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Election moves Vermont closer to single payer, plus new challenges

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Election moves Vermont closer to single payer, plus new challenges

November 18, 2010

Dear PNHP colleagues and friends,

Fresh from PNHP’s Annual Meeting in Denver, we have much to report! 

Surprisingly, the Nov. 2 election included some bright spots for single payer.  Vermont is now poised to be the first state to pass single payer (see below).  At the same time, advocates for an improved Medicare for All face new challenges, including from the Deficit Commission and the powerful interests opposing reform. 

Your help – by donating to support efforts in Vermont and elsewhere, opposing cuts to Medicare, and speaking out in support of single payer – is needed now more than ever.

1. PNHP hosts “spectacular” Annual Meeting in Denver

Amy Goodman

First, if you weren’t able to get to Denver, you missed a terrific program and exchange among 250 physicians, medical students, and activists from all over the country about the way forward for single payer. The mood was decidedly upbeat, particularly in view of developments in Vermont and elsewhere (see below).

As a small taste of what transpired last weekend, you can watch the remarks of Democracy Now’s Amy Goodman here. In addition, some photos of the participants can be viewed here.

An interview with PNHP’s incoming President Dr. Garrett Adams appeared in this month’s Louisville Medicine.

2. Vermont is closer to winning single payer

Former PNHP President Dr. Deb Richter reports that Peter Shumlin, a strong advocate for single-payer health reform, won his race for governor. Since the election he has reaffirmed his commitment to implementing a single-payer plan in Vermont and has already spoken to President Obama and Kathleen Sebelius, the head of Health and Human Services, about getting the required federal waivers.

Shumlin’s win, combined with (1) the support of other pro-single-payer lawmakers in the state, (2) an impending report to the state Legislature by Harvard health economist William Hsiao about the merits of three health reform models, one of which is single payer, and (3) the existence of a vibrant movement for single payer in the Green Mountain State, has laid the basis for a historic breakthrough there.

You can help by making a tax-deductible donation to PNHP and designating that it be used for organizing in Vermont. Dr. Richter’s goal is to raise $50,000 by December 1.  Help us meet or exceed that goal!

3. More single-payer election news

  • All but one of the 88 congressional sponsors of H.R. 676, Rep. John Conyers’ single-payer bill, were re-elected to office on Nov. 2, often by hefty margins.

  • Pro-single-payer gubernatorial candidates were also elected in California (Jerry Brown), where single payer legislation has twice passed the state’s legislature, and in Hawaii (Neil Abercrombie), where single-payer also enjoys substantial support.  Brown supported single payer in his 1992 primary race for the presidency against Bill Clinton.

  • In Massachusetts, in 14 of 14 legislative districts a ballot question for single payer in Massachusetts won a majority vote, including in some of the most conservative districts in the state and several that went for Republican Sen. Scott Brown last year. This follows a similar referendum in 2008 that swept 10 other districts.  Needless to say, coming from Massachusetts, the incubator of the new health law, this resounding vote of support for a single-payer Medicare-for-all program packs a wallop. So, too, does a new survey of the state’s physicians by the Massachusetts Medical Society. The MMS survey shows a plurality of the state’s doctors, 34 percent, favor a single-payer system, with only 14 percent supporting the Massachusetts plan as a model for reform.

  • PNHP National Coordinator Dr. Quentin Young’s latest Huffington Post article with a full election roundup is below.

4. Deficit Commission urges cuts to Medicare  

On Nov. 11, the co-chairs of the president’s National Commission on Fiscal Responsibility and Reform, businessman Erskine Bowles and former Sen. Alan Simpson, issued a draft document calling for an increase in the eligibility age for Social Security benefits to 69, cuts in Medicare payments to providers, an increase in cost-sharing by Medicare beneficiaries, and increased powers for the Independent Payment Advisory Board created under the new health law.  Since then another group of lawmakers has issued similar recommendations.

All of these measures (and more) move in a bad direction, as this assessment by Dr. Don McCanne and this testimony by Dr. Margaret Flowers point out.  PNHP hosted a Congressional briefing opposing the cuts featuring economist Tsung-Mei Cheng in late September.

5. Insurance industry whistleblower Wendell Potter speaks out

The former head of PR for Cigna, Wendell Potter, revealed new details about the insurance industry’s campaign to keep single payer “off the table” in the health reform debate, including their coordinated attack to discredit the film “Sicko” by Michael Moore.

Potter appeared on Democracy Now with Amy Goodman to discuss his new book, “Deadly Spin.”  A transcript of his interview is here.

On a lighter note, a tongue-in-cheek critique of the insurance industry by Dr. Carol Paris, “Private Insurance Induced Stress Disorder” or “PIISD,” appeared in Psychiatric Times.

6. What You Can Do

  • Donate – A victory for single payer in Vermont would reverberate nationwide. Help us raise funds for an educational and organizing campaign in Vermont.  Donors of $250 or more also renew their membership for 2011.  Donors of $100 or more receive a free copy of “Hijacked: The Road to Single Payer in the Aftermath of Stolen Health Care Reform” by former PNHP president Dr. John Geyman.

    If you can, please consider an end-of-year donation of $1,000 or more. You know more than anyone how important PNHP’s work is.  We’ll put your gift to immediate good use in Vermont and elsewhere where the needs and opportunities for single payer organizing are greatest. 

  • Stop the Deficit Commission – Call the Senate – PNHP activists are encouraged to ask their senators to vote against any attempt to privatize Social Security or Medicare, in whole or in part; any proposals to raise the eligibility ages for Social Security or Medicare; any recommendations for means-testing for these programs; and any proposal for benefit cuts for current and future beneficiaries.  The Capitol Switchboard number is 202-224-3121.

  • Speak out – Please join the growing number of physicians who have given talks or published op-eds in support of single payer, Medicare for All.  PNHP Congressional Fellow Dr. Margaret Flowers is giving several talks this week in Wisconsin (organized by chapter leaders and PNHP national organizer Ali Thebert); Flowers’ latest op-ed just appeared in the Charlotte (N.C.) Observer.

7. One more thought: if you missed this year’s meeting, just think of all the money you saved in airfare and other travel expenses. Then think about what you can contribute to PNHP’s next steps forward! 

Cordially,

Quentin Young Signature
Quentin Young, M.D.
National Coordinator

Ida Hellander Signature
Ida Hellander, M.D.
Executive Director

Mark Almberg Signature
Mark Almberg
Communications Director

They Said They Would Push Me “Off a Cliff”

By Michael Moore, Open Mike Blog
17 November 2010

Michael Moore

Yesterday, on the TV and radio show “Democracy Now” hosted by Amy Goodman, the former Vice President of CIGNA, one of the nation’s largest health insurance companies, revealed that CIGNA met with the other big health insurers to hatch a plan to “push” yours truly “off a cliff.”

The interview contains new revelations about just how frightened the health industry was that “Sicko” might ignite a public wave of support for “socialized medicine.” So the large health insurance companies came together over a common cause: Stop the American people from going to see “Sicko” – and the way to do that was to cause some form of harm to me (either personally, professionally or … physically?).

Take a look at this stunning section of the interview with Wendell Potter:

WENDELL POTTER [former executive, CIGNA]: … We were concerned that the movie [“Sicko”] would be as successful as “Fahrenheit 9/11” had been. And we knew that if it were, it really would change public opinion about our health care system in ways that would be harmful to the profits of health insurers. So, it was very important for this [attack] campaign to succeed. At one point during a strategy meeting, one of the people from [the insurance companies’ public relations firm] APCO said that if our efforts, our initial efforts, were not successful, then we’d have to move to an element of the campaign to push Michael Moore off a cliff. And not meaning to do that literally, but to –

AMY GOODMAN: Are you sure?

WENDELL POTTER: Well, I’m not sure. To tell you the truth, when I started doing what I’m doing [as a whistleblower], I was concerned about my own health and well-being, maybe just from paranoia. But these companies play to win. And we’re talking about some big bucks at stake here – billions and billions and billions of dollars.

AMY GOODMAN: So what were they talking about when they said, “If this doesn’t work, we’re going to push him off the cliff”?

WENDELL POTTER: Well, it would be just an incredibly intense PR effort, if necessary, to spend more premium dollars to defame Michael Moore, to discredit him even more as a filmmaker.

AMY GOODMAN: So, were you doing research on him?

WENDELL POTTER: Oh, yeah. Oh, yeah.

AMY GOODMAN: You were going – personally?

WENDELL POTTER: Well, I was a part of the effort. I didn’t – that was part of the reason for hiring APCO and to work with a trade association, is that it relieved me of the responsibility of doing that kind of work. You paid for it to be done by people who were experts in doing that kind of research.

AMY GOODMAN: But they were doing an investigation into him personally?

WENDELL POTTER: Well, absolutely. We knew as much about him probably as he knows about himself.

AMY GOODMAN: About his wife, about his kid, about –

WENDELL POTTER: Oh, yeah. You know, it’s important to know everything that you might be able to use in some kind of a campaign against someone, to discredit them professionally and often personally.

AMY GOODMAN: And did you use that?

WENDELL POTTER: You use it if necessary.

The interview goes on as Potter reveals how his front group was able to get its talking points and smears into stories in the New York Times and CNN. It is a chilling look inside how easy it is to manipulate our mainstream media – and just how worried the health insurance companies were that the American people might demand a true universal health care system.

In particular, Potter talks about how they may have succeeded in influencing CNN to run a factually untrue story about “Sicko” by its reporter, Sanjay Gupta (which led to my infamous encounter w
ith Wolf Blitzer and later, an apology from CNN for getting their facts wrong).

 Potter believes his work to defame “Sicko” succeeded, as the film didn’t end up posting “Fahrenheit 9/11” grosses. To be clear, “Sicko” went on to become the 3rd largest grossing documentary of all time at that point. And as the release of “Sicko” in June of 2007 was the first time since the defeat of Hillary Clinton’s healthcare bill in 1994 that the issue of health insurance was brought to the forefront of the national media, I believe it helped to reignite the issue during the 2008 election year by exposing millions of Americans to the truth about the health insurance industry. More than one person on Capitol Hill will admit that “Sicko” was a big help in rallying public support for the compromise bill that eventually passed earlier this year. But I agree, their smear campaign was effective and did create the dent they were hoping for – single payer and the public option never even made it into the real discussion on the floor of Congress.

(There was really only one reason “Sicko” didn’t sell as many tickets as “Fahrenheit” and that was because of a felony that was committed – a felony that I will discuss for the first time on this site in the coming weeks or months ahead. Stay tuned.)

Please read or watch the entire interview with Wendell Potter. It’s a fascinating peek behind the curtain of how corporate America really runs this country. And how if any of us get in their way, then those people must be stopped. It begs the question: Seeing how there’s more of us than there are of them, how long will we let their takeover of our democracy continue?

God Bless the Ruling Class,

Michael Moore

P.S. Over the next few days I will continue this examination of the Wendell Potter revelations on “Democracy Now” and in his new book. Please check in here on MichaelMoore.com.

Single Payer after the Midterm Elections

By Quentin Young, M.D.
The Huffington Post
November 17, 2010

While it’s clear from post-election surveys that having voted for “health care reform” was not a major cause of the Democrats’ defeats, the new health law didn’t help. What should have been a feather in the administration’s cap – i.e. a genuine reform that guaranteed truly universal, comprehensive care – instead became an albatross.

Many Democrats, sensing the electorate’s unease with the new health law’s mandates to buy private insurance, its lack of cost controls, and its limited reach – e.g. 23 million will remain uninsured in 2019 – found it difficult to defend. Some even boasted they voted against it.

In a fundamental sense, health care reform was botched by Congress. People wanted serious reform and didn’t get it. The big insurance and drug companies got their way, making a few concessions that they are already trying to wriggle out of.

As a result, what was adopted last March was so defective that ultra-conservatives were actually able use it against the president’s party.

Yet those who might interpret the election results as a repudiation of any health care reform should pause for a moment and consider these developments:

In Vermont, Peter Shumlin, an outspoken supporter of single-payer health reform who defeated four opponents (some of whom also supported single payer) in the primary, went on to win the governor’s race.

Shumlin reports that he has already spoken with President Obama and Health and Human Services Secretary Kathleen Sebelius about getting the necessary federal waivers to implement a single-payer system in the state of Vermont.

Besides Shumlin, four other political heavyweights in the state also support single payer: former governor Howard Dean, Senators Bernie Sanders and Patrick Leahy, and Rep. Peter Welch.

Dr. Deb Richter, a family physician in the Green Mountain State, says, “Peter Shumlin’s election shows Vermonters want a single-payer health care system. We’re going to get this done.”

In California, Jerry Brown won the governorship, defeating Meg Whitman, who spent $141 million of her own money in her failed campaign. In his 1992 presidential primary bid, Brown declared his support for single-payer health reform, and California activists hope he will sign a single-payer bill in 2011 when it comes to his desk. (The Legislature there has twice passed a single-payer bill, only to have it vetoed both times by Gov. Arnold Schwarzenegger.)

In Hawaii, former congressman Neil Abercrombie, a co-sponsor of Rep. John Conyers’ single-payer bill, H.R. 676, was also elected governor. He, too, takes office in a state where many lawmakers have signaled their openness to the single-payer alternative.

Significantly, in the House races, only one of 88 co-sponsors of H.R. 676, Rep. Phil Hare, D-Ill., was defeated in the general election by a Republican. Seven other co-sponsors were lost due to death, resignation, defeat in the primary or retirement. Just one of those went to a Republican, Tom Reed, who won Rep. Eric Massa’s old seat in New York.

The Congressional Progressive Caucus also did well, losing only three of its 69 members. In contrast, over half of the 54-member conservative Blue Dog Democrats went down to defeat.

In Massachusetts, voters in 14 of 14 legislative districts affirmed their support for single-payer health reform by turning in a majority of “Yes” votes (overall, around 2 to 1) for the following ballot question: “Shall the representative from this district be instructed to support legislation that would establish health care as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?”

Benjamin Day, executive director of MassCare, writes: “The ballots spanned 80 different cities and towns in a state of 351 municipalities, winning in every city and town reporting results so far [as of Nov. 3] except two. Five of the districts backing single-payer reform voted for Scott Brown in last year’s special Senate election, whi
ch was largely seen as a referendum on national health reform, showing that the goal of improved and expanded Medicare for All is supported by a diverse range of communities across the state.”

A similar referendum in 2008 swept 10 of 10 different legislative districts in Massachusetts, refuting the Republican boast that single-payer health care reform is unpopular.

Apparently, whenever people are given serious choices, single payer’s popularity is sustained, even in the face of scurrilous attacks from the right claiming it is “socialistic” or “un-American.”

There were also setbacks to the single-payer cause, too.

The defeat of Sen. Russ Feingold of Wisconsin was a very heavy loss. Just last February, Feingold had reaffirmed his longtime support for single payer. He should be sought out to help lead the movement for single payer in this new phase.

One of the most egregious results was the election of former hospital company executive Rick Scott to the governor’s mansion in Florida. In 1997, Scott was forced to resign his post as CEO of Columbia/HCA, a giant hospital chain, amid a scandal pointing to massive Medicare fraud and other improper billing practices. The company ultimately admitted to 14 felonies and agreed to pay the federal government over $1.7 billion in fines. Scott spent at least $73 million of his own money to get elected to Florida’s top office.

In Arizona and Oklahoma, ballot initiatives purporting to uphold “freedom of choice” in health care passed. Couched in anti-mandate language, these initiatives are in fact intended to keep patients prisoner of their insurance company networks and are really directed against enactment of single-payer systems.

So what to do going forward?

Aside from the very promising prospects for fundamental reform in Vermont, one of the immediate tasks of single-payer supporters is to block the proposals from the co-chairs of the Deficit Commission to reduce Social Security and Medicare benefits. The commission is set to make its recommendations to Congress by Dec. 1.

As my colleague Dr. Margaret Flowers has testified, the best way to safeguard Medicare is to improve its benefits and to expand it to cover everyone.

Otherwise the battle for fundamental health reform remains front and center, on both the state and national levels. The Medicare-for-all proposal is simple, clear, legitimate and compelling in its logic. The destructive role of private corporations in our health system is also plainly evident.

Just as women’s suffrage and civil rights laws were widely seen as unattainable – sometimes just a few years before they were enacted – single payer is an idea whose time has come. It is unstoppable.

http://www.huffingtonpost.com/dr-quentin-young/single-payer-after-the-mi_b_784961.html

New health law falls short

By Margaret Flowers
The Charlotte Observer
Thursday, Nov. 18, 2010

It’s been said that a society can be judged by how it treats its most vulnerable. If that’s the case, what can we say about today’s United States?

I recently toured several cities in North Carolina to speak about national health insurance. I had the pleasure of meeting with physicians, health advocates and citizens from all walks of life.

Many of the physicians I met are working in health centers that treat the uninsured. While such efforts are important and commendable, the doctors are saying that they are unable to meet the growing need.

The Census Bureau reports that the number of uninsured in the U.S. jumped 10 percent to 51 million people in 2009. In North Carolina, about 1.7 million – nearly 1 in 5 residents – lacked coverage last year. That’s 300,000 more than the year before. Much of the increase, of course, can be chalked up to job losses.

Lack of insurance fatal for many

We know that people who lack insurance suffer much more than their insured counterparts. They also more frequently die of preventable causes. A recent study in the American Journal of Public Health, for example, shows about 45,000 deaths annually can be linked to lack of health insurance. That’s about 120 preventable deaths a day.

And then there’s the problem of underinsurance – people having poor-quality insurance policies that require high co-pays, deductibles and other out-of-pocket expenses. These onerous “cost sharing” measures are obstacles to getting care. The gaps in such policies can easily lead to personal bankruptcy in the event of serious illness.

Sadly, the new federal health law falls short of the remedy we need.

Most of the provisions in the legislation do not take effect until 2014. Thus, for the foreseeable future, literally tens of millions of Americans will remain uninsured. In fact, the Congressional Budget Office estimates that about 23 million people will still lack coverage in 2019. That’s a deadly scenario.

I’m a pediatrician, so I was particularly interested in two provisions in the federal bill relating to children that kicked in last month. One measure allows children under 26 to remain on their parents’ policies. While beneficial, this provision will expand coverage to only about 20 percent of the young adults who need it.

Insurors screen out the sick

Another measure would prevent health insurers from denying new policies to children with pre-existing conditions. However, just before it went into effect, insurers like WellPoint, UnitedHealth Group, Aetna, Cigna and Humana announced that they would no longer offer new policies to individual children.

What can we conclude from these and similar episodes? As long as private insurers occupy a commanding role in our health system, we will never be able to achieve truly universal or affordable care. The insurers make money by enrolling the healthy, screening out the sick, denying claims and raising premiums. They do not put patients’ interests first; they do not provide care.

And yet the new health law keeps the big insurers – the main obstacle to care – at the heart of our system.

There is a better alternative: a national health insurance program that is publicly financed and privately delivered. This solution is commonly referred to as improved Medicare for all. It’s supported by about two-thirds of the population and a solid majority of physicians, according to national surveys.

Make it Medicare for all

Improved Medicare for all would be truly universal – every person living in the United States would be guaranteed high-quality care from birth to death. People would no longer worry about losing coverage if they changed jobs or became unemployed. Coverage would be comprehensive, including dental care, vision care, mental health services and prescriptions.

Patients would be able to go to any physician and any health facility of their choice, and decisions about treatment would be made by patients and their health professionals without inte
rference by insurance company administrators.

By replacing our inefficient, dysfunctional patchwork of private insurers with a streamlined, single payer of all medical bills, much like Medicare operates today, our nation would save about $400 billion annually in reduced administrative costs.

That’s enough to cover everyone, with no co-pays or deductibles. We’d also acquire very strong cost-control tools like the ability to negotiate fees and purchase medications in bulk.

I urge you to learn more about the improved-Medicare-for-all approach to health care. Let’s be the great society that we have the potential to be.

Margaret Flowers, M.D., lives in Baltimore and is congressional fellow for Physicians for a National Health Program ( www.pnhp.org). She is also a board member of Healthcare-Now ( www.healthcare-now.org).

http://www.charlotteobserver.com/2010/11/18/1845659/new-health-law-falls-short.html

New health law falls short

By Margaret Flowers
The Charlotte Observer
Thursday, Nov. 18, 2010

It’s been said that a society can be judged by how it treats its most vulnerable. If that’s the case, what can we say about today’s United States?

I recently toured several cities in North Carolina to speak about national health insurance. I had the pleasure of meeting with physicians, health advocates and citizens from all walks of life.

Many of the physicians I met are working in health centers that treat the uninsured. While such efforts are important and commendable, the doctors are saying that they are unable to meet the growing need.

The Census Bureau reports that the number of uninsured in the U.S. jumped 10 percent to 51 million people in 2009. In North Carolina, about 1.7 million – nearly 1 in 5 residents – lacked coverage last year. That’s 300,000 more than the year before. Much of the increase, of course, can be chalked up to job losses.

Lack of insurance fatal for many

We know that people who lack insurance suffer much more than their insured counterparts. They also more frequently die of preventable causes. A recent study in the American Journal of Public Health, for example, shows about 45,000 deaths annually can be linked to lack of health insurance. That’s about 120 preventable deaths a day.

And then there’s the problem of underinsurance – people having poor-quality insurance policies that require high co-pays, deductibles and other out-of-pocket expenses. These onerous “cost sharing” measures are obstacles to getting care. The gaps in such policies can easily lead to personal bankruptcy in the event of serious illness.

Sadly, the new federal health law falls short of the remedy we need.

Most of the provisions in the legislation do not take effect until 2014. Thus, for the foreseeable future, literally tens of millions of Americans will remain uninsured. In fact, the Congressional Budget Office estimates that about 23 million people will still lack coverage in 2019. That’s a deadly scenario.

I’m a pediatrician, so I was particularly interested in two provisions in the federal bill relating to children that kicked in last month. One measure allows children under 26 to remain on their parents’ policies. While beneficial, this provision will expand coverage to only about 20 percent of the young adults who need it.

Insurors screen out the sick

Another measure would prevent health insurers from denying new policies to children with pre-existing conditions. However, just before it went into effect, insurers like WellPoint, UnitedHealth Group, Aetna, Cigna and Humana announced that they would no longer offer new policies to individual children.

What can we conclude from these and similar episodes? As long as private insurers occupy a commanding role in our health system, we will never be able to achieve truly universal or affordable care. The insurers make money by enrolling the healthy, screening out the sick, denying claims and raising premiums. They do not put patients’ interests first; they do not provide care.

And yet the new health law keeps the big insurers – the main obstacle to care – at the heart of our system.

There is a better alternative: a national health insurance program that is publicly financed and privately delivered. This solution is commonly referred to as improved Medicare for all. It’s supported by about two-thirds of the population and a solid majority of physicians, according to national surveys.

Make it Medicare for all

Improved Medicare for all would be truly universal – every person living in the United States would be guaranteed high-quality care from birth to death. People would no longer worry about losing coverage if they changed jobs or became unemployed. Coverage would be comprehensive, including dental care, vision care, mental health services and prescriptions.

Patients would be able to go to any physician and any health facility of their choice, and decisions about treatment would be made by patients and their health professionals without interference by insurance company administrators.

By replacing our inefficient, dysfunctional patchwork of private insurers with a streamlined, single payer of all medical bills, much like Medicare operates today, our nation would save about $400 billion annually in reduced administrative costs.

That’s enough to cover everyone, with no co-pays or deductibles. We’d also acquire very strong cost-control tools like the ability to negotiate fees and purchase medications in bulk.

I urge you to learn more about the improved-Medicare-for-all approach to health care. Let’s be the great society that we have the potential to be.

Margaret Flowers, M.D., lives in Baltimore and is congressional fellow for Physicians for a National Health Program ( www.pnhp.org). She is also a board member of Healthcare-Now ( www.healthcare-now.org).

http://www.charlotteobserver.com/2010/11/18/1845659/new-health-law-falls-short.html

Jan Schakowsky and Rivlin/Domenici on the deficit

Schakowsky Alternative to Simpson-Bowles Deficit Reduction Plan

Congresswoman Jan Schakowsky
November 16, 2010

Today Rep. Jan Schakowsky (D-IL), a member of the bipartisan National Commission on Fiscal Responsibility and Reform, offered a comprehensive proposal to reduce the federal deficit without making middle class Americans foot the bill.  Schakowsky’s plan is an alternative to the Simpson-Bowles plan and would reduce the deficit by $427.75 billion in 2015, surpassing President Obama’s $250 billion target. Critically, the Schakowsky plan accomplishes deficit reduction without making cuts to essential federal expenditures that benefit the middle class.

http://schakowsky.house.gov/index.php?option=com_content&view=article&id=2777:schakowsky-alternative-to-simpson-bowles-deficit-reduction-plan&catid=21:2010-press-releases&Itemid=58

And…

Reviving the Economy, Cutting Spending and Debt, and Creating a Simple, Pro-Growth Tax System

By The Debt Reduction Task Force, Senator Pete Domenici and Dr. Alice Rivlin, Co-Chairs
Bipartisan Policy Center
November 2010

Strengthen Medicare for the Long Term: Transition to a Premium Support Option

Like today, Medicare enrollees will be in the traditional fee-for-service program unless they choose a private plan. However, if federal spending per enrollee for the benefits specified in legislation rises faster than GDP growth plus one percent, beneficiaries will have to pay an additional premium to cover the difference. They can avoid that additional premium, however, and potentially get higher quality health care, if they choose a private health plan offered on a new Medicare Exchange. The expectation is that increased competition among plans fostered by the Medicare Exchange, and increased beneficiary interest in these plans, will keep costs from rising rapidly and result in higher quality, more cost-effective health care.

This proposal will limit growth in federal support for Medicare per beneficiary to one percentage point per year higher than a five-year moving average of GDP growth. If Medicare spending per enrollee for the benefits specified in legislation rises at a faster rate, enrollees will have the option of paying an additional premium to cover the difference and remaining in the traditional Medicare program, or selecting a private insurance plan from the Medicare Exchange.

While the proposed premium support option resembles the current structure of Medicare Advantage, there are differences. Competition among plans will be enhanced by creating a federal Medicare Exchange, which will facilitate beneficiary choice and enrollment and increase the competitiveness of the market, leading to lower premiums.

This proposal will provide incentives for Medicare Exchange plans to develop products that will save beneficiaries money. Today, if a Medicare Advantage plan has very low costs, it cannot pay a rebate to enrollees; instead, it must increase benefits. Under this proposal, Medicare Exchange plans can offer beneficiaries relief from rising Medicare premiums. The Task Force plan might also increase political support – by Medicare beneficiaries, their children, and those approaching Medicare eligibility – for federal policies that promote cost containment in health care.

Asking beneficiaries to pay more for their Medicare coverage (or shift to a lower-cost plan) mirrors what has happened in private insurance over the past decade, with increases in patient cost-sharing to keep premium growth from exceeding income growth by too large a margin. Employers have generally opted to increase patient cost-sharing rather than increase the percentage of the premium that employees contribute. The former keeps employees enrolled in the plan and encourages more judicious use of health services.

http://bipartisanpolicy.org/system/assets/drupal/FINAL%20DRTF%20REPORT%2011.16.10.pdf

Comment: 

By Don McCanne, MD

The co-chairmen of President Obama’s deficit commission advanced a proposal that disappointed those of us who believe that the government has an important role in promoting a healthy and secure future for all of us. Erskine Bowles and Alan Simpson recommend reducing the deficit by cutting back on important social programs such as Medicare and Social Security, while failing to recommend tapping obvious potential revenue sources in our upside-down economy. Two members of their committee, Jan Schakowsky and Alice Rivlin, have now released alternative proposals.

Alice Rivlin is also co-chair, along with Pete Dominici, of The Debt Reduction Task Force from the Bipartisan Policy Center (BPC), an organization founded by Howard Baker, Tom Daschle, Bob Dole, and George Mitchell. Frankly, their report is also disappointing for basically the same reasons. It is very heavy on program reductions (though some are appropriate) and very light on seeking new revenues.

Discussed here is only one feature of the BPC recommendation: converting Medicare to a premium support program. This had been mentioned only cryptically in the Bowles/Simpson report, but more details are provided in the Rivlin/Domenici report (excepts above).

Premium support was a proposal advanced a dozen years ago by John Breaux, Bill Thomas, Bill Frist, and Bobby Jindal that barely failed to receive a super-majority vote in their Bipartisan Medicare Commission, and is now being trotted out again. It is a proposal to convert Medicare from a defined benefit to a defined contribution.

Premium support places a limit on the amount that the government contributes toward the Medicare beneficiaries’ premiums, exposing individuals to the increasing costs of health care. It then uses the leverage of higher individual premiums to encourage “voluntary” purchase of less expensive private plans in the marketplace.

Since private plans have much higher administrative costs, they can achieve lower premiums only by reducing benefits or increasing out-of-pocket costs for the beneficiaries, making coverage worse than under the traditional Medicare program. Instead of overpaying private plans as with the current Medicare Advantage program, the premium support underpays the private plans but allows them to obtain the balance from the Medicare beneficiaries. It is a plan to privatize Medicare that can have only disastrous consequences for Medicare beneficiaries.

In sharp contrast is the proposal of Jan Schakowsky. She would balance revenues and expenditures with the goal of reducing the deficit, as opposed to the unstated goals of Bowles/Simpson and Rivlin/Domenici to reduce government. Her recommended reductions in spending are carefully targeted to programs that many in America believe should be reduced anyway. Her proposed increased revenues not only would help wipe out the deficit, but they also would provide corrections to the current massive income transfer from middle-income workers to the very wealthy – one of the greatest social injustices in modern history.

Other than improving the way we would purchase pharmaceuticals, she has little to say about Medicare. Her position is that of protecting what we do have. We can go her one better on that. We can improve Medicare and then provide it for everyone. That frankly won’t reduce the deficit much, but it would provide us with much greater value for our health care taxes.

What more could we ask for out of our government than sustainable budgets that provide us with real value?

ACTION ALERT:  The heavy hitters are out in force, and they intend to dismantle as much of government as they can, in the name of “fiscally responsible hard choices.” It is imperative that President Obama and members of the Senate receive our clear and unrelenting message that we must both protect and improve our public programs dedicated to social justice. The House alone cannot take those away from us if we have the President and the Senate on our side.

Single Payer after the Midterm Elections

By Quentin Young, M.D.
The Huffington Post
November 17, 2010

While it’s clear from post-election surveys that having voted for “health care reform” was not a major cause of the Democrats’ defeats, the new health law didn’t help. What should have been a feather in the administration’s cap – i.e. a genuine reform that guaranteed truly universal, comprehensive care – instead became an albatross.

Many Democrats, sensing the electorate’s unease with the new health law’s mandates to buy private insurance, its lack of cost controls, and its limited reach – e.g. 23 million will remain uninsured in 2019 – found it difficult to defend. Some even boasted they voted against it.

In a fundamental sense, health care reform was botched by Congress. People wanted serious reform and didn’t get it. The big insurance and drug companies got their way, making a few concessions that they are already trying to wriggle out of.

As a result, what was adopted last March was so defective that ultra-conservatives were actually able use it against the president’s party.

Yet those who might interpret the election results as a repudiation of any health care reform should pause for a moment and consider these developments:

In Vermont, Peter Shumlin, an outspoken supporter of single-payer health reform who defeated four opponents (some of whom also supported single payer) in the primary, went on to win the governor’s race.

Shumlin reports that he has already spoken with President Obama and Health and Human Services Secretary Kathleen Sebelius about getting the necessary federal waivers to implement a single-payer system in the state of Vermont.

Besides Shumlin, four other political heavyweights in the state also support single payer: former governor Howard Dean, Senators Bernie Sanders and Patrick Leahy, and Rep. Peter Welch.

Dr. Deb Richter, a family physician in the Green Mountain State, says, “Peter Shumlin’s election shows Vermonters want a single-payer health care system. We’re going to get this done.”

In California, Jerry Brown won the governorship, defeating Meg Whitman, who spent $141 million of her own money in her failed campaign. In his 1992 presidential primary bid, Brown declared his support for single-payer health reform, and California activists hope he will sign a single-payer bill in 2011 when it comes to his desk. (The Legislature there has twice passed a single-payer bill, only to have it vetoed both times by Gov. Arnold Schwarzenegger.)

In Hawaii, former congressman Neil Abercrombie, a co-sponsor of Rep. John Conyers’ single-payer bill, H.R. 676, was also elected governor. He, too, takes office in a state where many lawmakers have signaled their openness to the single-payer alternative.

Significantly, in the House races, only one of 88 co-sponsors of H.R. 676, Rep. Phil Hare, D-Ill., was defeated in the general election by a Republican. Seven other co-sponsors were lost due to death, resignation, defeat in the primary or retirement. Just one of those went to a Republican, Tom Reed, who won Rep. Eric Massa’s old seat in New York.

The Congressional Progressive Caucus also did well, losing only three of its 69 members. In contrast, over half of the 54-member conservative Blue Dog Democrats went down to defeat.

In Massachusetts, voters in 14 of 14 legislative districts affirmed their support for single-payer health reform by turning in a majority of “Yes” votes (overall, around 2 to 1) for the following ballot question: “Shall the representative from this district be instructed to support legislation that would establish health care as a human right regardless of age, state of health or employment status, by creating a single payer health insurance system like Medicare that is comprehensive, cost effective, and publicly provided to all residents of Massachusetts?”

Benjamin Day, executive director of MassCare, writes: “The ballots spanned 80 different cities and towns in a state of 351 municipalities, winning in every city and town reporting results so far [as of Nov. 3] except two. Five of the districts backing single-payer reform voted for Scott Brown in last year’s special Senate election, which was largely seen as a referendum on national health reform, showing that the goal of improved and expanded Medicare for All is supported by a diverse range of communities across the state.”

A similar referendum in 2008 swept 10 of 10 different legislative districts in Massachusetts, refuting the Republican boast that single-payer health care reform is unpopular.

Apparently, whenever people are given serious choices, single payer’s popularity is sustained, even in the face of scurrilous attacks from the right claiming it is “socialistic” or “un-American.”

There were also setbacks to the single-payer cause, too.

The defeat of Sen. Russ Feingold of Wisconsin was a very heavy loss. Just last February, Feingold had reaffirmed his longtime support for single payer. He should be sought out to help lead the movement for single payer in this new phase.

One of the most egregious results was the election of former hospital company executive Rick Scott to the governor’s mansion in Florida. In 1997, Scott was forced to resign his post as CEO of Columbia/HCA, a giant hospital chain, amid a scandal pointing to massive Medicare fraud and other improper billing practices. The company ultimately admitted to 14 felonies and agreed to pay the federal government over $1.7 billion in fines. Scott spent at least $73 million of his own money to get elected to Florida’s top office.

In Arizona and Oklahoma, ballot initiatives purporting to uphold “freedom of choice” in health care passed. Couched in anti-mandate language, these initiatives are in fact intended to keep patients prisoner of their insurance company networks and are really directed against enactment of single-payer systems.

So what to do going forward?

Aside from the very promising prospects for fundamental reform in Vermont, one of the immediate tasks of single-payer supporters is to block the proposals from the co-chairs of the Deficit Commission to reduce Social Security and Medicare benefits. The commission is set to make its recommendations to Congress by Dec. 1.

As my colleague Dr. Margaret Flowers has testified, the best way to safeguard Medicare is to improve its benefits and to expand it to cover everyone.

Otherwise the battle for fundamental health reform remains front and center, on both the state and national levels. The Medicare-for-all proposal is simple, clear, legitimate and compelling in its logic. The destructive role of private corporations in our health system is also plainly evident.

Just as women’s suffrage and civil rights laws were widely seen as unattainable – sometimes just a few years before they were enacted – single payer is an idea whose time has come. It is unstoppable.

http://www.huffingtonpost.com/dr-quentin-young/single-payer-after-the-mi_b_784961.html

Healthcare For All Ohioans Would Promote Economic Prosperity

by Margaret Brinich
The Lakewood (Ohio) Observer, Nov. 16, 2010

Charles Shaughnessy interviewed April Stoltz on the Health Care For All Ohioans Act (HCFAOA)

Q. April, your picture was on the front page of the Huffington Post last week. What were you protesting so soon after the mid-term elections? Your sign read “Healthcare …” but it was cut off in the picture.

A. Actually, that was an AP image from a “Medicare for All” protest that occurred in Cleveland in October of 2009. The sign said “Healthcare is a Human Right”. The picture is old, but the debate continues. There are nineteen states with single payer healthcare initiatives at various stages. The non-profit organization SPAN Ohio is working to promote a Medicare-for-All style plan known as the Health Care for All Ohioans Act (HCFAOA). SPAN stands for Single-Payer Action Network.

Q. Most people have health insurance and they’re generally satisfied with it. Why rock the boat?

A. Premiums will continue to rise. More and more Ohioans will be priced out of the health care market. It’s not only a health care crisis, but a major contributor to the economic crisis. Lack of health insurance leads to lack of health care and a less-healthy working population. Ohio needs jobs. If Ohio had a comprehensive health care plan covering all citizens and the costs were known, prospective employers would be encouraged to start up new businesses or move businesses into Ohio. It’s in our economic self-interest.

Q. Is it possible to extend health care to everyone without raising the collective cost?

A. Absolutely. The premiums being paid today by individuals, employers, and taxpayers, and the co-pays being paid for medical service could pay for comparable coverage for all. The savings would come from a number of efficiencies. Administrative costs would decline significantly if there were one Medicare-type system in place of a number of private insurance carriers. There would be no need for multi-million dollar executive salaries. No shareholder dividends to pay out quarterly. No marketing budget. Equipment costs for million-dollar imaging machines would be reduced. Today there are too many MRI machines in some areas, sitting idle, while other parts of the state have a shortage. Emergency departments would no longer be a substitute for a doctor’s office. Ohio’s population of about 13 million would mean prescription prices could be negotiated downward significantly. As a local example, health insurance savings for the Lakewood School System would exceed $7 million annually with the passage of the Health Care for All Ohioans Act. Elimination of waste is not possible with the Federal plan, as insurance companies are left to their own devices with no caps on premiums.

Access to medical care for all, including preventive care programs, would lead to a healthier, more productive population. Aside from a better quality of life for all, employees could choose a job or profession based on true interest rather than availability of employer-provided health care coverage. It’s been shown for many years that European and Asian countries have enjoyed a higher level of medical care for less cost than in the United States. SPAN Ohio is showing the PBS special “Sick Around the World ” Thursday November 18th at 7:00 p.m. at the Shaker Heights Community Bldg. at 3450 Lee Rd. It’s free and parking is free.

Q. What about all the workers engaged in claims processing at doctor’s offices and insurance companies who would lose their jobs?

A. Fewer workers would be needed to process claims in a Medicare-type single-payer system, but extending coverage would increase the number of workers needed to run the state plan. Those who wouldn’t be needed would be protected by a provision of Ohio’s proposed plan. They would be paid their previous income, up to $60,000 annually, for up to two years, while training for new jobs or until they took other jobs.

Q. It seems that many people get upset over discussions of health care issues. Can you explain that?

A. I don’t know what others are thinking, but poling show 85% of the population is in favor of no pre-existing condition restrictions and in favor of extending coverage for children and young adults up to age 26. The biggest complaint about the Federal plan is that many provisions don’t take effect until 2014 and that it still leaves the insurance companies in the drivers seat raising costs and cutting coverage.

Q. You have said health care access has become especially important due to the current economic crisis. Please explain.

A. Ohioans know we must have attractive conditions to bring in new job opportunities and that includes having a healthier work force and known health care costs for employers. Ohio is a leader in agricultural production, manufacturing, exports to other countries, and the development and manufacture of climate-friendly sources of energy, yet we’re suffering in a few measures, notably high unemployment. Fiscal responsibility is not a partisan issue. The Healthcare for All Ohioans Act (HCFAOA) could make an impact on our state budget and would promote economic prosperity by creating an entrepreneur-friendly environment.

Q. What local entities support this effort?

A. Endorsers of the campaign sponsored by the Single-Payer Action Network Ohio (SPAN Ohio) to pass the Health Care For All Ohioans Act (HCFAOA) include health care professionals, unions, faith-based organizations, businesses, and government bodies throughout the state.  Local support comes from Ohio Senator Michael Skindell, Ohio State Reps. Nickie Antonio and Michael Foley, Cleveland City Council and Lakewood City Council.

April Stoltz retired early from the U.S. Post Office and has good health insurance coverage, but works for health care for all, as a “civilized and responsible” access solution. She volunteers for Single-Payer Action Network Ohio (SPAN Ohio).  www.spanohio.org

Charles Shaughnessy is a long-time resident of Lakewood, Ohio and currently serves as Treasurer of the Lakewood Democratic Club. www.lakewooddemocrats.com

http://lakewoodobserver.com/read/6/23/healthcare-for-all-ohioans-would-promote-economic-prosperity

Physician-Congressman Andy Harris wants his health care, but forget yours

GOP frosh: Where's my health care?

By Glenn Thrush
Politico
November 16, 2010

A conservative Maryland physician elected to Congress on an anti-Obamacare platform surprised fellow freshmen at a Monday orientation session by demanding to know why his government-subsidized health care plan takes a month to kick in.

Republican Andy Harris, an anesthesiologist who defeated freshman Democrat Frank Kratovil on Maryland’s Eastern Shore, reacted incredulously when informed that federal law mandated that his government-subsidized health care policy would take effect on Feb. 1 – 28 days after his Jan. 3rd swearing-in.

Harris, a Maryland state senator who works at Johns Hopkins in Baltimore and several hospitals on the Eastern Shore, also told the audience, “This is the only employer I’ve ever worked for where you don’t get coverage the first day you are employed,” his spokeswoman Anna Nix told Politico.

Harris said in an Oct. 30 statement, “In Washington, I will never vote to raise taxes, I will fight to repeal health-care reform, and I will work to balance the budget.”

http://www.politico.com/news/stories/1110/45181.html

Comment:

By Don McCanne, MD

Freshman Congressman Andy Harris, a physician, certainly understands the importance of health insurance. He is incensed that the government would make him wait until the month following the onset of his employment for his insurance benefits to begin, even though that is standard in both the public and private sectors. Actually he does not have to face a lapse in insurance coverage since another government program, COBRA, guarantees that he will be able to extend his previous insurance through the month of January.

But what about our citizens who are uninsured? The 30 million or so who would become insured under the Patient Protection and Affordable Care Act? He says he will “fight to repeal health care reform.” And we already know that the proposals that he and his Republican colleagues support instead would insure only about 3 million people.

He, a physician, demands his taxpayer-financed health care at the same time that he fought to become a government steward and will use that position to deny tens of millions of Americans their health care. A physician!

No. A real politically-empowered physician would use that power to see that financial barriers to health care would be removed for everyone.

Our medical school admissions committees need to set the bar higher. All applicants accepted should meet the standard of possessing common decency. Too bad Andy Harris snuck through.

Progressive Groups: Salem to See Single-Payer Health Care Bill in 2011

By James Pitkin
Willamette Week, November 15th, 2010

After President Obama and Democrats in Congess failed to even put universal single-payer health care on the table, progressive groups say they’ll bring a bill to the Oregon Legislature in 2011 that would establish that option in the state.

The announcement from Health Care for All-Oregon, Jobs with Justice, Physicians for a National Health Program and the Oregon League of Women Voters says state Rep. Michael Dembrow (D-Northeast Portland) will introduce the bill.

Dembrow has yet to return a phone call seeking comment. And the measure would be a tough sell in a a House evenly split and a Senate where Democrats have only a 16-14 advantage. But the groups that drafted the bill say it would provide comprehensive health benefits for every Oregon resident without co-payments or deductibles. Insurance companies would be forbidden from competing directly but could still provide benefits not covered under the plan.

Critics have blasted the national health-care bill because it lacks any meaningful cost controls and does not cover all Americans. But states have been encouraged by the feds to experiment with their own programs. And any state that passes single-payer health care has the potential to see a huge economic revival once businesses realize they’ll no longer be saddled with paying for employees’ spiraling health costs.

Read a draft of the proposed bill here.

http://blogs.wweek.com/news/2010/11/15/progressive-groups-salem-to-see-single-payer-bill-in-2011/

Drew Altman on hard choices for Medicare

Health Care Takes a Hit in New Commission Plan

By Drew Altman
The Fiscal Times
November 12, 2010

Three national commissions are hammering out recommendations for reducing the debt and reining in entitlement spending, putting two giant health programs that serve the elderly, disabled and low-income Americans, Medicaid and Medicare, as well as Social Security, in the crosshairs of a new policy debate.

The discussion of these issues is framed almost always in terms of “hard choices” to reduce spending, increase taxes, or both. In general, Democrats will resist cuts in these programs and Republicans will resist any new taxes.

But these choices are also hard on legitimate policy grounds, especially when it comes to Medicare.  And the most important reason they are hard is that so many seniors and disabled people on Medicare have low incomes and already pay a significant share of those incomes for their health care today.  It will be difficult if not impossible to ask the majority of beneficiaries ––to pay more or make do with less.  That has been the missing element in the entitlement/deficit reduction debate: Warren Buffet is not the typical Medicare beneficiary.  Instead the prototype is an older woman with multiple chronic illnesses living on an income of less than $25,000 who spends more than 15 percent of her income on health care.  It is the people on these programs and the realities of their lives that have been left out of the discussion.

http://www.thefiscaltimes.com/Issues/Health-Care/2010/11/12/Health-Care-Takes-a-Hit-in-New-Commission-Plan.aspx

Comment: 

By Don McCanne, MD

Medicare is already an inadequate program for our seniors and for individuals with long term disabilities. The commissioners are making an egregious mistake in framing the problem as a budget deficit that needs “hard choices” to reduce federal spending by shifting more costs to Medicare beneficiaries.

Medicare does need to be improved, not by cutting benefits, but rather by expanding benefits and by eliminating financial barriers to care. Then Medicare would be a much more suitable program, not only for current beneficiaries, but for everyone else as well.

It is true that the federal budget spending would increase, but the federal budget deficit would be reduced by financing Medicare through equitable taxes, and wasn’t this supposed to be all about reducing the federal budget deficit in the first place? Further, our entire national health expenditures, public and private, finally would be brought under control. As both patients and taxpayers, we couldn’t ask for a better deal.

Privatizing health care is risky for all of us

By Danielle Martin and Irfan Dhalla
The Globe and Mail, Toronto, Nov. 12, 2010

In poll after poll, Canadians reaffirm their commitment to a health-care system in which access is based on need rather than wealth. So it stands to reason that opening up medicare to a private second tier would be bad for people who have no choice but to rely on the public system. With a relatively fixed number of health-care providers, wait times in the public system would increase as staff were recruited to the private sector. From Australia to Zimbabwe, this scenario has unfolded repeatedly around the world.

But, deep down, some of us wonder: If I had the money to buy my way to the front of the line, wouldn’t I be better off in a two-tier system?

The answer, perhaps surprisingly, is probably not. Private health care would be almost as bad for the wealthy as for the poor, as long as the public system provides high-quality care (and most Canadians who use the system rate it highly).

The reason is, there’s such a thing as too much health care – too many tests, too many interventions and too many pills. The emergence of for-profit health care in Canada would produce just this situation – not enough health care for some, and too much health care for others.

This is exactly what happens in the United States, where people with private health insurance find themselves subjected to the risks of unwarranted procedures. The U.S., for example, has the highest rate of invasive cardiac procedures in the world – 45 per cent more than the next highest country. Yet, all these additional procedures have not bought Americans better heart health. Worse still, each invasive cardiac procedure carries a small but real risk of a serious complication – stroke, a torn coronary artery or even death.

Similarly, in a two-tier system, the wealthy would be bombarded with advice to get “checked out,” and many would end up receiving unwarranted screening tests such as CT scans, which produce enough radiation to increase the risk of cancer.

Even if there were a well-developed private health-care system in Canada, the wealthy would still need to use the public system for many forms of health care – trauma care, for example – because the private system would focus on elective and outpatient care. The erosion of political support for medicare probably would result in worse public care for everyone.

A two-tier system also would be bad for business. In a world where wealth buys faster access to more health care, corporations would be expected to pay for their employees to jump to the front of the line. Some Canadian businesses do this already, purchasing too much health care – executive physicals, for example – for their most-favoured employees. The cost of providing too much health care for a large proportion of the work force would be enormous.

Bank CEOs understand this already. Charles Baillie, the former CEO of TD Bank, said a few years ago: “I choose to talk about health care as a banker – as a corporate leader – because I believe it’s high time that we in the private sector went on record to make the case that Canada’s health-care system is an economic asset, not a burden, one that today, more than ever, our country dare not lose.”

Danielle Martin is a family physician at Women’s College Hospital in Toronto; Irfan Dhalla is a general internist at St. Michael’s Hospital. Both serve on the board of Canadian Doctors for Medicare.

http://www.theglobeandmail.com/news/national/time-to-lead/healthcare/privatizing-health-care-is-risky-for-all-of-us/article1795709/

I’m Over 100, and I’m Still Fighting for Health Care Reform

By Genie Ahders
The Faster Times, Nov 12, 2010

President Obama was wrong. The recent mid-term election proved that this is how the American people felt. He tried to compromise too much. That was obvious when it came to health care reform. I can still see him walking into a meeting on health care legislation with Big Pharm and insurance company executives, literally by his side, and with his back to single payer advocates. He turned his back on the American people. And the deal was done. It was all finished. But it can’t be finished for those of us who support the only method of health care reform that will be fair to everyone — the single payer system.

Every industrialized nation, with whom we compete in the world economy, has some form of universal health care. Are they all wrong? There is so much misinformation out there about the single payer option. Canada is often used as an example of the problems with a single payer, yet no one dies in Canada due to a lack of health insurance. But over a hundred a day die here from a lack of health insurance. In response to the myth about rationing of health care, Public Citizen points out that our health care is already rationed by private health insurance companies. By eliminating their administrative costs and profits we could be saving billions and billions of dollars.

Why can’t we have a system that takes profit out of the health care? Let us begin at the beginning. This is a concept I first wrote about years ago, insuring children from birth. Howard Dean instituted this type of program in Vermont with the understanding that not only do you raise healthier children but they are less of a burden on society later on. The children have improved eyesight and hearing, do better in school, are less likely to go to prison.

The ramifications are obvious to most of us. Our country is in dire straits and we need money. That money is already being given away to the very profitable health industries. I’m still hoping for the day, so vivid in my mind, that the president will consult will all the people on this issue and health care reform will be true reform.

http://thefastertimes.com/lifeafter100/2010/11/12/im-over-100-and-im-still-fighting-for-health-care-reform/

Kevin Drum explains the budget deficit

Is the Deficit Commission Serious?

By Kevin Drum
Mother Jones
November 10, 2010

So this report matters (the “chairman’s mark” of the deficit commission report), even though it’s really nothing more than the opinion of Alan Simpson and Erskine Bowles. So here’s what I think of it, all contained in one handy chart from the Congressional Budget Office:

(If the chart is not transmitted by this email, it can be accessed at the link below.)

Here’s what the chart means:

*  Discretionary spending (the light blue bottom chunk) isn’t a long-term deficit problem. It takes up about 10% of GDP forever. What’s more, pretending that it can be capped is just game playing: anything one Congress can do, another can undo. So if you want to recommend a few discretionary cuts, that’s fine. Beyond that, though, the discretionary budget should be left to Congress since it can be cut or expanded easily via the ordinary political process. That’s why it’s called “discretionary.”

*  Social Security (the dark blue middle chunk) isn’t a long-term deficit problem. It goes up very slightly between now and 2030 and then flattens out forever. If Republicans were willing to get serious and knock off their puerile anti-tax jihad, it could be fixed easily with a combination of tiny tax increases and tiny benefit cuts phased in over 20 years that the public would barely notice. It deserves about a week of deliberation.

*  Medicare, and healthcare in general, is a huge problem. It is, in fact, our only real long-term spending problem.

To put this more succinctly: any serious long-term deficit plan will spend about 1% of its time on the discretionary budget, 1% on Social Security, and 98% on healthcare. Any proposal that doesn’t maintain approximately that ratio shouldn’t be considered serious. The Simpson-Bowles plan, conversely, goes into loving detail about cuts to the discretionary budget and Social Security but turns suddenly vague and cramped when it gets to Medicare. That’s not serious.

There are other reasons the Simpson-Bowles plan isn’t serious. Capping revenue at 21% of GDP, for example. The plain fact is that over the next few decades Social Security will need a little more money and healthcare will need a lot more. That will be true even if we implement the greatest healthcare cost containment plan in the world. Pretending that we can nonetheless cap revenues at 2000 levels isn’t serious.

And their tax proposal? As part of a deficit reduction plan they want to cut taxes on the rich and make the federal tax system more regressive? That’s not serious either.

Bottom line: this document isn’t really aimed at deficit reduction. It’s aimed at keeping government small. There’s nothing wrong with that if you’re a conservative think tank and that’s what you’re dedicated to selling. But it should be called by its right name. This document is a paean to cutting the federal government, not cutting the federal deficit.

http://motherjones.com/kevin-drum/2010/11/deficit-commission-serious

Comment: 

By Don McCanne, MD

After reading Kevin Drum’s explanation of the federal deficit, it becomes even more obvious that all we have to do is improve Medicare, provide it for everyone, and then use its power as a monopsony serving the public good to bring the growth of health care costs to a manageable level. Compared to this, the other budget issues are a piece of cake. 

Repeal and Replace?

Not so fast. An insurance-company defector explains why the most controversial provision of the health-care law will survive.

By Wendell Potter
Newsweek, Nov. 5, 2010

Conservatives who voted for congressional candidates because they pledged to repeal and replace the health-care-reform law are in for a rude awakening. Once those newly elected members of Congress have a little talk with the insurance industry’s lobbyists and executives, they will back off from that pledge. They will go through the motions, of course. They’ll hold hearings and take to the floor of both Houses to rail against the new law, and they’ll probably even introduce a bill to repeal it with much fanfare — but it will all be for show. That’s because health insurers, one of Republican candidates’ biggest and most reliable benefactors — the industry contributed three times as much money to Republicans as to Democrats since January — can’t survive without it.

Despite all the attacks on “Obamacare,” the new law props up the employer-based system that insurers and large corporations benefit from so greatly. It also guarantees that private insurers will get billions of dollars in new revenue. And the insurers won’t have to share a penny of that windfall with a government-run public option the president once said was necessary “to keep insurers honest.”

I know what the insurers are thinking because, not long ago, I was on their side. I am sorry to admit it, but over nearly two decades I had a hand in planning the industry’s PR and public-policy strategies to either kill or shape any health-care reform proposal that might hinder profits. I was part of the strategic-communications team that planned and carried out the successful attack on the Clinton plan in the 1990s as well as the one that killed the patients’ bill of rights a few years later. I left my job handling communications for Cigna in 2008 because I didn’t have the stomach to be part of yet another spin campaign to cheat Americans out of the reform they needed.

For months before I left my job, I worked closely with my counterparts at the other big insurers to develop the list of must-haves our well-connected army of lobbyists would take to Capitol Hill when lawmakers began drafting reform legislation. Despite their public statements to the contrary, insurance companies really liked much of what was in both House and Senate versions of the bill — big chunks of which they actually wrote behind the scenes — especially the requirement that all Americans buy insurance if they’re not eligible for an existing public program like Medic-aid or Medicare.

During the reform debate, the industry’s deception-based PR strategy had two active fronts. One was a highly visible charm offensive designed to create an image of the industry as an advocate for reform and a good-faith partner with the president and lawmakers in achieving it. The second was a secret fearmongering campaign using shadowy “AstroTurf” groups and business and political allies as shills to disseminate misinformation and lies — like the one about the creation of “death panels” — with the sole intent of killing any reform that might hurt the bottom line.

Although I was ashamed of many of the things I did during my career, I didn’t plan to speak out about the industry’s devious practices until I saw Karen Ignagni, president of America’s Health Insurance Plans, tell President Obama at the end of his March 2009 White House Forum on Health Reform, “You have our commitment to play, to contribute, and to help pass health-care reform this year.” Then I knew the industry’s disingenuous charm offensive had begun. Soon after that I read that, Aetna chairman and CEO Ron Williams, the driving force behind the industry’s effort to get the individual mandate enacted, had met with the president half a dozen times. I knew Williams was trying to persuade the president to drop his insistence on the public option and to embrace the individual mandate. Sure enough, Williams got his wish.

It is ironic, of course, that the requirement to purchase insurance has become the centerpiece of Republicans’ condemnation of the new law and their court challenge of its constitutionality. Insurers have no reason to worry, however, because they fare very well when the Republicans are in charge. Their profits soared — as did the number of Americans who are uninsured and underinsured — during the Bush years and Republican control of Congress.

The real reason insurers want the GOP leading Congress again is not to repeal “Obamacare,” but to try to gut some of the provisions of the law that protect consumers from the abuses of the industry, such as refusing to cover kids with preexisting conditions, canceling policyholders’ coverage when they get sick, and setting annual and lifetime limits on how much they’ll pay for medical care. Insurers also hate the provision that requires them to spend at least 80 percent of premium revenues on medical care, as well as the one that calls for eliminating the billions of dollars that the government has been overpaying them for years to participate in private Medicare plans. (Be on the lookout for a death panel-like fearmongering campaign to scare people into thinking, erroneously, that Granny and Pawpaw will lose their government health care if Congress doesn’t restore those “cuts” to Medicare.)

Insurers are not waiting for all their new members of Congress to be sworn in to get what they want. They and their big-business allies are already pressuring the Obama administration to waive or delay the implementation of provisions they don’t like, all the while working behind the scenes not only to protect the individual mandate but to have the government enforce it with much greater gusto. The one thing the industry didn’t like about the mandate provision was that the penalties for not buying their overpriced products won’t inflict nearly enough financial pain.

Retiring Sen. Judd Gregg (R-N.H.), who once had been a part of the repeal-and-replace brigade, provoked the wrath of conservative pundits shortly before the midterm elections when he said, in a moment of unguarded candor, that repealing the law was not realistic. Instead, he said, the GOP should focus on “retooling” it. You can be certain that insurance-industry lobbyists will be helping their newly expanded congressional caucus determine what needs retooling. As my former Cigna colleague Bill Hoagland, the company’s top lobbyist, told the Associated Press a few days ago: “If you ended up repealing [the individual mandate], the whole thing blows up. It doesn’t work. The cost would explode.” In other words, feel free to repeal those pesky consumer protections, but keep your hands off our mandate.

Potter is a senior analyst at The Center for Public Integrity. This piece is based on his book “Deadly Spin,” published this week by Bloomsbury Press.

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