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By Barbara Ehrenreich
The Huffington Post
Posted September 20, 2007

Bow your heads and raise the white flags. After facing down the Third Reich, the Japanese Empire, the U.S.S.R., Manuel Noriega and Saddam Hussein, the United States has met an enemy it dares not confront — the American private health insurance industry.

With the courageous exception of Dennis Kucinich, the Democratic candidates have all rolled out health “reform” plans that represent total, Chamberlain-like, appeasement. Edwards and Obama propose universal health insurance plans that would in no way ease the death grip of Aetna, Unicare, MetLife, and the rest of the evil-doers. Clinton — why are we not surprised? — has gone even further, borrowing the Republican idea of actually feeding the private insurers by making it mandatory to buy their product. Will I be arrested if I resist paying $10,000 a year for a private policy laden with killer co-pays and deductibles?

It’s not only the Democratic candidates who are capitulating. The surrender-buzz is everywhere. I heard it from a notable liberal political scientist on a panel in August: We can’t just leap to a single payer system, he said in so many words, because it would be too disruptive, given the size of the private health insurance industry. Then I heard it yesterday from a Chicago woman who leads a nonprofit agency serving the poor: How can we go to a Canadian-style system when the private industry has gotten so “big”?

Yes, it is big. Leighton Ku, at the Center for Budget and Policy Priorities, gave me the figure of $776 billion in expenditures on private health insurance for this year. It’s also a big-time employer, paying what economist Paul Krugman has estimated two to three million people just turn down claims.

This in turn generates ever more employment in doctors’ offices to battle the insurance companies. Dr. Atul Gawande, a practicing physician, wrote in The New Yorker that ”a well-run office can get the insurer’s rejection rate down from 30 percent to, say, 15 percent. That’s how a doctor makes money. It’s a war with insurance, every step of the way.” And that’s another thing your insurance premium has to pay for: the ongoing “war” between doctors and insurers.

Note: The private health insurance industry is not big because it relentlessly seeks out new customers. Unlike any other industry, this one grows by rejecting customers. No matter how shabby you look, Cartier, Lexus, or Nordstrom’s will happily take your money. Not Aetna. If you have a prior conviction — excuse me, a pre-existing condition — it doesn’t want your business. Private health insurance is only for people who aren’t likely to ever get sick. In fact, why call it “insurance,” which normally embodies the notion of risk-sharing? This is extortion.

Think of the damage. An estimated 18,000 Americans die every year because they can’t afford or can’t qualify for health insurance. That’s the 9/11 carnage multiplied by three — every year. Not to mention all the people who are stuck in jobs they hate because they don’t dare lose their current insurance.

Saddam Hussein never killed 18,000 Americans or anything close; nor did the U.S.S.R. Yet we faced down those “enemies” with huge patriotic bluster, vast military expenditures, and, in the case of Saddam, armed intervention. So why does the U.S. soil its pants and cower in fear when confronted with the insurance industry?

Here’s a plan: First, locate the major companies. No major intelligence effort will be required, since Google should suffice. Second, estimate their armed strength. No doubt there are legions of security guards involved in protecting the company headquarters from irate consumers, but these should be manageable with a few brigades. Next, consider an air strike, followed by an infantry assault.

And what about the two to three million insurance industry employees whose sole job it is to turn down claims? Well, I have a plan for them: It’s called unemployment. What country in its right mind would pay millions of people to deny other people health care?

I’m not mean, though. If we had the kind of universal, single-payer, health insurance Kucinich is advocating, private health insurance workers would continue to be covered even after they are laid off. As for the health insurance company executives, there should be an adequate job training program for them — perhaps as home health aides.

Fellow citizens, where is the old macho spirit that has sustained us through countless conflicts against enemies both real and imagined? In the case of health care, we have identified the enemy, and the time has come to crush it.

Contacts:
Merton Bernstein
Founding Member, National Academy of Social Insurance
Coles Professor of Law Emeritus at Washington University in St. Louis
bernstein@wulaw.wustl.edu
508-896-8383

By Jessica Martin
Washington University in St. Louis News & Information

Sept. 18, 2007 — “Universal health care is getting the attention it deserves, but unfortunately the proposals receiving the most attention ignore the ‘Big Leak,'” which is the enormous non-benefit costs incurred by health care providers who must match their billions of billings with thousands of differing private health care plans,” says Merton C. Bernstein, a founding member of the National Academy of Social Insurance and the Coles Professor of Law Emeritus at Washington University in St. Louis. “Putting everyone under the Medicare umbrella would eliminate that leak,” he says.

“Medicare’s single-payer system would reduce non-benefit spending by doctors, hospitals, clinics, laboratories and health care insurers by about $300 billion a year, providing funds to insure everyone without additional outlays.”

Bernstein is available to discuss current universal health care proposals as well as the Medicare-for-all option. His current comments on health insurance follow:

Health insurance companies, unlike Medicare, deal with vast administrative costs:

“Hundreds of private insurers offer innumerable differing plans,” Bernstein says.

“Those differences usually reflect marketing considerations rather than medical goals. In contrast, Medicare has one set of charges in a region. That helps explain Medicare’s low administrative costs — about 2 percent of benefit outlays. In addition, Medicare does not have the marketing and advertising costs that add significantly to private insurer outlays. In dealing with Medicare, medical care providers need master only one set of rules and schedule of charges — a clear gain in efficiency.”

Giving patients a choice:

“Some contend that their proposals offer patients a choice,” he says. “To start, patients don’t choose their coverage, their employers do. Even when there are several plans on offer, the employer chooses which ones to include. Further, the employer chooses who administers the plans. That’s where much of insurance competition occurs — who can offer the lowest cost to the employer/chooser; that turns on who can produce lowest benefit payout.

“The choice patients cherish most is who will be their doctor and which hospital will provide care. Many private insurance arrangements limit those choices. Under Medicare, the patient chooses.”

Proposed plans rely on tax breaks and other subsidies:

“The major proposals depend upon tax breaks and other subsidies to make coverage appear more affordable,” Bernstein says. “This merely shifts costs to other plan participants or taxpayers. This increase total costs and thereby make the programs themselves less affordable.”

Contacts:
Merton Bernstein
Founding Member, National Academy of Social Insurance
Coles Professor of Law Emeritus at Washington University in St. Louis
bernstein@wulaw.wustl.edu
508-896-8383

By Jessica Martin
Washington University in St. Louis News & Information

Sept. 18, 2007 — “Universal health care is getting the attention it deserves, but unfortunately the proposals receiving the most attention ignore the ‘Big Leak,'” which is the enormous non-benefit costs incurred by health care providers who must match their billions of billings with thousands of differing private health care plans,” says Merton C. Bernstein, a founding member of the National Academy of Social Insurance and the Coles Professor of Law Emeritus at Washington University in St. Louis. “Putting everyone under the Medicare umbrella would eliminate that leak,” he says.

“Medicare’s single-payer system would reduce non-benefit spending by doctors, hospitals, clinics, laboratories and health care insurers by about $300 billion a year, providing funds to insure everyone without additional outlays.”

Bernstein is available to discuss current universal health care proposals as well as the Medicare-for-all option. His current comments on health insurance follow:

Health insurance companies, unlike Medicare, deal with vast administrative costs:

“Hundreds of private insurers offer innumerable differing plans,” Bernstein says.

“Those differences usually reflect marketing considerations rather than medical goals. In contrast, Medicare has one set of charges in a region. That helps explain Medicare’s low administrative costs — about 2 percent of benefit outlays. In addition, Medicare does not have the marketing and advertising costs that add significantly to private insurer outlays. In dealing with Medicare, medical care providers need master only one set of rules and schedule of charges — a clear gain in efficiency.”

Giving patients a choice:

“Some contend that their proposals offer patients a choice,” he says. “To start, patients don’t choose their coverage, their employers do. Even when there are several plans on offer, the employer chooses which ones to include. Further, the employer chooses who administers the plans. That’s where much of insurance competition occurs — who can offer the lowest cost to the employer/chooser; that turns on who can produce lowest benefit payout.

“The choice patients cherish most is who will be their doctor and which hospital will provide care. Many private insurance arrangements limit those choices. Under Medicare, the patient chooses.”

Proposed plans rely on tax breaks and other subsidies:

“The major proposals depend upon tax breaks and other subsidies to make coverage appear more affordable,” Bernstein says. “This merely shifts costs to other plan participants or taxpayers. This increase total costs and thereby make the programs themselves less affordable.”

Wall Street Journal
Letter to the Editor
September 19, 2007; Page A19

In regard to John Stossel’s Sept. 13 editorial-page commentary “Sick Sob Stories:” By focusing on the narrow subject of bone marrow transplantation, Mr. Stossel is missing the big picture of the major problems in health care in the U.S.

He fails to comment on the fact that there are 47 million people in the U.S. who do not have any health care. While promoting health care for profit, he neglects to mention that 31% of health-care costs in this country are for administrative salaries and advertising. Salaries of HMO executives (along with their lawyers and lobbyists) are obscene. The previous CEO of United Health Care made $1.6 billion (including back dated stock options) last year. This is not where health-care dollars should go. The current for-profit health-care system is not working.

The only solution is to eliminate the HMOs and go to a single-payer system that does not have to be administered by the government. The savings would increase reimbursements to health-care providers (and, it is hoped, stem the annual loss of primary care physicians) so that there would be greater access to care for more patients with fewer hassles.

J. David Gaines, M.D., FACP
Associate Clinical Professor of Medicine
Yale University School of Medicine
New Haven, Conn.

By Rose Ann DeMoro
The Huffington Post
September 18, 2007

The pundits might have it right on this one. Hillary Clinton did learn a lesson from her 1994 fiasco on healthcare reform. Unfortunately for most of us who don’t have an Inc. after our name or a private jet to cart us around, it was the wrong lesson.

In the days leading up to the announcement of her latest, much anticipated health plan, Sen. Clinton threw around the word “consensus” a lot. In this case, the consensus she was seeking was with the same industry that so savaged her prior experience with healthcare.

This time, she apparently wants to soften them up in advance with a proposal that will generate hundreds of millions of dollars in additional profits for the insurance giants. It’s probably not a coincidence that she is also the top recipient of healthcare sector contributions to her presidential campaign.

Looking past the bells and whistles — which do at least include some good sound bites on retiree health and giving regular Americans the same health plan options as members of Congress — the Clinton plan seems to rest on three shaky legs:

1. Forcing all Americans, who do not have current coverage and do not qualify for public assistance, to buy and maintain insurance;

2. Mandating large employers to either provide health benefits or contribute to the cost of coverage

3. Tax credits for just about everyone

If the central elements here sound familiar, they should. The plan is a smorgasbord of the worst elements of what we’ve seen and heard from some other presidential candidates and the plans floating around several state Capitols.

Ironically, given the overheated reaction from Republican candidates, Clinton’s plan most closely resembles the approach of two Republicans — the Mitt Romney-crafted law in Massachusetts and the proposal by California Gov. Arnold Schwarzenegger.

That’s hardly a badge of honor. The Massachusetts model is working best for those with public subsidies, and Schwarzenegger’s plan is now buried in the minutia of a special legislative session while public support for it has been plummeting in the polls.

The biggest failing of this plan, like the Romney and Schwarzenegger schemes before it and like most of the other Democratic candidates’ proposals, is the abject failure to challenge healthcare industry price gouging and runaway costs.

Insurance premiums have climbed 87 percent the past decade, and though they have slowed a bit in the past year, the increase is still double the average increase in wages. That does not include, of course, the rising cost of deductibles, co-pays, prescription drug prices, hospital charges, and, the latest fad, annual doctor fees, like what many people are charged for the privilege of having a credit card or checking account.

This is only the biggest healthcare story of the year. One recent example. Consumer Reports last month reported that more than half of the “underinsured” postponed needed medical care due to cost and a third had to dig deep into their savings to pay for medical expenses. Another third of those over 50 said decisions about their retirement were adversely affected by healthcare costs, one quarter had outstanding medical debt, 38% postponed home or car maintenance repairs due to medical bills, and only 37% said they were prepared to financially handle unexpected major medical costs in the next year.

Throwing more Americans under the wheels of the insurance industry will not solve this problem any more than criminalizing the uninsured is humane or sound health policy.

Clinton’s solution is a combination of tax credits, unspecified encouragement to drug companies to “offer fair prices,” and promoting “consumer price consciousness in choosing health plans.”

But tax credits mostly benefit higher income Americans. And families grappling with skyrocketing prices, and no controls on costs, will likely choose the cheapest, high deductible plans that provide the worst coverage. The sad outcome may be seen in a report earlier this year by the American Academy of Pediatrics that families with high deductible health plans are far more likely to put off needed care, including immunizations and recommended treatment, due to the cost.

Sen. Clinton might have drawn an entirely different idea from her prior unpleasant history with the healthcare industry. She might have decided to cut them out of the business of profiting off pain, suffering and medical debt, and proposed a very different solution, such as expanding Medicare, Medicaid, or the State Children’s Health Program to cover everyone.

Accommodating the insurance behemoths, and effectively offering them massive public subsidies — using the considerable power of government to force everyone to become paying customers of the private insurers — is not the kind of leadership on healthcare we need.

Rose Ann DeMoro is executive director of the California Nurses Association/National Nurses Organizing Committee and a national vice president of the AFL-CIO

New York Times
Letters to the Editor

September 19, 2007

To the Editor

Re “Mayo Clinic Proposing a Universal Health Plan” ( Business Day, Sept. 15):

The Mayo Clinic proposal runs aground where most proposals for universal health care do — how to pay for it.

We have many urgent needs: to improve schools, make roads and bridges safe, meet the needs of veterans and their families. So there are no new sources of funding. “Taxes” is a dirty word, and proposals for subsidies and tax breaks would increase governmental deficits. They are nonstarters.

Our sole hope for funding is to make better use of over $2 trillion already being spent by business and governments. Medicare-for-all would save literally hundreds of billions of dollars on nonbenefit charges by simplifying the processing of billions of billings for insurers and health care providers.

Reducing provider conflicts of interest — which lead to enormous outlays determined by self-interest rather than health needs — could save billions more.

Medicare is marvelously efficient. We do not need to re-invent the wheel.

Merton C. Bernstein
St. Louis, Sept. 15, 2007

The writer served as principal consultant to the 1982-83 National Commission on Social Security Reform.

By Annette Fuentes
USA Today
September 19, 2007

When it comes to protecting our children’s health, where does the federal government’s role end and the responsibility of families begin?

Both houses of Congress want to expand health care coverage of low-income children under the State Children’s Health Insurance Program (SCHIP), which expires at the end of this month. Most members of Congress are concerned that more and more low-income children are falling into the growing pool of the USA’s uninsured, most recently estimated to be 47 million.

But President Bush says expanding the program could encourage families whose children are covered by private health insurance to opt for the government-paid program. Bush says he will veto any bill that would increase the number of children eligible because it would be another step toward a nationalized health care system.

But what’s wrong with such a system?

While the president and his supporters try to scare voters away from the idea of a national health care system, calling it “socialized medicine,” why shouldn’t all ideas be on the table for discussion?

The political skirmish over SCHIP is a microcosm of a larger debate this country needs to have over the direction of national health care reform as we head into the 2008 presidential election.

Put aside politics

Any discussion should begin by acknowledging that the USA already has a national health system: Medicare. The program has been an unqualified success as a government-subsidized and -administered health insurance system.

Ida Hellander, executive director of Physicians for a National Health Program, a non-profit that supports a single-payer approach, notes that Germany was the first to have a national health system early in the 20th century. U.S. conservatives in the post-World War I era attacked proposals for a U.S. national plan by linking it to the former enemy. “The way conservatives scared people off was to call national health ‘the Kaiser’s plan,’ ” Hellander says.

But two “allies” with national health care plans are worth noting:

* Great Britain guarantees all its citizens coverage, paid for by taxes and delivered by doctors employed by the health care system. According to the World Health Organization, the United Kingdom spends 6% of its economy on health care and ranks 18th out of 191 countries in health system performance. The United States spends 16% of its economy on ours, but we rank 37th, a step ahead of Cuba.

* Canada has a single-payer system that guarantees every Canadian coverage. It’s paid for by tax dollars. The government pays all claims, so there is no private insurance industry acting as middleman to administer the system. That’s where the big savings come. In Canada, administrative costs are less than 17% of all health spending, compared with 31% in the USA.

Longer waits

But the Canadian system does have one drawback: Its citizens face somewhat longer waits for some care — such as seeing specialists, receiving MRIs and non-emergency surgeries — than Americans.

In recognition of the high priority Americans place on health care reform, the leading U.S. presidential candidates have at least paid lip service to addressing their concerns, with the Democrats articulating more developed ideas.

On the Democratic side, only long-shot Rep. Dennis Kucinich of Ohio supports a single-payer system. Many use the term “universal health care,” which means that everyone would be covered in some fashion, including through public programs such as Medicare and SCHIP or private insurance plans. John Edwards would require employers to provide coverage or financial assistance, and he would expand public programs such as Medicaid and SCHIP. He also would create regional purchasing pools to make health insurance more affordable. Sen. Barack Obama, D-Ill., calls for a “new national health plan” with guaranteed eligibility and a federal subsidy for those who can’t afford to buy into the new plan. Sen. Hillary Clinton, D-N.Y., proposes a universal health care system that would cover all the uninsured, in part by expanding SCHIP, and that would make health insurance more affordable and protect coverage of those with chronic illness.

Of the Republican candidates, Rudy Giuliani proposes up to $15,000 in tax deductions for families to buy health insurance. Sen. John McCain, R-Ariz., has no plan other than to create “affordable” health insurance without added government spending. And Mitt Romney, who as Massachusetts governor implemented a mandatory universal health insurance plan, now opposes the same approach for the nation. Instead, he supports tax incentives and market reforms to lower costs.

There could be drawbacks to a single-payer system, but there are more good reasons to consider just such a system. We need an open, honest discussion of all possibilities without fearing the bogeyman of nationalized health care. With broad popular support for reform, maybe the debate will yield actual change when a new administration moves into the White House.

Annette Fuentes is an adjunct professor at the Columbia University Graduate School of Journalism and a member of USA TODAY’S board of contributors.

Sptember 14th, 2007 11:03 pm

Dear John,

My name is Julie Pierce. My husband was Tracy Pierce. I am featured in Michael Moore’s documentary ‘SiCKO.’ In the movie, I share my deceased husband’s story — his unsuccessful battle with our insurance company to receive what could have been life-saving treatments for kidney cancer.

I just read your Wall Street Journal article written on Sept. 13, 2007, titled “Sick Sob Stories.” You begin by talking about Tracy’s role in ‘SiCKO,’ and claim the bone marrow transplant denied by our insurer would not have saved him. You also accuse me of “sneering” over our situation.

In your ‘reporting’ of this story, you did not contact me, and you did not contact my husband’s doctors. I cannot believe that a publication like the Wall Street Journal would print such an accusation without talking to anyone involved — especially in such a personal matter, which resulted in the death of my 37-year-old husband and the father of my child.

If you had contacted me, I would have told you that bone marrow transplants became a last option, only after our insurer denied many other treatments again and again and again.

I would have shown you a letter from our doctors at the Blood and Marrow Transplant Program at the University of Kansas Hospital, in which they argued strongly for the bone marrow transplant, citing “strong evidence” supporting the past success of that treatment — they wrote that it could “give him a chance to achieve complete remission.” In fact, they called the bone marrow transplant “his only chance of survival.”

Instead of calling me up and doing real reporting, all you can do is throw around studies from 1999 about the supposed inefficiency of bone marrow transplants for breast cancer patients — even though Tracy didn’t have breasts. He had kidney cancer! I understand that you want to try to prove that private insurance in this country really isn’t that bad. And I can see that you won’t let the facts get in the way.

You go on to claim that Tracy wouldn’t have received his transplant in a country with socialized medicine, either. Where is the evidence? Not only are more bone marrow transplants performed every year in Canada, but they invented the technology! So much for your ridiculous claim that “profit is what has created the amazing scientific innovations that the U.S. offers to the world. If government takes over, innovation slows, health care is rationed.”

You are simply carrying water for the for-profit insurance industry that killed my husband. And then you have the nerve to accuse me of “sneering” about it. My husband has only been dead since January 18th, 2006. It is still fresh to me and my family, and comments like this are inhumane.

I have since tried to contact you via email, but you have not responded. I don’t expect an answer. People like you just write with an agenda, without coming to the source or getting any facts, because your main goal is to try to discredit Michael Moore and universal health care. I understand it’s a game — you did it without thinking about how you would hurt a family who have suffered — and are still suffering — such a tragic loss.

My family is not a “Sick Sob Story.” We are a normal, American family that has had a significant member die from a horrible cancer that ravaged his body due to repeated denials from a health insurance company. We will never know for sure what would have worked because Tracy was never given a fighting chance. Over 18,000 Americans die each year because they don’t have health insurance. I suppose theirs are “sob stories,” too.

I don’t want a hit-piece. I want answers. Why does our wonderful profit-driven system of medicine kill 18,000 Americans each year? Why do we pay far more for our health system than any other country, but have some of the lowest life expectancies and highest infant mortality rates in the Western world? Would you discredit the work of your late colleague Peter Jennings who, while suffering with lung cancer, did an excellent report titled “Breakdown: America’s Health Insurance Crisis”?

I hope you have answers, but I am not optimistic. I pray that you will never have to go through what we went through — if you did, you wouldn’t be so quick to cheerlead the system we were victimized by.

Julie Pierce
Mission, Kansas