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By Daniel Gallington
The Washington Times
December 9, 2007

Absent another large-scale terrorist attack on U.S. soil, health insurance could easily be the issue that determines the 2008 election.

The health insurance issue set — by its very nature and history — favors the Democrats, who have already started telling voters “what they are going to get” under various new national health insurance schemes. So far, almost all the Republicans have been able to say is that the Democrats propose faceless socialized medicine, a la Canada, the Britain and Europe — and that it’s way too expensive and will require massive tax increases.

However, the Democrats aren’t proposing that — they are proposing almost everyone be required to buy private health insurance (Hillary Clinton) and/or that people who can’t afford it, especially children, would get private health insurance free or at low cost (Barack Obama).

One thing is certain: Private insurance companies are licking their chops over national insurance ideas that would have billions of dollars paid to them — no matter who pays. Another key issue associated with such proposals is whether the American heath care “system” can provide health care for everyone, even if there is a way to pay for it.

We can hope the debates on national health insurance — and health care — will get more responsible and informative. But there’s no assurance of that, judging from the content and coverage of the discussions so far. To start, the public is way “underinformed” on the basics of any kind of insurance.

For example, insurance companies make their money in three ways, only one of which has much to do with insuring risks:

(1) They typically own and manage vast real estate holdings, billions and billions of dollars worth, so they are indirect partners in lots of other kinds of businesses and ventures.

(2) They have billions and billions of dollars that they invest in stocks, bonds and other kinds of investments. In fact, insurance companies have always been among the largest “institutional investors” on Wall Street.

(3) They employ armies of actuary scientists, risk managers, lawyers and other experts to reduce the amount of money they have to pay for losses they have insured people against. They even take out insurance to cover their own liability exposure for catastrophic losses — this is called “reinsurance” and is huge financial industry in its own right.

Surprising to most people, the regulatory “turf” for insurance was divided up in the 1940s with a little known law, called the “McCarran Act,” the most important part of which cedes insurance regulation to the individual states.

So, could the establishment of a comprehensive heath insurance system for all Americans require — of necessity — a federal legislative revamping of the entire regulatory basis for one of the largest U.S. financial operations?

Sure it could, and one can only imagine the intensity of the lobbying efforts to influence how that regulatory turf would be recast. It would make all past lobbying campaigns in Washington look like skirmishes — this as the various insurance special interests lined up to protect their interests.

Accordingly — for a universal health insurance “solution” — the insurance industry will have in mind the kind of sweetheart deal they got in the past: They manage the programs and get lots of money from the government to do it — like Medicare, Medicaid and the Medicare Drug Program.

Think about it — these programs have been financial booms to the health insurance industry, primarily because the government has assumed the long-term obligation to pay for the highest risk groups: People over age 65. Accordingly, for any new national health insurance program — insurance companies will insist the government pay for those (a) who can’t otherwise pay their premiums, and (b) those in higher-or chronic-risk categories.

While the insurance industry certainly won’t mind if the federal government makes huge cash payments into their business system, they will mind if the government actually takes over — or manages — the health insurance business. Therefore — even if it becomes the cheapest and most efficient way for any part of a new health insurance system to work (for younger people, for example) it is unlikely to happen.

For proof of this, one need only look at how the intensively lobbied Congress “resolved” the recent addition of drug coverage (Medicare “D”) to the Medicare program: They were simply bought off by the drug companies (to make sure the highest prices for drugs were paid) and the insurance companies (to make sure there was enough money in the Medicare/Medicaid system to pay the new claims). Bottom line? All Congress really did was throw money — our money — at the insurance companies, and they love it.

In sum, how will individual voters, taxpayers and health insurance consumers figure in the new universal health insurance debate? The short answer is that they won’t: Just as the most expensive and least efficient alternatives for our other forms of government-sponsored health insurance (e.g., Medicare, Medicaid and Medicare “D”) have prevailed in the past — they will likely prevail again.

Daniel Gallington is a senior fellow at the Potomac Institute for Policy Studies in Arlington, Va.

By BRAD WARTHEN
Editorial Page Editor
The State
Posted on Sun, Dec. 09, 2007

CAN ANYONE among those with a chance of becoming president say “single-payer?” If not, forget about serious reform of the way we pay for health care.

It doesn’t even necessarily have to be “single-payer.” Any other words will do, as long as the plan they describe is equally bold, practical, understandable, and goes as far in uprooting our current impractical, wasteful and insanely complex “system.”

And the operative word is “bold.” Why? Because unless we start the conversation there, all we might hope for is that a few more of the one out of seven Americans who don’t have insurance will be in the “system” with the rest of us — if that, after the inevitable watering-down by Congress. And that’s not “reform.” Actual reform would rescue all of us from a “system” that neither American workers nor American employers can afford to keep propping up.

But the operative word to describe the health care plans put forward by the major, viable candidates is “timid.”

“Single-payer” is definitely not that — at least, not within an American context. Seen from the perspective of most advanced nations — which accept medical care as just another part of a nation’s infrastructure, like roads and post offices — it’s no big deal.

Not here, though — not by a long shot. Here, we have too many people preprogrammed to go ballistic at the mention of “single-payer.” That’s because of the identity of that payer.

It’s… well, it’s the government!

This column will now take a short break while libertarians run around shrieking until they turn blue and fall over… da-da-dum-dum, hmmm… readers might want to go look at the Sunday comics until we resume… da-dee-da-dahhh… Still screaming, so let’s get another cup of coffee… Ah, that’s good stuff…

OK, we’re back, and they’re still screaming, but we’ll just have to accept that they’re going to do that, and proceed.

“Government,” in America, is a word that we use for a free people banding together to do something that we can do far better working together than working separately. Some people don’t accept that fact. They seem to believe that “government” is some scary thing that intrudes on their lives from out there somewhere, like a spaceship full of aliens with ray guns that will turn us all into toads or something.

Those people are one of the two big reasons why you don’t hear any presidential candidates saying “single-payer” except Dennis Kucinich. You may recall recent reports that Mr. Kucinich had a close encounter with a UFO, and it was a positive experience, so I guess he’s just not scared of the aliens any more.

But the major candidates are. Or rather, they’re scared of being labeled as extremists. Also, they don’t want to offend the health insurance companies whose reason for being would disappear under “single-payer.”

Last week, I got a press release from a labor union that complained “that no Republican candidate has a plan to ensure all Americans have access to health care.” That’s true. But the union, which represents blue- and pink-collar workers in health care, was missing the fact that the leading Democrats are little better.

“Sens. Hillary Clinton and Barack Obama have been engaged in a bitter back-and-forth over whose health plan covers more people,” The Wall Street Journal reported last week. “Former Sen. John Edwards has jumped in, saying his plan is the best of all.”

But what they’re fighting over are plans that would pull varying numbers of the uninsured into the same overly expensive, wasteful, maddening system of private health insurance that the rest of us are caught in. Conveniently, they say their plans would be paid for by repealing the “Bush tax cuts for the wealthy.”

Maybe you could pay for a health plan that way — as long as it doesn’t provide real reform.

Make no mistake: A single-payer national health plan would cost a lot of money, and you would pay for it in new taxes. The good news is that most of us would probably still pay less than we currently pay in premiums.

According to the Web site of Physicians for a National Health Program, which promotes single-payer, “This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”

But when not even touchy-feely liberal Democrats have the guts to say it’s worth paying a new tax to make health care affordable for all, even when that’s the hottest domestic issue among voters (which would not be the case if the insured majority were happy), we’re in trouble.

Little wonder that Dow Jones’ MarketWatch reported last week that “Those who hope the 2008 presidential election will finally bring about drastic health-care reform may well end up finding it’s a case of politics and business as usual, experts say.” The same article noted that Hillary Clinton has received $1.8 million in contributions from accident and health insurers, followed by Barack Obama with $1.45 million, Mitt Romney with $1.09 million and Rudy Giuliani with $1.08 million.

That, by the way, is money that you and I and the guy down the street paid for health care that didn’t go to health care.

Given the odds against substantive reform — between the government haters, the insurance industry and Big Pharma, all of whom have a demonstrated willingness to outlast the rest of us in any protracted political fight — the only way we’re going to see significant change is if a president is elected with a mandate for bold reform. Only a president is elected by the whole nation, so only a president would ever have that kind of juice.

Unfortunately, as previously noted, none of the viable candidates will say “single-payer.”

But I will: Single-payer. Single-payer, single-payer! Now, do you have anything better to say?

Posted by Marisa Treviño
29 November 2007

As the presidential debate deepens, or gets more desperate, it won’t be surprising to hear more and more candidates who are scared of the immigration issue spouting off just plain WRONG information.

What’s sad is that they and their staff are relying on sources whose only intent is not to present the facts but drive public opinion against any facet of humanely resolving the plight of undocumented immigrants.

Whenever studies are released actually supporting the true facts, these same sources are quick to pounce on it and tear it apart like African lions devouring a kill. They accuse the study’s authors of being biased or twisting the statistics in their favor.

So, it’s more than gratifying when two different entities on two different coasts of the nation, independently release studies that say the same thing: “Undocumented immigrants are not a burden on society.”

This week in California, the University of California’s School of Public Health released a report that found undocumented Latino immigrants do not cause a drag on the U.S. healthcare system as they are always being accused.

In fact, the vast majority of undocumented immigrants don’t even have a regular doctor or healthcare provider and only visit the ER as a last resort.

“Low rates of use of health-care services by Mexican immigrants and similar trends among other Latinos do not support public concern about immigrants’ overuse of the health care system,” the researchers wrote.

“Undocumented individuals demonstrate less use of health care than U.S.-born citizens and have more negative experiences with the health care that they have received,” they said.

It’s a finding that is repeated in today’s released study by the Immigration Policy Center (IPC), the think tank of the American Immigration Law Foundation.

The IPC study found that:

per capita health care expenditures were 55 percent lower for immigrants than for natives in 1998. On average, immigrants received about $1,139 in health care, compared with $2,546 for native-born residents. Although all immigrants are eligible for emergency medical services, they had lower expenditures for emergency room visits, doctor’s office visits, outpatient hospital visits, inpatient hospital visits, and prescription drugs.

But the IPC study doesn’t stop there.

It also addresses the accusations by defamation critics who say undocumented immigrants overuse government services, increase the poverty rate and don’t pay taxes. The IPC authors are puzzled at where the defamation critics are getting their “supposed” information.

Immigration increases the U.S. Gross Domestic Product by approximately $37 billion each year. And national and state studies find that immigrants pay more in taxes than they use in government services. As for undocumented immigrants, it is a myth that they do not pay taxes. Up to 75% of them pay federal and state income and payroll taxes and all immigrants (legal and undocumented) pay sales taxes and property taxes.

while the poverty rate for U.S.-born citizens increased slightly, it fell slightly for immigrants. And, as immigrants integrate into U.S. society, they work their way out of poverty. For example, the children and grandchildren of Hispanic immigrants have made great strides in closing the economic gap with native-born whites by getting an education, getting better jobs, and earning higher incomes than their parents and grandparents. As a case study, homeownership reflects the economic advancement of the immigrant population, and, in California, the homeownership rates for Latino immigrants rose from 16.4 percent among those who arrived in the U.S. in the last 10 years to 64.6 percent among those who have lived here for 30 years or more.

Some immigration critics exaggerate immigrants’ welfare use by measuring the welfare costs of “immigrant households.” These studies include welfare benefits paid to U.S.-citizen children as “immigrant welfare costs” if any member of the child’s household is an immigrant. But, in fact, most legal immigrants are not eligible for publicly financed benefits and undocumented immigrants are not eligible for any public benefits. In addition, the participation rates of non-citizens in some federal benefits programs have been declining.

Putting this study out there is like dangling fresh meat in front of those same hungry lions who can’t digest what the truth is.

Luckily, there’s a whole herd ready to deliver the same message until either the lions give up or wake up — their choice.

By BRAD WARTHEN
Editorial Page Editor
The State
Posted on Sun, Dec. 09, 2007

CAN ANYONE among those with a chance of becoming president say “single-payer?” If not, forget about serious reform of the way we pay for health care.

It doesn’t even necessarily have to be “single-payer.” Any other words will do, as long as the plan they describe is equally bold, practical, understandable, and goes as far in uprooting our current impractical, wasteful and insanely complex “system.”

And the operative word is “bold.” Why? Because unless we start the conversation there, all we might hope for is that a few more of the one out of seven Americans who don’t have insurance will be in the “system” with the rest of us — if that, after the inevitable watering-down by Congress. And that’s not “reform.” Actual reform would rescue all of us from a “system” that neither American workers nor American employers can afford to keep propping up.

But the operative word to describe the health care plans put forward by the major, viable candidates is “timid.”

“Single-payer” is definitely not that — at least, not within an American context. Seen from the perspective of most advanced nations — which accept medical care as just another part of a nation’s infrastructure, like roads and post offices — it’s no big deal.

Not here, though — not by a long shot. Here, we have too many people preprogrammed to go ballistic at the mention of “single-payer.” That’s because of the identity of that payer.

It’s… well, it’s the government!

This column will now take a short break while libertarians run around shrieking until they turn blue and fall over… da-da-dum-dum, hmmm… readers might want to go look at the Sunday comics until we resume… da-dee-da-dahhh… Still screaming, so let’s get another cup of coffee… Ah, that’s good stuff…

OK, we’re back, and they’re still screaming, but we’ll just have to accept that they’re going to do that, and proceed.

“Government,” in America, is a word that we use for a free people banding together to do something that we can do far better working together than working separately. Some people don’t accept that fact. They seem to believe that “government” is some scary thing that intrudes on their lives from out there somewhere, like a spaceship full of aliens with ray guns that will turn us all into toads or something.

Those people are one of the two big reasons why you don’t hear any presidential candidates saying “single-payer” except Dennis Kucinich. You may recall recent reports that Mr. Kucinich had a close encounter with a UFO, and it was a positive experience, so I guess he’s just not scared of the aliens any more.

But the major candidates are. Or rather, they’re scared of being labeled as extremists. Also, they don’t want to offend the health insurance companies whose reason for being would disappear under “single-payer.”

Last week, I got a press release from a labor union that complained “that no Republican candidate has a plan to ensure all Americans have access to health care.” That’s true. But the union, which represents blue- and pink-collar workers in health care, was missing the fact that the leading Democrats are little better.

“Sens. Hillary Clinton and Barack Obama have been engaged in a bitter back-and-forth over whose health plan covers more people,” The Wall Street Journal reported last week. “Former Sen. John Edwards has jumped in, saying his plan is the best of all.”

But what they’re fighting over are plans that would pull varying numbers of the uninsured into the same overly expensive, wasteful, maddening system of private health insurance that the rest of us are caught in. Conveniently, they say their plans would be paid for by repealing the “Bush tax cuts for the wealthy.”

Maybe you could pay for a health plan that way — as long as it doesn’t provide real reform.

Make no mistake: A single-payer national health plan would cost a lot of money, and you would pay for it in new taxes. The good news is that most of us would probably still pay less than we currently pay in premiums.

According to the Web site of Physicians for a National Health Program, which promotes single-payer, “This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”

But when not even touchy-feely liberal Democrats have the guts to say it’s worth paying a new tax to make health care affordable for all, even when that’s the hottest domestic issue among voters (which would not be the case if the insured majority were happy), we’re in trouble.

Little wonder that Dow Jones’ MarketWatch reported last week that “Those who hope the 2008 presidential election will finally bring about drastic health-care reform may well end up finding it’s a case of politics and business as usual, experts say.” The same article noted that Hillary Clinton has received $1.8 million in contributions from accident and health insurers, followed by Barack Obama with $1.45 million, Mitt Romney with $1.09 million and Rudy Giuliani with $1.08 million.

That, by the way, is money that you and I and the guy down the street paid for health care that didn’t go to health care.

Given the odds against substantive reform — between the government haters, the insurance industry and Big Pharma, all of whom have a demonstrated willingness to outlast the rest of us in any protracted political fight — the only way we’re going to see significant change is if a president is elected with a mandate for bold reform. Only a president is elected by the whole nation, so only a president would ever have that kind of juice.

Unfortunately, as previously noted, none of the viable candidates will say “single-payer.”

But I will: Single-payer. Single-payer, single-payer! Now, do you have anything better to say?

Louisville Courier-Journal
Readers’ forum
Monday, December 3, 2007

The results of the studies have been released and they prove what every hospital nurse knows from experience. Understaffing endangers patients.

For each additional patient assigned to an RN, the likelihood of death within 30 days increases by 7 percent. Four additional patients increase the risk by 31 percent (JAMA, 10/22/02).

In 1989 Louisville nurses formed the Nurses Professional Organization with the goal of organizing their union so that they could win better staffing and conditions for their patients and themselves.

The nurses took on the giants of corporate health care. Staff nurses stood their ground before high salaried CEOs, anti-union consultants, and supervisors who, under threat themselves, threatened the jobs and licenses of nurses who continued to speak up. Nurses threw themselves into the struggle with hope. The hospitals hired consultants to spread fear.

By committing mountains of unlawful actions, Norton Healthcare as well as Columbia/HCA blocked the nurses’ efforts. But these powerful corporations did not violate the law unchallenged. In almost every case in which the NPO filed charges against the hospitals, the nurses won. NPO nurses have exposed the understaffing, testified on patient care issues in Frankfort, won back the jobs of nurses unjustly dismissed, called in the state inspectors, testified before the JCAHO, spoken to the press, and kept alive the hope that staff nurses can organize and make things better. Bruised but never broken, the NPO has now won another victory. The turtle’s pace of labor law enforcement in our nation allows employers to delay interminably. First Columbia/HCA, and then Norton Healthcare, stalled the progress for the 13 years since the 1994 election at Audubon. In August, the NLRB turned down Norton Audubon’s appeal of one of NPO’s cases.

In November, Norton Audubon paid over $171,000 to three nurses who were unlawfully denied positions. Nurses at Audubon and in Louisville now have a new opportunity to organize and to win the right to practice under truly professional conditions.

The Nurses Professional Organization has affiliated with the California Nurses Association/National Nurses Organizing Committee. This 75,000 strong organization has empowered nurses to win the best contracts and the best patient protections in the nation. CNA staff nurses used their power to advocate for patients. Now they have minimum staffing ratios in hospitals that are enforceable — written into both California law and into union contracts. No more than five patients per nurse on a medical/surgical floor. No more than two patients per nurse in Intensive or Critical Care. No more than four patients on a step down unit — advancing to no more than three in 2008. No more than four patients per nurse in ER; no more than 2 ICU patients per nurse in the ER — no more than one ER Trauma patient. No more than five patients per nurse in telemetry moving to no more than four in 2008. In addition, nurses must be increased above these ratios whenever acuity levels require. Plus the ratios apply on all shifts at all times including during lunch and breaks. (www.calnurses.org) Nurse power makes a difference.

Bringing good conditions to patients and nurses ends the nursing shortage. Actively licensed RNs in California increased by more than 60,000 following enactment of the staffing ratio law. Since the ratio law was signed, actively licensed RNs have grown by nearly 10,000 a year, compared to just 3,200 a year prior to the law. (Board of Registered Nursing data).

We cannot solve the nursing “shortage” in Louisville without solving the conditions that force good nurses from the bedside and from their chosen profession. Many can’t sleep after their 12-hour shifts for thinking about what almost happened and what could happen. The lack of organized nurse power to change these conditions and win truly professional standards of care and benefits has stifled health care progress in Louisville.

When Norton Healthcare, called Alliant at the time, purchased Audubon Hospital, there was an NLRB bargaining order in place. Norton Audubon didn’t sit down and bargain with the nurses. Instead Norton Healthcare spent our community’s health care dollars on a nine year oppositional path of challenges to NLRB orders and to nurses’ rights.

Among Norton Healthcare’s numerous unfair labor practices are: unlawful discipline for protected activity, unlawful termination, unlawful denial of a position, unlawful restriction of the right to distribute literature in the cafeteria and non-work areas, unlawful restriction of the right of a nurse to speak about the union in the break room, unlawful institution of a more restrictive distribution policy in response to a union campaign, unlawful attack on a nurse’s license, and unlawful interrogation.

The NLRB overturned the unfair election at Audubon Hospital and has ordered a new election. Audubon nurses are talking and organizing and will move forward to advocate for their patients and to build their union. Nurses across Louisville are once again hopeful. When nurses organize, the patients and the community are the beneficiaries. Silencing nurses endangers patients.  

KAY TILLOW

Director of Organization

Nurses Professional Organization/CNA/NNOC

Louisville 40202

By Mary Ann Garnar
OP-ED
Special to The Courier-Journal
Monday, December 3, 2007

Most thoughtful people in the United States recognize that the difficulties of obtaining health insurance — with the resulting lack of access to quality medical care — must be remedied.

Advances in the field of medicine, dazzling new diagnostic tools, the ever-increasing range of procedures and the proliferation of new and better drugs have driven the cost of medical care beyond the reach of far too many people of even average means, if they lack health insurance.

At the same time, health insurance premiums continue to rise to unconscionable levels, in large part to satisfy stockholders’ demands for higher and higher profits, to the point that purchase of health insurance is an impossibility for millions.

Those of us with insurance take for granted our routine medical examinations, blood work, X-rays, inoculations, etc. If we have the flu, we don’t hesitate to see the doctor, who prescribes the needed medicine and off we go to the pharmacy, hardly giving a thought to the actual cost of it all. We spend a few days recovering and then return to work.
If the gall bladder goes bad, we are not troubled beyond anxiety about the actual surgery. We yield to the surgeon’s knife, spend a day or two in the hospital being looked after by doctors, nurses and attendants, and don’t worry too much about the co-pay.

But there are millions of people whose asthma, aching joints, chest pains and even more serious ailments go untreated because they lack health insurance. Critical diagnostic procedures are missed because they cannot afford to pay the doctor. Drugs are not bought. The consequences can, and often do, escalate into something more difficult and more costly to treat.

Allowing this crisis to continue is morally and economically indefensible. Because of damage to the health, finances and dignity of people affected, and to the larger economy, we must find a solution — and find it soon.

People of conscience are earnestly trying to sort through the many plans being proposed to correct the inequities in order to determine which plan will provide a remedy that is both affordable and covers the cost of needed medical care. And they are beginning to understand that the solution must not be piecemeal; it must be one which guarantees insurance for everyone. No one can be left out.

Most people now agree that government must be a part of any solution.

A realistic and honest assessment of the proposals leads to the inevitable conclusion that the best solution for the greatest number is what is called universal, single-payer health insurance. That is, health insurance for all residents of the United States, largely funded with a tax based on income, and benefits paid out by the federal government. (A bill now in Congress, HR 676, the United States National Health Insurance Act, if passed, would establish just such a plan.)

Single-payer insurance is the most efficient use of available health care resources because there is no profit motive and administrative waste is eliminated. Medicare, the model for a universal, single payer system, spends only 3 cents of every dollar paid into the system on administrative expenses. Fully 97 cents on the dollar is spent on patients’ medical bills. Private insurance companies and health maintenance organizations (HMOs), on the other hand, spend 20-30 cents on the dollar for administrative costs and only 70-80 cents for patient care.

Single-payer insurance is not “socialized medicine.” Those who now have private insurance would receive the same medical care from the same doctors, dentists, psychiatrists, hospitals, etc., as they do now. Those currently without insurance would have their medical needs met. And the joy of it is that, for most people, their costs would be less than the costs of their private insurance, because the unnecessary costs of the private health insurance industry would be removed.

Opponents’ claims to the contrary, we can afford to do this.

No new government program will be free of problems. But people of goodwill will be prepared to give such a program a chance to work.

We cannot continue to allow people to go without medical care because they cannot afford to pay the doctor or buy insurance. And we must not treat inability to pay as a moral failure.

The moral failure would be to allow the crisis to continue.

Mary Ann Garnar lives in Louisville and is a retired attorney. She is a 2007 Forum Fellow.