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President Obama’s Concession Proposal

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President Obama’s Concession Proposal

From Ben Day, Executive Director, Mass-Care
Mon, 22 Feb 2010

Dear Single Payer Supporters – At 10AM today, the White House released the outlines of President Obama’s health reform proposal “incorporating and improving on ideas from the House and the Senate, along with some new ones,” in anticipation of a summit this Thursday with Congressional Republicans.

Many supporters of comprehensive health reform had hoped that the President and the Democratic leadership would turn to the “reconciliation process” – a way of passing certain types of provisions through the budget that does not allow filibusters on the Senate – to pass a more robust health reform bill than the sad beast that had emerged in the Senate even prior to the election of Senator Scott Brown in January. The Senate bill offered virtually no cost relief for households, taxpayers, and businesses facing spiraling health costs, and attempted to pay for subsidized care for low-income people through a tax on workers’ benefits. Polls following the January 25 election show clearly that Massachusetts voters strongly oppose this approach to health reform, particularly in a state facing the highest premiums in the nation, but that – perhaps not intuitively – they felt that Congress was not going far enough on health reform, not that they were going too far.

The President’s proposal, which you can read more about at whitehouse.gov, unfortunately does not address these concerns, and by and large adopts the Senate bill’s approach to health reform. Here are the details as far as we can tell at this early date:

  • The President’s proposal drops the public option, making no mention it.
  • The proposal adopts the Senate’s approach to financing, relying on an ‘excise tax’ on workers benefits instead of taxing high-income taxpayers, as the House bill did. It delays implementation of the excise tax until 2018 and lifts the premium threshold slightly, but like the Senate bill it links the tax to general inflation – not medical inflation – virtually guaranteeing that a larger and larger percentage of workers’ benefits will face steep taxes, and will likely have their co-pays and deductibles hiked to avoid the tax threshold.
  • The proposal follows the Senate in not imposing an employer pay-or-play tax, which would require businesses to cover their employees or face a fine.
  • The proposal is closer to the Senate in imposing a fine on individuals who do not purchase health insurance of $695 per year OR a percentage of their income, whichever is higher.
  • The proposal does follow the House in closing the Medicare ‘donut hole’ for seniors, but not fully until 2020, when the hole would be covered at 25% coinsurance.
  • The proposal sticks with both House and Senate proposals to outlaw ‘recissions’ (insurance companies retroactively canceling coverage of sick patients), extending dependent coverage, and starting in 2014 disallowing exclusion based on pre-existing conditions, as well as lifetime or annual caps on benefits.
  • The proposal includes a concept new to national health reform of establishing a ‘Health Insurance Rate Authority,’ which would provide oversight of insurance plans’ proposed premium increases, and potentially have the power to block premium hikes if they were considered unfair. This is clearly an attempt to replace the public option with something else that promises to control costs. There are states that currently and in the past have implemented what’s called ‘prior approval’ for premium increases in the individual and small group markets (people or small businesses buying insurance on their own) – there is very little evidence about whether this is effective. It has the potential to prevent price gouging by insurers if it’s implemented aggressively, which would be a good thing, but not much promise of controlling the underlying drivers of health care costs, which is that we waste too much money on overhead, overuse certain goods and procedures, and that the cost of individual procedures is much higher than it should be.
  • There is no mention in the initial documentation put out by the White House of where the President’s plan stands on some key “wedge issues” such as women’s access to reproductive health services, or how immigrants – both documented and undocumented – would be affected.

All in all, we are disappointed that the fundamental problems with the Senate reform bill – that there is little promise of effective cost control, and it pays for reform on the backs of working people – are being replicated in the President’s proposal. This seems likely to lead to further voter backlash and alienation from workers and workers’ organizations.

Mass-Care will continue fighting for fundamental reform that addresses the root causes of the health care crisis we all face, and we are looking forward in particular to advancing the Campaign for Health Care Justice in the coming year. We will keep you informed as we learn more about national health reform efforts.

http://www.masscare.org/

President Obama's Concession Proposal

From Ben Day, Executive Director, Mass-Care
Mon, 22 Feb 2010

Dear Single Payer Supporters – At 10AM today, the White House released the outlines of President Obama’s health reform proposal “incorporating and improving on ideas from the House and the Senate, along with some new ones,” in anticipation of a summit this Thursday with Congressional Republicans.

Many supporters of comprehensive health reform had hoped that the President and the Democratic leadership would turn to the “reconciliation process” – a way of passing certain types of provisions through the budget that does not allow filibusters on the Senate – to pass a more robust health reform bill than the sad beast that had emerged in the Senate even prior to the election of Senator Scott Brown in January. The Senate bill offered virtually no cost relief for households, taxpayers, and businesses facing spiraling health costs, and attempted to pay for subsidized care for low-income people through a tax on workers’ benefits. Polls following the January 25 election show clearly that Massachusetts voters strongly oppose this approach to health reform, particularly in a state facing the highest premiums in the nation, but that – perhaps not intuitively – they felt that Congress was not going far enough on health reform, not that they were going too far.

The President’s proposal, which you can read more about at whitehouse.gov, unfortunately does not address these concerns, and by and large adopts the Senate bill’s approach to health reform. Here are the details as far as we can tell at this early date:

  • The President’s proposal drops the public option, making no mention it.
  • The proposal adopts the Senate’s approach to financing, relying on an ‘excise tax’ on workers benefits instead of taxing high-income taxpayers, as the House bill did. It delays implementation of the excise tax until 2018 and lifts the premium threshold slightly, but like the Senate bill it links the tax to general inflation – not medical inflation – virtually guaranteeing that a larger and larger percentage of workers’ benefits will face steep taxes, and will likely have their co-pays and deductibles hiked to avoid the tax threshold.
  • The proposal follows the Senate in not imposing an employer pay-or-play tax, which would require businesses to cover their employees or face a fine.
  • The proposal is closer to the Senate in imposing a fine on individuals who do not purchase health insurance of $695 per year OR a percentage of their income, whichever is higher.
  • The proposal does follow the House in closing the Medicare ‘donut hole’ for seniors, but not fully until 2020, when the hole would be covered at 25% coinsurance.
  • The proposal sticks with both House and Senate proposals to outlaw ‘recissions’ (insurance companies retroactively canceling coverage of sick patients), extending dependent coverage, and starting in 2014 disallowing exclusion based on pre-existing conditions, as well as lifetime or annual caps on benefits.
  • The proposal includes a concept new to national health reform of establishing a ‘Health Insurance Rate Authority,’ which would provide oversight of insurance plans’ proposed premium increases, and potentially have the power to block premium hikes if they were considered unfair. This is clearly an attempt to replace the public option with something else that promises to control costs. There are states that currently and in the past have implemented what’s called ‘prior approval’ for premium increases in the individual and small group markets (people or small businesses buying insurance on their own) – there is very little evidence about whether this is effective. It has the potential to prevent price gouging by insurers if it’s implemented aggressively, which would be a good thing, but not much promise of controlling the underlying drivers of health care costs, which is that we waste too much money on overhead, overuse certain goods and procedures, and that the cost of individual procedures is much higher than it should be.
  • There is no mention in the initial documentation put out by the White House of where the President’s plan stands on some key “wedge issues” such as women’s access to reproductive health services, or how immigrants – both documented and undocumented – would be affected.

All in all, we are disappointed that the fundamental problems with the Senate reform bill – that there is little promise of effective cost control, and it pays for reform on the backs of working people – are being replicated in the President’s proposal. This seems likely to lead to further voter backlash and alienation from workers and workers’ organizations.

Mass-Care will continue fighting for fundamental reform that addresses the root causes of the health care crisis we all face, and we are looking forward in particular to advancing the Campaign for Health Care Justice in the coming year. We will keep you informed as we learn more about national health reform efforts.

http://www.masscare.org/

Doctors group: Obama plan leaves millions uninsured, boosts private insurers

FOR IMMEDIATE RELEASE    
Feb. 24, 2010

Contact:
Steffie Woolhandler, M.D., M.P.H.
Margaret Flowers, M.D.
Quentin Young, M.D., (312) 782-6006
Mark Almberg, PNHP, (312) 782-6006

President Obama’s health care proposal, preserving as it does a central role for the for-profit, private health insurance industry, is incapable of achieving the kind of universal, comprehensive and affordable reform the country needs, a spokesman for a national doctors’ group said Wednesday.

“Regrettably, the president’s proposal is built on some of the worst aspects of the Senate bill,” said Dr. Quentin Young, national coordinator of Physicians for a National Health Program, an organization of 17,000 doctors who support a single-payer, Medicare-for-All approach to reform. Young’s statement comes on the eve of the president’s bipartisan summit in Washington.

“For example, the president’s proposal would ship hundreds of billions of taxpayer dollars to the private health insurance industry in the form of subsidies,” Young said. “And to help finance this, it would impose a new tax on health benefits of workers, especially those in high-cost states.

“Its individual mandate would force millions of middle-income uninsured Americans to buy insurers’ skimpy products – insurance policies full of gaps like ever-rising co-pays, deductibles and premiums. Such policies already leave middle-class American families vulnerable to economic hardship and medical bankruptcy in the event of a serious illness like cancer,” continued Young, citing a recent study.

“Even so, at least 23 million people would remain uninsured,” he said. “We know that being uninsured raises your chance of dying by about 40 percent,” he continued, citing another recent study. “That translates into about 23,000 unnecessary deaths each year. As physicians, we find this completely unacceptable.”

“In short,” Young said, “this proposal is an insurance company bonanza, not good, evidence-based health reform. The president would do better by abandoning the insurance and drug companies and instead taking up the single-payer approach.” His group has estimated that such an approach could save hundreds of billions of dollars annually by simplifying health administration.

“By building on and improving the already popular Medicare program, we could put our patients’ interests first,” he said. “Were President Obama to do so, he would meet with strong public support, including from the medical community.”

Although the physicians’ group requested an invitation to Thursday’s summit at Blair House, no reply from the White House has been forthcoming, Young said. Similarly, requests from Reps. Dennis Kucinich of Ohio, Anthony Weiner of New York and Peter Welch of Vermont that single-payer advocates be included in the meeting have apparently gone unanswered.

Outside the Blair House on Thursday, a grassroots “Sidewalk Summit for Medicare for All” will underscore popular support for the measure.

*******

Physicians for a National Health Program (www.pnhp.org) has a number of national spokespersons who can talk about President Obama’s health reform proposal, along with local spokespersons in virtually every state. To arrange for an interview, call (312) 782-6006 or (312) 622-0996, or write info@pnhp.org.

Where's the Single-Payer Advocate?

By Michael McAuliff
New York Daily News
February 23, 2010

Reps. Anthony Weiner and Peter Welch are reprising a question that proved thorny for President Obama’s last health care summit: Where’s the single-payer advocate?

Weiner and Welch — single-payer advocates who are not invited, yet — argue in a letter to the President today that someone from the single-payer side should be at the Blair House summit on Thursday.

“Dear Mr. President,” they write. “During the State of the Union address, you stated, ‘But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.’

“We’d like to take you up on the offer.”

Their idea is pretty easy to understand: Medicare for all.

The letter is after the jump.

Dear Mr. President:

During the State of the Union address, you stated, “But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.”

We’d like to take you up on the offer. The best way to advance these goals is to expand what we know already works. We and many Americans propose Medicare for All. We would urge you to make sure that someone is invited to the summit that supports this position.

Building on Medicare, which has a 1% overhead rate, would reduce costs by eliminating insurance company profits and cut administrative costs which currently consume 31%, nearly double that of other nations. A universal Medicare for All system would provide Americans with complete autonomy in choosing their health care provider without regard to provider networks or referrals from primary care doctors. Patients would no longer be responsible for premiums, deductibles or co-payments. Government safety net programs, such as Medicaid and SCHIP, as well as the State and local government portions for these programs, would no longer be needed.

Furthermore, a Medicare for All system would be easily understandable by the American public. Medicare has been an enormous success for seniors and there is no reason, we believe, to not expand Medicare coverage to all Americans.

Thank you in advance for your consideration.

Read more: http://www.nydailynews.com/blogs/dc/2010/02/wheres-the-single-payer-advoca.html#ixzz0gSzOv63O

Where’s the Single-Payer Advocate?

By Michael McAuliff
New York Daily News
February 23, 2010

Reps. Anthony Weiner and Peter Welch are reprising a question that proved thorny for President Obama’s last health care summit: Where’s the single-payer advocate?

Weiner and Welch — single-payer advocates who are not invited, yet — argue in a letter to the President today that someone from the single-payer side should be at the Blair House summit on Thursday.

“Dear Mr. President,” they write. “During the State of the Union address, you stated, ‘But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.’

“We’d like to take you up on the offer.”

Their idea is pretty easy to understand: Medicare for all.

The letter is after the jump.

Dear Mr. President:

During the State of the Union address, you stated, “But if anyone from either party has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.”

We’d like to take you up on the offer. The best way to advance these goals is to expand what we know already works. We and many Americans propose Medicare for All. We would urge you to make sure that someone is invited to the summit that supports this position.

Building on Medicare, which has a 1% overhead rate, would reduce costs by eliminating insurance company profits and cut administrative costs which currently consume 31%, nearly double that of other nations. A universal Medicare for All system would provide Americans with complete autonomy in choosing their health care provider without regard to provider networks or referrals from primary care doctors. Patients would no longer be responsible for premiums, deductibles or co-payments. Government safety net programs, such as Medicaid and SCHIP, as well as the State and local government portions for these programs, would no longer be needed.

Furthermore, a Medicare for All system would be easily understandable by the American public. Medicare has been an enormous success for seniors and there is no reason, we believe, to not expand Medicare coverage to all Americans.

Thank you in advance for your consideration.

Read more: http://www.nydailynews.com/blogs/dc/2010/02/wheres-the-single-payer-advoca.html#ixzz0gSzOv63O

The Rise & Fall of the American Medical Empire

A Trench Doctor’s View of the Past, Present, and Future of the U.S. Healthcare Systems

by Robert A. Linden, MD, FACP

“Rise and Fall” is written specifically for American citizens and discusses four of the most pressing problems with U.S. healthcare today: healthcare insurance, the disappearing primary care physician, pharmaceutical industry infiltration into the practice and science of medicine, and medical malpractice litigation. Dilemmas along with solutions with the pros and cons for each are reviewed through the eyes of an independent thinking, office/hospital, board-certified internist/geriatrician with hands-on experience and without a personal agenda. Despite this, the single-payer system for healthcare financing and the health court for malpractice reconciliation are both championed.

Purcahse “Rise & Fall” on Amazon.

The Rise & Fall of the American Medical Empire

A Trench Doctor's View of the Past, Present, and Future of the U.S. Healthcare Systems

by Robert A. Linden, MD, FACP

“Rise and Fall” is written specifically for American citizens and discusses four of the most pressing problems with U.S. healthcare today: healthcare insurance, the disappearing primary care physician, pharmaceutical industry infiltration into the practice and science of medicine, and medical malpractice litigation. Dilemmas along with solutions with the pros and cons for each are reviewed through the eyes of an independent thinking, office/hospital, board-certified internist/geriatrician with hands-on experience and without a personal agenda. Despite this, the single-payer system for healthcare financing and the health court for malpractice reconciliation are both championed.

Purcahse “Rise & Fall” on Amazon.

Towers Watson survey on employer-sponsored wellness programs

Purchasing Value in Health Care

Selected Findings From the 15th Annual National Business Group on Health/Towers Watson Survey Report — 2010

Towers Watson
February, 2010

The prolonged economic downturn is putting additional pressure on companies to change their health care programs to help relieve financial strain. The results of this year’s survey also show employers are frustrated by employees’ poor health habits and are struggling to effectively motivate behavior change. Additionally, they are uncertain about the future of employer-sponsored benefits, especially in light of the potential for health care reform legislation. Against this backdrop, employers are doing more to hold the line on costs and achieve better health and productivity outcomes.

Key Findings

* Annual median health care cost increases rose slightly in 2009 to 7%, compared with 6% in 2008. This pace is still more than twice the rate of inflation.

* Fifty-seven percent of respondents are very confident that employers will continue to offer health care benefits 10 years from now. This figure is down from 2009, when 62% of employers expressed a high level of confidence.

* Employers report that lack of employee engagement is the biggest obstacle to changing health behaviors. Still, they are trying new ways to encourage employees to become healthier and buy health care services more efficiently.

* There is considerable room for improvement in vendor programs designed to change member health habits and encourage efficient use of health care services. Employers rate these programs as ineffective.

* Today, 54% of companies have a consumer-driven health plan (CDHP) in place – a 6% increase over last year’s findings – and is expected to increase to 61% in 2011.

http://www.towerswatson.com/assets/pdf/1258/WT-2010-15571.pdf

Comment:

By Don McCanne, MD

Everyone agrees that it is better to practice good health habits. So who could object to employers providing incentives for their employees to improve their health behaviors?

During the national health reform dialogue, opponents of comprehensive reform frequently attempt to reframe the problem as a lack of individual responsibility for personal health. If people would eat better, exercise, and not smoke, many of the reform proposals would not be necessary.

This concept has now been co-opted by many of the nation’s large employers as they introduce wellness programs into their companies. What has been their experience?

According to this Towers Watson survey (a consolidation of Towers Perrin and Watson Wyatt), “employers are frustrated by employees’ poor health habits.” Employers report that “lack of employee engagement is the biggest obstacle to changing health behaviors.” Regarding their vendor programs that are designed to change employees’ health habits, “employers rate these programs as ineffective.”

Though they rate their wellness programs as ineffective, the sister programs that actually have slowed the growth in employer costs have been the consumer-driven health plans (CHDPs). A majority of large employers have now introduced CHDPs. Although the supporters of CHDPs use the rhetoric of placing the consumer in charge, these plans are nothing more than very high deductible plans which shift more of the responsibility of paying for health care from the employer to the employee.

During the period of employment, most injuries and illnesses for which the employee would require care would not be prevented by the wellness interventions. Employers who shift costs to employees who are unfortunate enough to need health care are being dishonest when they claim that they are doing this to enhance wellness.

During the reform dialogue, we cannot allow the opponents to reframe the debate as the need for wellness programs to address employees’ lack of engagement in correcting poor health habits, while these opponents in truth are supporting passing more costs onto the infirm.

Keep the framing on target. We need to remove financial barriers to care so that absolutely everyone can have the health care that they need. Properly designed wellness programs are fine, but we cannot let them distract us in our efforts to enact a single payer national health program – an improved Medicare for everyone.

Don’t It Make Your Wide Eyes Cry, Iowa? Another Cancer Patient Grovels

by Donna Smith
CommonDreams.org
Tuesday, February 23, 2010

Some patient stories just fill me with anger and shame.  This one — from Iowa — is one of those stories.  By now, we all know the plot.  Patient has insurance.  Patient gets sick.  Patient cannot afford to keep insurance or find insurance that will cover illness.  Patient goes without coverage.  Providers demand up-front payment for cancer care.  Patient calls on friends, family and community to help.  Patient grovels.  Cancer spreads.  Patient grovels.

Ah, the mid-western values.  This is Iowa.  My mom was born in Boone during the Great Depression.  Iowa is the place many think of when we think of those salt-of-the-earth, kind and hard-working Americans with traditional, perhaps even faith-based values.  A kind and gentle place with a no-nonsense work-ethic.  Iowa.  Fields of farmers’ dreams and the stuff of mid-America at its finest.

So, why in Iowa should we allow Deb, a cancer patient who is currently receiving chemotherapy, to beg and grovel for her care?

Is her life less valuable than her two Senators’ lives? Come on, Senators Harkin and Grassley. Fess up.  Is your constituent’s life less worthy of protection and care than your own?  And what about you, President Obama?  Didn’t the Iowans who braved the cold and ice of the primary day way back in 2008 help catapult you to the presidency?  Deb’s vote sure as hell mattered then.  What happened?  When did Deb’s life become so expendable?

Do any of the leaders know what it feels like to face a cancer fight and have to come up with $2,000 up front every single month or be denied chemotherapy?  Do they care enough to actually create a US healthcare system that would stop this horror from unfolding in Iowa?

Come on now, boys.  And girls.  This is clearly not rocket science.  Other civilized countries have not abused their cancer patient like this for many years.  We clearly could stop this through a proven and effective and enhanced Medicare for all.  No more begging, groveling Iowa patients.  No more providers booting patients like Deb to the curb to die.  Just healthcare for all.

It’s the ethical, moral, economical and sensible way to go — so why are we stuck trying to have a bipartisan measure to keep the for-profit insurance companies, the pharmaceuticals and the big hospital corporations happy?  I’ll tell you why.  Because Deb isn’t invited to the summit.  She’s back in Iowa raising money for her next round of chemo.  Shame on us all.

Donna Smith is a community organizer for National Nurses United (the new national arm of the California Nurses Association) and National Co-Chair for the Progressive Democrats of America Healthcare Not Warfare campaign.

http://www.commondreams.org/view/2010/02/23-0

Grassroots Activists Hold ‘Sidewalk Health Summit,’ Call for Medicare for All

From the National Single Payer Alliance

For Immediate Release

Contact:  
Katie Robbins
Donna Smith
Dr. Margaret Flowers

The 20-million member strong grassroots alliance, the Leadership Conference for Guaranteed Health Care, supporting improved Medicare for all will hold its own summit on health reform outside the White House on Thursday, February 25.  While politicians inside Blair House will be attempting to reach some bipartisan agreement to pass legislation that aims to make marginal improvement in health insurance markets,  activists outside the formal venue will be answering President Obama’s call from his State of the Union address:

“But if anyone…has a better approach that will bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare for seniors, and stop insurance company abuses, let me know.”

There is a better answer. The people’s summit will feature diverse speakers representing doctors, nurses, patients, labor, faith-based groups, and community political advocacy groups who continue to press the President and Congress to act responsibly and ethically to address the nation’s healthcare crisis by extending an improved Medicare for all model.

When:  9 – 10 a.m., Thursday, February 25; participants gather at 9 a.m. and summit begins at 9:30 a.m.

Where: NE Corner of Lafayette Park (H St and Vermont), Washington, D.C.

In other communities across the nation, other Medicare for all advocates will gather in solidarity summits and actions, including San Francisco, Cedar Falls, IA, Louisville, KY, New York City, Georgia and Colorado (a complete listing is available at http://www.healthcare-now.org/sidewalk/)

This action is not in support of the current reform bills – House, Senate or the plan offered up for consideration during the President’s Blair House summit.  LCGHC members do not support the current legislation with or without a public option – robust or not.

Of note: Tea Party activists have signaled that they may also send a contingent to Washington to agitate for the status quo. This action is not in support of the status quo.  LCGHC members support improving and expanding the successful Medicare program to all Americans, including  the 46 million Americans who currently lack coverage and tens of millions more who are under-insured and at risk of bankruptcy in the event of illness.

How much does President Obama expect us to pay for health care?

The President's Proposal

The White House
February 22, 2010

Policies to Improve Affordability and Accountability

Example for a family of four with income of $66,000:

Maximum percent of income paid for premiums: 9.5%

Percent of costs paid by health insurance plan: 70%

Penalty for remaining uninsured: (in 2016) the higher of $695 (with indexed increases) or 2.5% of income

Hardship exemption – threshold income below which the penalty is waived: The income tax filing threshold ($9,350 for a single or $18,700 for a married couple in 2009)

http://www.whitehouse.gov/health-care-meeting/proposal

Comment: 

By Don McCanne, MD

The greatest significance of President Obama’s health care reform proposal released today is that he has now formally placed his stamp of approval on the fundamental policies already contained in the House and Senate reform bills. While remaining silent on some of the third rail issues (public option, Medicare buy-in, pregnancy termination, etc.), he and his staff merely tweaked the bills and added insurance premium rate review, whatever that’s worth, and some rhetoric on waste, fraud, and abuse.

His proposal still falls far short on two of the most important goals of reform: 1) insuring everyone, and 2) ensuring that health care is affordable for each of us. Merely tweaking the Senate version, which is what they did, could not have attained these goals since the most effective policies were already traded away before serious negotiations began.

That said, let’s look at what the President expects a family of four with an income of $66,000 to pay for health care. The premium contribution would be 9.5% of income, or $6270 for the basic plan with an actuarial value of 70%. If they wanted or needed a better plan, they would have to pay the full difference in the premium. At an actuarial value of 70%, they would also have to pay an average of 30% of all health care costs. This can vary considerably because of plan design in the form of deductibles, copayments, coinsurance, non-covered benefits, stop loss, out-of-network care exempt from stop loss, and other factors. If they either elected not to or were unable to pay the premium, they would have to pay a penalty of $1650, but then, of course, they would have no protection at all against potential health care costs.

Clearly, President Obama has not done any better than Congress in protecting families from financial hardship should they have the misfortune of developing significant medical problems. Unaffordable underinsurance is not the change that we needed.

Put Single Payer Back on the Table

By Dr. Quentin Young
The Huffington Post
February 22, 2010

One year after its much-ballyhooed launch, the Obama administration’s approach to health reform is now in serious disarray.

The president’s health care summit on Feb. 25 is being portrayed as a last ditch bid to find some common ground with his “just say no” Republican opposition. He also faces an increasingly wary group of disgruntled Democrats, whose memory of the Massachusetts massacre — the election of a Republican to Sen. Edward Kennedy’s seat — remains fresh.

The summit proceedings, which will be televised in the name of “transparency,” will no doubt be laden with a formidable amount of stagecraft. They will be preceded by the unveiling of the president’s own legislative proposal — presumably the odious Senate bill with some tweaks — a few days before.

But it’s almost certain that this latest White House initiative, undertaken with the stated goal of salvaging and passing at least some elements of the stalled congressional bills, is foredoomed.

The House bill, contrary to many who believe otherwise, is disastrous. And if such a thing is possible, its Senate counterpart is even worse. Both would shovel hundreds of billions of taxpayer dollars into the coffers of the private health insurance industry. Both would make it a federal offense, with fines, for a person to fail to buy the insurers’ shoddy products.

Even so, at least 23 million people would remain uninsured under the new law. And those who have insurance would remain vulnerable to extort premium increases, not unlike Anthem Blue Cross’ recently announced premium hikes of up to 39 percent in California.

While one could imagine the enactment of certain piecemeal measures that might ameliorate our condition — e.g., a simple prohibition of insurance company denials of coverage because of pre-existing conditions — these are precisely the stand-alone measures most stubbornly opposed by Republicans, conservative Democrats and their corporate patrons. Such concessions, in their eyes, must be linked to shoring up the very culprits who are most responsible for our health care mess.

The presence of the for-profit health industry — the private health insurance conglomerate and the Big Pharma drug companies in the first place — in the legislative process has certainly been “transparent” from the get go. Through their lobbyists and campaign contributions, they shaped a bill that would enhance their domination of our health system. They are at the root of the catastrophe that passes for health care financing in the United States today.

Of course, the conspicuous omission in the debate has been single-payer national health insurance proposal, an improved Medicare for All. This was assured on the Senate side when the powerful chairman of its Finance Committee, Max Baucus, D-Mont., informed the world that everything was on the table but single payer.

How the chairman of a congressional committee, however powerful, can set the terms of debate in a democratic society by excluding such a popular and well-substantiated solution is hard to rationalize. Baucus did, of course, prevail, and what came out of the Senate was execrable. Like the House bill, it fails the three tests of genuine reform: universal coverage, quality improvement and cost control.

One can reasonably suspect that President Obama now wants something — anything — to pass in Congress as evidence of the fulfillment of his campaign pledge to accomplish health care reform. But if he looks to the House and Senate bills as the starting point, his efforts will be in vain.

It’s not too late for the president to re-embrace his earlier support for single-payer national health insurance and set the nation on the right path. Were he to lay out the facts to the American people and provide energetic leadership for this eminently rational proposal, he would get strong, grassroots support from the public.

We’re now spending $8,000 per capita annually on health care, $2.5 trillion in total. That’s nearly one-fifth of our GDP. Yet our health outcomes rank among the lowest in the industrialized world. Some 45,000 people die each year chiefly because they have no health insurance, and medical bills and illness are now linked to nearly two-thirds of personal bankruptcies. This reality in the richest country in the world is unnecessary and intolerable.

I suggest the president look to an improved and expanded Medicare program as the solution. Medicare, which was enacted in 1965 and which has served our elderly and the totally disabled so well, is a solid foundation to build upon.

Enactment of an improved Medicare for All would save our nation $400 billion annually by eliminating the bureaucracy and paperwork inflicted on our system by the private insurers. That’s more than enough to provide universal, comprehensive care to everyone and to eliminate all co-pays and deductibles. A single-payer system would also allow us to rein in costs and better allocate resources.

We have a talented health care workforce. But to fully unlock their potential, we need to get out from under the greedy dictates of the health industry.

Mr. President, it’s time to put single payer back on the table.

http://www.huffingtonpost.com/dr-quentin-young/put-single-payer-back-on_b_471811.html