at Planned Parenthood facilities. Having made an error so grievous that some suggest could result in the demise of this public service organization dedicated to fighting breast cancer, we should ask if we can afford to lose their contributions to this effort.

We need to take a look at their program services.

The $75 million that they spend on research could easily be incorporated into the budget of the National Institutes of Health, the world’s largest medical research institute.

The $181 million spent on public education has reached all of us through their pink ribbon campaign. Although it certainly is important for the public to know about screening mammography, isn’t it likely that this will still be common knowledge, even without the pink ribbons?

The $54 million for screening and the $23 million for treatment actually are already being paid for by taxpayers. If you consider that the marginal tax rate for Komen donors likely averages about 30 percent, then tax subsidies for the $471 million in public support amount to about $141 million, far more than the $77 million being spent on screening and treatment. In fact, the balance of our tax subsidies would pay for most of the research that they fund.

A more fundamental question is why aren’t all women guaranteed appropriate screening and necessary treatment for breast cancer? They would be if we had a single payer national health program – an improved Medicare for all. If so, the loss of the Komen Foundation would not be all that tragic, though it is still painful to say that.

More bad news about "essential health benefits"

HHS Essential Benefits 'Bulletin' Draws Tide Of Comments

Kaiser Health News
February 2, 2012

As the official window of time allowed for groups to react to the Department of Health and Human Services essential benefits proposal closed, a variety of objections, concerns and common themes became clear.

CQ HealthBeat: State ‘Flexibility’ For Essential Benefits Gets Cool Reception

A tide of objections and worries rolled in just before Tuesday’s deadline for health groups to react to a Department of Health and Human Services proposal on essential health benefits. Input from health interests and consumers on the benefits “bulletin” is not being made public by the Obama administration, which asked that comments be sent to an email address rather than posted on a government website as would be the practice with a proposed regulation (Norman, 2/1).

Politico Pro: EHB Comments Show Some Common Themes

Believe it or not, businesses, insurers and consumers do see eye to eye on essential health benefits — well, on some parts, anyway. They’re at odds on some of the bigger issues, which doesn’t exactly come as a surprise. The comments submitted to HHS on its essential health benefits approach shows a wide divide between consumers … and businesses and insurers, who don’t see enough safeguards to keep the essential health benefits package affordable (Millman, 2/2).

http://www.kaiserhealthnews.org/Daily-Reports/2012/February/02/essential-benefits.aspx

Comment:

By Don McCanne, MD

Yesterday we reported that some of the most politically powerful organizations in the nation have joined together in a coalition to try to weaken the package of “essential health benefits” that will be required of health plans under the Affordable Care Act.  Excerpts from two new articles covered in the Kaiser Daily Health Policy Report should have us even more concerned.

In Politico Pro, it is reported that businesses and insurers “don’t see enough safeguards to keep the essential health benefits package affordable.” The proposal already has reduced the required benefits down to the relatively austere level of small group plans offered in the various states. These plans leave patients facing financial hardship when they must access health care.

Yet the powerful businesses and insurers want an even lower standard of benefits in order to keep the health benefits package affordable. The insurers want to protect their markets by keeping the insurance premiums affordable, and businesses also want the lowest premiums they can negotiate. Low premiums equate with higher out-of-pocket expenses for those with medical needs. In trying to make the health insurance plans more affordable, actual health care for the patients will be even less affordable.

As we have seen, the process has always been about powerful interests, with only a passive concern for patients.

In CQ HealthBeat, we see that comments on the proposal are being “sent to an email address rather than posted on a government website as would be the practice with a proposed regulation,” and are “not being made public by the Obama administration.”

The White House gave these special interests carte blanche with secretive access during the reform process. Secrecy continues. Should we be surprised when the final rule on “essential health benefits” pleases business and insurance interests, at a cost of exposing those with health care needs to greater financial hardship? No, not surprised. Outraged is more like it!

More bad news about “essential health benefits”

HHS Essential Benefits ‘Bulletin’ Draws Tide Of Comments

Kaiser Health News
February 2, 2012

As the official window of time allowed for groups to react to the Department of Health and Human Services essential benefits proposal closed, a variety of objections, concerns and common themes became clear.

CQ HealthBeat: State ‘Flexibility’ For Essential Benefits Gets Cool Reception

A tide of objections and worries rolled in just before Tuesday’s deadline for health groups to react to a Department of Health and Human Services proposal on essential health benefits. Input from health interests and consumers on the benefits “bulletin” is not being made public by the Obama administration, which asked that comments be sent to an email address rather than posted on a government website as would be the practice with a proposed regulation (Norman, 2/1).

Politico Pro: EHB Comments Show Some Common Themes

Believe it or not, businesses, insurers and consumers do see eye to eye on essential health benefits — well, on some parts, anyway. They’re at odds on some of the bigger issues, which doesn’t exactly come as a surprise. The comments submitted to HHS on its essential health benefits approach shows a wide divide between consumers … and businesses and insurers, who don’t see enough safeguards to keep the essential health benefits package affordable (Millman, 2/2).

http://www.kaiserhealthnews.org/Daily-Reports/2012/February/02/essential-benefits.aspx

Comment:

By Don McCanne, MD

Yesterday we reported that some of the most politically powerful organizations in the nation have joined together in a coalition to try to weaken the package of “essential health benefits” that will be required of health plans under the Affordable Care Act.  Excerpts from two new articles covered in the Kaiser Daily Health Policy Report should have us even more concerned.

In Politico Pro, it is reported that businesses and insurers “don’t see enough safeguards to keep the essential health benefits package affordable.” The proposal already has reduced the required benefits down to the relatively austere level of small group plans offered in the various states. These plans leave patients facing financial hardship when they must access health care.

Yet the powerful businesses and insurers want an even lower standard of benefits in order to keep the health benefits package affordable. The insurers want to protect their markets by keeping the insurance premiums affordable, and businesses also want the lowest premiums they can negotiate. Low premiums equate with higher out-of-pocket expenses for those with medical needs. In trying to make the health insurance plans more affordable, actual health care for the patients will be even less affordable.

As we have seen, the process has always been about powerful interests, with only a passive concern for patients.

In CQ HealthBeat, we see that comments on the proposal are being “sent to an email address rather than posted on a government website as would be the practice with a proposed regulation,” and are “not being made public by the Obama administration.”

The White House gave these special interests carte blanche with secretive access during the reform process. Secrecy continues. Should we be surprised when the final rule on “essential health benefits” pleases business and insurance interests, at a cost of exposing those with health care needs to greater financial hardship? No, not surprised. Outraged is more like it!

Time to raise our voices: health justice still not won

The following remarks by Dr. Claudia Fegan, past president of Physicians for a National Health Program, were delivered to the annual strategy conference of Healthcare-Now! on Jan. 28 in Houston.

By Claudia Fegan, M.D.


Dr. Claudia Fegan

On Jan. 19, Sarah Burke, a Canadian treasure, a pioneer in the sport of freeskiing who was instrumental in getting that sport added to the next Winter Olympics, died at the age of 29.

Sarah, a resident of British Columbia, died from injuries sustained in a fall on Jan.10 at the end of a practice run in Salt Lake City, Utah.

Sarah Burke was a phenomenal skier, immensely talented and tremendously enthusiastic about her sport. If you want to see grace in motion you should search Sarah Burke’s name on YouTube. She soared like an eagle and glided through the air effortlessly.

Immediately following her death her young husband and parents were presented with a bill for $550,000.

While she is Canadian and had cradle-to-grave coverage by Canadian medicare, she did not have coverage for this accident which occurred in the United States. She was covered by her professional skiing organization when she participated in sanctioned events; however, her training run in Salt Lake City was not a part of a sanctioned event.

Now it is true Canadians were stunned by the bill she had racked up during her 10-day ICU stay. However, they were shocked to learn that how much you are billed depends upon your insurance status. They were even more appalled to discover that being uninsured would result in being charged more for health care than if you were insured.

Sarah’s friends took to the Internet and have already raised $294,200 toward her outstanding bills. Unfortunately, most of the 50 million people who are uninsured in the United States today aren’t lucky enough to have a following to raise money to pay their medical bills.

That brings me to why I am here today. I would like to do five things this evening, although my English teacher husband tells me I should never to try to do more than three. So here goes:

1. I want to tell you what I do

2. Tell you why I do what I do

3. Tell you what Barack Obama did

4. Tell you why you must do why you must do what I do

5. Tell you how you can do it

What I do

So I am the Chief Medical Officer for the John H. Stroger Jr. Hospital of Cook County, or as most people outside of Chicago know us, Cook County Hospital. We are unusual among the public hospitals that remain open in the United States today because we still take care of everyone who comes to our door, regardless of their ability to pay.

That means last year 80 percent of the outpatients we saw were uninsured. Fifty-six percent of the patients we admitted were uninsured. The variance is because almost a quarter of those we admitted were able to get insurance once they were in the hospital and we had a chance to apply for coverage on their behalf.

Over the years I have spoken a lot about health care and I usually speak about my patients.

I remember at the Democratic National Convention in 2008 I talked about my patient Nina, who was a hairdresser who had no insurance. When she found a lump in her breast she was afraid to come to the hospital. When her daughter finally brought her in both breasts were rock hard and the tumor had begun to drain from one of the breasts.

Camille had been diagnosed with breast cancer when she was employed and was initially cared for at the University of Chicago where got excellent care. A couple of years later, after she had been laid off, she began to have problems again. Her surgical oncologist wouldn’t return her phone calls and her oncologist told her she couldn’t see her without insurance. So she came to County, where we took care of her.

I have talked about my 63-year-old patient Delois who needed a hip replacement because her joint had been destroyed by arthritis and she had bone grinding on bone. At County we don’t do joint replacements because we can’t afford the prosthetics. All we can do is give those patients pain medication, try to get them disability coverage so they can go somewhere else or wait for them to turn 65.

Then there is my patient Joan, who after a career as a bookkeeper thought she could contribute more to society by teaching music to children. She was frugal with her funds, purchased a small studio and some instruments. She hired instructors, most of them part-time. It means most of the instructors are musicians or schoolteachers whose available time coincides with when there is the most demand for lessons.

For years Joan was able to provide affordable lessons for students and sometimes free instruments for students who couldn’t afford them. She never made much money, but it gives her great joy to bring music to children. Joan does this work because she says it makes us a better society.

In the last three years the number of parents bringing their children for lessons has decreased, the expenses for the studio have increased and Joan has struggled to make ends meet.

For years I have managed Joan’s blood pressure and that has been a cost-saving to her because in the Cook County Health and Hospital System we charge patients based on their ability to pay. So last winter when she fell from her bicycle in Chicago snow and broke her ankle, there was no one to raise money for the surgery she would need to put it back together. With a broken ankle she couldn’t even climb the stairs to her second-floor studio.

Joan did the only thing she knew to do — she dragged herself with her broken ankle to our emergency room, where she knew she would be treated with dignity and respect and where she knew she would not receive a bigger bill because she was uninsured. Surgery went well and Joan has not traded her bike for a car; she has splurged on a three-wheeler instead.

So what I do is advocate for the 50 million uninsured in this country who seek nothing more than Health Care Justice. Yes, I personally take care of the Ninas, Deloises, Camilles and Joans who come to our doors, but in my spare time I fight for social justice.

Why do I do what I do?

Martin Luther King said, “The time is always right to do what’s right.” Well it is not right to punish people who don’t hav
e health insurance. We live in one of the wealthiest, most powerful nations in the world. We have no problems marching all over this world to tell developing nations how they should treat their citizens and yet we don’t have the common decency to provide for our own.

We are an arrogant lot, we Americans. We always think we know what is best for everyone else, but we refuse to look in the mirror and see the indignity and humiliation we impose on those of who do not have health insurance in this country.

We allow the health insurance industry and the pharmaceutical industry to profit tremendously on the misfortunes of many. Most pharmaceutical companies today are multinational entities that sell the same medications in the U.S. as they sell elsewhere in the world, but in the U.S. they are able to sell these medications for twice, three times and sometimes 10 times as much as they sell them elsewhere. That is because the U.S. allows them to sell medications for whatever the market will bear and most of the rest of the world regulates the cost of medications.

Why do I do what I do? Because my parents taught me right from wrong and they taught me to fight for what is right. What we do to people in this country without health insurance is wrong. Single-Payer National Health Insurance would provide our country with health care justice and that is right.

What did Barack Obama do?

Barack Obama pushed for and passed the Patient Protection and Affordable Care Act. Now let’s be clear, I’m a big fan of Barack Obama. His home in Chicago is less than two blocks from mine, he was my state representative before he was my senator and he is a very smart man.

But at the end of the day, he is a politician and I am a physician. I think our values are different, not right or wrong, just different. I think he is the best president we have had in a generation, but it is the job of a politician to compromise and I happen to disagree with where he has chosen to compromise. Passing the Patient Protection and Affordable Care Act was nothing short of miraculous — every single president since Franklin Roosevelt attempted to pass legislation for national health insurance, and not one before Obama had succeeded.

In the book “The Heart of Power,” David Blumenthal chronicles the efforts of presidents from Franklin Roosevelt through George W. Bush to achieve access to health care for the American public. He writes, “Major health reform is virtually impossible: difficult to understand, swarming with interests, powered by money, and resonating with popular anxiety.”

Blumenthal quotes congressional veteran and co-chair of the 9/11 Commission, Lee Hamilton: “Health care is so difficult because Congress is an incremental body and health care is a non-incremental issue.”

PPACA, or the Affordable Care Act as it is commonly called today¸ is badly flawed. It has no cost containment and will not address the issues of cost, access and quality. Single payer will.

Why must you do what I do?

The Affordable Care Act, once fully implemented, will leave 23 million people uninsured. About 45,000 people die each year as a result of not having health insurance, which means 180,000 more people will die before full implementation of the Affordable Care Act.

Single payer will cover everyone.

Barack Obama worked hard and maneuvered a massive piece of legislation through an intellectually constipated Congress, but he did not get us what we need. We need health care justice for this country.

He and others might argue that we did not make him fight for single payer. We weren’t marching up the front lawn of Congress or the White House shouting for it, or not shouting loudly enough, so there was no incentive for those on the inside to fight for it.

We didn’t lose the war to gain access to health care for all Americans. We got battered in an ugly skirmish, but we’re not done.

It is time to change our tactics

The opportunity for change is still ahead of us. The Affordable Care Act has not made health care a right.

Access to care in this country a profit center controlled by the insurance industry. We pay them to limit access to care. We spend more per capita on health care than any country in the world more than $7,500 per person and yet we are ranked only 37th in the world by the World Health Organization for the care we provide.

What we have done now is required everyone to purchase insurance. For those who can’t afford it, we’ve required states to either cover them under Medicaid or we’ve provided federal subsidies so they can purchase private insurance.

This is an industry that has a history of profiteering by retroactively denying coverage to people with illnesses. So now we are requiring everyone to buy coverage and, yes, we have told the insurance companies they can’t deny coverage to those with illnesses.

My question is this: Why can’t we just pay for care without having to go through the insurance industry?

We spend enough money on health care in this country. We just let too many people who aren’t involved in providing care take profit from it.

This is about justice. Health care should be a right to which everyone is entitled.

Remember we live in the wealthiest country in the world. We spend more on health care than any other country; it is time we got our money’s worth. It is time we got the health care we deserve, not the care the insurance industry is willing to let us have. It is time we made health care a right and not a privilege.

How can you do it?

You have to speak up. You have to speak loudly. You have to make your voices heard. The Affordable Care Act is an opportunity. It is not going to work!

You have to remind the people that there is still a simpler, easier solution. People want to know, they have questions. They will ask, is the new health law the answer? Will this work? Will this solve the problem? The answer is NO, the answer is NO!

The Affordable Care Act didn’t go too far, it didn’t go far enough and we can’t be afraid to say that. You have to tell the truth, you have to fight for what is right. You can’t be afraid to tell our representatives who are under attack from the right that what they have done in not enough and there are important points on which they cannot compromise. They need us to demand single payer, they need us to make them do it.

Being right is not enough; you have to fight and you have to fight hard to win the hearts and minds of th
e American public.

I keep reminding you that this is an issue of social justice and issues of social justice require struggle and tenacity because there are always reactionary forces ready and willing to push back against change. There are always people who benefit from the status quo. They will resist the change that will provide more for the many and instead want to retain the most for a few. We have to fight that.

My father was a labor union organizer, but he loved literature. He taught me a poem by Langston Hughes that I think applies to our current struggle. It is called “Mother to Son.”

Mother to Son

Well, son, I’ll tell you:
Life for me ain’t been no crystal stair.
It’s had tacks in it,
And splinters,
And boards torn up,
And places with no carpet on the floor —
Bare.
But all the time
I’se been a-climbin’ on,
And reachin’ landin’s,
And turnin’ corners,
And sometimes goin’ in the dark
Where there ain’t been no light.
So, boy, don’t you turn back.
Don’t you set down on the steps.
‘Cause you finds it’s kinder hard.
Don’t you fall now —
For I’se still goin’, honey,
I’se still climbin’,
And life for me ain’t been no crystal stair.

You are going to spend some time tonight and tomorrow discussing strategy, it is important that strategy be about getting the politicians to do what is right and not about compromising on the basic principle of single payer: Everybody in and nobody out! Everybody in and nobody out!

Calif. single-payer campaign to begin new push

Special to The Union
The Union (Grass Valley, Calif.), Feb. 1, 2012

The Campaign for a Healthy California on Wednesday denounced the failure of the California Senate to pass SB 810, the California Universal Care Act. The bill died when it remained two votes short of passage.

Democrats fell short of previous levels of support, which successfully passed similar bills through the legislature twice before, only to be vetoed by then Gov. Arnold Schwarzenegger. This year 19 voted in favor of the bill, two against, and four abstaining in spite of intensive efforts at persuasion by grassroots proponents. The bill received no support from Republicans.

The California Universal Care Act would have created a single public health insurance program for all Californians, much like an improved Medicare-for-All plan that has been proposed at the federal level.

CHC member organizations spoke out against the disappointing vote, “Nurses will not give up on winning guaranteed universal healthcare, like SB 810” stated DeAnn McEwen, RN, co-president of the California Nurses Association, “because we will not abandon our patients who need this vital reform.”

Nan Brasmer, president of the California Alliance for Retired Americans, stated: “This is a very sad day for seniors and all Californians. With millions of us uninsured or underinsured, SB 810 offered the only solution to our skyrocketing health care costs while covering everyone. And the added bonus is that it would save the State billions of dollars once implemented, at a time when essential programs for seniors are being slashed and out of pocket costs for health care have gone through the roof. We will continue to fight for single payer in the legislature and at the ballot box.”

SB 810 would create a new California Healthcare System to provide health insurance for all Californians, replacing the private insurance providers. Critics claim that such as system, often referred to as “single payer,” would be too costly. “Not true,” said Dr. Henry L. Abrons, president of PNHP California. “Currently the U.S. spends twice as much as any other country on health care. We have plenty of money in the system, enough to insure 100% of us; we just need to spend it more wisely.” He continued, “The best way to save money is to take the private insurers out of the system. They are responsible for 30% of each healthcare dollar being lost to pay for exorbitant CEO salaries, lobbyists, sales and marketing, administration and shareholder profit. Medicare’s overhead by contrast is only 3%. Californians would still be free to seek services from any medical provider in the private sector — only the financing would change. The difference is that that everyone in California would be fully covered.”

Joseph Foy, spokesman for the California Health Professional Student Alliance said, “Grassroots activists are not deterred by this setback in the Senate. The movement for single-payer health insurance is growing stronger every day among students who are the doctors, nurses, and other caregivers of the future.”

“Healthcare is a human right,” Progressive Democrats of America’s California state coordinator and emergency physician Dr. Bill Honigman stated, “It is immoral for businesses to profit from the illness of others, just as we would not expect them to profit from other public services such as police, fire, or education.”

“We’re disappointed today, but this is just the beginning of our efforts to win quality, comprehensive health care for all,” said Pilar Schiavo, the CHC campaign coordinator. “We will continue to build on the momentum we have created through our recent actions and statewide activism, and build an even broader and more powerful grass roots movement to ensure we win universal healthcare in California.”

The Campaign for a Healthy California represents over 1.4 million Californians and includes: California Alliance for Retired Americans, Physicians for a National Health Program – California, California Health Professional Student Alliance, Communication Workers of America – District 9 (California & Nevada), Health Care For All, Single Payer Now, California Nurses Association, California OneCare, California School Employee Association, Democracy For America, The Progressive Caucus of California, and Progressive Democrats of America.

http://www.theunion.com/article/20120201/BREAKINGNEWS/120209999/1001&parentprofile=1053

Beware the Essential Health Benefits Coalition

Essential Health Benefits Coalition

January 31, 2012
Letter
To: HHS Secretary Kathleen Sebelius
From: Neil Trautwein, National Retail Federation

Re: Request for Information on the Essential Health Benefits Bulletin

The Essential Health Benefits Coalition (“EHBC”) appreciates the opportunity to provide comments in response to the “Essential Health Benefits Bulletin” as issued by Department of Health and Human Services’ (HHS’s) Center for Consumer Information and Insurance Oversight (CCIIO) on December 16, 2011.

As you finalize the definition of the Essential Health Benefits (EHB) package, we want to emphasize our concerns regarding the affordability of coverage for small employers and individuals under the Affordable Care Act (ACA). HHS seeks to give states flexibility to structure their own EHB package using private market coverage options in use today to serve as benchmarks.  Yet these benchmark options are subject to the same state mandates that today keep coverage unaffordable and out of reach for many small employers and individuals. We urge HHS to consider an approach that balances reasonably comprehensive benefits with affordability for employers and individuals. A definition that does otherwise will make health coverage more expensive for employers and individuals to purchase and make jobs more difficult for employers to create.

Excerpt from recommendations:

Specifically, we urge the Department to reiterate that the Bulletin reflects the statutory requirements that:

* The EHB package does not dictate cost sharing requirements.

* Use of benefit limits included within benchmark plans is not barred.

* Future state mandates will not be added to the benchmark plan.

* Use the benchmark plan only to define the 10 categories of EHBs required by the ACA, and not any additional benefits that the benchmark may cover.

Members of the Essential Health Benefits Coalition Steering Committee:
 
American Osteopathic Association
America’s Health Insurance Plans
Blue Cross Blue Shield Association
Express Scripts Inc.
National Association of Health Underwriters
National Association of Manufacturers
National Association of Wholesaler-Distributors
National Federation of Independent Business
National Retail Federation
Pharmaceutical Care Management Association
Prime Therapeutics
Retail Industry Leaders Association 
U.S. Chamber of Commerce 

http://ehbcoalition.org/wp-content/uploads/2012/02/EHBC-Comments.pdf

Comment: 

By Don McCanne, MD

HHS has proposed that “essential health benefits” for plans under the Affordable Care Act need meet only the minimal standard of state regulated plans in the small group market. Now a coalition of the usual suspects which push self-serving reforms is proposing to further weaken the “essential health benefits” standard.

The details of their recommendations are not nearly as important as the fact that this maneuver represents what has been wrong with the reform process all along. The vested interests have been in the front seat while the guileless  patients have had to accept their work product – a mandate to purchase unaffordable under-insurance, amongst many other flawed policies.

Instead of fighting over the definition of minimal essential benefits in a highly flawed health financing program, we should be joining with the nation’s patients in demanding that our elected leaders quit listening to these self-serving interests and instead enact a program that puts patients in the front seat – an improved Medicare for all.

Addendum:  Members of the American Osteopathic Association (AOA) may want to advise their leadership that, as a patient-oriented organization, AOA should immediately withdraw from this dastardly coalition.

Emanuel and Liebman predict the end of private insurance

The End of Health Insurance Companies

By Ezekiel J. Emanuel and Jeffrey B. Liebman
The New York Times, January 30, 2012

Here’s a bold prediction for the new year. By 2020, the American health insurance industry will be extinct. Insurance companies will be replaced by accountable care organizations — groups of doctors, hospitals and other health care providers who come together to provide the full range of medical care for patients.

… thanks to the accountable care organizations provided for by the health care reform act, a new system is on its way, one that will make insurance companies unnecessary. Accountable care organizations will increase coordination of patient’s care and shift the focus of medicine away from treating sickness and toward keeping people healthy.

… accountable care organizations will typically be paid a fixed amount per patient, along with bonuses for achieving quality targets. The organizations will make money by keeping their patients healthy and out of the hospital and by avoiding unnecessary tests, drugs and procedures. Thus, they will actually have a financial incentive to hire that nurse for follow-ups.

In addition to providing better and more efficient care, A.C.O.’s will also make health insurers superfluous. Because they will each be responsible for a large group of patients (typically more than 15,000), they will pool the risk of patients who have higher-than-average costs with those with lower costs. And with the end of fee-for-service payments, insurance companies will no longer be needed to handle complicated billing and claims processing, nor will they need to be paid a fee for doing so. Payments can flow directly from an employer, Medicare or Medicaid to the accountable care organizations. A.C.O.’s will require enhanced information systems to track patients and figure out how to deliver more effective care, but this analytic capacity will be directed at improving health outcomes, not at imposing barriers to those seeking treatment.

A.C.O.’s are not simply a return to the health maintenance organizations of the 1990s. Although in both models patients are members of a provider network with a specific group of doctors and hospitals, and both are paid primarily per member rather than per procedure or test, there are big differences between them. H.M.O.’s were often large national corporations far removed from their members. In contrast, A.C.O.’s will consist of local health care providers working as a team to take care of patients who are likely to be members for years at a time.

A few health insurers see this asteroid coming. Wellpoint, for example, bought the clinic operator CareMore for $800 million last summer to make the transition into the A.C.O. business. Others, like the Optum unit of UnitedHealth Group, are developing data analysis services to provide to future A.C.O.’s. If they don’t want to go the way of the dinosaurs, insurance companies will have to find a new business to be in, one that is useful in the new world of coordinated care.

http://opinionator.blogs.nytimes.com/2012/01/30/the-end-of-health-insurance-companies/

Comment:

NYT Pick

Don McCanne
San Juan Capistrano, CA

The policy community, as represented by Ezekiel Emanuel and Jeffrey Liebman, speaks in glowing terms about idealistic, altruistic accountable care organizations (ACOs) in which health care professionals and institutions join together to improve quality and lower costs. Yet the specifics of the Medicare Shared Savings program that would establish ACOs through the Affordable Care Act (ACA), has only a superficial resemblance to these idealistic models.

The fact that the two largest for-profit insurers in the nation – WellPoint and UnitedHealth – are going after the ACO business is proof that we are in for more of the same. Eliminating private insurers by merely setting up ACOs is a pipe dream. The state insurance exchanges mandated by ACA are exchanges of private insurance plans, not ACOs.

We need to improve Medicare, dump the private insurers including the Medicare Advantage plans, and provide Medicare for everyone. Medicare has been far more effective than the private insurers in controlling costs, and would be even more so if it were our own publicly-financed single payer system.

http://opinionator.blogs.nytimes.com/2012/01/30/the-end-of-health-insurance-companies/?comments#permid=7

Market reforms will not result in health care for all in Maine

Federal and state programs will not achieve the savings promised by a single-payer system

By Julie Pease, M.D.
Portland Press Herald (Maine), Jan. 30, 2012

For two years, while great effort has been spent debating health care reforms, costs for health insurance have continued to spiral out of control. Contrary to the assertions of Sen. Deborah Sanderson in a Dec. 30 column (“Legislature is tackling the causes of Maine’s high health care costs”), there is simply no evidence to suggest that increasing competition in the for-profit insurance market will control health care costs, just as there is no evidence to suggest that federal reforms will be able to bring costs under control.

How much longer must we wait before we can agree that our health care system is irretrievably broken and recent incremental “reforms” are ineffective? How many families will go bankrupt due to medical expenses? How many people will die due to delaying care or being unable to access care at all?

The best way to control health care costs and to bring quality comprehensive health care to all Maine people is through a universal single-payer health care system. Under a universal system, everybody would be equally affected by changes in benefits and eligibility would become a moot point. The conversation in Augusta would be much different if Gov. LePage were proposing health care cuts for all Mainers rather than our most impoverished and vulnerable citizens.

Eliminating administrative waste would save a great deal of money. In testimony before the Maine Legislature, Harvard Professor William Hsiao estimated potential savings in the first year under single-payer to be $1 billion in Maine alone!

Maine could use these savings to provide real health care benefits instead of wasting money on administrative overhead or insurance company profits. Shifting from a for-profit to a not-for-profit financing mechanism would place the focus of health care on healing and health rather than profitability.

It is time to follow the lead of our neighbors in Vermont who have taken steps toward universal health care. We can’t afford to wait.

Julie Pease, M.D., is president of the board of directors of Maine AllCare. She lives in Brunswick.

http://www.pressherald.com/opinion/market-reforms-will-not-result-in-health-care-for-all-in-maine_2012-01-30.html

To rein in health costs, look to single payer

Letters, The New York Times, January 29, 2012

To the Editor:

Ezekiel J. Emanuel chooses to assign liberals with controlling costs in health care, when he should be waving his finger at the health care sector. When “skyrocketed” health care costs come up, profit never makes it into the discussion or calculations.

Dr. Emanuel should remember, too, that many liberals wanted the cost-saving, improved Medicare-for-all system to be included in Senator Max Baucus’s committee hearings. Sadly, the cabal made sure that its proponents got no seat at the table.

H.R. 676, the Expanded and Improved Medicare for All Act, would have cut out unnecessary administrative costs, given Americans real choice in their health care, and dissolved the employment-benefits contract that keeps us an indentured labor force. These are factors that both liberals and conservatives should be able to support.

BARBARA COMMINS
San Francisco, Jan. 22, 2012

The writer is a registered nurse.

To the Editor:

Ezekiel J. Emanuel suggests that liberals “ignore costs.” He doesn’t seem to recognize that many conservatives oppose the payment reform proposals in the Affordable Care Act. Remember the outcry about “death panels”?

Moreover, it should not be a given that insurers should continue to consume a large fraction of the health care dollar.

There are many good options for payment reform not included in the health care law. We need a wider discussion on how care is paid for, and how everyone can have access to care in a way that is more efficient, safer and better.

Our government should not write off the possibility of single-payer (which it has so far, largely because of conservative opposition). Those are liberal ideas, and they do not mean that costs should be ignored.

BRUCE L. WILDER
Pittsburgh, Jan. 22, 2012

The writer is a neurosurgeon and a lawyer.

http://www.nytimes.com/2012/01/30/opinion/health-costs-regardless-of-your-politics.html

Paying for a free screening colonoscopy

'Free' preventive care can cost patients big money: Is procedure a screening or therapeutic?

By Tom Kisken
Ventura County Star, January 28, 2012

Patients are getting charged as much as $3,000 for screenings they thought would be free under a federal health care reform mandate that promises free preventive care.

Most of the problems revolve around colonoscopies — screenings designed to detect colon and rectal cancers that kill about 52,000 Americans a year.

The procedure has been covered by federal health care reform for men and women 50 and older since September 2010, although many older insurance policies are exempt from the new provision.

Some patients are still receiving bills for deductibles or co-pays when the procedures show an abnormal growth called a polyp that can develop into cancer.

Insurance companies may charge for screenings or tests if patients show symptoms of cancer or are going through a colonoscopy as a follow-up to an earlier diagnosis, said Robert Zirkelbach, spokesman for the trade group. But many insurers consider colonoscopies to be preventive care — and covered — regardless of whether polyps are present, he said. Bills are sent when they aren’t told the nature of the procedure.

“One of the challenges is: How are those procedures being coded by physicians?” he said. “Is it clear that it’s a preventive service?”

Some doctors, however, insist the issue isn’t coding, but rather money and the insurers’ desire for it.

“That is subterfuge,” said Dr. Paul Sanders, a Thousand Oaks gastroenterologist, contending insurers are shifting blame from themselves to physicians. “It’s utter baloney. The insurance companies have quite intentionally blocked any way that anybody could understand what they’re going to, and not going to, pay for.”

Charles Rosen, a Simi Valley insurance broker and president-elect of the California Association of Health Underwriters, tells clients to minimize chances of any billing confusion by not talking to a doctor about any health concerns during a screening exam.

“If you have a pending issue, make another appointment,” he said.

http://www.vcstar.com/news/2012/jan/28/free-preventive-care-can-cost-patients-big-money/

Comment: 

By Don McCanne, MD

Colonoscopy is one of several cancer screening tests that are covered 100 percent – no deductibles nor coinsurance are required. What separates out colonoscopy from the other screening tests is that it is frequently converted, on the spot, to a therapeutic procedure when polyps are detected and removed.

Somewhere between the billing office for the physician or outpatient department and the processing of the claim by the insurer, the diagnostic and procedure coding is changed from the free screening test to the therapeutic procedure, subject to cost sharing. The physician blames the insurer, and the insurer blames the physician. But it is the patient who is harmed by being required to pay the out-of-pocket costs of a therapeutic procedure after having been promised a free screening test.

As is typical in our health care financing system that turns decisions over to private insurers (even if only private administrators of Medicare), the president-elect of the California Association of Health Underwriters advises patients to withhold medical information until after they have received their free screening. Only then should they inform their physician about the rectal bleeding or the tenesmus that they have been experiencing. What’s a little fraud if it is only the patient that is committing it?

There are two policy lessons here.

One is that deductibles, co-payments and coinsurance should be eliminated for all appropriate care. Payment issues should not interfere with health care decisions made by the patient with the best advice of the physician. The harm dome by erecting financial barriers to care is potentially far greater than the almost negligible decrease in our national health expenditures that would result from cost sharing (most of which is merely shifted from the insurer to the patient). Obtaining appropriate health care should not result in the assessment of cost sharing penalties or fines.

The second policy lesson is that we need to throw the middleman crooks out. Only that industry would come up with a solution that patients should be instructed to lie to their health care professionals. Not a lie to withhold information? Isn’t the oath for swearing in, “The truth, the whole truth, and nothing but…”? Maybe the whole truth is confidential proprietary information. At least that’s what the insurers keep telling us when we ask for transparency.