PNHP

OWS Receives Flu Shots From Doctors And Nurses

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OWS Receives Flu Shots From Doctors And Nurses

By GLENN WILBURN
MyFoxNY.com, Sunday, 13 Nov 2011

MYFOXNY.COM – Doctors and nurses from Physicians for a National Health Program (PNHP) provided free health care to the Occupy Wall Street protesters at Zuccotti Park on Sunday.

However, a counter protest is being planned against the Occupy Wall Street demonstrators staying in at the park.

The Occupy Wall Street movement is in its third month and many small businesses and residents say it’s time for them to leave.

According to the NYPD, there were two arrests of protesters Saturday night. One of the arrests was for punching an officer.

Police said a fight had started between two men and when they tried to break up it, one of the men stopped and another kept going hitting the officer in the face. The officer wasn’t injured, but both men were taken in.

The Zuccotti Park protesters have been dealing with cold that has been spreading throughout Zuccotti Park.

OWS said within 24 hours of the call for volunteers, close to 70 professionals signed up to provide flu shots.

“We support Occupy Wall Street because economic and social inequalities make our patients sick,” says a statement on PNHP-NY Metro’s blog. “We support OWS because the private health insurance industry exemplifies the central complaint of the OWS movement: unchecked corporate greed threatens human needs.”

The physicians spoke out after providing the flu shot clinic. The health professionals and patients shared their personal stories they feel a national health care system is needed.

http://www.myfoxny.com/dpp/news/ows-receives-aid-from-doctors-and-nurses-20111113

Single-Payer System Would Fix Mandates

By Joseph R. Barrie, M.D.
Letters, The Wall Street Journal, Nov. 14, 2011

Edwin Schindler’s comments (“The Other Side of Insurance Mandates,” Letters, Nov. 10) about autism coverage in New York state are of interest to me because, like Bob and Suzanne Wright (Letters, Nov. 7), I have an autistic grandchild.

I sympathize with Mr. Schindler’s complaint about the cost of coverage but suggest that the balance sheet of his insurer ought to figure in his concerns.

His letter is another reason for this country to consider a single-payer insurance system, and get the for-profit and not-for-profit vultures out of the loop. Pity that our current president lacks the guts to support this concept.

Joseph R.. Barrie, M.D., resides in Harvard, Mass.

http://online.wsj.com/article/SB10001424052970204224604577030540772225510.html

Dr. Jacqueline Davis on the fight to save Britain’s NHS

The Fight to Save Britain’s NHS: Luncheon address by Jacqueline Davis, M.D.

Physicians for a National Health Program
National Meeting, Washington, D.C., October 29, 2011

(Excerpts)

First I want to thank you for inviting me here. I bring greetings from the land of socialized medicine and death panels, to the land of “islands of excellence in a sea of misery.”

I’ve never been to this city before and when I told family and friends about my invitation to Washington they assumed I was off to meet the president. I told them it was much more important than that. But just in case he’s listening – I could be free for tea tomorrow….

****

Of course the NHS faces the challenges that all health systems do, i.e. changing demographics, increased range and cost of treatments, rising patient expectation and the global financial crisis. But in the face of all these the NHS still manages to be one of the most cost-efficient and equitable health services in the world. And the public love it. At the end of the Labour government’s 13 years in power it had the highest satisfaction ratings ever, and it still is the most popular institution in the UK bar none, and that includes the royal family.

So if it’s so good, why are we having to fight for it? Because there’s another big challenge which all public services face and that is the neoliberal agenda which still has the upper hand despite its current manifest failures on a global scale.

****

A successful public service is an affront to the free marketeers. They simply won’t let the facts get in their way. Despite all evidence to the contrary they continue to insist anything the public sector can do the private sector can do better and more cheaply, and no evidence to the contrary will persuade them otherwise.

So the politicians for ideological reasons, and the private sector for financial reasons, have had the NHS – traditionally publicly funded, publicly delivered and publicly accountable – in their sights for some time. They have acted together, beneath the radar, to turn the NHS from a cost-effective integrated public service into a kite mark attached to a ragbag of competing private providers.

****

Up till now you trusted your GP to give advice on clinical grounds. But now – if your GP says no to treatment and/or referral is it because they want to pocket the money that is saved – which the bill allows them to do? Or if they refer you to Hips R Us down the road, is it because their wife has a financial interest in it? 25 percent of GPs already have a direct interest in the private sector. This suspicion will be very corrupting, and most GPs are worried about it.

****

We fear NHS services being reduced to a core of poor services for poor people, with those who can afford it topping up their personal health budgets with insurance or out-of-pocket payments and those who can’t afford it going without.

And we really fear the arrival of the private companies, many of them from the U.S., whose behavior leaves much to be desired. They want to “cherry pick.” leaving the NHS to pick up the complex expensive patients as well as providing the expensive emergency care and the training that is not attractive to the private sector. We fear they will behave in a fraudulent way as they do already in the USA.

****

Our organization was vociferous from day one, saying that the bill spelled the end of the NHS, and of course we were accused of shroud waving and gross exaggeration. But we stuck in there and joined together with other campaigning organizations and the pressure has built up over the last year. How did we do it?

We produced analyses and simple 10-point critiques of the bill in our regular campaign newspaper as well as special pamphlets and postcards. We wrote doggedly – all of us would take it in turns – to national and local papers and had a lot of articles and letters published.

We offered to do public talks, to our own groups and also to anyone from medical students to pensioners, and in fact those two groups turned into some of our most outspoken supporters. We helped organize online petitions. We put a lot of energy into lobbying politicians.

We have helped expose the scandals of the revolving door between government and the private sector and the infiltration of government by corporate interests. We have questioned the neutrality of so called think tanks and helped expose the strength of the health lobbying industry in Westminster.

We marched, we used social media to spread our message and some of us even got elected to the Council of the British Medical Association so that we could begin to change our union from within.

****

The problem we have come to realize is that we aren’t just fighting the Tory government; we are fighting the global medical industrial complex with all its power, influence and money. And its cozy relationship with today’s politicians.

It’s easy to lose hope but we mustn’t. We have to take on this cozy configuration of politicians and giant corporations which have come to a “comfortable accommodation” at our expense. We must change the tone of the debate with these people who know the price of everything and the value of nothing.

We must say that the market should serve society rather than society serving the market, that there are public goods and goals for which the market is not suited and that what matters is not how affluent a country is but how unequal it is. We must collect evidence and use it to criticize and expose. We must create the strong voice of civil society and we doctors have a particular duty to be that voice and we must organize and use it.

Firstly because – and we must never lose sight of the fact – we are right. Secondly, we are the patients’ true advocates and our patients are depending on us. And finally Aneurin Bevan, the great founder of the NHS, said, “The NHS will last as long as there are folk left with the faith to fight for it.”

We must be those folk because, personally, I am not prepared to let him down.

(Dr. Jacqueline Davis is a consultant radiologist working in a hospital in London. She is co-chair of the NHS Consultants’ Association, a nationwide group of distinguished physicians representing all specialties, and a member of the Keep Our NHS Public campaign.)

(You may have to cut and paste this link for it to work.)
https://pnhp.org/news/2011/november/the-fight-to-save-britain’s-nhs

Comment: 

By Don McCanne, MD

We share with the British concerns about the neoliberal attack on our health care services. In their case it is an attack on their public National Health Service, whereas in our case it is an attack on Medicare and other public programs and, even greater, a virtual blockade – a dysfunctional private financing construct that often uses public money – that prevents us from bringing comprehensive health care services to all of our people.

This luncheon address by Dr. Jacqueline Davis was a highlight of PNHP’s recent annual meeting in Washington, DC. You may want to take a moment this weekend to read the entire address, available at the link above, and then savor it. You’ll then understand clearly why we gave her a standing ovation, not to mention that it will reinforce your dedication to the cause of health care justice for all.

Occupy actions, PNHP Annual Meeting report, Healthcare Reform 2.0

Nov. 10, 2011

Dear PNHP colleague,

Today’s message contains six points:

1. Update on the Occupy movement and single payer
2. ‘Healthcare Reform 2.0’ by Woolhandler and Himmelstein
3. PNHP’s Annual Meeting draws large crowd
4. Update on protest of IOM’s skimpy benefits model
5. More rumblings from Super Committee on cuts to Medicare, Medicaid and Social Security
6. Keep PNHP in mind for end-of-year giving

1. Update on the Occupy movement and single payer


Photo by Thomas Good / NLN

If you’ve watched or participated in the Occupy Wall Street movement that’s been sweeping the nation, giving voice to the demand of “the 99 percent” to put human needs before corporate greed, you’ve probably noted the appearance of signs and chants such as “Health care is a human right,” “Get Wall Street out of our health care,” and “Medicare for All.”

PNHP members and other single-payer advocates have definitely been part of the mix.

You may have seen, for example, Drs. Kenneth Weinberg and Steven Auerbach of PNHP’s N.Y. Metro chapter talking about why physicians support OWS on “Countdown with Keith Olbermann” recently. (You’ll spot many other PNHP members in the 6-minute video footage too.)

The N.Y. Metro chapter played a central role in the formation of a “Health care for the 99 percent working group” within the OWS movement and helped spark an Oct. 26 “March against the insurance industry” that drew more than 1,000 people who protested outside the corporate offices of WellPoint and the for-profit WellCare Health Plans, and protested the closing of St. Vincent’s Hospital in Greenwich Village.


Photo by Thomas Good / NLN

The march drew national media attention. This gallery of photos shows the spectrum of the marchers’ demands, including a call for “Single payer now.” You’ll find more on the march and the chapter’s statement of why PNHP supports the OWS (among them: “We support OWS because economic and social inequalities make our patients sick”) at the N.Y. Metro chapter’s blog.

Many doctors, nurses and other health professionals have provided medical help to the occupiers in Manhattan’s Zuccotti Park, too.

And this is only New York City! Ongoing actions are taking place in more than 100 U.S. cities, according to OccupyTogether.org, not to mention actions under way around the world.


Photo by Thomas Good / NLN

As the OWS workshop at PNHP’s Annual Meeting revealed, our members are involved all across the country, in cities large and small. (By the way, there was a march and protest led by Dr. Margaret Flowers and the October2011.org Freedom Plaza occupiers outside the offices of America’s Health Insurance Plans, the trade group, in Washington, around the time of our Annual Meeting. Quite a few PNHP members marched and spoke there, calling for a single-payer health system. Many Annual Meeting attendees visited the Occupy DC site too.)

Some PNHP activists are giving teach-ins on single payer to the general assemblies. Others are providing other forms of support. If you’d like to become more involved but don’t know how to do so, drop us a note at admin@pnhp.org and we’ll be happy to help.

2. ‘Healthcare Reform 2.0’ by Woolhandler and Himmelstein

This week a new article titled “Healthcare Reform 2.0” by Drs. Steffie Woolhandler and David Himmelstein was published by Social Research, an international quarterly. Dr. Don McCanne, senior health policy fellow at PNHP, observes: “This brief primer (9 short pages plus references) on Healthcare Reform 2.0 will provide little new information for those who have followed the research and educational efforts of the leadership of PNHP. Nevertheless, it should be downloaded to be used as an advocacy piece to explain to others why Healthcare Reform 1.0 (Affordable Care Act) will remain a failure, and why we have to move on to Healthcare Reform 2.0 (expanded and improved Medicare for All). By distributing this, electronically or in hard copy, you can become a part of the popular movement to counter corporate power [echoing a theme in the article].” Download the article here.

3. PNHP’s Annual Meeting draws large crowd


Photos by Mark Almberg / PNHP

Nearly 300 people from 28 states and the District of Columbia packed the ballroom of the Kellogg Conference Hotel at Gallaudet University in Washington on Oct. 29 for PNHP’s Annual Meeting. It was one of our largest meetings ever, and the mood was decidedly upbeat and forward-looking.

The participants listened to PNHP leaders such as Drs. David Himmelstein and Steffie Woolhandler along with Canada’s Robert Evans, the U.K.’s Dr. Jacqueline Davis, authors Phillip Longman and Dr. David Ansell, and activists like Drs. Mardge Cohen, Claudia Fegan, Garrett Adams and Quentin Young. Several of the plenary presentations and workshop slideshows can be found here, and more will be forthcoming.

The workshops covered everything from state single-payer efforts to the Occupy movement to how to build a PNHP chapter, to mention just a few. Participants joined in roundtable discussions and informal exchanges in the hallways and, in the case of the 40 or so medical students who were in attendance, also danced to the music of “the Cornel West theory” late into the night.

You’ll find some photos of the Annual Meeting here.

4. Update on PNHP’s protest of IOM’s skimpy benefits model

More than 2,000 physicians, including some of the most distinguished figures in U.S. medicine, have signed a letter to the Institute of Medicine protesting the IOM’s recommendation that cost rather than medical need be the basis for defining the “essential benefits” that insurance policies must cover when the federal health reform law takes effect in 2014.

The protest letter and the names of its signers have been submitted to a journal for publication, and in due time the letter will be submitted to Secretary Kathleen Sebelius of the Department of Health and Human Services as part of the formal comment process on the IOM committee’s recommendations. If you’d like to sign the letter, it’s not too late to do so.

5. More rumblings from the Super Committee on cuts to Medicare, Medicaid and Social Security

Since our last message about the secret discussions of the congressional Super Committee, the 12-member bipartisan panel appointed by President Obama charged with finding at least $1.2 trillion in cuts to federal spending, word has leaked out that Democrats on the committee (and the Democratic leadership) may approve a “deficit deal” with Republicans that involves cuts to Social Security, Medicare and Medicaid benefits in exchange for small revenue increases.

This has resulted in a storm of opposition from a wide spectrum of groups, including the AFL-CIO and the National Organization for Women.

For several years now, PNHP, Healthcare-Now and other single-payer advocates have consistently opposed any proposals to weaken to our nation’s social insurance programs and have instead argued that to save lives and money we should adopt a single-payer health system.

Please continue to send that message to your elected representatives. The Super Committee is scheduled to make its recommendations by Nov. 23. The Congressional Switchboard phone number is (202) 224-3121.

6. Keep PNHP in mind for end-of-year giving

It’s not too early to begin thinking about making a tax-deductible donation to PNHP before the end of the calendar year. As you know, we receive no financial support from large foundations — not to mention the insurance industry and Big Pharma! We instead rely on our membership base to fund all of our organizing and educational activities.

Please give generously to PNHP’s work to advance the cause of single payer in the year ahead.

Cordially,

Garrett Adams, M.D., M.P.H.
President

Why are we here?

By Claudia Fegan, M.D.

[Note: The following remarks were delivered to the participants in this year’s PNHP Leadership Training Institute in Washington, D.C., on Oct. 28.]

Why are we here?

We are here because every patient deserves to be treated with dignity and respect.

I had a patient who worked as a laborer, not a high-paying job, but a job that allowed him to buy a home and support his family. I met him 10 years ago. I was challenged to control his blood pressure. It was very difficult. I tried numerous combinations of medications.

Over the course of 2-3 years he had frequent visits, allowing me to adjust his meds. We talked a lot. I got to know this man very well. He always came alone. He talked about his children, his wife, his disappointments, his accomplishments and life.

Eventually we got that blood pressure under control and we saw each other less frequently. Five years later he had a massive myocardial infarction, a heart attack. His wife brought him to County Hospital and we admitted him. He was a good candidate for bypass surgery, so he had the procedure, did well and went home weakened, but hopeful.

I remember he told how fortunate he felt because his brother, with poorly controlled diabetes, doesn’t live near County and is unable to get regular care.

Six months after his bypass surgery my patient had a massive gastrointestinal bleed and again his wife brought him to County where he eventually had to have a hemicolectomy. After that his wife brought him to all his appointments with all of his medications. It was clear he was having trouble with his memory and he needed help to manage his complicated regimen.

There were good times and bad, sometimes everything was working and sometimes not.

He developed claustrophobia and could not stand being sent to the Emergency Department at County where there was usually a 12-24 hour wait on a gurney before he got admitted to the floor. Sometimes he yelled and complained and his wife cried, sometimes the three of us had a good laugh about something silly. Life carried on.

Last month in the middle of the night he became short of breath and stopped breathing before the paramedics arrived. Although he was revived it was clear by the time he arrived at the hospital we had lost the man we all knew.

I had that conversation with his wife – that he would not want to be preserved on a ventilator this way indefinitely. She told me she believed that, but wanted to know how I knew.

I told her we had had that conversation early on in our relationship and, although he never returned the advance directives form, despite being given it numerous times, he was clear on his wishes. I don’t think he could read the form and he didn’t want to discuss it with his wife.

Once his brothers and sisters arrived from out of town, life support was discontinued and he died.

His wife called me a week later to thank me for all I had done. I told her it was my job.

Two weeks later his sister called to ask if I would be her doctor.

Why are we here? Because there is no patient in need who doesn’t deserve what my patient got: he was treated with dignity and respect.

Why are we here? This month Wal-Mart, the largest private employer in the United States, decided all future part-time workers who work less than 24 hours a week would no longer be eligible for insurance benefits; new workers who work 24-33 hours a week would no longer able to cover their spouses on their policies; employees with HMO coverage would now have a $5,000 deductible; and all employees would have to pay a larger share of their premium costs, causing more employees to opt out of accepting the company’s health insurance benefit.

We are here because access to health care should be a right and not a privilege based on your ability to pay for it.

Why are we here? We are here because this month the esteemed Institute of Medicine decided the “essential health benefits” under the new health law should be defined as a package that will fall under a pre-defined cost target instead of building a package of essential benefits based on appropriate data and then figuring out what that would cost.

We are here because someone has to say this is wrong.

Why are we here? We are here because a Consumer Reports analysis of National Committee for Quality Assurance rankings noted the five largest national insurers, Aetna, Cigna, Humana, Kaiser Permanente and United Healthcare, plus the mostly state-based Blue Cross Blue Shield plans, account for about 75 percent of the 390 ranked private plans, but only 36 percent of the top 50 in terms of quality.

United Healthcare is the nation’s largest health insurance company, but none of its private plans rank among the top 100, and most occupy the bottom half.

We are here because we know there is a better way to guarantee the public access to quality health care. A single-payer health care system would actually allow us to get a better handle on the quality of care delivered.

Why are we here? We are here because undocumented immigrants represent 1 in 7 of the uninsured. These undocumented immigrants will not be eligible for public insurance or any type of the private coverage obtained through the exchanges created under the Affordable Care Act.

If we had a real single-payer national health program, the financing of the system and the delivery of care would be separated from each other. Everyone would contribute funds to the system based on their ability to pay.

In such a system, everyone, including undocumented immigrants, would receive care. We are here because in a just society we would guarantee access to care to everyone, regardless of their ability to pay or their immigration status.

Archbishop Oscar Romero from El Salvador said, “Do not give in charity what is due in justice.” Archbishop Romero was assassinated one day after a sermon where he called on Salvadoran soldiers, as Christians to obey God’s higher order and to stop carrying out the government’s repression and violations of basic human rights.

I mention Archbishop Romero not because I am a religious person, but because he spoke to a responsibility of people in positions of authority.

As physicians we have a responsibility to those in need, particularly to our nation.

Why are we here? We are here because people are suffering, people are dying and we know the answer. We are here to arm ourselves with the information we need to heal our nation, to save our patients.

Why are we here? We are here because Dr. Quentin Young turned 88 years old this year. He has worked tirelessly in this effort his entire professional career. We owe it to Quentin to carry on this fight and to win it in his lifetime.

Although Quentin’s parents Abe and Sarah each lived to be 98, we should not assume we have 10 more years to win this fight. We know what needs to be done and we know how to frame the discussion.

It is so simple, we need a plan that takes everybody in and leaves nobody out. Come one say it with me, we will feel better for it:

Everybody in, Nobody out!
Everybody in, Nobody out!
Everybody in, Nobody out!

Now let’s go out and change this country for the better.

Claudia Fegan, M.D., F.A.C.P, C.H.C.Q.M., is interim chief medical officer at the Cook County Health and Hospitals System and past president of Physicians for a National Health Program. She is co-author of the book “Universal Health Care: What the United States Can Learn from Canada” and a contributor to another book, “10 Excellent Reasons for National Health Care.”

Reinhardt: Placing "All-Payer" in the reform dialogue

The Many Different Prices Paid To Providers And The Flawed Theory Of Cost Shifting: Is It Time For A More Rational All-Payer System?

By Uwe E. Reinhardt
Health Affairs, November 2011

Abstract

In developed nations that rely on multiple, competing health insurers — for example, Switzerland and Germany — the prices for health care services and products are subject to uniform price schedules that are either set by government or negotiated on a regional basis between associations of health insurers and associations of providers of health care. In the United States, some states — notably Maryland — have used such all-payer systems for hospitals only. Elsewhere in the United States, prices are negotiated between individual payers and providers. This situation has resulted in an opaque system in which payers with market power force weaker payers to cover disproportionate shares of providers’ fixed costs — a phenomenon sometimes termed cost shifting — or providers simply succeed in charging higher prices when they can. In this article I propose that this price-discriminatory system be replaced over time by an all-payer system as a means to better control costs and ensure equitable payment.

http://content.healthaffairs.org/content/30/11/2125.abstract

Comment: 

By Don McCanne, MD

This is an important contribution to the health policy literature. It is intended to be a seminal paper designed to displace the useless discussion of cost shifting between public programs and private insurers with a discussion of reducing price discrimination (charging individuals, private insurers or government programs different prices for the same services) by shifting to an all-payer system that would better control costs and ensure equitable payment.

An all-payer system simply establishes “uniform price schedules that are either set by government or negotiated on a regional basis between associations of health insurers and associations of providers of health care.”(1) Why is this important?

Although there is considerable variation in prices throughout the health care system, high prices, on average, have been a major contributor to our very high per capita spending on health care.(2) As Uwe Reinhardt explains, much of this excessive pricing has resulted from private insurers, with a weak market presence, negotiating with health care providers, especially hospitals, that dominate their respective markets. The health care provider consolidation that is taking place can only compound the impact of this market distortion.

Although private insurers also are consolidating, competing plans are still not in a position to extract major price concessions from dominant health care providers. All-payer price setting through government or association negotiation is designed to displace the ineffectual private insurers as price negotiators while establishing both better cost control and more equitable payments for health care.

(In some areas, private insurers have been able to hold prices down at Medicare rates for physicians where the physicians have a very weak negotiating clout. This is less true of hospitals that have a weaker clout.)

Price discrimination – charging different prices for the same services – hits especially hard those who have the weakest bargaining power: individual patients who are now bearing more of the costs of health care. Contrary to widely held ideological beliefs, here it is price discrimination in the private insurance market and not the government that has created the perversity of rationing based on the ability to pay.

In his article, Reinhardt explains, “It should be recognized that the higher the fraction of health care spending that individuals and families must bear out of their own resources, the more heavily the model relies on rationing health care by price and the patient’s ability to pay — that is, rationing by income level. It may surprise some readers that anyone would associate markets with rationing. But as economists tell their students, free markets represent just one of many styles of rationing. Relying on price and ability to pay is precisely how markets in general manage to ration scarce resources among unlimited ends.”(1)

One of the reasons that this article on all-payer systems is so important is that we are at a crossroads in the reform process. He writes, “At this time, the US health system appears to stand at a clearly delineated crossroads. On one road, Americans would seek better control over national health spending through an all-payer system, such as the one operated by Maryland for the hospital sector. On the other road, Americans would seek better control of health care prices and national health spending through greater reliance on market forces for most of the health system. Depending on how that road is traveled, it could entail more pronounced rationing of health care by income class, meaning less health care for those who cannot afford it. The battle over US health policy in the coming decades is likely to be over which road to take.”(1)

Since an all-payer system would correct only a portion of the flaws in our health care financing, why shouldn’t we go full bore and enact a single payer system? Reinhardt brings up the political feasibility argument, as follows, “In any event, an all-payer system with multiple private insurers would be likely to be more broadly politically feasible than a government-run single-payer system, such as Canada’s provincial, government-run single-payer insurance systems. A single-payer system, of course, would be another alternative that would eliminate price discrimination and any cost shifting.”

Reinhardt discusses the effectiveness of all-payer for hospitals in the state of Maryland. In a previous response to the Maryland all-payer system, I stated, “If we can succeed in reestablishing a public service role for government, then wouldn’t it be reasonable to simply enact an all-payer system for hospitals? The problem is that it only makes one change in our fragmented, dysfunctional system of financing care, and not a complete change at that. Under all-payer, only the rates are controlled, but each service still must be accounted for and paid for independently, and the hospitals would still have multiple public and private payers with which they would have to interact.”(3)

So what about Switzerland? Reinhardt mentions it as having successfully applied an all-payer system. In another previous message on the OECD/WHO report on Switzerland, I stated, “It is not clear why so many in the U.S. are enamored of the Swiss health insurance system when this OECD/WHO report confirms that it is highly inefficient and fragmented, with profound administrative waste, inequitably funded, with regressive financing and with wide variations in premiums, has the highest out-of-pocket costs, has an increasing prevalence of managed care intrusions, and is controlled by a private insurance industry that has learned how to game risk selection at significant cost to those on the losing end.”(4)

Uwe Reinhardt is to be highly commended for moving us in the right direction, but…

We’ve said it before and we’ll say it again. If political feasibility is the barrier to enacting a single payer system, let’s not simply jettison single payer; let’s change the political feasibility instead! All-payer might be a modest incremental improvement (modest when compared to what needs to be done), but why settle for that when we can have it all through an improved and expanded Medicare for all?

(1) http://content.healthaffairs.org/content/30/11/2125.full

(2) https://pnhp.org/docs/Its-The-Prices-Stupid.pdf

(3) https://pnhp.org/news/2011/september/hospitals-all-payer-or-global-budgets

(4) https://pnhp.org/news/2011/october/oecdwho-report-on-the-swiss-health-system

Healthcare Reform 2.0 – Woolhandler and Himmelstein

Healthcare Reform 2.0

By Steffie Woolhandler, MD, MPH and David Himmelstein, MD
CUNY School of Public Health, Social Research, Fall 2011

So while the American people want an expanded and improved Medicare for All — that is, a single-payer system — corporations dead-set against single-payer reform have come to dictate the agendas of both political parties. Hence, the only way to win national health insurance is to build a popular movement to counter corporate power.

http://www1.cuny.edu/mu/forum/2011/11/09/dr-steffie-woolhandler-and-dr-david-himmelstein-on-their-recent-publication-“healthcare-reform-2-0″-in-the-fall-2011-issue-of-social-research/

Healthcare Reform 2.0 (12 pages):
http://www1.cuny.edu/mu/sph/files/2011/11/783_Woolhandler-Himmelstein_719-730.pdf

Comment: 

By Don McCanne, MD

This brief primer (9 short pages plus references) on Healthcare Reform 2.0 will provide little new information for those who have followed the research and educational efforts of the leadership of Physicians for a National Health Program. Nevertheless, it should be downloaded to be used as an advocacy piece to explain to others why Healthcare Reform 1.0 (Affordable Care Act) will remain a failure, and why we have to move on to Healthcare Reform 2.0 (expanded and improved Medicare for All). By distributing this, electronically or in hard copy, you can become a part of the popular movement to counter corporate power.

Massachusetts struggles with cost control after reducing uninsured

National health reform may show similar results because it was based largely on the state's model, according to advocates of a single-payer system

By Doug Trapp
amednews.com, November 4, 2011

Health system reforms in Massachusetts may have reduced its uninsured population to the smallest of any state, but the effort has not controlled growth in health care costs — at least not yet.

Five years after Massachusetts launched its groundbreaking health reform initiative, health care costs continue to grow, emergency department visits have increased, and many more residents have high-deductible health plans, according to a critique released on Oct. 25 by Physicians for a National Health Program, an advocacy group with 18,000 members who support a single-payer health system.

These trends could become a national story under the health system reform law, which largely was based on Massachusetts’ reforms, Benjamin Day said. He is the report’s lead author and executive director of “Mass-Care: The Massachusetts Campaign for Single-Payer Health Care.” The state’s health insurance exchange offers health plans with income-based subsidies, while a Medicaid expansion covers virtually all residents earning up to 150% of the federal poverty level.

“Based on what we’ve seen in Massachusetts … it’s reasonable to expect a similar course for the Affordable Care Act: a significant initial expansion of insurance coverage and a moderate improvement in access to care,” Day said.

As few as 2% of Massachusetts residents are uninsured, according to state estimates, but ongoing physician shortages have been exacerbated by thousands more residents gaining health coverage, according to the report. The state still has some of the costliest insurance premiums and the highest per capita health spending in the country. Emergency department visits have increased 13% since 2006. In addition, 11% of residents have health coverage with deductibles of $1,000 or more compared with 3% in 2006, mirroring a national trend.

However, some health care cost increases have been held in check. For example, premium hikes for Massachusetts’ subsidized exchange coverage have been limited to about 3% annually, said Richard Powers, spokesman for the Massachusetts Health Connector, the independent agency that runs the insurance exchange.

Also, state leaders continue to work on legislation to enact global payments, a type of pay bundling that is expected to restrain cost growth further. A significant first step in this movement occurred on Oct. 5, when Partners HealthCare — a local network of hospitals, health centers and physicians — signed a risk-based global payment contract with Blue Cross Blue Shield of Massachusetts. The contract requires Partners to meet or exceed quality standards for its patients, keep cost growth lower than the insurer’s network average, and accept financial risk. The contract is expected to save the insurer $240 million over three years.

Meanwhile, Massachusetts residents have significant concerns about health care costs, according a poll published Oct. 21 by the Blue Cross Blue Shield of Massachusetts Foundation. For example, 78% of residents believe health care costs in the state are a major problem or a crisis. Residents were divided on the solutions, with one-third expecting government action to solve the problem, 27% expecting insurance companies to help control costs, and 17% saying hospitals and doctors could help.

The Physicians for a National Health Program report is available online (www.pnhp.org/news/2011/october/the-fundamental-flaws-
in-the-massachusetts-and-aca-model), as is the Blue Cross Blue Shield of Massachusetts Foundation poll about public perceptions of health care costs (bluecrossfoundation.org/).

http://www.ama-assn.org/amednews/2011/10/31/gvse1104.htm

Pension Trusts Strapped

By SHARON TERLEP And MATTHEW DOLAN
The Wall Street Journal, November 7, 2011

DETROIT—Retirement trust funds created to cover billions of dollars in medical costs for unionized workers and their families are running short, forcing the funds to cut costs, trim benefits, and ask retirees and companies to pony up more cash.

The biggest such fund—a trio of United Auto Worker trusts covering benefits for more than 820,000 people, including Detroit auto-maker retirees and their dependents—is underfunded by nearly $20 billion, according to trust documents filed with the U.S. Labor Department last month.

The funds, known as VEBAs, or voluntary employee beneficiary associations, are being hit by rising medical costs and poor investment performance. Their funding comes in part from company stock, rather than just cash payments, making them vulnerable to the market’s volatility.

Fearing a shortfall, the UAW is looking for answers in its U.S. government-orchestrated bailout deals with General Motors Corp. and Chrysler. The union, under new labor accords reached last month with GM, Ford Motor Co. and Chrysler, will seek to divert 10% of active workers’ profit-sharing checks into the VEBA funds, but the plan still needs to clear legal hurdles and could get blocked by the auto makers.

Improved investment returns could reduce the shortfall over time. And, if the union doesn’t win approval to transter funds, it has some leeway to make benefit cuts before the funds run short of cash because UAW retirees still get richer benefits than most retired workers,

Without some sort of intervention, the gap could grow quickly. This past summer, Joe Ashton, the UAW’s top official dealing with GM, said the VEBA performance was weighing on the union. “It’s definitely an issue,” he said.

The UAW also isn’t the only union being squeezed.

In Pittsburgh, the United Steel Workers union is laboring to provide benefits to tens of thousands of employees covered by more than 30 VEBAs. “No matter how good your investment performance is, you are not going to be able to keep up with health-care inflation,” says Tom Conway, vice president of the USW. “The trustees are having to take a serious look at increasing premiums, and the retiree contribution has to be bigger.”

Union-run VEBAs gained popularity in the last decade as a way to clear retiree-benefit obligations off companies’ books and shift the burden to independent trust funds. Often, they were last-ditch efforts by unions to salvage health-care benefits for their members amid major restructurings or bankruptcies. But now that the VEBAs are running low on cash, unions are the ones doing the slashing.

Two years ago, when the UAW VEBA cut its ties with auto makers and became an independent trust, it quickly trimmed some prescription benefits, including free Viagra, and boosted co-payments for retirees. Next year, it will increase deductibles and out-of-pocket payments by participants, according to a statement posted on its Web site this fall.

Vincent Forbes, a GM retiree from Lansing, Mich., says he has managed without the dental and vision benefits he lost in the shift to the VEBA. “It’s the reality of what people are dealing with today,” he says. “Other people have to pay for these kinds of benefits. I don’t mind paying a little bit more.”

VEBA benefits are considered generous by many standards and many other retirees have lost benefits as companies eliminated retiree health-care funding. Just 26% of large U.S. companies that provide health care extend those benefits to retirees, down from 37% a decade ago, according to the Kaiser Family Foundation.

The UAW first agreed to let the Detroit Three auto makers offload their obligation to fund health-care benefits for retirees in a 2007 labor agreement. By the end of that year, GM had spent $4.6 billion on health care for active and retired workers, more than it spent on steel.

Under the 2007 pact, the auto companies paid into the separate trust immediately and agreed to a series of future payments. Combined, the three auto makers committed $54 billion. Today, the trust is one of the largest private health-care providers in the nation.

Since then, the Detroit car companies have heralded the agreement as transformative because their health-care costs had made them uncompetitive with their nonunionized rivals.

In 2009, when GM and Chrysler fell into bankruptcy, the government-brokered restructuring allowed the auto makers to use more company stock to fulfill their obligation to contribute to the VEBA. (The trust cashed out its holdings in Ford in 2010.)

That year, it also became clear that the UAW would have to do something to shore up the VEBA. The fund was stretched because returns were falling short of assumptions and health-care costs were rising faster than expected, people involved in the restructuring say. The volatility increased after the UAW agreed to accept more payments from GM and Chrysler in stock. GM shares have dropped 28% since its IPO last year, further affecting the VEBA’s bottom line.

GM declined to comment.

“At that time, everybody understood the VEBA would probably not cover all of retirees’ health care benefits and that the UAW or trustees of the VEBA would have to made decisions about cutbacks,” said Steven Rattner, who headed the Obama administration’s bailout and restructuring of the U.S. auto industry. “It was going to their problem, not the companies’ problem.”

The UAW VEBA has indeed fallen short of the 9% annual return that was assumed at the fund’s creation to be enough to provide current benefits to retirees for 80 years, says UAW President Bob King . Health-care costs, meantime, have risen far more quickly than the 5% a year assumed by the union.

According to VEBA trust officials, the funds for all autos averaged a 9.7% rate of return in 2010. They decline to say how the funds have performed in 2011 but, in response to written questions, they say the fund has adopted a more conservative assumption of 7% going forward. At GM, the fund currently has total assets of $33.23 billion and total benefit obligations of $44.68 billion, resulting in an $11.4 billion, or 26%, shortfall.

In negotiations this year with GM, union bargainers sought help to cover itsVEBA costs, according to two people familiar with the discussions. GM quickly shot down the idea but the two sides reached a compromise.

The UAW, if it clears legal hurdles, will look to transfer 10% of the profit sharing GM pays current workers under the contract directly to the VEBA. Such a step is expected to increase funding by around $40 million a year. The original court settlements bar the company from making additional direct contributions, but they permit this transfer, according to lawyers who worked on the deal. GM, in negotiations, expressed “serious threshold accounting, tax, legal and other concerns,” according to UAW documents. If those concerns are addressed within a year, the union could begin diverting cash.

Mr. King, speaking to reporters, said he is “really confident” the transfer from profit sharing will clear regulatory hurdles.

http://online.wsj.com/article/SB10001424052970203707504577011901934288534.html

2011 Annual Meeting Materials

Find below a selection of slideshows and handouts from PNHP’s 2011 Annual Meeting. For highlights from the 2011 Annual Meeting, please click here.

The Case for Single Payer in the Obama Era Annual Meeting Main Session

Slideshow: PNHP Short Set and PNHP Long Set By Drs. David Himmelstein and Steffie Woolhandler

Faith, social justice, and organizing in the South Workshop
Highlights from Dr. Pippa Abston
Slideshow: Advocating for Single Payer in the South by Dr. Garrett Adams
Commentary: Building Support for National Health Insurance in the South by Dr. Garrett Adams

Building an effective chapter of PNHP Workshop
Slideshow: PNHP Chapter Organizing – “The Minnesota Experience” from Dr. Ann Settgast

Slideshow: Network from Drs. Mike Huntington and Marc Sapir
Workshop outline from Dr. Mike Huntington

Labor and the movement for single payer Workshop
Sample Resolution Endorsing HR 676 – Single Payer Universal Health Care
Labor Flyer: The way forward for labor on health care–national single payer legislation, HR 676

The state single payer movement Workshop
Slideshow: Act 48: Vermont’s New Health Care: How did we get here? What does it do? What needs to happen next? from Ellen Oxfeld, Ph.D.

Occupy Wall Street and October2011.org Workshop
Slideshow: OWS, Inequality & Why doctors and other health care workers support OWS from Dr. Steve Auerbach
Workshop notes, useful web links, and media tips from Dr. Steve Auerbach
Useful Articles Dr. Steve Auerbach

The fight to save Britian’s NHS Lunch
Speech by Dr. Jacqueline Davis, co-founder of Keep our NHS Public

Organizing by medical specialty Workshop
Slides from Drs. Robert Zarr and Deborah Leiderman, and Richard Bruno, medical student

Divestment: A new campaign for single payer Workshop
Slides from Dr. Rob Stone

Why are we here Leadership Dinner

Speech by Dr. Claudia Fegan

Can Occupy Wall Street Push Us To Single Payer?

By Joanne Boyer
OpEdNews, Nov. 7, 2011

In the mid 1990s, I worked with an individual in Minnesota who fought hard to enact legislation for universal health care. His passion and desire to see health care reform that included coverage for all was as heartfelt as any I’ve ever seen. In what seemed (at the time) like a never ending legislative battle to change a health care system failing its people, I heard him say that he was going to round-up every three-ring binder report that had been done on the need for health care reform in the last year and just dump them all on the legislators’ desks and claim, “We don’t need another report. We need health care for everyone.” For the first time since I heard that, I feel we may be reaching the point of no more reports and binders. Thanks to Occupy Wall Street, I believe real action for single payer may be within our grasp.

Recently, attention has been focused — and rightly so — on the Occupy Wall Street movement as it continues to shine light on the simple reminder that it was Wall Street who caused the 2008 financial collapse. But lurking not far behind is the natural extension in the discussion for “We are the 99 percent.” The cry heard today from the Wall Street patriots in the streets can easily turn from “people, not profits” to “patients, not profits.” There’s little doubt that the continuing debate on health care will take center stage AGAIN during the 2012 presidential campaign. The Affordable Health Care for America Act will be under assault by many for various reasons. Only this time, the Occupy Wall Street Movement may finally empower people to no longer settle for corporate controlled heath insurance solutions.

Perhaps no one draws the parallels between Occupy Wall Street and the need for an Occupy Health Insurers better than Wendell Potter. The former CIGNA executive-turned-whistleblower remains one of the most vigilant and articulate spokespersons to call the health insurance companies what they are: corporations who value profits over the health of the people of our nation. In a recent column Potter points out but one of the horrific practices of the health insurance companies: the selling of “junk” insurance coverage to millions of Americans in 2014. He concludes that article by saying:

“As I write this, the insurance industry and its corporate allies are lobbying the Obama administration to grant limited-benefit plans permanent waivers from that provision. If the White House caves in to their demands, millions of low-wage earners will be forced to buy junk coverage on January 1, 2014. That’s the date all of us will have to buy coverage from a private insurer if we’re not eligible for a public plan like Medicare or Medicaid. If you don’t want to be forced to buy junk, send the White House a message. Now.”

As Senator Bernie Sanders (I-Vt.) always reminds us, the United States remains the only industrialized nation in the world with a for-profit health care system. The need to push the Affordable Health Care Act to do more should remain a primary goal for all of us in 2012. No more three-ring binders”no more studies”no more lobbyists. We need to move to single payer. The Occupy Wall Street movement has unleashed the simple reminder for all of us: We the People have a tremendous amount of power to bring positive change to our financial and social institutions. With Super Committees looking to put Medicare and Medicaid on the cutting block, we simply cannot take our eyes off the real prize: single payer in the United States. To help maintain a focus on this issue, we offer samplings of recent articles or blogs that continue to keep the issue of single payer in the spotlight.

Dave Zweifel, editor emeritus of The Capital Times in Madison, Wisconsin, wrote that the solution to health care is simple: single payer. It’s such an obvious answer staring us all in the face that we have missed the forest through the trees.

This summer, Rochester, Minnesota, physician Mark Liebow, wrote a column for Physicians For A National Health Program urging Minnesota to follow Vermont’s lead and become the second state to pass single payer legislation. With DFL Governor Mark Dayton’s hands tied with a Republican-controlled state house and senate, the task remains a big one. But with the momentum gained from Occupy Wall Street, the old rules may no longer apply.

Health Care-Now is an excellent blog that provides information and resources on what you can do and where activities that promote single payer are planned. Bookmark this wonderful site and keep it handy when you need information on the “who, what, where, when, why and how” of health care reform.

No more reports, no more binders, no more studies. As Jim Wallis, founder of Sojourners Magazine said so eloquently back in 2009:

“So let us have the moral dialogue and debate. Let’s take the best of who we are, the greatest parts of our tradition and use that to lead the way. The misinformation, falsehoods and outright lies that many are now circulating obscure the moral and religious core of this debate: that millions of people are suffering in an inequitable and inefficient health care system, and that too many powerful people are profiting from that broken system in defiance of the common good.”

Occupy the health care for profit industry now in existence? Impossible you say?  After what we’ve witnessed the last few weeks, I’m no longer so sure.

Joanne Boyer is founder and editor of Wisdom Voices Press and www.WisdomVoices.com.

http://www.opednews.com/articles/Can-Occupy-Wall-Street-Pus-by-Joanne-Boyer-111107-498.html