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By Don Terry
Chicago Sun-Times
May 14, 2009

An army of lawyers and lobbyists is gathering along the Potomac.

The upcoming battle in Washington over national health care reform is going to be fierce.

Billions of dollars are at stake.

There will be blood.

So, I called a doctor.

About 70 percent of the patients who Dr. Claudia Fegan treats at her South Side clinic don’t have health insurance — like the housekeeper whose breasts were purple and rock-hard from cancer.

“She was just waiting at home to die,” Fegan says. “She didn’t have insurance. She didn’t know what to do. Her daughter finally brought her in.”

Fegan, past president of Physicians for a National Health Program, has seen cases like that again and again. A parade of preventable misery. That’s why she supports a single-payer system that would essentially expand Medicare coverage to include every American, regardless of age.

Under such a plan, the government would pay the health-care bills of all Americans. Advocates say the somewhat higher taxes that result would be offset by massive savings in administrative costs rung up by the scores of private insurance companies that dominate the current system.

Yet health-care services would remain private. People would still get their choice of doctors and hospitals — which isn’t always permitted under some of today’s insurance plans.

A single-payer system is not socialism, as its wackier opponents contend. But the S-word has become the far right’s boogey- man of the moment.

No wonder. Big money is at stake. America spends more on health care than any country in the world, about $7,200 a year for every man, woman and child.

France, Germany and Switzerland rank higher than the U.S. in overall health care yet spend only about $3,400 per capita. Like most of the developed world, those countries have single-payer health-care systems.

Under a single-payer system, the private insurance industry would be largely out of the health-care business. That’s what’s keeping them up at night — and at the White House just the other day, when they made sketchy promises to help cut costs.

A single-payer system would do it for them. Fegan says the program would save the country $400 billion a year in administrative costs and other waste. That’s a lot of foreclosed homes and jobs that could be saved.

“The current system,” she says, “allows insurance companies to dictate who gets care and what kind of care they get. We shouldn’t allow the insurance companies to practice medicine without a license.”

Before Barack Obama went to Washington, he supported a single-payer system. He has since backed off that position.

He has proposed a somewhat vague public/private system that would keep the insurance companies in the game — and in the money. That’s the most politically feasible option, he contends.

He barely gives single-payer advocates the time of day and begrudgingly included them at a recent White House health-care reform conference.

“I’m sorry to say, like many before him, Obama is worried about the awesome clout of the insurance industry,” says Dr. Quentin Young, a Hyde Park neighbor of Obama and a physician for more than 50 years. “The fix is in.”

“The economy can’t tolerate this market-based system. There’s a growing awareness that single-payer is the way to go,” says Young, national coordinator for Physicians for a National Health Program.

Fegan says more pressure has to be put on Obama and other officials to support a single-payer plan. “We have to create a movement. . . . He’s still making politically feasible arguments instead of doing what he knows to be right. Issues of social justice are never politically feasible.”

Fegan makes a lot of sense.

Remember, electing a black man from the South Side of Chicago president wasn’t politically feasible, either.

http://www.suntimes.com/news/terry/1573936,CST-EDT-terry14.article

by Donna Smith
CommonDreams.org
Sunday, May 17, 2009

It’s coming. You and me and every middle class, working person in this nation is about to start handing over more and more of their hard earned cash to the private insurance industry, courtesy of our own elected members of Congress and our very popular President. Fire up those Treasury Department presses. We’re going to be printing and providing money for insurance companies like no bail-out we’ve seen yet this economic crisis cycle.

The healthcare legislation under design and so far under wraps for the American people is slowly being leaked via carefully staged forum and meetings and a few well-timed hearings and grand press announcements. Much of the work is still going on behind closed doors in private meetings attended by those who are deemed appropriate participants and industry friends.

Remember how open these proceedings were to be following all the Clinton plan debacles of the early 90s? Well, today’s stagings are far more sophisticated and planned out. So learning did occur by the industry giants and their political friends over these last 17 years, I will give them that.

And what do we know so far about what middle class Americans can expect from the legislation being privately crafted?

First, no matter what percentage of your take home pay it takes, you will be legally required to buy private health insurance. Second, if all you can afford is a policy that leaves you financially exposed to bankruptcy and foreclosure, then you will still be legally required to purchase that private insurance product. Third, should you fail to buy a policy, you will pay a fine.

Like it so far? Feeling free and protected? Like the choices so far? It gets better.

The private, for-profit insurance industry has made concessions we are asked to celebrate. First, they’ll issue every one of us a policy provided every one of us is legally forced to buy coverage. Second, they stop discriminating against women because they have uteruses and child-bearing capacity, provided we all have to buy their product. And third, and this was a real coup according to our leaders, the insurance companies, medical equipment folks and providers will slow the rate of increase in charging for their products to charge just a bit less in terms of percentages of overall costs than they had planned to do and as is predicted. Laughable concessions sold as real compromise.

It’s as if we’ve been beaten a few times every month by an abuser whose violence and anger is increasing over time, and we know by calculating the trend that we’ll be beaten daily within a very short time. Up steps the abuser to say, “Wait. I will still have to beat you more than I do now, but I think I can hold it to 25 times a month instead of every day.” That’s the sort of promises we’re supposed to see as victories with the healthcare industry involvement in crafting the legislation that will determine our families’ financial well-being and matters of life and death.

Let me spell this out for families like mine. You’ve been getting overcharged for underinsurance for many years and you’ve seen the costs out of your own pocket rise to the point where it is truly driving whether or not you even try to seek care when ill. You’ve seen premiums rise and coverage shrink in employer based coverage, and 14,000 of you a day are losing those employer based benefits in this stinking economy.

And most importantly to me and millions of other middle class folks, when you do get sick and need care, you are forced to see only those doctors and providers your insurance company says you can and those providers can only give you the insurance company says they can give you. That’s the way our insurance companies want it now and forevermore, and that’s what they are going to get.

Feeling free? Your choices broadening? Your costs lowering?

Wait. There’s more. In order to make sure every single American buys the private products from insurance companies and knowing some families won’t make enough to afford what is offered, we’ll all chip in and pay our taxes to subsidize those who cannot afford to buy the pricey plans. So, when each of us calculates our own monthly costs for healthcare, we’ll need to factor in not only our own health insurance premium, our co-pays and deductibles, our medications and other out-of-pocket costs, but also the percentage of our payroll taxes dedicated to pay for the subsidies for low-income folks, the agencies to collect the fines paid by health-insurance-mandate-evaders, and the agency envisioned to be our clearing house for selling us the private product we’re all forced to buy. If our real costs are added up, there will be a substantial increase for most middle class families.

These folks are really hoping you will not do the math. They think middle class folks are too dumb to figure it out.

Let me repeat. This Congress and this President are about to give us healthcare reform that will make the middle class burden for payment higher and will even more deeply restrict personal choices in medical care. And they are about to do it all with great fanfare claiming just the opposite.

No doubt many of you have feared really looking at a single payer approach as something scary and restrictive of your personal freedoms. I can promise you that nothing could be further from the truth. In fact, your freedom to choose would be greatly enhanced under a publicly funded, privately delivered national program. Greatly enhanced freedom. Lowered costs as we each pay the percentage we can afford from our income. Greatly enhanced choice of providers – no more being told who is in-network or out. No more risk of financial ruin if medical care is not approved by a profit-driven entity. And no more being told a service we already received isn’t covered after all – the great bait and switch the health insurance industry is allowed to do all the time, leaving so many people with bills they never even knew they were accepting responsibility to pay.

I like being free to choose. And if this healthcare reform plan restricts my freedom, takes my hard-earned money and makes my life more difficult, I won’t have any problem at all assigning blame to the folks who forced it on me.

Look, what’s the old saying about excrement rolling downhill? This president is very popular. He won’t get blamed when middle class folks figure out the ruse. And the Senate is pretty safe, as they get to sit for six years before answering to the people – and they get oodles of cash from the industry to make sure they are comfy, cozy. It’s the U.S. House of Representatives – the people’s house, they say – that will take the hit when the moms and dads of this nation figure it out that they didn’t get healthcare reform at all. The middle class will get a huge burden to bail-out the health insurance and healthcare industry under the plan moving so carefully but swiftly through the process.

The kicker? When it’s finally unveiled in all its bi-partisan glory, it’ll be sold as a human rights victory. And on that day, 60 more American families will bury a loved one denied care. And on the day after that, 60 more will die. And the day after that, they’ll be a big damn party paid for by you and by me for all of those who helped craft the monstrosity. And the insurance industry CEO salaries will be enhanced by your money paid to them. Bail-out bonanza for Karen Ignagni and America’s Health Insurance Plans, an industry very fond of its government entitlements.

Costs will be successfully shifted even more heavily onto the backs of America’s middle class workers. I mean, middle class chumps. And then, my fellow worker-bees, it will be mid-term election time again.

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

Letters
New York Times
May 16, 2009

To the Editor:

David Leonhardt, in his May 13 column (“Health Care, a Lesson in Pain,” Economic Scene), is quite right that “the only way to have a sustainable universal health care system is to control costs.” But in analyzing the experts’ testimony before the Senate Finance Committee on how to pay for health care, he did not mention a solution that neither the experts nor the committee wants to consider: major reform of the system.

Runaway costs are due largely to high overhead expenses throughout the system, and to the excessive use of expensive technology. Both of these result from a health care system that is organized like a profit-seeking industry instead of a social service.

If we want health care to be a universal entitlement, it cannot be controlled by market forces and the financial interests of insurers and providers (and the investors who own such a large part of the system).

Some kind of government-regulated single-payer insurance plan and a reorganized nonprofit medical care delivery system may be “off the table” for policy makers right now, but we will never achieve affordable universal coverage without major reform that deals with the real causes of medical inflation.

We don’t need more money; we need a new system.

Arnold S. Relman
Marcia Angell
Cambridge, Mass., May 14, 2009

The writers, medical doctors, are former editors in chief of The New England Journal of Medicine.

By PAUL DeMARCO
Spartanburg (S.C.) Herald-Journal
Sunday, May 17, 2009

I live in a town with a population of 7,000. I own a pair of shotguns, and I know how to use them — a wood duck and a turkey are mounted on my office wall. I drive a 2001 Dodge Dakota pickup with 150,000 miles on it.

I wear a coat and tie every day to work. I’m in church each Sunday and am not embarrassed to tell you that Jesus is my Savior. I believe in chivalry; I open doors for women and expect my teenage daughter’s dates to come into the house when they visit.

My usual TV-watching dilemma is “The Andy Griffith Show” or “M*A*S*H.” I’m about as old-fashioned, square and conservative as they come.

So where do I get off backing a single-payer national health plan, a plan where everybody’s covered in one big risk pool and health care is publicly financed (but privately delivered)? Shouldn’t I be a rugged individualist, telling people that if they want good health insurance they can pay attention in class, go to college and get a good job with full benefits just like I did?

Well, part of me could do that. No country can survive unless individual responsibility is at the core of its ethos.

But to the other part of me, the go-it-alone attitude just sounds downright mean.

That puts me in about the same mind-set as a Midwestern farmer in the mid-19th century. Farmers then and now are often independent, self-sufficient

and hesitant to incur a debt. But when a neighboring family needed a barn raised, that was a different story. No matter how hearty the farmer, he couldn’t raise a barn alone. And there was a healthy dose of self-interest in the proposition. If I help raise your barn, then when mine needs repairs, I’ll have your help.

So I look at single-payer health care in that conservative light. I recognize that a significant portion of America’s chronic disease burden is self-induced (e.g., some people eat, drink or smoke too much and make themselves sick). But I also know that much of your health is beyond your control — it’s either in your genes or not significantly altered by lifestyle. Think breast cancer and many other malignancies, flu and many other infectious diseases, Alzheimer’s dementia or rheumatoid arthritis.

I don’t suspect that farmers of yore did any research on the family who they helped. Whether the family was industrious or lazy, a barn was built because everyone needed a barn. Without a place to store hay and protect animals in the upcoming winter, livestock would die and the family would soon follow. No farmer, no matter how stoic, would consign his neighbor to that fate.

I support single-payer health care in this tradition. A single-payer program, which would expand Medicare to all Americans (rather than just those 65 and over), would create one large barn-raising community, 300-million strong. We would all chip in our share so that all families could have health care. Almost all of us would end up paying less than we do now (there would be no co-pays or deductibles), and we could choose any doctor or hospital we wanted.

Under our present setup, it’s hit and miss. Money typically dictates who gets care and who doesn’t.

A carpenter who works for a big company with insurance may get care; another who works for a small one can only dream about it.

A woman with lupus loses her job and her insurance and then becomes uninsurable because of her pre-existing condition.

A 60-year-old man with a bad knee is laid off when a plant closes in his rural hometown. Lame and unskilled in a region with rising unemployment, he will limp for five years until he qualifies for Medicare and can have his knee replaced.

Barn-raising worked because it is was a nonprofit enterprise. A farming community bound itself in a social contract. Many countries have single-payer social contracts, including our neighbor Canada, to ensure the health of all their citizens. There are many ways to inject a profit motive into the process, but they all taint it. Until the 1960s, medicine was also primarily a nonprofit endeavor. In recent decades, the huge profits available to for-profit insurance companies and hospitals have often elevated shareholders above patients, resulting in higher costs and inferior care.

All my instincts call for problems to be solved by individuals operating in a free-market economy. But private enterprise cannot solve this one. We have 40 years of evidence of the free market’s failure to control costs or cover everyone.

The plain truth is that the public single-payer systems we already have (Medicare, Medicaid and the VA) provide better coverage with less overhead than private companies. I know that statement is hard for many, including me, to swallow, but it’s true.

Medicare for all will not be a perfect system, but it will be far better than the fragmented, profit-warped system we have.

When America was younger, we knew not to turn our backs on new neighbors in need of a barn. In this older — and I hope wiser — America, we should not turn our backs on those who need health care. Tell your representative and senators to put single payer on the table in Washington.

Paul DeMarco, MD is a general internist who lives in Marion. He is a member of Physicians for a National Health Program (www.pnhp.org).