PNHP

Views on IRAs and HSAs contrast sharply

pnhpf3a

Views on IRAs and HSAs contrast sharply

Not the Next IRA: How Health Savings Accounts Shape Public Opinion

By Jason Barabas
Journal of Health Politics, Policy and Law
April 2009

This study has documented policy feedback effects of a personal nature. The central finding is that policy feedback effects occur, but they can be domain specific. That is, participation in investment accounts for retirement or health do not lead to uniformly conservative or liberal policy opinions. As expected, IRA owners tend to favor Social Security privatization, but that does not mean that investing always or unequivocally engenders support for investment account-based policy solutions. Participation in HSAs reduces public support for health care privatization. In particular, HSA owners, owing to their wildly different programmatic experiences, are much less likely to endorse individualized health care coverage. Thus, HSAs and related forms of consumer-driven health plans are not automatically designed to become “the next IRA.” The irony is that dissatisfaction with HSAs is greatest among those who have them.

http://jhppl.dukejournals.org/cgi/content/abstract/34/2/181

Comment:

By Don McCanne, MD

Much has already been written about the wisdom, or lack thereof, of health savings accounts (HSAs) and the high-deductible health plans that are linked with them. By design, they benefit higher-income individuals who are able to take advantage of the regressive tax policies, and who remain healthy, allowing the savings to accumulate for use in their retirement years. But they don’t work for individuals with modest incomes who have significant health care needs.

You would think that HSAs would be dismissed from the current dialogue on reform, but no. Our politicians are struggling with how to pay for comprehensive reform. One goal is to reduce spending on insurance premiums, and that makes lower-cost, high-deductible plans more attractive to those attempting to make reform cost-neutral, for the government, that is.

As Congress plays games with the budgeting of health care reform, it is imperative that they understand that the “dissatisfaction with HSAs is greatest among those who have them,” whether conservative or liberal.

It is hoped that soon Congress will give up looking for magical solutions to pay for health care for everyone, and get serious about a solution that actually would work – a single payer national health program.

Insurers waste your dollars to invade your privacy and cheat you

Insurers shun those taking certain meds

How health insurers secretly blacklist those with certain ailments.

By John Dorschner
The Miami Herald
March 28, 2009

Some insurers will automatically reject applicants who are using certain prescription drugs.

The medications, of course, are indications of specific health problems. To make sure that applicants are not lying, insurers hire a data-gathering service — Medical Information Bureau, Milliman’s Intelliscript or Ingenix Medpoint.

Intelliscript and Medpoint do computerized searches of a person’s drug use, gleaned from pharmacy benefits managers and other databases. The two companies say they comply with privacy laws. “Ingenix requires each Medpoint client to obtain the authorization of the individual applicant or insured person,” said Ingenix spokeswoman Karin Olson.

http://www.miamiherald.com/living/health/costs/story/973158.html

Comment:

By Don McCanne, MD

The health care financing systems in other nations are designed to assist patients in paying for their health care. Computerized searches of personal drug use as described in this article is yet one more example of how our private insurance industry adopts policies that are designed to avoid paying for the patients’ health care.

It is no surprise that UnitedHealth’s Ingenix is a player in this scheme to protect the insurers’ finances to the detriment of patients. They recently reached a settlement for cheating patients and physicians through another scheme to underpay for legitimate services, again protecting the insurers finances.

There are two issues here, about which we should all be concerned. First is that this is still another example of health care costs that are wasted on excessive administrative services. It is particularly egregious that these services, for which we are the payers, are detrimental rather than beneficial for the patients. That’s the opposite of what we should expect from our health care financing system.

The second concern is perhaps more ominous. Right now Congress and the administration are pushing the expansion of information technology (IT) systems when it is not at all clear that privacy and confidentiality issues are being adequately addressed. Pharmacy benefit managers (PBMs) are already using IT systems, and look at what is happening. Private insurers are doing computerized searches of your personal drug use gleaned from the PBM databases. Not only are they invading your privacy, but the intent is to defeat the purpose of insurance by denying you coverage.

Intelliscript (Milliman) and Medpoint (Ingenix/UnitedHealth) say that they comply with privacy laws, yet how many people in this gigantic private administrative bureaucracy have access to your personal information? The Fair Credit Reporting Act requires the companies to let you see your personal information if you so request, and how many more administrators are there to peek at your private records as the information is transmitted back to you? Merely passing laws against invasion of medical privacy is not enough. If invading your privacy in an IT system can be done, it will be done.

Isn’t there a theme here? We pay a whole lot of extra money to a private health care financing industry that uses our funds to cheat us out of the health care that we should have. And Congress and the administration are calling for an expansion of this very sick system of financing health care?

Congress should have the common sense, integrity, and decency to jettison the private insurance industry and provide us with our own public health care financing system that would save us money so it could be used where we want it to be used – on our health care. What is so difficult about this concept?

The way forward on health care reform

By CORNELIUS HOGAN
Rutland Herald
Published: March 25, 2009

President Obama and Budget Director Peter Orzag are “on the money” in their views about controlling the cost of health care as the key to future health care access and quality, plus the role that controlling health care costs plays in our economic recovery. Without controlling cost, all changes and initiatives currently in motion and contemplated will not work and will quickly make things worse.

For example, in the two states of Massachusetts and Vermont, which were highlighted at the president’s health care forum at the University of Vermont on March 17, well-meaning programs and actions taken to date, are doomed to failure because they do not begin to address the cost issue.

In Vermont subsidizing health care has perhaps helped a very few people, but it is fiscally unsustainable in an environment where the cost of health care is rising at two to three times inflation. Nor will “disease management,” although good public policy, have an impact on controlling health care cost within our lifetime.

In Massachusetts, if it were not for the temporary and major largesse of the federal government, the mandate program would be dead in its tracks.

Both of these experiments, even though positioned as paradigms of progress, don’t come close to being remotely sustainable.

If we are to have even a chance at controlling the overall cost of health care, we need to put in place several basic practices, which at this point are not in evidence, or even being contemplated. They are: an integrated, enforceable budget (what other human enterprise doesn’t have one?); fair financing where we all contribute and all are in; health care planning based on the need of the population; and elimination of unnecessary and costly utilization review, benefit review, eligibility review, advertising, and the gross transaction costs of billing, collecting, generally chasing the money, much of it from people who cannot afford it.

Actions short of these will continue to promote uncontrolled cost rises (health care costs have doubled over the last eight years) which will result, at some point in the near future, in a collapse of our hospitals, physician practices, and other vital health care services. It will also result in pricing tens of thousands more Vermonters out of care. Federal bailouts won’t last forever.

Let us help our president control these costs. Put some bigger options, such as Medicare for all, hospital benefit for all, or even single-payer on the table. These broad-based approaches are our only chance at up-righting health care, which is now ever ripe for a collapse.

Cornelius Hogan was secretary of human services under Govs. Richard Snelling and Howard Dean. He was coauthor of “At the Crossroads: The Future of Health Care in Vermont.”

Faith groups: health care is a moral right

Albany, N.Y., forum shows support for single payer

By Single Payer New York

ALBANY, N.Y. — The Presbyterian Church joined today with local community, labor and medical groups to sponsor a Congressional Town Hall forum in support of a single-payer health care system that would provide health care to all Americans regardless of the economic or employment status. The forum drew about 300 people who jammed the Westminster Presbyterian Church.

The keynote speaker was Rep. John Conyers (D-Mich.), the lead sponsor of H.R. 676, the U.S. National Health Care Act, also titled Expanded and Improved Medicare for All. Joining Conyers on the platform was Rep. Paul Tonko (D-N.Y.).

Conyers’ bill, which would replace private health insurance with a single public financing system to provide comprehensive coverage for everyone in the nation, has the most support of any universal health care proposal now in Congress. It also is the plan that is most favored by the American public, doctors, nurses and researchers
Conyers participated in the recent White House Summit on Health Care Reform to advocate for single-payer health care.

“Serious reform of the health care system is the first step towards economic recovery,” Conyers told the assembly. “I am pleased to take part in this critical discussion on health care reform with the president, medical professionals, healthcare scholars, patients’ advocates and labor leaders. Those who have been working so tenaciously for single-payer reform to our health care system will finally have their voices heard. Our goal: quality health care for all.”

Single-payer legislation is also pending in both houses of the New York State Legislature and a state study on various universal health care options is due shortly after the budget is released. A majority of Assembly members and a majority of Democratic state senators have sponsored single-payer legislation; Gov. David Paterson was a sponsor as a member of the state Senate. A state-funded study on various universal health care options is due shortly after the budget is released.

The Town Hall Meeting, sponsored by the Albany Presbytery, is one of 10 nationwide meetings funded by the Presbyterian Church USA to open discussion of single-payer health care for the United States. A major focus of the event was the moral right of all Americans to have health care. Faith representatives include Rev. Cass Shaw, the General Presbyter of the Albany Presbytery; Chandlee Gill of the Albany Presbytery; Dr. Richard Propp of the B’nai Sholom Reform Congregation (Albany) and Yussouf Mir of the Islamic Center of the Capital District.

Co-sponsors of the event included the Albany Presbytery, Capital Area Council of Churches, Interdenominational Ministers Conference, Fifth Avenue AME Zion Church of Troy, Labor Religion Coalition of N.Y. State, Single Payer New York, Capital District Area Labor Federation, Capital District Alliance for Universal Health Care, Solidarity Committee of Program (PNHP) Capital District Chapter, Albany Medical College Student PNHP Chapter, Hunger Action Network of NYS and Faith and Hunger Network.

The groups urged President Obama and Congress to reject a Massachusetts-style plan that mandates that individuals purchase health insurance.

“America deserves the health benefits offered to the people of every other country in the industrialized world, all medically necessary care and freedom from the fear of economic ruin due to illness,” said Mike Keenan, president of the Troy Area Labor Council. “The bottom line is that single payer is the one proposal that guarantees quality, affordable health care to every American. This would also be a great benefit to our economy in our time of crisis, helping to control costs for taxpayers, consumers and employers.”

Single payer merely means that one program pays all bills, like Medicare does for senior citizens. It eliminates the paperwork, high administrative costs and profits of the for profit private insurance system. An article in the New England Journal of Medicine concluded the single-payer approach would save $350 billion a year in costs; somewhat smaller savings estimates have been made by the Congressional Budget Office. A study done for the state of California estimated that a state single-payer plan would reduce health costs by $38 billion annually over a 10-year period.

President Obama has also been a supporter of single payer health care in the past and acknowledged its benefits during his election campaign. While he said recently that he would enact single payer if he were “starting from scratch,” he has so far failed to put the issue on the table as part of his forums on health care.

The federal single payer bill (H.R. 676) has gained the support of 94 representatives in the last session of the U.S. House, 480 union bodies, 39 state AFL-CIOs (including New York’s), 117 central labor councils, 20 international unions, the U.S. Conference of Mayors, the Houses of Representatives in Kentucky, New Hampshire and N.Y. (State Assembly), and hundreds more cities, counties, faith groups and organizations. Rep. Tonko is a sponsor in the new session. (Seventy-two sponsors have co-sponsored in Congress this session, with more being added every week. New York sponsors so far include Reps. Clarke, Engel, Hinchey, Maloney, Massa, Meeks, Nadler, Tonko and Velazquez.)

A recent national survey by Indiana University of 2,193 doctors found almost 60 percent in favor of national health insurance (NHI) — a 10 percent increase in support since 2002. A March 2007 poll by CBS/ N.Y. Times found that 64 percent of respondents said the government should guarantee health insurance for all; 27 percent said it should not. An overwhelming majority in the poll said the health care system needed fundamental change or total reorganization.

“America’s health care system is in deep trouble,” said Mark Dunlea, executive director of the Hunger Action Network of NYS. “Nearly 50 million Americans are currently without health insurance, more than 75 million went without insurance for some length of time within the past two years, and tens of millions more have inadequate coverage. More than 18,000 Americans die annually due to a lack of insurance.”

A 2008 study published in the journal Health Affairs concluded that as many as 101,000 deaths a year could be prevented by ensuring that all patients receive quality care in a timely manner.

The United States spends 16 percent of gross domestic product on health care ($7,129 per capita), twice what any other industrialized nation spends, yet ranks 37th in performance according to the World Health Organization. We lag behind other industrialized countries in life expectancy and infant mortality. Health care bills cause over 50 percent of bankruptcies and three out of four of those bankrupted by medical bills had health insurance.

The reason the U.S. spends more and gets less than the rest of the world is because we have a patchwork system of for-profit payers. Private insurers necessarily waste health dollars on things that have nothing to do with care: overhead, underwriting, billing, sales and marketing departments as well as huge profits and exorbitant executive pay. Doctors and hospitals must maintain costly administrative staffs to deal with the bureaucracy. Combined, this needless administration consumes about one-third (31 percent) of Americans’ health dollars.

The groups urged President Obama to reject the idea of mandating that individuals purchase insurance. The recent insurance mandate in Massachusetts is already running into problems due to higher taxpayer costs than anticipated; inadequate coverage being offered; and many residents deciding to pay the penalty rather than buying insurance they can’t afford.

“We’ve done many experiments tweaking private health insurance,” said Dr. Paul Sorum, chairperson of the Capital District chapter of the Physicians for a National Health Program. “It doesn’t work. Two decades of state-level reform efforts have demonstrated that mandate plans don’t reduce costs or the number of uninsured. They add bureaucracy and regulation, not health care value.

“We’ve also done an experiment with national health insurance,” he said. “It works. Medicare is not perfect, but Americans with Medicare are happier with their insurance than those with private insurance. Doctors have less hassle getting paid by Medicare than by private insurers.”

Variants of the mandate model, first proposed by Richard Nixon, were passed with great fanfare in Massachusetts (1988), Oregon (1989) and Washington State (1993). All failed. As costs soared, legislators backed off from enforcing the mandates or funding new coverage for the poor. Massachusetts’ recent reform, which largely excuses employers from the mandate but imposes steep fines on the uninsured, appears poised to follow a similar path. Of the middle-income uninsured that are required to pay the full premium for coverage, few have signed up. Meanwhile, the state has already announced a $147 million shortfall in funding for subsidies for the poor.

Dr. Richard Propp, chair of the Capital District Alliance for Universal Health Care, said: “We can’t afford to include bloated administrative overhead and profit in universal coverage. Administrative costs in the for-profit health insurance system consume nearly one-third of our health care spending. We will never have enough money to provide everyone with decent care until we eliminate private insurance, the main source of waste and inadequate coverage.

Propp continued: “Single payer reduces administrative costs and provides an infrastructure to supports chronic disease management, an emphasis on primary care and the use of electronic medical records. The fragmented private insurance system created the perverse incentives that have set us so far behind other countries in these areas. Mandate proposals preserve the fragmentation.”

Under a single-payer system, all Americans would be covered for all medically necessary services, including: doctor, hospital, long-term care, mental health, dental, vision, prescription drug and medical supply costs. Patients would regain free choice of doctor and hospital, and doctors would regain autonomy over patient care.

Physicians would be paid fee-for-service according to a negotiated formulary or receive salary from a hospital or nonprofit HMO/group practice. Hospitals would receive a global budget for operating expenses. Health facilities and expensive equipment purchases would be managed by regional health planning boards.

A single-payer system would be financed by eliminating private insurers and recapturing their administrative waste. Modest new taxes would replace premiums and out-of-pocket payments currently paid by individuals and business. Costs would be controlled through negotiated fees, global budgeting and bulk purchasing.

Photos from the event at http://picasaweb.google.com/jonflan/SinglePayerTownHallWithJohnConyers#

Single Payer New York: http://www.singlepayernewyork.org/

A supplementary note from Mark Dunlea:

After the event, the speaker receiving was the most praise was Dr. Andy Coates of Physicians for a National Health Program, who explained single payer and its importance at the moment.

Forum participants wrote several hundred letters to their elected officials after the meeting adjourned.

Rep. Conyers also spoke about single-payer care to 100 people at a fundraiser for Rep. Tonko and had a meeting after his talk at the church with 15 local African American leaders, who asked him to come back in a few months for an event they will organize.

STAKEHOLDERS AGREE! (to block reform)

Health Reform Dialogue

March 27, 2009

A Time for Reform:

…several widely diverse, national organizations began a series of unique discussions six months ago to exchange ideas and see where their agreements and differences lay.

This health reform dialogue was never intended to cover every issue likely to arise as health reform is considered in the ensuing months. Some issues currently elude consensus.

Increasing coverage and access:

Regarding coverage, reform should build upon the key pillars of health care coverage today — employer-sponsored insurance and public safety-net programs for low-income people and families.

* Improve Medicaid and Children’s Health Insurance Program (CHIP) outreach and enrollment.

* Establish a nationwide floor for Medicaid eligibility for all adults no lower than 100 percent of the federal poverty level.

* Give individuals eligible for Medicaid and CHIP the option to utilize those dollars to purchase employer-sponsored insurance…

* Provide advanceable, refundable tax credits or other subsidies on a sliding scale for individuals and families to purchase adequate and affordable coverage…

* Provide subsidies for small businesses to provide health insurance for their employees.

* Enact reforms necessary so that all individuals will purchase or obtain quality, affordable health insurance.

Strengthening wellness and prevention:

The Centers for Disease Control and Prevention estimate that eliminating three risk factors — poor diet, inactivity, and tobacco use — would prevent 80 percent of heart disease and stroke, 80 percent of Type 2 diabetes, and 40 percent of cancer.

* Identify effective clinical preventive services.

* Encourage clinicians and providers to deliver effective clinical preventive services and follow-up treatment, as indicated.

* Ensure a sufficient primary care workforce through an ongoing, dynamic, national planning and development process.

* Continue to invest in health information technology (HIT) that supports wellness and prevention, both on the individual and community levels.

* Further encourage businesses to support healthy behaviors.

* Encourage communities to be healthy.

* Eliminate disparities in health.

* Help individuals improve their health.

Ensuring quality and value:

* Conduct comparative clinical effectiveness research (CER) studies via a public-private partnership to provide additional information that can help improve care decisions.

* Expand and accelerate the development of meaningful quality measures.

* Fund state demonstrations of alternative medical liability reform models.

* Improve billing efficiencies to reduce confusion and duplication for patients, clinicians, and providers.

* Reduce administrative costs.

* Work to reduce geographic, racial, ethnic, and gender disparities in health care delivery.

* Ensure an adequate health care delivery workforce, including funding for training and loan forgiveness programs and payment reforms directed at primary care, public health and nursing, and other high-priority areas facing imminent shortages.

Context for Financing Health Care:

* Cost efficiencies can be gained by improving health care delivery.

* Methodologies for quantifying long-term cost savings can be improved.

* To jumpstart health reform, additional investments in U.S. health care will be needed.

Enacting meaningful health reform requires a careful and balanced approach of fiscal prudence, accompanied by efforts to contain costs, increase savings, and enhance efficiencies. Such investments will enable transformational changes to be achieved — and those transformational changes will ultimately place the United States on a path toward greater financial and health care security.

Organizations endorsing this document include:

AARP
Advanced Medical Technology Association
America’s Health Insurance Plans
American Cancer Society Cancer Action Network
American College of Physicians
American Hospital Association
American Medical Association
American Nurses Association
American Public Health Association
Blue Cross and Blue Shield Association
Business Roundtable
Catholic Health Association of the United States
Families USA
Federation of American Hospitals
Healthcare Leadership Council
National Federation of Independent Business
Pharmaceutical Research and Manufacturers of America
U.S. Chamber of Commerce

http://www.advamed.org/NR/rdonlyres/42134469-D897-4AE8-B48E-DBB46B84255F/0/HRDCommonGroundFINALEMBARGOED32709.pdf

Comment:

By Don McCanne, MD

This report, “Health Reform Dialogue,” contains a few modest but obvious recommendations that any reasonable reform effort must include. Much more important is that the primary theme of this report, as exemplified by the sampling of recommendations listed above, is that we should continue with the status quo, dumping more of our dollars into our dysfunctional, wasteful, inefficient, fragmented system of financing health care.

So why should we pay any attention at all to this worthless contribution to the national dialogue on health care reform? It is because it exposes the blatant lie that we are close to agreeing on reform that would bring affordable, high quality care to all residents of the United States.

This highly touted, closed door process has been taking place over the past half year. Theoretically all important stakeholders were included (except patients). They agreed that we have finally come to the time that reform is an absolute imperative. Through intensive negotiations behind closed doors in a (symbolically) smoke-filled room, they finally agreed… that smoking is bad for your health (and a couple of other points of less significance).

There is absolutely no mention of a single payer national health program, or Medicare for All. That option was discarded before anyone walked into the room.

The compromise position to which the progressives had agreed would be to offer a public, Medicare-like insurance program to compete in the market of private plans. “Health Reform Dialogue” remains silent on such an option.

In a decision to exclude the progressive community from playing any serious role in reform, moderates are now proposing a government-sponsored, managed care PPO program, insulated by a double firewall from the government, so that it must compete on a “fair playing field” with the private plans. “Health Reform Dialogue” even remains silent on the possibility of offering a government PPO that would be required to include the same perverse policies that are inherent features of the private health plan models.

Look again at the organizations that signed on to this report. Two organizations that participated in the process are conspicuously absent: American Federation of State, County and Municipal Employees (AFSCME) and the Service Employees International Union (SEIU). At the end of this process, they refused to sign on to a document that would have even less impact than a no smoking pledge.

Look again at the list and decide which organizations actually controlled the process. Yes, those are the same organizations that have an ownership position in the Congress of the United States.

Unless Americans are ready to march on Washington, both literally and figuratively, the reform process is dead. Yes, dead!

Focus health care money on care

Albany Times Union
Letter to the Editor
Friday, March 27, 2009

A close reading of Harry Rosenfeld’s thoughtful March 1 column, “Health care still Gordian knot,” reveals an intriguing framing of the single-payer option.

Despite “opponent criticism” that single payer denies physician and hospital choice, the factual record for traditional single-payer Medicare is that it does indeed preserve choice of physicians and hospitals.

Privatized Medicare Advantage plans, however, as in Medicare part D, and HMO plans, do ration doctor, hospital and pharmaceutical choice to maximize profits.

A taxpayers’ subsidy adds to profits. The 45 million uninsured have complete rationing.

Single-payer guaranteed health care for all, as in HR676, with an overhead of 4 percent, deserves equal consideration in all hearings and negotiations. Let there be honest comparisons with subsidized incremental private health insurance proposals, with their overheads of 15 to 25 percent and uncontrolled premium increases, totaling 100 percent in the last decade.

There is plenty of money in the system to cover all if it was spent on health care and not administration.

We were told by the Obama campaign that “while the insurance companies would be at the (negotiating) table, they would not own the table.” Millions of American voters are actively calling for that to be true.

Richard Propp, M.D.
Capital District Alliance for Universal Healthcare
Albany

Sen. Bernie Sanders introduces single payer bill

Single-payer health reform bill introduced in Senate

PNHP
Press release
March 26, 2009

Challenging head-on the powerful private insurance and pharmaceutical industries, Vermont’s Sen. Bernie Sanders introduced a single-payer health reform bill, the American Health Security Act of 2009, in the U.S. Senate Wednesday.

The single-payer approach embodied in Sanders’ new bill stands in sharp contrast to the reform models being offered by the White House and by key lawmakers like Senators Max Baucus (D-Mont.) and Edward Kennedy (D-Mass.). Their plans would preserve a central role for the private insurance industry, sacrificing both universal coverage and cost containment during the worst economic crisis since the Depression.

In contrast, Sanders’ new legislation would cover all of the 46 million Americans who currently lack coverage and improve benefits for all Americans by eliminating co-pays and deductibles and restoring free choice of physician. The most fiscally conservative option for reform, single payer slashes private insurance overhead and bureaucracy in medical settings, saving over $400 billion annually that can be redirected into clinical care.

Highlights of the bill include the following:

* Patients go to any doctor or hospital of their choice.

* The program is paid for by combining current sources of government health spending into a single fund with modest new taxes amounting to less than what people now pay for insurance premiums and out-of-pocket expenses.

* Comprehensive benefits, including coverage for dental, mental health, and prescription drugs.

* While federally funded, the program is to be administered by the states.

* By eliminating the high overhead and profits of the private, investor-owned insurance industry, along with the burdensome paperwork imposed on physicians, hospitals and other providers, the plan saves at least $400 billion annually – enough money to provide comprehensive, quality care to all.

* Community health centers are fully funded, giving the 60 million Americans now living in rural and underserved areas access to care.

* To address the critical shortage of primary care physicians and dentists, the bill provides resources for the National Health Service Corps to train an additional 24,000 health professionals.

Sanders, who serves on the Senate Committee on Health, Education, Labor, and Pensions, is a longtime advocate of fundamental health care reform. His new bill draws heavily upon the single-payer legislation introduced by the late Sen. Paul Wellstone (D-Minn.) in 1993, S. 491, and closely parallels similar legislation pending before the House, H.R. 1200, introduced by Rep. Jim McDermott (D-Wash.).

https://pnhp.org/news/2009/march/singlepayer_health_.php

S.703 – American Health Security Act of 2009 – full text:
https://pnhp.org/PDF_files/American-Health-Security-Act-single-payer.pdf

Thomas (S.703 is listed but the text has not yet been received from GPO):
http://thomas.loc.gov/

Comment:

By Don McCanne, MD

At a rare time in our history when comprehensive reform may become a reality, it is important that the single payer model be represented in the legislative process. The House already has Rep. John Conyers’ H.R.676 and Rep. Jim McDermott’s H.R.1200, and now the Senate has Sen. Bernie Sanders’ S.703.

S.703 is very similar to H.R.1200, with two important additions regarding budgeting. Specified funds are budgeted for community health centers, and other specified funds are budgeted for the support of the National Health Service Corps, health professions education, and nursing education, including education of clinical nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, and physician assistants.

These additions in budgeting are not simple tweaks to the bill. They provide a remedy for both the deterioration in our primary care infrastructure and the impaired access to care in underserved regions. There is an urgent need to provide the professionals and the facilities that can help fill the most serious voids in our health care delivery system today.

S.703 has been referred to the Senate Finance Committee, chaired by Sen. Max Baucus, who is determined to join with Senators Ted Kennedy, Charles Grassley and Mike Enzi to enact reform this year. Sen. Sanders will have some input as a member of the Budget Committee and a member of Sen. Kennedy’s HELP Committee.

What happens now? Will Senators Baucus and Kennedy take a fresh look at single payer as a model that addresses many of the policy problems that they currently face with their model based on private plans? Or will they accept Sen. Sanders’ contribution emphasizing the importance of health centers and primary care professionals? Or will they look at his budgeted numbers and decide that they can’t add those to the deficits they already face with their unnecessarily over-priced model of reform? Will they simply say that they’ll have to deal with that later, after they fix the insurance problem (the later that never comes)?

It’s great that there is a single payer bill in the Senate, but now is not the time to sit back and watch the process unfold. We certainly support the emphasis on improving primary care access, but we need to support that within a financing framework that will make it happen – a single payer national health program.

Congressmen will talk about health reform

By Cathleen F. Crowley
Albany Times Union
March 26, 2009

As the nation grapples with improving the health care system and making it more affordable, a contingent of people believe the answer is a single-payer system.

But advocates worry that their idea is being sidelined.

Representatives of the single-payer movement were initially locked-out of health care summit called by President Barack Obama earlier this month — until supporters raised a ruckus.

“I think mainstream wisdom in Washington is reform that is not built on the private health insurance industry will not pass,” said Dr. Andrew Coates, an Albany doctor who is secretary of the Capital District Chapter of Physicians for a National Health Plan. “They do not want a knock-down, drag-out fight.”

Under a single-payer system, private doctors and hospitals deliver health care but the bill is paid by the government. It’s also known as “Medicare for all.”

Single-payer advocates will host a forum on Sunday at the Westminster Presbyterian Church to explain the system to people who are not familiar with it. U.S. Rep. John Conyers Jr. of Michigan, who has proposed a single-payer bill in Congress, will speak along with U.S. Rep. Paul Tonko, of Amsterdam, who signed on as a co-sponsor to his fellow Democrat’s bill.

Conyers, who eventually attended Obama’s health summit, said he presumes the late invitation was due to the administration’s reluctance to give his bill prominence.

A single-payer system would eliminate the need for private health insurance and potentially wipe out the industry.

“The insurance lobby is the one that has kept us from a single-payer system for the last three or four generations,” Conyers said in a telephone interview.

The Presbyterian Church USA has decided that a single-payer system is the best option for health reform, and is hosting 10 forums around the country to educate people about it.

Single-payer “streamlines what is the biggest waste in the system, which is the incredible (duplication) of effort and time doctors and practitioners spend just following the paper trail,” said the Rev. Cass Shaw.

Shaw is leader of the Albany Presbytery, which represents 73 congregations and 8,000 Presbyterians in the Capital Region.

In addition to the congressmen, the forum will have a panel of faith leaders from churches, mosques and synagogues in the area.

“For us, it’s a religious issue as well as a civic issue,” Shaw said.

Sunday’s free forum will be from 2 to 4:30 p.m. at Westminster Presbyterian Church, 262 State St., Albany. Call 434-7371 for more information.

Change we can believe in: Americans need single payer now

by Claudia Chaufan
www.opednews.com
March 27, 2009

As president Obama recently acknowledged, the need to reform health care is no longer an issue. Indeed, on March 5th the White House convened a Health Care Summit, that so far have been followed by Regional Forums in Michigan on March 12, in Vermont on March 17, in Iowa on March 23rd, and upcoming ones in North Carolina on March 31st and in our state, in Los Angeles on April 6th.

But the question remains: what sort of health care reform will serve our needs so that we do not find ourselves having this conversation again ten or twenty years down the road? After all, back in 1973 we also “hoped” that the HMO Act introduced that year by President Nixon would resolve the problem of rising costs and of an increasing number of individuals unable to protect themselves from the financial burden of disease.

Yet we are no better today than we were back then. And we will not be better tomorrow unless we get things right. Which is why I want to argue that, special interest groups aside, from a strictly policy perspective neither the State of California nor the nation as a whole can afford not to choose single payer. It is no longer just the moral problem of millions of uninsured, underinsured, or the thousands dead for lack of health insurance — and we will keep counting the bodies unless we get things right — but also the severe economic problem that is eroding the fiscal health of our state and of our nation.

Let me illustrate my claim with the example of our state. As both Democrats and Republicans in Sacramento are well aware, the State of California spends a great deal on health care, to fund public programs and insure state employees and their families, including retirees. Just recently, it was reported that retiree health care costs for our state will exceed 50 billion dollars this year. From the point of view of the current budget this is unaffordable. And even if it were affordable this year, unfortunately for the California General Fund the revenue that purchases that care keeps growing at a rate roughly equal to that of the economy, yet costs of health care are growing four times faster. This means that unless costs are controlled, the state will be forced to continue cutting benefits, reimbursement rates, or enrollment — most likely all of these.

And here is where single payer becomes critical: it is the only well tested financing mechanism, internationally, and nationally, that can bring costs of health care down, because it is the only one which embodies two demonstrable policy principles critical to cost control.

The first, risk pooling, simply means putting all those who will be insured into large pools, preferably a single one, which is precisely what single payer does. Risk pooling is critical to cost control for several reasons: the most obvious one is that it allows the system to purchase on behalf of a large number of people, an extremely powerful, and well documented, cost-cutting strategy in health care. For instance, while people in Spain, that has a single payer system, pay 9 dollars for Lanzoprasol, a widely used drug to reduce acidity, people in Maryland, U.S., with its public-private financing system, pay $329 for the same dose of the same product.

Risk pooling also cuts costs by reducing administrative waste, because it eliminates useless paper pushing, which results from marketing multiple plans or underwriting policies for different categories of people and eats up no less than 30 cents of each health care dollar. While this administrative overhead is not “waste” for private for profit insurers — indeed, their very survival depends on being able to separate “good” from “bad” customers to meet their first and foremost responsibilities with shareholders — from the perspective of a high-performing health care system this overhead stands in the way of meeting the very goal of the system: eliminating financial barriers to medically necessary care. Attempting to regulate these solidly engrained business practices among experience-rating private insurers, as some have suggested, would not only be largely futile — it has been tried repeatedly, and has failed — but also extraordinarily expensive.

Last yet not least, risk pooling allows for cross-subsidizing, which means that at any given moment the least costly majority, roughly 80%, subsidizes the most costly minority, roughly 20%. We do not know who will be in that minority at any given moment, but we know that the division between those who need more or expensive care and those who need less or less costly care gravitates towards those proportions, which is why cross-subsidizing is critical to the system being not only financially sustainable as a system but also affordable to individuals and families participating in the system when they most need it, that is, when they need medical care.

Cross-subsidizing is also critical to minimizing the need for programs of subsidies for “special categories” — the too sick, too old or too poor or “not poor but not rich enough to shop alone in the private market” — which are ultimately paid by taxpayers, whether or not they qualify for those subsidies or programs.

The second principle, compulsory cooperative financing, simply means that playing is not optional — everybody must. And because playing is not optional, single payer meets the criterion of shared responsibility, very popular among health policy experts these days. Yet because of the cooperative dimension, people are not expected to pay more than what they can afford, so contributions are a proportion of income and unrelated to health status. This way, individuals and families can always predict and afford their part.

And by combining public financing with private delivery, cooperative compulsory financing, the single payer version of shared responsibility, has the added advantage of being the sort of public-private partnership that gives people meaningful choices, not of undecipherable policies with obscure restrictions, including restricted lists of “preferred providers”, but choices of services they need and providers they prefer, who are given the healthy incentive to compete for patients by providing good services.

Now, some argue that Americans need to embrace the principle of “shared responsibility” — incidentally, hardly a meaningful policy concept. At any rate, what could be more “shared responsibility” than single payer, while still being economically sound? With single payer, playing is not optional, yet the rules of the game are fair and sustainable, because contributions are a predictable proportion of income that individuals and families can surely afford. And the advantage of the single-payer version of shared responsibility is that by combining public financing with private delivery, single payer is the public-private partnership that gives people meaningful choices, not of undecipherable policies that let us down when we get sick, or that constrain health care consumers to lists of “preferred providers”, but choices of services we need and providers we prefer.

Meaningful choices also encourage the competition that matters: among providers of services who try to excel to attract patients, not among insurers for “good customers”, those who happen to be more profitable and need health care the least.

More recently, many have praised the individual-mandate, Massachusetts style. Yet I would invite those who support this model to ponder over the critical distinction between coverage and care: it is well-established in the health policy community that much of the coverage available to Massachusetts residents, even if affordable, hardly qualifies as insurance, because it does little to eliminate financial barriers to care. In fact, the courts have ruled that several thousand residents were to be allowed to remain uninsured, i.e., exempted from buying policies that were
affordable, but useless. And the program overall is also proving fiscally unsustainable.

And to those who argue for a “public option” — one that, interestingly, private insurers, self-proclaimed lovers of “free market competition” are fighting to the death on the grounds that competing with a public plan would be “unfair” — let me remind them that this option has tended to fall under the burden of “adverse risk selection” — yet another well studied problem of mixed-financing systems. What this means is that the public plan, sooner or later, ends up with all the “bad customers” — the too old, too sick or too poor — that the private insurers have succeeding in avoiding for the last several decades, and will continue to avoid. We really have no good reason to believe that the outcomes will be different this time, which is why the rest of the international community –Canada, all European nations, Australia, Japan, and more recently, Taiwan — has long opted for social insurance, of which the single payer model is the strongest type in terms of cost control.

For all these reasons, if the goal of health care reform in California and in our nation is to control costs, while guaranteeing a medically necessary amount of health care universally, single payer, SB810 in California and HR 676 at the federal level, is not only the best but really the only way to go, and the time to go for it is now, both for our children’s sake, and for the viability of our economy.

Himmelstein and Woolhandler on a public plan option

Public Plan Option in a Market of Private Plans

By David Himmelstein, M.D. and Steffie Woolhandler, M.D., M.P.H.:

The “public plan option” won’t work to fix the health care system for two reasons.

1. It forgoes at least 84 percent of the administrative savings available through single payer. The public plan option would do nothing to streamline the administrative tasks (and costs) of hospitals, physicians offices, and nursing homes, which would still contend with multiple payers, and hence still need the complex cost tracking and billing apparatus that drives administrative costs. These unnecessary provider administrative costs account for the vast majority of bureaucratic waste. Hence, even if 95 percent of Americans who are currently privately insured were to join the public plan (and it had overhead costs at current Medicare levels), the savings on insurance overhead would amount to only 16 percent of the roughly $400 billion annually achievable through single payer — not enough to make reform affordable.

2. 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 the single payer for seniors and has now become a funding mechanism for HMOs — and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public plan.

www.pnhp.org

Comment:

By Don McCanne, MD

The option to purchase a public plan within a market of private health insurance plans would merely provide one more player in our inefficient, dysfunctional, fragmented, multi-payer system of financing health care, that is if the public option even survives the political process. It would leave in place the deficiencies that have resulted in very high costs with the poorest health care value of all nations (i.e., overpriced mediocrity in health care).

Those who believe that the people of this nation would have the wisdom to drop their private plans and join the government program are ignoring history. When Congress authorized private plans to compete with our existing public program, Medicare, many enrollees did just the opposite. One-fifth have left the traditional Medicare program and joined the private plans.

So why should we care? Why shouldn’t they have the right to choose private plans if they want them? We know that those private plans are wasting money, both in their own costs and the administrative burden they place on the delivery system, but what all too many don’t realize is that we are all paying for that waste because of the inherent structural deficiencies in our financing system. Plus we are being deprived of the reforms needed in our health care delivery system that our own single payer monopsony would bring us.

Single payer activists, don’t give up. As President Obama said in his press conference this week, “persistence!”

Media Advisory: Single-payer supporters to rally at March 31 health forum in Greensboro

Physicians, nurses and health reform advocates to urge enactment of an improved 'Medicare for All,' decry outsized influence of corporate medicine at regional meeting

FOR IMMEDIATE RELEASE
March 26, 2009

Contacts:
Jonathan Kotch, M.D.
Mark Almberg, PNHP, (312) 782-6006, cell: (312) 622-0996, mark@pnhp.org

What

Press conference and rally to express support for single-payer national health insurance and to protest the “marginalization of majority opinion” at Tuesday’s White House Forum on Health Care Reform at the North Carolina A&T Alumni Foundation Event Center in Greensboro, at 9 a.m. EDT.

The health forum will be hosted by North Carolina Gov. Bev Perdue. Senior White House policy officials will participate and help moderate a discussion involving diverse stakeholders in health care reform, according to Perdue’s office.

Advocates of single-payer national health insurance, sometimes called an improved “Medicare for All,” will be inside and outside, urging that single payer be “on the table” as a full-fledged option for reform. They will also decry the outsized role of the private health insurance industry, Big Pharma, and other representatives of corporate medicine at the forum.

Physicians wearing their white coats and other health reform advocates will assert that national health insurance is being accorded a minor, marginalized role at the forum, even though surveys show two-thirds of Americans and 59 percent of U.S. physicians support it.

They will demand that the single-payer model be given pride of place in the health care debate in view of that model’s effectiveness in providing truly universal, comprehensive care; its ability to contain costs; and the fact that the annual savings in administrative costs — $400 billion — would mean that a U.S. single-payer system would require no increase in overall health spending.

The pro-single-payer rally is co-sponsored by Health Care for All NC, the state chapter of Physicians for a National Health Program (PNHP); Progressive Democrats of America and its local coalition partner, Progressive Democrats of North Carolina; and Healthcare-Now, a national grassroots coalition for single-payer health reform.

Dr. Jonathan Kotch said today: “The single-payer alternative to industry-driven proposals has been systematically ignored until PNHP and others took their message to the streets. It is only through direct action that the political and financial power of insurance, pharmaceutical and for-profit medical interests can be challenged. The majority of the people want single payer, and our message to the White House is, pay attention.”

Who

Jonathan Kotch, M.D., professor of maternal and child health, University of North Carolina at Chapel Hill
Miriam Thompson, M.S.W., Health Care for All – North Carolina
Carol Shores, M.D., an ear, nose and throat specialist in Chapel Hill

When

9 a.m. EDT, Tuesday, March 31

Where

North Carolina A&T Alumni Foundation Event Center, 200 N. Benbow Rd., Greensboro, N.C.

###

Physicians for a National Health Program (www.pnhp.org), a membership organization of over 16,000 physicians, supports a single-payer national health insurance program. PNHP is headquartered in Chicago and has chapters across the United States. To contact a physician-spokesperson in your area, contact info@pnhp.org or call (312) 782-6006.

Press Release: Single-payer health reform bill introduced in Senate

Would save $400 billion on bureaucracy, enough to cover all 46 million uninsured Americans

FOR IMMEDIATE RELEASE
March 26, 2009

Contacts:
Quentin Young, M.D., (312) 782-6006
Mark Almberg, (312) 782-6006, cell: (312) 622-0996, mark@pnhp.org

Challenging head-on the powerful private insurance and pharmaceutical industries, Vermont’s Sen. Bernie Sanders introduced a single-payer health reform bill, the American Health Security Act of 2009, S. 703, in the U.S. Senate Wednesday. The bill is the first to directly take on the powerful lobbies blocking universal health reform in the Senate since Sen. Paul Wellstone’s tragic death.

The single-payer approach embodied in Sanders’ new bill stands in sharp contrast to the reform models being offered by the White House and by key lawmakers like Senators Max Baucus (D-Mont.) and Edward Kennedy (D-Mass.). Their plans would preserve a central role for the private insurance industry, sacrificing both universal coverage and cost containment during the worst economic crisis since the Depression.

In contrast, Sanders’ new legislation would cover all of the 46 million Americans who currently lack coverage and improve benefits for all Americans by eliminating co-pays and deductibles and restoring free choice of physician. The most fiscally conservative option for reform, single payer slashes private insurance overhead and bureaucracy in medical settings, saving over $400 billion annually that can be redirected into clinical care.

“This is excellent news for the nation’s health,” said Dr. Quentin Young, national coordinator of Physicians for a National Health Program and a past president of the American Public Health Association. “There is now an affordable cure for our dysfunctional health care system. In the face of our present economic calamity, this is an urgent necessity.”

Highlights of the bill include the following:

* Patients go to any doctor or hospital of their choice.

* The program is paid for by combining current sources of government health spending into a single fund with modest new taxes amounting to less than what people now pay for insurance premiums and out-of-pocket expenses.

* Comprehensive benefits, including coverage for dental, mental health, and prescription drugs.

* While federally funded, the program is to be administered by the states.

* By eliminating the high overhead and profits of the private, investor-owned insurance industry, along with the burdensome paperwork imposed on physicians, hospitals and other providers, the plan saves at least $400 billion annually – enough money to provide comprehensive, quality care to all.

* Community health centers are fully funded, giving the 60 million Americans now living in rural and underserved areas access to care.

* To address the critical shortage of primary care physicians and dentists, the bill provides resources for the National Health Service Corps to train an additional 24,000 health professionals.

“We are confident that Sen. Sanders’ bill will accelerate the national drive for the only reform that we know will work,” Young said. “A majority of physicians endorse such an approach. Fifty-nine percent of U.S. physicians support national health insurance. Two-thirds of the public also supports such a remedy. We remember well that President Obama once acknowledged that single-payer national health insurance was the best way to go. It still is.”

Sanders, who serves on the Senate Committee on Health, Education, Labor, and Pensions, is a longtime advocate of fundamental health care reform. His new bill draws heavily upon the single-payer legislation introduced by the late Sen. Paul Wellstone (D-Minn.) in 1993, S. 491, and closely parallels similar legislation pending before the House, H.R. 1200, introduced by Rep. Jim McDermott (D-Wash.).

A single-payer bill introduced by Rep. John Conyers Jr. (D-Mich.), H.R. 676, obtained 93 co-sponsors in the House during the last session. It has been reintroduced in the new Congress as the U.S. National Health Care Act with the same bill number.

A copy of the bill is available here. (PDF)

Physicians for a National Health Program, a membership organization of over 16,000 physicians, supports a single-payer national health insurance program. To contact a physician-spokesperson in your area, call (312) 782-6006 or visit www.pnhp.org/stateactions.