PNHP

IT’S THE INSURANCE COMPANIES, STUPID!

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IT’S THE INSURANCE COMPANIES, STUPID!

Rules rein in Medicare Advantage marketing

By Tom Murphy
Associated Press

Regulators clamped down last fall on shady sales practices for privately run Medicare health insurance for the elderly.

But customers and advocate groups say the plans’ confusing nature still leaves room for pitches bordering on the deceptive, and abuses still crop up.

Medicare Advantage plans are privately run versions of the government’s Medicare program, which provides health coverage for the elderly and disabled. The government subsidizes these plans, and the industry has developed what can be a mind-numbing array of them.

Seniors report being pressured with unsolicited phone calls or home visits that are clearly prohibited. Some have signed up for plans that didn’t include their longtime doctors or hit them with unexpected costs, things they learn weeks later.

CMS learns every year about areas that need more vigilance, said Timothy Hill, deputy director for the Center for Drug and Health Plan Choice.

http://abcnews.go.com/Business/wireStory?id=8446040

And…

Some question private Medicare plans’ advantage

By Matt Sedensky
Associated Press

Seniors have flocked by the millions to Medicare Advantage, privately run plans offered as an alternative to traditional, government-run Medicare.

In the debate on overhauling the U.S. health care system, Advantage has been criticized as an example of a broken system that costs too much, confuses enrollees and suffers from a lack of oversight.

But even many backers acknowledge one of its toughest problems is few seniors understand the essential difference in private plans: Even services covered by traditional Medicare that doctors deem medically necessary routinely need the insurers’ advance approval and are sometimes denied.

Participants have been denied visits to specialists, rehabilitation to help them walk again and countless other services they’d be entitled to under traditional Medicare.

“Every decision is based on not what’s right for the patient, but what’s right for the bottom line,” said Dr. Michael Sedrish, who coordinates HMO payments for Medisys Health Network, which runs three New York City hospitals.

With basic Medicare, seniors generally know what sort of coverage they’re getting. That’s not the case with the roughly 7,000 Medicare Advantage plans, where one person’s coverage could be completely different from a next door neighbor’s.

A 2008 Government Accountability Office report found wide differences in enrollee costs depending on the plan, including home health service costs that could be up to 84 percent more than traditional Medicare.

“The plans tell them they have the same coverage,” said Delores Bowman, who handles calls to the Medicare Rights Center, “and they don’t.”

http://www.washingtonpost.com/wp-dyn/content/article/2009/08/29/AR2009082900957.html

Comment:

By Don McCanne, MD

What’s beautiful about the Medicare Advantage program is that it has provided us with a real-life laboratory experiment which allows us to compare the functioning of highly-regulated private insurance plans as contrasted with the functioning of a public insurance program: traditional Medicare. The results are in, though that would be tough to ascertain if you simply observe the response of Congress.

What have we learned? The private plans take away the choice of health care providers that the traditional public program offers. The private plans insert intrusive interventions between the patient and the physician – interventions that are not found in the public plans. Private plans divert more resources to excessive, wasteful administrative services while increasing the administrative burden on the health care providers and on the public stewards who must provide oversight of our tax dollars that are diverted to this industry. Private plans also provide more entry points for the criminal element to cheat the taxpayers, patients, and providers. And for this we are paying far more of our tax dollars than we do in the traditional Medicare program for comparable levels of care. The obvious lesson is that we should dump the private plans.

What has Congress learned? They have decided that we should provide more subsidies to the private plans so that they can expand their markets!? And they have apparently decided that we will not even have a genuine public plan because it would provide unfair competition to the private plans because of Medicare’s greater efficiency and lower costs!?

It is true that a fragmented, multi-payer system is much more expensive and much less equitable, leaving too many exposed to suffering and financial hardship. But our Medicare Advantage experiment has demonstrated that it is the private plans that must be jettisoned, and it is Medicare that must be granted to everyone after modest, appropriate reengineering so that it works even better than it does now.

We need to send this urgent message to Congress and the administration, immediately:

IT’S THE INSURANCE COMPANIES, STUPID!

Former Jasper County Republican Chairman on Single Payer

Beware health-industrial complex

By Jack Bernard
Ledger-Enquirer
August 23, 2009

I am a Republican, former chairman of the Republican Party in Jasper County, Ga., and chair of that county commission. Under our two-party system, it is easy to see why we Republicans oppose Democratic Party reform proposals. We are the opposition party and do not want them to get the political credit for solving a nasty problem.

Since the Democrats are in the driver’s seat, it is up to them to lead and bring their stragglers in line. However, the Democrats are fighting internally, failing to articulate a straightforward vision of the future or even one bill (Obamacare, if you will).

Republican pundits are sitting back and chuckling, as they always do when reform is mentioned, and repeating the same self-serving platitudes.

What amazes me is that no one is calling these individuals to account. In my view, it is unpatriotic to continue to lie to the American public about the situation facing us. Over the last 10 years, wages have gone up by about one-fourth. Health insurance premiums have gone up well over 100 percent. We cannot continue along this path to fiscal destruction. Inaction is not an option.

It is also against American values to mislead the public into believing that everyone can get good care even if they do not have insurance. The mark of a great nation is not how well it treats its privileged, but rather how well it treats its downtrodden. On this measure, we fail miserably; strange for a nation that prides itself on being the most religious democracy in the world.

Very few health or insurance professionals advocate for a single-payer system, the best way to control costs and ensure access. I hear all sorts of reasons: rationing (really, like HMOs do not do that now), paperwork (apparently insurance company bureaucracy does not count), socialism (come on — practitioners will still be independent and we all know it) and so forth. It is rare that we hear the underlying cause openly stated: greed. It will cut my income.

The members of Physicians for a National Health Plan are an exception to this rule. If you take a look at their Web site, www.pnhp.org, the rationale for a single-payer system is clearly articulated.

Universal Medicare will both control costs and achieve universal access to high quality care. Congressmen would get the same insurance as you and I. You better believe your coverage would be just as good as or better than what you are getting now.

The problem is not technical; it is political. It is high time we put the country ahead of ourselves and establish a single-payer system.

(Jack Bernard is CEO of Monticello (Ga.) Health Care Solutions and a former chairman of the Jasper County Commission and the Jasper County Republican Party.)

http://www.ledger-enquirer.com/sunday_voices/story/814348.html

Comment:

By Don McCanne, MD

If you set politics aside and look at proposed policies for reform, the logic of a single-payer, improved Medicare for all should unite those with views as diverse as a Democrat fighting for health care justice and a Republican demanding common sense business principles that would provide all of us with much greater value in health care.

The Republicans would do well to listen to former Jasper County Republican Party chairman Jack Bernard. But it’s also the Democrats who must lay down their swords and health insurer lobby money, and listen to this gentleman. The price of maintaining a partisan barrier is too high.

Fiscal Responsibility and Health Care Reform

Robert A. Levine, M.D.
New England Journal of Medicine
August 26th, 2009

It has been clear for some time that the primary hurdle to enacting health care reform is figuring out how to pay for it. Virtually all Republicans and some Democrats have been unwilling to sign on to increasing taxes on high-income Americans as a partial answer. The idea of taxing the most generous health insurance benefits has met with resistance as well. The use of electronic health records and an emphasis on prevention and early treatment of illnesses have been ballyhooed as ways to generate savings to help pay for reform, but there is no solid evidence that these measures will reduce spending anytime soon, although they might improve care. Unfortunately, legislators are ignoring the option of funding reform by harvesting available savings from within the health care system itself. I believe Congress must go back to the drawing board. Given the state of the economy and the continuing rapid growth in health care expenditures, lawmakers need the political will to devise a plan that will control accelerating costs and be budget-neutral — and to disregard the expected backlash from stakeholders (organized medicine, the insurance companies, the pharmaceutical industry, and the trial lawyers) and an uninformed public.

Time and again over the past century, there have been attempts to make the health care system more effective and efficient, the only real success being the passage of Medicare and Medicaid in 1965. Since then, various stakeholders have managed to block any efforts at restructuring that have threatened their profits. When the U.S. economy faced its most severe test during the Great Depression, Social Security was enacted over vigorous opposition. The current crisis presents a similar opportunity to provide high-quality health care coverage to all Americans while bringing spending back in line. Comprehensive reform might also act as a government stimulus package, freeing up cash that consumers would otherwise be spending on medical care and thereby aiding the recovery.

Some drivers of health care costs (such as demographic changes) cannot be controlled; others (such as unhealthy lifestyles) are difficult to attack. However, great savings could be achievable in two areas: administrative costs and unnecessary care. In the current health care system, administrative costs are generally estimated to account for 15 to 25% of total expenditures1; if we settled on an estimate of 20%, that would amount to $500 billion annually. The complexity of the present system, with multiple sources of coverage, is the main cause of such high administrative costs. Every insurance plan has different benefits with different copayments and deductibles, and many require preapprovals for various tests. The multiple interactions this complexity necessitates between physicians’ offices and insurance companies — to get authorization and to haggle over payment — translate into personnel requirements (and associated costs) on both sides. Insurance companies also conduct extensive vetting of applicants for individual policies to determine whether any preexisting conditions disqualify them from coverage and what their premiums should be — an activity that, along with spending on marketing, further raises companies’ overhead.

Unnecessary care is believed to be responsible for as much as 30% of health care spending,2 or up to $830 billion this year alone. This problem results largely from the perverse incentives built into the health care system, in which there is a clear conflict of interest. Physician remuneration depends on the volume of patients seen, particularly on the number and intensity of the procedures performed. The need for these services is determined by the very physicians who then arrange for or perform the procedures. This is not the way a high-quality health care system should work. Unnecessary surgery and other invasive procedures may be ordered simply to augment physicians’ incomes, the potential for adverse outcomes notwithstanding. Even if all physicians were highly ethical and ordered only tests and treatments they deemed truly important, it would take saints not to have their judgment skewed in favor of decisions that will provide them with financial rewards. Defensive medicine also generates unnecessary care, as do duplication of tests when data are unavailable and patients’ demands for tests or treatments not in keeping with good medical practice.

The dollars lost to fraud are difficult to quantify but may be considerable; one estimate puts the cost at 3% of annual health care expenditures3 — a conservative estimate that would translate into $75 billion this year. Costs for the use of technology that has not been proved effective are also difficult to estimate but are believed to be substantial.

All told, then, administrative expenditures, unnecessary care, and fraud probably account for $1 trillion or more in health care spending that does not go toward providing appropriate care. These are the areas in which the proper reform measures could generate savings that could pay for universal coverage.

To reduce administrative costs and simplify the system, I believe that a single-payer system that provides universal coverage is mandatory. Of course, this concept is anathema to free-marketeers and does not currently have much public resonance — largely because Americans have been misled by negative advertising and denigration of the single-payer approach by politicians and others who label it “socialized medicine” and government interference in medical care. A new advertising campaign using the Internet as well as traditional media might help to educate the public about the benefits of this approach. A single-payer system could be run by a federal board that would be independent of the government, appointed by the president, and confirmed by the Senate. The board would function in a manner similar to that of the Federal Reserve, with the assistance of committees of experts and immunity to political interference. Regional health care entities operating under the board’s aegis could be used for the day-to-day management of health care delivery.

To limit unnecessary care, physicians’ incentives for increasing the volume of services must be curbed, breaking the link between income and the number of tests or procedures generated. To accomplish this task, a variety of mechanisms could be used — among them, capitation, global payments, a salary system for physicians, payment for episodes of care, and intensive monitoring of physicians’ services — each of which has its advantages and disadvantages. The simplest approach, and the one most likely to succeed, is putting physicians on salary, as more than 30% of U.S. physicians already are. To end defensive medicine, which also contributes to unnecessary care, malpractice reform must also be a part of any health care reform package. A review of all malpractice claims by peer panels should be a first step in the process to decide whether malpractice has actually occurred.

I believe that neither the government nor individual Americans would have to spend a penny more to reform health care, including provision of universal coverage,4 if administrative costs and unnecessary care could be substantially reduced. Enough money is available in the current system to completely fund reform; it simply has to be redirected. Although overcoming opposition from the insurance industry, organized medicine, and other stakeholders to produce a sensible reform plan may seem impossible, the recent financial meltdown has changed the political landscape. Initiatives that were previously unthinkable might now have a chance if properly presented, particularly given the public concern about the ballooning federal deficit. But to ensure that cost constraints become the guiding principle of health care reform, Americans must comprehend the gravity of the situation and force their legislators to act accordingly. If Congress passes reform that does not tackle the problems of excessive administrative spending and unnecessary care, major revisions will be required in the future. Unfortunately, such revisions would come only after Americans had suffered additional economic pain.

No potential conflict of interest relevant to this article was reported.

Source Information

From Norwalk Hospital, Norwalk, CT.

This article (10.1056/NEJMp0906503) was published on August 26, 2009, at NEJM.org.

References

1. Himmelstein DU, Woolhandler S, Wolfe SM. Administrative waste in the U.S. health care system in 2003: the cost to the nation, the states, and the District of Columbia, with state-specific estimates of potential savings. Int J Health Serv 2004;34:79-86. [CrossRef][Web of Science][Medline]

2. Orszag PR. Opportunities to increase efficiency in health care: statement at the Health Reform Summit of the Committee on Finance, United States Senate, June 16, 2008. Washington, DC: Congressional Budget Office, 2008.

3. Iglehart JK. Finding money for health care reform — rooting out waste, fraud, and abuse. N Engl J Med 2009;361:229-231. [Free Full Text]

4. Levine RA. Shock therapy for the American health care system — why comprehensive reform is needed. Santa Barbara, CA: Praeger, 2009.

Single Payer: A Conversation with David Himmelstein and Steffie Woolhandler

Health Care Cost Monitor
The Hastings Center
Aug. 27, 2009

One of the biggest arguments against a public choice option is that it would lead to a single payer system. Many critics frame this as a frightening prospect, a radical intrusion of government into health care. But many doctors and others regard a single payer system as the best way — perhaps the only way — to control health care costs well enough to provide coverage for all. Advantages include saving hundreds of billions of dollars and helping to reduce regional inequities in available medical services. David Himmelstein, M.D., and Steffie Woolhandler, M.D., M.P.H., cofounders of Physicians for a National Health Program, answered questions about the single payer system and why they think it is superior to a public choice option.

Why do you support a single payer health care system?

We support nonprofit, single-payer national health insurance because it would greatly improve access to medical care; ameliorate the dire financial consequences of illness; realize large savings on bureaucracy that would make a transition to universal, comprehensive coverage affordable; establish a framework for restraining the growth of medical costs in the long run; and address the regressive nature of current U.S. health care financing.

Health reform must cover the uninsured, but also address the cost crisis for insured Americans. Illness and medical bills contributed to almost two-thirds of all personal bankruptcies in 2007, a 50 percent increase since 2001.

Covering the 50 million uninsured and upgrading coverage for the tens of millions who are underinsured will cost hundreds of billions each year. A single-payer reform would make this affordable through vast savings on bureaucracy and profits.

As we’ve shown, administration consumes 31 percent of health spending in the United States, nearly double what Canada spends. If we cut our bureaucratic costs to Canadian levels, we’d save nearly $400 billion annually — more than enough to cover the uninsured and to eliminate copayments and deductibles for all Americans.

Altogether, U.S. hospitals could save about $120 billion annually on bureaucracy under a single payer system. And doctors in the U.S. could save about $95 billion each year, which they now waste fighting with insurance companies and filling out useless paperwork.

Single payer national health insurance would also facilitate (though not ensure) rational health planning, a proven cost control strategy. Today’s market-driven capital allocation mechanism has resulted in an expensive surplus of high-tech facilities in many regions, which inevitably leads to unnecessary and even dangerous tests and interventions. Meanwhile investments in underserved communities and underprovided services (e.g., public health and mental health) lag.

National health insurance would establish explicit capital allocation mechanisms, separating operating and capital funds, allowing restraints on the supply of medical resources that are keys to long-term cost containment.

In sum, a single-payer national health insurance would make universal, comprehensive coverage affordable by diverting hundreds of billions of dollars from bureaucracy to patient care, and sustainable by enabling rational health planning. Lesser reforms cannot realize such savings. While reforms that maintain a major role for private insurers may seem politically expedient, they are economically and medically nonsensical.

The term “single payer” is normally used to characterize tax-based, national health insurance systems (Canada, the United Kingdom, and Sweden). Do you think they are better than the social insurance systems (France, Holland, Switzerland)?

A single payer national health insurance has several advantages over social insurance systems — particularly those with multiple insurers. First, national health insurance is administratively far simpler and less expensive.

From the providers’ point of view, multiple payers result in sharply increased administrative costs — as we found several years ago when we studied the administrative costs of Germany’s social insurance system for the Office of Technology Assessment. Moreover, as Hans Maarse’s recent post here illustrates, the diffusion of responsibility for financing care to multiple payers makes cost control far more complex.

We are also concerned that the flat tax financing used for many social insurance programs (e.g., Medicare’s payroll tax) is less healthy than a system based on an income tax or other progressive levy, and that an employment-based system is ill suited to the current economic situation in the U.S.

Moreover, the transition from our current health financing system to a functional social insurance system would be no easier than a transition to national health insurance.

Instituting a reasonably stable social insurance system (we would not include the still unfolding experiment in the Netherlands in this category) would require a complete recasting of our insurance firms — changing their ownership, control, and regulatory frameworks. Similarly, regulation of health facilities would have to be completely revamped. It’s far simpler to establish a national health insurance payment system than to conjure up a completely revamped set of insurers and regulations for a social insurance system.

Do you consider a public choice plan designed to compete with the private insurers to be a reasonable compromise?

Unfortunately, adding a public plan option as a patch to the current private insurance system cannot correct its flaws. As long as multiple private plans coexist with the public plan, hospitals and doctors would have to maintain their costly billing and internal cost tracking apparatus. Indeed, we estimate that even if half of all privately insured Americans switched to a public plan with overhead at Medicare’s level, the administrative savings would amount to only 9 percent of the savings possible under single payer.

There’s no evidence that competition from a public plan would restrain costs, as Daniel Callahan has argued here. A public plan might cut private insurers’ profits, which is why they hate it. But their profits account for only 3 percent of the money squandered on bureaucracy.

Far more goes for marketing (to attract healthy, profitable members). And tens of billions are spent on the armies of insurance administrators who fight over payment and their counterparts at hospitals and doctors offices. All of these would be retained with a public plan option.

Unfortunately, competition in health insurance involves a race to the bottom. Insurers compete by not paying for care: by denying payment and shifting costs onto patients or other payers. These bad behaviors confer a decisive competitive advantage.

A public plan option would either emulate them — becoming a clone of private insurance — or go under. A kinder, gentler public plan option would quickly fail in the marketplace, saddled with the sickest, most expensive patients, whose high costs would drive premiums to uncompetitive levels.

Eight decades of experience teach that private insurers cannot control costs or provide families with the coverage they need. A government-run clone of private insurers cannot fix these flaws.

David Himmelstein, M.D., is an associate professor of medicine at Harvard. His research focuses on problems in access to care, administrative waste, and the advantages of a national health program. Steffie Woolhandler, M.D., M.P.H., is a professor of medicine at Harvard and codirector of the Harvard Medical School General Internal Medicine Fellowship program. She was previously a Robert Wood Johnson Foundation health policy fellow at the Institute of Medicine and the U.S. Congress.

http://www.thehastingscenter.org/HealthCareCostMonitor/Default.aspx?id=3818&blogid=87870

Liar, Liar … Well, Healthcare Pants on Fire

by Donna Smith
CommonDreams.org
Published on Thursday, August 27, 2009

So, we’ve been told over and over again that under the healthcare reform plans currently defended and pushed by the President and Congress that we can keep what we’ve got if we like it. No one will take your health insurance bennies away. Not under our employer-based, for-profit system.

Well, tell that to the latest batch of employees in Chicago to have their insurance benefits cut right out from under them — they sure didn’t get to keep what they had.

The workers at SK Tools had no choice. Their health insurance benefits were cancelled. Sick family member? Too damn bad. Need a doctor. Tough luck. The company representatives say the recession has hurt them, and they have no choice. The company is also asking for 20 percent cuts in hourly wages. Wow.

Now, the workers have voted to strike. And there will perhaps be some resolution for this bunch of employees. Folks will cry out, perhaps even President Obama will step in, and this situation will probably get resolved — though folks will suffer in the interim.

But the larger issue remains. Just how gullible are we when we trust that any private company will be forced to keep any benefit plan it chooses not to keep?

Employers will still be able to change up healthcare plans to meet the company’s needs — and if that means you have to see another doctor or pay a higher co-pay or drive to a more distant in-network provider, that will not be your decision. And health insurance companies will still be able to change their provider lists and covered services and all sorts of other things without any input from policyholders.

So, America, it just isn’t true that you can keep what you have if you like it when it comes to private, employer-based healthcare benefits. It’s a big, fat lie. And the company noted in the article above provides but one example. There will be many more.

The House bill on healthcare reform, the Senate plan for healthcare reform and the President’s plan for healthcare reform — none of these actually guarantee that you can keep what you have if you like it, because tomorrow your employer or your insurance company may change what you like to suit their bottom line. That’s the truth.

If this big lie about healthcare reform rolls off their messaging engines like melting butter on a warm slice of bread, what else do you suppose they are lying about? Come on. Get real. We won’t have what we want in terms of truly having the freedom to choose and keep or change our doctors, our providers and our own treatments until we break free from the lies and produce reform that guarantees a progressively financed, single high-quality standard of care for everybody. Everybody in, nobody out.

Then you can keep what you like. Your choices. Your decisions. Your health. Your healthcare. Your money. Period.

It’s not just the right-wing selling myths in this discussion. We need to admit that and work to be as honest as we can. Too many lives depend on this. There will be no death panels to order Grandma’s demise, but there are also no guarantees that you can keep what you have if you like it under this system. Both things are lies.

We can provide one another the healthcare security that we’re being misled to believe is in the current reform plans. But we will have to help our fellow Americans to understand that a publicly financed, privately delivered healthcare system — like Medicare — for all of us is the most reasoned, most economical and most freedom-protecting choice.

And that’s the truth.

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

Employers Face 10.5 Percent Health Care Cost Increases

Employers Face 10.5 Percent Health Care Cost Increases, Says Aon Consulting

Aon
August 25, 2009

Aon Consulting surveyed more than 60 leading health care insurers, representing more than 100 million insured individuals, and found that health care costs are projected to increase by 10.4 percent for HMOs, 10.4 percent for POS plans, 10.7 percent for PPOs and 10.5 percent for CDH plans.

In addition, health care rate increases for retirees over the age of 65 are projected to be 6.6 percent for Medicare Supplement plans and 7.3 percent for Medicare Advantage plans.

http://aon.mediaroom.com/index.php?s=43&item=1676

Comment:

By Don McCanne, MD

Under the management of private insurers health care costs continue to increase at outrageous rates – this year at 10.5 percent. With the decision of Congress to leave private insurers in charge, and with no measures that would have any major impact on slowing health care spending, it can be anticipated that these outrageous increases will continue even after reform is enacted.

The Medicare Supplement (Medigap) and Medicare Advantage plans are also private insurance plans, and so you might expect their increases to be similar. In fact, though technically complex, rate setting of these plans is linked to spending in the traditional fee-for-service Medicare program. The fact that rate increases in these programs are lower is not due to any efficiencies instituted by the private plans, but is due to greater efficiency of the public Medicare program.

In fact, there is much waste in these private Medicare programs.

The Medicare Advantage plans are overpaid deliberately to give the plans an unfair competitive advantage over the traditional Medicare program, with the intent of privatizing Medicare. Most of the extra payment is wasted in administration and profits, and what little benefit there is should be given to all Medicare beneficiaries, not just those enrolled in these plans.

The Medigap plans provide the worst value in the private insurance market. The insurers pay a much lower percentage of the premiums they collect for actual health care than they do in any of their other insurance product lines. Americans would be receiving a much greater value if the benefits of the Medigap plans were rolled into the traditional Medicare program, and these wasteful private supplemental plans were totally eliminated.

This Aon report should lead to two obvious conclusions: 1) get the private health plans out of our Medicare program, and 2) replace the private employer-sponsored plans with an improved Medicare program for all of us.

If you agree, let President Obama and the members of Congress hear your message loud and clear. Immediately.

Taking back the health care debate

It's time to get angry about the fact that an opportunity for health care reform is slipping through our grasp

By Nancy Welch
Vermont Woman
August 27, 2009

THE MORNING after the November election, I visited my father in a Cleveland rehab hospital. Weak from surgery to reinforce his disintegrating spine, he was nevertheless grinning as I walked in. “We’re going to get national health care,” he said.

My father was not a radical, not even a lifelong liberal. But having suffered through a layoff in the mid-1970s, he later watched with helpless frustration as his children struggled with multiple layoffs, a home foreclosure, loss of health insurance and mounting debt.

What I should say, then, is that my father was not born a radical, but if supporting a national health program is a radical position, he–like millions of others–had become one by the time he died, 101 days into Obama’s presidency.

My father didn’t live to see the resurrection of the lunatic far right, nor the sad confusion–“Keep government out of my Medicare!”–that results when we debate health care just once every 20 years, and without any mobilization to counter the misinformation that the intractable opponents of reform are bound to spread.

My father would also never learn that well before the corporate deployment of angry mobs to derail the August town hall meetings, President Obama had promised the pharmaceutical industry not to seek lower drug prices for “public option” beneficiaries nor allow the re-importation of cheaper drugs from Canada. If he had lived, my father might have concluded that Obama, like the Clintons in 1992, had been routed by an industry lobby whose power is too great, an American “your-health-your-problem” individualism too deeply entrenched.

But before any of us exchange “Yes, we can” for “No, we can’t,” consider:

— With rising unemployment swelling the ranks of the uninsured toward 50 million, with medical costs the leading cause of personal bankruptcy even for people with insurance, and with thousands lining up in a single day in one Los Angeles suburb for the free care offered at a M.A.S.H.-style clinic, the desperate need is plain.

— With all credible studies demonstrating that public insurance provides better care to more people at less cost than our government is already spending on health care, and with Medicare’s 44-year track record, an affordable–and popular–solution to this crisis is at hand.

— With clear Democratic majorities in the House and Senate and a national economic meltdown that forced even Alan Greenspan to admit his free-market faith was mistaken, Obama should have been well poised to advocate not merely for limited reform of private insurance accompanied by a public option, but for a government-administered, taxpayer-funded national health insurance program–single-payer or “Medicare for All.”

— With 556 union organizations in 49 states endorsing Congress’s Medicare for All bill (introduced by John Conyers in the House and Bernie Sanders in the Senate), joined with the grassroots army of Obama volunteers whose aspirations for change soared beyond getting their candidate elected, the means to launch a mass popular campaign for single-payer was–and still is–at hand.

– – – – – – – – – – – – – – – –

IF 2009 seems like deja vu, it’s because Obama took a page from the Clintons’ sorry playbook. Like Hillary Clinton, who in 1992 told Physicians for a National Health Program’s David Himmelstein that she had no interest in polls showing 70 percent of Americans favoring national health insurance, Obama and the congressional Democrats barred single-payer from consideration, going so far as to arrest 13 doctors and nurses in May who sought a place for single-payer at the Senate’s “public roundtables.”

Like Bill Clinton, who struck a deal with the “Jackson Hole” insurance-industry insiders not six weeks into his presidency, Obama asked corporate insurers to help Congress draft the various bills.

Yet even a bill that would expand the private insurance market by requiring people to purchase high-deductible policies and that would hand corporate insurers public dollars to peddle skimpy polices to the young and poor doesn’t satisfy industry lobbyists and the “Blue Dog” Democrats tucked in their pockets.

Meanwhile, in the vacuum created by Democratic Party leaders when they shut out single-payer advocates lest they frighten the big business “stakeholders,” the Republican far right has staged a comeback.

Where we should have seen thousands demonstrating for the services urgently needed in an economic crisis, we have hundreds holding signs that aren’t only ridiculous, but vilely racist and, especially when accompanied by firearms, frightening. My father was shaken by the rabble who turned out for Klan-like Palin rallies across Ohio last summer. He would have been stunned to witness their return from November’s defeat.

I suspect, however, that my father would also have been–like his favorite commentators–righteously angry. Consider Rachel Maddow castigating Obama for his “collapse of political ambition,” and Bill Maher calling for a progressive party to “represent the millions of Americans who aren’t being served by the Democrats.” What a welcome change from 1992 when most commentators blamed a supposedly government-phobic American public for the demise of a national health plan Clinton never sought.

Maher’s call for a party of the people is reminiscent of the mid-1930s, when burgeoning support for a labor party spurred a reluctant Roosevelt into delivering much of the New Deal. Even more welcome are signs of stirring among activists on the ground, from the boycott against Whole Foods, whose CEO opined against health care reform in the Wall Street Journal, to Vermont’s Health Care Is a Human Right campaign, whose carpools carried hundreds–many carrying “Single-Payer Now!” signs–to August’s town-hall meetings.

An Oregon group called “Mad as Hell Doctors” plans a September cross-country caravan to demand “Health Care for People–Not Profit!” Imagine them joined by “Mad as Hell Nurses,” by “Mad as Hell Patients”–and also by “Mad as Hell Women” demanding, with “Medicare for All,” the repeal of the Hyde Amendment so we finally have full reproductive health care rights.

My father may not have been a radical, but he understood radical action might be needed for winning health care, reversing the Bush tax cuts, stopping the wars. In November, he said, “See what he does. Then you can say, ‘To the barricades.'” I think he’d agree: The time is now.

Whole Foods CEO vs. Conservative Support for NHS, Medicare

By Ben Day
Mass-Care
Monday, August 17, 2009

Last week Whole Foods CEO John Mackey wrote an editorial in the Wall Street Journal opposing health care as a right, and proposing instead that insurers be allowed to foist crummier health plans on residents and that states be limited in their ability to regulate health insurers. The root cause of our health crisis, Mackey claims, is that people are failing to keep themselves healthy, and need to be held responsible:

http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html

Many news outlets have already run stories about customers boycotting Whole Foods based on the op-ed. There is, however, one supreme irony in John Mackey’s op-ed. It begins with a quote from former Conservative Prime Minister of the United Kingdom, Margaret Thatcher: “The problem with socialism is that eventually you run out of other people’s money.” Mackey writes “the last thing our country needs is a massive new health-care entitlement that will create hundreds of billions of dollars of new unfunded deficits and move us much closer to a government takeover of our health-care system.” What Mackey forgets is that the Conservative Party in the UK has NEVER attempted to roll back health care as an entitlement. Margaret Thatcher when running for re-election in 1982 famously proclaimed “The National Health Service is safe in our hands,” and Conservative Party leader David Cameron just days ago published an online article regarding the Party’s commitment to the NHS. He wrote: “One of the wonderful things about living in this country is that the moment you’re injured or fall ill – no matter who you are, where you are from, or how much money you’ve got – you know that the NHS will look after you.”

The United States is one of the few countries where a right to health care is considered a liberal position, and conservatives publicly attack the proposal. Those who have lived under single payer would no sooner dismantle the right to health care than we would dismantle Medicare for our seniors as a right. Opposing single payer health care is as untenable a position in the UK – for candidates of any party – as would be attempts to eliminate the right to health coverage for seniors in the US. Particularly in light of the recent attacks even a public option has come under from right-wing media and politicians, this is a key talking point for advocates of single payer to discuss at divisive town hall meetings, and on radio programs.

FURTHER LINKS

ABC article on boycotts of Whole Foods:
http://abcnews.go.com/Business/story?id=8322658&page=1

David Cameron article on Conservative support for the NHS:
http://www.conservatives.com/News/Blogs/We_are_proud_of_the_NHS.aspx

Older Health Affairs article on “Why Britain’s Conservatives Support a Socialist Health Care System:”
http://content.healthaffairs.org/cgi/reprint/4/1/41.pdf

JHPPL: Exploring the Concept of Single Payer

Today’s message is in honor of Sen. Edward M. Kennedy who told us,

“For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.”

Special Issue: Exploring the Concept of Single Payer

Single Payers, Multiple Systems: The Scope and Limits of Subnational Variation under a Federal Health Policy Framework

By Carolyn Hughes Tuohy, University of Toronto
Journal of Health Politics, Policy and Law
August 2009

Neither Obama nor any other major contender for the presidency in 2008 proposed a universal single-payer (“Medicare for All”) model. The Obama proposal for a new public plan, to be offered in parallel with regulated private plans through a National Health Insurance Exchange modeled on the Federal Employees Health Benefits Program (FEHBP), would indeed represent a distinctive American hybrid, but it would not be a single-payer system. By definition, a government plan is not “single payer” if it competes with other insurers in offering comprehensive coverage. This is not merely a definitional issue, however: it has critically important implications for the economic and political dynamics of the system. Economically, competition between public and private insurers raises potentially crippling problems of risk selection requiring a regulatory framework that has so far eluded even those European jurisdictions with much longer experience with the regulation of social and private insurance. Politically, such a competitive framework renders the arena much more pluralistic and volatile — and effective regulation therefore much more difficult — than does a pure single-payer model with its central axis of profession-state accommodation.

In 2009, the colliding waves of hope, generated by the election of Barack Obama, and fear, generated by global financial turmoil, may produce (a paradigm shift in U.S. health care policy and a paradigm shift in the political landscape). At the very least, it seems inevitable that they will yield a larger governmental role in the health care arena. The shape of the resulting hybrid, and whether that hybrid has any room for a single-payer element, is much less clear.

http://jhppl.dukejournals.org/cgi/reprint/34/4/453

Comment:

By Don McCanne, MD

The fact that the entire August issue of the Journal of Health Politics, Policy and Law is devoted to exploring single payer certainly indicates that the concept has not died within the policy community.

Although a majority (but by no means all) of the political community dismisses single payer as not being politically feasible, much of the policy community accepts it as a feasible policy approach that would bring affordable health care to everyone. Even those opposed based on ideology understand clearly the feasibility of single payer from the policy perspective. Otherwise why would the opponents of reform keep insisting that policies that improve our health care financing would inevitably lead to a single payer system?

Trumka Tells Netroots Nation: "My Preference Is Single Payer"

Kay Tillow
All Unions Committee For Single Payer Health Care–HR 676

Pittsburgh, Pennsylvania — In a wide ranging speech to the annual Netroots Nation Convention, Richard Trumka, AFL-CIO Secretary-Treasurer, said, “My preference, and the feeling of many in the labor movement, is that we should have a single payer health care system.” Netroots Nation is the largest annual assembly of progressive bloggers and web journalists.

Trumka’s speech followed an impassioned appeal for single payer by Pennsylvania State Senator Jim Ferlo who presented the Paul Wellstone Award to Congressman Eric Massa (D-NY). Massa is a co-sponsor and one of the most outspoken supporters of HR 676, single payer healthcare legislation introduced by Congressman John Conyers (D-MI).

Trumka will return to Pittsburgh in mid September for the AFL-CIO Convention where he is expected to be elected President. More than fifty resolutions calling for the endorsement of HR 676 have been submitted to the convention.

Trumka’s remarks can be seen at: http://www.youtube.com/watch?v=WnNolT275Yw

HR 676 would institute a single payer health care system by expanding a greatly improved Medicare system to everyone residing in the U. S.

HR 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, and long term care.

HR 676 ends deductibles and co-payments. HR 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

In the current Congress, HR 676 has 86 co-sponsors in addition to Conyers. Vermont Senator Bernie Sanders has introduced SB 703, a single payer bill in the Senate.

HR 676 has been endorsed by 556 union organizations in 49 states including 130 Central Labor Councils and Area Labor Federations and 39 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NY, NV & MA).

My Brain and the Ontario Health Care System

By Paul E. Barber
Huffington Post
August 25, 2009

You may have seen the stories about the television ad with first person testimony from a woman who claims she had a brain tumor and was unhappy about her care in the Ontario health care system, part of the ongoing assault on “Obamacare.” Five years ago I actually had a brain tumor and dealt with the Ontario health care system. The truth about our system is much different than the misinformation spewing forth over the internet and the airwaves. This is my story.

I am not the type of person who would be described as a hypochondriac. I am more likely to dismiss aches and pains as of no consequence. Thus when I developed some peculiar head and neck symptoms in early 2004 I did not pay much attention to them at first.

Even when I called for an appointment with my GP in March, I was asked by the receptionist if it was urgent and I said no. The GP said he was puzzled by my condition and referred me to a neurologist. I saw him in early April. His assessment included some physical tests, all of which I passed with flying colors. This is perhaps not surprising as throughout this period I was regularly Scottish country dancing, a physically and mentally demanding form of exercise that no doubt kept me in decent shape.

I did have some blood pressure abnormality. The neurologist concluded, not inappropriately, that I should see a cardiologist and said he would recommend that my GP refer me. Shortly thereafter I had an appointment for early May.

A week or so later we were invited by close friends to a delightful Saturday evening dinner. I didn’t think I had drunk too much wine, but my wife was driving, so it didn’t matter. When I woke up the next morning, it was Sunday April 17 and I felt quite sick with a headache — a hangover I thought at the time.

However, unlike all previous hangovers, this one did not disappear on Sunday afternoon — I remained very ill and in bed. By the afternoon of Wednesday April 21, we finally concluded, after consulting my GP on the phone, that I should seek emergency treatment the next day if I showed no improvement.

Late that night, unable to sleep because of a splitting headache, I got up to take some strong headache medication. The last thing I remember was reaching up to the cabinet containing the pills. My wife then heard a crash as I hit the floor. I had collapsed and gone into a convulsion.

This is the point where we discovered just how fast and effective our health system could be. The complaints you hear directed at Canada’s health system about waiting times for treatment are simply without foundation. As you will see from what happened next, my experience says quite the opposite.

The next thing I recall I was being carried downstairs by some fire fighters who responded to the 911 call and had made it to our house ahead of the ambulance. I was taken immediately in the ambulance to the Mount Sinai Hospital emergency. I drifted in and out of consciousness and don’t remember much from that period but a CAT scan done in the wee hours of Thursday, April 22, 2004 revealed a large mass in my brain.

A few hours later I was admitted to the Toronto Western Hospital neurology ward (which has an international reputation for excellence). I had a brain tumor and needed surgery. The doctors were optimistic that what they didn’t get with surgery could be dealt with by chemotherapy and radiation. They assumed I had brain cancer but they said it would be a few weeks after surgery before tests could determine the exact nature of the tumor. The medical staff could scarcely believe that I had actually been at work the previous Friday.

Hooked up to an IV and rehydrated I began to feel a little better. However, I discovered that I had lost considerable sensation on my right hand side. I could not hold a cup of water without dropping it, a very distressing discovery.

Early the next morning, Friday, April 23, I had an MRI. This marvelous machine provided a precise three dimensional portrait of the tumor. That evening my neurosurgeon, Dr. Taufik Valiante, came by the hospital room to discuss my case. He felt I needed surgery in the near future, although not necessarily right away (he thought I might have to wait a week). However, he cheerfully went off to check on the availability of the space and personnel needed to do the surgery, and found we could do it the next day.

Just 60 hours or so after my collapse, on Saturday, April 24, 2004, I underwent five and a half hours of surgery to remove a large brain tumor. The surgery left a large scar running across the top of my head, now just barely visible through my thinning hair. Twinges in my right hand and stiffness in my lower right leg are the only long-term consequences of my experience. I have an MRI every couple of years (I just had one) to check that the tumor has not returned.

Despite the extensive nature of the surgery, it was performed so skilfully that I felt able to leave the hospital and go home the following Tuesday — April 27, 2004. And the next day Dr. Valiante called with the news that the tumor was benign, a slow growing pilocytic astrocytoma, generally thought of as a brain tumor one sees in children. I would not need any further treatment. In less than a week the system had me on the road to full recovery. My wife recalls this period as a blur of unfolding events.

By the way, I did see the cardiologist a week or two later while still recovering from surgery. She did a few tests and pronounced me fine.

As you can see from my story, the delays encountered in my care were entirely of my own making, not wait times in the health care system. Once it kicked into gear, I received incredibly fast, world class health care. Apart from my initial ride in the ambulance and my hospital phone, the only other cost to me was the rental of the hospital TV set. A couple of days after the surgery I remember watching a Toronto Blue Jays-Minnesota Twins game, featuring a first rate performance by then Blue Jays starter Ted Lilly. Full value for my money spent on the TV and full value for my tax dollars that pay for our health care system.

Our experience with Canada’s health care system has been first rate. This includes the cancer care my wife is currently receiving, which has included a sophisticated procedure whereby she successfully received a transplant of her own stem cells at the wonderful Princess Margaret Hospital in Toronto. She did not have to wait for that complex operation either: it was performed upon completion of the essential preliminary treatment.

On another occasion my son dislocated his shoulder playing a pick up game of ice hockey. He called me at work to help him get to the hospital. When we entered emergency the triage nurse gave Alex a quick inspection and then instantly whisked him away for treatment. Once again, no waiting.

I think our experience with health care is comparable to that of most Canadians. Our system may not be perfect but we are more than happy with how it has treated us, and, like other Canadians, we would not trade it for the American system.

Paul Barber is a former journalist and television producer. This article was originally published at The Reaction.

http://www.huffingtonpost.com/paul-e-barber/my-brain-and-the-ontario_b_268128.html

We need major health reform

By Glen Peterson
My View
The Free Press (Mankato, Minn.)
August 25, 2009

The author of two recent My View columns argues against a “public option” being added to our health care system in one column and argues that health insurance should be private in another column. Referring to a report published by the World Health Organization that compared 191 nations, he cites one WHO analysis of “being responsive to patient needs” in which the United States had the highest rating.

He fails to mention that was just one of many analyses conducted, and in the same report the WHO ranked the U.S. 37th in overall health system performance, just ahead of Cuba and Slovania and just behind Costa Rica.

Why does the U.S. compare so poorly to the rest of the industrial world? Among many reasons, our costs are excessive and a great number of Americans are uninsured or underinsured. These problems can be directly attributed to the practices of private health insurers who uniquely in the U.S. provide our primary means of connecting consumers with providers.

According to data published in the medical journal Health Affairs, in 2009 health care spending in the U.S. will total $2.5 trillion or $8,160 per capita (approximately double the health care spending in other industrial countries). Health care spending will account for 17.4 percent of the U.S. gross domestic product (GDP), compared to typically around 10 percent among other industrial countries.

Approximately 60 percent of the funding for health care comes directly or indirectly from taxes. We already pay as much per capita in taxes for health care as do residents in other nations that cover 100 percent of their citizens without additional costs to consumers or to businesses. Approximately 20 percent is paid by consumers for charges such as premiums, deductibles, co-pays, and other uncovered costs. The final 20 percent comes from employers who provide health insurance as part of employee compensation.

Where does the money we pay for health care go? While publicly administered health care programs such a Medicare or Veterans Health Administration have administrative overhead of about 2 or 3 percent, private insurers have varying costs for overhead. A widely cited and accepted average of 20 percent is consistent with the range of 10 percent to 30 percent that is estimated by Paul Keckly, executive director of Deliotte Center for Health Solutions. Executive compensation is just one example of why private insurer overhead is so costly. Current and previous CEOs of Minnetonka-based UnitedHealth Group both have been awarded unexercised stock options worth hundreds of millions of dollars. The previous CEO, who was ousted in a stock options backdating scandal, had many years of annual compensation of more than $50 million.

The Minnesota Office of the Legislative Auditor admits that oversight is inadequate and estimates overhead of “non-profit” health insurers to range from 6 percent to 20 percent. CEOs of Minnesota’s three major non-profit health insurers consistently exceed $1 million each in annual compensation with one CEO receiving closer to $3 million in many years. Among other “overhead” costs we are all paying for, The Center for Responsive Politics reports that insurers and HMO’s have contributed more than $40 million to current members of Congress over the past 10 years.

Recently private insurers are spending over $1 million per day on lobbying. Some insurers also pay employees whose job is to find ways and excuses to deny the claims of policy holders, even when denials are life threatening. It is not publicly administered programs that operate “death panels.” These examples of exorbitant costs are being paid for with our money intended to provide needed health care.

A second major problem associated with private health insurance has to do with limited coverage. With 47 million Americans having no form of health insurance approximately 16 percent of Americans have no systematic, reliable access to needed health care services. This “rationing” is virtually nonexistent in other industrial nations.

Also, in a recent study published in The American Journal of Medicine, researchers from Harvard found that 62.1 percent of all bankruptcies in the U.S. were related to medical costs. Of these, 75 percent actually had health insurance. Even with private health insurance, policy holders are tremendously vulnerable to caps, exclusions, denials and similar gaps that can result in needed treatments not being provided and bills not being paid.

Closer to home, during the August recess, staff from Congressman Tim Walz’s campaign office report retrieving over 130 personal stories from Congressional District 1 residents telling of being unable to get insurance, being dropped from insurance, having claims that are denied by insurers, and going broke or bankrupt. These abuses do not occur in publicly operated systems such as Medicare or the Veteran’s Health Administration, or in other industrial nations with entirely or primarily publicly administered health care systems.

The United States has by far the most expensive health care system in the world. Still, millions of Americans are un-served or underserved in our system. Much of the excessive cost and inefficiency can be attributed directly to the uniquely American approach of using private insurance as the “middleman” or connection between consumers and providers. Publicly administered systems in the United States and in other industrial nations have demonstrated the ability to better meet the needs of more people for less money. This fact should be a primary consideration in enacting much needed major health care reform.

Glen Peterson is a professor of rehabilitation counseling at Minnesota State University. He is an active member of the Minnesota chapter of Physicians for a National Health Program and of the Minnesota Universal Health Care Coalition, with whom he is a member of the Steering Committee and chair of the Community Organizing Committee.

http://www.mankatofreepress.com/letters/local_story_237225053.html