PNHP

Baucus closes door on single-payer in national health care debate

pnhpf3a

Baucus closes door on single-payer in national health care debate

By JOHN S. ADAMS
Great Falls Tribune
May 17, 2009

HELENA — Last week lawmakers on the U.S. Senate Finance Committee wrapped up a series of hearings aimed at laying the groundwork for reforming the nation’s ailing health care system.

That committee will play a crucial role in any health care reform forwarded by Congress, and its chairman, Sen. Max Baucus, D-Mont., could be the most important player of all.

Representatives from the health insurance industry, the business community, retiree groups and others were invited to take part in the May 5 and May 12 roundtable discussions, but missing from the panels were advocates for single-payer health insurance. That fact led to a pair of dramatic protests on the hearing floor that disrupted the proceedings and ended in 13 arrests.

Supporters of single-payer insurance — in which the federal government provides health insurance for all Americans and pays doctor, hospital and other health care bills, replacing the private for-profit insurance industry — say it is the only option for fixing the broken and expensive health care system. They say they repeatedly tried to meet with Baucus to urge him to allow a single-payer advocate to take part in the hearings, but the senator refused.

Baucus, who sets the Finance Committee’s agenda, has consistently stated that single-payer is off the table.

“We’ve got to reform our system fairly quickly, and to be candid with you, very few members of the House and Senate advocate single-pay. The vast, vast majority do not,” Baucus said in an interview Friday. “It tells me that if I go down that road, it’s not going to be successful — it’s not going to pass the Congress.”

Though no single-payer bills have been introduced in the Senate, Rep. John Conyers, D-Michigan, has introduced a universal health care measure in the House, House Resolution 676, entitled “The United States National Health Care Act.” The bill has 75 sponsors in the House and is endorsed by more than 500 unions in 49 states, including the Montana AFL-CIO and the state teacher’s union, MEA-MFT.

“There are 50 million people without insurance in this country. That’s equivalent to 24 state populations. If we had 24 states where nobody had insurance they would be out in the streets raising all kinds of hell,” said Phil Campbell, spokesman for the group Montanans for Single-Payer and the former political director of the Montana Education Association before it merged with the Montana Federation of teachers. “We’re just frustrated with Baucus because all the players are at the table, all the insurance companies and other folks, except advocates for single-payer. We think it’s the solution to the problem. It’s a system that will pay for itself rather than figure out how we’re going to pay for the system.”

With some polls showing approximately 60 percent of Americans in support of single-payer health insurance, advocates say Congress is excluding the majority of Americans from a critical national debate. Single-payer supporters say politicians are unfairly criticizing the idea as politically unfeasible without even having an open and public dialogue on its merits.

“If you have a policy debate on the merits, that’s going to serve the ultimate purpose, which is to come up with the best health care reform plan possible,” said Michael Lighty, director of public policy for the California Nurses Association, one of the groups that staged a protest at Tuesday’s hearing. “If you let political feasibility truncate the policy debate then you haven’t done service to the debate.”

Protesters showed up at the two Senate hearings this month to urge Baucus to give single-payer advocates a seat at the table. In both cases, protesters were escorted out of the room by police and arrested. In all, 13 protesters — dubbed “The Baucus 13” by some — were charged with unlawful conduct for disruption of Congress.

The protests were organized so that as one protester was escorted out of the room, another would stand and demand the panel consider single-payer.

Dr. Judy Dasovich, a volunteer medical director of a free clinic in Springfield, Mo., was arrested at Tuesday’s hearing. As the hearing got under way, Dasovich stood up and said, “We request that single-payer advocates be allowed at the table. Health care should be for patients, not for profit.”

Dasovich said she was promptly escorted out of the Dirksen Senate Office Building by police. She spent the next five hours in jail.

“I don’t understand how a country that is as rich as ours can allow 20,000 of its citizens to die for lack of health care and allow others to be financially ruined by exorbitant costs. Callous neglect is not an American value,” Dasovich said in an interview from her home Friday.

According to federal estimates, 46 million Americans are without health insurance and another 25 million are underinsured, or more than 20 percent of the United States population. Additionally, those numbers are increasing as more workers lose their jobs in the ongoing recession.

Meanwhile, the cost of health care continues to skyrocket, making it more difficult for those who do have insurance to pay for it.

According to the National Coalition on Health Care, in 2008 total national health expenditures rose 6.9 percent from the previous year, or twice the rate of inflation. Meanwhile, health care spending topped $2.4 trillion in 2007, or $7,900 per person. Currently, total health care spending represents about 17 percent of the gross domestic product.

So what would single-payer advocates have told the Senate Finance Committee if given the chance?

“In terms of having a health care system that’s sustainable and we can afford, it is the only realistic option,” said Marcia Angell, a prominent critic of America’s health care system and the former editor of the New England Journal of Medicine. Angell also is a senior lecturer in social medicine at Harvard medical school and author of the book, “The Truth About the Drug Companies: How They Deceive Us and What to Do About It.”

Many single-payer supporters publically urged Baucus to let Angell take part in the hearings.

“What I would have said is that the underlying problem with our health care system, the thing that makes it such a mess, is that it is based on seeking profits and not on providing health care,” Angell said. “It entrusts the financing of health care in the private sector to hundreds of investor-owned insurance companies who maximize profits by avoiding covering high-risk patients, and stinting on the services of people that they do cover.”

Baucus said he believes there is a dire need to reform health care, but that a majority of Americans are mostly happy with their current health insurance coverage.

“I think to be successful here, we have to somewhat work with what we have. Work with changing the system we Americans know and are comfortable with rather than some major change that would disrupt Americans in a way that most Americans don’t want to be disrupted,” Baucus said.

Some conservative critics of single-payer say it is “socialized medicine,” adding that it puts the government in a position of choosing which doctors patients see and imposes a massive bureaucracy on the health care system.

Angell says that’s hogwash.

“The notion that the private sector is efficient is total mythology,” Angell said.

According to Angell, private health insurers take 10 to 20 percent of premiums patients pay just to cover administrative overhead costs. She said some smaller insurance companies take up to 30 to 40 percent of premiums.

“Medicare pays only 3 percent in overhead. Right there you see a much more efficient system,” Angell said.

Baucus favors a program similar to what Massachusetts implemented in 2006, in which everyone is required to be covered by some sort of health insurance, either through their employer or out of their own pocket. If a resident can’t afford to buy his or her own coverage, the state helps that person pay for it. Baucus outlined the main points of his proposals in a report last November.

“Massachusetts is being held up as some sort of a model. I live in Massachusetts, and I can tell you it’s not a model you would want to follow,” Angell said. “Most people in Massachusetts are now insured, but the costs are going up so rapidly that they are having to shrink benefits and increase co-payments, and it cannot last in the form intended. The state is broke.”

Angell said the federal government could face the same fate if it adopts that model of reform.

Though Baucus refuses to include single-payer advocates in the heath care reform hearings, he said he cares about their ideas and is listening.

“In fact, I’m meeting with advocates of the single-pay system. I have in Washington, and I’m in Montana right now (and) will soon be meeting with them in Montana,” Baucus said Friday.

He also is considering the idea of offering a publicly run insurance plan that would compete with private plans.

“We have a public option on the table,” Baucus said. “It’s one of the so-called coverage options, and it’s similar to single-pay and that’s being discussed, that’s being debated.”

A single-payer plan would take greed out of the health-care business

By Wayne Madsen
Arizona Daily Star
05.11.2009

Americans finally are starting to realize what citizens in other advanced democracies took for granted decades ago: Private health insurance is a shopworn relic from a bygone era when few people could afford quality medical care.

In an ideal world, Congress would have passed a government-administered universal health-care system when it was first introduced by Rep. John D. Dingell, D-Mich., in 1945. When the congressman died in 1954, his son John D. Dingell Jr. won his seat in a special election and has introduced his father’s National Health Insurance legislation at the start of each new Congress.

Unfortunately, the Dingells’ clear vision thus far has been the victim of powerful interests — physicians organized under the banner of the American Medical Association, the pharmaceutical industry and, of course, the nation’s private health insurers.

All profit immensely from the present system, which has ratcheted up costs to the point where the United States now spends twice as much on health care as other industrialized countries — $7,129 for every man, woman and child.

While the other advanced nations provide excellent medical coverage for all of their citizens, our nation falls shamefully short. More than 47 million Americans — including 9 million children — have no health-care insurance.

The two major reasons for this gaping disparity between consumer spending and actual services are the inefficiencies inherent in a system that involves thousands of delivery agents and, sadly, outright greed.

The vast private insurance bureaucracy and the forests of paperwork they produce vociferously consume 31 cents of every health-care dollar consumers shell out, according to the advocacy group Physicians for a National Health Program.

Funneling that money into a single system run by the federal government would save more than $350 billion per year — more than enough to provide comprehensive health care of the highest quality for all Americans.
Some experts believe that the savings from eliminating the pervasive greed in the current system might double that amount although they acknowledge there’s no way to calculate that.

One of the major problems with private insurers is their desire for ever-rising profits means they have little incentive to insure people with prior health conditions — those that are already sick or have had a bout with a serious illness like cancer.

A friend of mine — some eight years cancer-free after breast surgery — constantly receives letters from her insurer asking her to fill out a comprehensive survey on her overall medical condition. She wisely declines each opportunity because she believes the insurers are trolling cancer survivors looking for any excuse to cancel current policies and deny applications for new ones.

Ironically, it appears that President Obama and congressional health-care leader Sen. Edward Kennedy, D-Mass., may be about to give the insurers the type of reform they have spent millions of dollars lobbying for — despite their posturing as champions of rational change.

The proposal by America’s Health Insurance Plans would mandate that the federal government force everyone to purchase private health insurance. All Americans would be covered under this scheme, but the feds would step in and subsidize those with health risks that are extremely costly to treat.

The idea is to continue to let private health insurers reap obscene profits and continue to make large campaign contributions to compliant candidates.

It reminds one of the classic line from “The Leopard,” Giuseppe Tomasi di Lampedusa’s great novel about the unification of Italy in the 1860s: “If we want things to stay as they are, they will have to change.”

Rather than retaining the notorious Capitol Hill sleight-of-hand that delivers cash-filled envelopes, Americans should push for a single-payer system like the ones currently enjoyed by Canadians and most Europeans.

Under such a system, all Americans would be covered for virtually every medical expense and regain the once cherished right of freely choosing their doctors and hospitals.

That, indeed, would be revolutionary reform: one that marches under the banner of “Patients before Profits.”

Scare tactics aimed at single-payer health system

By GENE FENDERSON
Guest Opinion
Billings (Mont.) Gazette
May 16, 2009

Ezra Klein, a prominent health care and political journalist/blogger was recently interviewed by Mike Dennison, a reporter at the Gazette State Bureau. The interview addressed the hearings on health care reform being held by Sens. Max Baucus of Montana and Charles Grassley of Iowa, the U.S. Senate Finance Committee chairman and the ranking member. The most important question in the interview was, “Shouldn’t a single-payer or Medicare-for-all system of universal coverage be considered?”

Klein replied: “When the politicians say, ‘We’re going to take what you have now away and you can trust the federal government to do this [health care] now’ – that scares the hell out of people.”

Old scare tactics at work

So the old scare tactics on health care reform are still around. But think about it. If Congress won’t even consider a single-payer health care system, what kind of a “system” will our nation and we, as individuals, end up with? I am convinced the outcome will be even more complicated and detrimental than what we have now, a hodgepodge on top of an existing hodge-podge of insurance plans. In other words, no plan and certainly no “system.”

You will continue to get health insurance coverage through your employment, which will make our employers less competitive in world markets and create more job losses. Or you will be forced to buy insurance individually. If you cannot afford individual coverage, you will be given a public subsidy to get it.

Remember, you will probably change jobs seven times in your career, like most Americans. So you may have to buy some kind of bridging coverage in between those jobs and pay the full premium, including what your employer paid before. If you’re broke, you’ll have to prove to the system you need some financial help. If you don’t get coverage or can’t figure out the system, you’ll end up in the emergency room. Just like now, everyone will pay for it – through their taxes or through increases in their health insurance premiums to help health care providers offset the losses of giving care to the uninsured.

Will you be able to keep your private plan if you move across the nation? Will your plan coverage be the same? Will each state have the same coverage? What if you move within the state?

A Medicare plan for all

A Medicare-type plan; single-payer for all; everybody in, nobody out approach is efficient and effective. It will save $400 billion for the American taxpayer every year, instead of spending the $700 billion Baucus and Grassley helped set aside for health care reform in the recent federal budget. Savings from single-payer can be used to help adequately cover the 50 million people who are uninsured and the 70 million who are underinsured. The single-payer plan would concentrate on prevention and offer free choice of doctors, hospitals and other medical providers. It would eliminate in-network, out-of-network, deductibles, exclusions and co-pays.

According to recent polls, the majority of the American people, including a majority of doctors, nurses and health economists want a single-payer plan. Why don’t Baucus and Grassley, the senators elected to represent us?

Call them. E-mail them. Fax them. Tell them America needs single payer. To lower the current 17.4 percent of U.S. gross national product spent on health care to 9 percent of GNP like the rest of the industrialized world, we must have single-payer health care.

Gene Fenderson of Helena was a board member for a Montana Taft-Hartley Health Care Trust Fund for 25 years and is a founding member of Montanans for Single-Payer, www.montanansforsinglepayer.org.

South Thomaston man arrested at Senate session

By Abigail Curtis
Bangor Daily News
May 16, 2009

A Maine health care activist was arrested, shackled and put in leg irons Tuesday in Washington for disrupting a U.S. Senate Finance Committee round-table discussion on health care reform.

Jerry Call, 64, of South Thomaston, co-founder of the group Midcoast Health Care Reform, spent 30 hours in a Washington, D.C., jail after he stood up at the round table and said 60 percent of the nation’s citizens want a single-payer system.

“Why do you insist on spending more money, when the single payer would give it to us at the price we’re spending now? Sixty percent! Why not 60 percent of the people in front of you representing single payer?” Call said before a Capitol police officer pulled him out of the hearing room. “This is a sham! All you’ve got is special interests groups up there.”

In response to Call’s words, Sen. Max Baucus, D-Mont., who is chairman of the committee, said the hearing would take a break “until the police can restore order.” He then asked for the police to “please come more expeditiously,” according to a C-SPAN video of the event.

Call was representing the national group Physicians for a National Health Program. He and four other single-payer advocates were arrested outside the hearing room, he sa
id in a telephone interview Wednesday night.

“It needed to be said,” he said of his comments. “I wouldn’t even be involved in this except for the fact that polls show that over 60 percent of Americans want a single-payer system.”

At the start of this week’s round table, more than a dozen nurses stood in silent protest and turned their backs on Finance Committee Chairman Baucus as he spoke. They had signs attached to the backs of their shirts supporting single-payer or government-run health care and protesting industry influence.

Baucus did not incorporate any advocates of a single-payer health care system in this series of hearings.

On May 5, eight doctors, lawyers and activists were arrested after they disrupted the opening comments of the hearing to ask why single-payer experts were being excluded from the proceedings, according to Physicians for a National Health Program.

“This is totally new for me,” Call said. “If I hadn’t been so incensed by [Baucus’] attitude and dismissiveness, I wouldn’t have come to Washington.” A spokeswoman for the Senate Finance Committee said Thursday that Baucus has been working on health care reform for a year and a half.

“Senator Baucus wants to achieve quality, affordable health care for all Americans,” Erin Shields said. “And he wants to make sure that all Americans who20like the coverage they have now can keep it. For that reason, he wants to build on the employer-based health insurance system we have today.”

She said that health care advocates who were not allowed to testify at the round table were invited to submit statements for the record, and that the senator had offered to meet with anyone in his office. That offer didn’t sit well with people like Call, who said that his message about single-payer health care was important enough to be said in public — not behind closed doors.

“He’s just continuously said that he’d refuse to let us take part, and refuse to let single payer be part of the discussion,” he said of Baucus.

Call said that he did not see Sen. Olympia Snowe, who also sits on the Finance Committee.

A representative of Snowe’s office, Julia Wanczo, said the senator has attended the round tables and asked questions, but that she has not been involved in choosing the witness list.

“I know that she has been a longtime advocate for overhauling the [health care] system,” Wanczo said. “At this point, she hasn’t taken anything off the table. She’s exploring all viable options.” Call said that he originally got involved with health care reform several years ago after he was diagnosed with an aggressive form of cancer.

“Going into the operation, I said that
if I lived through it, I’d find a way to pay back society for my good fortune,” he said. “When I heard about single payer, I knew what I’d have to do. We already spend twice as much as any other industrialized nation [on health care] and the outcomes are worse.”

In Maine, Call has organized a single-payer health care rally planned for May 30 in Augusta.

Mark Almberg, communications director for the 16,000-physician-strong advocacy group with which Call is affiliated, said that the activists felt compelled to speak out at the roundtable because they had sent “literally thousands” of e-mail messages, phone calls and faxes to Baucus but that no representative of the single-payer viewpoint was included.

“I think it was in the best traditions of civil disobedience in the United States,” Almberg said. The Associated Press contributed to this report.

Single-payer health care is smart solution for America

Hedda Haning
The Charleston Gazette
May 16, 2009

CHARLESTON, W.Va. — Everyone agrees that we should all have health care. Most agree the federal government can fund it because we’re desperate. Even the insurance companies agree. The one thing no one discusses is “single payer.”

In case you can’t tell, it’s a swear word; the phrase is always followed by “Socialized medicine. Boo!” You never hear the fact that all other civilized nations have some form of a single-payer system and provide better health care than we do at much lower cost. If that does leak out, the next thing you hear is that it is obviously “Un-American.”

So what is a single-payer health-care system? It is non-profit. It is Un-American like roads and schools and fire and police and Social Security. It is not socialized medicine. Everyone chooses his own private doctor and hospital. The difference is in the payment system. Patients submit a card to doctors and hospitals and payments are made from a single payer, a trust fund established by taxes collected in a fair way at the federal level.

There would be no co-pays, deductibles or balance billing. The tax bill for most people would be much less than they pay for medical insurance and uncovered care because there would be no profits, the administrative costs would be cut by approximately 80 percent, and care would no longer be fragmented and disorganized. Insurance companies would no longer make medical decisions, and no doctor or hospital would be out of network.

There would be negotiated fees and global budgets keeping costs predictable and controllable. The mechanisms would have to be transparent and open to comment and the administrators widely representative. Today, many doctors will not accept Medicare and Medicaid patients because the fees are set lower than their expenses. Everyone suffers. In the single-payer system, the responsible board in charge would have to negotiate regularly with those doctors for changes. Also, without paperwork for each visit by each patient, administrative costs in each office (now huge because of all of the pre-approving, denying and re-submitting) would be greatly reduced – cutting the doctor’s overhead substantially.

A single-payer system would cover everyone, including the CEO of GM, your senator and you. Do you think Congress would pay more attention if they had the same health care we do? The Gazette has recently commented that our Congressional folks want universal coverage. Watch out, because it is a glib trap. Their plan is to mandate that everyone get care through private for-profit insurance firms with public assistance as needed. Unsurprisingly, the insurance industry is strongly supportive. Their huge overhead will be built into the plan. Call it what it is: welfare for insurance corporations.

This approach has been tried in several states, most recently Massachusetts, and has failed everywhere to be affordable and provide necessary care.

In a single-payer national health program, it doesn’t matter if you are rich or poor, just lost your job, have diabetes and heart disease or are healthy. We will no longer have to humiliate people by having them prove they are poor enough to be eligible. The care is comprehensive, covering all medically necessary expenses including primary care, medications, procedures, hospitalizations, mental health, dental, nursing home and home health care.

In case you want to move to Arizona, you will have medical care there, too. Think of single-payer as a better Medicare covering everyone.

A single-payer system can better assess the application of new technology and quality of care outcomes. It can make better long-term decisions and investments, based on patient needs rather than profit. Since we would all be in the same boat, we would all have an incentive to fix the problems that come up. Other countries do this.

Most people don’t know that the federal government already pays for two-thirds of health-care costs through programs including Medicare, Medicaid, the military and tax breaks. The federal government alone already pays – right now – more per capita for health care than any other developed nation pays, but it does not control the system. It is run by insurance companies protecting their profits.

And here’s another little secret: our economy would be much more vibrant if every employer did not have to carry the burden of health care for every employee and if employees were not often stuck in dead-end jobs for fear of losing medical coverage.

Single-payer’s most serious problem is that it puts people before profits: the insurance and pharmaceutical companies hate it. Their lobbyists are already hard at work convincing your legislators that it isn’t feasible. No doubt the ads will be on TV any minute. There was just a conference at West Virginia State University. Single-payer was never mentioned.

It’s apparently not enough that most physicians (an overwhelming majority of primary care physicians) support such a program, as do nurses, many other medical professionals, unions and non-profit organizations.
And doctors in other capitalist countries are quite positive about their own single-payer systems. They are financially comfortable. They do research, develop and use new drugs, and often have access to more advanced technology than we do. They have less interference with their medical decisions than private insurance imposes on our doctors and patients. And study after study shows their health outcomes are better than ours, all while keeping their health-care costs half of ours. Did I mention their patients aren’t bankrupt by medical costs? No other country rations care as we do by ability to pay.

The best kept secret is that polls show two-thirds of Americans supporting such a program, even if they have to pay more in taxes to get it, which would still cost less and be a more predictable expense than paying for private insurance. The fact is if what we’re after is medical care for all Americans at a price we can afford – hugely important to our stressed economy – then single-payer, not-for-profit health care is the ONLY feasible solution.
Haning, a Charleston doctor, is a member of Mountain State Physicians for a National Health Program.

In health care reform, even the supporters are divided

by Bob Braun
Columnist
New Jersey Star-Ledger
May 17, 2009 10:16PM

WASHINGTON — The debate over health care already has turned ugly — and it hasn’t formally begun. Long before Republicans and other opponents of big government involvement in health care even have a chance to denounce it as “socialized medicine,” supporters of bigger involvement are clawing away at each other.

Proponents of a single-payer system feel they were ignored in the congressional debate. That’s hard to refute — activists have been arrested at Senate hearings when they protested the failure of Democrats to take their cause seriously.

Proponents have lashed back, reminding Democrats of inconvenient campaign promises last fall and raising questions about the amount of campaign contributions key Democrats receive from insurance companies and drug firms that oppose single-payer.

“The best solution would be a single-payer system, similar to what all other developed countries have,” says Bill Armbruster of Jersey City, who is active in the group Health Care Now. “Yet single-payer isn’t even on the table in all the discussions about health care reform. That’s because of the power of the insurance lobby.”

Supporters of the bill likely to emerge from the Democrats argue single-payer proponents jeopardize any chance for reform. Says U.S. Rep. Rob Andrews (D-1st Dist.), one of the authors of the impending legislation:

“The country needs a law that will reduce the health care cost explosion for insured people while extending coverage to uninsured people. Single-payer does not have majority support in either house and cannot pass, largely because insured people are understandably reluctant to give up coverage that they have negotiated for and earned.

“We are trying to build a coalition broad and strong enough to deliver the change in health care that Americans voted for.”

U.S. Rep. Frank Pallone (D-6th Dist.), another author of the administration-backed bill, warns that division among reform supporters will endanger a key provision — a government insurance plan competing with private insurers in a so-called “marketplace.”

“It represents a clear compromise between those on the right who want competition only among private plans and those on the left who might prefer a sole public option or even a single-payer system,” says Pallone.

So that’s the stark choice, as painted by congressional Democrats — get on board the compromise train or health care reform will never leave the station.

Only one New Jersey congressmen, Donald Payne (D-10th Dist.), is supporting a single-payer bill. He is one of 75 co-sponsors of legislation — HR 676 — creating a system that would provide every American with government-backed health insurance.

One of the state’s chief supporters of single-payer is Winthrop Dilliway, a faculty member at the University of Medicine and Dentistry of New Jersey and a member of the Physicians for a National Health Program.

He called such a system “the most humane, most efficient, and most democratic” way of providing health care. It would not be “socialized medicine,” he says, because, unlike the British system, there would be no national health service that actually provides the doctors. The payment would come from the government — not the service.

All doctors would be paid by the same system so issues of choice would not come up. It would, in effect, extend the Medicare system for retirees to all Americans.

“It is the most efficient provider in the nation right now,” he says.

The Canadian single-payer system, he says, has reduced health care costs so that they are now one-half of those in the United States.

“There are complaints, sure, but Canadians would never give up their system for the non-system we have — who would? They do not have inferior quality of care.”

Dilliway argues that costs for private insurance companies are twice those of Medicare “because they have dividends to pay and all those clerks to hire.”

The issue at the heart of the debate is the risk pool. Medicare covers the elderly, the people most likely to need health care. If Medicare were extended to everyone, the pool would be expanded to include young as well as old, sick as well as healthy. Insurance can be efficient to the extent it can spread the risk.

Keeping private insurers — even in a “marketplace” approach with a public option — would not allow for a large risk pool with low-risk insured, Dilliway says.

“The government is already paying for costly programs — it needs the rest of the population on board to keep per-capita costs down,” he says.

Dilliway cites polls suggesting majorities of both the general population and of physicians themselves favor a national insurance system.

He knows, however, that, without Obama’s support, single-payer doesn’t have much of a chance — at least this time around.

“The president doesn’t want to have that fight now.”

Questioned, Obama Says Single Payer Would Be Best

Institute for Public Accuracy
News Release
May 14, 2009

AP is reporting: “President Barack Obama says if he were building the health care system from scratch, a single-payer system would be the best approach. But he says his goal is to improve the current system.” The comments were made in response to the first question at the “town hall” type event in Rio Rancho, N.M. by Linda Allison, a local resident. Video of her question and Obama’s reply is here.

Reached by the Institute for Public Accuracy, Allison said: “I asked why they were excluding single payer from healthcare reform. We have this convoluted system where veterans get one system, Indians get another, there’s Medicare, Medicaid and of course many employees get coverage from their companies. Why not just cover everyone under one plan?

“I see people without healthcare, like my son. He served in Iraq and Afghanistan as a reservist. He’s in college now and he’s doesn’t have health insurance. There are people who work who don’t have coverage, or their children don’t have coverage. Why should having healthcare be tied to your employment?

“It’s pretty unclear to me, but Obama seems to be for a plan that would leave the insurance companies in a dominant position and we really need to get them out.

“Obama said that single payer would be good if we were starting from scratch. Well, I think things are pretty bad, so we should start from scratch. But actually, a single-payer system is basically like expanding Medicare to include everyone, so we have a model just waiting for us to use. I recently learned that in Taiwan, they looked around the world for a system and they decided they would copy our Medicare and use it to cover all the people there. Why don’t we do that?

“The other part of my question, which Obama didn’t respond to, was about Max Baucus [chairman of the Senate Finance Committee] and about how he’s chairing the hearings while he’s taken all this money from the insurance companies. I asked if that wasn’t a conflict of interest.” According to the Center for Responsive Politics, Baucus’s top funders include PACs associated with American International Group, Goldman Sachs, New York Life Insurance and Blue Cross/Blue Shield.

For more information, contact at the Institute for Public Accuracy:
Sam Husseini, (202) 347-0020; or David Zupan, (541) 484-9167

What Is 'Socialized Medicine'?: A Taxonomy of Health Care Systems

By Uwe E. Reinhardt
New York Times
Economix Blog
May 8, 2009, 6:48 am

With another “national conversation” about health reform upon us — as it is every decade or so — we will hear a lot of derisive talk about the evils of “socialized medicine.”

The term is regularly confused with “social health insurance,” which is not at all the same concept. The chart below may be helpful in appreciating the distinction.

Socialized medicine refers to health system in which the government owns and operates both the financing of health care and its delivery. Cell A in the chart represents socialized medicine.

Social health insurance, on the other hand, refers to systems in which individuals transfer their financial risk of medical bills to a risk pool to which, as individuals, they contribute taxes or premiums based primarily on ability to pay, rather than on how healthy or sick they are.

Socialized medicine is one form of social insurance. More typically, however, social insurance is coupled on the health-care delivery side with a mixture of government-owned facilities (e.g., municipal hospitals), private nonprofit hospitals (roughly 90 percent of all American hospital beds) or private for-profit facilities (investor-owned hospitals, private medical practices, pharmacies and so on). It follows that one cannot simply treat social insurance as socialized medicine. In principle, one could have social insurance with 100 percent private for-profit delivery facilities.

Under private commercial insurance, individuals also transfer the financial risk of bills for health care to a risk pool, but the premium the individual contributes to the risk pool reflects that individual’s health status. These premiums are, as actuaries put it, “medically underwritten” and “actuarially fair.” The risk pools under private insurance can be operated by not-for-profit or for-profit insurers. And like social insurance, private insurance typically is coupled with a mixed private and public delivery system.

In the chart, cells A, B, C jointly represent single-payer social insurance — e.g., traditional Medicare. Cells D, E, F jointly represent multiple-payer social insurance — e.g., Medicaid Managed Care. Cells G to L jointly represent individually purchased private insurance with actuarially fair premiums. Finally, cells M, N and O represent the uninsured or the cost-sharing portion of insured persons.

In between these distinct systems falls employment-based health insurance.

Large employers typically self-insure and use private insurers only to procure health care on behalf of employees (e.g., negotiate fees with the providers of health care) and administer claims. Other employers do not self-insure and instead purchase so-called group health insurance policies for all their employees jointly, as if they were one large family. The premium for a group policy is “experience rated” over the covered group of employees, which means that they reflect the average actuarial cost of all of one company’s employees.

The individual employee’s own contribution toward his or her employment-based insurance, however, is divorced from the individual’s (or the attached family’s) health status. In this sense, then, employment-based insurance could be described as “private social insurance,” as distinct from “government-run social insurance.”

Former Mayor Rudolph Giuliani of New York has exemplified the perennial confusion in this country over socialized medicine. In his ill-fated presidential bid, and subsequently as a supporter of Senator John McCain’s bid for the presidency, Mr. Giuliani routinely decried as socialized medicine (or “socialist”) any proposal presented by Democratic candidates, because typically the latter advocated tax-financed subsidies toward the purchase of health private insurance or expansions of public insurance programs. But technically none of them advocated socialized medicine.

Perhaps Mr. Giuliani was unaware that Americans all along the ideological spectrum reserve the purest form of socialized medicine — the V.A. health system — for the nation’s veterans. I find this cognitive dissonance amusing. Indeed, if socialized medicine is so evil, why didn’t Republicans privatize the V.A. health system when they controlled both the White House and the Congress during 2001-06?

Mr. Giuliani also seems to forget that, in 1996, he found social health insurance a perfect solution to the financial problems faced by former Mayor John V. Lindsay, who fell on financially hard times during the 1990s as a result of chronic illness.

In a fit of compassion, then Mayor Giuliani rushed to his friend’s assistance with — you guessed it — taxpayers’ money, rather than with a private sector solution. He did so by appointing Mr. Lindsay to two no-show city jobs that came with tax-financed municipal health insurance and a tax-financed pension.

It seems fair, then, to ask Mr. Giuliani why it was perfectly fine to bail out a financially distressed man who had been wealthy enough in his younger years to provide adequately for his old age, when proposals to extend the same kind of assistance to hard-working, uninsured members of lower-income families are decried by him as “socialism.”

One can only hope that our members of Congress and the typical American voter can make the right distinctions.

Uwe E. Reinhardt is an economics professor at Princeton.

Insurance companies want to hide truth

Judith Dasovich
Springfield (Mo.) News-Leader
May 16, 2009

Government-financed health care is not government-run health care. Private for-profit insurance companies do not want you to understand this. Right now, your health care is run by people who value profits, not patients. Private insurance companies set the fees you can’t afford, for care they will deny you when you need it. They decide which doctor you can see and which hospital you can use. You think you’re “covered” until you get sick and find out that you are not. This is what happened to President Obama’s mother when she was dying.

In contrast, improved Medicare for all (also called single payer financing or national health insurance) uses the same system that builds interstate highways — general tax revenues pay private businesses to produce a common good. Medicare for all is not government run. It pays the same private doctors and hospitals that deliver your care now, just like our current Medicare system. Traditional Medicare has an overhead of less than 3 percent. Private insurance companies average 16-20 percent. Doctors and hospitals pay additional money to deal with their complex systems. Duke University Hospital has 900 billing clerks for 900 beds. Do you think they have one nurse for every patient? William McGuire, former CEO of United Health Care insurance company, received $37.7 million per year in salary and $1.776 billion in stock options. That “b” is not a typo. In retirement, he is guaranteed $5 million per year. $350 billion dollars per year goes to administrative waste and profits. We could provide everyone in the U.S. with health care if we used this money for actual care. The money is already there. You could have your choice of doctors and hospitals, not the ones dictated to you by the insurance companies.

The private insurance companies do not want you to understand this. That is why they will not allow Sen. Max Baucus of the Senate Finance Committee to have even one single-payer advocate at the “reform” table. Private insurance companies do not want real reform. They want you to be forced by law to buy insurance you can’t afford for care you won’t get when you need it. In 2008, Sen. Max Baucus took $1,826,652 from health care special interests in his virtually uncontested re-election bid. Patients, not profits, are the special interests of the single-payer advocates. Our speech is truly “free.” We haven’t paid Max Baucus a single dime. Is that why we can’t get a seat at his table? Is that why his response to this question was “Call the police?”

Editor’s note: Dr. Dasovich was among a group of protesters Capitol Police removed from a health care hearing after interrupting U.S. senators.

Judith Dasovich, MD, FACP is the volunteer Medical Director at the Kitchen Clinic.

Congressional visit ‘How to’ kit

Setting up the meeting

Call the District Office. When you call your legislator’s office, ask to speak with the person who handles the legislator’s schedule. Tell the scheduler the date and time you would like to meet with your legislator (be flexible) and the general topics you wish to discuss.

For visits to the local office, seek appointments during congressional recess periods when your Member of Congress returns to your district (check the House schedule at www.house.gov/house/House_Calendar.shtml). Legislators are also frequently home in the district Friday through Monday when Congress is in session.

Let the scheduler know that the meeting should take no longer than one hour. If there is more than one person attending the meeting, let the scheduler know their names and affiliations. (A good delegation is between five to eight persons.) If someone in your group knows the legislator personally or professionally, make sure that the scheduler is aware of the relationship.

Congressional visits in Washington, D.C. Please coordinate your visit with members of our D.C. chapter; let them know you’re planning a visit and ask them for suggestions and useful tips. Remember that most legislative business occurs Tuesday through Thursday and that the closing days of a session are extra busy. When you arrive in Washington, call the Member’s office to confirm your appointment.

Be persistent. The objective of this initial contact is to secure a time and date to meet with your representative. Be persistent yet polite, and make it clear that YOU, the Member’s constituent, are the most important person (s)he will ever listen to. Lots of times it can be hard to get a meeting, but persistence will generally be rewarded with a meeting with your representative.

Meet with somebody. If your Member of Congress can’t meet with your group, don’t feel snubbed. Meet with the staff member who works on the issue that most concerns you. For most issues relating to health care reform, you will want to meet with the domestic policy staffer. Usually that person will be based in Washington, but there will also be an aide in the local office who can meet with you. Try to meet with the highest ranking aide possible in the local office, i.e. the Senior Aide.

Confirm your appointment. After you schedule a meeting, send a confirmation letter that includes a list of those who will attend the meeting.

Preparing for the Meeting

Research your representative. You can use the Congressional Directory: www.congress.org, www.house.gov, www.senate.gov.

Just punch in your ZIP Code and the site provides you with contact information and a web page for your Member of Congress. You will be able to find biographical information, committee and subcommittee assignments, and key issues of concern for your Member. Review your legislator’s voting record and any publicly stated views or opinions. If you are uncertain whether he or she has endorsed the U.S. National Health Insurance Act, H.R. 676, sponsored by Rep. John Conyers Jr. (D-Mich.), visit http://tinyurl.com/3prleu. Check the legislative status of the bill.

Determine your agenda and goals for the meeting. Your group’s members should meet beforehand in order to determine the agenda and to delegate who will raise which agenda items. Have different people cover different issues, but have one person act as a facilitator for the discussion and deliver the bulk of your message. Your main objective is to get your Member to commit to endorsing single-payer legislation (if he or she hasn’t already done so) and to attempt to enlist other legislators to do so.

Bring it all back home. All legislators supposedly want to improve the economy and quality of life in their district/state. It is your job to convince them that single-payer national health insurance will have a beneficial impact on people living in their own congressional district.

Make sure everyone in your group is prepared. Be certain everyone agrees on the central message and what will be asked of the legislator. This way you will avoid a possible internal debate in front of your legislator. Don’t feel that you have to be an expert. Most representatives of Congress are generalists. Be open to counter-arguments, but don’t get stuck on them. If you don’t know the answer to a question, say so. Nothing is worse than being caught in a lie or inaccuracy. Offer to look into the question and get back to the Member (this is also an excellent opportunity to stay in touch).

Prepare an information packet to leave with your legislator. This should include information on your organization including the group`s contact information, as well as a description of your objectives. You should also leave a business card with the receptionist.

Conducting the Meeting

Be on time, listen well, and don’t stay too long. Be on time! Arrive five minutes early. When the meeting begins, introduce yourselves and say what issues and legislation you want to discuss. Stress that you are constituents. However, make sure that all introductions are kept brief, allowing more time for conversation with the representative.

Listen well! You will hear occasional indications of your representative’s actual views, and you should take those opportunities to provide good information.

Don’t stay too long! Try to get closure on the issues you discuss but leave room to continue the discussion at another time.

Build the relationship. If your representative has supported single payer in the past, be sure to thank him/her; if the opposite is true, consider that your visit may prevent more active opposition in the future, and perhaps even result in a positive vote at a later time.

Remember: This meeting shouldn’t be an end in itself. Think of it as the beginning of a relationship with your representative that will allow you to voice your opinion on topics in the future. With this in mind, make sure the relationship you build is a positive one, based on respect. Try not to be hostile: agree to disagree, if necessary. They may not share your viewpoint, but your information does have an impact on how they vote.

Take notes. Make sure someone in your group takes notes on what is said during the meeting. However, don’t use any recording devices. These notes should be circulated to the entire group after the meeting, as well as shared with others.

Ask for specific action. Avoid asking open-ended questions that may result in ceding control of the meeting to the legislator or his/her aide, who may spend a large part of the meeting talking about an unrelated issue. Always ask for specific actions; always get a specific commitment and then follow up. No matter how supportive or unsupportive your legislator is, there is always a next step. Visit the PNHP web site or otherwise consult with PNHP’s national office to find out what specific action(s) should be sought at the time of your meeting.

Ask his or her position. Zero in on the basics: How will s/he vote? Do party leaders have positions on the issue? What is their influence likely to be? Is the office hearing from opponents? If so, what are their arguments and what groups are involved? Does the Member know any other key House Members or Senators who should be contacted to get favorable action on the bill? Is s/he willing to facilitate contact and to write a “Dear colleague” letter?

The Member likely won’t give you an answer on the spot. Tell them you will follow up with an aide in two weeks, and be sure to do so. Offer to answer their questions or to provide additional information.

If the Member says no, be sure to find out why. Ask them what, specifically, they oppose in the bill.

Provide affirmation where possible. Look for areas of agreement and affirm them. Convey your appreciation for positive steps, no matter how small. Try to end the meeting on a positive note.

Debrief/Follow up. After the meeting, find a place where you can relax with your delegation and compare notes on the meeting. This is important because different people might have different interpretations of what happened. Agree as a group on who will do which follow-up tasks. Send a thank-you note after the meeting to the representative via the person who scheduled the meeting, and, if commitments were made during the meeting, repeat your understanding of them. Don’t forget to give a phone number and address where you can be reached. Finally, let PNHP know how the meeting went.

(Above compiled and adapted from multiple lobbying guides by nonprofits.)

Health care’s enigma in chief

David Sirota
San Francisco Chronicle
Friday, May 15, 2009

The most stunning and least reported news about President Obama’s press conference with health industry executives this week wasn’t those executives’ willingness to negotiate with a Democrat. It was that Democrat’s eagerness to involve those executives in a discussion about health care reform even as they revealed their previous plans to pilfer $2 trillion from Americans.

That was the little-noticed message from the made-for-TV spectacle administration officials called a health care “game changer”: In saying they can voluntarily slash $200 billion a year from the country’s medical bills over the next decade and still preserve their profits, health care companies implicitly acknowledged they were plotting to fleece consumers, and have been fleecing them for years. With that acknowledgment came the tacit admission that the industry’s business is based not on respectable returns but on grotesque profiteering and waste – the kind that can give up $2 trillion and still guarantee huge margins.

Chief among the profiteers at the White House event were insurance companies, which have raised premiums by 119 percent since 1999, and one obvious question is why – why would Obama engage those particular thieves?

It’s a difficult query to answer, because Obama is a health care mystery, struggling to muster consistent positions on the issue.

Listening to a 2003 Obama speech, it’s hard to believe he has become such an enigma. Back then, he declared himself “a proponent of a single-payer universal health care program” – i.e., one eliminating private insurers and their overhead costs by having government finance health care. Obama’s position was as controversial then as today – which is to say, controversial among political elites, but not among the public. ABC’s 2003 poll showed almost two-thirds of Americans desiring a single-payer system “run by the government and financed by taxpayers,” just as CBS’ 2009 poll shows roughly the same percentage today.

In that speech six years ago, Obama said the only reason single-payer proponents should tolerate delay is “because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

This might explain why when Illinois contemplated a 2004 health care proposal raising insurance lobbyists’ “fears that it would result in a single-payer system,” those lobbyists “found a sympathetic ear in Obama, who amended (read: gutted) the bill more to their liking,” according to the Boston Globe. Maybe Obama didn’t think single payer was achievable without a Democratic Washington. And when, in a 2006 interview, he told me he was “not convinced that (single payer) is the best way to achieve universal health care,” perhaps he was following the same rationale, considering his insistence that he must “take into account what is possible.”

Of course, even as a senator aiming for the “possible” in a Republican Congress, Obama promised to never “shy away from a debate about single payer.” And after the 2008 election fulfilled his single-payer precondition of Democratic dominance, it was only logical to expect him to initiate that debate.

That’s why the White House’s current posture is so puzzling. As the Associated Press reports, Obama aides are trying to squelch any single-payer discussion, deploying their health care point-person, Sen. Max Baucus, D-Mont., to announce that “everything is on the table with the single exception of single-payer.”

So it’s back to why – why Obama’s insurance industry-coddling inconsistency? Is it a pol’s payback for campaign cash? Is it an overly cautious lawmaker’s paralysis? Is it a conciliator’s desire to appease powerful interests? Or is it something else?

For a president who spends so much time on camera answering questions, these have become the biggest unanswered questions.

David Sirota is a fellow at the Campaign for America’s Future. Find his blog at OpenLeft.com or e-mail him at ds@davidsirota.com.

This article appeared on page A – 13 of the San Francisco Chronicle
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/05/14/EDMF17KIVP.DTL

Health-care status quo pushing out single-payer advocates in nation’s capital

By Amy Goodman
Syndicated columnist
The Seattle Times
Thursday, May 14, 2009

Barack Obama appeared this week with health-industry bigwigs, proclaiming light at the end of the health-care tunnel. Among those gathered were executives from HMO giants Kaiser Foundation Health Plan and Health Net Inc., and the health-insurance lobbying group America’s Health Insurance Plans; from the American Hospital Association and the American Medical Association; from medical-device companies; and from the pharmaceutical industry, including the president and CEO of Merck and former Rep. Billy Tauzin, now president and CEO of PhRMA, the massive industry lobbying group. They have pledged to voluntarily shave some $2 trillion off U.S. health-care costs over 10 years. But these groups, which are heavily invested in the U.S. health-care status quo, have little incentive to actually make good on their promises.

This is beginning to look like a replay of the failed 1993 health-care reform efforts led by then-first lady Hillary Rodham Clinton. Back then, the business interests took a hard line and waged a PR campaign, headlined by a fictitious middle-class couple, Harry and Louise, who feared a government-run health-care bureaucracy.

Still absent from the debate are advocates for single-payer, often referred to as “Canadian-style” health care. Single-payer health care is not “socialized medicine.” According to Physicians for a National Health Program, single-payer means “the government pays for care that is delivered in the private (mostly not-for-profit) sector.”

A February CBS News poll found that 59 percent in the U.S. say the government should provide national health insurance.

Single-payer advocates have been protesting in Senate Finance Committee hearings, chaired by Democratic Montana Sen. Max Baucus. Last week, at a committee hearing with 15 industry speakers, not one represented the single-payer perspective. A group of single-payer advocates, including doctors and lawyers, filled the hearing room and, one by one, interrupted the proceedings.

Protester Adam Schneider yelled: “We need to have single-payer at the table. I have friends who have died, who don’t have health care, whose health care did not withstand their personal health emergencies. … Single-payer now!”

Baucus gaveled for order, guffawing, “We need more police.” The single-payer movement has taken his words as a rallying cry. At a hearing Tuesday, five more were arrested. They call themselves the “Baucus 13.”

One of the Baucus 13, Kevin Zeese, recently summarized Baucus’ career campaign contributions:

“… from the insurance industry, $1,170,313; from health professionals, $1,016,276; pharmaceuticals/health-products industry, $734,605; hospitals/nursing homes, $541,891; health services/HMOs, $439,700.”

That’s almost $4 million from the very industries that have the most to gain or lose from health-care reform.

Another of the Baucus 13, Russell Mokhiber, co-founder of SinglePayerAction.org, has been charged with “disruption of Congress.”

He was quick to respond: “I charge Baucus with disrupting Congress. It once was a democratic institution; now it’s corrupt, because of people like him. He takes money from the industry and does their bidding. He won’t even diffuse the situation by seating a single-payer advocate at the table.”

As I traveled through Montana recently, from Missoula to Helena to Bozeman, health-care activists kept referring to Baucus as the “money man.” Montana state Sen. Christine Kaufmann sponsored an amendment to the Montana Constitution, granting everyone in Montana “the right to quality health care regardless of ability to pay,” or health care as a human right. It died in committee.

Wisconsin Sen. Russ Feingold, a single-payer advocate, said his position will not likely prevail in Washington: “I don’t think there’s any possibility that that will come out of this Congress.” That’s if things remain business as usual.

Mario Savio led the Free Speech Movement on the UC Berkeley campus. In 1964, he said: “There comes a time when the operation of the machine becomes so odious, makes you so sick at heart, that you can’t take part, you can’t even passively take part, and you’ve got to put your bodies upon the gears and upon the wheels, upon all the apparatus, and you’ve got to make it stop. And you’ve got to indicate to the people who run it, the people who own it, that unless you’re free, the machine will be prevented from working at all.”

“Unless you’re free,” the Baucus 13 might add, “to speak.” The current official debate has locked single-payer options out of the discussion, but also escalated the movement — from Healthcare-NOW! to Single Payer Action — to shut down the orderly functioning of the debate, until single-payer gets a seat at the table.

Amy Goodman is the host of “Democracy Now!,” a daily international TV/radio news hour airing on more than 750 stations in North America. Denis Moynihan contributed research to this column.