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Lance Dickie
Seattle Times | Editorial Columnist
Friday, March 23, 2007

Here is an unadorned fact of political life: An anxious middle class makes things happen, which explains the persistent drum beat of national interest in universal health-insurance coverage. People are uneasy.

The exact shape of the change to come is not clear, but more and more Americans are eager to listen to the options. One of the most straight-forward, and familiar, is national single-payer health insurance.

Everyone keeps their own doctors. Or more to the point, everybody can have one. Health care via physicians, nurses, hospitals, clinics, tests and technicians does not change. The caregivers are not employed by Uncle Sam.

Instead of having private insurance, everyone pays something into a common fund, and government writes the checks. Maybe it is the federal government that pays the bills, or states could be given the cash to devise a payment system that works best closest to home.

The revolution is in financing and reimbursement, not health-care delivery.

All the more curious is this uneasy mood occurring in what are understood to be recession-free, stable economic times of low unemployment.

Not long ago, the observation that unpaid medical bills are the No. 1 cause of personal bankruptcy might have been mildly interesting, like the unemployment rate if you have a steady job. Instead there is an unsettling recognition of vulnerability.

The middle class watches as medical benefits are cut as they grow more expensive or are lost altogether. Parents worry about grown children going without insurance because of the cost or employers who do not provide it.

Two short generations out from broad employer-based coverage, grandchildren come into the world without the neo-natal talisman of economic stability, a health-insurance card.

Two things are happening. In huge numbers, voters — a key word — are telling pollsters they think the federal government should guarantee health insurance. They are willing to pay higher taxes and forego tax cuts for the coverage, according to a recent New York Times/CBS News Poll.

Politicians hear the rumblings, and they are reacting in state capitals and on Capitol Hill with ideas and plans, many of which have been around a while. The stunning reversal of fortune for Congressional Republicans helped with the sensitivity training.

Last Friday on an unseasonably balmy evening, 300 people were in Kane Hall on the University of Washington campus to offer a rock-star welcome to three leaders working to provide universal health care. Given the topic and the weather, it was like packing Key Arena.

Rep. Jim McDermott, D-Seattle, and Dr. Quentin Young, co-founder of the Chicago-based Physicians for a National Health Program, have seen the political climate and national conversation turn in their direction. At the heart of both their optimistic talks was the need for public education.

Young, a wise-cracking octogenarian praised as a policy bulldog, works to keep the essence of single-payer simple. Repeat after him: Everybody in. Nobody out.

McDermott is equally tenacious. He first introduced his single-payer legislation in 1992. Bloodied but unbowed by the health-care debacle of the Clinton years, McDermott sees versions of his federal bill sprout in legislatures around the country. In a telephone call this week, McDermott said he sees the activity in the states as part of a welcome ferment that will help drive action at the national level.

The other significant change in the dynamic for universal health care is the interest being shown by major employers and labor unions. Over time, he expects state efforts and business support to point toward a single universal national plan.

Rep. Sherry Appleton, D-Poulsbo, was given an award by the Northwest chapter of Young’s group, for her work on The Washington Health Security Trust, which is dead for this session. A good idea, it will be back. Washington has 643,000 people without health insurance, 15 percent of the 43 million Americans without any coverage. Millions more have inadequate insurance.

State by state or via Washington, D.C., anxious Americans are demanding change. In this atmosphere, no credible presidential candidate can afford to be without a coherent health-insurance plan.

Lance Dickie’s column appears regularly on editorial pages of The Times. His e-mail address is ldickie@seattletimes.com

Copyright (c) 2007 The Seattle Times Company

By Gregory Lopes
Washington Times
March 23, 2007

America’s largest organized labor union is setting the stage for a campaign to reform the country’s health care system.

The AFL-CIO’s Working America, an affiliate of the union, this week set up the Web site: “Health Care Hustle.”

The site is a public forum for medical horror stories from the country’s health care system. “We’re getting hustled by powerful interests who don’t want to pay their fair share for real reform,” said Working America Director Karen Nussbaum.

The Web site already has 550 health care horror tales posted. The stories assess blame for health care hardships, whether it’s special-interest organizations such as the pharmaceutical lobby and insurance companies or the Bush administration.

At the end of the year, Working America will tally the “evildoers” in each story and create a media campaign targeted at that entity.

“We’re going to take the power of the people combined with the institutional power of the AFL-CIO and teach the evildoers a lesson. We think they will feel the pressure,” said Ms. Nussbaum.

The AFL-CIO is not part of a recent health care collaboration between the Service Employees International Union and corporate giants such as Wal-Mart. Ms. Nussbaum said that plan takes the wrong path to universal health care by shifting too many medical expenses to workers. Instead, she said a universal health care system must be built on the government-run Medicare program.

Using Web-based weapons is a new tactic for trade unions that, not long ago, were able to wield influence through numbers rather than technology. But federal statistics released this month show national union membership for 2006 at 12 percent of wage and salary workers, down from 12.5 percent in 2005 and 20.1 percent in 1983.

Media Advisory
March 20, 2007

CONTACTS:
Don McCanne, MD — (949) 493-3714
David Himmelstein, MD — (617) 665-1032
Nicholas Skala — (312) 782-6006

Leaders of the 14,000-member Physicians for a National Health Program (PNHP) will be available for commentary and analysis of candidates’ health proposals related to the “New Leadership on Health Care” presidential forum hosted by the Service Employees’ International Union and the Center for American Progress. The event will be Saturday, March 24th, 2007, 12:15 pm ET at the University of Nevada, Las Vegas.

PNHP is the nation’s largest organization advocating a single-payer national health insurance system. For more than 20 years, PNHP has been at the forefront of the U.S. health policy debate. PNHP leaders have published original research in the New England Journal of Medicine, the Journal of the American Medical Association, and Health Affairs. Members have also done countless media appearances and interviews, including the New York Times, USA Today and the Wall Street Journal. Major research by PNHP includes:

* Americans already pay the world’s highest health care taxes. We spend enough for national health insurance — we just don’t get it.
_{(Woolhandler, et al. “Paying for National Health Insurance — And Not Getting It,” Health Affairs 21(4); July / Aug. 2002)}

* Nearly one-third (31 percent) of health spending goes to administration and paperwork which result from our reliance on private insurance companies.
_{(Woolhandler, et al “Costs of Health Administration in the U.S. and Canada,” NEJM 349(8) Sept. 21, 2003)}

* Half of all U.S. bankruptcies are due in part to illness and medical bills.
_{(Himmelstein et al, “Illness and Injury as Contributors to Bankruptcy,” Health Affairs Web Exclusive, February 2, 2005)}

Local physician experts are available for most state and metropolitan media.

WHAT: Physician health policy experts available for interview about presidential candidates’ health proposals

WHEN: Following SEIU/CAP “New Leadership on Health Care” forum, Saturday, March 24th, 2007, 12:15 pm ET

WHERE: Experts are available for comment on all areas of national policy, and local PNHP representatives are available in most states and major metropolitan areas.

To Schedule an Interview: Contact Nicholas Skala at 312-782-6006. An analysis of John Edwards’ health proposal by PNHP Senior Health Policy Fellow Dr. Don McCanne is available at:

Critique of Edwards’ Health Plan:
https://www.pnhp.org/news/2007/february/harry_and_louise_on_.php

And a policy analysis archive by Dr. McCanne is available at:
https://www.pnhp.org/news/quote_of_the_day.php

Physicians for a National Health Program is an organization of 14,000 physicians that support single-payer national health insurance. PNHP is headquartered in Chicago and has chapters and spokespeople across the U.S. To contact a physician-spokesperson in your area, contact nick@pnhp.org or call 312-782-6006. www.pnhp.org.

By Alex Gerber
Washington Times
Commentary
March 18, 2007

Modern medicine has probably done more to mitigate the misery and suffering that plague mankind than all the political ideologies, economic theories and religious persuasions combined.

The triumphs of modern medicine, however, are marred by the failure of health-care socioeconomics to keep pace with the brilliant advances of medical science and technology. The soaring costs of health care and the millions of medically uninsured Americans are stark testimonies of this truism.

Health-care costs are rising the fastest in history. Since 2000, private, employer-based insurance premiums have risen 4 times faster than wages. Total health-care spending has reached $1.9 trillion annually, 16 percent of the national gross domestic product (GDP), almost twice the ratio of the other industrialized nations and projected to climb to $4 trillion, 20 percent of the GDP, by 2015.

We can no longer ignore the dire consequences of the increasing health-care costs. Federal Reserve Board Chairman Ben Bernanke has warned us a fiscal crisis looms due to these unsustainable costs and “the U.S. economy could be seriously weakened, with future generations bearing the costs.” This admonition was first raised by George Washington’s 1796 Farewell Address when he impugned “ungenerously throwing upon posterity the burden which we ourselves ought to bear.”

Also hovering like dark clouds over our health-care system are 47 million medically uninsured Americans — having risen 5 million since President Bush assumed office. That the uninsured have poorer medical outcomes has been well documented. Indeed, there are wards in our nation’s capital where health statistics are akin to those of Third World countries. The National Institute of Medicine has reported that 18,000 Americans die yearly for lack of health insurance, and our economy loses $60 billion to $ 130 billion per year due to poor health and early death.

The problem of runaway health costs and huge numbers of medically uninsured is related to the unanticipated nature of accidents and disease. The answer to preventing a medical calamity from becoming a financial catastrophe is budgeting in advance through insurance as we do for a possible house fire or auto accident.

But there are modifying factors with health insurance, revolving around society’s decision that health care, unlike owning a home or an auto, is a fundamental right. Thus, health problems beyond an individual’s control — diabetes, congenital birth defects, being hit by a drunk driver — should be insured by the community’s pooling of resources (not unlike the collective responsibility civilized societies assume for allaying the costs of natural disasters like hurricanes or floods). Since Otto von Bismarck introduced this concept in Germany more than a century ago, all modern industrial nations, except the world’s richest, have come to this conclusion.

The reason for this American anachronism is buried in history. During World War II, the War Labor Board froze wages and workers were in short supply. To lure them, employers picked up the tab for complete health insurance. National health-care costs in those days totaled only $40 billion yearly — less than 5 percent of the Federal GDP. Due to the influence of its well-paid lobbyists in Washington, the private insurance industry has maintained its dominance of health insurance to this day.

Many health-care insurers are more interested in the bottom line than in the public’s health. The obvious way to increase profits is to decrease benefits by excluding poor health risks from insurance programs. This adverse selection of “cherry picking” plus the 10 percent to 30 percent overhead of marketing, advertising, stockholder dividends and huge executive salaries — none of which cures a single patient — is largely responsible for health-care costs that have “broken” our health-care system.

The answer to our outmoded, multipayer, profit-oriented health-care industry is its replacement by a nonprofit, single-payer government agency. In short, universal health insurance (UHI) through Medicare for our entire population. President Clinton attempted to reform our health-care system along these lines but could not compete with the insurance industry’s $19 million, Harry and Louise TV blitz that conned the public and Congress into believing UHI was “socialized medicine,”

In fact, our country already has UHI — workman’s compensation, which is the law in all 50 states. Society mandates health insurance for breadwinners who are injured on the job but not if they suffer the same injury while driving home from work. Why should a 5 o’clock whistle determine whether medical expenses are covered?.

In this regard, UHI will not be as costly as popularly assumed — perhaps one-tenth the eventual $2 trillion cost of the Iraq war. The uninsured are not all dying on the streets. The majority are obviously receiving care, admittedly delayed, somewhere — emergency rooms, public hospitals or uncompensated care at private hospitals and clinics — with a “cost shift” to the insured. We thus already largely pay for the care of the uninsured.

The model for a UHI program could well be the Canadian UHI health care system, with modifications, which boasts a quality of care equal to ours at far lower cost. Indeed more personnel are needed to administer Blue Cross in Massachusetts than to administer the entire health care system in Canada.

It was not always so. In 1971, the ratio of total health care costs to GDP was 7.1 percent in Canada and 7.6 percent in the United States. With the adoption of its single-payer health care system 25 years ago, Canada’s ratio rose to 9.6 percent in 2006 while ours has almost doubled to 16 percent.

Briefly, Canada’s health-care system provides one standard of care for the entire population, rich and poor alike, under a tax-funded plan. There are no additional expenses (deductibles or co-payments) at the time of treatment.

The superiority of Canada’s health-care system was perhaps best expressed by a recent Harris Interactive poll among the leading industrial societies that evaluated patient satisfaction with their health-care system. Canada ranked first and the United States last. An ABC News poll found that, by a 2-to-1 margin, Americans prefer a switch to Canada’s health-care system.

We should heed the voice of the people.

Alex Gerber, M.D.,a clinical professor of surgery, emeritus, at the University of Southern California, is a former health-care consultant to the White House and the U.S. Department of Health and Human Services.