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California Democratic Party endorses single payer

Health Care Reform

WHEREAS, access to quality health care is essential for the good health and productivity of every American citizen and qualifies as a human right, not a privilege; and

WHEREAS, the steadily increasing cost of accessing health care is causing financial individual hardships, bankruptcy, and mortgage foreclosures, causing business to be uncompetitive in the world market and making it difficult to decrease the national deficit; and while the U.S. spends more than any other industrialized country for health care, the U.S. has demonstrably inferior outcomes, even for the insured; and

WHEREAS, the current commercial market model mediated by private health insurance corporations must function to create profits for the companies, their administrators and shareholders, creating an unavoidable conflict-of-interest between promoting quality health care and maximizing their profits and currently diverts up to 25% of the insurance premium dollar from medical services and leaves 46 million people uninsured;

THEREFORE BE IT RESOLVED, that the California Democratic Party supports the establishment of a universal, single-payer, national health care system in the United States; and

BE IT FURTHER RESOLVED, that such a system be publicly financed and privately delivered with automatic enrollment of all residents (regardless of age, status of employment, pre-existing condition, or income level) allowing people to choose from any licensed health care provider, providing all appropriate medical services including preventive education, dental care, mental health care, long-term in-home care, and affordable prescription medications.

Authored by: Margaret Budd, Dr. Michael McQuary, Mike Copass, Jerry Malamud, Ethan James Soutar-Rau, Anita Simons, Jeoffrey B. Gordon, MD MPH, and the La Jolla Democratic Club’s Focus For Change Health Care Issue Group; Co-Sponsored by Los Angeles County Democratic Party; (Partial List)

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Adopted by the Democratic State Central Committee of California AKA “California Democratic Party” At its Annual State Convention Sacramento Convention Center April 26, 2009

Medical student debt and specialty selection

Where Did All the Doctors Go?

The New York Times
May 3, 2009
Letters

To the Editor:

Re “Shortage of Doctors Proves Obstacle to Obama Goals” (front page, April 27), about a lack of primary care providers :

As those of us responsible for delivering health care know, the battle between specialists and primary care doctors has been going on for years, and one side has been winning.

The marketplace has rewarded specialists financially, and like any other special interests, they are amply financed for this conflict. Still, I don’t fault them. They have studied and worked hard, and are responding to market incentives, like good red-blooded Americans.

What we really need is a European-style single-payer system, with primary care doctors who emerge from their training with European-style debt loads: zero.

Georganne Chapin
Tarrytown, N.Y.

The writer is president and chief executive of the Hudson Health Plan, a not-for-profit managed care organization.

http://www.nytimes.com/2009/05/04/opinion/l04doctors.html

And…

Subject: Graduate Medical Education: Trends in Training and Student Debt

GAO (Government Accountability Office)
May 4, 2009

In summary, we found that medical students prefer surgical and procedural specialties, and physician subspecialization is increasing. Relative to the number of available residency positions, more medical students have preferred surgical and procedural specialties over primary care specialties since 1999, according to national data.

Some factors may also lead students to pursue certain specialties while avoiding others. For example, the desire for a controllable lifestyle — a predictable schedule and fewer on-call hours — and high salary may lead students to pursue procedural specialties such as anesthesiology, and avoid other specialties such as primary care.

Medical school tuition and fees have increased significantly since 1998. Medical students can borrow up to $40,500 per year through the federal Stafford loan program with additional funding available through other federal loan programs; these loan programs can cover the full cost of medical school. The median amount of educational debt for indebted medical students graduating in 2008 was $155,000 — a 53 percent increase since 1998, controlling for inflation. Once out of medical school, residents earn stipends â€” on average about $3,729 a month for a 1st year resident. With $155,000 in debt, a resident’s monthly loan payment could reach over $1,700 (about 48 percent of pretax income). However, residents have repayment options that can reduce their monthly debt payment until they complete postgraduate training.

http://www.gao.gov/new.items/d09438r.pdf

Comment:

By Don McCanne, MD

This statement from a highly respected executive of a not-for-profit managed care organization, and this new GAO report, both further confirm what we already knew. Medical students are graduating with excessive debt, and this is likely contributing to the decline in the numbers choosing the primary care specialties.

Without increasing total health care spending, a few policies could be adopted which would realign incentives to improve our primary care infrastructure, while relieving students of the necessity of accumulating debt. That would be much easier to accomplish through a single payer monopsony than through a dysfunctional, fragmented, multi-payer, health care financing system.

Himmelstein replies to AARP falsehoods, distortions

Ain't Arguing with the Ruling Powers (AARP)

By Single Payer Action
May 1, 2009

AARP tries to convince the public they are the good guys.

In reality, AARP represents the corporate powers that be.

Take health care reform.

AARP is closely aligned with the private health insurance industry.

Or as Oregon doc Paul Hochfeld told us last year — “AARP is the enemy.”

“AARP has a for-profit side and a not-for-profit side,” Hochfeld said.

“Their for-profit side brings in a big chunk of their annual revenues. They allow insurance companies to use their name — because they have the greatest brand name of any in the county — even better than Nike or Coke.”

And so, AARP has a vested interest in fighting off single payer.

But citizens been pounding AARP in recent weeks over this conflict.

And AARP has now responded with propaganda that would make Karen Ignagni, Max Baucus, Andy Stern and Ron Pollack proud.

We asked Dr. David Himmelstein, a founder of Physicians for a National Health Program, to respond point by point to AARP’s propaganda against HR 676 — the single payer bill in the House.

AARP: H.R. 676 does not address the problem of increasing healthcare costs. Rather, it allows costs to continue to grow. By 2016, projections show total health spending almost doubling to $4.1 trillion and consuming one-fifth of the nation’s gross domestic product. Possible efforts to control costs include: “comparative effectiveness” research, a generic pathway for biologic drugs, and increased attention to prevention and care coordination, none of which are included in H.R. 676.

Dr. David Himmelstein: There is absolutely no evidence that the AARP’s favored cost control mechanisms work. The CBO has refused to credit significant savings from care coordination, or prevention. The recently published Medicare Demonstration project of care coordination found no savings. A New England Journal of Medicine review of prevention found that most prevention efforts result in increased costs, not decreased.

Comparative effectiveness research is worthwhile — as are prevention and care coordination — if done right — but is unlikely to significantly cut costs.

The major recent example is the ALLHT study, a massive federally-financed research project which demonstrated that cheaper drugs for high blood pressure are at least as effective as more expensive ones, but utterly failed to influence prescribing patterns.

Similarly, while pushing generics is worthwhile, the large increase in use of generics in recent years has hardly moderated cost increases.

A single payer program provides a structure within which all of the beneficial aspects of these initiatives could flourish, but does not depend on these vaporware solutions to the cost crisis.

Instead, it relies on massive bureaucratic savings which have been well demonstrated — and credited by the CBO and GAO in the past — as well as improvements in health planning that would slow the proliferation of useless high tech machinery and interventions.

AARP: HR 676 essentially eliminates Medicare, Medicaid, and the SCHIP programs that have served the American public well for many years.

These programs have very finely tuned financing arrangements and have adapted their coverage to meet the needs of many Americans.

Starting over with a new, single-payer program will not eliminate the problems Medicare, Medicaid, and SCHIP currently face, such as the spiraling costs of procedures and prescription medications, as well as technological advances that are often not comprehensively tested to be proven safe or effective before marketing.

Dr. David Himmelstein: HR 676 improves and upgrades Medicare and extends it to all. It would provide far better coverage than SCHIP, and without the onerous enrollment hurdles that keep many needy children off that program. Medicaid is a second class program that is only marginally better than no coverage.

AARP: HR 676 does not promote shared responsibility for healthcare coverage among employers, employees and the government — a basic principle of AARP policy. The bill would relieve employers and individuals of their obligation to contribute toward healthcare coverage.

Therefore, even with the trust fund contained in the bill and other sources of funding, the single-payer system cannot remain solvent for long. Taxes will need to be increased. This means that the bill simply shifts the burden of the rising costs of health care onto the taxpayer alone, with no motivation built in its structure for cost-containment.

Dr. David Himmelstein: Employers and rich people would contribute — by paying taxes, as would employees. Who does the AARP thinks pays taxes if not employers and employees?

AARP: In addition H.R. 676 has not gathered bipartisan support which is important to enacting and implementing any reform.

Dr. David Himmelstein: If freeing the slaves failed to attract bipartisan support would the AARP also oppose it?

AARP: We do, however, support comprehensive healthcare reform. We will continue to monitor H.R. 676 and other legislation regarding the crucial issue of adequate health care for all. We believe quality health care and protecting lifetime financial security are the most pressing domestic issues facing our nation. The time for action is now. Therefore, it is vital that Congress deliver healthcare legislation with the strength to elicit bipartisan support and end the gridlock that continues to obstruct positive change in our country.

Dr. David Himmelstein: The AARP supports reform that protects its massive insurance revenues and has no chance of actually solving the health care crisis.

Uwe Reinhardt's prescience on the auto industry

Obama Vows Swift Overhaul As Chrysler Enters Bankruptcy

By Peter Whoriskey, Brady Dennis and Kendra Marr
The Washington Post
May 1, 2009

Chrysler, the nation’s third-largest automaker, filed for bankruptcy protection yesterday, with President Obama promising that court relief would give the company a “new lease on life.”

Now largely under government control, Chrysler will seek in court to strip itself of its overwhelming debts.

The new majority owner will be Chrysler’s union retiree health fund, which would receive a 55 percent stake in the new company. Fiat would get a 20 percent stake, with its share potentially rising to 35 percent over time based on performance. The United States would take 8 percent, while the Canadian government, which is also providing financing, would receive 2 percent.

http://www.washingtonpost.com/wp-dyn/content/article/2009/04/30/AR2009043001639.html?sid=ST2009043001828

And…

Bondholders Propose an Alternative to G.M.’s Plan

By Cyrus Sanati
The New York Times
April 30, 2009

Under the proposal released Thursday, G.M.’s bondholders would receive 58 percent of the restructured company in exchange for tearing up their $27 billion in unsecured G.M. bonds.

The United Automobile Workers, through an entity known as a VEBA, which holds workers’ health care obligations, would get about 41 percent to offset the $20 billion G.M. owes the union. Current shareholders would receive 1 percent.

Under (another) proposal that G.M. made this week, bondholders would get 10 percent of the company for their unsecured debt, while the government would receive 50 percent in exchange for forgiving at least half of G.M.’s outstanding Treasury debt by June 1, which G.M. estimates would be about $10 billion. The VEBA would get 39 percent of the equity for giving up $10 billion of the $20 billion G.M. owes it, while current shareholders would get 1 percent.

http://www.nytimes.com/2009/05/01/business/01gm.html?_r=1

And…

UAW, Ford reach agreement on VEBA

By Brent Snavely
Detroit Free Press
February 23, 2009

The UAW said today it has reached a tentative agreement with Ford Motor Co. to modify the payment requirements for a retiree health care trust fund, and is likely to use the agreement as a template for talks with General Motors Corp. and Chrysler.

Ford said the tentative agreement gives it the option to use stock for up to 50% of its payments to fund the Voluntary Employee Beneficiary Association, or VEBA.

The UAW and each of the domestic automakers agreed to create a union-managed retiree health care trust fund during contract talks in 2007, and the UAW is scheduled to begin managing the fund in 2010.

http://www.freep.com/article/20090223/BUSINESS01/90223018/

And…

Health Costs Soaring, Automakers Are to Begin Labor Talks

By Danny Hakim
The New York Times
July 15, 2003

Uwe Reinhardt, a Princeton University health care economist, calls the Big Three “a social insurance system that sells cars to finance itself.”

http://www.nytimes.com/2003/07/15/business/15AUTO.html

Comment:

By Don McCanne, MD

It was almost six years ago that Uwe Reinhardt called the Big Three “a social insurance system that sells cars to finance itself.” We have frequently quoted him, even though the statement was an exaggeration to make a point. But how prescient!

Saddled with legacy costs, each of the Big Three negotiated the transfer of their retiree health funds to the United Auto Workers (UAW) in the form of a voluntary employee beneficiary association (VEBA). With further deterioration in the auto industry’s financial status, the VEBAs are now accepting a major ownership position in these firms.

Thus Uwe Reinhardt was spot on. The VEBAs actually are “a social insurance system that sells cars to finance itself.”

Health care reform anyone?

Uwe Reinhardt’s prescience on the auto industry

Obama Vows Swift Overhaul As Chrysler Enters Bankruptcy

By Peter Whoriskey, Brady Dennis and Kendra Marr
The Washington Post
May 1, 2009

Chrysler, the nation’s third-largest automaker, filed for bankruptcy protection yesterday, with President Obama promising that court relief would give the company a “new lease on life.”

Now largely under government control, Chrysler will seek in court to strip itself of its overwhelming debts.

http://www.washingtonpost.com/wp-dyn/content/article/2009/04/30/AR2009043001639.html?sid=ST2009043001828

And…

Bondholders Propose an Alternative to G.M.’s Plan

By Cyrus Sanati
The New York Times
April 30, 2009

Under the proposal released Thursday, G.M.’s bondholders would receive 58 percent of the restructured company in exchange for tearing up their $27 billion in unsecured G.M. bonds.

http://www.nytimes.com/2009/05/01/business/01gm.html?_r=1

And…

UAW, Ford reach agreement on VEBA

By Brent Snavely
Detroit Free Press
February 23, 2009

Ford said the tentative agreement gives it the option to use stock for up to 50% of its payments to fund the Voluntary Employee Beneficiary Association, or VEBA.

The UAW and each of the domestic automakers agreed to create a union-managed retiree health care trust fund during contract talks in 2007, and the UAW is scheduled to begin managing the fund in 2010.

http://www.freep.com/article/20090223/BUSINESS01/90223018/

And…

Health Costs Soaring, Automakers Are to Begin Labor Talks

By Danny Hakim
The New York Times
July 15, 2003

Uwe Reinhardt, a Princeton University health care economist, calls the Big Three “a social insurance system that sells cars to finance itself.”

http://www.nytimes.com/2003/07/15/business/15AUTO.html

Comment:

By Don McCanne, MD

Thus Uwe Reinhardt was spot on. The VEBAs actually are “a social insurance system that sells cars to finance itself.”

Health care reform anyone?

Dr. Chaoulli’s private clinic waiting room death

Waiting-room death triggers review of Quebec private clinic rules

Canadian Medicine
April 22, 2009

Quebec coroner Catherine Rudel-Tessier’s report released today on the death of Jean-Jacques Sauvageau, who died January 11, 2008, in the waiting room of a private Montreal urgent-care clinic, demands that the Collège des médecins du Québec refine its regulations on such clinics to better protect patients.

Ms Rudel-Tessier said the 2007 Collège guidelines on private clinic administration should be “more precise” on certain points and must help administrators “offer a safe environment to their patients and permit them to adequately deal with emergencies.”

The Collège’s president and CEO, Dr Yves Lamontagne, said the guidelines would be either revised or replaced, depending on the results of the Collège’s investigation of the incident. He said he expects two new measures will be incorporated into the guidelines. “One, every physician or nurse working in that type of clinic should follow a course on cardiopulmonary resuscitation. And two, all clinics should have equipment — a defibrillator.”

Ms Rudel-Tessier also recommended that the Collège investigate the doctor or doctors who attended to Mr Sauvageau.

Dr Jacques Chaoulli — the same crusading Jacques Chaoulli whose high-profile 2005 Supreme Court case against the government of Quebec forced the province to overturn some of its restrictions on private health insurance — examined Mr Sauvageau minutes after he stopped breathing and decided not to attempt resuscitation, instead leaving Mr Sauvageau’s body in his waiting room seat until an ambulance arrived. An autopsy later revealed that Mr Sauvageau died of massive bilateral pulmonary embolisms and would not have been saved by resuscitation but Ms Rudel-Tessier concluded that Dr Chaoulli could not have known that at the time and should have tried to save Mr Sauvageau.

http://canadianmedicine.blogspot.com/2009/04/waiting-room-death-triggers-review-of.html

Rapport d’enquête sur LE DÉCÈS DE M. JEAN-JACQUES SAUVAGEAU
http://qgov.newswire.ca/gouvqc/communiques/GPQF/Avril2009/22/c4034.html?slang=en

Comment:

By Don McCanne, MD

In the Canadian Supreme Court case of Chaoulli v. Quebec, Justice Deschamps wrote, “The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care.”

This decision has resulted in intense efforts to privatize both the Canadian health insurance system and the Canadian health care delivery system. The outspoken proponents of privatization would have you believe that only the private sector is capable of saving lives that would be lost by neglect in the public sector.

Dr. Chaoulli’s patient did not die while on a waiting list for an elective orthopedic procedure. He collapsed and died in Dr. Chaoulli’s private waiting room. Dr. Chaoulli withheld cardiopulmonary resuscitation – a standard of care that surely would have been provided in any public health care facility – with questions over whether or not he had adequately trained staff and appropriate equipment to initiate such care. Dr. Chaoulli then asked his nurse to call 911 (to have the body removed), and he returned to his work. Only after the ambulance team arrived was cardiopulmonary resuscitation instituted.

The lesson of the tragic death of Jean-Jacques Sauvageau is simply that Crusader Dr. Jacques Chaoulli and the other privatizers have no credibility when they claim that the private system has a special capability of saving lives that the public system lacks.

AFL-CIO’s Health-Care Survey Ignores ‘Single Payer’ Plan Favored by Unions

By Harry Kelber
Labor’s Voice for Change (31)
April 30, 2009

An AFL-CIO-sponsored on line health care survey of 26,419 respondents, more than half of them union members, reveals a widespread discontent with the cost, benefits and operating procedures of current health insurance plans. The survey, taken between Jan. 14 and March 3, shows that “ninety-four percent of the insured say the health care system needs fundamental change or to be rebuilt.”

Curiously, the survey makes no mention of the Single Payer (H.R. 676) health care system or Medicare as possible options that the respondents were never asked. Those questions were left out, says Amaya Smith, survey director, “for no particular reason.”

H.R. 676, introduced in Congress by Representative John Conyers (Dem.-Mich, has been gathering sensational support from unions across the country. It has already been endorsed by 512 union organizations in 49 states. That includes 39 AFL-CIO-affiliated State Federations and 125 Central Labor Councils. The Service Employees International Union and other Change to Win internationals have also endorsed it.

Surely, Single Payer is worth at least an occasional story on the AFL-CIO’s Web, but none has appeared. Instead, it has been totally ignored. The health care advantages that H.R, 676 has to offer have been given only limited coverage in the labor media, despite the strong record of union endorsements. Why? The short answer is that AFL-CIO President John Sweeney and his close associates are supporting a universal health care plan that would include profit-making insurance companies and HMOs.

Under H.R. 676, a single public payer would replace the many hundreds of private, for profit insurance companies, each with an expensive bureaucracy and a different set of rules, that is focused on making money for the company rather than the health of their customers. The billions that could be saved from the continuing increases in premiums, co-payments and deductibles could be used to cut costs or improve health care services.

For those who are unfamiliar with Single Payer, H.R. 676 would provide every resident in the United States with an expanded and greatly improved Medicare system. It would cover every person for all necessary medical care, including prescription drugs, hospital, surgical, outpatient services, as well as dental, substance abuse, mental and other health problems. No insurance company bureaucrat would come between you and your doctor.

Let’s Have an Open Dialogue on the AFL-CIO’s Web Site

Health care insurance, particularly for the tens of millions of people who don’t have any, is one of the most important issues worrying working families. It is a good sign that there is general agreement among our unions that our current health care system needs to be reformed. There is also consensus that some form of universal health care insurance is necessary, but which plan?

The Sweeney camp believes that Congress won’t pass a bill for universal coverage without a clear role for the powerful insurance companies. On the other hand, the Single Payer advocates say that the insurance companies are part of the problem, not the solution. Letting them participate in any eventual health care plan would retain the abuses and shortcomings that working families currently encounter in protecting their health.

It will be interesting to see how the health care issue is debated and voted upon at the AFL-CIO’s 2009 convention in Pittsburgh, less than five months away.. The odds are that there will be a general resolution of support for universal health care insurance, but it will stop short of making a specific recommendation..

Strange things have happened before at AFL-CIO conventions, where a vote called for at a critical time on a particular issue can decide the outcome of an election of officers… It will be worth watching how the health care issue is played out at this convention.

Mass. Model for Health Overhaul ‘Not Viable,’ Expert Tells Lawmakers

By Alex Wayne, CQ Staff
CQ TODAY ONLINE NEWS — HEALTH
April 23, 2009

A Massachusetts doctor and health policy expert told Congress on Thursday that he believes his state’s 2006 overhaul of its health system — legislation that may be a model for a national overhaul — “will fail.”

The physician, David Himmelstein, told the House Education and Labor panel’s health subcommittee that based on his experience working in the Cambridge Health Alliance, Harvard University’s hospital system, Massachusetts’ health overhaul won’t work in the long term because it is too expensive.

“I think it’s economically not viable and I see from my patients it’s not viable,” Himmelstein said after Rep. Dennis J. Kucinich, D-Ohio, asked him if he thought the overhaul would fail.

“I think it will fail,” said Himmelstein, who is an associate professor of medicine at Harvard and a well known advocate for a single-payer health system, in which the government would provide everyone health care.

His observations might be important as lawmakers in Washington move toward a Massachusetts-style overhaul of the nation’s health system. Many Democrats have expressed admiration for the Massachusetts system, in which a government agency called the Commonwealth Connector helps state residents obtain private health insurance if they can’t get it through their employers or government programs such as Medicare.

The overhaul has greatly boosted insurance coverage in Massachusetts; the state says that less than 3 percent of its residents lack insurance, and the U.S. Census says the state has the lowest rate of uninsurance in the country.

But the overhaul has also been more expensive than expected. Massachusetts legislators have been criticized for doing little, when the overhaul was written, to try to control health care costs.

State legislators predicted when the law was written that the new system would cost the state $400 million in fiscal 2008; it actually cost $628 million. Fiscal 2009 spending was forecasted to be $725 million; the budget for the system is $869 million this year, though the state expects to spend less.

Long-term cost problems in the state are even worse, according to the Urban Institute, which published a study on the Massachusetts overhaul in January. Massachusetts has some of the highest health costs in the nation, in part because its hospital, physician and insurance markets are all highly concentrated and lack serious competition, according to the Urban Institute. For those and other reasons, premiums for insurance offered through the Connector are often unaffordable if residents make too much money to qualify for subsidies, the Urban Institute says.

“The way we’re increasing coverage is by buying additional insurance from [private insurers] on top of already high costs,” Himmelstein said. “We’ve had no means of cost containment.”

Kucinich, a single-payer advocate himself, thinks Congress is too concerned about preserving a role for private insurers within the health care system.

“Our efforts in Congress should be about health care, not insurance care,” Kucinich said. “What we know, and what Dr. Himmelstein was talking about is, the insurance companies make money not providing health care.”

But a single-payer system is not supported by President Obama or many Democratic leaders. That is because previous efforts at health care overhauls, particularly former President Bill Clinton’s effort in 1993-94, failed after people with insurance became worried they would lose their coverage and be forced into a government-run system.

“As we go forward, we need be mindful of those 160 million people getting insurance from their employers and we not pull that string unless and until we’re ready to replace the paradigm,” warned Rep. John Kline, R-Minn.

Dr. Chaoulli's private clinic waiting room death

Waiting-room death triggers review of Quebec private clinic rules

Canadian Medicine
April 22, 2009

Ms Rudel-Tessier also recommended that the Collège investigate the doctor or doctors who attended to Mr Sauvageau.

http://canadianmedicine.blogspot.com/2009/04/waiting-room-death-triggers-review-of.html

Rapport d’enquête sur LE DÉCÈS DE M. JEAN-JACQUES SAUVAGEAU
http://qgov.newswire.ca/gouvqc/communiques/GPQF/Avril2009/22/c4034.html?slang=en

Comment:

By Don McCanne, MD

Fight for single-payer health care

Kay Mueller
Indiana Daily Student
Apr. 28, 2009

Soon, thousands of IU students will be graduating. Those who were carried on their parents’ health insurance will now be on their own.

Many, if not most, entry-level jobs do not offer health insurance. The stereotype is that young people don’t care about universal health insurance. Recently I heard of two new graduates who were surprised to find themselves suddenly without insurance. One of them has a pre-existing condition and is unable to get any insurance at all.

President Barack Obama has promised to reform our health care system. Unfortunately, he intends to rely on the for-profit insurance companies. These insurers add so much overhead to health care that we could never afford to cover everyone as long as the system is based on them. The U.S. now spends 16 percent of its GNP on health care and leaves more than 45 million uninsured.

All other developed countries, which do not rely on for-profit insurers, and which do cover everyone, spend less than 12 percent.

Whether or not you see yourself as needing insurance right now, your tax money will be wasted on insurance company profits and bureaucracy. A better approach is a Medicare-like “single-payer” system: You choose your own doctor and hospital, but a single payer, such as the government, pays the bills.

What can you do? You can e-mail or call Obama and say you support a single-payer system, such as Medicare for all (president@whitehouse.gov, 202-456-1111). Contact your Representative and urge him to support HR-676, which provides Medicare for all. Baron Hill is the Representative for Bloomington (baronhill.house.gov, 202-225-5315). Contact Sens. Evan Bayh and Richard Lugar, and ask them to support S-703, which also provides Medicare for all (bayh.senate.gov, 202-224-5623; lugar.senate.gov, 202-224-4814).

You can also join a demonstration at 11 a.m. May 20 on Monument Circle in Indianapolis. Hoosiers for a Commonsense Health Care Plan will be demonstrating against health insurance companies immediately after the shareholders’ meeting of WellPoint (a huge national insurer with headquarters in Indianapolis).

For information, call 824-1082. If the energy put into the Obama campaign can be applied to fixing health care, anything can be accomplished.

AFL-CIO's Health-Care Survey Ignores 'Single Payer' Plan Favored by Unions

By Harry Kelber
Labor’s Voice for Change (31)
April 30, 2009

Let’s Have an Open Dialogue on the AFL-CIO’s Web Site

Subcommittee Members Spar Over Cost Control Tactics

By Jane Norman
CQ HealthBeat Associate Editor
CQ HEALTHBEAT NEWS
April 23, 2009

The lack of a middle ground among lawmakers on an approach to the health care overhaul was on full display Thursday as the Health, Employment, Labor and Pensions Subcommittee of the House Education and Labor Committee probed witnesses on how to cut U.S. health insurance costs now exceeding $2 trillion annually.

“We spend too much on our health care system relative to our national income and do not get the results we should,” said Subcommittee Chairman Robert E. Andrews, D-N.J. He said that he wanted to encourage a “dynamic interchange” at the hearing on how to curb costs that are rising for workers at three times the rate of their paychecks, and keeping many Americans from obtaining insurance at all.

Andrews and the subcommittee heard solutions offered that included a single-payer system similar to Canada’s; a system of “employee benefit cooperatives” that would allow small employers, employees and families to band together to buy access to affordable coverage; choices between private and public plans within a national insurance exchange; expansion of Medicaid; and making changes to increase affordability while continuing traditional group employer plans.

But Democrats John Tierney of Massachusetts and Dennis J. Kucinich of Ohio, both of whom back a single-payer plan, strongly objected that not enough time was being spent discussing private insurers and their role in rising costs. “The 800-pound gorilla in this room is unspoken, and it’s insurance companies,” said Tierney. “Everybody’s trying to find a way to keep insurance companies in business.” Congress should “find the gumption” to order insurers to spend a set percentage on providing care as opposed to administrative costs, he said.

Kucinich said that “our effort in Congress should be about health care, not insurance care,” and pointed out 70 members of the House have signed on to the single-payer plan. Yet he said from all he is hearing and reading about the debate over an overhaul, “I am deeply concerned Congress is going to miss a rare opportunity to adopt a single payer health plan.”

Ron Pollack, executive director of liberal-leaning Families USA, said it is “not likely” that insurance companies will vanish but more could be done to rein them in, including establishment of standardized benefits and reforms in the ways pre-existing conditions among patients are treated.

Another witness, David U. Himmelstein, a primary care doctor and associate professor of medicine at Harvard University who testified in favor of a single-payer plan like Canada’s, retorted: “The problem is actually the private insurer wants not to pay.” Himmelstein said lesser reforms, including a widely discussed public option accompanying private plans, could not realize the same kind of savings in administrative costs as a single-payer plan.

“While reforms that maintain a major role for private insurers may be politically attractive, they are economically and medically nonsensical,” he said.

On the Republican side, Rep. John Kline of Minnesota said, “we have wonderful health care in this country” and Canadians who can’t get health care they need wind up in his border state. Group employer plans cover 160 million Americans, he said. “We may be changing the paradigm, but we need to be very careful to do no harm and pull a thread on the sweater that is ERISA,” he said, referring to the Employee Retirement Income Security Act, which covers employee benefit plans.

Rep. Phil Roe, R-Tenn., said he wants to see access to health care improved, and care should be made portable and less costly. But he expressed the fear that’s heard often among Republicans that a public plan will lead private employers to drop their own coverage, and the government will become the primary player in health care. “If you like the way government has managed AIG, you’re going to love the way they manage your health care,” said Roe, a physician.

Rep. Phil Hare, an Illinois Democrat, extracted some agreement from the witnesses that most Americans like their health care.

“They’re happy generally until they get sick,” said Himmelstein.

Hare expressed interest in Himmelstein’s point of view and praised the veterans’ health care system as a model, while also observing “at times you swear the federal government can’t do anything right.” Whatever is done, “we’ve got to be bold and we better do it right,” he said.

Rep. David Wu, an Oregon Democrat, said it would be difficult to change health care “in a way that’s perceived as taking these health plans away.”

The discussion was a beginning, said Andrews, of how to provide a system with high quality and access for all. “This committee, the House, the Congress, the country are going to struggle with these questions,” he said.

Kline said, “There is obviously a great deal of disagreement and diversity here. . .we’ve got a long way to go here.”

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