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CBO report on premiums

An Analysis of Health Insurance Premiums Under the Patient Protection and Affordable Care Act

Congressional Budget Office
November 30, 2009

The analysis looks separately at the effects on premiums for coverage purchased individually, coverage purchased by small employers, and coverage provided by large employers.

Nongroup Policies

Average premiums per policy in the nongroup market in 2016 would be roughly $5,800 for single policies and $15,200 for family policies under the proposal, compared with roughly $5,500 for single policies and $13,100 for family policies under current law.

The majority of nongroup enrollees (about 57 percent) would receive subsidies via the new insurance exchanges, and those subsidies, on average, would cover nearly two-thirds of the total premium, CBO and JCT estimate.

Employment-Based Coverage

By CBO and JCT’s estimate, the average premium per policy in the small group market would be in the vicinity of $7,800 for single policies and $19,200 for family policies under the proposal, compared with about $7,800 and $19,300 under current law. In the large group market, average premiums would be roughly $7,300 for single policies and $20,100 for family policies under the proposal, compared with about $7,400 and $20,300 under current law.

Those figures do not include the effects of the small business tax credit on the cost of purchasing insurance. A relatively small share (about 12 percent) of people with coverage in the small group market would benefit from that credit in 2016. For those people, the cost of insurance under the proposal would be about 8 percent to 11 percent lower, on average, compared with that cost under current law.

http://www.cbo.gov/ftpdocs/107xx/doc10781/11-30-Premiums.pdf

Comment:

By Don McCanne, MD

For most individuals and families, the Senate health care reform bill will have very little impact on the premiums to be paid for health plans. There are three important exceptions:

* Premiums in the individual market will increase significantly because the plans will be required to provide an actuarial value of 60 percent, higher than the average value in the current individual market.

* About 57 percent of individuals eligible for coverage in the exchange will receive subsidies which will more than offset the premium increases. Note that most individuals are not eligible for coverage in the exchange and would not receive these subsidies.

* Although there will be little change in premiums for small group plans, about 12 percent of people in the small group market will benefit from a small business tax credit designed to encourage small business owners to offer coverage to their employees.

The really bad news in this report is that, on average, premiums for group plans will continue to increase at the same intolerable rates that they would have if we did nothing. This CBO analysis demonstrates that, in 2016, the family premium alone for employer-sponsored coverage, not including deductibles and other out-of-pocket costs, would be over $20,000 for a large group plan, whether or not the proposed legislation is enacted. That is quite a hit for a hard-working family with a $60,000 income.

The only hope for premium relief is for innovative insurance products that would reduce costs for those who don’t need health care, but would increase even more the costs for those who do. This demonstrates why focusing on premium relief has been a misguided endeavor. We have been diverted from the the much more important goal of relieving the financial burden of those who actually need health care.

We can achieve that goal by improving Medicare, funding it equitably, and using its monopsonistic powers to provide us with greater value in our health care purchasing. Had we done that when the Clintons were proposing their flawed model of reform, our national health expenditures would be about 20 percent less than they currently are.

It’s tragic that we would be starting from an inflated baseline, but we can still achieve that level of efficiency in the future if we dumped the highly flawed proposal before Congress and adopted the much more humane system of an improved Medicare for all.

Obama's Privatized Health Care Propaganda Tour.

Public's Favorite Option, Single Payer, Wasn't on Baucus or Kennedy's

Allison Kilkenny
The Huffington Post, June 11, 2009

The public finally got a look at Senator Kennedy’s behemoth 615-page health care bill, a document so gargantuan that Huffington Post put out an SOS to readers to help the editors read it. During the lead-up to the health care war, Kennedy promised Americans that the conversation about their health industry would be a national one, unlike the debacle the first time when the Clintons tried to take on private health care. No more secrecy, Teddy promised. Except, this time the negotiations are — once again — happening behind closed doors, and the public’s favorite option, single-payer, isn’t represented at the table.

Kennedy has depicted this secret operation as essential to negotiations, but the popular single-payer option has been almost entirely shut out of the debate (59% of Americans believe the government should provide national health insurance). Meanwhile, according to The New York Times, lobbyists from “AARP, Aetna, the A.F.L.-C.I.O., the American Cancer Society, the American Medical Association, America’s Health Insurance Plans, the Business Roundtable, Easter Seals, the National Federation of Independent Business, the Pharmaceutical Research and Manufacturers of America, and the United States Chamber of Commerce,” are all present at the Kennedy meetings.

You’d think single-payer advocate House Judiciary Chair John Conyers has the plague these days from the way his associates on the hill are dodging him. Conyers has been criticizing his fellow politicians for sabotaging the single-payer option.

“There is some notion that universal single-payer healthcare is off the table. Well, that raises a very important question. If you take the most popular healthcare reform measure and take it off the table, heaven knows what it is, I guess, you think you’re left with. This is the most popular form, and it would be very unlike the party in the majority now to determine that the most popular system would not even be examined. I am asking for a hearing in every committee, every committee, and if they will let us into the Senate, as well.”

Conyers, who — once again represents what the majority of Americans actually want — has been forced to chase the back of the health care bus like a crazed dog ever since March when he was not invited to President Obama’s Health Care Summit. Ultimately, Obama invited him when Conyers threatened to take his case to the president himself.

Why does one of the only politicians truly representing a populist desire need to grovel, beg, and holler to be included in the Kennedy-Obama closed-door meetings?

One reason may be that men like Max Baucus are permitted to aid in health care reform. Baucus is a human version of a NASCAR race car except all his corporate logos advertise pharmaceutical companies. Great Falls Tribute reports that Baucus “received more campaign contributions from the pharmaceutical and health insurance industries than any other sitting Democrat in the House or Senate, receiving $183,750 from health insurance companies and $229,020 from drug companies during that period.” It’s self-explanatory why a man who makes a living sucking from the teat of private health care wouldn’t be the most enthusiastic advocate of single-payer representatives being included in negotiations.

Others, like President Obama argue that the single-payer option isn’t (his favorite word) “pragmatic.”

“If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense…We don’t want a huge disruption as we go into health care reform where suddenly we’re trying to completely reinvent one-sixth of the economy.”

But now is precisely the moment when the system needs to be reinvented and purged of pharmaceutical and health insurance lobbyists. America’s health care system is already a global embarrassment. The World Health Organization (WHO) reports the U.S. health care system rates 37th in the world in terms of quality and fairness. WHO Director-General Dr. Gro Harlem Brundtland says: “The main message from this report is that the health and well- being of people around the world depend critically on the performance of the health systems that serve them. Yet there is wide variation in performance, even among countries with similar levels of income and health expenditure. It is essential for decision- makers to understand the underlying reasons so that system performance, and hence the health of populations, can be improved.”

Dr. Julio Frenk, Executive Director for Evidence and Information for Policy at WHO says: “It is especially beneficial to make sure that as large a percentage as possible of the poorest people in each country can get insurance…Insurance protects people against the catastrophic effects of poor health. What we are seeing is that in many countries, the poor pay a higher percentage of their income on health care than the rich.”

The message seems lost on the US government. Secret meetings with healthcare lobbyists, a 600+ page, dense bill offered without a summary cover page, killing the popular single-payer option? Kennedy’s bill appears to be extremely undemocratic.

President Obama has promised to bring his message to the people soon. Starting in the Midwest, he’ll try to convince the American people that his public-private hybrid health care is best for the nation. The single-payer option seems to already be a thing of the past. Instead of listening to what the majority of Americans want, Obama and associates are trying to convince the American people that a partially privatized system is best for them. This is the opposite of democracy. It’s a privatized health care propaganda tour.

Cross-posted from Allison Kilkenny’s blog, this article ran under the title “Density and Secrecy Will Defeat Democracy in Kennedy’s Health Care Bill” on Huffington Post

http://www.huffingtonpost.com/allison-kilkenny/density-and-secrecy-will_b_214292.html

Obama’s Privatized Health Care Propaganda Tour.

Public’s Favorite Option, Single Payer, Wasn’t on Baucus or Kennedy’s

Allison Kilkenny
The Huffington Post, June 11, 2009

“There is some notion that universal single-payer healthcare is off the table. Well, that raises a very important question. If you take the most popular healthcare reform measure and take it off the table, heaven knows what it is, I guess, you think you’re left with. This is the most popular form, and it would be very unlike the party in the majority now to determine that the most popular system would not even be examined. I am asking for a hearing in every committee, every committee, and if they will let us into the Senate, as well.”

Why does one of the only politicians truly representing a populist desire need to grovel, beg, and holler to be included in the Kennedy-Obama closed-door meetings?

Others, like President Obama argue that the single-payer option isn’t (his favorite word) “pragmatic.”

“If I were starting a system from scratch, then I think that the idea of moving towards a single-payer system could very well make sense…We don’t want a huge disruption as we go into health care reform where suddenly we’re trying to completely reinvent one-sixth of the economy.”

Cross-posted from Allison Kilkenny’s blog, this article ran under the title “Density and Secrecy Will Defeat Democracy in Kennedy’s Health Care Bill” on Huffington Post

http://www.huffingtonpost.com/allison-kilkenny/density-and-secrecy-will_b_214292.html

Aetna to dump 600,000 members

Aetna prepares for loss of 600,000 members as it raises 2010 prices

By Emily Berry
American Medical News
November 30, 2009

Back when it was the largest private health plan in the country, Aetna downsized its membership by millions but boosted profits during an overhaul of its business several years ago.

Now it looks to be making a similar — but smaller — move with a planned price increase for many of its customers in 2010.

The company figures it will lose between 600,000 and 650,000 members next year because of the price hikes.

In a conference call with investment analysts to discuss the company’s third-quarter earnings, Chair and CEO Ron Williams told analysts, “The pricing we put in place for 2009 turned out to not really be what we needed to achieve the results and margins that we had historically been delivering.”

Aetna President Mark Bertolini laid out how the company planned to raise prices to improve the company’s profit margin. He said the firm had “implemented a combination of underwriting enhancements, pricing actions and plan design changes, intended to ensure that each customer is priced to an appropriate margin.”

Laying out specific expected membership losses is “pretty candid,” said David Gibbs, a retired health insurance industry consultant from San Luis Obispo, Calif. He worked for and consulted with health insurers, including Aetna, for 25 years.

He said Aetna’s decision comes from a system that encourages insurers to drive away sicker members — a strategy not unique to one insurer. “They’re running a business, and their obligation is a very singular one: to increase shareholder profits.”

Gibbs said simply raising prices probably would not get Aetna what it wants. That actually tends to result in sick people who are more “desperate” for coverage to keep it, and healthier groups to drop it. Instead, Aetna might change benefit designs, scaling back prescription drug coverage, for example, which sicker populations tend to value but healthier ones don’t notice as much.

http://www.ama-assn.org/amednews/2009/11/30/bisb1130.htm

Comment:

By Don McCanne, MD

This act by Aetna indicates the level of sincerity the insurance industry has in its alleged new effort to cooperate in ensuring that everyone has the health care coverage that they need. Aetna is redesigning and repricing its products in order to dump over 600,000 of its less profitable members. They need to be sure that “each customer is priced to an appropriate margin.” And, above all, they owe it to their shareholders “to drive away sicker members.”

But that’s one of the ways that markets work – improve profits by cutting losses. We keep hearing that markets improve quality while reducing costs, yet in a bit of irony, for those healthier populations that remain with the Aetna, the insurer is reducing quality through product redesign, and increasing costs through higher premiums.

Once Aetna dumps these members, what private insurer is going to jump in to capture this higher cost population? None you say? And under reform? The higher cost individuals buy into the weak public option driving premiums up through adverse selection to even more unaffordable levels?

Try to imagine Medicare dumping over 600,000 patients because they need more medical care. That is unthinkable and would be reprehensible in a public social insurance program such as Medicare. Yet for the private insurance industry, it’s business as usual. And President Obama and Congress want to keep these marketeers in charge? Talk about reprehensible!

Filibustering the Public

Editorial
The Nation, Nov. 24, 2009

This is not what democracy looks like. When Americans vote, by overwhelming majorities, to place control of the executive and legislative branches in the hands of a party that has promised fundamental change, they are supposed to get that change. They are not supposed to watch as a handful of self-interested and special-interested senators prevent progress by exploiting the arcane rules of the less representative of our two legislative chambers–rules requiring that not a majority but a supermajority be attained in order even to discuss necessary reforms, and that a similar supermajority be in place to thwart a filibuster.

Yet this is where America, a nation often inclined to tell other nations how to practice democracy, finds itself as the debate about healthcare reform reaches its critical stage. We have a president who is prepared to sign legislation to expand access to healthcare while establishing at least some controls against profiteering by insurers. We have a House of Representatives in which a majority has voted for imperfect but real reform. We have a Senate in which a majority is ready to vote for what could be even better reform. Unfortunately, that majority is sidelined as a few wavering senators game the system.

Unless Harry Reid and his colleagues implement majority rule–by abolishing rules that allow two-fifths of the chamber’s members (as few as forty-one senators) to prevent passage of that legislation–the character and quality of any “reform” will be dictated by a tiny minority from some of the nation’s least populous states.

The Nation has argued for years that the filibuster is antidemocratic. We long ago rejected the notion that rules preventing the majority of senators from implementing the will of the people must be maintained as a bow to tradition. The filibuster is not constitutionally mandated. It was established by rules that have been repeatedly altered over the years. Besides, as Thomas Geoghegan recently noted (see “The Case for Busting the Filibuster,” August 31/September 7), the proper reply to the history buffs is, “Yes, well, slavery and segregation are also part of our history, and that’s what the filibuster was used to defend. I’m all in favor of history and tradition, but I see no reason to go on cherishing either the filibuster or the Confederate flag.”

The healthcare debate highlights everything that’s wrong with the filibuster. Polling shows that more than 75 percent of Americans favor a public option, yet it could be eliminated–not to gain majority support in the Senate but to gain supermajority support. That’s absurd, and citizens know it. That’s why tens of thousands have signed petitions circulated by the Progressive Change Campaign Committee, Florida Congressman Alan Grayson and Firedoglake demanding alteration of the filibuster rule.

Reid should listen to the outcry. This is about more than healthcare. At stake is the promise of democratic governance and the credibility of Congress. A great lie of politics is that all legislators are “bought” by special-interest donors. In fact, most senators are not bought by insurance-industry contributions. Think of Bernie Sanders and Tom Harkin, who have stood so forthrightly for robust reform, and Jay Rockefeller, who battled another senior Democrat, Max Baucus, on behalf of the public option.

But as long as antidemocratic rules remain, the deliberations will be guided not by Sanders, Harkin or Rockefeller but by the likes of Ben Nelson, who from 2003 to 2008 banked more than $600,000 in insurance-industry donations, and Blanche Lincoln, another collector of industry cash, who is so worried about potential 2010 election challenges that she cannot think straight. Nelson and Lincoln are not holding out for a better deal for their constituents; they are watching out for special interests and perceived political self-interest. And they are not even doing a good job of that, especially Lincoln, who has resisted backing a public option even though polls show a clear majority of her constituents favor this approach. It’s even worse with supposedly moderate Republicans like Olympia Snowe and Susan Collins, who want to be seen as reformers but won’t back real reform.

Compromise with these senators compromises democracy. It warps the will of the people. And it creates bad policy–don’t forget that Reid’s decision earlier this year to cut funding for job creation in the stimulus bill in order to get three GOP votes limited the government’s ability to address rising unemployment.

Reid should take a stand for majority rule. He has decided against the budget reconciliation process, which would allow a simple majority to pass legislation with a robust public option. That’s understandable, as this procedure is arduous. But that decision must not become an excuse for making the compromises demanded by a corrupt or self-absorbed minority. No matter where the healthcare debate takes us, Reid and Senate Democrats should commit to getting rid of rules that stifle debate and prevent action, and they should eliminate the filibuster and implement majority rule. That, after all, is what democracy is supposed to look like.

This article appeared in the December 14, 2009 edition of The Nation.

Dr. John Shearer

By Lori A. Carter
Press-Democrat, Santa Rosa, Calif., Nov. 27, 2009

John Shearer, a Petaluma physician for more than 40 years and outspoken advocate for health care, died Nov. 18 only a few weeks after being diagnosed with pancreatic cancer. He was 77.

Services are pending.

Shearer began his career making house calls to patients, providing obstetric care and delivering hundreds of babies to Petaluma mothers.

Over the past two decades, he became concerned with the number of residents who were either denied medical coverage or couldn’t afford it, said his wife of 32 years, Donna Brasset Shearer of Petaluma.

“He actually had been working on health care reform for almost 20 years,” she said. “He was really a pioneer. Before and after he retired, he never stopped working for health care reform. He was always speaking at conferences and working on panels.

“In his practice, he knew many people who couldn’t afford health care and he saw them suffer. He saw quite a few tragedies because of people’s lack of coverage. It became personal for him.”

Shearer retired earlier than he could have after becoming disillusioned by the insurance industry’s control over medical care, she said.

Shearer was born in Kokomo, Ind., and later moved to Detroit with his family, where he met his first wife, Mary Diedrich, in 1955. Shearer earned his medical degree in family practice in 1962 from Wayne State University, where he graduated among the top in his class in medical school.

Two years later, he moved to Petaluma and joined the El Rose Medical Group with three other physicians. He served as president of the medical staffs of Hillcrest Hospital in 1974 and at Petaluma Valley Hospital in 1986-87. He was the chair of the Ethics Committee at Petaluma Valley for several years until 2005.

He served on a variety of local health care boards, including the California Physician’s Alliance, a chapter of Physicians for a National Health Program, an organization that advocates for a single-payer, national health insurance.

He also worked locally for children’s health care. He helped create the Children’s Healthcare Access Coalition, which led to a program that provides health insurance for every child in Sonoma County.

He also volunteered his medical services at the Jewish Community Free Clinic in Rohnert Park, serving as its medical director for two years.

“Beyond being thoroughly kind and warm-hearted, he was also the least judgmental, least critical person I’ve ever known,” his wife said. “My life with him was a song.”

As the cancer worsened, Shearer became philosophical about the end of life.

“He said he was the luckiest person, he was surrounded by people he loved and who loved him,” she said. “He had a sense of accomplishment about his life. He was happy that he did it the way he wanted to.”

As recently as a month ago, he was walking 18 to 20 miles a week, she said. He died in the hospital, surrounded by his wife and family.

In addition to his wife, he is survived by his daughter, Annette Moussa of Petaluma; son David Shearer of Gig Harbor, Wash.; sisters Marianna Shearer of Woodland and Linda Rook of Arizona; and three grandchildren.

In lieu of flowers, the family prefers written reminiscences that can be sent to dosdocs2@hotmail.com or a donation to California Physicians Alliance, 2344 Sixth St., Berkeley, CA, 94710.

http://www.pressdemocrat.com/article/20091127/ARTICLES/911279933?Title=Dr-John-Shearer

Single-payer supposition: Medicine should save lives

Letters to the editor
The Oregonian
November 24, 2009

The article “Study: More uninsured die in ER” (Nov. 17) and the accompanying sidebar story on health care reform costs deserve a comment.

The article states that trauma patients without insurance are 80 percent more likely to die than those with insurance. This follows research that shows, after adjusting for age, sex and race/ethnicity, uninsured adults are at least four times as likely as the insured to report delaying or foregoing needed health services, that cancer patients without insurance are twice as likely to die over a 5-year span than their insured counterparts and that those without insurance have an overall death rate higher than those who are insured leading to 45,000 deaths a year.

Clearly leaving 15 percent or 50 million people uninsured in our country leads to suffering and death and should be unacceptable in our rich country.

The current federal health reform legislation’s answer is to insure most Americans by mandating citizens buy private insurance. Unfortunately the private insurance industry and its related bureaucracy and administration waste $400 billion a year and leave many millions more underinsured and laden with medical bills.

Furthermore, since there are no effective cost controls in the legislation, we will be unable to subsidize private insurance when premiums rise at 10 percent a year as they have historically.

Eventually, premiums will rise too high and the number of uninsured will rise again or insurance companies will charge lower premiums but skimp on coverage and pass more of our health care costs on to the individual and family.

The problem of the uninsured and their shamefully worse health outcomes as well as ongoing medical debt and bankruptcy will continue.

The only way to insure everyone while containing costs at the same time is to eliminate private insurance and create a single pool of all Americans — single-payer national health insurance. By enrolling everyone in the same risk pool financed with progressive premium payments to the government, which then pays doctors and hospital bills for everyone, we can offer comprehensive care without co-pays, deductibles and cost shifting to 100 percent of Americans.

As Harvard health care economist and architect of Taiwan’s popular single-payer health care system William Hsiao says, “You can have universal coverage and good quality health care while still managing to control costs. But you have to have a single-payer system to do it.”

DR. PETER MAHR
Southeast Portland

http://blog.oregonlive.com/myoregon/2009/11/single-payer_supposition_medic.html

Labor Bargains for Too Little on Health Care, Gets Even Less

Jane Slaughter
Labor Notes, Nov. 23, 2009

Its been a frustrating year for supporters of single-payer health care reform–Medicare for all. They protested as their proposal, which they call the most comprehensive, humane, and economical solution to the health care mess, was sidelined from the get-go. Their jaws dropped as the Houses health care bill, which subsidizes the insurance industry by forcing almost everyone to buy insurance, with government help, was dubbed socialistand fascist.

And their fight is not over, as the Senate grinds out a plan that may reject a public option, repeat the Houses curtailment of access to abortion, or even tax those who have insurance now.

Single-payer activists are voicing a mix of frustration and pride at having grown and fortified their movement while they worry about possible side-effects down the road.

Jim Savage, a Steelworkers local president at a Sunoco refinery in Philadelphia, said, Youre talking to a depressed guy right now. We thought we elected the right people last year. We knocked on doors, made the phone calls, donated moneyand we ended up with a shitty bill.

Will this years outcome feed cynicism in general, Savage asks, and give health care reform a bad name?

Now that its clear the final bill wont even provide much of a public option,single-payer activists are assessing the role labor played in the debate.

LEAD FROM THE MIDDLE?

The forces against single payer were vastthe Obama administration, most of Congress, right-wing media, not to mention the insurance companies. But how could labor have pushed for a better bill this year while positioning the single-payer cause for the next stage of the fight?

The basic problem? I dont think you go into these fights with your compromise position as your opening position,said Tom Leedham, a Teamsters local president who sits with Savage on the steering committee of the Labor Campaign for Single Payer (LCSP). Leedham said it was a huge setback for single payer to be ruled out of the discussion, leaving Congressional supporters nowhere to compromise from.

Mark Dudzic, who staffs the LCSP, got specific. If labor had mobilized independently around single payer from the beginning and held peoples feet to the fire, it could have restructured the whole discussion. Instead of bailing out the insurance industry we could have ended up with something incremental to move us closer to single payer, like moving Medicare eligibility down to age 55,Dudzic said.

Instead theyve ensconced private insurance at the heart of the system.

FEET TO FIRE

In countless actions throughout the year, single-payer activists inside and outside the labor movement took the fight to the decision-makers.

In Portland, Oregon, Jobs with Justice delivered an oversized $395,000 check to Senator Ron Wyden, what the senator took in in campaign contributions from the medical-industrial complex,explained JwJ director Margaret Butler. Single-payer advocates are looking to set up a free clinic for the uninsuredas close to Wydens office as possible.

In Detroit the JwJ chapter invited Canadian unionists to a forum to explain how single payer works in practice. (The Canadians were appalled at the stories from this side of the border.) In Los Angeles, union members were among those arrested for civil disobedience at Cigna, the health insurance giant, in late October.

And everywhere, union supporters of single payer trained speakers, went to community meetings of all kinds, distributed fact sheets, ran radio ads, met Congressional delegations, and disrupted hearings that excluded single-payer views. Says Leedham, Its the easiest organizing Ive ever done. People totally get it.

Leedhams most effective handout showed when, given current trends, the cost of family health insurance will equal average household income. The two lines on the graph cross in 2025.

WHY DIDNT LABOR LEAD?

But labor didnt lead the single-payer movement. Almost all union headquarters devoted their political capital with members, exhorting them to call their Congress members in favor of a public option or against taxing benefits. Why didnt the official labor movement lead on single payereven as a bargaining chip?

No surprise here: Unions are tied into the Democratic Partyin particular the public worker unions of Teachers (AFT) and AFSCME, the state and local employees.

AFSCME and AFT have enormous influence within the AFL-CIO, and AFSCME and AFT are dependent on Democratic local politicians for much of what they do in collective bargaining and what theyre able to do in new organizing,says one union staffer. So they are held accountable by the Democrats to carry out Democratic policies.And Democrats from the White House to the statehouses made clear that single payer was untouchable.

Add to this the usual acquiescence to realismId love to see single payer but were not going to get it this yearand the desire to be seen as a playerunion lobbyists love being in the room for the briefings.

Some labor leaders may have hoped early on that the public option could be solid enough to form a step toward single payer. Indeed, proponents were buoyed by early estimates that half the working-age population, and their families, would enroll.

AFL-CIO President Rich Trumka said labor wouldnt support a bill without an employer mandate to provide insurance, no taxation of benefits, and a public option. (The Service EmployeesAndy Stern and TeamstersJames Hoffa, on the other hand, said the public option was not a deal-breaker.)

But the wrangling wore on and the House version of a public option was whittled down to 6 million eligible participantsjust 2 percent of the non-Medicare population and far from an effective counterweight to insurance companies.

Unions in turn became wrapped up in the defensive fight around taxing benefits and a symbolic fight around preserving some form of public option,Dudzic says.

Even then, unions had to confront the Obama administration, which wasnt committed to the public option and seemed unconscious of the unpopularity of taxing benefitswhich would hit far more people than just union members.

With no cost controls in place, Leedham warns that the tax floated by the Senate Finance Committee, on family plans costing more than $21,000, will hit most union plans by 2013 or soon after.

Savage is worried about the tax. The Steelworkers spent months in 2008 convincing members to vote for Obama over McCain on that very issue. If the bill ends up taxing health care benefits, I think weve completely lost any credibility with the rank and file,he said.

TAKE IT OFF THE TABLE

Dudzic points out that an implicit goal for labor was to take health care off the bargaining table, because it eats up so much of the available dollars.

That didnt happen, although (assuming these provisions survive negotiations with the Senate), some small progress was made.

The expansion of Medicaid will help low-income workers, including low-income union members. The employer mandate and penalties for employers who dont provide insurance will help equalize costs in partially unionized industries, making union employerscosts not as far out of line.

And a $10 million fund for pre-Medicare retirees was set up, described by the Auto WorkersAlan Reuther as temporarybecause of its small size. It will pick up part of the cost of catastrophic insurance and thus encourage employers not to drop coverage for retirees under 65.

FORWARD OR BACKWARD?

As activists anxiously await the House-Senate compromise, opinions are divided on whether an inadequate bill sets back the cause of health care reform or should be supported for the improvements it does include.

Some say the weak public option will be a flop that makes any public health care look bad. Others will support just about any bill in order to avoid the appearance of a defeat, fearing that to weaken Obama would jeopardize all labors goals, particularly the Employee Free Choice Act.

Savage and others fear the bill will feed the cynicism that already exists about political involvement, recalling union membersanger after President Clinton busted a gut to pass NAFTA in 1993.

Despite piercing disappointment, there is no question that the movement for Medicare for Allhas strengthened in the last year.

We kept the issue in the game throughout the entire discussion,notes Dudzic, because there was a real movement pushing it, not just insiders but people pushing from outside.

What are next steps for the movement?

Many groups will turn to winning single payer in their states, whether or not national lawmakers enact a waiver that would make that easier. (Obamas chief of staff Rahm Emanuel was hyperactive in making sure the Kucinich amendment, which would have allowed such waivers, was killed.)

Geri Jenkins, co-president of the California Nurses Association, says, Single payer may be something we have to push forward on a state level and prove it works before we roll it out nationally.

A major barrier we need to confront is ideological,says Sandy Eaton, a member of the Massachusetts Nurses Association.

We need to say that health care is a right, not a commodity. People are so used to worrying about getting the best benefit you can negotiate over the table rather than thinking, I have a right to it.

Savage says quit relying on elections and put your feet on the street.

The LCSPs Dudzic is optimistic that the experiences of this year will win over more activists to the single-payer cause when public-option advocates realize the public option wont establish health care for all.

LCSP will hold a conference to plan the next years work in Washington March 5-7.

http://labornotes.org/2009/12/labor-bargains-too-little-health-care-and-gets-even-less

Ignagni calls for lawmakers (not insurers) to control costs

White House says health-care bills contain cost-cutting remedies

By Shailagh Murray
The Washington Post
November 26, 2009

Critics of the Democratic bills point to cost control as a chief deficiency. Karen Ignagni, president of America’s Health Insurance Plans, said the Senate bill includes only “pilot programs and timid steps” to reform the health-care delivery system, “given the scope of the cost challenge the nation faces.”

Unless lawmakers institute changes across the entire system, Ignagni said in a statement Wednesday, “Health costs will continue to weigh down the economy and place a crushing burden on employers and families.”

http://www.washingtonpost.com/wp-dyn/content/article/2009/11/25/AR2009112503474.html

Comment:

By Don McCanne, MD

AHIP president Karen Ignagni says that unless lawmakers institute changes across the entire system, health care costs will continue to weigh down the economy, placing a crushing burden on employers and families. There could not be a more explicit admission that the private insurance industry is not and never has been capable of controlling our very high health care costs. Yet their administrative excesses along with the administrative burden they place on the delivery system are major sources of waste in our health care system.

We need everyone covered, and we need costs controlled in a system designed to provide us greater value. Neither will occur under the proposal before Congress. Although the private insurance industry can’t do it, an improved Medicare program would be designed specifically to accomplish those goals, and at a much lower administrative cost.

Karen Ignagni says that the lawmakers must institute the necessary changes across the entire system (because the insurers can’t). Let’s join her in demanding that Congress take the actions necessary, and then thank her for her efforts, as we dismiss her superfluous industry from any further obligations to manage our health care dollars.

Single-payer health advocate tells Congress: 'Start from scratch'

Statement of Dr. Margaret Flowers on the House and Senate health bills

‘The pending legislation is a turkey,’ physician says, adding lawmakers need to ‘start from scratch with a Medicare-for-All approach’

FOR IMMEDIATE RELEASE
Nov. 25, 2009

Contact:
Margaret Flowers, M.D., mdpnhp@gmail.com
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

WASHINGTON – “The current health insurance reform legislation passing through Congress amounts to a massive bailout of the profit-making health industries, which will enrich them and increase their ability to lobby and otherwise influence legislators in the future,” said Dr. Margaret Flowers, a pediatrician and Congressional Fellow for the 17,000-member Physicians for a National Health Program, today.

“At the same time, patients will receive little in the way of long-lasting protection or ability to afford needed health care,” she said. “The legislation is designed to fail. In the meantime, it will waste billions of dollars and delay the process of creating effective health reform.

“We at Physicians for a National Health Program call on Congress to start from scratch. Improving and expanding Medicare to all people would save over $400 billion annually on insurance overhead and bureaucracy, enough to cover all 47 million uninsured Americans. It is the simplest and quickest way to achieve our goal of universal and financially sustainable health care.

“The pending legislation is a turkey,” she said. “It closely resembles health reforms that have already been tried and have failed at the state level.”

Flowers cited 10 additional reasons why the draft legislation “is not the reform America needs on this Thanksgiving eve”:

1. During the time that it will take for the health insurance legislation to begin (2013 in the House version and 2014 in the Senate version), tens if not hundreds of thousands of Americans will die.

2. Once the insurance reform takes effect, people will still be left without health insurance. Whether it is the 17 million left out of the House version or the 24 million left out of the Senate version, we find this unacceptable. We know that the actual number of uninsured people is likely to be higher than these estimates and we know that people without insurance have a 40 percent higher risk of death than those who have insurance.

3. Medical bankruptcies will continue to occur as families will face out-of-pocket costs on covered services of up to $10,000 in addition to the cost of premiums and the cost of uncovered services. The average medical debt that causes insured families to become bankrupt is $18,000.

4. People who are uninsured will suffer the further indignity of being forced to pay a fine which may be as high as 2.5 percent of their income (House version).

5. The number of people who are underinsured will increase with this legislation. People will be required to purchase health insurance or face a penalty. There is no guarantee that premiums will be affordable even for those who qualify for federal subsidies. Health insurers have already predicted that the cost of premiums will rise because they are being required to stop the practices of excluding pre-existing conditions and rescissions. The public insurance is estimated to be more expensive than private insurance plans. A similar reform in Massachusetts has resulted in a rise of patients who forgo needed care because they cannot afford the co-pays and deductibles once they have paid for their premiums.

6. People will continue to be consigned to only receiving the quality of care that they can afford. Instead of a standardized benefit plan that covers all necessary care, people will have to choose from a tiered set of plans. The least expensive plans will cover only 60 percent of necessary care and patients will be required to pay the balance.

7. The legislation will not control health care costs and will in fact increase the waste in health care spending. The regulation of insurance companies, which has failed to date and is predicted to fail again by industry whistleblowers, will be expensive to enforce. And the “exchanges” will have to be created from scratch. The exchange will add another level of bureaucracy which in Massachusetts has added a 4 percent charge to each insurance premium. Unfortunately, this legislation does nothing to reclaim the hundreds of billions of dollars that are currently wasted on administration, paperwork and marketing for the hundreds of health plans in existence.

8. The legislation transfers hundreds of billions of public dollars to private insurance companies. People will be mandated to purchase health insurance whether they can afford it or not, so the insurance companies benefit by having millions of new enrollees. In addition, between $447 billion and $605 billion in public dollars (depending on the Senate or House version) will be given to the private insurers in the forms of subsidies to help people purchase their defective product.

9. The legislation protects the outrageous profits of the pharmaceutical corporations. The majority of Americans will not see any improvement in the costs of medications and the pharmaceutical corporations have already raised prices on brand name prescriptions by 9 percent this year. Biotech firms receive a windfall 12-year patent on new pharmaceuticals.

10. The legislation continues to allow discrimination based on age and immigration status. Older enrollees can be charged up to twice as much as younger enrollees. And enrollees will be required to prove citizenship in order to receive subsidies. Non-citizens will be required to bear the full cost of purchasing insurance.

“We urge support for Senator Bernie Sanders’ single-payer, Medicare-for-All bill, S. 703, as a replacement for the current Senate bill,” stated Flowers. “We urge people who support real health care reform to join with us in this movement.”

****

Dr. Margaret Flowers is a Maryland pediatrician with experience as a hospitalist at a rural hospital and in private practice. She is currently the Congressional Fellow of Physicians for a National Health Program. In addition to her activity with PNHP, she is a board member of Healthcare-Now! Flowers obtained her medical degree from the University of Maryland School of Medicine and did her residency at Johns Hopkins Hospital in Baltimore.

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.

Single Payer Advocates Address Deep Flaws in Democratic Health Bill

By Kevin Gosztol
Op-ed News, November 25, 2009

On the day before Thanksgiving, members of single payer advocacy organizations gathered for a press conference to voice strong concerns with a Democratic health bill that they feel fails to address the biggest problems with health care in America.

Dr. Carol Paris and Dr. Margaret Flowers of Physicians for a National Health Program(PNHP), Kevin Zeese of Prosperity Agenda, and Russell Mokhiber of Single Payer Action were all present for the press conference in the National Press Club in Washington, D.C. at 10 am ET.

All four were members of the Baucus Eight that were arrested for confronting senators anddisrupting a Senate hearingafter Sen. Max Baucus and other senators took single payer off the table.

Dr. Paris said the Democratic bill makes the mistake of “keeping the biggest problem, which is the waste of the private insurance industry” a part of the health reform solution being proposed by Congress.

According to Russell Mokhiber, “It’s unfair to call this health reform. This is an insurance industry and pharmaceutical industry bailout.”

Dr. Flowers said, “It’s designed to fail. If our goal for this country is to provide healthcare for every person in a way that is financially sustainable and have it be both universal and cost-efficient, this is not the way to do it.”

Like many advocates for single payer, Dr. Flowers is bothered by how much the insurance industry has influenced the health insurance enrichment bill and how the legislation will “further enrich and empower the health insurance industry by mandating that people purchase their products by usinghundreds of billions of federal dollars to subsidize the purchase of private insurance.”

Single payer advocates do not want to make the perfect the enemy of the good but because the Democratic bill currently mandates that people purchase a defective product—private insurance—compromise, for many advocates, is unjustifiable.

“By forcing people at the point of increased taxes and threat of incarceration to buy a product that’s defective, first, it’s an amazing first in our history, but second, it really undermines the good in this bill because it empowers the cause of health care problems,” said Zeese.

Zeese added “to mandate [that] people buy health insurance under threat” of fines that are up to 2.5% of their income or to threaten criminal punishment is unconscionable especially since none of the basic problems of health insurance would be fixed with this bill.

The single-payer movement believes millions will still be uninsured, the underinsured will still face medical bankruptcy, and massive waste, fraud, and abuse that occurs as a result of the private health insurance industry will continue.

So, some members of the single payer movement are calling on progressive Democrats in Congress to start from scratch and expand Medicare to cover all Americans as an end result goal.

“The system’s not going to work with these kinds of for-profit health insurance companies in the game,” said Mokhiber. “Single Payer Action istrying to peel off a number of members in the House and Senate to vote with them and use [defeating the bill] as a teaching moment.”

Mokhiber is largely critical of progressive Democrats who claimed to support single-payer yet refused to defend or fight for it. In contrast, he says, Blue Dog Democrats have been willing to draw lines in the sand and make people pay attention. And, that’s what progressives need to do instead.

Those participating in the conference that wish to see this bill defeated so that Congress can start from scratch, do not feel that Americans will have to wait another decade for another opportunity for reform to come back around.

Zeese argued that’s wrong because the healthcare crisis has become a government crisis and it has become a primary cause of deficit and debt at the state and federal level.

And, Mokhiber said having single payer activists kill this is “the best way” to do reform and activists should defeat the legislation and make it clear they are doing it so single payer can continue to be possible.

Advocates like Mokhiber and Zeese differentiate themselves from Republicans who simply wish to kill the bill and ensure that not even piecemeal steps toward reform health care are taken.

They make it clear that if Democrats went back to the drawing board they would be there, as they have been since the beginning, advocating for an “everybody in, nobody out” single payer not-for-profit health care system.

Having been a psychiatrist for twenty years, Dr. Paris communicated the need to get this right now and not later.

“There’s this anxiety and stress that’s created by our inability, by the inability of average citizens to access healthcare,” said Dr. Paris. “It’s not bad enough that you’ve got an anxiety disorder or depression or schizophrenia. But then add to it the stress of not knowing how you’re going to pay for your medication, not knowing how you’re going to afford therapy to see a psychiatrist is just adding insult to injury.”

Dr. Flowers is convinced that “we can do much better than this.”

“We have the resources to provide healthcare to every person in this country and to improve our health outcome to be en par the top industrial nation,” said Dr. Flowers. “And there’s no reason why we shouldn’t be going in that direction.”

http://www.opednews.com/articles/Single-Payer-Advocates-Add-by-Kevin-Gosztola-091125-983.html

Insurance Industry Antitrust Fight Headed To Conference Committee

Ryan Grim
Huffington Post, 11-24-09

The insurance industry successfully fought off a Senate threat to revoke its antitrust exemption as part of health care reform, but the issue lives to fight one more battle in the conference committee negotiations that will take place between the two chambers.

The issue surfaced in mid-October, shortly after the industry lobby, America’s Health Insurance Plans (AHIP), pushed hard against the Democratic health care reform effort, claiming it would significantly raise premiums.

Senate Majority Leader Harry Reid (D-Nev.) responded by saying the industry should lose its cherished antitrust exemption — implemented some 60 years ago by the McCarran-Ferguson Act — and be forced to compete under the same rules as any other enterprise.

“Insurance companies have become so large they dominate entire regions of the country,” he said. “They have become so powerful they block start-up businesses from entering the market, and they put smaller companies out of business. They have become so dominant that they dictate business practices. They are so influential that they exert tremendous influence over public policy.”

House Speaker Nancy Pelosi (D-Calif.) seconded Reid the next day, twisting the knife and adding that “it is well known to the public that the health insurance companies are the problem.” The following day Judiciary Committee Chairman John Conyers announced a hearing and a committee vote on revoking the exemption. It passed and was included in the House health care bill that passed two weeks ago.

The insurers recognized the politics at work and strongly voiced their opposition to the provision. “Health insurance is one of the most regulated industries in America at both the federal and state level. McCarran-Ferguson has nothing to do with competition in the health insurance market. The focus on this issue is a political ploy designed to distract attention away from the real issue of rising health care costs,” AHIP spokesman Robert Zirkelbach told HuffPost.

A week before House passage, HuffPost reported that Reid decided not to include the repeal of the exemption but to go for it as a floor amendment instead. The move was seen as a sop to Nebraska Democrat Ben Nelson, an industry backer who had yet to offer his support for Reid’s motion to proceed and who is a strong public supporter of keeping the antitrust exemption in place.

Asked by HuffPost if he had asked Reid to drop the measure in exchange for his vote, Nelson demurred. “That would come as a surprise to Harry Reid,” he said of multiple reports that he had pushed for it to be left out.

But there’s more than one way to push in the Senate and, regardless of whether Nelson raised the issue with Reid, even the Capitol cafeteria workers were aware of Nelson’s strong position.

Nelson argues that repealing the exemption wouldn’t hurt the big insurers because they’re already so big they don’t need to collude with each other. Repealing it, he argues, would only hurt the little guys.

But there are very few little guys left: one or two big insurers are dominant in almost every region of the country.

Nelson, now that he has voted to move the bill forward, is still threatening to filibuster a final bill if he finds it objectionable. Nelson and others want the public health insurance option stripped from the Senate bill, but if it goes to conference too friendly to the industry, the antitrust repeal is likely to be in the bill that comes back. For the industry, it’s pick your poison.

pnhpf3a

Comment:

Public’s Favorite Option, Single Payer, Wasn’t on Baucus or Kennedy’s

Comment:

Comment:

‘The pending legislation is a turkey,’ physician says, adding lawmakers need to ‘start from scratch with a Medicare-for-All approach’

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