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Labor Campaign for Single-Payer's Letter to President Obama

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Labor Campaign for Single-Payer's Letter to President Obama

February 3, 2010

Dear President Obama,

The lives and livelihoods of a vast majority of Americans have been held hostage for decades by this country’s failure to provide an equitable, socially just health care system. Your Administration should be commended for identifying the need and pushing for a comprehensive solution to this uniquely American dilemma. But this year’s rancorous, special interest driven Congressional debate is now stalemated over differing House and Senate passed Bills, which do not meet the test of either equity or justice.

As grassroots representatives of millions of this country’s union members and in the interest of all working people, we respectfully submit that taking the single-payer solution off the table was both a strategic and tactical mistake. Medicare is an example of a successful single payer model and it is a very popular health care program. A “Medicare-for-All” system would be far more cost effective than any of the proposed current reforms based on the continuation of for-profit, market-based insurance. And it is a program that Americans are already familiar with–a solution right at our fingertips.

The rising cost of health care is one of the biggest issues in the collective bargaining process. Many working families have given up wage increases and are being asked to cover more of their health care costs. Others are losing their health care benefits altogether because more employers are dropping individual and family coverage. This is a crisis and a moral issue. People currently covered by private health insurance are understandably apprehensive when it is suggested that their only alternative to degrading that coverage is not to be covered at all–as is the current situation for approximately 50 million of our fellow citizens today.

Our current jobs crisis is further aggravated since the cost of health care in the U. S. is almost double that in other industrial countries, making our export sector increasingly uncompetitive and a major cause of the off-shoring of jobs.

At this past year’s AFL-CIO Convention in Pittsburgh, on the very day that you, Mr. President, addressed the Convention and were so warmly received, the delegates unanimously adopted a detailed resolution in support of a Single-Payer, “Medicare for All” system in America.

We welcome your call for a better approach that will “bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare and stop insurance company abuses.” We submit to you that a “Medicare-for-All” health care system accomplishes all of these worthy goals, contrary to the untruths that have been advanced by opponents of true health care reform.

The American people deserve better. We want our leaders to solve the health care crisis and to do so in a transparent way. No one in this country should have to fear losing their health care coverage or face bankruptcy. This is simply unacceptable for the United States of America. The time for single payer health care is now. We urge you to use this impasse as the time to put single payer health care on the table and into the health care reform discussions as the real solution.
Millions of working people and an overwhelming majority of unionists voted their confidence in your call for “change we can believe in.”

Respectfully Submitted,

The Labor Campaign for Single-Payer Health Care Steering Committee & Advisory Board

cc: Nancy Pelosi
Harry Reid

Labor Campaign for Single-Payer’s Letter to President Obama

February 3, 2010

Dear President Obama,

The lives and livelihoods of a vast majority of Americans have been held hostage for decades by this country’s failure to provide an equitable, socially just health care system. Your Administration should be commended for identifying the need and pushing for a comprehensive solution to this uniquely American dilemma. But this year’s rancorous, special interest driven Congressional debate is now stalemated over differing House and Senate passed Bills, which do not meet the test of either equity or justice.

As grassroots representatives of millions of this country’s union members and in the interest of all working people, we respectfully submit that taking the single-payer solution off the table was both a strategic and tactical mistake. Medicare is an example of a successful single payer model and it is a very popular health care program. A “Medicare-for-All” system would be far more cost effective than any of the proposed current reforms based on the continuation of for-profit, market-based insurance. And it is a program that Americans are already familiar with–a solution right at our fingertips.

The rising cost of health care is one of the biggest issues in the collective bargaining process. Many working families have given up wage increases and are being asked to cover more of their health care costs. Others are losing their health care benefits altogether because more employers are dropping individual and family coverage. This is a crisis and a moral issue. People currently covered by private health insurance are understandably apprehensive when it is suggested that their only alternative to degrading that coverage is not to be covered at all–as is the current situation for approximately 50 million of our fellow citizens today.

Our current jobs crisis is further aggravated since the cost of health care in the U. S. is almost double that in other industrial countries, making our export sector increasingly uncompetitive and a major cause of the off-shoring of jobs.

At this past year’s AFL-CIO Convention in Pittsburgh, on the very day that you, Mr. President, addressed the Convention and were so warmly received, the delegates unanimously adopted a detailed resolution in support of a Single-Payer, “Medicare for All” system in America.

We welcome your call for a better approach that will “bring down premiums, bring down the deficit, cover the uninsured, strengthen Medicare and stop insurance company abuses.” We submit to you that a “Medicare-for-All” health care system accomplishes all of these worthy goals, contrary to the untruths that have been advanced by opponents of true health care reform.

The American people deserve better. We want our leaders to solve the health care crisis and to do so in a transparent way. No one in this country should have to fear losing their health care coverage or face bankruptcy. This is simply unacceptable for the United States of America. The time for single payer health care is now. We urge you to use this impasse as the time to put single payer health care on the table and into the health care reform discussions as the real solution.
Millions of working people and an overwhelming majority of unionists voted their confidence in your call for “change we can believe in.”

Respectfully Submitted,

The Labor Campaign for Single-Payer Health Care Steering Committee & Advisory Board

cc: Nancy Pelosi
Harry Reid

Single-Payer-Minded

Local health-care practitioners explain why they're willing to go to jail in the name of health-care reform

By Erin Sullivan
Baltimore City Paper, Feb. 3, 2010

No matter how strongly we may feel about the health-care debate–and no matter which side of the debate we’re on–most of us stay safely out of it. Aside from a few boisterous town-hall meetings, we monitor the dealings in Congress from couches, desks, and smartphones, where we can keep tabs on the action, make donations to the activist groups of our choice, and post our opinions on FaceBook or Twitter.

Carol Paris
Dr. Carol Paris

Charles Loubert

Dr. Eric Naumburg

Dr. Margaret Flower
Photographs by Frank Klien

But as the discussion about health care has shifted from coverage for all citizens to a system that will force people to purchase private health insurance–without the controversial “public option” that would offer some kind of government-run health plan for those who wanted it–pockets of unlikely activists are mobilizing. Health-care practitioners are expressing their opinions via old-fashioned civil disobedience. Many of these protestors say the solution to the nation’s health-care dilemma is in what’s known as single-payer health-care–a government-funded medical system, much like Medicare, that would cover all citizens from birth to death. So far, the notion of single-payer health care has not gotten much serious play in the current discussion. But this new breed of professionals-turned-activists feels strongly enough about the topic that some of them are putting themselves on the line to draw attention to it.

On May 5, 2009, eight representatives of several activist groups, including Physicians for a National Health Program, Healthcare-Now of Maryland, and Single Payer Action–three of whom were doctors, two of them from Maryland–sat in on a Senate Finance Committee roundtable discussion chaired by Sen. Max Baucus (D-Montana). They observed that no representatives at the roundtable supported single-payer health care, and repeatedly requested that they be permitted to speak at the hearing. Baucus had all of them arrested.

On May 12, at a second roundtable sponsored by Baucus’ committee, five more health-care practitioners who were not given a seat at the table crashed the hearing, spoke out in favor of single-payer health care, and were arrested.

And in a series of actions that took place across the country this fall, more than 150 people–many of them working health-care providers–were arrested for staging sit-ins at the offices of health-insurance companies and Congressional representatives, such as senators Joe Lieberman (I-Conn.) and Nancy Pelosi (D-Calif.). One such action took place in Baltimore on Oct. 29, 2009, resulting in the arrest of two doctors, a retired psychologist, and a schoolteacher.

City Paper asked some of these individuals to tell us what made them feel so strongly about health-care reform that they were willing to go to jail for it.

Dr. Carol Paris is a practicing psychiatrist from Leonardtown. She was arrested during the May 5 incident at Sen. Max Baucus’ Finance Committee meeting, one of eight people locked up. Paris was charged with unlawful conduct on Capitol grounds. She received six months’ probation, though the charges were diverted in January. She is a member of Physicians for a National Health Care Program.

Prior to last year, I was working, via volunteer time primarily, with the [physicians’ group] Maryland State Medical Society. I did some work for about three years on their legislative committees, and I did a lot of work on pieces of legislation that were designed to try to get the [insurance] industry to play fairly. And what I realized . . . is that it doesn’t matter what you get passed in the law. What matters is what the regulations are, and who writes the regulations and enforces the regulations. In the state of Maryland, the regulations were written in large part by the insurance lobby themselves. . . . And the Maryland Insurance Administration is tapped with enforcement of the regulations. And what I’ve come to realize is that the Maryland Insurance Administration is ineffective. . . . The only trigger for the Maryland Insurance Administration to enforce a law is a complaint. They are not even monitoring, and they don’t even enforce unless somebody complains.

We had this bill that was passed in the Maryland Legislature called the Clean Claims Act. It said if you as a physician submit a claim to an insurance company, and you’ve dotted your “I”s and crossed your “T”s, your forms are all filled out correctly, they have either 30 or 45 days to pay the claim. And if they don’t pay in that amount of time, they have to give you interest on the money. . . . I had a case where, the [patient] had two insurers, Medicare and a private insurer. I submit the claim to Medicare, they pay what they are going to pay, then they send the paperwork to the private insurance company, and they are supposed to pay me the rest. I sent $3,000 worth of claims to Medicare. Medicare sent them to CareFirst BlueCross BlueShield. CareFirst put in the wrong provider number [on the forms] and sent my money to a doctor in Fredericksburg, Va. My staff identified the problem within a month, and it took two years to fix it. I kept a list of every interaction with CareFirst over those two years, and I determined that at a rate of $13 an hour, it cost me $13,000 to collect the $3,000 owed to me. I didn’t even get interest on the money.

All of this is to paint the picture of the frame of mind I was in last January, when I met Margaret Flowers and realized there were organizations out there that were advocating for a single-payer plan. I was a case in point as a physician of how bureaucratic and wasteful the private insurance industry is in so many ways. It just resonated with me all over the place, and that’s why I joined.

It was a combination of that and of being a practicing physician and just seeing day after day after day how the system is abusing doctors and abusing my patients. That reinforces my determination every single day. . . . I jokingly have come up with a new psychiatric diagnosis called PIISD–private insurance-induced stress disorder. When Margaret called me and said, “Do you want to protest at the Senate Finance Committee hearing?” I didn’t have to think about it. I said yes.

We decided we weren’t going to disrupt in the middle of the proceedings . . . So as soon as Sen. Baucus pounded his gavel, Russell Mokhiber [of Single Payer Action] got up and said basically, “You have repeatedly refused to allow a single-payer spokesperson to address the committee . . . . We have three doctors here, any one of whom could speak to this issue. Will you give them a seat at the table?” And Baucus said that proceedings would adjourn until order can be restored and had Russell arrested. As soon as order was restored, Margaret Flowers got up and spoke for a minute or so, and she was arrested. As soon as order was restored . . . someone else got up and spoke and was arrested, same thing. I was number four. And there were eight of us total. [Activist] Katie Robbins got up and said “We need single payer in this country,” and Baucus’ reply was “We need more police.”

[They] put us in a paddy wagon and we spent five ho
urs sitting on a bench handcuffed to a wall in jail. While we were sitting there talking to the Capitol police, they were telling us their stories of health-insurance woes with their families. They completely got it, what we were doing and why we were doing it. In fact, there was a sign in the jail that said if you are having a medical problem, let us know and we’ll get you medical care. In fact, the Supreme Court has ruled that its cruel and unusual punishment to deny a prisoner health care. In Baltimore, you get medically cleared before they will even put you in the general population [at] the jail. So think about it: You have more rights to health care as a prisoner in this country than you do as a law-abiding citizen.

Charles Loubert is a retired counseling psychologist who lives in Southwest Baltimore. Loubert, who is 81 years old, was arrested on Oct. 29, 2009, when he and a group of 30 supporters of single-payer health care held a rally outside the offices of CareFirst BlueCross BlueShield in Canton. Loubert was one of four people arrested that day. He was charged with trespassing and disorderly conduct. Despite the fact that his case was nolle prosequi–not prosecuted–by the State’s Attorney’s Office, a warrant was issued for Loubert’s arrest in December 2009. Officers showed up on his doorstep early one morning, handcuffed him, and hauled him down to Central Booking again, where he was held until a court commissioner determined that the warrant was issued in error. Loubert is a member of Veterans for Peace, as well as Healthcare-Now of Maryland.

I’m a retired psychological counselor. I was a school counselor and I worked with adults, as well, in the community and at a health clinic.

I can do this because I pretty much have my time as my own.  And that’s not heroic, that’s just convenience. There are many people that I know who feel the same way I do, but they’ve got jobs, they’ve got families. I’m a little bit of a rabble-rouser, you know, and at my age what do I have to lose?

We went to CareFirst, to their office is at the 1st Mariner Tower [in Canton]. About 30 of us went there. We were protesting at the front door, and they had the doors locked because they didn’t want us to come in.

We were protesting and so on, and then Margaret Flowers and Eric Naumburg, two doctors, and Kevin Zeese and Del. Jill Carter [D-41st District] went to the back door and talked to a representative of CareFirst and asked them to stop denying doctor-ordered procedures, and said they wanted to speak with the CEO of the company.  And the representative said, “Well, we’ll put it in writing and we’ll consider it.”  Fat chance was my silent answer when they came back.

So anyway the four of us decided, including Margaret and Eric and another lady who is a teacher, we decided we’re going to risk arrest if necessary to get the point across. The plan was we were going to go into the lobby, all 30 of us, and then when they asked us to leave, four of us would not leave.  Well, what they had done is, apparently, they had notified the police. So as soon as we rounded the corner to go to the door, the 30 of us were surrounded. Out of the blue came about 40, I think–there were more of them than there were of us–Baltimore police. They came racing to the door to keep us out.

The other three got in because they were quicker [than me], but my old bones beat this one younger cop to the door, and we got in and we sat on the floor, and the manager of the building asked us to leave, the police asked us, and we said no. They handcuffed us and took us out into the paddy wagon, and they took us off to Central Booking.

I hate to say it, but I was a little ashamed of our country. We do so many good things, and we are a haven for people from all over the world to come here to be citizens of this country, and yet we do this kind of thing.

Eric Naumburg is a retired pediatrician from Columbia. Today, he says he sees more and more doctors in the Howard County area getting out of traditional medical practices and setting up “concierge” practices, where individuals pay a large membership fee each year for guaranteed access to the physicians of their choice–a luxury for those who can afford it, an impossibly expensive proposition for most. Naumburg was arrested at the Oct. 29 protest in the lobby of CareFirst BlueCross BlueShield’s offices in Canton. He was charged with trespassing and disorderly conduct. The charges were eventually nolle prossed. Naumburg is a member of Physicians for a National Health Program and Healthcare-Now of Maryland.

Most people don’t understand what the term single-payer means, because it’s a technical term, but it’s a one-payer system, like Medicare used to be, that pays for the care, but the care is provided privately. . . . Since this debate has gone on, single-payer has been systematically taken off the table. It’s not included at all. When the Baucus [Senate Finance] committee had hearings on health reform back in May, the room was filled with lobbyists, health insurers, pharmacies, all the people you would expect. But there was not one person representing patients’ interests in the room. Nor was there anybody there representing doctors’ interests.

The people who were struggling, in my practice, were the ones who didn’t qualify for Medicaid. They had jobs and they were doing what they should be doing. And they were the people you had to go back and look in the sample closet to see if you could find antibiotics for a child who was sick, that kind of thing. A lot of them would just stop coming because they just couldn’t afford it.

We have a very expensive, very poorly run health system. And there’s no system to it–it’s a mishmash. And the biggest waste in the system is all this administrative stuff. It makes practicing medicine very unpleasant because at every turn you have to worry about, Well what does this person’s insurance cover? What forms am I going to have to fill out to make the insurance company happy, so they’ll pay? To make the pharmaceutical plan happy so they’ll give out the drug that I think the patient needs? You’re fighting with the private insurers to get care for people. . . . fighting with people who don’t really understand.

One of my last cases was a real frustration for me. I had a 3-month-old who had noisy breathing and his mother was working and she had private insurance, Aetna. I wanted to get this child seen by two or three specialists, and they had the family going to–instead of the people that I know and know were good–they had them going to a cardiologist that I’d never heard of at one place and a pulmonary clinic at another, then finally they ended up at an ENT [ear, nose, throat specialist] down in Washington. They had them going all over the place. . . . And the bottom line is I didn’t know he ended up in Washington, I never got a chance to talk to the ENT doctors down there. They ended up doing a tonsillectomy, which on a 3-month-old is pretty unusual. I wanted them to just look for an underlying cause, and I never got a chance to tell them what I was thinking about. When I got a chance to talk to the surgeon three days later, I told them “I was hoping you guys happened to get a biopsy,” and he said “No, if you’d told us that we would have done it, that’s a good idea.” . . . It’s that kind of thing. That’s just an example, but it happens all the time.

When we were doing the protest at the CareFirst building, there were a lot of police around. We started talking to them about their medical coverage, and they have issues, they have gaps in their coverage. The people arrested in Washington had the same experience with the guards. When I was in Central Booking in Baltimore, there were two of us in the cell, we were wearing our T-shirts, and . . . the minute they found out what we were doing, they were very supportive of us. It’s all levels of society who know that their health insurance is not working for them. It’
s universal.

[Physicians] are leaving primary care in droves. It’s a real problem here. The health commissioner in Howard County has been having meetings about the lack of primary-care providers. Howard County is the richest county in the richest state in the nation, and they’re having trouble finding enough primary-care providers. People aren’t going into primary care anymore–they want to become specialists because it’s very hard to make a go of it as a primary care provider, because of the insurance reimbursement issues. Doctors want to be able to practice medicine without feeling like being in a mill, which is what it’s like. You have to churn out so many patients just to get enough reimbursements.

In a wealthy country like this, everybody should have access to health care without having to worry about how to pay for it.

Dr. Margaret Flowers is a pediatrician from Sparks. She stopped practicing medicine two years ago to devote herself full-time to advocating for single-payer health care. She serves as co-chair for Physicians for a National Health Program, and is also a member of Healthcare-Now of Maryland. Flowers was arrested twice in her effort to push for health-care reform: She was one of the so-called Baucus Eight who were arrested at the May Senate Finance Committee hearing, and she violated her probation on that arrest to participate in the CareFirst protest in Baltimore, where she was again hauled off in handcuffs. Flowers was charged with unlawful conduct on Capitol grounds for her Baucus committee arrest, for which she received six months’ probation, and with trespassing and disorderly conduct for her arrest at CareFirst. Those charges were eventually nolle prossed.

I went into the practice of medicine thinking it was the doctors and patients who made the decisions about what was the best care for patients, and that there would be a certain amount of respect for the knowledge that physicians gained after many years of studying and training. But instead what I found is the insurance companies that you bump into at every level–in the hospital, in your practice, in the pharmacy–are not making decisions based on sound medical practice. Initially, I was surprised by it, and then I started to get curious about why it was that way. One thing led to another, and it’s been about five or six years now that I’ve been trying to educate myself and others about health-care reform and fighting for it.

One of the things we learned this year is that the regular physician’s voice is not heard in Congress. They hear from special-interest groups, and many of those have somewhat corporate affiliations. And many of the people that were involved in devising the numbers about health policies didn’t really understand health policy. So we brought doctors and nurses and other health providers into Congress and we met with members of Congress and we presented them with packets of information about health policy and we also spoke to them about our real experiences with real patients, about what the reality is, why we are losing primary-care doctors, why our health outcomes are bad, just a voice they haven’t heard before.

We spoke to everybody, we didn’t limit it to any kind of affiliation. People who believe in a free-market [health-care] model would say, “Well, we think that there should be competition.” So we would say, “Well, explain to us how that would work, how does competition improve health care?” And they couldn’t. Then, we would say, “This is what it actually does to health care, and this is why the real competition we want to have is between doctors and hospitals. If everybody can come to see you, then you are competing based on who’s the best [provider], not which insurance company covers you.”

The first committee to take up health care was Sen. Baucus’ Finance Committee, and so the Leadership Conference [for Guaranteed Healthcare] sent a letter and requested that one of our representatives be present. They had 41 people testifying over three days at these roundtables. It became very clear that they did not want our voice to be included. [But] if you talk about universality, single-payer wins, if you talk about cost saving, single-payer wins. They didn’t want to hear that.

We were actually prepared to testify that day if need be, and as the roundtable was opening, the first member stood up and he said, “Why aren’t you allowing single-payer on the table? We have three doctors here, will you let one of them testify?” And he was arrested. I stood up next and said, “I’m Dr. Margaret Flowers, and I speak on behalf of the true stakeholders,” because they kept calling the people at the table the stakeholders, and we’re going, “The pharmacy [representatives] are not the stakeholders.” So I said, “It’s the patients and the providers who want a national health program.” And they arrested me.

We knew we were risking arrest. It was a public hearing, but they weren’t allowing the public to speak. They gave us unlawful conduct and disruption of Congress. That actually caries a six-month sentence, it was a little more than we expected. We just had our probation hearing last week. But the effect was actually rather positive. Sen. [Ted] Kennedy [D.-Mass.] was still alive at that point, and his office reached out to us, and I was the first person to testify at his committee hearing when they brought up health care.

The more you learn about what is going on and why we don’t have real reform, and what health-insurance companies are able to get away with, I came to a point where I felt like if I was going to make a difference, I was going to have to do this full-time. So many of my friends were leaving their practices and just giving up. I now do this full-time.

This is a matter of life or death for people. My outrage is at the fact that our government is not acting in the best interests of the people, and they are getting away with it. It’s just unacceptable. You can work a job, you can pay your premiums, you can do all the things you are supposed to do, and then you get sick, and you lose everything. And it can happen to any one of us.

Part of the reason I became a doctor is because I care about people. So I can’t see this happening and not do something about it.

© 2010 Baltimore City Paper

http://www.citypaper.com/news/story.asp?id=19708&p=1

Higher Medicare managed care copayments cause increased hospital use

Increased Ambulatory Care Copayments and Hospitalizations among the Elderly

By Amal N. Trivedi, M.D., M.P.H., Husein Moloo, M.P.H., and Vincent Mor, Ph.D.
The New England Journal of Medicine
January 28, 2010

We examined the consequences of increasing copayments for ambulatory care in a large, nationally representative sample of elderly Medicare enrollees in managed-care plans. As compared with matched control plans in which copayments for ambulatory care were unchanged, Medicare plans that increased these copayments by an average of 95% for primary care and 74% for specialty care had a reduction in the number of outpatient visits but an increase in hospital admissions, in the number of days of hospital care, and in the proportion of enrollees who used hospital care. According to our estimates, for every 100 elderly enrollees exposed to this level of increased cost sharing for ambulatory care, there would be 20 fewer outpatient visits during the first year after the increase but more than 2 additional admissions for acute care and approximately 13 additional inpatient days in the year after the increase. The effects of copayment increases on the subsequent use of inpatient care were magnified for enrollees living in areas with low income and low educational levels, for black enrollees, and for enrollees who had hypertension, diabetes, or a history of acute myocardial infarction as compared with the effects observed for the entire study cohort.

http://content.nejm.org/cgi/content/full/362/4/320

Cracks in the moral hazard foundation:
https://pnhp.org/news/2007/september/cracks-in-the-moral-hazard-foundation

Comment:

By Don McCanne, MD

This is an important study. It demonstrates, once again, that requiring already insured patients to pay more out of pocket if they access care can have a detrimental impact on both their health and on total health care spending. This is the opposite of what we should be striving for as we attempt to reform health care. Yet Congress and the administration are including this ill-considered policy of cost sharing in the unfounded belief that it would be a harmless method of slowing health care spending.

In order to reduce premiums for private insurance plans offered by the proposed insurance exchanges, the current legislation calls for plans with actuarial values 50 to 100 percent lower than typical employer-sponsored plans (with limited exceptions). These lower values are achieved partly by requiring patients who need to use health care to pay an even larger amount out-of-pocket in the form of deductibles, copayments, and coinsurance.

Those who defend cost sharing usually cite the RAND HIE – an experiment that supposedly demonstrated that patients were not harmed by not receiving care that required out-of-pocket spending – the moral hazard argument. One problem with that study was that it was limited to the relatively healthy workforce, their young, healthy families, during a short, healthy interval in their lives. The conclusions of the study do not have external validity for an entire population, with all their ills, covered in a universal program. The study was further flawed by the fact that participants were allowed to drop out at any time and return to their prior insurance, and the cost-sharing wing did so at an eighteen-fold rate over the control wing. These individuals, many of whom were no doubt facing higher costs, were excluded from the results of the study. How can they possibly claim that the cost-sharing group fared no worse than the control group? (See the “Cracks in the moral hazard foundation” link above for further information.)

The problem of ever-increasing health care costs must be addressed, but assessing financial penalties (cost sharing) against individuals for having  accessed necessary health care is one of the very worst ways to do it. This and other studies demonstrate that it can actually increase total health care spending, not to mention impairing health outcomes.

A single payer system – an improved Medicare for all – uses much more effective policies to control health care spending while removing financial barriers to the care that patients need. Aren’t you tired of hearing the President and members of Congress tell us that single payer is the program that would work, but we’re not going to do it?

Stein's Law – hitting the wall

Herb Stein's Unfamiliar Quotations

By Herbert Stein
Slate
May 16, 1997

If something cannot go on forever, it will stop.
–Stein’s Law, first pronounced in the 1980s

This proposition, arising first in a discussion of the balance-of-payments deficit, is a response to those who think that if something cannot go on forever, steps must be taken to stop it–even to stop it at once.

http://www.slate.com/id/2561/

And…

Huge Deficits May Alter U.S. Politics and Global Power

By David E. Sanger
The New York Times
February 1, 2010

… as Prof. James K. Galbraith of the University of Texas puts it, “Forecasts 10 years out have no credibility.”

Simply projecting that health care costs will rise unabated is dangerous business.

His greatest hope, Mr. Galbraith said, was Stein’s law, named for Herbert Stein, chairman of the Council of Economic Advisers under Presidents Richard M. Nixon and Gerald R. Ford.

Stein’s law has been recited in many different versions. But all have a common theme: If a trend cannot continue, it will stop.

http://www.nytimes.com/2010/02/02/us/politics/02deficit.html?hp

And…

The Long-Term Outlook for Health Care Spending

Congressional Budget Office
November 2007

Projections of Health Spending

Over the past 30 years, total national spending on health care has more than doubled as a share of GDP. Under the assumptions described (in this CBO report), according to CBO’s projections, that share will double again by 2035, to 31 percent of GDP. Thereafter, health care costs continue to account for a steadily growing share of GDP, reaching 41 percent by 2060 and 49 percent by the end of the 75-year projection period.

http://www.cbo.gov/ftpdocs/87xx/doc8758/Intro.shtml
Graph: http://www.cbo.gov/ftpdocs/87xx/doc8758/Figure4.gif

And…

GOP House Issues Conference

January 29, 2010

Congressman Paul Ryan (speaking to President Obama):  … Medicare, as you know, is a $38 trillion unfunded liability…

http://www.whitehouse.gov/the-press-office/remarks-president-gop-house-issues-conference

Comment: 

By Don McCanne, MD

At over $2.5 trillion (almost 18 percent of our GDP), the level of health care spending in the United States this year is almost intolerable. Yet we hear predictions that health care will represent half of our GDP by 2082, and that Medicare will accumulate a deficit of $38 trillion.

Thank goodness for Stein’s Law. We will never see these numbers for the simple reason that this rate of increase cannot go on forever. It will stop once it hits the wall.

Herbert Stein, being from the Chicago School of Economics (think Milton Friedman), did not believe that steps must be taken to intervene since the problem would take care of itself. Although that is true, the problem with this sterile, amoral view, common amongst those of the Chicago School, is that it ignores the consequences of a spontaneous economic process devoid of the input from the heart and soul of beneficent public stewards.

To be clear, in the economics of health care, Stein’s Law does not represent one point in the expansion of health care spending at which everything stops and the health care system collapses. Nor does it represent a single point at which expansion stops and spending becomes static. Rather it represents a multitude of various walls for various payers, including individuals, employers and the various levels of government, each of which has its own wall as a barrier represented by Stein’s Law.

In our fragmented system of financing health care, Stein’s Law is already in play. Tens of millions are no longer able to afford health insurance. Tens of millions more are no longer able to afford adequate insurance products and must face the financial hardships of the underinsurance products that have been the response of competing insurers in our market economy in health care. The rate of employer-sponsored coverage has been declining because too many businesses, especially small businesses, have already hit the wall. Many states are struggling with the need to reduce Medicaid payments to providers in order to try to include more under the umbrella, while watching the safety-net of providers crumble from protracted financial losses. Even the federal government is struggling to find ways to fill the void in the face of massive budget deficits.

With Stein’s Law, we can predict that the rate of spending increases will very soon slow down, but under our current financing system, that will inevitably result in more financial hardship, suffering, and even death as health care access becomes ever less affordable.

Suppose the Senate bill passes, along with the reconciliation tweaks, then what will happen? Since our beneficent stewards in Congress neglected their duties, failing to adopt policies that would slow the growth in health care spending, health care costs will continue to test Stein’s Law.

Some of the multitude of walls will move, but none of them will go away. The states will see their walls move further out with the infusion of Medicaid funds. The federal government will see its wall move closer, signaled by the shrill cacophony of the budget hawks. Employers will not see their wall move much, but they will continue to barrel forward, eventually hitting it one by one.

But what about our hard-working, middle-income Americans? The wall will be moved much closer. For several reasons, mostly related to costs, there will be an attrition of employer-sponsored plans. Since the subsidies to purchase private plans will be less than the employer contributions, fewer individuals and families will be able to afford the plans. To slow the rise in premiums, more benefits will be stripped out. The Obama administration would accelerate this deterioration in benefits by imposing an excise tax on the plans as “the most effective way to control costs.” The Obama/Orszag policy of controlling costs by erecting financial barriers to necessary health care is a very sick policy indeed. The legislation before Congress adds afterburners to middle-income Americans only accelerating their trip to Stein’s impenetrable wall.

When our economic models have immoral consequences, we should abandon the amoral models of the Chicago School, and move to normative economics. It is not a sin for an economist to have a heart.

Under a single payer national health program – an improved and expanded Medicare for all – Stein’s wall will still be there. But instead of letting the entire system crash into the wall, our own beneficent public stewards – if we elect ones with a heart – will be there to make sure that everyone receives the care that they need. The resources that we use may take us up to the wall, but we won’t be crashing into it.

Every other industrialized nation has an impenetrable Stein wall, but by using normative economics, they don’t sacrifice their citizens by slamming them into that wall.

Stein’s Law – hitting the wall

Herb Stein’s Unfamiliar Quotations

By Herbert Stein
Slate
May 16, 1997

If something cannot go on forever, it will stop.
–Stein’s Law, first pronounced in the 1980s

This proposition, arising first in a discussion of the balance-of-payments deficit, is a response to those who think that if something cannot go on forever, steps must be taken to stop it–even to stop it at once.

http://www.slate.com/id/2561/

And…

Huge Deficits May Alter U.S. Politics and Global Power

By David E. Sanger
The New York Times
February 1, 2010

… as Prof. James K. Galbraith of the University of Texas puts it, “Forecasts 10 years out have no credibility.”

Simply projecting that health care costs will rise unabated is dangerous business.

His greatest hope, Mr. Galbraith said, was Stein’s law, named for Herbert Stein, chairman of the Council of Economic Advisers under Presidents Richard M. Nixon and Gerald R. Ford.

Stein’s law has been recited in many different versions. But all have a common theme: If a trend cannot continue, it will stop.

http://www.nytimes.com/2010/02/02/us/politics/02deficit.html?hp

And…

The Long-Term Outlook for Health Care Spending

Congressional Budget Office
November 2007

Projections of Health Spending

Over the past 30 years, total national spending on health care has more than doubled as a share of GDP. Under the assumptions described (in this CBO report), according to CBO’s projections, that share will double again by 2035, to 31 percent of GDP. Thereafter, health care costs continue to account for a steadily growing share of GDP, reaching 41 percent by 2060 and 49 percent by the end of the 75-year projection period.

http://www.cbo.gov/ftpdocs/87xx/doc8758/Intro.shtml
Graph: http://www.cbo.gov/ftpdocs/87xx/doc8758/Figure4.gif

And…

GOP House Issues Conference

January 29, 2010

Congressman Paul Ryan (speaking to President Obama):  … Medicare, as you know, is a $38 trillion unfunded liability…

http://www.whitehouse.gov/the-press-office/remarks-president-gop-house-issues-conference

Comment: 

By Don McCanne, MD

At over $2.5 trillion (almost 18 percent of our GDP), the level of health care spending in the United States this year is almost intolerable. Yet we hear predictions that health care will represent half of our GDP by 2082, and that Medicare will accumulate a deficit of $38 trillion.

Thank goodness for Stein’s Law. We will never see these numbers for the simple reason that this rate of increase cannot go on forever. It will stop once it hits the wall.

Herbert Stein, being from the Chicago School of Economics (think Milton Friedman), did not believe that steps must be taken to intervene since the problem would take care of itself. Although that is true, the problem with this sterile, amoral view, common amongst those of the Chicago School, is that it ignores the consequences of a spontaneous economic process devoid of the input from the heart and soul of beneficent public stewards.

To be clear, in the economics of health care, Stein’s Law does not represent one point in the expansion of health care spending at which everything stops and the health care system collapses. Nor does it represent a single point at which expansion stops and spending becomes static. Rather it represents a multitude of various walls for various payers, including individuals, employers and the various levels of government, each of which has its own wall as a barrier represented by Stein’s Law.

In our fragmented system of financing health care, Stein’s Law is already in play. Tens of millions are no longer able to afford health insurance. Tens of millions more are no longer able to afford adequate insurance products and must face the financial hardships of the underinsurance products that have been the response of competing insurers in our market economy in health care. The rate of employer-sponsored coverage has been declining because too many businesses, especially small businesses, have already hit the wall. Many states are struggling with the need to reduce Medicaid payments to providers in order to try to include more under the umbrella, while watching the safety-net of providers crumble from protracted financial losses. Even the federal government is struggling to find ways to fill the void in the face of massive budget deficits.

With Stein’s Law, we can predict that the rate of spending increases will very soon slow down, but under our current financing system, that will inevitably result in more financial hardship, suffering, and even death as health care access becomes ever less affordable.

Suppose the Senate bill passes, along with the reconciliation tweaks, then what will happen? Since our beneficent stewards in Congress neglected their duties, failing to adopt policies that would slow the growth in health care spending, health care costs will continue to test Stein’s Law.

Some of the multitude of walls will move, but none of them will go away. The states will see their walls move further out with the infusion of Medicaid funds. The federal government will see its wall move closer, signaled by the shrill cacophony of the budget hawks. Employers will not see their wall move much, but they will continue to barrel forward, eventually hitting it one by one.

But what about our hard-working, middle-income Americans? The wall will be moved much closer. For several reasons, mostly related to costs, there will be an attrition of employer-sponsored plans. Since the subsidies to purchase private plans will be less than the employer contributions, fewer individuals and families will be able to afford the plans. To slow the rise in premiums, more benefits will be stripped out. The Obama administration would accelerate this deterioration in benefits by imposing an excise tax on the plans as “the most effective way to control costs.” The Obama/Orszag policy of controlling costs by erecting financial barriers to necessary health care is a very sick policy indeed. The legislation before Congress adds afterburners to middle-income Americans only accelerating their trip to Stein’s impenetrable wall.

When our economic models have immoral consequences, we should abandon the amoral models of the Chicago School, and move to normative economics. It is not a sin for an economist to have a heart.

Under a single payer national health program – an improved and expanded Medicare for all – Stein’s wall will still be there. But instead of letting the entire system crash into the wall, our own beneficent public stewards – if we elect ones with a heart – will be there to make sure that everyone receives the care that they need. The resources that we use may take us up to the wall, but we won’t be crashing into it.

Every other industrialized nation has an impenetrable Stein wall, but by using normative economics, they don’t sacrifice their citizens by slamming them into that wall.

The President at the GOP House Issues Conference

Remarks by the President at GOP House Issues Conference

The White House
January 29, 2010

Congressman Price (Dr. Tom Price from Georgia):  Mr. President, multiple times, from your administration, there have come statements that Republicans have no ideas and no solutions.  In spite of the fact that we’ve offered, as demonstrated today, positive solutions to all of the challenges we face, including energy and the economy and health care, specifically in the area of health care — this bill, H.R.3400, that has more co-sponsors than any health care bill in the House, is a bill that would provide health coverage for all Americans; would correct the significant insurance challenges of affordability and preexisting; would solve the lawsuit abuse issue, which isn’t addressed significantly in the other proposals that went through the House and the Senate; would write into law that medical decisions are made between patients and families and doctors; and does all of that without raising taxes by a penny.

But my specific question is, what should we tell our constituents who know that Republicans have offered positive solutions to the challenges that Americans face and yet continue to hear out of the administration that we’ve offered nothing?

The President:  It’s not enough if you say, for example, that we’ve offered a health care plan and I look up — this is just under the section that you’ve just provided me, or the book that you just provided me — summary of GOP health care reform bill:  “The GOP plan will lower health care premiums for American families and small businesses, addressing America’s number-one priority for health reform.”  I mean, that’s an idea that we all embrace.  But specifically it’s got to work.  I mean, there’s got to be a mechanism in these plans that I can go to an independent health care expert and say, is this something that will actually work, or is it boilerplate?

If I’m told, for example, that the solution to dealing with health care costs is tort reform, something that I’ve said I am willing to work with you on, but the CBO or other experts say to me, at best, this could reduce health care costs relative to where they’re growing by a couple of percentage points, or save $5 billion a year, that’s what we can score it at, and it will not bend the cost curve long term or reduce premiums significantly — then you can’t make the claim that that’s the only thing that we have to do.  If we’re going to do multi-state insurance so that people can go across state lines, I’ve got to be able to go to an independent health care expert, Republican or Democrat, who can tell me that this won’t result in cherry-picking of the healthiest going to some and the least healthy being worse off.

So I am absolutely committed to working with you on these issues, but it can’t just be political assertions that aren’t substantiated when it comes to the actual details of policy.  Because otherwise, we’re going to be selling the American people a bill of goods.  I mean, the easiest thing for me to do on the health care debate would have been to tell people that what you’re going to get is guaranteed health insurance, lower your costs, all the insurance reforms; we’re going to lower the costs of Medicare and Medicaid and it won’t cost anybody anything.  That’s great politics, it’s just not true.

So there’s got to be some test of realism in any of these proposals, mine included.  I’ve got to hold myself accountable, and guaranteed the American people will hold themselves — will hold me accountable if what I’m selling doesn’t actually deliver.

http://www.whitehouse.gov/the-press-office/remarks-president-gop-house-issues-conference

Comment: 

By Don McCanne, MD

The President enters the Republicans’ den, and politics broke out. At least that’s the impression you might have from the media coverage of the President’s appearance at the GOP House Issues Conference. But this was not simply an exchange of partisan political rhetoric; it was a plea by President Obama to set aside rhetorical grandstanding and to join together in a fair, credible, and objective discussion of the impact of the actual policies under consideration.

Did that happen? It is puzzling how Congressman Tom Price, a physician, could state directly to the President that their Republican bill “would provide health coverage for all Americans.” That goes beyond political grandstanding for the benefit of the television cameras. That is shameless, arrogant lying to the President of the United States and to the American people. It is impossible to have a constructive dialogue with liars.

President Obama is right when he states that these proposals must pass the test of realism, while at the same time holding himself accountable. But realism alone isn’t enough. The policies must be effective and efficient. Yet the President and Congress abandoned those health care reform policies that pass the tests with the highest scores, and accepted flawed, lower-scoring policies that were believed to comply better with the political tests, though that political support is waning.

When objectivity and realism demonstrate that the Democratic proposal falls far short, and when better, proven policies would bring affordable care to everyone, we should hold the President and Congress accountable. But we should also support them politically when they throw the liars out so they can get on with the reform that we need.

One more lie. Congressman Price said that H.R.3400 “has more co-sponsors than any health care bill in the House.” It has 52 cosponsors. Congressman John Conyers’ H.R. 676, “United States National Health Care Act or the Expanded and Improved Medicare for All Act,” has 87 cosponsors.

More importantly, Conyers’ bill is based on sound health policy that would actually work, whereas Price’s bill is based on feeble policies that will have almost no impact on the problems we face in health care. But their bill does provide them with rhetoric they can use for political grandstanding, even if based on lies (e.g., “provides health coverage for all Americans”).

Fact Sheet: The California Universal Healthcare Act

Affordable Health Insurance for All Californians

SB 810 (LENO)

February, 2009

En Español

Background:  Health care costs are crushing California’s economy and the state budget, forcing steep annual cuts in health care access and quality for Californians and their employers.  Health insurance premiums annually grow 4 times faster than wages, and have risen 87% since 2000 [1].

There are now 7 million uninsured Californians, but as insurance companies reduce health coverage, polls show that most insured Americans are now worried about how to pay for their health care if they get sick.

The U.S. spends more on health care—and gets less for it—than any other wealthy country. The $2.5 trillion that we spend every year (17.6% of our GDP)[2], is twice as costly as other wealthy nations, but it buys us a health care system ranked 37th by the World Health Organization. Alarmingly, studies repeatedly show that the quality of care in the U.S. is falling behind other wealthy nations.

California spent an estimated $212 billion in healthcare last year[3]. This is plenty of money to provide every resident of the state with excellent healthcare, ensure fair and reliable reimbursements to doctors, nurses and other providers, and guarantee a high quality of care for all.

SB 810 (Leno), the California Universal Healthcare Act would provide fiscally sound, affordable healthcare to all Californians, give every Californian the right to choose his or her own physician and control health cost inflation.

Truly Universal: Eligibility is based on residency, instead of on employment or income. Under the Act, all residents are covered. No California resident will ever again lose his or her health insurance because of unaffordable insurance premiums, because he or she changes or loses a job, goes to or graduates from college or has a pre-existing medical condition.

Shared Responsibility: Under the Act everyone – individuals, employers and government pays something in and everyone gets healthcare.

Affordable: The plan involves NO NEW SPENDING on healthcare. The system will be paid for by federal, state and county monies already being spent on healthcare and by affordable insurance premiums that replace all premiums, deductibles, out-of-pocket payments and co-pays now paid by employers and consumers.

Total Choice: Under SB 810, delivery of care remains as it is; a competitive mix of public and private providers. All consumers have complete freedom to choose their healthcare providers. No more restrictive HMO networks.

Fair Reimbursements: The Act requires actuarially sound reimbursements for providers. Doctors, nurses, hospitals and other healthcare providers will receive fair and reasonable reimbursements for all covered services they provide. No more uncompensated care.

Efficient: The Act eliminates waste by consolidating the functions of many insurance companies into one comprehensive insurance plan, saving the state and consumers billions of dollars each year. Currently about half of every dollar spent on healthcare is squandered on clinical and administrative waste, insurance company profits, and overpriced pharmaceuticals. The Act is based on a model that has been estimated to save California about $20 billion through reduced administrative costs in the first year alone.

Under the Act, California will use its purchasing power to buy prescription drugs and durable medical equipment in bulk. It has been estimated that this model of systemwide bulk purchasing could save California $5.2 billion in the first year.

Most importantly, the Act will make our healthcare system more reliable and secure by stabilizing the growth in health spending; linking spending increases to state GDP and population growth, employment rates and other relevant demographic indicators.

The Act will combine needed cost controls with medical standards that use the best available medical science, and place an emphasis on preventative and primary care to improve California’s overall health in a way that also saves billions of dollars.

The Act utilizes proven financial incentives that support the delivery of high quality care, including bonuses for providers working in rural or under-served areas. The plan invests in needed healthcare infrastructure such as electronic claims and reimbursement systems and statewide medical databases that improve healthcare quality.

Benefits: Coverage includes all care prescribed by a patient’s healthcare provider that meets accepted standards of care and practice.

Specifically, coverage includes hospital, medical, surgical, and mental health; dental and vision care; prescription drugs and medical equipment such as hearing aids; emergency care including ambulance; skilled nursing care after hospitalization; substance abuse recovery programs; health education and translation services, including services for those with hearing and vision impairments; transportation needed to access covered services, diagnostic testing; and hospice care.

For more information contact Sara Rogers at (916) 651-4646 or sara.rogers@sen.ca.gov, or Zak Meyer-Krings at (916) 651-4003 or zak.meyer-krings@sen.ca.gov.

~~~~~

1 Kaiser Family Foundation.  Employer Health Benefits 2006 Annual Survey.

2 [Health Affairs 28, no. 2 (2009): w346-w357 (published online 24 February 2009; 10.1377/hlthaff.28.2.w346)]

3 Lewin Group Costs and Economic Impacts Analysis. January 2005.

La Propuesta de Ley de Cuidado Médico Universal para California

Seguro Médico Asequible para Todos los californianos

SB 810 (LENO)

HOJA INFORMATIVA

Antecedentes: El costo del cuidado médico está restringiendo la economía de California y el presupuesto del estado, forzando recortes considerables cada año al acceso y calidad del cuidado médico para californianos y sus empleadores. Primas de seguro médico crecen cuatro veces más rápido que los sueldos cada año y han aumentado un 87% desde el año 2000 [1]. Siete millones de californianos carecen de seguro médico, mientras que las compañías de seguros disminuyen su cobertura médica. Como resultado, encuestas nacionales indican que la mayoría de americanos asegurados están preocupados por como pagaran su cuidado médico si se enferman.

Los E.E.U.U. gasta más en cuidado médico –y recibe menos –que cualquier otro país avanzado. Los $2.5 billones de dólares que gastamos cada año (un 17.6% de nuestro producto interior bruto, PIB) [2], es dos veces más costoso que otros países avanzados, pero nos otorga un sistema de salud que se clasificó 37º por la Organización Mundial de Salud. Alarmantemente, los estudios siguen indicando que la calidad del cuidado medico en los E.E.U.U. se está quedando atrás de los otros países avanzados.

Es mas, california gastó aproximadamente $212 mil millones en cuidado médico el año pasado [3]. Este dinero es más que suficiente para proporcionarle a cada residente del estado un cuidado médico de calidad, y asegurar reembolsos justos y fiables a doctores, enfermeras, y otros proveedores.

SB 810 (Leno), la propuesta de ley de Cuidado Médico Universal de California proporcionaría un cuidado médico fiscalmente sano y asequible para todos los californianos, le daría a cada californiano el derecho de escoger su doctor, y controlaría la inflación en costos de salud.

Verdaderamente Universal: Elegibilidad se basa en residencia, en ves de empleo o ingresos. Bajo esta propues
ta de ley, todos los residentes recibirán cobertura medica. Ningún residente de California jamás perderá su seguro médico a causa de primas de seguro inasequibles, cambio o perdida de su trabajo, o por tener una condición médica preexistente.Asequible: El plan no requiere GASTOS NUEVOS para el cuidado médico. Se pagará a través de fondos federales, estatales, y del condado que actualmente se gastan en el cuidado médico y con primas de seguro asequibles que reemplazaran todas las primas, los deducibles, los gastos por cuenta propia (o pagos directos), y los pagos compartidos que ahora son pagados por los empleadores y consumidores.

Elección Completa: Bajo la propuesta de ley SB 810, la entrega de cuidado médico sigue siendo la misma, una mezcla competitiva de proveedores públicos y privados. Todos los consumidores tienen plena libertad para elegir sus proveedores de cuidado médico –doctores, clínicas, hospitales, etc. Ya no habrá redes de aseguradores restrictivas.

Reembolsos Justos: Esta propuesta de ley exige reembolsos adecuados para los proveedores. Doctores, clínicas, hospitales y otros proveedores de cuidado médico recibirán reembolsos justos y razonables por todos los servicios que proporcionan. Ya no habrá cuidado médico sin compensación justa.

Eficaz: Esta propuesta elimina desperdicios de fondos mediante la consolidación de las funciones de varias compañías de seguros en un plan de seguro integral, ahorrándole al estado y a los consumidores mil millones de dólares cada año. Actualmente, cerca de la mitad de cada dólar gastado en el cuidado médico se malgasta en desperdicios clínicos y administrativos, ganancias para las compañías de seguros, y en farmacéuticos demasiado caros. En reducir o eliminar estos malgastos, se estima que esta propuesta ahorrara a California cerca de $20 mil millones en solo el primer año.

Mediante SB 810, California hará uso de su poder adquisitivo para comprar en mayoreo medicamentos y equipo médico duradero. Se ha estimado que este modelo de compras por mayoreo podría ahorrarle a California $5.2 mil millones en el primer año.

De mayor importancia, esta propuesta hará que nuestro sistema de cuidado médico sea más confiable y seguro. Estabilizará el crecimiento de los gastos médicos, conectando los aumentos de gastos con el crecimiento de la población, los niveles de empleo y otros índices económicos pertinentes.

La propuesta de ley combinará controles de costos necesarios con normas médicas que utilizan la mejor ciencia médica disponible, y también pondrá un énfasis en el cuidado primario y preventivo para reducir problemas médicos para ahorrar mil millones de dólares.

SB 810 utiliza incentivos financieros comprobados que apoyan la entrega de cuidado médico de alta calidad, incluyendo beneficios para los proveedores que trabajan en áreas rurales o en comunidades de bajos recursos sin suficiente atención medica. El plan invierte en los sistemas de reclamaciones y reembolsos electrónicos, y un sistema estatal de datos médicos que mejoran la calidad del cuidado médico.

Beneficios: La cobertura incluye todo el cuidado medico prescrito para el paciente por su doctor o proveedor que cumple con las normas de cuidado y prácticas aceptadas.

Específicamente, la cobertura incluye cuidado de hospital, atención médica, atención quirúrgica y cuidado de salud mental; cuidado dental y de visión; medicamentos recetados y equipo médico; cuidado de emergencia incluyendo la atención de ambulancias, y cuidado de enfermería especializada después de la hospitalización; programas para la recuperación del abuso de sustancias; educación sobre la salud y servicios de traducción, incluyendo los servicios para las personas con discapacidad auditiva y de vista; el transporte para acceder a los servicios necesarios; pruebas diagnósticas; y atención en hospitales para enfermos terminales.

Para más información, comuníquese con: Sara Rogers al (916) 651-4646 o sara.rogers@sen.ca.gov, o con Zak Meyer-Krings al (916) 651-4003 o zak.meyerkrings@sen.ca.gov.

~~~~~

1 Kaiser Family Foundation. Employer Health Benefits 2006 Annual Survey.

2 [Health Affairs 28, no. 2 (2009): w346-w357 (published online 24 February 2009; 10.1377/hlthaff.28.2.w346)] http://content.healthaffairs.org/cgi/content/abstract/hlthaff.28.2.w346

3 Lewin Group Costs and Economic Impacts Analysis. January 2005. Responsabilidad Compartida: Bajo esta propuesta de ley todos –individuos, empleadores, y el gobierno –pagan una parte y todos los residentes reciben cuidado médico.

Let Him Know

By Katie Robbins
MichaelMoore.com
February 1st, 2010

After a sobering loss for Democrats in the special election held to replace Sen. Ted Kennedy in Massachusetts, probing exit polls about health reform show that the win of Republican Scott Brown who pledged to cast the vote that would kill national health reform, didn’t come from people who thought the national legislation was going too far, but that it wasn’t going far enough.  Among Brown voters, 36 percent thought it didn’t go far enough.  Among voters who stayed home and opposed health care, a full 53 percent said they opposed the Senate bill because it didn’t go far enough.

The people in the commonwealth of Massachusetts have been living for three years with the same reform the national legislation is modeled after…and it isn’t working.  Even though more people have insurance through the mandate and subsidies for private plans, it fails to provide universal access to health care.  In addition, health costs continue to sky rocket, as it does little to guarantee that people can clear the hurdles of copays and deductibles in order to actually access health care when they need it.

A recent article from the Massachusetts state treasurer, Timothy P. Cahill, cites a recent study prepared by Drs. Rachel Nardin, David Himmelstein, and Steffie Woolhandler of Harvard Medical School showing that the least expensive plan available to a middle-income, 56-year-old individual costs $4,872 in annual premiums. That does not include a $2,000 deductible if the person actually gets sick, or the 20 percent of the person’s medical costs — up to $3,000 a year — he or she is required to pay, meaning that an individual’s total annual bill for health care could reach $9,872.

Cahill continues, “Rather than providing a solution, the Massachusetts health care laws have only created more problems, both on the state’s balance sheet and in struggling households across the state. Our residents deserve accessible, affordable health care that will not jeopardize the Commonwealth’s fiscal health, goals we cannot attain under the current system.”

To really understand the message coming from Massachusetts, let’s take a look back at the historic election in November 2008, two years after “health reform” was implemented in the state when voters turned out in record numbers to support the election of now President Obama and his message of change.   A little highlighted ballot initiative at the time reveals an insight into popular opinion on the state’s health plan.   In all ten legislative districts in the commonwealth, local ballot initiatives supporting single payer and opposing individual mandates passed by landslide margins.  With almost all precincts tallied, roughly 73 percent of 181,000 voters in the ten districts voted YES to the following:

“Should the representative from this district be instructed to support legislation creating a cost-effective single payer health insurance system that is available to all residents, and oppose laws penalizing those who fail to obtain health insurance?”

The measure passed with margins ranging from 65 to 82 percent in support of single-payer health care.

Unfortunately, the clear support for single-payer in Massachusetts and around the country falls on deaf ears of the current administration.  President Obama, in his recent remarks in the State of the Union address, opened the door for further discussion on the health care debate.  He said, “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.”

The growing movement for universal and improved Medicare has been trying to “let him know” for some time now, and will continue to do so.  Drs. Margaret Flowers and Carol Paris were recently arrested for responding to the President’s call for better ideas on how to reform the health care system.   Dr. Flowers left practice as a pediatrician because she was unable to provide quality care in this system.  They are now urging everyone to join them in letting President Obama know about Medicare for All.

We must find strength and power in our unified demand for improved Medicare for all.  Together, let’s raise our voices and let the President know that Medicare for all, a single-payer national health care plan, will meet his goals of a health plan that will save billions of dollars, tens of thousands of lives, cover everyone, strengthen Medicare, and guarantee free choice of doctor and hospital in access of quality, comprehensive health care with no financial barriers.

Please join Drs. Flowers and Paris, and the growing movement of patients, nurses, and physicians in telling President Obama that we know of a better plan for the nation than the failure in Massachusetts – Medicare 2.0 – improved Medicare for everyone.

Email him or call the White House today.

We’ve got to let him know.

http://www.michaelmoore.com/words/mike-friends-blog/let-him-know

Better approach to health care: A single payer solution for Obama

By John Marty
MinnPost
Friday, January 29, 2010

An open letter in response to President Obama’s State of the Union request for a better approach to health care reform:

Dear President Obama,

During your State of the Union address, you explained why you are fighting for health care reform, expressed frustration at the lack of success, and invited others to suggest a better approach.

I’m taking you up on that invitation and offer a bold suggestion:

Take a look at our Minnesota Health Plan — a proposal that covers everyone, saves money, and creates a logical health care system to replace the dysfunctional non-system which currently exists. It is a proposal that would provide health care to everyone, not merely health insurance for many. Our MN Health Plan (mnhealthplan.org) could be readily adapted as a nation-wide plan. It would meet each of the five requirements you mentioned in your State of the Union request:

Bring Down Premiums. Most Americans would see a big reduction in premiums because the plan would be significantly cheaper than our current health care non-system. Because the premiums for the MHP would be based on ability to pay, everyone’s premiums would be affordable. Some would pay more, but overall, costs would go down. Most people would save money, while getting the care they need and deserve. The total costs for the plan would be less than we now are paying for premiums, co-pays, deductibles, and taxes for medical programs.

Bring Down the Deficit. By keeping people healthier and by delivering quality health care efficiently, it would save hundreds of billions of dollars for the federal government, and even more for states. For example, by covering chemical dependency treatment and providing comprehensive mental health services, it would cut crime and human service costs (such as out-of-home placement of children), some of the biggest and fastest growing expenses facing state and local governments.

Cover the Uninsured. It would cover the uninsured and the under-insured. In fact it would cover everyone – 100 percent of the public.

Strengthen Medicare for Seniors (and everyone else). It would cover prescription drugs — with no “doughnut hole.” It would cover long term care, in-home care, dental, eye care, physical therapy, and medical supplies — it would cover all medical needs. And, they would have their choice of doctor, hospital, clinic, dentist — complete freedom to choose their medical providers.

Stop Insurance Company Abuses. There would be no “pre-existing conditions” to worry about, no underwriting, no denials of coverage, no “out of network” problems. I like to use the analogy of police and fire protection. When you return home to find a burglary in process and call 911, the police dispatcher does not ask if you qualify. They do not ask if you have police insurance. They do not ask whether your policy covers home burglary. They don’t ask if you have pre-existing conditions that would disqualify you. They don’t waste time and money having you fill out forms so your insurance company can be billed. The police response does not depend on your insurance status. Everyone is treated equally. It’s the American way. It is time to treat health care the same way.

As a 23 year member of the Minnesota Senate, let me comment briefly on the politics of this proposal:

The MHP is a single payer proposal. You have acknowledged that single payer is the only way to cover everyone. Seven years ago you said that single payer health care is “what I’d like to see. But… we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.” Now that we have taken back the White House and the Congress, it is time to act.

I recognize, as you do, that you do not have the votes to pass truly universal health care at this time. The insurance and pharmaceutical industries contribute so much to members of Congress — they control the debate — so health care for everyone isn’t even on the table.

This, however, is your opportunity for leadership. If you propose and fight for health care for all, as FDR did with Social Security in 1935, the voters would respond. If you don’t win this year, ask the American people to elect candidates who will stand with you. Make it the issue of the campaign: Health Care for All vs. Health Insurance for Some. Instead of losing Democratic members of Congress this year — as Massachusetts illustrates — you would gain votes and could actually pass the bill next year.

Dr. Martin Luther King stated, “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”

Almost a half century later, we still have not addressed the injustice in health care that Dr. King described as the most inhumane. Ignoring this injustice is immoral and it is economically unsustainable. People are hurting, some are literally dying, businesses are folding, and it is crushing our national economy.

Please, restore the hope that you raised in all of us, bring back the inspiration that made the American people so excited by your inauguration. I urge you to step back, reconsider, introduce a health care plan that is truly universal, and fight for it.

Justice requires no less.

State Sen. John Marty, DFL-Roseville, is a candidate for governor.

http://www.minnpost.com/community_voices/2010/01/29/15447/better_approach_to_health_care_a_single_payer_solution_for_obama

What I Have Learned “Doing Civil Disobedience for Single Payer”

By Dr. Carol Paris

“People should go where they are not supposed to go, say what they are not supposed to say, and stay when they are told to leave.”  –Howard Zinn

Well, that quote pretty well sums up “what to do”.  But my biggest challenge is “how”.  Specifically, how do I neutralize some pretty powerful fear?

I was scared Friday when I joined Margaret Flowers to attempt to deliver a message to the President.  My thoughts raced.  We’re talking secret service. 

“How do I get myself into these things?” 
“This is crazy.” 
“This is pointless.” 
“I can’t even make sensible statements; I know what I want to say but I’m so nervous.” 
“Other people are so much more knowledgeable and speak so much more eloquently.”
“But I am doing it!”

We stood in front of the Harbor Hotel in Baltimore clutching a banner that read “Letting you know.  Medicare for all” and Margaret’s letter for the President written in response to his appeal for solutions to health reform.  The hotel manager, police and secret service surrounded us and asked us to move.

If you watch the video, you’ll see that there was a point, a moment, which felt suspended in time, when Margaret looked at me and I looked at her and we both knew “we ain’t goin’ across the street.”

The feeling associated with that awareness was not fear, or anger, or self-righteous indignation.  It was a feeling of quiet liberation.  The things I was saying to myself, thoughts powerful enough to imprison me in a jailhouse of fear, had been neutralized.  In their place was a calm determination to trust my intuition. 

My gut told me “so be it.  You’re doing the best you can.  This is a no-brainer.  Gotta do it.  Margaret and I have been needing some quiet time to catch-up; might as well be in a police station.”

My gut has a great sense of humor.

Fear overcomes me when I listen to my head; calm enfolds me when I listen to my gut.

So, for what it is worth, here are few tips for “doing cd for Single Payer”:

1. Ignore your head.  That means, all those familiar thoughts that leave you feeling fearful and bad.

2. Listen to your gut.  You know it’s your gut talking if you start feeling calmness, clarity, and quiet determination.

3. We need people engaging in “gut-driven” cd to right all kinds of wrongs.  Be authentic; for many of us, the gut issue is Medicare For All.  If yours is the environment, then do cd for that. 

4. Don’t try this alone.  Take a friend. Or several.

5. Do the best you can.  Speak from your heart.  Once you’re in handcuffs, the worst is over.  The “authorities” aren’t your enemy; most will treat you respectfully and the ones who don’t are just having a bad day.  Don’t take it personally.

6. I like to take a “token” with me, tucked in my pocket with my driver’s license. For me, it’s a picture of my grandchildren and the holy card from my father’s funeral.  It reminds me that he would be proud of me and that I’m doing this for the people who inspire me–my family and my patients.

7. If you have the choice of doing cd in the winter or the summer, definitely choose summer!  Wear layers either way because it’s cold in jail.

Remember that we all have talents to contribute.  Without Bill Hughes taking the video, our action wouldn’t have been as fruitful.  Without Kevin Zeese, we’d have worried about our families and “legal stuff.”  Without Mark Almberg, we wouldn’t have a press release.  Without researchers like David Himmelstein and Steffie Woolhandler, we wouldn’t have compelling data to support us.  We draw support from each other.

As Margaret Mead said:  Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it is the only thing that ever has.”