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

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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.

Source: CQ Today Online News
Round-the-clock coverage of news from Capitol Hill.
(c) 2009 Congressional Quarterly Inc. All Rights Reserved.

State legislators launch effort to push H.R. 676

By All Unions Committee for Single Payer Health Care — H.R. 676

A group of state legislators has initiated a nationwide effort to publish an appeal to President Obama and members of the 111th Congress to support H.R. 676, single-payer health care legislation introduced in Congress by Rep. John Conyers Jr. and presently co-sponsored by 75 other House members.

Last week, 24 state legislators from 16 states sent a copy of the appeal to all 7,500 state legislators in the United States asking them to add their names to the appeal which will be published in Roll Call, a widely read Capitol Hill publication, in late May or in June.

The legislators, in their letter, cite the growing “economic crisis” and “badly strained” state budgets as the reason why they are asking “the U.S. Congress … to heal our hemorrhaging state budgets while bringing comprehensive, quality health care to all our people by passing H.R. 676.”

Co-conveners of the campaign are state Sen. Jim Ferlo of Pittsburgh and Assemblyman Richard Gottfried of New York. State senators and representatives from Colorado, Georgia, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, New Jersey, Texas, Virginia and Wisconsin also signed the letter.

Kay Tillow, coordinator of the All Unions Committee for Single Payer Health Care — H.R. 676, welcomed the effort by the state legislators and urged everyone to contact their own state senator and representative and ask them to sign the appeal.

“State legislators are caught in a vise of escalating health care costs, driven largely by the for-profit insurance industry and declining revenues,” Tillow said. “Without a national single-payer system, state budgets will continue in crisis and health needs will not be met.”

The “Dear Colleague” letter, the appeal and other materials can be found at:

http://www.healthcare-now.org/campaigns/state-legislators/

Ed Show: Bernie Sanders on single payer

Bernie Sanders on the Need for a Single Payer Health Care System

Ed Show
April 28, 2009

(Clip courtesy of Video Cafe)

Bernie Sanders: … We can guarantee every man, woman and child health care with a single payer system.

Ed Schultz: Senator, that is what just boggles my mind. We have, right now, a political moment in this country. The president has high approval ratings; you have the people out there; town hall after town hall I hear it, they want single payer; you’re close to the super majority depending on how…

Sanders: Ed, what are you forgetting in that equation?

Schultz: Well, I’m forgetting the filibuster I guess.

Sanders: And you’re forgetting the power of the insurance companies…

Schultz: Yes. Right.

Sanders: The huge amounts of money they spend; the power of the drug companies, and if you think that every member of the Democratic caucus is prepared to stand up to those guys, you’re mistaken.

****

Sanders: But the bottom line here, Ed, is, you’re absolutely right; we have a Democratic president, a strong majority in the House, sixty votes in the Senate. If we can’t deliver on energy, on health care, on workers’ rights, then what’s the sense of it all. The answer is people have got to put pressure on Congress to have the guts to stand up to the insurance companies, the drug companies, the banks, the military-industrial complex.

Schultz: Well, who’s going to put pressure on them?

Sanders: We’re going to need a strong grassroots movement to make that happen.

Schultz: So you think the people can be heard on this.

Sanders: Absolutely. Absolutely they can.

****

Schultz: I think this is a real moment for the president. What if the president comes out tomorrow night at the press conference… I would love to hear President Obama come out and say, “Look, I don’t have all the answers, but everything is on the table.” And this idea that single payer is not politically achievable, Mr. President, respectfully, I think you’re wrong on that. I think it is politically achievable, because the people want it.

Video clip (7 minutes, 41 seconds):
http://videocafe.crooksandliars.com/heather/ed-show-bernie-sanders-need-single-payer-health

Comment:

By Don McCanne, MD

When the people lead, Congress will follow.

Big health care rally planned Friday

By DANIEL BARLOW
Times Argus, Barre, Vt.
Published: April 28, 2009

MONTPELIER — During her years working for non-profit organizations, Peg Franzen saw the same story over and over again.

First, a person gets hit with a surprise medical problem — and they have no insurance. Then they lose their job. And finally, they lose their home.

Franzen, a retired resident of Montpelier, said she has witnessed many Vermonters between 40 and 60 years old suddenly have their entire lives derailed by the financial burdens of a medical illness because they lack health insurance.

“We really need to have a health care system that is based on moral values rather than the market economy,” she said Monday.

Health care has received little attention in this year’s legislative session in Vermont. But residents worried about the future of the system will gather at the Statehouse on Friday for what promises to be a massive rally.

Organized by the Vermont Worker’s Center and sponsored by more than 100 other organizations and groups in Vermont, Friday’s “Health Care is a Human Right” rally will draw attention to two bills that would institute a single-payer health care system in the state.

James Haslam, the director of the Worker’s Center, said the estimate is that more than 1,000 people will turn out for the rally, which begins at noon on the Statehouse lawn.

“We believe that this will be the largest political rally for health care reform in the history of the state of Vermont,” Haslam said. “It may be one of the biggest rallies in Vermont ever.”

The Vermont Worker’s Center launched its Health Care is a Human Right campaign last year, and this Friday’s rally will be its first major step toward building a grassroots coalition around health care reform.

Speakers at the rally include Dr. Deb Richter, a Montpelier resident who has been a force for single-payer health care at the Statehouse, and U.S. Sen. Bernard Sanders, who has sponsored legislation at the federal level.

The rally will also include street theater, giant puppets and a “dump-the-insurance-companies” dunk tank.

“There has been resistance to single-payer because of how invested those who make money off health care are in the political system,” Haslam said, “The pharmaceutical companies, the insurance companies … they make their profit off of our health.”

Sen. Doug Racine, D-Chittenden, the chairman of the Senate Health and Welfare Committee, said Monday that he is a supporter of single-payer health care, but added that creating such a system is never as easy as simply passing a bill.

His committee held a hearing last week on a Senate bill that would begin to create such a health care system. Racine said even supporters who testified in favor of the bill said Vermont would require waivers from the federal government.

“For a true single-payer system in Vermont, we would need to opt out of programs such as Medicaid and Medicare,” Racine said. “And that can’t happen without a waiver from the federal government , and I doubt it would happen under the administration of Gov. Douglas.”

Racine said he’s hoping that President Barack Obama’s health care reforms, which are expected to be unveiled later this year, will include provisions to allow states such as Vermont to begin testing certain reforms.

“I think there is a lot of interest in seeing what Vermont can do,” Racine said.

Contact Daniel Barlow at Daniel.Barlow@timesargus.com.

http://www.timesargus.com/article/20090428/NEWS02/904280338/1003/NEWS02

The Public Option Con

Selling Out Single-Payer

By HELEN REDMOND
Counterpunch
April 26, 2009

“As we roll out new products we will continue to price businesses for appropriate margins. We will not sacrifice profitability for membership.”

— Angela Braly, Wellpoint CEO

At the Health Care for America Now (HCAN) and Citizen Action Illinois sponsored rally in Chicago last weekend, single-payer advocates confronted HCAN leadership and Democratic Congresswoman Jan Schakowsky (D-Illinois) who instead of working to pass HR 676, John Conyers single-payer bill titled the United States National Health Insurance Act, are supporting the so called “public option.”

What the public option plan is, no one can exactly say. There are no concrete proposals spelling out what the plan would include, who could join it, how much it would cost, or how it would be funded. But the details don’t matter, they advocated for it anyway.

In a heated exchange with Schakowsky before the rally, she argued HR 676 (she is a cosponsor of the bill, yes that’s right) has no chance of passing and something has to be passed this year. She lied and said there isn’t enough support for single-payer, but there is for a public option. I and other activists challenged Schakowsky on every assertion and demanded she fight to pass HR 676. We said the insurance industry is going to fight just as hard against a public option as it will single-payer so let’s have a smackdown for single-payer. We argued the passage of HR 676 would guarantee an end to the crisis and finally make health care a human right that could never be taken away. She got pissed and complained loudly to her staff as she walked into the building, “Can you believe she is lecturing me?” I yelled after her, “I’m just expressing my opinion, I’m your constituency.”

The rally was a slick “Sell out single-payer and confuse em’ show” from start to finish, replete with retro 70’s song Ain’t no Stoppin’ Us Now blasting into the auditorium.

HCAN staffers, state representatives, Tom Balanoff – President of SEIU Local 1, small business owners, patients, doctors and medical students all took the stage, outlined different aspects of the crisis, and rightfully denounced the insurance and pharmaceutical companies. Their solution: the creation of a public plan to compete against the private insurance industry they despise. Speaker after speaker projected a wish list of health care reforms onto the nonexistent public option plan: benefits must be comprehensive, coverage must be affordable, no denial of care, and equal access to quality care. Who could disagree if a plan like that could actually be enacted? The problem is the United States will never, ever get a plan like that while the private insurance industry is still breathing. HCAN and liberal Democrats have to engage in this “magical thinking” in order to convince a skeptical public that a public option embedded in a for-profit system can work. Only a single-payer system, one that drives a stake through the heart of the insatiably greedy insurance corporations once and for all, can deliver on those promises.

A little history is in order.

The American health insurance system is based on the avoidance of the elderly and sick so insurers didn’t care much when Medicare was created: seniors have complex and costly health care needs that cut into profit margins. Let the government and taxpayers foot the bill for old people. Plus, people aren’t eligible for Medicare until they turn 65 so the vampires would have decades of opportunity to bleed Americans into medical bankruptcy. A similar dynamic was at work with Medicaid: poor people tend to have chronic health problems and that cuts into profit margins. Let the government and the taxpayers take care of them, but the minute they are healthy enough to work, kick ‘em out of the program and into the clutches of the vampires or the ranks of the uninsured. Whose left? Everybody in between. That’s what is driving the insurance industry and Karen Ignagni, the Chief Evil Officer (CEO) of America’s Health Insurance Plans (AHIP), into a frenzy. They fear a public plan will snatch away “their” market: the millions of people who don’t fall into the above categories of old and poor, especially the young and the healthy. It’s the profits, stupid!

Ignagni and the industry are whining that if a new government insurance program is created to compete with them, like Medicare, that’s unfair competition and they’d be driven out of business. Ohhh, don’t you feel sorry for Ignagni and all the other millionaire CEOs?

They think a government health plan would be unfair to them. But they’re exaggerating the effects a public plan would have on their pursuit of profit. Just look at how they have sunk fangs into Medicare.

Doctors Himmelstein and Woolhandler from Physicians for a National Health Program (PNHP) explain:

“A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan — which started as single-payer for seniors and now has become a funding mechanism for HMOs — and a place to dump the unprofitably ill. A public plan option doesn’t lead toward single-payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public one.”

Private Medicare Advantage plans cost the government 13 percent more per beneficiary on average in 2008, and overhead for private plans is also much higher, at 13 percent, compared to 2-3 percent in traditional Medicare. Of the 45 million Medicare recipients, 23 percent are in private plans. Most Americans aren’t aware of the extent of privatization of Medicare.

What is the lesson HCAN draws from the privatization of Medicare? On their website an article is posted titled, Will Government Give Public Health Insurance an Unfair Advantage? Experience Tells Us No. Experience shows the government has given an unfair advantage to private insurers when it comes to the Medicare program, which HCAN acknowledges. In twisted logic that is hard to follow, HCAN thinks that’s a good thing, it’s proof the government won’t lower reimbursement rates or impose cost controls on private insurers. Now HCAN is all about reassuring the insurance industry they claim to loathe so much they only want a public plan to compete against them on a level playing field: the goal is not to drive them out of business.

This is the logic that confuses people mightily. One minute HCAN is calling out the insurance industry for the profit-hungry killers they are, then they argue the companies need to stay in business to compete against a public plan honestly in the marketplace — even though they agree they never compete fairly, Medicare being the prime example.

The health care reform proposals advocated by Jacob Hacker from the University of California at Berkeley are suddenly all the rage, but there is nothing new about them. He proposes a national health exchange of private plans with the addition of a public option (essentially Obama’s position.) Hacker, like HCAN, is careful to assuage the fears of the private insurers and says under his scheme, “More Americans have private insurance after reform than do before — either through their employer or through the national exchange.” Smells a bit like Massachusetts where 200,000 people remain uninsured and the costs to subsidize the program have doubled from $630 million to $1.3 billion.
Single-payer advocates oppose the creation of a public plan for a different set of reasons.

1. It doesn’t make health care a human right that can never be taken away.

2. It continues to divide, devalue, and define people by their health status.

3. It can’t address the endemic racial and gender disparities in the system, including the 12 million undocumented.

4. It leaves the employer based system of health care provision intact. That link has to be broken so workers are free to change jobs, go on strike and not fear loss of coverage.

5. The system would continue to have multiple payers and therefore the complexity and gaps in coverage that are inevitable when there are numerous bureaucracies to navigate.

6. Where will the money come from to finance the plan, especially in a time of economic recession, like right now? A public plan is not fiscally sustainable because it’s rooted in a multiple payer system that foregoes at least 84% of administrative savings.

Single-payer on the other hand, would immediately inject 400 billion into the system by eliminating bureaucracy, billing apparatus, administrative waste, advertising, corporate profits, and CEO compensation. That’s enough money to bring everyone into the system with no co-pays or deductibles.

We don’t need any more feasibility studies or examinations of single-payer in other countries. It’s a proven fact that a single-payer system can cover everyone and control costs. Period, end of discussion.

So the question becomes why don’t the Democrats and HCAN fight to get rid of the parasitic private health insurance industry (the source of the crisis) once and for all instead of constantly and unsuccessfully, decade after decade, trying to rein in, regulate, and do an end run around them?

For the Democrats, with the exception of John Conyers and a few others, they simply don’t want to abolish the private insurance industry. They are capitalists and believe in the capitalist system that makes health care a commodity to be bought and sold. For them, health care is not a human right. And importantly, they don’t want to take on President Obama who is opposed to single-payer. Like the true cowards they are, they will not oppose Obama on health care reform even though they disagree with him.

HCAN thinks it’s impossible to get rid of the insurance companies, they’re too powerful, and they have too much money and influence. They don’t believe a large social movement can be built to take on and win against the insurers and the government. The leadership of HCAN are the ones who would have said under slavery, “We can’t win abolition, so let’s settle for a few reforms that make the lives of slaves more bearable.”

This attitude is astonishing given the sea change in consciousness around health care. A number of events have coalesced to make winning a single-payer system possible. No longer does the invoking of “socialized medicine” scare people, not after the government has socialized billions of dollars of losses in the financial sector. If the government can bail out AIG, why not the health care system? Poll after poll shows the majority of Americans want a government run health care system that guarantees health care. People often express this by saying, “I want what they have in Canada.” Physicians used to be an obstacle to single-payer, now 59% support single-payer.

Employment-based health care is collapsing and employers want to get out of the business of providing health care to workers: it costs too much. Millions of laid off workers now realize tying insurance to employment status is a disaster; lose your job, lose coverage. Those with jobs are paying staggering premium increases for less coverage. Single-payer legislation has been introduced into the House HR 676, and SB 703 in the Senate. There is a grassroots movement, including unions, all over the country organizing and fighting for single-payer. And most significantly, people are ANGRY and want change.

HCAN and Democrats like Schakowsky are deceiving and leading people down yet another dead end alley of incremental reform. We’ve had decades of incremental reform and now there are 50 million uninsured, 25 million underinsured and between 18,000 to 100,000 people die every year because they lack access to health care. For spineless Democrats like Schakowsky and HCAN, the day will never come when single-payer is “politically feasible,” because if now isn’t the time, when will it be?

The fight to make health care a human right is the new civil rights struggle. We are standing on the shoulders of all the great social movements that have come before us.

The time to win single-payer has never been better. We are going to keep fighting like hell to destroy the corporate killers, not create a faux option that allows them to live another day.

Sí se puede, yes we can!

Helen Redmond is a member of the Chicago Single-Payer Action Network and a Licensed Clinical Social Worker. She works in the emergency room at Cook County Hospital and blogs at http://helenredmond.wordpress.com She can be reached at redmondmadrid@yahoo.com

Single-payer system and Florida's budget are linked

Ray Bellamy
Tallahassee Democrat
My View
April 29, 2009

No to offshore drilling in a state that depends on pristine beaches and an attractive environment to attract a vibrant tourist industry. No to Seminole gaming, which would siphon money from those least able to afford it and create a number of other social problems.

What to do? Say yes to single-payer national health insurance. How would this help, you ask? The single largest expenditure in Florida’s budget is the $16 billion for Medicaid. And this Medicaid cost goes up annually at an unsustainable rate. That item, the entire Medicaid budget, would disappear if we had single payer national health insurance, such as HR 676 in the U.S. House, or S703 in the U.S. Senate. Since everyone would have comprehensive health coverage, including long-term care, dental, pharmacy and mental health — think a very comprehensive “Medicare for All” from the day of birth — state Medicaid expenditures would vanish from the budget. Also eliminated would be Leon County’s costs for providing employee and retiree health care, the same costs for the city of Tallahassee, and also for state employees and state retirees. Now this is sustainable improvement for our state’s budget number-crunchers to love.

Single payer is the only health care reform proposal that is revenue neutral in our $2.4 trillion national health care cost equation. It achieves universal coverage by saving an estimated $380 billion a year in wasted profit for the insurance industry and counter-productive administrative excess caused by that industry. These savings would go toward covering all of us with comprehensive coverage, free choice of physician and free choice of hospital, just as Medicare would be if it were much better funded.

Single payer is the only proposal for covering the uninsured that is fiscally responsible, the only proposal that covers all citizens, and the only proposal that utilizes a successful business model: Medicare. Australia, Canada, Taiwan and other countries with better-rated health care quality at half the per-capita costs of the U.S. patchwork system have greater success with the single payer model at far less cost than we. There is no successful model in the world experience for a private, for-profit insurance system such as proposed by those opposed to single payer.

We have a unique opportunity to achieve this needed reform in health care and solve our Florida budget crisis. Our own congressman, Allen Boyd, has stated his support for “universal health coverage.” But if the Obama administration is successful in shepherding through the Obama plan, Boyd is likely to be presented with a bill that will subsidize the health coverage for the uninsured at an additional national cost of $150 billion to $200 billion, but leave in place the 31-percent overhead and excessive insurance company profits within the present system. In fact, additional administrative costs would be added.

Boyd, as a leader of the Blue Dog caucus in Congress, is in a position to lead the redirection of health care reform toward single payer and take a true leadership role in Congress. The more than $18 billion saved from our state budget would go a long way toward helping our education, law enforcement, state worker salaries and other pressing social needs. Let Congressman Boyd know how you feel.

ABOUT THE AUTHOR: Ray Bellamy is a physician practicing in Tallahassee. Contact him at ray.bellamy@med.fsu.edu.

Congressman predicts single-payer health plan

By John Sammon
The Herald, Monterey County (Calif.)
April 27, 2009

National health care for all Americans is an idea whose time has come, a visiting lawmaker said Sunday at CSU- Monterey Bay.

“It’s in our face,” Rep. Jim McDermott, D-Wash., said. “We can’t avoid it. That’s why something is going to happen.”

A physician serving his 11th term in the House, McDermott has long championed health care reform and supports “single-payer” legislation guaranteeing affordable coverage to all Americans.

McDermott said the election of Barack Obama is among the most fundamental change in the effort to get all Americans health care.

“The first thing that has to happen, is that you have to have a president who will lead,” he said.

McDermott spoke to about 100 people in the CSUMB University Center at an event sponsored by the Compassionate Care Alliance.

He said 45 million Americans do not have medical insurance, while another 30 million are underinsured. But, he said, several influential groups, including doctors and unions, recognize the need for national health coverage.

“Industry also wants a national health plan,” he said. “They want to divest themselves of health costs. Health care costs are the number one cause of bankruptcies.”

McDermott predicted that drug and insurance companies will resist change.

“People never had a problem with taking care of roads and schools,” he explained. “But some of them still have the idea that when it comes to health care, it’s your private responsibility.”

An earlier attempt to institute national coverage bogged down when the Clinton administration tried to sponsor a 1,600-page plan, he said.

“The president (Obama) is saying this time, if you’ve got good coverage, if you like it, it’s OK, there won’t be any change in your system,” he said. “But the problem is, we’ve got too many people today who have no coverage at all, and they’re just crossing their fingers hoping nothing happens to them until they can find a job.”

McDermott described a dysfunctional health care system beset by soaring costs. As an example, he noted a patient who during a one-day visit, had an MRI and two CAT scans costing $11,000. The reading of a couple of X-rays generated another $1,500 charge.

“You can’t tolerate a system that operates that way,” he said.

Added to high costs is the often bewildering array of separate payment plans, resulting in a mountain of wasteful, time-consuming paperwork, McDermott said

New doctors, McDermott said, face a make-big-money-or- else quandary.

“You’ve got a medical student who comes out of college $150,000 in debt, maybe $250,000. This doctor has a family with children and says to himself, ‘I’ve got to make a lot of money.’ … You don’t go into primary care in an underserved (poor) area because it isn’t sufficient to pay off the debt.”

He said a possible solution would be to give free or low-cost tuition to medical students if they agreed to provide primary care in an underserved area for four years.

McDermott indicated that part of the problem is America’s reverence for the free-market system: It’s hard for us to visualize a national system.

He cited France as an example of an effective health care system. “The French are rated the best in the world, and we’re No. 18,” he said. “In this country, it depends on who you are and what plastic (credit card) you have. The idea of us learning from other countries is a hard concept for the U.S. We say to ourselves, ‘how could they know more.'”

Nevertheless, McDermott said single-payer national health care will be adopted here.

“There will be a campaign to support this from the grass roots. You need to place pressure on your congressman. They will react to people asking them, why don’t you do something? There’s no question people can make a real impact.”

http://www.montereyherald.com/local/ci_12236288

Single-payer system and Florida’s budget are linked

Ray Bellamy
Tallahassee Democrat
My View
April 29, 2009

No to offshore drilling in a state that depends on pristine beaches and an attractive environment to attract a vibrant tourist industry. No to Seminole gaming, which would siphon money from those least able to afford it and create a number of other social problems.

What to do? Say yes to single-payer national health insurance. How would this help, you ask? The single largest expenditure in Florida’s budget is the $16 billion for Medicaid. And this Medicaid cost goes up annually at an unsustainable rate. That item, the entire Medicaid budget, would disappear if we had single payer national health insurance, such as HR 676 in the U.S. House, or S703 in the U.S. Senate. Since everyone would have comprehensive health coverage, including long-term care, dental, pharmacy and mental health — think a very comprehensive “Medicare for All” from the day of birth — state Medicaid expenditures would vanish from the budget. Also eliminated would be Leon County’s costs for providing employee and retiree health care, the same costs for the city of Tallahassee, and also for state employees and state retirees. Now this is sustainable improvement for our state’s budget number-crunchers to love.

Single payer is the only health care reform proposal that is revenue neutral in our $2.4 trillion national health care cost equation. It achieves universal coverage by saving an estimated $380 billion a year in wasted profit for the insurance industry and counter-productive administrative excess caused by that industry. These savings would go toward covering all of us with comprehensive coverage, free choice of physician and free choice of hospital, just as Medicare would be if it were much better funded.

Single payer is the only proposal for covering the uninsured that is fiscally responsible, the only proposal that covers all citizens, and the only proposal that utilizes a successful business model: Medicare. Australia, Canada, Taiwan and other countries with better-rated health care quality at half the per-capita costs of the U.S. patchwork system have greater success with the single payer model at far less cost than we. There is no successful model in the world experience for a private, for-profit insurance system such as proposed by those opposed to single payer.

We have a unique opportunity to achieve this needed reform in health care and solve our Florida budget crisis. Our own congressman, Allen Boyd, has stated his support for “universal health coverage.” But if the Obama administration is successful in shepherding through the Obama plan, Boyd is likely to be presented with a bill that will subsidize the health coverage for the uninsured at an additional national cost of $150 billion to $200 billion, but leave in place the 31-percent overhead and excessive insurance company profits within the present system. In fact, additional administrative costs would be added.

Boyd, as a leader of the Blue Dog caucus in Congress, is in a position to lead the redirection of health care reform toward single payer and take a true leadership role in Congress. The more than $18 billion saved from our state budget would go a long way toward helping our education, law enforcement, state worker salaries and other pressing social needs. Let Congressman Boyd know how you feel.

ABOUT THE AUTHOR: Ray Bellamy is a physician practicing in Tallahassee. Contact him at ray.bellamy@med.fsu.edu.

Testimony of David U. Himmelstein, M.D. before the HELP Subcommittee

The following text contains the testimony of Dr. David Himmelstein at a hearing on “Ways to Reduce the Cost of Health Insurance for Employers, Employees and their Families” organized by Health, Employment, Labor and Pensions Subcommittee of the House Committee on Education and Labor on April 23 in Washington.

April 23, 2009

Mr. Chairman, members of the Committee. My name is David Himmelstein. I am a primary care doctor in Cambridge, Massachusetts, and associate professor of medicine at Harvard. I also serve as national spokesperson for Physicians for a National Health Program. Our 16,000 physician members support nonprofit, single-payer national health insurance because of overwhelming evidence that lesser reforms will fail.

Health reform must address the cost crisis for insured as well as uninsured Americans. My research group found that illness and medical bills contributed to about half of all personal bankruptcies in 2001, and even more than that in 2007. Strikingly, three-quarters of the medically bankrupt were insured. But their coverage was too skimpy to protect them from financial collapse.

A single-payer reform would make care affordable through vast savings on bureaucracy and profits. As my colleagues and I have shown in research published in the New England Journal of Medicine, administration consumes 31 percent of health spending in the United States, nearly double what Canada spends. In other words, if we cut our bureaucratic costs to Canadian levels, we’d save nearly $400 billion annually — more than enough to cover the uninsured and to eliminate co-payments and deductibles for all Americans.

By simplifying its payment system, Canada has cut insurance overhead to 1 percent of premiums — one-twentieth of Aetna’s overhead — and eliminated mounds of expensive paperwork for doctors and hospitals. In fact, while cutting insurance overhead could save us $131 billion annually, our insurers waste much more than that because of the useless paperwork they inflict on doctors and hospitals.

A Canadian hospital gets paid like a fire department does in the U.S. It negotiates a global budget with the single insurance plan in its province, and gets one check each month that covers virtually all costs. They don’t have to bill for each Band-Aid and aspirin tablet. At my hospital, we know our budget on January 1, but we collect it piecemeal in fights with hundreds of insurers over thousands of bills each day. The result is that hundreds of people work for Mass General’s billing department, while Toronto General employs only a handful — mostly to send bills to Americans who wander across the border. Altogether, U.S. hospitals could save about $120 billion annually on bureaucracy under a single payer system.

And doctors in the U.S. waste about $95 billion each year fighting with insurance companies and filling out useless paperwork.

Significantly, these massive potential savings on bureaucracy can only be achieved through a single payer reform. A health reform plan that includes a “public plan option” might realize some savings on insurance overhead. However, as long as multiple private plans coexist with the public plan, hospitals and doctors would have to maintain their costly billing and internal cost tracking apparatus. Indeed, my colleagues and I estimate that even if half of all privately insured Americans switched to a public plan with overhead at Medicare’s level, the administrative savings would amount to only 9 percent of the savings under single payer.

While administrative savings from a reform that includes a Medicare-like public plan option are modest, at least they’re real. In contrast, other widely touted cost control measures are completely illusory. A raft of studies shows that prevention saves lives, but usually costs money. The recently completed Medicare demonstration project found no cost savings from chronic disease management programs. And the claim that computers will save money is based on pure conjecture. Indeed, in a study of 3,000 U.S. hospitals that my colleagues and I have recently completed, the most computerized hospitals had, if anything, slightly higher costs.

My home state of Massachusetts recent experience with health reform illustrates the dangers of believing overly optimistic cost control claims. Before its passage, the reform’s backers made many of the same claims for savings that we’re hearing today in Washington. Prevention, disease management, computers, and a health insurance exchange were supposed to make reform affordable. Instead, costs have skyrocketed, rising 23 percent between 2005 and 2007, and the insurance exchange adds 4 percent for its own administrative costs on top of the already high overhead charged by private insurers. As a result, 1 in 5 Massachusetts residents went without care last year because they couldn’t afford it. Hundreds of thousands remain uninsured, and the state has drained money from safety-net hospitals and clinics to keep the reform afloat.

In sum, a single-payer reform would make universal, comprehensive coverage affordable by diverting hundreds of billions of dollars from bureaucracy to patient care. Lesser reforms — even those that include a public plan option — cannot realize such savings. While reforms that maintain a major role for private insurers may seem politically expedient, they are economically and medically nonsensical.

New York HMO/POS death spiral

Consumer Guide to HMOs

New York State Department of Insurance

Choices Available for Individual Coverage

Under New York State Insurance Law, New Yorkers purchasing health insurance on their own can choose either an HMO or an HMO/POS plan option at any time during the year. You cannot be denied coverage if you have health problems, but you may be subject to a waiting period of up to one year for certain pre-existing conditions.

HMOs deliver health care to members using provider networks, which are groups of doctors, hospitals and other health care providers that have agreed to serve members of a particular HMO. Health benefits are covered if the member uses providers that are in-network.

All New York HMOs also offer a point of service (POS) option that allows members to seek care from providers that are out-of-network. Services provided by out-of-network providers generally cost members more in out-of-pocket expenses.

http://www.ins.state.ny.us/consumer/cg_hmo2008.pdf

And…

Premium Rates for Standard Individual Health Plans

April 2009

New York County

Monthly family premium rates for Point of Service Plans (POS)

$4450 – Aetna Health. Inc.
$3776 – Atlantis Health Plan, Inc.
$4066 – Empire BlueCross BlueShield HMO
$6824 – GHI HMO Select, Inc.
$4187 – Health Insurance Plan of Greater New York, Inc.
$3816 – Health Net of New York, Inc.
$3500 – Managed Health, Inc.
$4208 – Oxford Health Plans (NY), Inc.

HMO family rates for these same insurers range from $2266 to $5686

http://www.ins.state.ny.us/hmorates/html/hmonewyo.htm

Comment:

By Don McCanne, MD

So in New York County, for a premium of about $50,000 per year, you can have a choice of physicians and hospitals for your family, although you will have to pay more in out-of-pocket expenses if you select out-of-network providers. If you don’t mind losing choice by staying within the HMO for all of your care, you can have your family covered for under $40,000 per year.

What is going on here? Why are the premiums so high?

Well, first of all, New York has addressed the problem of underinsurance by requiring, through regulation, that insurers provide adequate benefits. Also, they must accept anyone, regardless of health status (though they can enforce a waiting period to prevent individuals from waiting until they need care to apply for coverage). Innovative insurance products that keep premiums competitive by shifting significant costs to the insured are prohibited in New York. Health care is very expensive in the United States, so premiums that reflect the true costs will be quite high.

Per capita spending for health care is already at $8,100 per year. For a family of four, that would be about $32,000, but these numbers in New York are even higher. What explains that? If you had an income of $80,000 per year, and you and your family are healthy, and you are told that your insurance premium will be $50,000, what would you do? You really don’t have much choice; you’d wing it. If you had ongoing medical expenses of maybe $250,000 per year, what would you do? You would try to stay in the plan and somehow pay that $50,000.

This is the classic “death spiral” of health insurance. A ever increasing number of individuals who are healthy would leave the plan, leaving within the risk pool the very high cost patients. Premiums skyrocket and become unaffordable for most.

The private insurance industry has an answer for this. They are asking Congress to require everyone, through an individual mandate, to purchase insurance so that the risk pools remain diluted with the large numbers of people who are healthy. That might take care of the death spiral, but it glosses over a very important point.

In most states, plans in the individual market are underinsurance products, and true reform must bring an end to their underinsurance innovations, otherwise people who need medical care will continue to face financial hardship. The New York experiment has demonstrated that well regulated individual plans (which Congress promises us) are too expensive. Congress understands this so they say that we should be able to chose our plans through a “connector” so that we don’t have to pay broker fees. Come on! It’s health care costs that are breaking us!

At today’s costs, private plans that are adequate to prevent financial hardship in the face of medical need must have unaffordable premiums, whether or not in a connector. We need to eliminate this obsolete system of premiums tied to a private package of health benefits. We desperately need an equitable, efficient, single payer national health program. Each person pays his or her fair share, and everyone gets health care.

And what is Congress preparing for us behind those closed doors? Look again at the premiums for New York County. At least you will have a choice of plans with perhaps $40,000 premiums, and for another $10,000 plus out-of-pocket cost sharing, you can have your choice of providers as well.

You say that premiums won’t be that high if we eliminate the death spiral? President Obama has already said that you can’t mandate people to buy an insurance plan they can’t pay for. That keeps the death spiral in play.

Only patients should profit

By MARK A. DUNLEA
Albany Times Union
Tuesday, April 28, 2009

America’s pundits used to deride the old Soviet Union for propping up obsolete factories and industries in the name of jobs.

We don’t hear such criticisms about President Barack Obama and the Democrats’ decision to prop up health insurance companies in the debate over universal health care. Yet our system of health insurance is costing us hundreds of billions of dollars annually, tying up the health care system in paperwork, and contributing to the deaths of tens of thousands of Americans annually.

An April 20th news article (“Health reform tough call”) focuses on whether Congress will agree to the Democrats’ call for a public option, allowing Americans the choice of obtaining insurance through a government-sponsored plan. The other major change, with more bipartisan support, is to mandate that everyone has to obtain or purchase insurance.

Nowhere does the article, from The Associated Press, mention the universal health care systems that most of the industrial world already has. A single-payer system merely means that one program pays all bills — just like Medicare — eliminating the need for private health insurance companies. Most serious health policy experts, starting with Obama, admit that single payer would be the best system, in terms of covering everyone, controlling costs and ensuring both quality of care and freedom of choice in choosing doctors and providers. The politicians just don’t believe they can stand up to the insurance companies, so they want to hide this solution from the public debate.

Presidents Franklin Delano Roosevelt, Harry Truman, John F. Kennedy, Lyndon Johnson, Richard Nixon and Bill Clinton all tried but failed to enact some sort of universal health care. Obama’s demand that private health insurance continue to play a major role will kill universal health care once again.

In recent decades, many states have proudly announced that they have enacted “universal health care” systems. The media tends to dutifully report that these reforms are a model for the rest of the country. In a short period of time, each of these proposals — in Vermont, Massachusetts, Tennessee, Oregon, Minnesota, Florida — collapsed because costs escalated much faster than anticipated while the number of uninsured people declined much slower than expected. They failed to control costs out of a desire to avoid taking on the insurance and drug companies as well as other special interests. And the “subsidized” insurance plans they created offered inferior coverage at prices still too high for many Americans.

Obama and the rest of the Democrats seem committed to repeating these mistakes. They have pulled up chairs at the table for the insurance and drug companies to make sure they are happy with the final solution. Obama also has sought to exclude single-payer advocates.

About one in five dollars in the America economy are spent on health care — much more than the rest of the industrial countries, all of which arguably have better performing health care systems. Reforming one-fifth of the economy means that money has to be moved around. No special interest will willingly agree to a smaller share of the pie. There is where political leadership is needed.

Failure to eliminate for-profit health insurance would doom us once again to lose the struggle for universal health care. We need to define universal health care as meaning that everyone has a right to such services, period — no discussions about creating “affordable policies.” Obama needs to start listening to the American people and have the courage to stand up for real change.

Mark A. Dunlea is co-chair of Single Payer New York and executive director of the Hunger Action Network of New York State.

Paperwork, profits clog health care's efficiencies

By DEAN CALBREATH
San Diego Union Tribune
April 26, 2009

It’s been nearly three decades since White House Chief of Staff John Ehrlichman floated the idea of creating a health care system based on health maintenance organizations.

President Richard Nixon at first balked at the idea. “You know, I’m not too keen on any of these damn medical programs,” he said on June 17, 1971, as recorded by his secret White House taping system.

Ehrlichman, who would later serve jail time for his role in the Watergate affair, patiently explained that privately run HMOs could be profitable, since “all of the incentives are for less medical care. Because the less care they give, the more money they make.”

“Not bad,” Nixon replied. The next day, he proposed “a new national health strategy” based on HMOs, saying that “the purpose of this program is simply this: I want Americans to have the finest health care in the world.”

In the years since, it’s an open question whether the United States has created the world’s finest health care system, but it’s definitely the costliest. In 2006, the United States spent $6,714 per person on health care.

In comparison, Japan — which, like most other industrialized countries, offers a largely socialized health care system — spent $2,474; the United Kingdom, $2,760; Sweden, $3,202; Germany, $3,371; and France, $3,449. We devote more than 15 percent of our gross domestic product to health care, while most other industrialized countries spend less than 10 percent.

What has that bought us? There are few areas where we do noticeably better than other countries — our hospital waiting times, for instance, are shorter than in other countries, and we provide greater access to advanced technologies.

But over the past decade, the United States has consistently ranked last on patient access, safety, efficiency and equity when compared with countries such as Germany, Australia, Canada, New Zealand and the United Kingdom in a biannual survey of the Commonwealth Fund, a New York-based health advocacy group.

By a number of other measures, such as infant mortality and life span, we lag behind most industrialized nations. And we still are a nation where nearly one out of four residents is uninsured. In fact, the number of uninsured is rising each day as more employees get laid off. Every 1 percent increase in the jobless rate translates into more than 1 million people losing health coverage nationwide, according to the Kaiser Family Foundation.

Why are our health care costs so high? Why aren’t we getting broader coverage, considering the amount of money we’re putting into the system?

There are a number of reasons, ranging from our fondness for CT scans and MRIs to the high profits of the drug industry. But some critics recently have focused on two other major factors: profits — as Nixon alluded to — and paperwork.

In testimony on Capitol Hill last week, David Himmelstein, national spokesman for Physicians for a National Health Program, argued that one reason for the high cost of health care in the United States is that American hospitals and clinics spend much more money on administrative services than other countries do, partly because U.S. doctors have to devote such a large portion of their time responding to questions and challenges from insurers.

Himmelstein, an associate professor at Harvard and doctor at Cambridge Hospital, said 31 cents out of every dollar that Americans spend on health care goes for administrative expenses. That compares with less than 17 cents in neighboring Canada, which uses a single-payer system.

“If we cut our bureaucratic costs to Canadian levels, we’d save nearly $400 billion annually — more than enough to cover the uninsured and to eliminate co-payments and deductibles for all Americans,” Himmelstein told the House Subcommittee on Health, Employment, Labor and Pensions.

Jim G. Kahn, health economist at the Institute for Health Policy Studies at the University of California San Francisco, found a similar pattern during a study of California hospitals, clinics and doctors’ groups. He found the doctors’ groups were spending an average of 14 cents per dollar related to legal, accounting and processing costs involved with health insurance.

“You have to have teams of lawyers and accountants to negotiate contracts and to figure out who pays for what,” Kahn said. “You have to have whole teams in place to figure out what errors there are (in the paperwork) and how to fix them.”

Kahn said that in a single-payer system like Canada’s, the data are centralized, resulting in less time, money and effort being spent on administrative tasks. “And then you could apply that savings to provide better health coverage,” he said.

Critics of a single-payer concept worry that a government-run system would end up being too costly and too bureaucratic, without providing the benefits of innovation and cost-cutting that competition is supposed to bring. But if that were true, why does our system cost more than those abroad?

The entities that seem to benefit most from the current system are the major pharmaceuticals, which are among the nation’s most profitable companies, and the life insurers, which have also done well.

Donald Cohen, executive director of San Diego’s Center for Policy Initiatives, a liberal think tank, said the top seven for-profit health insurers made a combined $12.6 billion in 2007, an increase of more than 170 percent from 2003. Part of those profits go toward paying high salaries for the top executives. The seven chief executives received an average compensation of $14.3 million in 2007, with pay packages ranging from $3.7 million to $25.8 million.

Cohen suggested that one way of lowering costs would be to create more competition, by having a government health plan competing with the private insurers. Government-run programs, he said, typically run with low administrative expenses, often with overhead running at 1 percent to 3 percent of their expenses. In contrast, the privately run insurance firms have overhead costs as high as 20 percent, partly because of their high salaries.

As Cohen noted, conservative think tanks like the Reason Foundation, Heritage Foundation and others have argued that allowing the private sector to compete with the public sector can benefit the taxpayer. Why shouldn’t the reverse be true?

“Public-private competition in health insurance will squeeze overhead and profits from the middlemen in the system so we can put more money into actual health care,” Cohen said.

Dean Calbreath: (619) 293-1891; dean.calbreath@uniontrib.com