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Testimony of Steffie Woolhandler, M.D., M.P.H., on medical bankruptcy

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Testimony of Steffie Woolhandler, M.D., M.P.H., on medical bankruptcy

Before the Subcommittee on Administrative and Commercial Law
House Judiciary Committee
July 28, 2009

Mr. Chairman, members of the Committee. I’m Steffie Woolhandler. I am a primary care doctor in Cambridge, Massachusetts, and professor of medicine at Harvard. I am also senior author of two studies on medical causes of bankruptcy, one published in Health Affairs in 2005, and the latest in the August 2009 issue of the American Journal of Medicine. Both studies were done in collaboration with colleagues at Harvard Law School and Ohio University.

In our most recent study, medical bills and illness contributed to 62.1 percent of all personal bankruptcies. Between 2001 and 2007, the proportion of all bankruptcies attributable to medical problems rose by 49.6 percent. The striking conclusion from our study is that private health insurance is a defective product that leaves millions of middle-class families vulnerable to financial ruin. Unfortunately, the health reform plan now under consideration in the House would do little to address this grave problem.

We found that most of the medical bankruptcy were middle class — before their financial crisis hit. Two-thirds were homeowners and three-fifths had gone to college. In many cases, high medical bills were part of a cascade of problems that resulted from illness, along with lost income as illness forced a breadwinner to lose time from work. Often illness led to job loss, and with it the loss of health insurance.

The overwhelming majority of those bankrupted by illness in our study had health insurance. Seventy-eight percent were insured at the start of the bankrupting illness; 60.3 percent who had private coverage. These families had done everything right. They worked hard, paid their premiums and thought they were covered. Yet when illness hit they found themselves unprotected, ruined by co-payments, deductibles and bills for uncovered services like home care and physical therapy. Medically bankrupt families with private insurance ran up uncovered medical bills that averaged $17,749.

Our study raises a warning flag that leaving most Americans to rely on private insurance plans means leaving them unprotected. And a public plan option that mimics the rules and coverage of private plans won’t help.

In Massachusetts, we have three years of experience with the kind of plan the House is now debating, and it’s a sad experience. Reform hasn’t made care affordable for the middle class, and it has decimated the safety net that the poor continue to rely on. In 2007, only 5.4 percent of Massachusetts were uninsured — the lowest in the nation. Yet, medical problems underlay 3 out of 5 bankruptcies — the same proportion as in the rest of the country.

In our state, failure to buy insurance is illegal, punishable by a $1,000 fine — as big a fine as for beating your wife or making a terrorist threat. For a middle-income 56-year-old, the cheapest coverage available through the Connector — the state’s insurance exchange — costs $4,900 for a policy with a $2,000 deductible before it pays for any care, and a 20 percent co-payment after that. A diabetic with such coverage is almost certain to lay out $10,000 each year for medical care. In two years he’d accumulate $20,000 in medical bills — more than the amount that bankrupted the average family in our study. This kind of insurance — sold with the stamp of approval of the Connector — is a cruel joke which Congress should not repeat.

And for everyone financially ruined by illness, many more suffer physically because they don’t get the care they need. Access to an insurance policy is not the same thing as access to health care. By 2008, only 3 percent remained uninsured in Massachusetts, yet among those WITH health insurance, 18 percent skipped care because they couldn’t afford it. Moreover, those unable to afford care find safety net hospitals and clinics shuttered. Our governor and Legislature — desperate to keep the reform afloat as costs escalate more rapidly than predicted — have drained funds from the safety net.

Reform needs to replace the defective private insurance that most families have with insurance that is always there, and that covers all medically necessary care without co-payments or deductibles. That’s the kind of coverage people in other wealthy nations get through single-payer national health insurance. Only single-payer national health insurance can make universal, comprehensive coverage affordable by saving the hundreds of billions we now waste on insurance overhead and bureaucracy . In nations like Canada that have single payer health plans, medical bankruptcy is rare. You have a historic opportunity to make real reform happen this year. But overwhelming evidence indicates that the reform you seem poised to pass will fail to protect American families.

Public Option Advocates: Time to Come Home to Single Payer

By Mark Dunlea
Executive Director, Hunger Action Network of NYS
Co-chair, Single Payer New York

As the various public option proposals in Congress for national health care reform become weaker every day, there is still time for its proponents to support what they really believe in: a single payer, Medicare for all type program.

The architects of creating a “public option” as part of the push for national universal health care have always admitted that a single payer Medicare for All type programs was the best solution for America. It does the best job in controlling costs by eliminating the waste and bureaucracy of private health insurance while guaranteeing that every American would receive quality health care and have freedom of choice in selecting whom to receive health care services from.

The public option advocates — well-funded public interest groups and unions used to insider political wheeling and dealing — argued that the lesson from the 1993 defeat of the Clinton plan was that insurance companies were too powerful to defeat. Thus they had to abandon the best solution, single payer, to instead craft a proposal that would have a chance of passage by ensuring a continued large role for the present for-profit health insurance industry.

Their solution was to create an “800 pound gorilla” in the form of a public health insurance system that would provide quality and affordable health care coverage to more than one hundred million Americans. It would be large enough to operate efficiently and achieve cost savings. They argued that by setting up a fair fight between a public option and the private for-profit health insurance companies, over time the advantages of the public option — no profit margins, reduced paperwork and administrative costs, less marketing costs — would become clear. The public option would grow stronger, and under the best case scenario, either we would move to a single payer system or private for-profit health insurance would become a boutique industry serving the rich.

Before either House of Congress has adopted a specific plan, the public option 800 pound gorilla has turned into a five pound Chihuahua. And with four months or more of intense negotiations to take place among the nation’s power players before a final deal is reached, the public option will only get weaker.

The only clear winner in the process will be insurance companies. Americans will be mandated to purchase health insurance — or pay a fine. Insurance companies’ revenues — and profits — will increase under the Congressional plans. The mandate that everyone purchase insurance is one of the few consensus positions; the fight instead is over how taxpayers, employees and employers will have to pay for it.

Single payer advocates have always contended that public option proponents, despite their commitment to Machiavellian politics, were naive politically.

First, public option advocates violated the basic rule of negotiation by significantly weakening their opening position (i.e., dropping single payer for a public option) without getting any concessions in exchange. In addition, by calling for a major continued role for private for-profit health insurance, public option proponents also removed what should have been a key focus on the health care debate, namely that it was in the public interest to eliminate our present insurance system

Second, there was the real question of whether a public option would actually accomplish what its proponents claimed. The history of similar approaches at the state level in recent decades was quite bad. Doctors and hospitals would still have to keep in place their expensive billing and cost-tracking systems to deal with the various insurance programs.

Third, it was quite clear to everyone but its proponents that a “robust” public option was going to generate significant political opposition from the insurance industry. Like most industries, it would oppose anything that sought major cuts in its market share. Unlike single payer, which had the evidence of both Medicare and most of the other industrial nations to prove that it would work, the insurance industry would have a much easier time challenging the claims of benefits of a public option. State plans which had tried similar approaches had all crashed and burned, largely due to its failure to control costs. In addition, evidence from prior Congressional fights – say with Medicare – showed that rather than setting up a “fair fight” between the public option and insurance companies, Congress would likely seek to tilt the “competition” to favor the insurance companies.

So how has the public option fared so far in Congress?

When the “public option” campaign began, its proponents sought a huge “Medicare-like” program. Studies by the Lewin think tank group of the Hacker proposal estimated that it would enroll as many as 130 million people. Thus it would enjoy the advantages that make Medicare so efficient — large size, low provider payment rates (about 20% less than what private insurance pays) and low overhead (2 to 3%).

Today, the “public options” outlined in the Democrats’ legislation, according to the Congressional Budget Office, might enroll 10 million people and will have virtually no effect on health care costs. The program is so small it would have no impact by itself on reducing the number of the uninsured. The main House bill would delay establishing a public option until 2013 — conveniently after the next Presidential election — and would require it to follow the same rules (drawbacks) of private insurance. The ability of workers and others who presently have insurance to move into a public option program is significantly restricted.

Hacker had proposed jump-starting the public option plan by moving all or most of uninsured people as well as Medicaid and SCHIP enrollees into it. Starting with a huge population would reduce its startup, administrative and marketing costs and give it the ability to negotiate lower premiums. Under the present Congressional proposals, it starts with no one, which will greatly increase its initial overhead and marketing costs while largely eliminating its ability to cut costs through lower premium.

The power and political campaign activities of the public option proponents means that many liberal Congresspeople feel obligated to insist that a public option be included in the final bill. It will a public option primarily in name only, especially since so few people ever understood the details of the initial proposal. Meanwhile, the Republicans and right wingers are using the “public option” as a focal point of their criticism of Congressional efforts for universal health care, claiming it is socialism and a first step to single payer, an effort to drive insurance companies out of business. Rather than saying “yes, we want to eliminate private health insurance”, Congress instead seeks to deflate these attacks by doing more to subsidize and strengthen insurance companies.

An additional problem is that Congress is largely equating access to quality health care with having insurance. Yet neither private health insurance nor even public programs like Medicaid guarantee that you will actually obtain health services. We see this in the fact that 77% of Americans who go bankrupt due to high health care bills had health insurance. The co-pays, deductibles, exclusions, prior approval and restrictions on out of network services that come with insurance all impede access to health care. Many Medicaid patients, due to lower physician reimbursement rates, have a difficult time accessing health services outside of a clinic setting. It is quite possible that the public option will experience some if not all of these problems.

Public option proponents started with good intentions. It is time for them to admit that their vision for a public option has been rejected by Congress. Hopefully they will rejoin the movement for single payer health care and fight to establish health care as a human right in America.

Plugging Single Payer…Sort Of

By Steven T. Jones
SFGB Politics on-line
July 23, 2009 01:06 PM

As President Barack Obama held a prime time news conference yesterday to boost his health care reform efforts, he tried to recast the imperative as saving the system for the average American rather than focusing on the 45 million Americans without insurance. But in the process of defending his plan, he also subtly reinforced the need for the single-payer system, as discussed in our cover story this week.

When asked about the approximately 2 percent of Americans that will be left uncovered by the Democrats’ plan, Obama said, “I want to cover everybody. Now, the truth is unless you have what’s called a single-payer system in which everyone’s automatically covered, you’re probably not going to reach every single individual.”

As Peter Baker wrote in the New York Times online story yesterday, Obama didn’t explain why he doesn’t then support single-payer, but Baker wrote, “In the past, he has said such a system might be preferable if the country were inventing a new health care structure from scratch but he does not want to completely upend the current system, which does work for many or most Americans.”

Unfortunately, that final statement is bullshit. Polls show most Americans don’t like the current system (56 percent want “major health care reform” this year, 62 percent want more government control over health care, etc.), although right-wing and insurance industry propaganda have made them scared of the change that is needed to realize the president’s goals of holding down costs, emphasizing preventive care, and ensuring universal access to quality and affordable care.

Upending the current system is precisely what needs to happen.

Advocates Call on Governor Paterson to Highlight Savings from Single Payer Health Care for All — Projected to Save $20 Billion annually by 2019

Groups Want State Lawmakers to Hold Hearings on Long-Delayed Universal Health Care Study

July 28, 2009
For More Info: Mark Dunlea, 518-434-7371 xt 1#
Dr. Richard Propp, 518-482-0420

(Albany, NY) Universal health care advocates today called upon the State Legislature and the Governor to organize a series of public forums and hearings around the state on the recently released study of the most cost-effective way to provide health care to all New Yorkers.

The groups also called upon the Governor to propose a single payer universal health care system for New York. The Governor was a long time sponsor of single payer as a State Senator.

The long awaited study, released late last Friday, concludes that a single payer Medicare for All type program is the most cost-effective way to provide health care to all New Yorkers. (A copy of the report is at http://www.partnership4coverage.ny.gov/) There will be a rally in DC this Thursday, July 30th, the 44th birthday of Medicare, to call for a national single payer plan. Groups in Albany will rally at 5 PM at 90 State St., the offices of the state insurance lobby group.

ā€œWhile we believe this report understates the savings from single payer and overstates the benefits from the public-private hybrid models, we are pleased that it finds that single payer is the most cost-effective approach to provide quality health care to all New Yorkers. We hope the Governor will widely publicize its findings to influence the national debate. Unlike the recent studies by the Congressional Budget Office, this report examined the impact of health care proposals on all segments, namely, taxpayers, consumers and employers,ā€ said Mark Dunlea, Executive Director of Hunger Action Network and Co-Chair of Single Payer New York.

Hunger Action Network, along with Rekindling Reform, led the NY Universal Health Care Options Campaign that sought state funding to study the costs associated with various approaches to universal health care.

The report found that savings from single payer substantially increase over time. By 2019, the Urban Institute concludes that single payer would save $20 billion annually based on the reportā€™s projected 6% annual increase in baseline health care cost ($130 billion for single payer vs. $150.25 billion for present system). Single payer would cost $28 billion less annually than the public-private hybrid (e.g., expand public programs like Medicaid, a small public option, and a mandate to obtain insurance). The hybrid model had been a favorite of Governor Spitzer and his health care advisors.

Single payer would also cost $19 billion less annually by 2019 than the NY Health Plus proposal by Assembly Health Committee Chair Richard Gottfried. NY Health Plus would automatically enroll all New Yorkers in Family Health Plus; however, employers could decide to opt out to purchase private insurances and a tax subsidy would be provided.

A similar report by the Lewin Group for the State of California concluded that a state single payer system would reduce spending below projected levels by an average of $34 billion annually over a ten-year period. Studies done in five other states also found that single payer was the most cost-effective approach to universal health care.

ā€œThe Urban Institute report clearly shows that adequate health care for every New Yorker is achievable. Now we need the will to make it happen,ā€ said Robb Smith, Executive Director of Interfaith Impact of New York State. ā€œHealth care for everyone is a fundamental moral issue. It is a human right that gets at the very foundation of what it means to be human and live in community.ā€

ā€œThe effort to guarantee quality health care to all Americans is a daunting challenge that has defeated Presidents and Congress a half-dozen times over the last sixty years,ā€ noted Dr. Richard Propp, Chair of the Capital District Alliance for Universal Health Care. ā€œTrying to re-organize and improve one-sixth of the national economy is a complicated task. It is important that health care reform be a transparent and participatory process, where New Yorkers can find out what is going on and have their voices heard. We call upon the Governor, Assemblymember Gottfried, Senators Breslin and Duane, to hold hearings in the next few months across this state on this important report,ā€ he added.

The groups want Congress to adopt a national single payer health care system this year such as HR 676 (Conyers) or S703 (Sanders). If Congress fails to act, they want the state to be able to start its own single payer system. The Canadian single payer system initially started at the province level. Ten Congress members from New York are single payer sponsors. More than half of the State Assembly and a majority of State Senators have sponsored single payer legislation. Both houses recently passed resolutions calling upon Congress to enact HR 676.

The Urban Institute estimated a single payer / public health insurance for all (excluding senior citizens) would cost an additional $2.4 billion in its first year, while the other expansion models would cost around $6 billion extra. Total cost in the first year for single payer would be $86.3 billion. While government spending would increase, employers and individuals would save an equal amount while covering everyone.

Even though single payer was found to be the most cost effective, advocates contend that the study underestimated savings. The study estimated that the administrative savings from single payer would only be 10% over 10 years- the same percentage it estimated for the much smaller public option model under the hybrid model. No basis is given for this and other assumptions. Single payer advocates say savings should be much higher, especially if the program includes all residents including Medicare and elderly Medicaid participants. The Lewin group study for California estimated administrative savings of $20 billion annually. The study appears to ignore the tremendous savings and cost reductions that would be available to doctors and hospitals under a single payer plan since they would no longer have to deals with scores of insurance companies and their conflicting policies and paperwork. Even though the study did not include Medicaid under single payer, it decided to charge both single payer and NY Health Plus 18% higher premiums for Medicaid participants; while somewhat higher payments would be expected, no such cost allocation appears to have been charged to the hybrid proposals.

The Lewin group study in California also found more savings from the bulk purchasing of prescription drugs under a single payer system

. The study also appears not to factor in the reduction of health care costs that would result from having a health care system that covers everyone. Especially combined with preventive care, other countries have shown that it is much cheaper to operate a health care system that focuses on keeping healthy rather than on the American approach of spending more money to cure the sick. In addition, having a health care system that automatically covers everyone would also reduce the cost of other programs that deal with health care costs, such as automobile insurance (e.g., for bodily injury), workers compensation and medical malpractice.

The report admitted that most of the public-private hybrid models (18 variations were studied) that focuses on incremental changes would not achieve universal health care. However, the Urban Institute did claim 100% coverage when expansion of eligibility and subsidies for existing programs were combined with a
n insurance mandate and public option. Other studies by the CBO and the Lewin group of such models have all found uninsurance rates of at least 3 to 4%, with the real numbers of uninsured significantly higher (which impacts on emergency room care) due to excluded populations such as legal immigrants and undocumented workers.

President Obama stated at his health care national press conference last week that single payer was the only system that would provide 100% health care coverage.ā€ Now, the truth is that unless you have a whatā€™s called a single-payer system, in which everybodyā€™s automatically covered, then youā€™re probably not going to reach every single individual,ā€ said Obama.

ā€œWe waited two years for this report, more than 14 months than initially predicted. Just because the results didnā€™t support the positions of certain administrative officials wasnā€™t a legitimate reason to try to bury the findings by releasing it late on the Friday after the Senateā€™s two day end of session marathon. When the Governorā€™s office first held the hearings, they admitted they were stunned to find that most of the hundreds of consumers, doctors, nurses and researchers who spoke said single payer was best. Even though they directed the Urban Institute to study a dozen variations of their favorite approach, single payer came out best. We need the Governor to stand with the people and do what is best in providing quality health care to all New Yorkers,ā€ added Mark Dunlea.

The report estimates that 10.5 million people (61.1% of the population) have health insurance coverage through employer-sponsored insurance. Medicare / CHIP / FHP covers 3.7 million people or 21.4%. About 250,000 (1.4%) are covered by the non-group market (including Healthy NY). An estimated 2.7 million are uninsured.

John Geyman’s “The Cancer Generation”

The Cancer Generation: Baby Boomers Facing a Perfect Storm

by John Geyman
Common Courage Press

You can be sure that cancer will be a part of your life. You’ll either get it – nearly half of all men and more than a third of women will. Or you’ll have a close friend who gets it, or be the child of someone who gets it, or the spouse of someone who has it, or in the worst case scenario, be the parent of a child struggling with cancer. You cannot help but stand on the battlefield of the war against cancer. How America wages this war is leaving an indelible mark on your life.

Cancer is now on track to replace heart disease as America’s leading cause of death within the next few years. This is a fight we have to win. Are we winning? And if we are off target, what changes are imperative for victory? Everything we discuss here focuses on these two questions.

So What Will Happen?

Lives hang in the balance on the answer to this question. The future down our current path is crystal clear – and devastating. Deregulated markets and the corrosive effects of profits over service over many years have brought U.S. health care to a crisis point. Because of soaring costs, patients with cancer are finding effective care increasingly unaffordable. Health care has entered a perfect storm, and it is certain to get much worse without real reform. Our primary care infrastructure is collapsing. ERs are overwhelmed, the ranks of the unemployed are rising quickly, adding to the numbers of uninsured. The economy has tanked, the federal deficit is massive, many states are forced to cut Medicaid to the bone, and our presumed safety net is falling apart.

Meanwhile, market stakeholders increase their efforts to maintain the status quo. The private insurance industry calls for the government to change tax policy and keep the subsidies flowing so that insurers can continue to rake off their profits from the system while offloading sicker and lower-income patients onto public programs.

http://www.commoncouragepress.com/index.cfm?action=book&bookid=398

Comment:

By Don McCanne, MD

No topic could serve as a better proxy for the deficiencies in the financing and delivery of health care in the United States than the ever increasing prevalence and expense of cancer. In The Cancer Generation, John Geyman describes the tragic and costly impact of the cancer burden, but then provides us with hope by describing a plan that would reduce these burdens of cancer.

His eight-point plan for one-tier cancer care stresses not only the importance of single payer national health insurance, Medicare for all, but also describes the great power that our own public national health program would have to strengthen our health care system, enabling everyone to have affordable access to high-quality cancer care if and when needed.

The Washington Post kills Blue Cross Blue Shield story

Research Firm Cited by GOP Is Owned by Health Insurer

By David S. Hilzenrath
The Washington Post
July 22, 2009

The political battle over health-care reform is waged largely with numbers, and few number-crunchers have shaped the debate as much as the Lewin Group, a consulting firm whose research has been widely cited by opponents of a public insurance option.

****

Lewin’s clients include the government and private groups with a variety of perspectives, including the Commonwealth Fund and the Heritage Foundation. A February report contained information that could be used to argue for a single-payer system, the approach most threatening to private insurers, Sheils noted.

But not all of the firm’s reports see the light of day. For example, a study for the Blue Cross Blue Shield Association was never released, Sheils said.

“Let’s just say, sometimes studies come out that don’t show exactly what the client wants to see. And in those instances, they have [the] option to bury the study — to not release it, rather,” Sheils said.

Asked to comment, Blue Cross Blue Shield Association spokesman Brett Lieberman said, “We’re still working with Lewin on a study, and, you know, we don’t talk about our studies until they’re done.”

In testimony last month to a House committee, Lewin disclosed its affiliation with UnitedHealth and Ingenix in its written submission, but in his oral testimony he did not bring it up until asked, according to a transcript.

****

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/22/AR2009072202216.html

And…

Insurer-Owned Consulting Firm Often Cited in Health Debate

By David S. Hilzenrath
The Washington Post
July 23, 2009

In a revised version of the same article published the next day, the section appearing between the rows of asterisks was rewritten as follows:

****

Lewin’s clients include the government and groups with a variety of perspectives, including the Commonwealth Fund and the Heritage Foundation. A February report by the firm contained information that could be used to argue for a national system known as single-payer, the approach most threatening to insurers, Sheils noted.

But not all of Lewin’s reports see the light of day. “Let’s just say, sometimes studies come out that don’t show exactly what the client wants to see. And in those instances, they have [the] option to bury the study,” Sheils said.

****

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/22/AR2009072203696.html

And…

A Sponsorship Scandal at The Post

By Andrew Alexander, Ombudsman
The Washington Post
July 12, 2009

The Washington Post’s ill-fated plan to sell sponsorships of off-the-record “salons” was an ethical lapse of monumental proportions.

Publisher Katharine Weymouth and Executive Editor Marcus Brauchli have now taken full responsibility for what was envisioned as a series of 11 intimate dinners to discuss public policy issues. For a fee of up to $25,000, underwriters were guaranteed a seat at the table with lawmakers, administration officials, think tank experts, business leaders and the heads of associations.

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/11/AR2009071100290.html

Comment:

By Don McCanne, MD

Just as the Blue Cross Blue Shield Association killed a study by The Lewin Group that had findings that they didn’t want people to see, The Washington Post killed the reporting of the decision of Blue Cross Blue Shield to bury that study.

The Washington Post is attempting to recover from one of the most serious ethical lapses in the history of mainstream journalism – the selling of access to the publisher, reporters, and others so participants could “build crucial relationships with Washington Post news executives in a neutral and informal setting.”

What has The Washington Post learned? In their decision to manipulate the news on behalf of the private insurance industry during the intensive effort in Washington to reform health care, it’s clear that The Washington Post didn’t learn squat about journalism ethics.

They would have been more honest if they simply sold The Washington Post Company to Fox News. At least we would know with no uncertainty where they stood. Maybe we already do.

Universal healthcare for all: Mandate whose time has come

PNHP note: Medicare’s administrative costs are 3 percent

By Robert Dodge, M.D.
Ventura County Star (Calif.)
Sunday, July 26, 2009

July 30 marks the 44th anniversary of Medicare providing healthcare to all over the age of 65. That system has provided a safety net to all of our seniors, irrespective of their ability to pay. As a single-payer system with the lowest administrative costs, it has proved the most cost-efficient for our nation.

It is the most fair and moral way to deliver healthcare.

When you get sick, you get care and the bill is paid. Nothing could be simpler.

Prior to Medicare, the whims of health, illness, luck and infirmity were the gamble facing the oldest segment of our population. Today, that same dilemma faces more than 45 million Americans — yes, 1 in 6 without health insurance.

According to a 2004 report by the Institute of Medicine of the National Academy of Sciences, this has resulted in the deaths of 50 Americans each and every day because they lacked health insurance! That is more than 18,000 American lives lost every year, not from war or the H1N1 flu pandemic, but lack of health insurance. Additionally, an estimated 50 million Americans have inadequate insurance, putting them in the precarious position of being one illness away from health or financial disaster.

As practicing physicians, every day, we face decisions of how to provide the best healthcare to our patients. Let there be no misconception. Our current system rations care based on financial means and ability to pay. Even those with coverage face the idiosyncrasies and gaps of health-insurance companies.

This is perhaps best said in recent testimony before the U.S. Senate Committee on Commerce, Science and Transportation by Wendell Potter, former head of corporate communications at Cigna: “I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers and they make it nearly impossible to understand — or even to obtain — information we need.”

These realities do affect outcomes and severity of illness, resulting in higher costs. In the words of former Surgeon General Dr. Joycelyn Elders, the U.S. has the best “sick care” in the world. This has also resulted in the most expensive care in the world. The excess costs are paid by all of us — each individual and business each and every day. We pay in cost-shifting, bankruptcy costs and, lastly, when businesses add their employee health costs to their product price and we reimburse them at the cash register.

Two-thirds of U.S. bankruptcies in 2007 were due in part to medical bills or illness, amounting to 1 million bankruptcies annually. Three-quarters of these individuals had insurance at the onset of their illness.

Healthcare is the fastest-growing part of our economy, currently consuming 18 percent of gross domestic product and growing. This is not sustainable.

How should we respond to this unacceptable and unethical dilemma? There is a solution to provide cost-effective, comprehensive healthcare to all. A reformed “Medicare for All,” as embodied in Rep. John Conyers’ bill (HR 676 in the House) with its 83 co-sponsors, provides the answer. This proposal involves removing the insurance company middlemen from the healthcare equation, substituting a “Medicare for All” single-payer program. This provides public financing with a private delivery system. Polls show that 62 percent of the public and 59 percent of physicians support this option.

How will it be paid for?

It is estimated that private insurance companies spend 31 percent of premium dollars on administration compared with 9 percent for Medicare. This amounts to approximately $400 billion annually in excess of the administration costs of the Medicare program. Under a single-payer “Medicare for All” program, these dollars would be put to healthcare delivery.

The estimated costs of the current healthcare-insurance proposals being considered by Congress (and used to engender fear by the opposition and vested interests) amount to $100 billion to $150 billion annually — far less than the expected savings amounting from a single-payer system. Thus, coverage for all under this plan would provide better care with far greater savings.

In addition, choice of physician and hospital would be maintained. Also, the focus would be changed to wellness and preventative health.

Americans have spoken and have the right to universal healthcare. Our elected officials who are often “bought” by corporate American dollars work for the people.

The problem is both Democrats and Republicans have shared in the $46 million in campaign contributions from the insurance industry and current estimates of $1.5 million spent daily by the industry to defeat these proposals. Our leaders have the obligation to respond to our demands to provide a solution to this crisis in healthcare. Divergent views will be held, but, make no mistake of what is at stake. The status quo is not acceptable. Proposals that do not cover all Americans with uniform, nonfragmented healthcare are not solutions, but only added problems to be dealt with at a later date.

Now, at long last, is the time to realize the goal first stated by President Harry Truman in 1945 of healthcare for all.

— Robert Dodge, M.D., of Ventura is a family physician; Evan Slater, M.D., of Ventura is an oncologist; Thomas F. Golden, M.D., of Ventura is an orthopedic surgeon; Fran S. Larsen, M.D., of Santa Paula is a family physician; Charles L. Murphy, M.D., of Ventura is a family physician; and Geoffrey L. Loman, M.D., of Ventura is a family physician.

http://www.venturacountystar.com/news/2009/jul/26/universal-healthcare-for-all-mandate-whose-time/

Single-payer health care will work

Not only will it give all Delawareans universal health coverage, but also, it will save us a bundle

By FLOYD E. McDOWELL SR.
The News Journal (Delaware)
July 19, 2009

Single-payer health care reform is a no-brainer for informed citizens and credible elected political decision-makers.

Our state’s growing list of 32 statewide organizations and individuals supporting our single-payer Delaware Health Security Act will see a breakthrough in state single-payer legislation in 2010.

It’s happening elsewhere.

California’s State Legislature has twice passed a single-payer act, but both were vetoed by their Terminator governor. Former Gov. Jerry Brown, now attorney general, has announced his bid for governor in 2010, is leading in the polls and is a strong single-payer advocate. California has 43 times the population of Delaware, and if it were a nation it would have the eighth largest economy among all nations. Maine’s state legislature has passed a single-payer act, and its coalition is working to elect a governor who won’t let the Brinks truck visit and cause a veto.

Coalitions in Massachusetts, Vermont and many other states are making solid progress toward enactment of single-payer acts.

If one of these Eastern Corridor states passes single-payer reform, few private businesses will come to our state and we’ll lose more than Chrysler and GM competing in the global economy.

Many polls, at state and national levels, show that about 70 percent of citizens polled want single-payer reform. Sensible single-payer or similar public-option reform will never occur in Washington, thanks to some 40,000 well-funded lobbyists protecting this largest cash cow in our nation’s history. It’s in the states where citizens can be informed and enlisted to support this desperately needed change.

The health-care page on our coalition’s nonprofit, nonpartisan DEinformed voters.org site thoroughly explains the Delaware act.

The following is a partial list of the many research-proven, cost-effective benefits it will provide all Delaware citizens and our state:

* All citizens and their families will receive comprehensive, universal health care coverage from conception until death without a cent needed for extra insurance, co-payments or deductibles. This also applies to Delaware workers and their families if the worker lives in another state and works at least 20 hours a week in Delaware.

* Health-care coverage will include all services for physicians, dentists, other health-care professionals, hospitals, pharmaceutical drugs, all types of long-term care, laboratories, diagnostic technologies, our disabled citizens, mental health treatment, drug addiction treatment, and special equipment and aids.

* The act will eliminate all health-care debt, now responsible for about 70 percent of personal bankruptcies. This is a big reason citizens lose their homes or can’t buy homes. Eighty percent of those filing for bankruptcy had health insurance.

* It will eliminate the Medicare/Medicaid pauper requirement that one must give up all savings and property to receive long-term care assistance.

* It will enable everyone’s health-care records to be electronically sent anywhere in the world, whereas only 20 percent are now being transmitted that way.

* Personal health-care savings will enable hundreds of millions annually to be spent in our economy.

* The act will reduce vehicle and home/building insurance cost by eliminating the personal injury liability requirement.

* The act will operate like our successful single-payer Medicare program, which has an administrative/overhead cost of 1.5 percent, and will have adequate funds to properly pay all health-care providers.

* Although we spend twice as much on health care as the other 29 developed nations and are ranked 37th among all nations by the World Health Organization on important health-care indicators, we’re the only developed nation that does not provide universal health-care coverage.

This act will eliminate the totally unnecessary broker health insurance industry (including AARP insurance), as they don’t contribute even a Band-Aid to any part of health care, waste about 40 percent of our state’s health-care funds via 30 percent administrative/overhead cost (tons of costly multi-payer paperwork, profits, advertising, lobbying, etc.) and a minimum of 10 percent in health-care fraud. This act will return all decision-making to physicians and other professionals, whereas now they have to get permission from health insurance industry staff for some life-or-death decisions. All citizens will choose their health-care physicians and other providers.

This act will save our state’s budget over $200 million each year in lowered costs for state employee/retiree health-care coverage and on other state-funded health-care programs. State workers would not have a salary cut and not have to pay 2 percent of salary on health-care costs.

It will be like a magnet to both attract and retain private businesses in our state. It will save private and public employers 40 percent in workmen’s compensation insurance rates. Private businesses will only pay about 10 percent into the state’s fund. Large businesses will pay less than they’re now paying, and small businesses will only contribute 3 percent, at one-half the rate of large businesses.

All state/federal funds for health care will go into the Delaware Health Security Fund. Ninety percent of our state’s health-care funds come from hard-working citizens, 70 percent from taxes and 20 percent from out-of-pocket expenses. Each taxpayer filing a Delaware tax return will be required to pay a 2.5 percent Health Security tax on net (after deductions) income. This will be less than the current and future out-of-pocket expense. This act asks our elected officials to let our citizens’ funds be used to cover themselves and family members just as their tax funds now provide and offer a comprehensive health-care benefit package to each of them and their family members. What irony!

Finally, this system is not government-run.

The ruling Delaware Health Security Authority will be composed of four members from the House and Senate Health Committees, the Secretary of Health and Social Services representing the governor’s office, five representatives from statewide organizations representing health-care professionals and five from consumer groups that have endorsed single-payer reform.

Fifteen-member County Advisory Councils will be established in each county from the same sources to work with the state authority on all planning, implementation and evaluation of health-care facilities, staffing and services in each county.

Any lobbyist, politician or citizen who does the Halloween routine that this will bring the “guvment” between you and this sensible, cost-effective health-care system is either uninformed, a pathological liar or both.

Who will run health care?

by Bob Balhiser
Queen City News
Wednesday, July 15, 2009

To the Editor:

With Barack Obama as our new president, Americans will never have a better opportunity to take our political system back from the lobbyists who are in control now. An ideal place to start would be with health-care reform. To illustrate just how ripe the opportunity is, ask yourself why the health-insurance lobby is spending $1.4 million every day running scare ads designed to prevent meaningful health-care reform.

Even Max Baucus recognizes that our health-care system is the most expensive in the industrialized world. For this, we can thank health-insurance companies that siphon off nearly 30 cents of every health-care dollar for administrative costs and outrageous executive salaries, not to mention the huge collateral costs they impose on doctors, hospitals, and pharmacies, which must pass them on to patients. Isn’t it time we said enough?

The trillion-dollar question before us now is whether we will let lobbyists continue to run health care, or will we regain control? We CAN change the way we pay for health care, and we don’t need to invent a whole new system to accomplish this. I have Medicare and, except for the “parts” managed by private insurers, it works quite well. Let’s upgrade Medicare, make it a “pure” government entity, and make it available to all American citizens. In doing so, we should incorporate some best practices from other successful systems to create an affordable, “world-class” universal health-care system that is the envy of the world.

Fixing A Sick Health Care System

By George E Curry
NNPA Columnist
6/17/2009

The debate over universal health care heats up this week amid false charges that President Obama wants to institute “socialized medicine” and health reform hurts those already covered by private insurers. One of the most important facts to keep in mind is that although the United States spends twice as much as other industrialized nations on healthcare ($7,129 per capita, it is at or near the bottom when it comes to such indicators as infant mortality and life expectancy.

If providing free, universal health care to all citizens is such a bad idea, why has it been adopted in England, Canada, Brazil, Israel, Germany, Australia and Scotland? In fact, the United States is the only industrialized nation in the world that does not provide universal health care for its citizens. Consequently, at least 43 million Americans are without health insurance and that figure is certain to grow with rising unemployment.

“The reason we spend more and get less than the rest of the world is because we have a patchwork system of for-profit payers,” Physicians for a National Health Program noted on its Web site. “Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sale and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy.

“Combined, this needless administration consumes one-third (31 percent) of Americans’ health dollars.”

By switching to a singlepayer system that covers all medical necessities, it is estimated that savings will amount to more than $350 billion per year.

Obama has made health reform one of his top priorities. Not unexpectedly, some leading Republicans are accusing him of favoring socialized medicine and urging the government to not meddle in affairs that should be handled by the private sector.

A group calling itself Conservatives for Patients’ Rights has already begun running spots on CNN designed to scare the public, saying Obama’s “government-run” plan would cut consumers’ choices.

Factcheck.org notes, “That’s not the type of public plan President Obama has proposed. Nor is such a plan gaining acceptance on Capitol Hill.”

A House summary of the United States National Health Care Act (H.R. 676) introduced by Rep. John Conyers and making its way through Congress states, “The bill would create a publicly financed, privately delivered healthcare system that uses the already existing Medicare program by expanding and improving it to all U.S. residents and all residents living in U.S. territories. The goal of this legislation is to ensure that all Americans will have access, guaranteed by law, to the highest quality and most cost effective healthcare services regardless of their employment, income, or healthcare status. With over 45-75 million uninsured Americans, and another SO million under-insured, the time has come to change our inefficient and costly fragmented non-healthcare system.”

The summary continues, “The program will cover all medically necessary services, including primary care, inpatient care, outpatient care, emergency care, prescription drugs, durable medical equipment, long term care, mental health services, dentistry, eye care, chiropractic, and substance abuse treatment. Patients have their choice of physicians, providers, hospitals, clinics, and practices. No co-pays or deductibles are permissible under this act.”

A recent poll by the New York Times and CBS News found that 57 percent of Americans would be willing to pay higher taxes if it meant universal coverage for all Americans. Thirty-eight percent opposed the idea. Not only is universal health care sound public policy, it can provide an economic advantage as well.

Writing in Canada’s Financial Post, Diane Francis said:

“Universal health care is a cornerstone of smart economic policy. Take, for example, the effect of guaranteed health care on economic activity, business expansion or the public’s sense of wellbeing. If a worker in Canada or Europe or Japan loses his or her job this recession, it’s a psychological and financial blow. But if an American loses his or her job, the family faces financial ruin if sickness strikes any member because they are without healthcare coverage.”

She continued, “Bridge coverage is available but unaffordable for anyone but the wealthy. Worse yet, if a major illness is diagnosed during unemployment, a worker becomes unemployable, bringing about a life sentence of poverty.

“Little wonder, then, that consumer spending has ground to a halt in the United States, which makes the economic meltdown that much harder to combat or ever solve.”

It’s time for the United States to catch up with the rest of the industrialized world by providing universal health care.
[Author Affiliation]

George E. Curry, former editor-in-chief of “Emerge” magazine and the NNPA News Service, is a keynote speaker, moderator, and media coach. He can be reached through his Web site, www.georgecurry.com.

Healthcare and Free Press: Two Human Rights We Lack

By David Swanson
July 23, 2009

President Obama said on Tuesday night:

“Now, the truth is that, unless you have a — what’s called a single-payer system, in which everybody is automatically covered, then you’re probably not going to reach every single individual because there’s always going to be somebody out there who thinks they’re indestructible and doesn’t want to get health care, doesn’t bother getting health care, and then, unfortunately, when they get hit by a bus, end up in the emergency room and the rest of us have to pay for it.”

Another name for “what’s called a single-payer system” would be: healthcare as a human right, not a commodity to be purchased. Many humans have this right. They just aren’t Americans.

Obama’s mention of single-payer, in passing, as something that would be better than anything else, but something that mysteriously lies out of reach, is typical of the very few mentions of single-payer healthcare in the U.S. corporate media.

I just did some searches in the Lexis Nexis databases of major US and world publications, news wire services, and TV and Radio broadcast transcripts. Searching for “healthcare” in July 2009 found over 1,000 documents, the maximum number that Lexis Nexis will display. In fact, searching just the past two days found over 1,000 documents. Another search confirmed that this is “Michael Jackson” level coverage. And another search confirmed that virtually none of these documents mentioned single-payer at all, much less told anyone what it was. A search for documents later than July 1st containing single-payer OR “single payer” turned up only 197 documents.

Americans have consistently told pollsters for decades that they want single-payer. But America’s government refuses to provide it, and therefore America’s state media refuses to discuss it. Of the 197 records of the media mentioning single-payer in July, almost half were congressional records or press releases or otherwise not media reports at all. Others were articles in medical trade publications. Even so, those articles tended to mention single-payer very briefly and dismiss it — in the unfortunate phrase used by Kaiser Health News — as “dead on arrival.” Several others were transcripts of unidentified local shows that mentioned the word in passing. Others were blurbs in local newspapers announcing events. And several were reports and columns in British and Canadian newspapers. The Canadians, by the way, seem to be under the impression that President Obama is seeking to create single-payer healthcare. Several more documents — by far the best and most extensive US coverage of single-payer — consisted of letters to the editor.

A Boston Globe editorial mentions single-payer in a list but says nothing about it. A four-sentence Associated Press report on an event mentions the word. A Washington Post column by Dana Milbank attempts to mock all humanity and somehow mentions single-payer in the process. Several articles report on town hall forums at which people have asked President Obama why he doesn’t support single-payer. The Washington Times complained that such questions were permitted. The Washington Post praised Obama for appearing ready for such a question and answering it “calmly.” No word on whether his answer made any sense or not. There’s a report of an event at which the Secretary of Health and Human Services opposed single-payer. There are several reports of a press conference held by the White House Press Secretary at which someone apparently shouted out “single payer” for a laugh and got it.

There are a number of reports and transcripts that attack single-payer without explaining what it is. Most of them attack the so-called “public option” as leading to single-payer. That is to say, the media is afraid that people will overwhelmingly prefer precisely what the media opposes, and the media opposes it precisely because people would prefer it. The public option could only lead to single-payer if everyone decided they prefered it to the high costs and poor health provided by the for-profit insurers. The reports taking this approach include a CNBC interview in which the host makes this claim, a Washington Times column by Senator Judd Gregg, an Associated Press story quoting Senator Gregg, a transcript of the Ed Schultz Show on which another Republican senator made the same claim, another MSNBC transcript with Senator Charles Grassley, a Copley News column by Phyllis Schlafly, a Fox News interview by Sean Hannity of Louisiana Governor Bobby Jindal, a Fox News transcript with Congressman John Fleming, and a transcript of Chris Matthews interviewing Senator Orin Hatch. Other transcripts attack single-payer more directly, if no more substantively. Two of these are from Fox News. One is from CNN. Two are from Bloomberg TV.

There’s a short New York Times interview of Howard Dean opposing single-payer. There’s an NPR Morning Edition transcript of Congressman Jerrold Nadler saying he’d like single-payer but that it’s “off the table.” There’s an NPR Talk of the Nation transcript that briefly mentions single-payer. There’s an NPR Fresh Air transcript in which Terry Gross asks a guest whether he would really prefer single-payer and the guest says “Yes, but . . . .” There’s a four-sentence editorial by the Boston Globe explaining that “Harry and Louise” advertisements are false because single-payer is not under consideration. There’s a Washington Times article suggesting that Obama might move away from single-payer. Never mind that Obama has not supported it for years. There’s a Toronto Star report on Wal-Mart’s proposal to solve the US healthcare crisis. There’s a Copley News column complaining that the Bill Moyers’ Journal on PBS has covered single-payer. There’s a Washington Post column by Harold Meyerson complaining, in passing, that citizens will not create a movement for single-payer, even though it was that movement that put single-payer on Bill Moyers’ program.

There are five transcripts from the Ed Schultz Show, some of them treating single-payer honestly, including an interview of Dennis Kucinich. There are interviews of Senator Bernie Sanders by Fox News as well as Ed Schultz. And there are reports in print. One article from McClatchy reports on a poll finding that Canadians prefer their system. A lengthy St. Petersburg Times article compares the US and Canadian systems, making Canada appear the winner. One Boston Globe column by Jonathan Cohn supports single-payer. And a short op-ed, accompanied by two opposing op-eds, in the Los Angeles Times, was written by a Brit who wants to know what in the world is wrong with single-payer. He won’t find an answer in the U.S. media, which is barely even willing to explain what single-payer is.

But an excerpt from a recent Washington Post article that did not mention single-payer may help make clear where our government and our government media are coming from:

“Private insurers have effectively engaged in rationing, so they’re doing the dirty work for everybody else,” said Jeff D. Emerson, a former health plan chief executive. “It’s a thankless job . . . but somebody has to do it or health care will be even more expensive than it is now.” Private insurers might be better situated than the government to do the unpopular work of saying no, said Paul B. Ginsburg, president of the Center for Studying Health System Change, because they are less susceptible to political pressure.”

There you have it. For-profit companies best serve the public interest precisely because they are not subject to public control. Why? Because the public wants what is worst for the public. And how does the Washington Post know this? It has dinner with all the right people, and charges them for the privilege.

By the way, a similar search in Lexis Nexis’ blogs database turned up another 139 reports, with much more substance and honesty. And most blogs are not included in the search engine.

For-profit insurance: No value added

By JAMES C. MITCHINER
Detroit Free Press
July 27, 2009

In the health care debate, the one question we should be asking is: What is the marginal value of having private health insurance?

After all, if the purpose of health insurance is to mitigate the financial consequences of catastrophic illness or injury, the current level of medical bankruptcy shows that having such “insurance” is, for many Americans, anything but. Recent research from Harvard University and Ohio University showed that 78% of the individuals whose illness led to bankruptcy had health insurance at the onset of the illness that pushed them or their families into bankruptcy court.

Yet we continue to trust private insurers. Policymakers and federal legislators seem to have blind faith in their ability to solve the problems of American health care.

In order to maintain their profit margins, insurance companies are raising premiums while pushing more of the costs of care onto individual policyholders. Premiums are increasing annually at a rate that is three times the rate of inflation. Fewer employers, especially small firms, continue to offer comprehensive coverage, and for workers with employer-based insurance, out-of-pocket expenses increased 34% between 2004 and 2007. Those who have been laid off are finding that extension coverage under COBRA is overpriced and unaffordable.

Moreover, it is hard to argue that premium money spent on administration, marketing, public relations, lobbying, inflated CEO salaries and corporate profits is preferred to spending money on actual patient care.

Aside from costs, for-profit insurance companies will tell you that they facilitate high-quality health care and offer more choices than a government plan would offer. Really? There is no evidence of which I’m aware that for-profit insurers consistently provide better quality of care than their nonprofit private and public plan counterparts.

The argument that for-profits preserve choice of medical providers is also invalid, given that the “choices” are made for you through the insurers’ selective contracting with provider networks that include a limited number of physicians and hospitals. In addition, those who feel that they can go to any doctor of their choice without incurring additional costs should remember that over 90% of metropolitan areas are served by only one or two insurers.

But there is a viable alternative. Single-payer health insurance is simply a way to finance universal health care. By replacing the 1,200 private insurance companies — each having its own set of regulations, provider networks, prescription drug formulary, pre-authorization forms, 1-800 number and Web site — into a single insurance entity, such a single-payer system would reap the benefits of economies of scale, reduce administrative waste, mitigate bureaucratic duplication, sever the link between health insurance and employment, reduce health care disparities, and at last provide creditable coverage for the millions who lack it now.

And, unlike so-called socialized medicine — which requires you to go to a doctor employed by the government and receive treatment at a government hospital — single-payer utilizes private physicians and private hospitals, chosen by you and not by your employer, your health plan or the government. It is basically a simplified, commonsense Medicare-for-All program, a plan that characterizes universal health care in Canada and is the established norm in most Western European countries.

In most polls where various health reform options are listed, a universal, tax-supported single-payer plan is preferred by the majority of respondents. Single-payer is supported by thousands of physicians, hundreds of labor unions, several large medical and public health organizations, over 80 members of Congress, and three Nobel laureates.

A bill, HR 676, the U.S. National Health Care Act, has been introduced by U.S. Rep. John Conyers of Detroit. And, although he evidently doesn’t like to admit it, single-payer was at one time publicly supported by candidate Barack Obama.

President Obama’s goals for health reform are to expand access to high quality affordable care, control costs and preserve choice. Single-payer health insurance is the only plan that will simultaneously and synergistically accomplish all three goals, and without breaking the bank. We should stop pretending that the private insurance industry can do it better.

James Mitchiner, M.D., is an Ann Arbor emergency physician and the former president of the Washtenaw County Medical Society.