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Socialized Medicine Belittled on Campaign Trail

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Socialized Medicine Belittled on Campaign Trail

by Julie Rovner
NPR Morning Edition
December 6, 2007

Click here to listen to the story.

In the debate over health care on the campaign trail, the term “socialized medicine” is getting thrown around more and more often.

It is almost never a compliment. But the politically loaded phrase means different things to different people.

For example, when Democratic Sen. Hillary Clinton unveiled her health plan in September, it included a requirement that all individuals have health insurance.

Republican rival Mitt Romney labeled the plan “socialized medicine” in his critique. “It’s a European-style socialized medicine plan,” he said. “That’s where it leads, and that’s the wrong direction for America.”

Romney’s fellow Republican candidate Rudolph Giuliani extends that label to all of the Democratic front-runners’ plans, even though Sen. Barack Obama’s wouldn’t require everyone to be insured.

“Whether it’s HillaryCare or ObamaCare or EdwardsCare, the idea that it’s not socialized medicine is a trick,” Giuliani said. “It’s a massive growth of government control of medicine.”

History of Term

But what is socialized medicine?

“The term socialized medicine, technically, to most health policy analysts, actually doesn’t mean anything at all,” says Jonathan Oberlander, a professor of health policy at the University of North Carolina.

Oberlander says the phrase actually dates back to the American Medical Association’s fights against national health insurance in the early decades of the 1900s.

“The AMA used it to mean any kind of proposal that involved an increased role for the government in the health care system,” he says. “They also used it to mean things in the private system that they didn’t like. So, at one point, HMOs were a form of socialized medicine.”

In terms of government programs, Oberlander says it was used against Medicare in the 1960s, and prenatal care in the 1920s and 1930s. “It really is a term that is very flexible, and because it means nothing precisely, you can define everything by it.”

These days, there is one potentially accurate use of the phrase, Oberlander says. It can be used to make the distinction between a so-called single-payer health care system — where the government pays all the health care bills — and a truly government-operated health system, he says.

Term’s Definition

“When you talk about Europe, and you talk about a British system where the hospitals are owned by the government and the doctors are directly employed by the government, then you might say that’s socialized medicine,” Oberlander says.

But that is different from what most single-payer proposals would do. “There, you would essentially have government financing, just like you do with Medicare, but you would continue to have private practicing physicians and private hospitals,” Oberlander says.

None of the leading Democratic candidates, however, has proposed anything like a single-payer system, much less a fully government-run program like Britain’s National Health Service.

One candidate, Rep. Dennis Kucinich, does support the leading single-payer proposal in Congress. But that bill would also give the federal government authority to determine the number and location of health facilities. So, it would go quite a bit further than other single-payer systems like Medicare in the U.S., or even like Canada’s system.

In a forum with health reporters earlier this fall, Kucinich was asked directly if that meant what he supports wasn’t more like England’s government-operated system than Canada’s single-payer plan.

“Is it like the U.K.’s? Somewhat similar. And it’s similar in form to many of the industrial democracies of the world where they provide health care to their people,” Kucinich responded.

Curbing Medicare Advantage Overpayments Would Strengthen Medicare

Center on Budget and Public Policies
December 5, 2007

This week, the Senate Finance Committee is planning to consider Medicare legislation averting a scheduled cut in Medicare physician payments. The legislation is also expected to modestly reduce the sizable overpayments now being made to private insurance plans that participate in the Medicare Advantage program. (In July, the House voted to fully eliminate these overpayments as part of legislation to strengthen Medicare and children’s health coverage.) “Leveling the playing field” in payments between Medicare Advantage and traditional Medicare would be a sound move for Congress to take before its year-end recess, for several reasons:

* The government pays Medicare Advantage plans roughly $1,000 more per beneficiary per year than it would cost to cover the same person through traditional Medicare. Even though private plans were brought into Medicare to lower costs, the Medicare Payment Advisory Commission (“MedPAC,” Congress’ expert advisory body on Medicare payment policy) and the Congressional Budget Office (CBO) have found that they are paid 12 percent more, on average, than it would cost traditional Medicare to cover the same beneficiaries. These overpayments currently average about $1,000 per beneficiary, according to The Commonwealth Fund. Moreover, CBO says the average overpayment will likely rise in the future because Medicare Advantage enrollment is growing fastest in the areas with the highest overpayments.

* These overpayments significantly weaken Medicare’s finances. The overpayments will total $54 billion over the next five years and $149 billion over ten years, according to CBO. That puts an added strain on Medicare, moving up by two years (from 2021 to 2019) the date when its trust fund will become insolvent, according to the chief actuary at the Centers for Medicare and Medicaid Services (CMS). It also means restoring solvency will require much larger benefit cuts and/or tax increases than would otherwise be needed; as MedPAC chairman Glenn Hackbarth warned Congress, Medicare faces “a very clear and imminent risk from this overpayment that will put this country in an untenable position.” Similarly, CBO director Peter Orszag has testified that if current trends in Medicare Advantage continue, “the result would be a fundamental change in the nature of the Medicare system that may then be hard to reverse.”

* The overpayments also force beneficiaries in traditional Medicare to pay higher premiums. According to both MedPAC and CMS’s chief actuary, the overpayments raised the premiums for Part B of traditional Medicare (which includes physician visits and other types of outpatient care) by $2 per month per person, or $48 a year for a couple, in 2007. This means that the 35 million seniors and people with disabilities enrolled in traditional Medicare are charged higher premiums every month in order to help subsidize overpayments for private plans that serve approximately 8 million beneficiaries. (For about 7 million of these 35 million beneficiaries — low-income people whose premiums are paid by Medicaid — the added costs are borne by the federal government and the states, which jointly fund Medicaid.)

* Medicare Advantage plans do not have to provide all the benefits available through traditional Medicare — and many do not. While the plans use part of their overpayments to offer services that Medicare otherwise does not cover or to reduce premiums and costsharing (the rest goes to administrative costs, marketing, and profits), some of the private plans have scaled back benefits available through traditional Medicare that are used primarily by sicker individuals, evidently to deter sicker people from enrolling. As a result, some beneficiaries in poorer health can wind up significantly worse off if they enroll in Medicare Advantage. Analyses by the Medicare Rights Center, The Commonwealth Fund, the Kaiser Family Foundation, and MedPAC all have found that Medicare Advantage beneficiaries who need hospital care, home health care, or another specialty service may have to pay more for it — or may receive less of it — under the private plans. Even CMS has acknowledged this problem. CMS recently stated it will scrutinize cost-sharing levels among the private plans for services such as physician-administered chemotherapy drugs and dialysis services.

* The private plans have not been shown to provide better care. Some plans have sought to justify their overpayments as promoting better quality of care. The lack of suitable measures makes it hard to compare the quality of care in Medicare Advantage and traditional Medicare, but MedPAC reports that their levels of beneficiary satisfaction are similar, and people in traditional Medicare are less likely to report problems seeing specialists. MedPAC has also found that more Medicare Advantage plans are reporting poor health outcomes and that the plans are failing to keep pace with commercial and Medicaid plans in improving quality of care. In addition, CBO has stated that “though Medicare Advantage plans cost more than care under [traditional Medicare] does, on average, they would be more cost-effective if they delivered a sufficiently higher quality of care. The limited [quality] measures available suggest that Medicare Advantage plans are not more cost-effective” than traditional Medicare.

* The overpayments have contributed to the marketing abuses committed by some Medicare Advantage plans. Over the past year, numerous media reports and several congressional hearings have documented a pattern of misleading and abusive marketing practices by some insurance agents, who seek to lure Medicare beneficiaries into Medicare Advantage plans without explaining how they differ from traditional Medicare. In one recent survey, 37 of the 43 states responding reported complaints about inappropriate or confusing marketing practices. The overpayments encourage such abuses by giving private plans a significant incentive to maximize their enrollment; many private plans have established lucrative financial inducements for agents who sign up new enrollees. In sum, by reducing wasteful private plan overpayments, Congress can strengthen Medicare and better serve the millions of seniors and people with disabilities who rely on it for health coverage.

http://www.cbpp.org/12-5-07health.pdf

Maine’s policy lesson to the U.S. – update

Leading the Way? Maine’s Initial Experience in Expanding Coverage through Dirigo Health Reforms

By Debra J. Lipson, James M. Verdier, and Lynn Quincy
The Commonwealth Fund
Mathematica Policy Research, Inc.
December, 2007

Since enacting comprehensive health care reform in 2003, Maine’s Dirigo Health program has helped expand coverage for low- and moderate-income individuals. By September 2006, about 16,100 individuals were enrolled in two coverage initiatives: DirigoChoice, a subsidized insurance product, and a Medicaid eligibility expansion for low-income parents of dependent children. While these programs are making health coverage more affordable to low-income individuals, small firms, and sole proprietors, with subsidies targeting those most in need, by late 2006, the initiatives had enrolled less than 10 percent of previously uninsured residents.

http://www.commonwealthfund.org/usr_doc/Lipson_leadingthewayMaineexpDirigo_1079.pdf?section=4039

Quote of the Day, June 14, 2003, predicting failure:
https://www.pnhp.org/news/2003/june/maine_succeeds_in_ad.php

Comment:

By Don McCanne, MD

Today’s lesson: Most of the nation’s leading politicians who claim that their proposals will achieve health care coverage for everyone are being dishonest with us. Worse, their positions are being supported by highly respected, presumably credible members of the policy community. Politics is displacing policy science in the national discourse on reform.

Effective health policies are not based on measures that we wish would achieve our goals of universality, comprehensiveness, quality, access, equity, efficiency and affordability. Rather they are based on principles well established within the discipline of health policy science.

Let me explain, using the example of Maine.

In 2003, Maine rejected single payer reform, but passed Dirigo Health claiming that it would achieve, within five years, the same goal as single payer, but without being disruptive to the current system. Well, it certainly has not been disruptive in that 90 percent of the uninsured are still without coverage.

For political reasons, Maine substituted for single payer a series of wish-they-would-work policies. The impact of those policies were completely predictable. In fact, if you read the Quote of the Day for June 14, 2003 (link above), the failure was fully predicted – not on guesswork or hunches, but on fundamental principles of health policy science.

Current efforts in other states to achieve universal coverage will not be mentioned here other than to state that all proposals that are not single payer are doomed to fall far short on our goals of reform because they are based on wish-they-would-work policies which have already been demonstrated to fail the tests of health policy science.

Because we are in another window wherein reform is possible, we need to look at the leading proposal which is most likely to be adopted, possibly as early as 2009. This is the proposal of the leading Democratic candidates. They contend that their model of a market of private health plans, with a competing public, Medicare-like program, would achieve all of the goals listed above. Again, the politicians and their policy advisors are using wish-they-would-work policies rather than the fundamentals of health policy science.

Let’s suppose their proposal passed in 2009. What would our health care system look like five years later, in 2014? Those with greater health care needs being left out by our current system would flood to the public program. Adverse selection would cause premiums to skyrocket resulting in a death spiral as everyone would bail out since they couldn’t possibly afford the premiums. Health care costs would continue to escalate due to a lack of effective cost containment measures. That would cause a further decline in private coverage, even with an individual mandate since individuals cannot pay premiums for which they simply lack the funds necessary. To try to make coverage more affordable, underinsurance would become the standard, but then financial barriers to actual health care would increase, further impairing access.

With this proposal, the politicians promise us universality, yet many more would be without coverage. They promise us comprehensive coverage, yet the majority of the plans would be stripped of benefits to slow the rise in the cost of insurance premiums. They promise us quality, yet an underfunded delivery system weighted down with charity care, would lack the resources to identify and correct quality deficiencies. They promise us access, yet they would fail to provide the most important first step to ensure access – comprehensive insurance coverage for everyone. They promise us equity, yet they would destroy what little equity we already have by ensuring that only the wealthy could access all of the care they need. They promise us efficiency, yet they reject the single payer model that would bring us that efficiency. And they promise us affordability, yet combined insurance and health care costs would be much worse for individuals, but, ironically, health care cost increases might well begin to slow for society as a whole. How? Health care would become so unaffordable for individuals that they would begin to relinquish care that merely maintains or improves quality of life, and access only life saving services.

Supporting a private insurance industry that thrives by keeping us away from care, and backing that industry up with a bankrupt public program creates an absolute guarantee for failure.

We know that many politicians distort and lie to get elected. But shame on their policy advisors. Reinforcing distortions and lies for political purposes compromises the ethics of their profession.

Instead of supporting wish-they-would-work policies, let’s support effective, proven policies based on the foundations of health policy science. If we really want to achieve these stated goals of reform, let’s enact a single payer national health program. A truly rational system of financing health care would move us a long way toward these goals.

Silencing nurses endangers patients’ care

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

The Presidential Candidates on Health Care

Farhana Hossain
The New York Times

Presidential candidates in both parties are promising to overhaul the nation’s health care system and cover more – if not all – of the nation’s uninsured. In 2005, 44.8 million people – 15.3 percent of the population – were without health insurance, according to estimates released by the Census Bureau in March. The leading Democrats are competing among themselves over who has the better plan to control costs and approach universal coverage. The Republicans, for the most part, are promising to expand coverage without increasing the role of the federal government, and reduce cost through tax incentives. Most of the candidates have not presented a detailed outline of their health care plans, but here is what they have said so far.

Read Len Rodberg’s Critique of the mainstream Democratic candidates’ proposals for universal health care.

Read Dr. Don McCanne’s Quote of the Day Comment on Sen. Hillary Clinton’s Health reform proposal.

Joseph R. Biden Jr.
Democrat

PROPOSAL TO EXPAND COVERAGE

IMMEDIATELY INSURE EVERYONE UNDER 18
“I would move immediately to insure all children under age 18, modernize medical records and provide catastrophic health insurance to lift the burden on the 46 million people who can’t afford coverage.”
— Las Vegas Sun, March 23, 2007

WORK WITH STATES TO MOVE TOWARDS UNIVERSAL COVERAGE
“I think the thing that will get us to total health coverage – health insurance for everybody the quickest – is to do what we did on welfare reform. What we did was we allowed the states considerable flexibility and leeway in reorganizing the system and we underwrote the cost of the poor states in doing it to get work programs going. Do the same exact thing with health care. You have a dozen states, including big ones, that are now passing legislation requiring universal insurance, just like liability insurance. Once you get to a critical mass of 30 to 35 states, you’ve established a national consensus. Cherry-pick those elements of the plans. Maybe even give them localized flavor rather than one simple standard that exists that require that there be total complete coverage across the board.”
— In New Hampshire, April 14, 2007

PAYING FOR ADDITIONAL COSTS

END WAR IN IRAQ; ROLL BACK PRESIDENT BUSH‘S TAX CUTS FOR THE HIGHEST EARNERS
“The first two things we could do and we could do it without having to fundamentally change anything other than the president’s unneeded tax cut for people making an average of $1.43 million dollars a year in the top one percent.”
— In Nevada, April 2007

“Eliminate the break for investment on dividends, which is $195 billion. For $26 billion a year, I can insure every single solitary child under the age of 18 in the United States. You need start-up dollars. The place I’d start off with is somewhere over $220 billion a year by the tax cuts and ending the war.”
— On NBC’s “Meet the Press,” April 2007

Hillary Rodham Clinton
Democrat

PROPOSAL TO EXPAND COVERAGE

REQUIRE EVERYONE TO GET INSURANCE, SUBSIDIZED BY EMPLOYERS AND THE GOVERNMENT
“I call my plan, the American Health Choices plan. … If you have private insurance you like, nothing changes … you can keep that insurance. … If, however, you don’t have health insurance or you don’t like the insurance you have, you can choose from the same wide variety of private plans that members of Congress choose from. … You will have access to a public plan that will provide a stable, competitive alternative to private insurance if that is your choice.”

“While I will be requiring all Americans to have health care, I will be calling on employers to do their part as well. … Under my plan, large companies will be required to help pay for their employees’ health care. Those that do so can simply maintain their current policy that they choose. Those that don’t, will need to contribute towards the cost of covering their employees on a sliding scale based on their size and average wages. … We won’t require small businesses to cover employees. Instead we will provide tax credits to ensure that many of them do. … The government will provide tax-credits to insure that every single American can afford health insurance.”
— In Des Moines, Sept. 17, 2007

PAYING FOR ADDITIONAL COSTS

ROLL BACK PRESIDENT BUSH‘S TAX CUTS FOR PEOPLE EARNING OVER $250,000 AND BY SAVINGS IN THE EXISTING HEALTH CARE SYSTEM
“I won’t pay for it by pouring money into a broken system. I won’t pay for it by raising taxes on middle class families who are already struggling with rising costs and stagnant wages. Instead, I’ll pay for part of it by implementing the cost saving measures I outlined in May. And I will pay for some of it by rolling back part of President Bush’s fiscally irresponsible tax breaks for the highest income Americans. And I’ll pay for some of it by limiting the tax breaks for people making over $250,000 a year to the same level that ordinary, middle class Americans get.”
— In Des Moines, Sept. 17, 2007

HAS OUTLINED A SEVEN-POINT PLAN TO CONTROL COST
– Ensure better preventative care
– Modernize record-keeping
– Streamline care for the chronically ill
– Create large insurance pools
– Start a “Best Practices Institute” to finance research
– Control prescription drug costs
– Revise medical malpractice system
— At George Washington University, May 24, 2007

Chris Dodd
Democrat

PROPOSAL TO EXPAND COVERAGE

HAS PLEDGED
UNIVERSAL HEALTH CARE, SUBSIDIZED BY EMPLOYERS AND THE GOVERNMENT
“Everyone participates, everyone benefits. All the stakeholders — individuals, employers, the government — are involved in coming up with a system here that would make it possible to reduce those numbers of 47 million of our fellow citizens who have no health care to make sure they’ll be included.
– Second is prevention alone. Minimum we try to do is see to it to reduce the cost by stopping people from getting ill in the first place.
– Thirdly is building upon the good things we’ve done already: Forty years of Medicaid and Medicare. I would extend Medicaid to poorer families, 100 percent of poverty; the ones with children, 300 percent of poverty.
– Last is the fourth principle, dealing with technology. Some $80 or $90 billion could be saved, not to mention the morbidity rates by doing a far better job and utilizing the technology that exists today.”
— Presidential Forum on Health Care, March 27, 2007

PAYING FOR ADDITIONAL COSTS

END WAR IN IRAQ; ROLL BACK PRESIDENT BUSH‘S TAX CUTS FOR THE HIGHEST EARNERS
“If you get rid of these permanent tax cuts to the top one percent of income earners, get the war ended in Iraq that we’re spending $2 million a week, $8 million a month, we can provide the resources to really move in this direction. So I would make it a top priority in my administration. I wouldn’t want to put a time frame on it because I think it’s too important, but for us to get there as soon as possible.”
— Presidential Forum on Health Care, March 27, 2007

John Edwards
Democrat

PROPOSAL TO EXPAND COVERAGE

REQUIRE EVERYONE TO GET INSURANCE, SUBSIDIZED BY EMPLOYERS AND THE GOVERNMENT
“What we’re going to do is cover every single American, including the 47 million who don’t have coverage. We’re going to bring down costs for everybody. And for most Americans, we’re going to help them pay the cost. It’s based on a concept of shared responsibility. In the case of employers, we’re going to ask them to do more to either insure all their employees or to contribute to their being insured. The government will help subsidize the health care and create health care markets so we have more competition and deal with issues like preventative care, mental health care, to make sure those kind of things — chronic care — are, in fact, being done. And then, finally, for individuals, we’re going to make sure they have insurance. They have to have insurance so that everybody has health insurance.”
— On NBC’s “Meet the Press,” Feb. 4, 2007

PAYING FOR ADDITIONAL COSTS

ROLL BACK PRESIDENT BUSH‘S TAX CUTS FOR THE HIGHEST EARNERS
“The tax cuts that George Bush gave to people who make over $200,000 a year will have to go away to pay for my health care plan. My universal health care plan costs 90- to $120 billion a year. I do not believe, having spent a lot of time on this, that you can achieve universal health care without—without finding a revenue source, and that’s my revenue source.”
— Face the Nation, Feb.25, 2007

Mike Gravel
Democrat

PROPOSAL TO EXPAND COVERAGE

ISSUE VOUCHERS TO EVERYONE BASED ON THEIR PROJECTED NEEDS
“Under the plan we would issue vouchers to every single American. And the vouchers, you don’t pay for them, they’re issued to you. You sign up every year for them. And the vouchers will have a very modest co-pay, a very modest deductible, but that’s it. Everybody gets the same product universally in the United States of America. And then if you want more than the product you got, you pay for it.
The vouchers are set up for risk on an individual basis, not on a collective this fits all, because if you’re young, you probably don’t have a cost of more than $3,000. When you’re my age, it could be $150,000-$180,000 in one year. One of the facets of the plan would be to keep in place Medicare and Medicaid and phase them out over time. Because plans to put everybody on Medicare aren’t going to fly financially and just can’t be met.”
— Presidential Forum on Health Care, March 24, 2007

PAYING FOR ADDITIONAL COSTS

FEDERAL GOVERNMENT WITH TAXPAYER‘S MONEY; CONTROL COST BY MODERNIZING RECORDS
“All Americans pay for it regardless of the system you have now but the system you’re going to get, single-payer Health Care Voucher plan. There’s no magic in this whole process. Somebody is going to pay. You know who pays, it’s the average American, one way or the other, particularly under our present system. And so to want to trash the business community and trash our tax system, which is already corrupt, with greater corruption as a way to solve the problem is a nonstarter. The way the plan is designed, it won’t raise costs, because the 30 percent that they’re talking about is paper cost. If you took that and put it into some real costs in health care, we’d cover everybody without raising any costs.”
— Presidential Forum on Health Care, March 24, 2007

Dennis Kucinich
Democrat

PROPOSAL TO EXPAND COVERAGE

ESTABLISH MEDICARE FOR ALL
“A not-for-profit health care system is not only possible, but H.R. 676, a bill that I introduced, and a number of Congressmen, the Conyers-Kucinich bill, actually establishes Medicare for all, a single-payer system and it’s a not-for-profit system. It’s time we ended this thought that health care is a privilege. It is a basic right, and it’s time to end this control that insurance companies have not only over health care but over our political system. I’m talking about a real deal for the American people, a universal single-payer not-for-profit Medicare for all.”
— Presidential Forum on Health Care, March 24, 2007

PAYING FOR ADDITIONAL COSTS

REMOVE COSTS RELATED TO PRIVATE INSURERS
“At least 30% of the $3.2 trillion spent annually for health care in the United States goes to the for-profit system, while 50 million Americans, many of them working, are without health insurance. About $660 billion goes for corporate profits, executive salaries, stock options, advertising, marketing, and the cost of paperwork. If we took all that money and we put it into a public health system, a national health care plan, we would have enough money to cover everything for everyone.”
— House floor, July 12, 2006

IMPLEMENT TAXES FOR THE HIGHEST EARNERS AND A PAYROLL TAX
“B). Increasing personal income taxes on the top 5 percent income earners.
C). Instituting a modest and progressive excise tax on payroll and self-employment income.
D). Instituting a small tax on stock and bond transactions.”
— H.R. 676

Barack Obama
Democrat

PROPOSAL TO EXPAND COVERAGE

REQUIRE CHILDREN TO GET INSURANCE; AIMS FOR UNIVERSAL COVERAGE
“The main disagreement with John [Edwards] and I is John believes that we have to have mandatory insurance for everyone in order to have universal health care. My belief is that most families want health care but they can’t afford it. And so my emphasis is on driving down the costs, taking on the insurance companies, making sure that they are limited in the ability to extract profits and deny coverage — that we make sure the drug companies have to do what’s right by their patients instead of simply hoarding their profits. If we do those things then I believe that we can drive down the costs for families. In fact, we’ve got very conservative, credible estimates that say we can save families that do have health insurance about a thousand dollars a year, and we can also make sure that we provide coverage for everybody else. And we do provide mandatory health care for children.”
— CNN debate for Democratic candidates, June 3, 2007

PAYING FOR ADDITIONAL COSTS

ROLL BACK PRESIDENT BUSH‘S TAX CUTS FOR PEOPLE EARNING OVER $250,000
To help pay for all this, we will ask all but the smallest businesses who don’t make a meaningful contribution today to the health care coverage of their employees to do so by supporting this new plan. And we’ll also allow the temporary Bush tax cuts for the wealthiest Americans to expire.
— University of Iowa, May 29, 2007

Bill Richardson
Democrat

PROPOSAL TO EXPAND COVERAGE

REQUIRE EVERYONE TO GET INSURANCE, SUBSIDIZED BY EMPLOYERS AND THE GOVERNMENT
“No. 1, my plan is mandatory. You do have everybody sharing — the employer, the employee, you have the state and the federal government. Secondly, I believe that we can have a plan where if you were satisfied with your health care plan, you can keep it. No new bureaucracy. But in addition to that, you focus on prevention. You allow everybody to get the Congressional plan that every member here has.You bring Medicare 55 and over.”
— CNN debate for Democratic candidates, June 3, 2007

“Our main responsibility should be to insure all children under five. We’ve done that in New Mexico and we should do that nationally. Secondly, we should insure all working adults, all working families. The third phase would be the chronically unemployed. The way you do that is by improving efficiencies and costs. The way you do that is not have Medicare and Medicaid covering seniors and disabled, it should be one. We should expand the S-Chip [State Children’s Health Insurance Program] to cover children.”
— A.F.S.C.M.E. forum, Feb. 21, 2007

PAYING FOR ADDITIONAL COSTS

FORM PARTNERSHIP WITH HEALTH CARE COMMUNITY
“I would not increase taxes. I believe that, if anything, Democrats have been viewed – our solution is always to increase taxes, and we shouldn’t. I don’t think the solution of the Democratic Party should always be to either spend more or tax more. I believe if we have partnerships between hospitals, between communities, between the state, the federal government, and you give flexibility to the states, we can have universal health care.”
— A.F.S.C.M.E. forum, Feb. 21, 2007

Rudy Giuliani
Republican

DETAILS OF THEIR PLANS

ADVOCATES MARKET-BASED HEALTH CARE; MAKE PRIVATE INSURANCE AFFORDABLE THROUGH TAX DEDUCTIONS
“I believe we can reduce costs and improve the quality of care by increasing competition. We can do it through tax cuts, not tax hikes. We can do it by empowering patients and their doctors, not government bureaucrats.”
— Boston Globe op-ed, Aug. 3, 2007

No estimate of cost. He proposes an income tax credit of up to $7,500 for individuals and $15,000 for families, allowing that money to be directed toward the purchase of health insurance and other medical spending. He also said he opposed any government mandates that would require people or businesses to buy insurance. He criticized Democrats’ plans, saying they should leave the important decision of choosing insurance to individuals, not the government. He did not promise that all the uninsured would be covered under his proposal. He would expand health savings accounts by simplifying the rules and regulations to participate in them. He wants to increase the efficiency of the evaluation process for new drugs. He said the current process is too heavily regulated.

PAYING FOR ADDITIONAL COSTS

HAS NOT ADDRESSED HOW HE WOULD PAY FOR THE TAX DEDUCTIONS; HAS SAID THAT A FREE-MARKET WOULD BRING DOWN COSTS
“He said competition among insurers for customers would lead them to reduce the costs of their policies, estimating that only 20 million to 30 million
of the 120 million who currently get their insurance through an employer would need to sign up for individual insurance plans for that to happen. “You have to start bringing the price down before you can figure out how many people can you include. It can’t be done with a magic wand all at once.”
— Rochester, N.H., July 30, 2007

Mike Huckabee
Republican

DETAILS OF THEIR PLANS

ADVOCATES MARKET-BASED HEALTH CARE; MAKE PRIVATE INSURANCE AFFORDABLE THROUGH TAX DEDUCTIONS AND COST CONTROL MEASURES
“We don’t need universal health care mandated by federal edict or funded through ever-higher taxes. We do need to get serious about preventive health care instead of chasing more and more dollars to treat chronic disease, which currently gobbles up 80% of our health care costs, and yet is often avoidable. The result is that we’ll be able to deliver better care where and when it’s needed.
I advocate policies that will encourage the private sector to seek innovative ways to bring down costs and improve the free market for health care services. I also value the states’ role as laboratories for new market-based approaches, and I will encourage those efforts. “

PAYING FOR ADDITIONAL COSTS

IMPLEMENT COST CONTROL MEASURES
“We can make health care more affordable by reforming medical liability; adopting electronic record keeping; making health insurance more portable from one job to another; expanding health savings accounts to everyone, not just those with high deductibles; and making health insurance tax deductible for individuals and families as it now is for businesses. Low-income families would get tax credits instead of deductions.”
— Campaign Web site

Duncan Hunter
Republican

DETAILS OF THEIR PLANS

ADVOCATES MARKET-BASED HEALTH CARE; OPPOSED TO GOVERNMENT-SUBSIDIZED UNIVERSAL HEALTH CARE
“I am not for universal health care. If everything is paid for by the government, you’ll have companies trying to get in and trying to overcharge. And you’ll lose what I call a consumer interest, in keeping the cost of health care down.”
— WMUR-TV, April 13, 2007

LET AMERICANS SHOP FOR INSURANCE ACROSS STATE LINES
“We need to be able to buy our health care insurance across state lines. Right now the same single policy that can be purchased in Long Beach for $73 costs $334 in New Jersey. The states lock up the insurance industry. They won’t let Americans buy across state lines just like they do everything else. If we’re able to do that, we’re going to bring down the cost of health insurance.”
— CNN debate for Republican candidates, June 5, 2007

PAYING FOR ADDITIONAL COSTS

NOT AVAILABLE

John McCain
Republican

DETAILS OF THEIR PLANS

HAS PLEDGED AFFORDABLE HEALTH CARE FOR EVERY AMERICAN WITHOUT A FEDERAL MANDATE
“The biggest problem with the American health care system is that it costs too much. … Businesses and families pay more and more every year to get what they often consider to be inadequate attention or poor care.”
— Des Moines, Oct. 11, 2007

No estimate of cost. He would provide $2,500 refundable tax credits for individuals, and $5,000 tax credits to families, if they have health insurance. He opposes universal health care mandates. He said he believed in limited government intervention, and wanted to give individuals freedom to choose their own health care. He would allow people to have portable insurance that could be purchased across state lines. He wants to bring greater competition to drug markets by safe reimportation of drugs and streamlining the process for introducing generic drugs.

PAYING FOR ADDITIONAL COSTS

SAYS UNIVERSAL HEALTH CARE IS POSSIBLE WITHOUT A TAX INCREASE
“I’m certainly not interested in raising people’s taxes, as many of the Democrats are interested in doing. I’m absolutely opposed to that.”
— On ABC’s “This Week,” June 10, 2007

Employers would no longer be allowed to deduct health care costs from their taxes under his plan.

Ron Paul
Republican

DETAILS OF THEIR PLANS

ADVOCATES MARKET-BASED HEALTH CARE; OPPOSED TO FEDERAL MANDATE
“It’s time to rethink the whole system. The rise of HMOs has created a harmful collusion between politicians, drug companies, and organized medicine that raises the price of health care by stifling competition between providers. And all this in favor of moving us towards universal health care! I believe strongly that patients are better served by having an element of choice in the matter, which is why I support letting the free-market determine health care costs. This won’t happen, however, until we unravel the HMO web and change the tax code to allow individuals to fully deduct health care costs from their taxes, as employers can.”
— Muckraker Report, June 28, 2007

PAYING FOR ADDITIONAL COSTS

WANTS TO MAKE HEALTH CARE MORE AFFORDABLE WITHOUT TAX INCREASE
“Congress needs to craft innovative legislation that makes health care more a
ffordable without raising taxes or increasing the deficit. It also needs to repeal bad laws that keep health care costs higher than necessary.”
— LewRockwell.com, August 23, 2006

Mitt Romney
Republican

DETAILS OF THEIR PLANS

ENCOURAGE STATES TO DEVELOP MARKET-BASED HEALTH CARE PROGRAMS; OPPOSED TO A NATIONAL VERSION OF THE PLAN HE SUPPORTED FOR MASSACHUSSETS AS GOVERNOR OF THE STATE, REQUIRING EVERYONE TO GET INSURANCE
“The way we improve something is not by putting more government into it. … Instead, the right way for us to go is to bring in place the kind of market dynamics that make the rest of the economy so successful.”
— Republican Debate, Dearborn, Mich., Oct. 9, 2007

The cost would depend on what kinds of plans states propose. He wants to allow people who buy their own health insurance to be able to deduct premiums, deductibles and co-payments from their income. He is against individual or employer health care mandates, but said he wanted to get everybody “in the system” by driving down costs with market reforms. His plan would assist low-income Americans in buying private health insurance plans of their choice. He has not specified a way to change the current process of regulating drugs.

PAYING FOR ADDITIONAL COSTS

USE FEDERAL MONEY NOW BEING USED TO HELP STATES COVER THE COST OF MEDICAL CARE FOR THE UNINSURED
“It’s a conservative idea insisting that individuals have responsibility for their own health care. I think it appeals to people on both sides of the aisle: insurance for everyone without a tax increase.”
— USA Today, July 5, 2005

Tom Tancredo
Republican

DETAILS OF THEIR PLANS

ADVOCATES MARKET-BASED HEALTH CARE; WOULD NOT RULE OUT FEDERAL SUBSIDIES FOR THE NEEDY
“As for the uninsured: as many as 25 percent of them are illegal aliens and should be deported or encouraged to leave. For citizens and legal residents who are employed by businesses which cannot afford coverage, I favor association health plans which band small businesses together to access lower-cost insurance. For those out of work, state governments should be the primary source of relief, although I would not rule out federal incentives or limited subsidies to make sure families who have fallen on hard times are not without coverage.”

PAYING FOR ADDITIONAL COSTS

PROPOSES IMMIGRATION REFORM TO CURB COST
“The two major problems are the high cost of care and the number of uninsured. Tort reform and immigration enforcement would save the system billions and drive down costs. In California alone, illegal immigrants cost the system $800 million annually and have forced 84 hospitals to close.
As for the uninsured: as many as 25 percent of them are illegal aliens and should be deported or encouraged to leave.”
— Campaign Web site

Fred D. Thompson
Republican

DETAILS OF THEIR PLANS

ADVOCATES MARKET-BASED HEALTH CARE, OPPOSES FEDERAL MANDATE
“The best way to improve the best health care in the world, which is what we get right here in the United States, is to expand choice—not punishment.”
— Orlando, September 2007

“Those who propose a one-size-fits-all Washington-controlled program ignore the cost, inefficiency, and inadequate care that such a system offers.”
— Campaign Web site

PAYING FOR ADDITIONAL COSTS

IMPLEMENT MEASURES TO CONTROL COSTS AND SAVE MONEY
Access to affordable, portable health care can be made available for all Americans without imposing new mandates or raising taxes. Current government programs must also be streamlined and improved so that those who truly need help can get the health care they need.
— Campaign Web site

Reform that women need

What women need in health care reform

By Carlina Hansen, executive director of the Women’s Community Clinic, San Francisco
Sacramento Bee
December 5, 2007

(Women) represent more than half the population, live longer and are more likely to have chronic health problems as they age. Women use more health care services over the course of their lives than men. At the same time, they earn less, and are less likely to have jobs with health benefits. Consequently, women are more dependent on public and spousal coverage — two forms of health coverage that are most threatened by state deficits and employer cost-shifting.

We have a window of opportunity this year to address the unique health care needs of women in California, but the policy solutions must be substantive.

The Women’s Working Group on Universal Health Care calls on legislators and the governor to deliver a health care reform plan that includes:

* Affordable, accessible, high quality, comprehensive health care for all residents, independent of income, employment, gender, sexuality, ability, immigration, incarceration or health status.

* Comprehensive benefits.

* Access to care that is equitable, confidential and culturally and linguistically appropriate, with particular attention to vulnerable and underserved communities.

* Health care coverage that is affordable for individuals and families in relation to income.

* Health care policy that is fairly financed and establishes mechanisms for controlling costs without impeding access.

This is what California’s women need from health care reform. And, we need it now.

http://www.sacbee.com/110/story/543262.html

Women’s Working Group on Universal Health Care:
http://www.womenleadforhealth.org/

Comment:

By Don McCanne, MD

Health care reform is very much a women’s issue, though a high-performance health care system that works for women works for men and children as well. If we do it right, we’ll all benefit.

Democrats get infusion of campaign money from health care

By JASON ROBERSON
The Dallas Morning News
jroberson@dallasnews.com
10:29 AM CST on Tuesday, December 4, 2007

In Texas and across the country, doctors, insurers and health care executives — long considered among the most conservative of Americans — are donating much more to Democratic candidates than in past campaigns, which some call an indication that the industry is ready for major change to the health care system.

The splurge comes at a time when polls show health care reform is a top concern among voters, with candidates on both sides of the aisle putting forward proposals.

So far, the candidate of choice, or at least the one collecting the most health care-related donations, is New York Sen. Hillary Rodham Clinton, who tried to overhaul the health care system while her husband was president.

The stakes are high, both for the nation’s patients and for the industry, since the next president is likely to shape the debate on how to pay for and deliver health care in this country.

CANDIDATE TOTALS

2008 campaign donations from the Texas
health care industry, through September:

Candidate Party Contributions
Biden D $1,000
Brownback R * $700
Clinton D $237,284
Edwards D $83,416
Giuliani R $223,350
Huckabee R $12,600
Hunter R $5,050
Keyes R $1,000
McCain R $90,150
Obama D $110,150
Paul R $45,559
Richardson D $27,800
Romney R $63,025
Tancredo R $1,200
Thompson R $31,600

* Dropped out of race on Oct. 19
SOURCE: Center for Responsive Politics

Depending on who is elected, the role of government and employers could swing dramatically, from Democrat John Edwards’ call to require all employers with five or more workers to provide coverage or contribute 6 percent of payroll toward a public program on one end of the spectrum, to Republican Fred Thompson’s call to “divorce [the] complete dependence people have on employment for their insurance.”

In Texas, health care executives have donated almost twice as much to presidential candidates in this campaign as they did in the last election. Doctors and hospitals have a vested interest in increasing the number of people who have insurance, since that ups their chances of getting paid. Meanwhile, insurers want to ensure that people and companies keep purchasing plans from private insurance companies, as opposed to switching to a government-run system.

So, perhaps it should not be surprising that, through September, Texans in areas ranging from surgery to medical supplies donated $934,000, up 75 percent from the $531,000 poured in during the same period of the 2004 campaign.

This time around, about as much of that money went to Democrats as Republicans. Democratic candidates raked in a total of $459,650, versus $474,234 for Republican presidential candidates.

On the national level, the Democrats actually beat the Republicans. Through September, Democratic candidates collected $6.5 million from the health care industry, compared with $4.8 million for Republican candidates, according to the Center for Responsive Politics, a Washington, D.C.-based campaign finance research group.

Mrs. Clinton, the Democratic front-runner, has been the biggest beneficiary from Texas health industry donations, with $237,000 through September; Republican front-runner Rudy Giuliani came in second, with $223,000.

Next in line for Democratic contributions was Illinois Sen. Barack Obama, with $110,000 from Texas health care donors. Mr. Obama also collected the state’s single-largest such donation, with $24,000 from the Dallas-based medical technology company T-System Inc., according to a study prepared for The Dallas Morning News by the Center for Responsive Politics.

Arizona Sen. John McCain was a distant second on the Republican side, at $90,000.

Different approaches

Not surprisingly, the Republicans and Democrats propose different approaches to solving the nation’s health care problems.

The top candidates in each party all call for expansion of the existing private insurance market, as opposed to creation of a single-payer, government-run system.

But, in general, Democratic candidates promise broader and more immediate changes, with new mandates, programs and funding.

Democrats would increase federal spending to pay for health insurance coverage, with the money raised primarily by repealing some of President Bush’s tax cuts. They also want to pass legislation requiring employers to either provide insurance for their employees or contribute to a fund to help workers buy their own.

Republican candidates would rely on indirect approaches rather than new government programs.

They do not propose an increase in federal health care spending. Instead, the Repubicans would extend the Bush tax cuts to provide tax incentives to help individuals purchase health coverage. The Republicans’ goal is to move insurance away from an employer-based model to one in which individuals buy their own policies with the help of a deduction or other tax break, according to a November analysis by PricewaterhouseCoopers, the national accounting and consulting firm.

One might think the free-market approach emphasized by Republicans would win more support among Texans than the mandate-driven Democratic plans.

But, despite the fact that Democrats have been out of power for nearly a decade, and the fact that Republicans traditionally outpace the Democrats in donations, that hasn’t been the case thus far.

Explanations for trend

Sheila Krumholz, executive director for the Center for Responsive Politics, says the Democratic surge shouldn’t come as a surprise — a similar donation migration (in reverse) was seen in many industries from 1994 through 1996, when the Republicans took control of Congress. “When power changes hands in Congress, the money follows the power.”

Another reason for the change in Texas, according to Darren Whitehurst, a lobbyist for the Texas Medical Association, is that doctors here have already won the Republican-led battle to limit medical malpractice lawsuits, via passage of the Texas tort reform bill in 2003, and can afford to switch horses.

But Texas has been a bedrock of conservative support, and that didn’t end in 2003. Mr. Bush collected four times as much from health industry contributors in 2004 as did his Democratic opponents.

That’s what makes this year’s donation symmetry so surprising.

The Scooter Store is an example of this shift. The supplier of motorized wheelchairs based in New Braunfels, just north of San Antonio, devoted its entire $4,000 contribution to Mr. Bush’s re-election campaign in 2004.

The store has upped the ante this time around, with $7,600 in donations. But, so far, all of that money has gone to Democrats — $6,600 to Mrs. Clinton and $1,000 to Mr. Obama.

The store, along with others in its business, has a vested interest in preserving a government insurance benefit that lets seniors use Medicare to purchase scooters.

Insurers doom reform effort

Berkshire Eagle
Letters
12/4/07

I read Dr. Susanne King’s account of Blue Cross Blue Shield executive William C. Van Fassen’s $16.4 million retirement package and $3 million salary with a combination of astonishment, outrage, anger, and disgust. (“Our health care dollars at work,” op-ed, Nov. 28).

Individuals, businesses, and town governments throughout the state paid our hard-earned dollars to fund Mr. Van Fassen’s package. But on reflection, we also owe Mr. Van Fassen our thanks for showing us so dramatically how insurance companies create an unnecessary layer of administrative costs as they skim money away from patient care.

Mr. Van Fassen’s outrageous income also demonstrates how our current health care reform strategy is destined to fail. Already over $100 million short of funds, insurance company executives can still divert money away from patient care and into their own pockets. As long as we have a system that includes insurance companies, money will continued to be channeled into executive salaries and other administrative expenses that do nothing to improve anyone’s health.

I agree with Dr. King and the majority of doctors in Massachusetts that we need to eliminate the multiple insurance companies and have a “single-payer” to take in our health care funds and distribute them to the providers of health care. I plan to contact my legislators about my support for single-payer, and I hope others in our community do so as well.

RICHARD M. BERLIN, M.D.
Lenox

The Mainstream Democratic Candidates’ Proposals for Universal Health Care

or “They have seen the enemy — and surrendered” — Barbara Ehrenreich>

By Len Rodberg, PhD

The mainstream Democratic candidates for President — John Edwards, Barack Obama, Hillary Clinton — have each put forward their proposals for “affordable quality health coverage for all.” The three Democrats’ proposals, while purporting to provide “universal health care”, will not actually achieve this goal:

* None of these plans offers a realistic way of containing the rising cost of health care.

* All will add additional funds to an already too-costly system.

* None will truly provide universal access to care.

Only a single payer national health insurance program can actually achieve affordable, workable universal access to health care.

The three proposals share a set of common elements:

* The private insurance system would remain in place, with no fundamental change in the way it operates. Those who currently have insurance would not experience any change in how they are insured or the coverage they have.

* Large employers would be required to provide insurance for their employees or (in the case of Edwards and Obama) pay into a fund to subsidize insurance for their employees.

* Everyone (for Edwards and Clinton) or children (for Obama) would be required to have insurance, either through their employer or purchased on their own (an “individual mandate”). Income-related subsidies would be provided through the tax system.

* Insurers would be required to offer coverage to everyone (“guaranteed issue”) without limits on pre-existing conditions, and without “large premium differences based on age, gender, or occupation” (from Clinton’s plan).

* All would make available a “choice” of private insurance plans, as well as a public insurance option modeled on Medicare. (They use the language of the insurance industry — and Hillary Clinton uses it in the name of her plan itself, the “American Health Choices Plan” — suggesting that what consumers want is a choice of plan.)

* All claim to achieve cost savings through expanded use of information technology, an emphasis on prevention, and better chronic care management.

What is missing from these plans?

* Since multiple payers would remain (even if one of them might be a public payer), few of the savings and simplifications that are possible with a singe payer can be achieved.

* Consumers must purchase insurance, but no limits are proposed on what insurers can charge them.

* No regulations are proposed that would assure the adequacy of benefits or that would affect either the restrictions that insurers now impose on the choice of doctor and hospital or the way they handle, and deny, claims.

* There is no simplification of the complex and wasteful private insurance system with its copays, deductibles, exclusions, and claim denials.

* There is no assurance of a “level playing field” between the public insurance plan and the private ones. Insurance company advertising and targeted marketing will still be used to promote private plans over public and to avoid the poor and the sick. At the same time, the private insurers will surely insist on the additional subsidies they already enjoy in the Medicare Advantage program.

* Nothing is proposed that would control the rising cost of health care. (The measures they suggest to achieve savings may well increase costs rather than reduce them. In any case, the possibility for savings is speculative at this point.)

Are these plans politically “realistic”?

* The insurance companies will resist guaranteed issue and community rating, as well as other requirements in some of the plans (e.g., Edwards would require that they spend at least 85% of their revenue on medical care).

* Business will resist a mandate that they purchase insurance. (In Massachusetts, they were unwilling to pay more than $295 per employee, and even objected to that small fee.)

* None of these plans improves the situation of those who currently have insurance. Thus they are unlikely to generate strong popular support.

* The proposed subsidies — amounting to about $2,400 per uninsured individual — are about half the cost of purchasing group insurance today. Millions will continue to find insurance unaffordable. (The attempt to impose an individual mandate in Massachusetts is already showing that, as long as the program continues to rely on private insurers, very large subsidies will be needed if coverage is to be both affordable and comprehensive; without such subsidies, either coverage will be limited, or it will be unaffordable.)

* Millions of Americans who are currently underinsured, and threatened with bankruptcy in the event of serious illness, will continue to be underinsured and insecure.

* These plans would add significantly to our overall spending on health care, already the highest in the world, with much of the additional spending going to insurance company administrative costs and profits.

Conclusion: These Plans Will Not Work!

None of these plans will truly provide universal access to care. They do not overcome the very significant deficiencies of private insurance. None assures the American people of comprehensive coverage, none offers a realistic way of containing the rising cost of health care, and all would add additional funds to an already too-costly system.

They are at best a diversion from the direction we should be going, toward the creation of a single national, publicly-funded insurance pool that can provide comprehensive, continuous, cost-effective coverage along with the budgetary tools needed to begin containing costs.

Prepared by Len Rodberg, Research Director, New York Metro Chapter, Physicians for a National Health Program, September 25, 2007.

ACP’s position on single payer reform

Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries

American College of Physicians
Annals of Internal Medicine
January 1, 2008
Position Paper

This issue contains a 3-part article about improving health care in the United States. Unlike previous highly focused policy papers by the American College of Physicians, this article takes a comprehensive approach to improving access, quality, and efficiency of care. The first part describes health care in the United States. The second compares it to health care in other countries. The concluding section proposes lessons that the U.S. can learn from these countries and recommendations for achieving a high-performance health care system in the United States.

Lessons from Other Countries and ACP Recommendations for Redesigning the U.S. Health Care System

Recommendation 1a: Provide universal health insurance coverage to assure that all people within the United States have equitable access to appropriate health care without unreasonable financial barriers. Health insurance coverage and benefits should be continuous and not dependent on place of residence or employment status. The ACP further recommends that the federal and state governments consider adopting one or the other of the following pathways to achieving universal coverage:

  1. Single-payer financing models, in which one government entity is the sole third-party payer of health care costs, can achieve universal access to health care without barriers based on ability to pay. Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access. They may require a higher tax burden to support and maintain such systems, particularly as demographic changes reduce the number of younger workers paying into the system. Such systems typically rely on global budgets and price negotiation to help restrain health care expenditures, which may result in shortages of services and delays in obtaining elective procedures and limit individuals’ freedom to make their own health care choices.
  2. Pluralistic systems, which involve government entities as well as multiple for-profit or not-for-profit private organizations, can assure universal access, while allowing individuals the freedom to purchase private supplemental coverage, but are more likely to result in inequities in coverage and higher administrative costs (Australia and New Zealand). Pluralistic financing models must provide 1) a legal guarantee that all individuals have access to coverage and 2) sufficient government subsidies and funded coverage for those who cannot afford to purchase coverage through the private sector.

http://www.annals.org/cgi/content/full/0000605-200801010-00196v1

Comment:

By Don McCanne, MD

The American College of Physicians agrees that there are really only two options, though they are both government solutions: (1) an efficient, single payer national health program, or (2) a more expensive, administratively complex, inefficient, highly regulated and heavily subsidized fragmented system of a multitude of private plans plus public programs, with means testing and mandates to participate. It doesn’t seem like a difficult choice.

At least we’ve removed from the table the option of waiting for reform from private plans competing in the marketplace. After decades of leaving them in charge we are left with the highest costs and poorest coverage, while falling far short of a high-performance system.

This position paper discusses several other important concepts such as the need for a patient-centered medical home for everyone. The entire paper should be downloaded to use as a resource in your reform efforts.

ACP's position on single payer reform

Achieving a High-Performance Health Care System with Universal Access: What the United States Can Learn from Other Countries

American College of Physicians
Annals of Internal Medicine
January 1, 2008
Position Paper

This issue contains a 3-part article about improving health care in the United States. Unlike previous highly focused policy papers by the American College of Physicians, this article takes a comprehensive approach to improving access, quality, and efficiency of care. The first part describes health care in the United States. The second compares it to health care in other countries. The concluding section proposes lessons that the U.S. can learn from these countries and recommendations for achieving a high-performance health care system in the United States.

Lessons from Other Countries and ACP Recommendations for Redesigning the U.S. Health Care System

Recommendation 1a: Provide universal health insurance coverage to assure that all people within the United States have equitable access to appropriate health care without unreasonable financial barriers. Health insurance coverage and benefits should be continuous and not dependent on place of residence or employment status. The ACP further recommends that the federal and state governments consider adopting one or the other of the following pathways to achieving universal coverage:

  1. Single-payer financing models, in which one government entity is the sole third-party payer of health care costs, can achieve universal access to health care without barriers based on ability to pay. Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access. They may require a higher tax burden to support and maintain such systems, particularly as demographic changes reduce the number of younger workers paying into the system. Such systems typically rely on global budgets and price negotiation to help restrain health care expenditures, which may result in shortages of services and delays in obtaining elective procedures and limit individuals’ freedom to make their own health care choices.
  2. Pluralistic systems, which involve government entities as well as multiple for-profit or not-for-profit private organizations, can assure universal access, while allowing individuals the freedom to purchase private supplemental coverage, but are more likely to result in inequities in coverage and higher administrative costs (Australia and New Zealand). Pluralistic financing models must provide 1) a legal guarantee that all individuals have access to coverage and 2) sufficient government subsidies and funded coverage for those who cannot afford to purchase coverage through the private sector.

http://www.annals.org/cgi/content/full/0000605-200801010-00196v1

Comment:

By Don McCanne, MD

The American College of Physicians agrees that there are really only two options, though they are both government solutions: (1) an efficient, single payer national health program, or (2) a more expensive, administratively complex, inefficient, highly regulated and heavily subsidized fragmented system of a multitude of private plans plus public programs, with means testing and mandates to participate. It doesn’t seem like a difficult choice.

At least we’ve removed from the table the option of waiting for reform from private plans competing in the marketplace. After decades of leaving them in charge we are left with the highest costs and poorest coverage, while falling far short of a high-performance system.

This position paper discusses several other important concepts such as the need for a patient-centered medical home for everyone. The entire paper should be downloaded to use as a resource in your reform efforts.

Doctors endorse single-payer

American College of Physicians said it backed the system because access to health care had deteriorated.

By Stacey Burling
Philadelphia Inquirer Staff Writer
Posted on Tue, Dec. 4, 2007

The Philadelphia-based American College of Physicians – the nation’s second-largest physician group – endorsed a single-payer health-care system yesterday.

But the organization stopped short of saying that a single-payer system like Medicare, in which the government would get and pay most bills, is the best way to achieve universal health coverage.

The group said the country also could do that through expansion of the current mix of private insurance and government coverage. Under the proposal, people would be required to get health insurance.

While some physicians have formed organizations that push for single-payer, David Dale, president of the ACP, said his was the largest general-interest doctor group to support the controversial idea.

The group said change was necessary because access to health care had deteriorated.

The largest physician group in the United States, the American Medical Association, does not support single-payer. Earlier this year, it released a proposal to expand insurance coverage, primarily through tax incentives and changes in insurance regulations.

The ACP’s membership includes 124,000 internal-medicine physicians and related specialists.

After analyzing health care in the United States and 12 other industrialized countries, the group concluded that universal coverage had been successfully achieved elsewhere through single-payer and pluralistic systems.

Either could work here, the report said. The pluralistic system gives consumers more choice, but also leads to higher administrative costs and inequalities. Because it is what the United States already has, it is less of a political challenge. “It’s like remodeling your house to make it better for your whole family,” Dale said.

Single-payer has lower administrative costs, but is not politically popular, he said. “I’m not a political analyst. I’m just a doctor,” Dale said. “But I think there will probably be resistance to that. That’s why we don’t have it now.” He said his group added it to its proposal to “heighten the debate.”

Thomas E. Getzen, a professor of insurance and health management at Temple University, said doctors had long resisted single-payer systems for fear it would give the government more control over them.

Because much of the growth in expense in the current system is in procedures performed by specialists or in increased use of technology like MRIs, doctors who work in those areas have the most to fear from a single-payer system, Getzen said. Internists, who serve as primary-care doctors for many people, have less to fear.

The ACP also called for better payments for primary-care doctors to help avert a shortage and for the creation of a uniform billing system and greater use of electronic health records to reduce administrative costs.

Dale said that some U.S. doctors and hospitals were better than their counterparts in other nations, but that this country’s health system compares poorly. “Part of our call is, ‘Look around, guys, and see how other people are doing,’ ” he said, “and they’re doing better than us.”

Contact staff writer Stacey Burling at 215-854-4944 or sburling@phillynews.com.