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Say no to status quo, go for single-payer

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Say no to status quo, go for single-payer

By Christopher Stack
Indianapolis Star
Posted: July 15, 2009

Serendipity is a wonderful thing. On June 29, The Star published the “Our View” article by executives and physicians employed by Anthem Blue Cross and Blue Shield titled “Beware pitfalls on road to health-care reform.” The same day, The New York Times printed an editorial titled “Insurance company schemes.” Those interested in the health-care debate now consuming Congress should read both. The contrast could not be more stunning.

On the one hand, three company physicians and an executive of WellPoint (it owns all the major shareholder-owned BC/BS plans in the country) make a plea for caution as Congress considers reform measures, particularly the public option. “Don’t throw out the baby with the bath water,” they seem to be saying. The “baby” is presumably our current system, which leaves 50 million uninsured, another 50 million underinsured, spends twice per capita of any other industrialized nation with poorer overall results, wastes 25 percent of the premium dollar on overhead, and is driven by profit-seeking behavior.

The WellPoint execs paint a frightening picture should any sort of strong public option exist: a government monopoly crushing a helpless industry, stifling innovation and efficiency, and threatening one-size-fits-all medicine as the prelude to dreaded “socialized medicine.” At the heart of the system they defend is the employer-based private insurance industry.

On the other hand, the Times editorial cites the recent testimony of Wendell Potter, former head of corporate communications for health insurance giant Cigna, before the Senate Committee on Commerce, Science and Transportation.

His testimony, supported by the committee’s own research, is particularly damning. It details industry practices such as rescission, the practice of retroactively finding fault in policy applications and then canceling policies. According to the Senate committee’s research, three large insurers canceled coverage for 20,000 people over a five-year period, saving the companies more than $300 million. WellPoint has paid substantial fines in the past year for such a practice. The industry also “purges” its base of unprofitable accounts.

Potter elaborates on industry practices such as cherry-picking, deceptive marketing and the deliberate design of confusing plans. He cites harsh underwriting terms that dictate maximum work-force age, number of female employees, and require an annual employee turnover rate such that many employees cannot qualify for benefits.

The final paragraph of the WellPoint piece is very ironic. It pleads for reforms that “focus on appropriate uses of resources currently available, improving the health and wellness of our society, and a reduction in the amount of unnecessary and inappropriate regulation placed upon the health-care system.” Such a reform already is operating — in the form of Medicare, which delivers care to the 45 million elderly and disabled with quality, efficiency, speed, and the backing of the federal government. The simplest, most cost-effective reform plan is “Medicare for All,” with more than 80 co-sponsors in the House, the single-payer option.

Stack is a physician in Indianapolis.

http://www.indystar.com/article/20090715/OPINION01/907150322/1002/OPINION/My+View++Say+no+to+status+quo++go+for+single-payer

U.S. Health Spending Breaks From the Pack

By Catherine Rampell
Economix Blog
New York Times
July 8, 2009, 7:51 pm

Despite the fact that the United States is the only industrialized nation that does not ensure that all its citizens have health care coverage, the United States spends a (much) higher percentage of its gross domestic product on health care than its peers. It also spends (much) more per person on health care than its peers.

But that hasn’t always been the case.


Source: Organization for Economic Cooperation and Development

The Organization for Economic Cooperation and Development recently released updated historical statistics on health care, showing that health expenditures have risen drastically across the industrialized world.

As demonstrated by the mass of squiggles in the chart above, the United States has generally been at the high end of health care spending. But once upon a time, it was more or less on par with its peers, and at various points even spent less of its G.D.P. on health care than some other countries (namely, Canada, Sweden, Denmark and Germany).

There were also a few years when it wasn’t the biggest spender per capita on health care, in purchasing power parity terms.


Source: Organization for Economic Cooperation and Development Data shown are in United States 2000 purchasing power parity dollars.

Although you could quibble about the exact trajectories, it seems to have been in the late 1970s or early 1980s that America’s health care spending really broke from the pack.

Since 1980, the portion of G.D.P. that America spends on health care has risen by about 7 percentage points, whereas the average for other Organization for Economic Cooperation and Development countries has risen by 2.3 percentage points. Health expenditures per capita in the United States have likewise more than tripled since 1980, adjusting for inflation. The average for the rest of the member countries, where data are available, has more than doubled.

Organization of Women’s 2009 Woman of Action

by Mike Hall
AFL-CIO Blog
Jul 10, 2009

Donna Smith, a community organizer and legislative representative for the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC), was recently honored as the National Organization for Women’s (NOW’s) 2009 Woman of Action.

Smith first came to the public’s attention in Michael Moore’s 2007 movie, “SICKO.” Despite having health insurance and even a health savings account, Donna and her husband Larry were forced to move into their daughter’s basement after being unable to pay staggering health care costs–and were left in financial ruin.

Donna’s husband, Larry, suffered three heart attacks and Donna was diagnosed and treated for uterine cancer. There is even a scene in the movie “SICKO” where Michael Moore takes Donna to Cuba to get the necessary treatment their insurance wouldn’t pay for.

After the film was released, Smith became a health care activist, taking her story and those of other victims of the badly broken health care system around the country at rallies, teach-ins, seminars and demonstrations. She is a founder of the health care advocacy group American Patients United.

At the group’s recent national conference, NOW President Kim Gandy said Smith “epitomizes how to best confront the injustices in this world.”

Donna is speaking out, organizing, pressuring and advocating for solutions to fix the long-standing crisis produced by our unfair for-profit health care system.

Donna’s story is remarkable–from illness, bankruptcy, financial ruin–to fighting back and becoming an icon to millions as a health insurance reform advocate. We salute Donna for her hard work and tenacity.

Senate HELP amendment on “data exclusivity”

NVCA Study Supports 12-Year Data Exclusivity Period

By Donald Zuhn
Patent Docs
Biotech & Pharma Patent Law & News Blog
July 13, 2009

On Friday, the National Venture Capital Association (NVCA) released the results of a study suggesting that “a data exclusivity period of at least 12 years for innovator products is a critical fulcrum in the effort to balance cost with the preservation of biotech innovation.”

http://www.patentdocs.org/

And…

Executive Session on the Affordable Health Choices Act

U.S. Senate HELP Committee
July 13, 2009

Consideration of the Enzi/Hatch/Hagan amendment on establishing a data exclusivity period of 12 years for biotech innovation

Sen. Orin Hatch: I don’t know a biotech company that isn’t for this bill, for this 12 year data exclusivity.

****

Sen. Kay Hagan: These individuals are out there looking for venture capital to obviously help them get these drugs to market… In order for our country to maintain this innovation and this research we need 12 years of data exclusivity.

****

Sen. Judd Gregg: Money flows into biologics research because capital moves there to make money. That’s the way a market system works.

****

Sen. Tom Harkin: Keep in mind what we’re talking about here. We’re not talking about patents. Everybody gets a 20 year patent… What we’re talking about here is data, data exclusivity… How do you get that data? You get it through FDA supervised trials… Where do they do those clinical trials? Academic health centers. Who supports academic health centers? Our taxpayers… When should that data be released so that another company out there, some other entrepreneurs, can look at the data and say… I’ll bet if we changed this and did this, we might come up with a new formulation that might actually help something else. They’re still going to have to go through their clinical trials… At least they’ll be able to look at the data. If you don’t do that that means that the company can sit on that data for 12 years. Then they let the data out. Clinical trials will take another 7 years or more, so you’re going to have at least a whole 20 year run in there… before anyone can ever surface with anything even comparable to what that drug or that biologic is.

****

Sen. Bernie Sanders: Let’s find out why year after year the drug companies make hugh profits, look at why the drug companies have never once, to the best of my knowledge, have never lost a political debate here in Congress… (medicine) doesn’t do anybody any good if they can’t afford it. I think for year after year we’ve been paying a lot of attention to our friends in PhRMA, who are spending, I don’t know what they spend in lobbying and campaign contributions, a whole lot of money. Maybe it’s time that we start worrying about the people who have to pay for this medicine.

****

Sen. Sherrod Brown: You know what we’ve not talked about, Mr. Chairman? We’re not talking about how much these biologics are costing patients. Let me give you some numbers. (examples)… 48 thousand dollars… 20 thousand dollars …100 thousand dollars. You know what the average wage in my state is? 46 thousand dollars… If we do this giveaway to the drug industry, this giveaway to the biologic companies, it means profits are up for them, it means executive salaries are up for them, it means we can all feel good, but let’s think about the patients, let’s think of the patient with breast cancer who has got to spend 1000 dollars a week… the patient with colon cancer who’s got to spend 2000 dollars a week… What kind of progress is that, Mr. Chairman?

****

The data exclusivity amendment passed by a vote of 16 to 7, with several Democrats voting in support.

421 minute video of the July 13 afternoon session:
http://help.senate.gov/Hearings/2009_06_17_E/2009_06_17_E.html

Comment:

By Don McCanne, MD

For the past week or so I’ve been live-streaming the Executive Session of the Senate HELP Committee as they have been marking up the Kennedy health care reform bill, the Affordable Health Choices Act. It has been running at the corner of my computer screen while I have worked on other projects. Since I am not competent at multi-tasking, I’m pretty jaded right now.

Last evening’s session devoted to the data exclusivity amendment was the longest amount of time they spent on any issue in the reform legislation. I stopped my other work to watch it. This morning, I’m not only jaded, but I’m also depressed. I’ll tell you why.

Earlier in the day yesterday, I sent out the following quote from Bill Moyers: “Nothing will change — nothing — until the money lenders are tossed out of the temple, the ATM’s are wrested from the marble halls, and we tear down the sign they’ve placed on government — the one that reads, ‘For Sale.'”

I didn’t sleep last night. Instead of counting sheep, I kept watching, in my nightmare, each of those Senators who voted yes picking up their bundle from the ATM machine in the marble halls on their way out as they passed the “For Sale” sign at the door.

But this isn’t about my nightmare. It’s about the 307 million of us who are the merchandise in Congress’s rummage sale. That’s why I’m depressed.

Senate HELP amendment on "data exclusivity"

NVCA Study Supports 12-Year Data Exclusivity Period

By Donald Zuhn
Patent Docs
Biotech & Pharma Patent Law & News Blog
July 13, 2009

On Friday, the National Venture Capital Association (NVCA) released the results of a study suggesting that “a data exclusivity period of at least 12 years for innovator products is a critical fulcrum in the effort to balance cost with the preservation of biotech innovation.”

http://www.patentdocs.org/

And…

Executive Session on the Affordable Health Choices Act

U.S. Senate HELP Committee
July 13, 2009

Consideration of the Enzi/Hatch/Hagan amendment on establishing a data exclusivity period of 12 years for biotech innovation

Sen. Orin Hatch: I don’t know a biotech company that isn’t for this bill, for this 12 year data exclusivity.

****

Sen. Kay Hagan: These individuals are out there looking for venture capital to obviously help them get these drugs to market… In order for our country to maintain this innovation and this research we need 12 years of data exclusivity.

****

Sen. Judd Gregg: Money flows into biologics research because capital moves there to make money. That’s the way a market system works.

****

Sen. Tom Harkin: Keep in mind what we’re talking about here. We’re not talking about patents. Everybody gets a 20 year patent… What we’re talking about here is data, data exclusivity… How do you get that data? You get it through FDA supervised trials… Where do they do those clinical trials? Academic health centers. Who supports academic health centers? Our taxpayers… When should that data be released so that another company out there, some other entrepreneurs, can look at the data and say… I’ll bet if we changed this and did this, we might come up with a new formulation that might actually help something else. They’re still going to have to go through their clinical trials… At least they’ll be able to look at the data. If you don’t do that that means that the company can sit on that data for 12 years. Then they let the data out. Clinical trials will take another 7 years or more, so you’re going to have at least a whole 20 year run in there… before anyone can ever surface with anything even comparable to what that drug or that biologic is.

****

Sen. Bernie Sanders: Let’s find out why year after year the drug companies make hugh profits, look at why the drug companies have never once, to the best of my knowledge, have never lost a political debate here in Congress… (medicine) doesn’t do anybody any good if they can’t afford it. I think for year after year we’ve been paying a lot of attention to our friends in PhRMA, who are spending, I don’t know what they spend in lobbying and campaign contributions, a whole lot of money. Maybe it’s time that we start worrying about the people who have to pay for this medicine.

****

Sen. Sherrod Brown: You know what we’ve not talked about, Mr. Chairman? We’re not talking about how much these biologics are costing patients. Let me give you some numbers. (examples)… 48 thousand dollars… 20 thousand dollars …100 thousand dollars. You know what the average wage in my state is? 46 thousand dollars… If we do this giveaway to the drug industry, this giveaway to the biologic companies, it means profits are up for them, it means executive salaries are up for them, it means we can all feel good, but let’s think about the patients, let’s think of the patient with breast cancer who has got to spend 1000 dollars a week… the patient with colon cancer who’s got to spend 2000 dollars a week… What kind of progress is that, Mr. Chairman?

****

The data exclusivity amendment passed by a vote of 16 to 7, with several Democrats voting in support.

421 minute video of the July 13 afternoon session:
http://help.senate.gov/Hearings/2009_06_17_E/2009_06_17_E.html

Comment:

By Don McCanne, MD

For the past week or so I’ve been live-streaming the Executive Session of the Senate HELP Committee as they have been marking up the Kennedy health care reform bill, the Affordable Health Choices Act. It has been running at the corner of my computer screen while I have worked on other projects. Since I am not competent at multi-tasking, I’m pretty jaded right now.

Last evening’s session devoted to the data exclusivity amendment was the longest amount of time they spent on any issue in the reform legislation. I stopped my other work to watch it. This morning, I’m not only jaded, but I’m also depressed. I’ll tell you why.

Earlier in the day yesterday, I sent out the following quote from Bill Moyers: “Nothing will change — nothing — until the money lenders are tossed out of the temple, the ATM’s are wrested from the marble halls, and we tear down the sign they’ve placed on government — the one that reads, ‘For Sale.'”

I didn’t sleep last night. Instead of counting sheep, I kept watching, in my nightmare, each of those Senators who voted yes picking up their bundle from the ATM machine in the marble halls on their way out as they passed the “For Sale” sign at the door.

But this isn’t about my nightmare. It’s about the 307 million of us who are the merchandise in Congress’s rummage sale. That’s why I’m depressed.

Senate HELP rejects enabling legislation for state single payer experiments

Senate HELP Committee
July 14, 2009

Sen. Bernie Sanders just offered an amendment to the Senate HELP health care reform bill that would allow a limited number of state experiments with single payer systems. The proposal would have provided waivers from federal regulations such as ERISA, and would have authorized current federal spending on programs such as Medicare and Medicaid to be transferred to the state to be used in the single payer program.

Those voting for the amendment:

Bernie Sanders
Tom Harkin
Sherrod Brown
Jeff Merkley

All Republicans and all other Democrats voted against it.

http://help.senate.gov/Hearings/2009_06_17_E/2009_06_17_E.html

List of committee members:
http://help.senate.gov/About.html

Bill Moyers on "The Select Few"

Bill Moyers & Michael Winship: Some Choice Words For "The Select Few"

Bill Moyers Journal
July 10, 2009

Enter “the select few who actually get it done.” Three out of four of the big health care firms lobbying on Capitol Hill have former members of Congress or government staff members on the payroll — more than 350 of them — and they’re all fighting hard to prevent a public plan, at a rate in excess of $1.4 million a day.

Health care policy has become insider heaven. Even Nancy-Ann DeParle, the White House health reform director, served on the boards of several major health care corporations.

President Obama has pushed hard for a public option but many fear he’s wavering, and just this week his chief of staff Rahm Emanuel — the insider del tutti insiders — indicated that a public plan just might be negotiable, ready for reengineering, no doubt, by “the select few who actually get it done.”

That’s how it works. And it works that way because we let it. The game goes on and the insiders keep dealing themselves winning hands. Nothing will change — nothing — until the money lenders are tossed out of the temple, the ATM’s are wrested from the marble halls, and we tear down the sign they’ve placed on government — the one that reads, “For Sale.”

http://www.pbs.org/moyers/journal/blog/2009/07/bill_moyers_michael_winship_so.html

Comment:

By Don McCanne, MD

The public option was the strategy of a large group of progressives to circumvent “the select few” who have continued to make sure that comprehensive reform was not politically feasible. With the favorable election results and with their campaign to market “your choice of health plans,” the progressives were confidant that they would be able to use the public option as a backdoor entry to affordable health care for all.

Once you think that you’ve closed the deal, you’re supposed to take down the “For Sale” signs. These progressives forgot to do that, and “the select few” came in with a lot more money and bought the place out from under them.

Who is left to toss the money lenders out of the temple? Or do they own the place in perpetuity?

Bill Moyers on “The Select Few”

Bill Moyers & Michael Winship: Some Choice Words For “The Select Few”

Bill Moyers Journal
July 10, 2009

Enter “the select few who actually get it done.” Three out of four of the big health care firms lobbying on Capitol Hill have former members of Congress or government staff members on the payroll — more than 350 of them — and they’re all fighting hard to prevent a public plan, at a rate in excess of $1.4 million a day.

Health care policy has become insider heaven. Even Nancy-Ann DeParle, the White House health reform director, served on the boards of several major health care corporations.

President Obama has pushed hard for a public option but many fear he’s wavering, and just this week his chief of staff Rahm Emanuel — the insider del tutti insiders — indicated that a public plan just might be negotiable, ready for reengineering, no doubt, by “the select few who actually get it done.”

That’s how it works. And it works that way because we let it. The game goes on and the insiders keep dealing themselves winning hands. Nothing will change — nothing — until the money lenders are tossed out of the temple, the ATM’s are wrested from the marble halls, and we tear down the sign they’ve placed on government — the one that reads, “For Sale.”

http://www.pbs.org/moyers/journal/blog/2009/07/bill_moyers_michael_winship_so.html

Comment:

By Don McCanne, MD

The public option was the strategy of a large group of progressives to circumvent “the select few” who have continued to make sure that comprehensive reform was not politically feasible. With the favorable election results and with their campaign to market “your choice of health plans,” the progressives were confidant that they would be able to use the public option as a backdoor entry to affordable health care for all.

Once you think that you’ve closed the deal, you’re supposed to take down the “For Sale” signs. These progressives forgot to do that, and “the select few” came in with a lot more money and bought the place out from under them.

Who is left to toss the money lenders out of the temple? Or do they own the place in perpetuity?

Excluding seasonal agricultural workers

Harvesting Justice

By Bruce Goldstein
July 10, 2009

Sen. Hagan (D-NC) introduced Amendment 200 for the health care reform bill being discussed in the Senate Health, Education, Labor and Pensions (HELP) Committee, called the “Affordable Health Choices Act.”

Hagan’s amendment would exclude from the definition of “employees” any “temporary or seasonal agricultural workers . . . for the purposes of determining the size of an employer.” Agricultural employers of seasonal farmworkers would not be required to participate in the system because they would be considered to be too small. Seasonal farmworkers would be denied health care coverage.

Seasonal agricultural workers earn an average of $12,500 to $15,000 per year . They put food on our table by cultivating and harvesting fruits and vegetables, raising chickens, herding sheep, cutting flowers, and harvesting our Christmas trees. They work in the second or third most dangerous occupation. They cannot afford health insurance. It’s morally wrong — and it’s counterproductive economically — to exclude farmworkers from the plans for a reformed health care system.

http://www.harvestingjustice.org/

Comment:

By Don McCanne, MD

Everyone should have health care. Everyone.

Premium increases in non-profit health plans

Health-plan costs soar for individuals

By Kyung M. Song
The Seattle Times
July 9, 2009

In what is becoming an annual ordeal for policyholders, Regence BlueShield is raising premiums for 135,000 individual health-plan members in Washington by an average 17 percent on Aug. 1.

It is the third consecutive year that the state’s largest provider of individual coverage has boosted rates by double digits. And it comes after two other insurers, Group Health Cooperative and LifeWise Health Plan of Washington, recently imposed similarly steep premium increases.

North Seattle resident Gail Petersen said having more choices won’t make health plans any more affordable. Petersen, 55, and her husband pay more than $1,400 a month to Regence to cover their family of five and will pay $300 more starting in August.

In 2008, Group Health rolled out eight products to join its lineup of a dozen individual health plans. They included high-deductible health savings accounts, which allow people to put aside up to $5,950 annually in pretax dollars — if they have that much upfront — to pay for medical expenses.

By catering to different population segments, Group Health in the past 15 months has nearly doubled its individual-plan members to 36,000. But those new customers are facing a 13 percent rise in premiums because Group Health underestimated anticipated medical claims, said Mike Foley, a spokesman for the co-op.

http://seattletimes.nwsource.com/html/health/2009436261_regence09m0.html

Comment:

By Don McCanne, MD

Once Congress passes a mandate for individuals to purchase health plans, presumably non-profit Regence BlueShield, as the largest provider of individual plans in the state of Washington, would be a provider of those plans. Also, Group Health Cooperative is the co-op that has been proposed to serve as a model for the public option.

Group Health has been shifting more costs to patients through consumer-directed high deductible plans and HSAs, and still has a double digit hike in premiums. Some model.

Can anyone seriously state, with a straight face, that mandating purchase of these plans will somehow magically end the double digit increases in premiums for these plans?

The answer to this question is actually quite complex, but the fundamental truth is that the cost containment measures under consideration in Congress will have very little impact in slowing the escalation of health care costs.

All other nations have health care financing systems that are much more effective in containing costs and without leaving people out, as we do. One simple click on this link will demonstrate in a single image how the United States is an outlier (and will remain so without bona fide financing reform):

http://economix.blogs.nytimes.com/2009/07/08/us-health-spending-breaks-from-the-pack/

In this graph, note that Canada and the United States followed the same curve until Canada established its single payer system. Then look at what happened.

Single-payer reduces waste dramatically

By Jeremy B. Stern
SouthCoastToday.com
July 07, 2009

I am an orthopedic surgeon who has been practicing in this community over the past 16 years and may be familiar to many of your readers. As our Congress debates the future of our health-care system, I am writing to urge my fellow citizens to get involved in the process. The debate in Congress is being framed largely by the insurance companies. This is problematic because of the large sums of money donated by the insurance lobby to the same senators who are crafting the reform.

What is not being considered fairly is H.R. 676, a single-payer health-care system.

In the U.S. today we spend approximately two times as much as other industrialized nations, over $7,000 per person per year, yet have nearly 50 million uninsured residents. What causes this waste of health-care dollars? We are the only industrialized nation that does not have a single-payer system. Instead our system is based on privately owned for-profit insurance companies.

In the average private health insurance company, one-third of the money paid in premiums is used for “administrative costs.” That means that one-third of all the money you and I now pay for our insurance is used to pay for things like salaries, marketing, overhead and, of course, profits and bonuses. Not to provide health care.

In addition, hospitals, nursing homes and physicians need to employ large staffs just to negotiate the maze of rules and regulations from multiple insurance companies. By eliminating these multiple insurance companies, the cost savings to the system would be more than a staggering $350 billion each year.

Many people are scared to have a single-payer system run by the federal government for two main reasons. First, there is a general impression that the government is inefficient and will be unable to manage the system well, and second, people fear that the government would limit their choice of providers. Most people don’t realize that the government plan we all know best, Medicare, runs at about 3 percent overhead while most HMOs run 15 to 20 percent overhead, and the Canadian system has 1 percent overhead. The government, then, is more efficient than the private sector.

As to the second fear, lack of choice, in the single-payer plan being talked about for the United States, the majority of the health-care system would run just as it does today. That means that most people would have greater choice of providers because they would no longer have an HMO telling them who they could see. Unlike the VA or Army system where the doctors and hospitals are run directly by the government, in a single-payer system here in the United States there would be no change in the providers; only the payers would change.

What would happen is that we and our employers would all pay taxes instead of premiums. These taxes would amount to a fraction of what we used to pay in insurance premiums. For those taxes we would have insurance that would pay for literally all of our health needs, from glasses to dental care to medical and surgical care.

The large cost savings of a single-payer system would come in various ways. By buying in bulk and demanding volume discounts, the single-payer plan would greatly decrease the cost of medication. The VA system in the United States gets a 40 percent reduction in medicine costs over what we all pay. A single-payer system would also greatly increase the country’s access to preventative care. This in turn would reduce the inappropriate overuse of highly costly emergency rooms. Having diseases diagnosed earlier and treated appropriately vastly decreases the overall cost of treatment of that disease. For example, by treating high cholesterol early with medicine, you may well eliminate the need for a very costly coronary artery bypass later in life.

While doctors and hospitals would be paid somewhat less, their costs of doing business would be drastically reduced since there would be a very low cost to billing and administration, and providers would get paid more quickly and reliably.

Lastly, but perhaps most importantly, there would be improvements to our actual patient care with a single-payer system. Having only one payer would allow us to use a unified computer system. With this single computer system, whenever you went for health care of any kind, the health-care provider would have all the information needed to treat you safely, such as the medications you take and the allergies you have. There would be fewer medical errors and a greater awareness of interrelated medical problems.

I strongly encourage you all to call, write, text or otherwise contact your congressmen and senators, and encourage them to strongly consider H.R. 676, the single-payer system that will fundamentally eliminate a huge waste of health-care dollars and restore our health-care system.

Dr. Jeremy B. Stern is an orthopedic surgeon. He lives in Marion.

http://www.southcoasttoday.com/apps/pbcs.dll/article?AID=/20090707/OPINION/907070310/-1/NEWS10

ECONOMIC SCENE: The missing piece of the healthcare debate

The idea of a government-paid national healthcare system hasnĆ¢ā‚¬ā„¢t gotten very far in the Washington debate.

By David R. Francis
Staff Writer
The Christian Science Monitor
July 1, 2009 edition

If no one is paying any attention, create a fuss.

Maybe that explains why 13 doctors and nurses got arrested last month when they disrupted a Senate hearing. Their protest: The committee wasn’t considering a single-payer solution to fix America’s healthcare system.

In fact, as healthcare reform works its way through Congress, the idea of a government-paid national health-insurance system hasn’t gotten very far in the Washington debate.

Perhaps it’s too politically radioactive. Or too difficult to pass. For whatever reason, neither the most Democratic Congress in decades nor the most liberal president since Jimmy Carter have opted for a sweeping national health-insurance system, as exists in Europe and Canada, where private insurers disappear and government pays the tab.

“There are countries where a single-payer system works pretty well,” President Obama, a onetime single-payer supporter, told the American Medical Association June 15. “But I believe … that it’s important for our reform efforts to build on our traditions here in the United States.”

That stance leaves single-payer advocates in a political quandary.

“We haven’t yet applied enough pressure to get done what has to be done,” says David Himmelstein, cofounder of Physicians for a National Health Program (PNHP). Maybe, he added, “we will have to give strong consideration to civil disobedience.”

Why are single-payer advocates so passionate? For one thing, many of them see medical healthcare as a civil right for all Americans.

Call up the Internet home page of Rep. John Conyers (D) of Michigan and immediately, without further clicking, a video shows the congressman talking on the House floor about one of “the biggest challenges of the 21st century” — healthcare reform. His bill would provide national health insurance to every person with no deductibles or copayments for medical treatment. Uncle Sam — via citizens — would pay the bill.

Prospects for his bill in Congress don’t appear strong, although 80 House members have signed on to his bill and 59 percent of physicians back national health insurance, according to a new poll.

Public support has also grown over the years. In 1979, 40 percent of Americans thought the federal government should provide national insurance; last month, 72 percent supported the idea, according to CBS News/New York Times polls.

“Things have gone very well for us,” says Quentin Young, PHNP’s national coordinator. “There has been a new surge of support in the last few months.”

Economic stress may explain some of that shift. In 2007, even before the recession, medical bills were the cause for more than 60 percent of bankruptcies, a new Harvard study finds. More than 75 percent of these bankrupt families had health insurance, but it wasn’t enough, Dr. Young points out.

Reformers of every stripe figure that today’s system is unsustainable in the long run. The Congressional Budget Office projects national healthcare costs to rise from today’s 18 percent of gross domestic product, the total output of goods and services in the nation, to more than 30 percent in 2030 and 50 percent by 2080. That assumes modest cost-cutting measures are imposed. Without them, healthcare costs would consume nearly the entire economy by 2080, an impossibility.

Compromise reforms under consideration in Congress are economically “not feasible,” Dr. Himmelstein says, “The likelihood we can afford what they are offering is nil.”

So he figures a single-payer plan is essential. Just cutting the system’s bureaucratic overhead from today’s 31 percent of total expenditures to Canada’s level (1 percent) would save nearly $400 billion annually, more than enough to cover the 48 million now uninsured, he argues.

So why hasn’t Congress moved toward a single-payer system? The financial and political clout of health industries, charges Himmelstein.

And who was the top recipient of their largess in the 2008 election cycle? Mr. Obama.