PNHP

Private insurers, Wall Street, Tiny Tim, and my granddaughter

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Private insurers, Wall Street, Tiny Tim, and my granddaughter

3 Stocks Soaring on Health-Care Bill

By Jack Hough
SmartMoney
December 22, 2009

America is getting augmented health care for Christmas, it seems. But of course, whether the changes count as reform is a matter of opinion.

Michael Cannon, director of health policy studies for the Cato Institute, a think tank that calls itself libertarian, wrote that the bill is… “a massive $450 billion bailout for private insurance companies that will drive health insurance premiums and taxes higher…”

Insurer shares, in particular, are zooming. There are three reasons. First, stripped from the Senate bill is the so-called public option — a government health plan that threatened to undersell private insurers. Second, a proposed $6.7 billion industry tax is now likely to be phased in only gradually beginning in 2011, which should give health plans enough time to raise prices accordingly. Third, individuals will be required to purchase insurance — a fine deal for insurance sellers — although critics say the penalties for noncompliance are weak, suggesting many individuals will prefer to remain uninsured.

Below are three health-care companies whose shares are soaring…

Aetna
Stock gain since end of October: 31%

Cigna
Stock gain since end of October: 29%

WellPoint
Stock gain since end of October: 28%

http://www.smartmoney.com/investing/stocks/3-stocks-soaring-on-healthcare-bill/

And…

Health Care Stocks Booming

The Kudlow Report
CNBC
December 17, 2009

Larry Kudlow:  I want health care to grow. I want government health care to be limited. I want our private health care to grow and soar with technology and baby boomers and rising incomes. I want health care to be a third of the economy. I just don’t want all this taxing and spending.

http://www.cnbc.com/id/15840232?video=1362269505

Comment: 

By Don McCanne, MD

Many individuals, including single payer supporters, disagree with the decision of PNHP’s leadership to oppose the reform bill currently before Congress. There are two basic issues that need to be sorted out: 1) the beneficial measures in the bill, and 2) the structure of the financing system.

The beneficial measures, such as expanding community health centers and reinforcing our primary infrastructure, we support. These measures, several of which were independent bills added into the omnibus package, should be taken out and immediately enacted separately.

The expansion of health care financing, based on private health plans, is quite another matter. In spite of the various pilot proposals in the legislation, health care costs are expected to continue to increase at rates well in excess of the growth of the GDP.

The only truly effective way to control the growth in government spending that would result from the subsidies used to purchase the private plans would be to allow the subsidies to increase at a slower rate than the rate of increases in the premiums (and the proposed indexing would do that). That shifts more of the premium costs to the individuals. The only truly effective way that the increase in spending on insurance premiums can be slowed is to shift more of the costs to out-of-pocket expenses for individuals who need health care (and the low actuarial values in the legislation would do that).

The proposal begins with a financial burden that is so great for middle and upper-middle income individuals and families that tens of millions will not be able to afford coverage. The private insurance model crafted will continue to expand that burden, adding more to the ranks of the uninsured, whereas underinsurance will have become the national standard (because of the low actuarial values). After another decade or two of this we may be ready for reform that works, but at the cost of tremendous unnecessary suffering and grief.

If you enjoy suffering and grief, then support the bill before Congress. As Larry Kudlow says, let’s make health care one-third of the economy, but without all the taxing and spending. Look how well it’s working for Aetna, Cigna and WellPoint. The private insurance-based bill will work just fine, providing we tell Tiny Tim and the others like him to go to hell.

A personal note:

Obviously I’m angry. I’m especially annoyed with our friends who should know better who keep telling us that we will have nothing if this bill fails, or that we are letting the perfect be the enemy of the good, or that our second choice is the status quo, or the rest of the crap that provides them with an excuse for being strange bedfellows with the private insurance industry.

Right now I’m especially emotional. Today is our granddaughter’s tenth birthday. She was recently in intensive care with newly diagnosed Type I diabetes. Decisions now about how birthday cake will fit into her medical regimen are hardly a glimmer of the future she faces.

When we inevitably depart, my wife and I want to know that we have in place a quality health care system that will always be there for our granddaughter when she needs it. It’s what any of us would want for our loved ones. Since she herself likely will never have to face rationing based on ability to pay, I feel comfortable that she will receive the care that she should have.

But what about the others? What about hard working American families who will not be able to afford the private insurers’ ticket to health care? What patchwork system will they have to take care of their ten year old granddaughter with newly diagnosed diabetes? I want a quality system to be there for them as well, and for everyone.

We can no longer allow the mediocre to be the enemy of the perfect. We know how to fix our dysfunctional health care system, and we can do it now. If you’re not ready to support that, then you go to hell!

And… oh yes… Merry Christmas!

Pro-single-payer physicians call for defeat of Senate health bill

Legislation ‘would bring more harm than good,’ group says

For Immediate Release
Dec. 22, 2009

Contact:
David Himmelstein, M.D.
Steffie Woolhandler, M.D., M.P.H.
Oliver Fein, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

A national organization of 17,000 physicians who favor a single-payer health care system called on the U.S. Senate today to defeat the health care legislation presently before it and to immediately consider the adoption of an expanded and improved Medicare-for-All program.

While noting that the Senate bill includes some “salutary provisions” like an expansion of Medicaid, increased funding for community clinics and the curbing of some of the worst practices of the private insurance industry, the group says the negatives in the bill outweigh the positives.

The negatives, the group says, include the individual mandate requiring that people buy private insurance policies, large government subsidies to private insurers, new restrictions on abortion, the unfair taxing of high-cost health plans, and cuts of $43 billion in Medicare payments to safety-net hospitals. Moreover, at least 23 million people will remain uninsured when the plan finally takes effect, they said.

“We have concluded that the Senate bill’s passage would bring more harm than good,” the group said in a statement signed by its president, Dr. Oliver Fein, and two co-founders, Drs. David Himmelstein and Steffie Woolhandler.

Addressing the Senate in an open letter, they write: “We ask that you defeat the bill currently under debate, and immediately move to consider the single-payer approach – an expanded and improved Medicare-for-All program – which prioritizes the advancement of our nation’s health over the enhancement of private, profit-seeking interests.”

The full statement appears below.

To the Members of the U.S. Senate:

It is with great sadness that we urge you to vote against the health care reform legislation now before you. As physicians, we are acutely aware of the unnecessary suffering that our nation’s broken health care financing system inflicts on our patients. We make no common cause with the Republicans’ obstructionist tactics or alarmist rhetoric. However, we have concluded that the Senate bill’s passage would bring more harm than good.

We are fully cognizant of the salutary provisions included in the legislation, notably an expansion of Medicaid coverage, increased funds for community clinics and regulations to curtail some of private insurers’ most egregious practices. Yet these are outweighed by its central provisions – particularly the individual mandate – that would reinforce private insurers’ stranglehold on care. Those who dislike their current employer-sponsored coverage would be forced to keep it. Those without insurance would be forced to pay private insurers’ inflated premiums, often for coverage so skimpy that serious illness would bankrupt them. And the $476 billion in new public funds for premium subsidies would all go to insurance firms, buttressing their financial and political power, and rendering future reform all the more difficult.

Some paint the Senate bill as a flawed first step to reform that will be improved over time, citing historical examples such as Social Security. But where Social Security established the nidus of a public institution that grew over time, the Senate bill proscribes any such new public institution. Instead, it channels vast new resources – including funds diverted from Medicare – into the very private insurers who caused today’s health care crisis. Social Security’s first step was not a mandate that payroll taxes which fund pensions be turned over to Goldman Sachs!

While the fortification of private insurers is the most malignant aspect of the bill, several other provisions threaten harm to vulnerable patients, including:

* The bill’s anti-abortion provisions would restrict reproductive choice, compromising the health of women and adolescent girls.
   
* The new 40 percent tax on high-cost health plans – deceptively labeled a “Cadillac tax” – would hit many middle-income families. The costs of group insurance are driven largely by regional health costs and the demography of the covered group. Hence, the tax targets workers in firms that employ more women (whose costs of care are higher than men’s), and older and sicker employees, particularly those in high-cost regions such as Maine and New York.

* The bill would drain $43 billion from Medicare payments to safety-net hospitals, threatening the care of the 23 million who will remain uninsured even if the bill works as planned. These threatened hospitals are also a key resource for emergency care, mental health care and other services that are unprofitable for hospitals under current payment regimes. In many communities, severely ill patients will be left with no place to go – a human rights abuse.

* The bill would leave hundreds of millions of Americans with inadequate insurance – an “actuarial value” as low as 60 percent of actual health costs. Predictably, as health costs continue to grow, more families will face co-payments and deductibles so high that they preclude adequate access to care. Such coverage is more akin to a hospital gown than to a warm winter coat.

Congress’ capitulation to insurers – along with concessions to the pharmaceutical industry – fatally undermines the economic viability of reform. The bill would inflate the already crushing burden of insurance-related paperwork that currently siphons $400 billion from care annually. According to CMS’ own projections, the bill will cause U.S. health costs to increase even more rapidly than presently, and budget neutrality is to be achieved by draining funds from Medicare and an accounting trick – front-loading the new revenues while delaying most new coverage until 2014. As homeowners seduced into balloon mortgages have learned, pushing costs off to the future is neither prudent nor sustainable.

We ask that you defeat the bill currently under debate, and immediately move to consider the single-payer approach – an expanded and improved Medicare-for-All program – which prioritizes the advancement of our nation’s health over the enhancement of private, profit-seeking interests.

Oliver Fein, M.D., President
David U. Himmelstein, M.D., Co-founder
Steffie Woolhandler, M.D., M.P.H., Co-founder
Physicians for a National Health Program

************

Physicians for a National Health Program (www.pnhp.org) is an organization of 17,000 doctors who advocate for single-payer national health insurance. To contact a physician-spokesperson near you, visit www.pnhp.org/stateactions or call (312) 782-6006.

PNHP's Letter to the Members of the Senate

Physicians for a National Health Program
December 22, 2009

To the Members of the U.S. Senate:

It is with great sadness that we urge you to vote against the health care reform legislation now before you. As physicians, we are acutely aware of the unnecessary suffering that our nation’s broken health care financing system inflicts on our patients. We make no common cause with the Republicans’ obstructionist tactics or alarmist rhetoric. However, we have concluded that the Senate bill’s passage would bring more harm than good.

We are fully cognizant of the salutary provisions included in the legislation, notably an expansion of Medicaid coverage, increased funds for community clinics and regulations to curtail some of private insurers’ most egregious practices. Yet these are outweighed by its central provisions – particularly the individual mandate – that would reinforce private insurers’ stranglehold on care. Those who dislike their current employer-sponsored coverage would be forced to keep it. Those without insurance would be forced to pay private insurers’ inflated premiums, often for coverage so skimpy that serious illness would bankrupt them. And the $476 billion in new public funds for premium subsidies would all go to insurance firms, buttressing their financial and political power, and rendering future reform all the more difficult.

Some paint the Senate bill as a flawed first step to reform that will be improved over time, citing historical examples such as Social Security. But where Social Security established the nidus of a public institution that grew over time, the Senate bill proscribes any such new public institution. Instead, it channels vast new resources – including funds diverted from Medicare – into the very private insurers who caused today’s health care crisis. Social Security’s first step was not a mandate that payroll taxes which fund pensions be turned over to Goldman Sachs!

While the fortification of private insurers is the most malignant aspect of the bill, several other provisions threaten harm to vulnerable patients, including:

* The bill’s anti-abortion provisions would restrict reproductive choice, compromising the health of women and adolescent girls.

* The new 40 percent tax on high-cost health plans – deceptively labeled a “Cadillac tax” – would hit many middle-income families. The costs of group insurance are driven largely by regional health costs and the demography of the covered group. Hence, the tax targets workers in firms that employ more women (whose costs of care are higher than men’s), and older and sicker employees, particularly those in high-cost regions such as Maine and New York.

* The bill would drain $43 billion from Medicare payments to safety-net hospitals, threatening the care of the 23 million who will remain uninsured even if the bill works as planned. These threatened hospitals are also a key resource for emergency care, mental health care and other services that are unprofitable for hospitals under current payment regimes. In many communities, severely ill patients will be left with no place to go – a human rights abuse.

* The bill would leave hundreds of millions of Americans with inadequate insurance – an “actuarial value” as low as 60 percent of actual health costs. Predictably, as health costs continue to grow, more families will face co-payments and deductibles so high that they preclude adequate access to care. Such coverage is more akin to a hospital gown than to a warm winter coat.

Congress’ capitulation to insurers – along with concessions to the pharmaceutical industry – fatally undermines the economic viability of reform. The bill would inflate the already crushing burden of insurance-related paperwork that currently siphons $400 billion from care annually. According to CMS’ own projections, the bill will cause U.S. health costs to increase even more rapidly than presently, and budget neutrality is to be achieved by draining funds from Medicare and an accounting trick – front-loading the new revenues while delaying most new coverage until 2014. As homeowners seduced into balloon mortgages have learned, pushing costs off to the future is neither prudent nor sustainable.

We ask that you defeat the bill currently under debate, and immediately move to consider the single-payer approach – an expanded and improved Medicare-for-All program – which prioritizes the advancement of our nation’s health over the enhancement of private, profit-seeking interests.

Oliver Fein, M.D., President
David U. Himmelstein, M.D., Co-founder
Steffie Woolhandler, M.D., M.P.H., Co-founder
Physicians for a National Health Program

https://pnhp.org/news/2009/december/pro-single-payer-physicians-call-for-defeat-of-senate-health-bill

Comment:

By Don McCanne, MD

reform (noun): 1) amendment of what is defective, vicious, corrupt, or depraved, 2) a removal or correction of an abuse, a wrong, or errors (Merriam-Webster)

In this day when cognitive processes are often displaced by political sound bites, we are likely to hear that PNHP IS AGAINST REFORM!

That is the exact opposite of the truth. PNHP has long advocated for reform that will bring everyone the health care that they need without being exposed to financial hardship.

But we want real reform. We want to replace the “defective, vicious, corrupt, and depraved” private insurance industry with a proven model that will work: an expanded and improved Medicare-for-All program.

For those who say that there are too many beneficial features in this bill that we can’t afford to pass up, our response is that we can pull those out and enact them immediately.

For those who say that we can’t do it because of politics, our response is that then we must change the politics.

Absolutely everyone agrees that the legislation before Congress falls far short of what we need. On the other hand, a great many agree that an expanded and improved Medicare-for-All program is precisely what we need. If it were already in place, Americans would be aggressively protecting it, just as our seniors are protecting our current Medicare program.

So when people grumble that PNHP is not a team player, you can respond by saying that’s because PNHP DEMANDS REFORM!

PNHP’s Letter to the Members of the Senate

Physicians for a National Health Program
December 22, 2009

To the Members of the U.S. Senate:

It is with great sadness that we urge you to vote against the health care reform legislation now before you. As physicians, we are acutely aware of the unnecessary suffering that our nation’s broken health care financing system inflicts on our patients. We make no common cause with the Republicans’ obstructionist tactics or alarmist rhetoric. However, we have concluded that the Senate bill’s passage would bring more harm than good.

We are fully cognizant of the salutary provisions included in the legislation, notably an expansion of Medicaid coverage, increased funds for community clinics and regulations to curtail some of private insurers’ most egregious practices. Yet these are outweighed by its central provisions – particularly the individual mandate – that would reinforce private insurers’ stranglehold on care. Those who dislike their current employer-sponsored coverage would be forced to keep it. Those without insurance would be forced to pay private insurers’ inflated premiums, often for coverage so skimpy that serious illness would bankrupt them. And the $476 billion in new public funds for premium subsidies would all go to insurance firms, buttressing their financial and political power, and rendering future reform all the more difficult.

Some paint the Senate bill as a flawed first step to reform that will be improved over time, citing historical examples such as Social Security. But where Social Security established the nidus of a public institution that grew over time, the Senate bill proscribes any such new public institution. Instead, it channels vast new resources – including funds diverted from Medicare – into the very private insurers who caused today’s health care crisis. Social Security’s first step was not a mandate that payroll taxes which fund pensions be turned over to Goldman Sachs!

While the fortification of private insurers is the most malignant aspect of the bill, several other provisions threaten harm to vulnerable patients, including:

* The bill’s anti-abortion provisions would restrict reproductive choice, compromising the health of women and adolescent girls.

* The new 40 percent tax on high-cost health plans – deceptively labeled a “Cadillac tax” – would hit many middle-income families. The costs of group insurance are driven largely by regional health costs and the demography of the covered group. Hence, the tax targets workers in firms that employ more women (whose costs of care are higher than men’s), and older and sicker employees, particularly those in high-cost regions such as Maine and New York.

* The bill would drain $43 billion from Medicare payments to safety-net hospitals, threatening the care of the 23 million who will remain uninsured even if the bill works as planned. These threatened hospitals are also a key resource for emergency care, mental health care and other services that are unprofitable for hospitals under current payment regimes. In many communities, severely ill patients will be left with no place to go – a human rights abuse.

* The bill would leave hundreds of millions of Americans with inadequate insurance – an “actuarial value” as low as 60 percent of actual health costs. Predictably, as health costs continue to grow, more families will face co-payments and deductibles so high that they preclude adequate access to care. Such coverage is more akin to a hospital gown than to a warm winter coat.

Congress’ capitulation to insurers – along with concessions to the pharmaceutical industry – fatally undermines the economic viability of reform. The bill would inflate the already crushing burden of insurance-related paperwork that currently siphons $400 billion from care annually. According to CMS’ own projections, the bill will cause U.S. health costs to increase even more rapidly than presently, and budget neutrality is to be achieved by draining funds from Medicare and an accounting trick – front-loading the new revenues while delaying most new coverage until 2014. As homeowners seduced into balloon mortgages have learned, pushing costs off to the future is neither prudent nor sustainable.

We ask that you defeat the bill currently under debate, and immediately move to consider the single-payer approach – an expanded and improved Medicare-for-All program – which prioritizes the advancement of our nation’s health over the enhancement of private, profit-seeking interests.

Oliver Fein, M.D., President
David U. Himmelstein, M.D., Co-founder
Steffie Woolhandler, M.D., M.P.H., Co-founder
Physicians for a National Health Program

https://www.pnhp.org/news/2009/december/pro-single-payer-physicians-call-for-defeat-of-senate-health-bill

Comment:

By Don McCanne, MD

reform (noun): 1) amendment of what is defective, vicious, corrupt, or depraved, 2) a removal or correction of an abuse, a wrong, or errors (Merriam-Webster)

In this day when cognitive processes are often displaced by political sound bites, we are likely to hear that PNHP IS AGAINST REFORM!

That is the exact opposite of the truth. PNHP has long advocated for reform that will bring everyone the health care that they need without being exposed to financial hardship.

But we want real reform. We want to replace the “defective, vicious, corrupt, and depraved” private insurance industry with a proven model that will work: an expanded and improved Medicare-for-All program.

For those who say that there are too many beneficial features in this bill that we can’t afford to pass up, our response is that we can pull those out and enact them immediately.

For those who say that we can’t do it because of politics, our response is that then we must change the politics.

Absolutely everyone agrees that the legislation before Congress falls far short of what we need. On the other hand, a great many agree that an expanded and improved Medicare-for-All program is precisely what we need. If it were already in place, Americans would be aggressively protecting it, just as our seniors are protecting our current Medicare program.

So when people grumble that PNHP is not a team player, you can respond by saying that’s because PNHP DEMANDS REFORM!

The wisdom of a legislated medical loss ratio

Democrats Move To Regulate How Insurers’ Spend Customers’ Money

By Julie Appleby
Kaiser Health News
December 20, 2009

Both the House measure and the newly recast Senate bill would force insurers to spend the vast majority of premium revenue on medical care for their customers, reducing the amount available for profits, executive salaries, sales and administration. The Senate bill would require insurers to spend at least 80 percent on medical care and quality improvements (85 percent minimum for plans sold to large groups), while the House bill specifies 85 percent.

Congressional supporters say those provisions would pressure insurance companies to be more efficient and help restrain price increases. But even some advocates say companies could game the system by broadly defining medical costs, for example. And spending limits alone may not stop insurers from raising rates. When New York State tried to limit non-medical care spending, many insurers companies complied – but still instituted double-digit rate increases.

http://www.kaiserhealthnews.org/Stories/2009/December/20/insurers.aspx

Comment: 

By Don McCanne, MD

If we are serious about providing everyone with health care while controlling costs, it is imperative that we reduce the profound administrative waste of our current fragmented system of financing health care.

Insurers consume typically about 18 percent of premium dollars (range 8 to 30 percent or sometimes even 50 percent), and they place an administrative burden on physicians and hospitals that consumes another 12 percent or so of the premium dollar. Thus about one-fourth to one-third of premiums paid to private insurers are largely wasted on just the administration of the health care finances. A single, universal, publicly-administered program can provide the same or better financing services for a small fraction of that level of administrative spending.

Congress and the Obama administration understand this waste, so what do they propose? They are going to limit the private insurers take of the premium to 15 to 20 percent, not much different from the typical 18 percent they are already consuming. And they will do very little to reduce the administrative burden placed on physicians and hospitals (suggesting that they use computers for billing, which they already do). Change we can believe in? Not much change here.

At our nearly intolerable level of health care spending, reducing this waste should have been one of the highest priorities during the reform process. It is unthinkable that we would allow the private insurance industry to continue to skim off a major portion of our health care dollars while inflicting this costly burden on the health care delivery system. Unthinkable, but that’s exactly what Congress is doing.

Think a moment about the irony of Congress’s decision to set in stone a medical loss ratio of 80 to 85 percent, meaning that they must spend that amount on patient care. That means that they have an ironclad guarantee, written into law, that they can keep 15 to 20 percent of the premiums they receive – our health care dollars.

Think of what that means. Though a public financing program is designed to use our dollars efficiently through a public service model, private insurer financing is designed on a business model. That business model dictates that they do everything possible to maximize revenues and, of course, profits for the investor-owned companies.

By fixing the insurers’ cut at a percentage of gross premium revenues, they can no longer reach down into the funds allocated for patient care, preventing medical loss ratios in the 50 to 80 percent range. The actual net revenues for the insurers would be the 15 to 20 percent that they keep.

If they can’t glom on to more of the health care dollars actually spend on care, then how do they increase their revenues? Since their revenues are limited to a percentage based on how much is spent on health care, to increase their own net revenues they are highly incentivized to dramatically increase spending on health care! The more dollars they throw at health care, the more their net revenues grow since they receive a fixed percentage of all dollars spent.

Just imagine entrepreneurial innovation at work. They will encourage every imaginable program that they can label as patient care because they will receive a fixed percentage of the spending on those programs. Think of it: more expensive electronic medical records and information technology systems, more home health services with a motorized scooter for each level in the home, more costly high-tech services regardless of demonstrated value, higher-priced brand drugs instead of generics, six-figure biologics and cancer drugs, rewarding increased frequency and intensity of services, and, the clincher, blinders to the massive fraud that would be rewarded under this system!

The hurdle cleared by the Senate reform bill in the early morning hours today has made it quite likely that President Obama will be signing the bill within the next several weeks. This should not be construed as a signal for supporters of health care justice to go into hibernation!

There are many measures in this bill that will benefit the nation, but the fundamental structure of a dysfunctional, fragmented financing system based on private insurance plans is a disaster and cannot possibly achieve the goal of affordable, high quality care for everyone.

The mandate for individuals to purchase private health plans will not begin until 2014. We still have a window of opportunity to educate, intensify grassroots efforts, intensify coalition efforts, and get this thing fixed! But we can’t wait for four more years to recharge our activism. Get off your duffs now!

Sen. Bernie Sanders on his amendment for single payer

By DANIEL BARLOW, Vermont Press Bureau
Times Argus (Barre, Vt.), Dec. 17, 2009

MONTPELIER – U.S. Sen. Bernard Sanders was expecting to make history Wednesday.

Instead, his amendment to create a single-payer health care system was used as a tool by Senate Republicans to create gridlock in the chamber as they sought to derail the health care reform plans of Democrats and President Barack Obama.

“That is an outrage,” said the Vermont independent on the floor of the Senate Wednesday afternoon. “People can have honest disagreements, but in this moment of crisis it is wrong to bring the United States government to a halt.”

Sanders’ proposal wasn’t going to garner many votes on the Senate floor, but it would have been the first time that a single-payer health care system was debated and voted on by Congress. Single-payer supporters saw that as a positive step forward.

But when Sanders introduced his amendment, Sen. Tom Coburn, R-OK, asked that it be read in its entirety before a vote, an unusual move given that the readings of most proposals are waived as a courtesy and for the sake of time.

Sanders’ amendment is 767 pages long. After 20 minutes, a Senate clerk got through reading the table of contents. Three hours later, a reluctant Sanders withdrew his amendment.

And then he unloaded on his Republican colleagues in the Senate.

“Everybody in this country understands that our nation faces a significant number of major crises, whether it is the disintegration of our health care system, the fact that 17 percent of our people are unemployed or underemployed, one out of four of our children are living on food stamps, we’ve got two wars, we’ve got global warming, we have a $12 trillion national debt,” Sanders said.

“And the best the Republicans can do is try to bring the United States government to a halt by forcing a reading of a 700-page amendment,” he concluded.

Sanders’ amendment to the health care reform bill would have created a single-payer system by allowing all Americans – regardless of age – to be covered by Medicare. [PNHP note: original version erroneously reported everyone could buy into Medicare.] The system would be funded federally through payroll and incomes taxes, but administered on a state level.

“This amendment starts from the premise that health care is a human right and that every citizen, rich or poor, should have access to health care, just as every citizen has access to the fire department, the police or public schools,” Sanders said.

Republicans defended the gridlock created by forcing a reading of the bill.

“I admire Sen. Sanders for his willingness to fight for publicly what many advocate only privately – a single payer health care system funded and controlled by bureaucrats and politicians in Washington,” Coburn said in a statement. “Every American should listen to the reading of this amendment and pay careful attention to its vote tally.”

In a phone interview after the debate, Sanders said he was “very disappointed” in the Republican leadership for effectively blocking a vote on a single-payer system. He said it is part of a pattern for the party to obstruct and delay in order to take down President Obama.

“They don’t want to do anything about health care and they don’t want to do anything about the economy because they want to point to President Obama as a failure,” Sanders said. “This is no secret. This is the goal of the Republican Party right now.”

Sanders said a request from Majority Leader Harry Reid, a Democrat, convinced him to pull the amendment from consideration. Reading the whole bill would have taken 10-15 hours, Sanders said, and a pressing vote on the new defense budget was scheduled for later that evening.

“I’ve been told that if there are more amendments to be considered, mine is at the top of the list,” Sanders said, adding that his single-payer plan still exists as a separate bill introduced earlier this year.

Forcing the reading of the single-payer amendment was just the latest attempt by Republicans “to suppress any debate on health care reform,” said Dr. Quentin Young, the national coordinator for Physicians for a National Health Program, a Chicago-based organization representing 17,000 medical professionals.

“This was a cynical and obvious move,” said Young, who described the country’s health care system as deteriorating.

Young didn’t hold Democrats free of criticism either, however. He said the bill considered by the Senate – which has been stripped of the public health insurance option and the Medicare expansion – is “a giant step backwards.” He said Sanders should vote against the bill.

“The President’s role in this has been shameful,” said Young, who was Obama’s friend and neighbor during the President’s early days as a politician in Chicago. “He’s backed off all of his campaign promises while caving into the insurance industry.”

Sanders said Wednesday that he has not decided yet how to vote on the bill, which now lacks many of the proposals he saw as vital to reform.

“The loss of the public option and the Medicare buy-in were serious blows,” Sanders said. “But, no, I haven’t made up my mind.”

Sanders’ Vermont colleague, U.S. Sen. Patrick Leahy, D-Vt., said in a statement that opponents of health care reform have “thrown around all manner of distortions about Canada’s single-payer system.”

“With his amendment, Sen. Sanders has helped inject some balance into the debate,” Leahy said. “Sen. Coburn may have intended to further obstruct and distort, but his stalling tactics actually have given the Sanders amendment a brighter spotlight.”

While on the Senate floor Wednesday, Sanders struck an optimistic tone, saying it is only a matter of time before the United States joins the rest of the major industrialized nations in the world by creating a single-payer health care system.

“The day will come when the country will do the right thing,” Sanders said.

daniel.barlow@timesargus.com

http://www.timesargus.com/apps/pbcs.dll/article?AID=/20091217/NEWS01/912170342/

CDC/NHIS – uninsured and underinsured

Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey (NHIS), January - June 2009

by Michael E. Martinez, M.P.H., M.H.S.A., and Robin A. Cohen, Ph.D., Division of Health Interview Statistics, National Center for Health Statistics
Centers for Disease Control and Prevention (CDC)
National Center for Health Statistics (NCHS)

From January to June 2009, 45.4 million persons of all ages (15.1%) were uninsured at the time of interview, 58.4 million (19.4%) had been uninsured for at least part of the year prior to interview, and 31.9 million (10.6%) had been uninsured for more than a year at the time of interview.

From January to June 2009, 60.6% of unemployed adults aged 18-64 years and 21.8% of employed adults in this age group had been uninsured for at least part of the past year. Also, 32.9% of unemployed adults aged 18-64 and 13.3% of employed adults in this age group had been uninsured for more than a year.

Estimates of enrollment in HDHPs, CDHPs

Based on data from the January to June 2009 NHIS, 22.7% of persons under age 65 years with private health insurance were enrolled in a HDHP (high-deductible health plan), including 6.4% who were enrolled in a CDHP (consumer-directed health plan) and 16.4 % who were enrolled in a HDHP without a health savings account (HSA). Enrollment in HDHPs increased from 17.5% in 2007 to 22.7% in the first 6 months of 2009. There was a significant increase in enrollment in HDHPs without HSAs and in CDHPs between 2007 (when NHIS started collecting this information) and June 2009.

Based on data from the first 6 months of 2009, among persons under age 65 with private health insurance, 20.3% with employer-based coverage were enrolled in a HDHP, compared with 48.7% of those with a private plan that was directly purchased or obtained through means other than an employer. The percentage of persons covered by employer-based private plans that are HDHPs increased from 15.6% in 2007 to 20.3% in the first 6 months of 2009. The percentage of persons covered by directly purchased private health plans that are HDHPs increased from 39.2% in 2007 to 48.7% in the first 6 months of 2009. HDHPs constitute a growing share of both employment-based and directly purchased health plans.

http://www.cdc.gov/nchs/data/nhis/earlyrelease/insur200912.htm

Comment: 

By Don McCanne, MD

One-fifth of the nation has been uninsured for at least a part of the past year. What makes that number even more alarming is that, at the beginning of the reform process, President Obama and the Congress decided, in deference to the private insurance industry, that they wouldn’t even begin to try to insure everyone. Instead they decided to include just those who would fit in under under their model that is designed to nurture the private insurance industry.

Still even more alarming is the insurance coverage that they propose. The standard policies for middle-income Americans will have an actuarial value of 60% to 70%, which provides much less financial protection than did more traditional employer-sponsored plans. But look what is already happening. Employers are shifting more workers to high-deductible health plans (HDHPs), and in the individual insurance market, almost half of the plans purchased are HDHPs. Furthermore, almost three-fourths of these do not have the backup of a health savings account (HSA).

Except for relatively wealthy individuals, these HDHPs are underinsurance products. They do not provide adequate financial security for those who do develop health care needs.

So President Obama and the Congress are bailing on not only on the tens of millions who will remain uninsured, but also the ever growing number of us who will be underinsured, whether through individual or employer-sponsored plans.

The status quo is unacceptable, but so is this legislation. Dump it and move on immediately with reform that protects the financial well-being of absolutely everyone who needs medical care.

Open Letter to the United States Senate

Dear Colleague:

We invite you to add your signature to the Open Letter from physicians and medical students.  It urges senators to defeat the bill now before them, and immediately start over on health reform.

While the Open Letter decries the current bill’s capitulation to private insurers, it does not advocate a specific alternative.  At this moment it’s essential to combine the voices of colleagues who believe that only a single payer reform will suffice and those who believe that a robust public option is acceptable, or even preferable.

Because of the impending Senate vote, time is of the essence. Add your signature, and circulate this letter to as many additional colleagues as possible.

To the Members of the U.S. Senate:

It is with great sadness that we urge you to vote against the health care reform legislation now before you.  As physicians, we are acutely aware of the unnecessary suffering that our nation’s broken healthcare financing system inflicts on our patients. We make no common cause with the Republicans’ obstructionist tactics or alarmist rhetoric. However, we have reluctantly concluded that the Senate bill is now so compromised that its passage would bring more harm than good.

We are fully cognizant of the many salutary provisions included in the legislation, notably an expansion of Medicaid coverage, increased funds for community clinics and regulations to curtail some of private insurers’ most egregious practices.  Yet these are outweighed by its central provisions – particularly the individual mandate – that would reinforce insurers’ stranglehold on care.  Those who dislike their current employer-sponsored coverage would be forced to keep it.  Those without insurance would be forced to pay private insurers’ inflated premiums, often for coverage so skimpy that serious illness could bankrupt them.  And the more than $400 billion in new public funds for premium subsidies would all go to insurance firms, buttressing their financial and political power, and rendering future reform all the more difficult.

Moreover, this capitulation to insurers – along with concessions to the pharmaceutical industry – fatally undermines the economic viability of reform.  Despite leaving at least 24 million uninsured and draining substantial funds from Medicare, the Senate bill would actually raise overall health spending.  The much ballyhooed goal of budget neutrality over the next 10 years is to be achieved through an accounting trick – front-loading the new revenues while delaying most new coverage until 2014.  As homeowners seduced into balloon mortgages have learned, pushing costs off to the future is neither prudent nor sustainable.

We ask that you defeat the bill currently under debate, and immediately move to consider alternatives which prioritize the advancement of our nation’s health over the enhancement of private interests.

Health Study for Chicago: Health Gap Widens Between Blacks, Whites

By Deborah L. Shelton
The Chicago Tribune, Dec. 18, 2009

A widening gulf in the health status of blacks and whites in Chicago comes even as disparities between the two races nationally have remained relatively constant, a new study has found.

The disparity is particularly jarring in five areas: death from all causes, heart disease mortality, breast cancer mortality, rates of tuberculosis and the percentage of women who received no prenatal care during the first trimester of pregnancy.

Nationally, the racial gap got worse from 1990 to 2005 for six of the 15 health indicators researchers studied. However, in Chicago, disparities worsened for 11 of the 15 indicators, according to research by the Sinai Urban Health Institute, published online Thursday in the American Journal of Public Health.

Poverty, segregation and access to health care all appear to play a role, researchers said. In Chicago neighborhoods and medical offices, doctors and patients see the same factors.

Dr. Charles Barron, medical director at Access Southwest Family Health Center, said many of his patients struggle to pay for health care.

“Access is definitely an issue, even at federally qualified health centers such as Access Community Health Network, which offers treatment on a sliding-scale basis,” he said.

Tonya Jackson, 39, of North Lawndale, takes seven medications to treat heart failure. She is a patient at Mount Sinai Hospital, which is widely known for its initiatives to treat low-income and poor patients.

“Even with health insurance, a lot of medicines are very expensive,” she said. “When you’re a single parent, you’re trying to pay rent, you have your child, and you’re trying to pay bills and buy food, so it’s difficult. A lot of people don’t get the care they need because they have to decide whether they want to eat that day.”

Dr. Niva Lubin-Johnson, an African-American physician, has witnessed the disparities firsthand in her 20-year solo practice in Chatham.

“Based on what I see,” she said, “we have a greater disease burden, and part of that comes from lifestyle, part of it comes from income, part of it comes from health literacy and people not understanding what they need to do to live a healthy lifestyle.”

An author of the study, institute director Steve Whitman, previously has compared breast cancer disparities in Chicago and New York. He said the health of African-Americans in Chicago fares worse than blacks elsewhere.

“The underlying issue here is racism and poverty,” Whitman said. “In Chicago, it’s exacerbated by segregation. Black people in Chicago are forced to live in neighborhoods where there are no stores to buy fresh fruits and vegetables, where schools are failing, where they don’t have parks to exercise in and where they tend to go to segregated health facilities that are poorly funded and, in different ways, failing.”

Dr. Georges Benjamin, executive director of the American Public Health Association, cautioned about making geographic comparisons.

“While it is important to measure an urban city like Chicago against national numbers,” Benjamin said, “the national statistics include lots of places where some of the challenges of racial disparity don’t exist.

“When you average numbers out — even though researchers try statistically to correct for some of those things — you have to be cautious.”

But he agreed that racial disparities appear to be worsening in Chicago.

“Despite Chicago’s … transit system, it still has pockets of people where people have tremendous problems accessing care, and that’s a huge overlay,” Benjamin said. “Part of it is lack of insurance, and part of it is access to care.”

Ultimately, money might matter most when it comes to good health, Benjamin said.

“If we were serious about doing something about eliminating these disparities, we would pay attention to the social determinants of health that put people in these situations to begin with,” he said. “At the end of the day, there is very strong correlation between health and wealth.”

Sinai researchers analyzed the 15 measures using data from city communicable disease records and Illinois birth and death records.

The study builds on work published in 2004, believed to be the first to examine the health of blacks and whites in a major urban center over time and put findings in the context of national trends.

Researchers reported that the African-American death rate from breast cancer was 99 percent higher in Chicago than for white women, a fivefold increase since 1990.

In 1990, blacks in Chicago were 8 percent more likely than whites to die of heart disease.

In 2005, blacks were 24 percent more likely to die.

In 1990, black women were two times more likely to go without prenatal care in the first trimester of pregnancy. By 2005, they were three times more likely to go without prenatal care.

Most of the measures showed improved health for both blacks and whites nationally and locally, but whites’ health status improved much more, widening the gap.

If health indicators were equal, 3,200 fewer African-Americans in Chicago would die every year, or about nine a day, the study estimates.

Joseph M. Harrington, assistant commissioner for chronic disease for the Chicago Department of Public Health, agreed that the problem in Chicago is significant.

“But,” he said, “what do we do about it? You can keep talking about how bad the numbers are, but the real question is, what do you plan to do?”

The city health department has initiated programs to address the problem, including a federally funded project focused on cardiovascular disease among blacks and Hispanics living in North and South Lawndale, Harrington said.

“These findings should provoke us to think about what can be done, that’s the call to action,” Harrington said.

“This should provoke us to do something.”

dshelton@tribune.com

American Journal of Public Health, 10.2105/AJPH.2009.165407
Dec. 17, 2009, First Look online
“Black–White Health Disparities in the United States and Chicago: A 15-Year Progress Analysis”
By Jennifer M. Orsi, Helen Margellos-Anast, Steven Whitman

http://www.chicagotribune.com/health/chi-chicago_health_gapdec18,0,628023.story

Better to Start Over Than to Pass These Bills

By Athena Godet-Calogeras, Peter Mott and Andrew Coates
The Buffalo News, Dec. 17, 2009

You might think that all of us who have worked so long and so hard for comprehensive and affordable health care would be jumping with joy at the recent passage of a House bill and the opening of the Senate debate on health insurance reform. Not so.

In fact, many of us, including some in Congress who are ardent proponents of universal health care — like Rep. Eric Massa, D-Corning— are convinced that the route to comprehensive and affordable health care has taken a dramatically wrong turn.

The main features of the legislation have often seemed obscure, despite unprecedented amounts of attention. For instance, neither a “government takeover” nor a “public option” really have anything much to do with the final bills.

Instead the centerpiece of the House bill will not start until 2013 (2014 in the Senate bill) and at that time health insurance will become mandatory for virtually every person, every family. Being uninsured could become a crime, punishable by an annual fine of up to 2.5 percent of adjusted income under the House bill. The fine in the Senate bill is lower, $95 per person starting in 2014, rising to $750 by 2019.

To make insurance affordable, tax money will be used to subsidize private insurance premiums for those who earn up to 400 percent of the federal poverty level. Even with these subsidies, presently uninsured families with income between 200 percent and 400 percent of poverty will be required to spend 8 percent to 12 percent of their income to purchase insurance. Meanwhile the insurance companies stand to gain tens of millions of new customers and at least $447 billion in taxpayer subsidies.

The bills in Congress offer no meaningful cost controls. Mild promises to “bend the cost curve” fall short when even middle-income people will still end up being saddled with huge, unsustainable health care costs.

Neither will the bills make health coverage universal. By 2019 the House bill still leaves at least 17 million uninsured in the United States. The Senate bill would do less.

Nor will the bills do anything substantial about the high cost of drugs. That is why the pharmaceutical industry has spent hundreds of millions of dollars to help pass the legislation.

We agree with Massa. These “solutions” in Congress will not fix the problems we face. We do not need “insurance reform.” We need health care, comprehensive and affordable for everyone. And we need it now, not over the next four to 10 years.

Congress should reboot the process and start with a proposal for workable reform: a single-payer, national health program, an expanded and improved Medicare for all.

Athena Godet-Calogeras is chairwoman of the Health Care Access Coalition (Allegany/ Olean). Peter Mott, M. D., is associate professor (retired) of community medicine at the University of Rochester. Andrew Coates, M. D., is assistant professor of medicine and psychiatry at Albany Medical College.

http://www.buffalonews.com/149/story/896953.html

U.S. Study: 1 in 5 Lost Health Insurance in Past Year

By Susan Heavey
ABC News (Reuters), Dec. 16, 2009

WASHINGTON (Reuters) – Nearly 20 percent of the U.S. population — or almost 60 million people — went without health insurance at some point since January 2008, according to government estimates released Wednesday.

The analysis by the Centers for Disease Control and Prevention comes as Democratic senators wrestle to pass their version of health reform legislation before the end of the year to help make good on President Barack Obama’s top domestic goal of overhauling the nation’s $2.5 trillion healthcare system.

Much of the focus so far has been on how to expand access to health insurance in a nation where coverage is closely tied to employment but 10 percent of the work force in unemployed. More than 45 million people are uninsured.

While the CDC’s findings largely backed that figure, they also found 58.4 million lacked coverage at some point in the year prior to the survey, while 31.9 million — or nearly 11 percent — did not have insurance for more than a year.

Two-thirds of those who did not have coverage for at least part of the time were unemployed working-age adults. Those most likely to lack health coverage were Hispanics, men and young adults ages 18 to 24, the CDC found.

The CDC’s National Center for Health Statistics analyzed data on 32,694 people who responded from January through June 2009 as part of an ongoing survey.

At a time when much of the debate on the Senate bill has focused on its inclusion of a government-run “public option” insurance plan, the CDC found 20 percent of children and adults age 64 or younger are already covered by government health programs. Democrats plan to strip the public option before the full Senate votes.

The Medicaid program helps cover many of the poor, including children. Youth can also get care under the Children Health Insurance Program, which was extended by lawmakers earlier this year. Younger people with disabilities could also be covered under Medicare, which covers those age 65 or older.

One bright spot in the report: more children received health coverage, largely through the government.

The number of children enrolled in government health insurance programs also rose from 34.2 percent in 2008 to 37.4 percent in the first half of 2009, according to the study.

Overall, 8.2 percent of children still lack health care coverage, it found.

(Reporting by Susan Heavey, editing by Anthony Boadle)

Sen. Sanders' floor speech on his single payer amendment

United States Senate
December 16, 2009

The reading of the Sanders single payer amendment continues in its third hour…

Senate President: The Senator from Vermont.

Sen. Bernie Sanders: I withdraw my amendment.

Voice off camera (believed to be Sen. Tom Coburn): Regular order, Mr. President.

Senate President: The Senator has that right. The amendment is withdrawn.

Sen. Sanders:  Mr. President. Pursuant to the thirty minutes…

Senate President: Under the previous order, the Senator from Vermont is recognized for thirty minutes.

Sen. Sanders: Mr. President, let me begin, not by talking about my amendment, but by talking about Republican action right here on the floor of the Senate. Everybody in this country understands that our nation faces a significant number of major crises, whether it’s the disintegration of our health care system, the fact that seventeen percent of our people are unemployed or underemployed, one out of four of our children are living on food stamps, we’ve got two wars, we’ve got global warming, we have a twelve trillion dollar national debt, and the best the Republicans can do is try to bring the United States government to a halt by forcing a reading of a seven hundred page amendment. That is an outrage! People can have honest disagreements, but in this moment of crisis it is wrong to bring the United States government to a halt.

Now, Mr. President, I am very disturbed that I am unable to bring the amendment that I wanted to bring to the floor of the Senate dealing with a Medicare for all single payer program…

… I was more than aware and very proud that this amendment would have been the first time in American history that a Medicare for all single payer bill was brought before a floor of Congress.

C-SPAN video of Sen. Sanders remarks (36 minutes):
http://www.c-span.org/Watch/Media/2009/12/16/Health/A/27367/Sen+Bernard+Sanders+IVT+Senate+Floor+Remarks+on+Single+Payer+Amendment.aspx

Comment: 

By Don McCanne, MD

Yesterday’s Quote of the Day message left off as the reading of the the Sanders amendment to the Senate health reform bill continued. It was suggested that this abuse of process and lack of civility on the part of Sen. Coburn and the Republican leadership be used as a teaching moment. That moment is here. The video of this Senate floor speech by Sen. Sanders should be shared with others who believe that everyone in our nation should have the health care that they need without having to face financial hardship.