PNHP

Lewin Group analysis of Sen. Wyden's plan

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Lewin Group analysis of Sen. Wyden's plan

Cost and Coverage Estimates for the “Healthy Americans Act”

Prepared By: John Sheils, Randall Haught, Evelyn Murphy
The Lewin Group
December 12, 2006

(The Healthy Americans Act is a bill being introduced by Sen. Ron Wyden of Oregon.)

Executive Summary (excerpts):

The “Healthy Americans Act” (HAA) establishes a centrally financed system of private health insurance for all Americans except those covered through Medicare or the military. Participants would chose from a selection of private plans offered through newly created regional purchasing organizations called “Health Help Agencies” (HHA’s). All Americans would have coverage at least as comprehensive as the health coverage now provided to members of Congress and federal workers, although an actuarially equivalent substitution of HMO and Health Savings Account (HSA) plans is permitted.

Employers would be required to “cash-out” their health plans by terminating their existing health coverage and paying the amount saved to their workers in the form of increased wages. The current tax exemption for employer provided health benefits is eliminated to strengthen incentives for families to seek lower cost coverage. However, a new “health premium” tax deduction is created so that these wage increases do not increase federal personal income tax payments. To maintain incentives to control costs, the deduction is fixed and can not be increased by purchasing more costly coverage.

All HAA participants would pay premiums through their annual income tax filings. The program would fully subsidize the premium for those below 100 percent of the federal poverty level (FPL), with the premium phasing-in for people living between 100 percent and 400 percent of the FPL. People who do not have enough income to pay taxes are assumed to be eligible for the program with full subsidies, thus eliminating the need to apply separately for assistance as under the current Medicaid program. Employers also would be required to pay an assessment ranging from 2 to 25 percent of the national average premium for the minimum benefits package, depending upon firm size and revenues per worker.

E. Private Employer Impacts (excerpts):

Private employer health spending under the HAA is reduced under the HAA by $309.8 billion, from $428.8 billion under current law to $119.0 billion under the program.

We assume that the savings to employers would be passed-back to workers in the form of increases in wages. This reflects the HAA requirement that employers “cash-out” their benefits plans. It also reflects economic theory and research indicating that changes in employer benefits for health care are, in the long run, passed back to workers in the form of wages or some other form of compensation such as pensions or disability insurance.

This reflects that the employer’s true cost of employing workers includes all compensation costs including: wages less employer payroll taxes, health benefits, pensions, and other non-cash benefits. In competitive labor markets, eliminating the health benefits (or any other form of compensation) would bid-up other forms of compensation such as wages so that aggregate compensation levels are largely unchanged.

http://wyden.senate.gov/Healthy_Americans_Act/HAA_Cost_Coverage_Report.pdf

Sen. Wyden’s plan (with links to the Act and other documents):
http://wyden.senate.gov/media/2006/12132006_Healthy_Americans_Act.htm

Comment:

By Don McCanne, MD

Sen. Wyden’s proposal is an individual mandate to purchase private health plans. Much has been written about the flaws of such models, and no attempt will be made to address most of those issues here. Rather only one serious fundamental flaw in the application of economic theory will be discussed.

The theory is that in competitive labor markets, total compensation is determined by the market, but the distribution between payroll and other benefits such as health plans and pensions does not influence the total compensation. Thus termination of a health benefit program results in an increase in wages that has the same monetary value.

In Sen. Wyden’s proposal, not only does it assume this theory to be true, it also provides back-up enforcement by requiring that employers increase wages by the same amount of the health benefit that will be terminated under this Act, but only for the first two years. After that, the competition of labor markets resumes, but without the complication of a health benefit program. Employees are on their own for accessing and funding their health plans.

Whether through union efforts or in the open job market, compensation is negotiated, at least theoretically. That includes wages and often health benefits and pensions. It does not include food. It does not include housing. It does not include transportation. It does not include any other basic needs. Those needs fall under the category of personal responsibility – use your wages wisely to meet those needs.

Now health care is shifted away from being considered as part of the compensation package, over into this realm of personal responsibility.

Have wages kept up with the costs of basic needs? There certainly has been a redistribution from wage earners to the wealthy. The minimum wage has not been increased for many years. Consumer debt continues to expand. Personal savings are now a negative. Personal insolvency continues to grow. Yet employers are not providing wage increases that are indexed to food, nor to housing, nor to transportation. Now that they are no longer in charge of health coverage, they will feel no obligation to index wages to health costs either.

The Lewin report contends that price competition between health plans, and greater administrative efficiencies will lower costs significantly. If the consolidated efforts of employers have been unable to control costs and waste, how can individual purchasers ever expect to exert market pressures to achieve these efficiencies?

The last section of the Act list many other potential sources of cost savings. Reading the list, the savings potential for many is simple rhetoric, not supported by fact. Some of them would actually increase costs. The Act excludes more effective cost measures such as those of the single payer model.

The point is that costs will continue to increase and wage earners will have to face those costs alone. Employers will have divorced themselves from the problem and will not make an exception for health care anymore than they already do for food, housing and transportation.

Wyden’s plan falls apart since it depends on price competition of health plans, which in turn depends on shifting more unaffordable costs directly to those who need care.

The shocking extent of underinsurance

Changes in Financial Burdens for Health Care National Estimates for the Population Younger Than 65 Years, 1996 to 2003

Jessica S. Banthin, PhD; Didem M. Bernard, PhD
JAMA
December 13, 2006
JAMA. 2006;296:2712-2719.

Context: Policymakers as well as physicians need to understand how rapidly rising health care costs are affecting specific groups of patients.

Objective: To estimate the number and characteristics of individuals in the United States faced with very high financial burdens for health care.

Design, Setting, and Population: Data from a nationally representative sample of civilian, noninstitutionalized US individuals younger than 65 years from the Medical Expenditure Panel Surveys were used to calculate 2 measures of financial burden as a function of tax-adjusted family income. Total burden included all out- of-pocket expenditures for health care services, including premiums.
Health care services burden excluded premiums and, when applied to the insured population, was used to identify the underinsured. We defined the underinsured as insured persons with health care service burdens in excess of 10% of tax-adjusted family income.

Main Outcome Measures: Total and health care services burdens exceeding 10% and 20% of family income in 1996 and 2003.

Results: In 2003, there were 48.8 million individuals (19.2%) living in families spending more than 10% of family income on health care, an increase of 11.7 million persons since 1996. Of these individuals, about 18.7 million (7.3%) were spending more than 20% of family income. In 2003, individuals with higher-than-average risk of incurring high total burdens included poor and low-income persons and those with nongroup coverage, aged 55 to 64 years, living in a non– metropolitan statistical area, in fair or poor health, having any type of limitation, or having a chronic medical condition. Applying our definition of underinsured to the insured population, an estimated 17.1 million persons younger than 65 years were underinsured in 2003, including 9.3 million persons with private employment-related insurance, 1.3 million persons with private nongroup policies, and 6.6 million persons with public coverage.

Conclusions: Our analysis identifies patients at greatest risk of health-related financial burdens that may adversely affect their access and adherence to recommended treatments. Our study also highlights the high costs associated with nongroup health insurance policies.

Author Affiliations: Division of Modeling and Simulation, Center for Financing, Access and Cost Trends, Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Md.

http://jama.ama-assn.org/cgi/content/abstract/296/22/2712?etoc

Comment:

By Don McCanne, MD

Not more numbers! Don’t we have enough to make the case for national health insurance?

These numbers are important. Let’s see if we can make some sense of them.

This study indicates that the financial burden on families of medical costs has continued to grow worse. We should look at the most recent year studied, 2003, to get a better idea of the extent of the problem as we experience it today.

This is not a study of the numbers of uninsured (we already know those numbers), nor is it a study of the numbers with inadequate insurance or underinsurance (we don’t know those numbers). Rather, it is a study of the numbers of individuals under 65 who experienced financial hardship in a single year because their health care costs were greater than our health care financing system was capable of protecting against. It is not a study of the potential risks, but rather it is a study of actual financial harm done.

Most can agree that spending more than 10% of family income on health care constitutes a financial hardship, except perhaps for the very wealthy. So how many individuals experienced this hardship in one year – 2003? 48.8 million individuals, or 19.2% of our population!

One-fifth of all Americans! If you were to average that out, that means that everyone of us would have a year of financial hardship due to medical bills within the next five years, and every five years. Of course, disease is not evenly distributed, so those who remain healthy will not have a problem, but those with medical disorders will have multiple years of hardship.

Spending 20% of family income would certainly be disastrous for almost all of us. How many individuals spent that in 2003? 18.7 million or 7.3% of our population! That’s a disaster!

Well let’s forget about the uninsured for a minute and look at those of us who have insurance. Let’s not even count the insurance premiums that we or our employers are paying, but let’s look exclusively at the out-of-pocket expenses that we are paying for health care. This will give us a better idea of just how well our insurance is working.
How many paid more than 10% of family income for health expenses not covered by their insurance? Of those younger than 65, 17.1 million individuals! Underinsurance is a national epidemic that engulfs many more everyday!

There are some very important numbers from the tables in the article that do not appear in the abstract above.

What percent of middle-income Americans spent more than 10% of family income on health care? The answer? 22.7%!! That is almost as much as the 23.7% of low-income families that spent over 10% on health care. Health care costs are not just a problem for the poor, they are very much a problem for middle-income America!

One very small number from the charts may say the most about our flawed system of financing health care. What percent of high-income Americans spent more than 20% of their incomes on health care? One- fifth of their high incomes is a lot of money. Well, it was only 0.6% But think about that. One out of every 167 high-income Americans had to spend over 20% of their incomes on health care. If our health care financing system cannot reliably protect the wealthy, then it is a flawed system indeed.

Maybe the wealthy don’t care. The chances are 166 out of 167 that they won’t experience major medical debt in any given year, and they will likely outlive those odds. But middle-income Americans should be very, very afraid!

Common Council of the City of Bloomington, Indiana

Presentations were made by members of Hoosiers for a Commonsense Health Plan: Drs. Rob Stone, and Mary Mahern, by retired Bloomington Hospital CEO Mr. Bud Kohr, and by Cindy Lott for the board of the Monroe County Volunteers in Medicine Clinic. Many members of the public testified as well. The final vote was 7 in favor, none opposed, and 2 abstentions.

Resolution 06-16:
SUPPORTING STATE AND FEDERAL LEGISLATION ENACTING UNIVERSAL PUBLICLY-PAID HEALTH INSURANCE

WHEREAS, over 46 million Americans, 860,000 Hoosiers and 15,000 Monroe County residents have no health insurance, and over 80% of these uninsured people live in families in which at least one family member works; and

WHEREAS, large and small businesses are having increasing difficulty providing health insurance to their employees, and this difficulty is adding to the number of uninsured; and

WHEREAS, The Institute of Medicine estimates that 18,000 people die every year because they lack insurance and cannot access adequate health care; and

WHEREAS, The Institute of Medicine estimates that tens of millions of Americans are under-insured, lacking sufficient coverage for vital care and medications; and

WHEREAS, even those with adequate insurance are facing growing premiums,
co-payments and deductibles, as well as the fear that their insurance might be cancelled; and

WHEREAS, illness and medical bills are the leading cause of personal bankruptcy in the nation and Indiana has one of the highest rates of medical bankruptcy in the country; and

WHEREAS, this growing problem cannot be ignored any longer by our legislative bodies; and

WHEREAS, United States Representative John Conyers has introduced House Resolution 676, (HR 676), the United States National Health Insurance Act, which would provide healthcare to all; and

WHEREAS, a proposal for Universal Publicly Paid Health Care in Indiana will be introduced in the Indiana legislature in January 2007; and

WHEREAS, the Common Council passed Resolution 94-54 in 1994 calling for a universal health care system and since that time, the health care crisis has only worsened; and

WHEREAS, health care is a basic human right;

NOW, THEREFORE, BE IT HEREBY RESOLVED BY THE COMMON COUNCIL OF THE CITY OF BLOOMINGTON, MONROE COUNTY, INDIANA, THAT:

SECTION I. The Council supports the principle of universal publicly-paid health insurance that would provide health care to everyone at reasonable costs.

SECTION II. The Council supports universal publicly-paid health insurance that would provide for physician and hospital visits, pharmaceuticals, preventative care, dental care, long-term care, substance abuse treatment and mental health care without deductibles and co-payments, and would provide all patients and providers freedom of choice.

SECTION III. The Council supports and endorses HR 676 the United States National
Health Insurance Act and respectfully requests our elected federal officials to endorse and adopt HR 676.

SECTION IV. The Council supports and endorses State legislation providing for universal publicly-paid health insurance for all Indiana residents.

SECTION V. The Council directs the City Clerk to send a copy of this resolution to the President of the United States, members of the Indiana Congressional Delegation, other members of the United States Congress in positions of leadership in the House and Senate and their committees with jurisdiction over public health, the Governor of Indiana and members of Bloomington’s delegation to the Indiana legislature, and other leaders of the State legislature as deemed appropriate.

SECTION VI. The Council directs that this resolution be posted on the City of Bloomington web site.

PASSED AND ADOPTED by the Common Council of the City of Bloomington, Monroe County, Indiana, upon this 6th day of December, 2006.

CHRIS STURBAUM, President | Bloomington Common Council

SIGNED and APPROVED by me upon this 7th day of December, 2006.

MARK KRUZAN, Mayor
City of Bloomington

ATTEST:

REGINA MOORE, Clerk
City of Bloomington

SYNOPSIS

This resolution is sponsored by Council members Tim Mayer, Andy Ruff, Chris Gaal, and Mike Diedhof, and documents the problem of access to affordable health care. The resolution points out that the growing cost of health insurance makes adequate care inaccessible to many, causes over 18,000 deaths in the country each year, brings about great suffering, triggers personal bankruptcy and stifles small businesses. Concluding that health care is a basic human right, the resolution supports the principle of universal publicly-paid health insurance that would provide care to everyone. The resolution supports a plan that would provide for physician and hospital visits, pharmaceuticals, preventative care, dental care, long-term care, and non-discriminatory mental health care without deductibles and co-payments, and would provide all patients and providers freedom of choice. Finally, the resolution supports federal and State legislative initiatives to implement universal publicly-paid health care.

Political Party Resolution

The following resolution was introduced by Rep. Kucinich (Oh-10) to the Democratic Party.

Whereas, each citizen’s “pursuit of happiness” depends upon maintaining health; and

Whereas, a healthy economy depends upon a healthy and productive citizenry; and

Whereas, the present health system has abandoned 40 million Americans and forces 30 million to use only emergency, often too-late care; and

Whereas, many families access to health care driven into poverty by the high cost of premiums and high deductibles and out-of-pocket costs; and

Whereas, health insurance costs for small businesses have increased steadily since 1998 and are predicted to double over the next four years; and often force small businesses to hire part-time staff with no benefits, or to stop offering health insurance completely; and

Whereas, insurance companies, being businesses, must work to protect and increase profits even when doing so is to the detriment of the very health care they are meant to make possible; and

Whereas, the removal of the profit motive from the health care system would refocus the system on health; and

Whereas the removal of the profit motive from the health care system would refocus the system on health; and

Whereas, the U.S. pays more than all other industrialized countries for health care, but provides less coverage to fewer people; and

Whereas, the General Accounting Office concludes that if the U.S. shifted to a single payer system of universal coverage, “the savings in administrative costs would be more than enough to offset the cost” of providing health care to everyone; therefore be it…

Resolved, that the Democratic Party support the establishment of a universal single payer, national health care system in the U.S.; and be if further

Resolved, that such a system be publicly financed, but privately delivered; allow people to choose their own health care providers; provide preventive health care, dental care, mental health care, and affordable prescription drugs; and make health care available to everyone regardless of pre-existing conditions, status of employment, or income level.

State Legislature Resolution

The following resolution was introduced to the House of Representatives of the General Assembly of the Commonwealth of Kentucky.

A concurrent resolution endorsing the National Health Insurance Act.

Whereas, every person in Kentucky and in the United States deserves access to affordable, quality health care; and

Whereas, there is a growing crisis in health care in the United States of America, manifested in rising health care costs, increased premiums, out-of-pocket spending, decreased international business competitiveness, and massive layoffs; and

Whereas, approximately 582,000 Kentuckians lacked health insurance in 2004; and

Whereas, those insured now often experience unacceptable medical debt and sometimes life-threatening delays in obtaining health care; and Whereas, one-half of all personal bankruptcies are due to illnesses or medical bills; and

Whereas, the increasing expense of Medicaid and the rising costs of insuring states employees and teachers can best be met not by limiting benefits, but by expanding them under a national, publicly-funded health insurance program; and

Whereas, the complex bureaucracy arising from our system of fragmented, for-profit, multi-payer system of health care financing consumes approximately thirty percent (30%) of the United States health care spending; and

Whereas, researches from Harvard University found that bureaucracy consumed more than $4 billion of Kentucky’s health care spending in 2003, which equals $8,216 per uninsured Kentucky resident; and

Whereas, the United State Representatives John Conyers and Dennis Kucinich have introduced H.R. 676, the United States National Health Insurance Act, in the United State House of Representatives for the 109th Congress, and this act would provide a universal, comprehensive, single payer system of high quality national health insurance;

Now, Therefore, Be it resolved by the House of Representatives of the General Assembly of the Commonwealth of Kentucky, the Senate concurring therein:

Section 1. The Kentucky General Assembly respectfully urges the United States Congress to enact the United States National Health Insurance Act sponsored by Representative Conyers.

Section 2. The Clerk of the House of Representatives is directed to transmit a copy of this Resolution to the President of the United States and the members of the Kentucky Congressional Delegation.

Sample Specialty Society Resolution

INTRODUCED BY: List Sponsors (The more, the better!)

TITLE: National Health Insurance- Improved Medicare for All

WHEREAS, the number of Americans uninsured is in excess of 46.6 million and tens of millions more Americans are underinsured and growing1;

WHEREAS, physicians have a moral imperative to advocate for a healthcare system in which all Americans have guaranteed access to high quality and affordable healthcare;

WHEREAS, business is increasingly withdrawing coverage from employees1;

Whereas, the quality of practice for physicians is declining and the lack of control over the practice of medicine (e.g. reimbursements, procedures and formularies) is growing;

WHEREAS, the healthcare infrastructure is inadequate and deteriorating (e.g. reduction in number of emergency rooms2, decrease in hospital beds3 and a decline in the ability to fulfill projected physician workforce requirements4);

WHEREAS, in the new global economy, American companies are at a competitive disadvantage, in part due to health care costs;

WHEREAS, our hodgepodge healthcare system is inadequate to meet homeland security threats (e.g. natural disasters, possible flu epidemics5 and terrorist attacks);

WHEREAS, universal health insurance would guarantee payment for all patients treated;

WHEREAS, the U.S. spends twice as much per capita in healthcare costs compared to other western democracies, yet fails to include all its citizens and fails to achieve equivalent healthcare statistics (e.g. life expectancy, infant mortality and vaccination rate)3;

WHEREAS, a single source government health insurance, i.e. Medicare, would reduce the vast sums of money spent on administrative costs that could more appropriately go to direct patient care6;

WHEREAS, medical malpractice premiums would decrease because settlements would not have to cover future medical expenses of the plaintiff;

WHEREAS, universal Medicare would increase choice of doctors and portability and eliminate job lock;

NOW, THEREFORE BE IT Resolved: that the (Name of Organization) does hereby endorse and will support HR 676, United States National Health Insurance Act (or the Expanded and Improved Medicare for All Act), which covers all medically necessary care for every American and guarantees meaningful physician input and/or negotiating power over all aspects of medical practice and the healthcare system;
and be it further Resolved: that the (Name of Organization) does hereby commit to encourage other medical groups to adopt the same policy and work together with other medical organizations work towards bringing this to reality.

Thanks to Harvey Fernbach for introducing a similar version of this resolution to the Maryland Medical Society.

1. Income, Poverty, and Health Insurance Coverage in the United States; 2005, August 2006. Current Population Reports U.S. Census Bureau
2.”Hospital-Based Emergency Care: At the Breaking Point,” Institute of Medicine, June 14, 2006
3. Health at a Glance- OECD Indicators 2005
4. “Physician Workforce Policy Guidelines for the U.S. 2000-2020,” Council on Graduate Medical Education, July 2004
5. National Strategy for Pandemic Influenza: Implementation Plan, Homeland Security Council, May 2006
6. Woolhandler, S., Campbell, T., and Himmelstein, D. “Costs of Health Care Administration in the United States and Canada.” New England Journal of Medicine 349:768-775, 2003

Insurance broker fraud

Only wreckage remains when insurance agents breach trust You think you're covered? You might be surprised, and at the worst possible time.

By Mark Morris
The Kansas City Star
December 11, 2006

Insurance agent misconduct and fraud is widespread and getting worse, according to experts interviewed by The Kansas City Star.

Among the most common abuses: agents who steal a client’s premiums by failing to forward them to the insurance company. Bad agents also sell unlicensed products or coverage that is unsuitable. And some are just crooks, no better than a policyholder who commits insurance fraud.

“A disturbing and growing number (of agents) won’t hesitate to bilk their own clients in order to pad their own lifestyle or bail out an agency that’s in trouble,” said James Quiggle, a spokesman for the Coalition Against Insurance Fraud, a nationwide advocacy group supported by insurance companies, regulators and consumer groups.
“It’s a front-and-center problem for regulators all over the country.”

To be sure, most agents are honest, according to experts who have studied the insurance industry.

http://www.kansascity.com:80/mld/kansascity/16210675.htm

Comment:

By Don McCanne, MD

Health care injustice is not only tragic, it is also infuriating when it is due to criminal misdeeds of entrusted advisors. But the problem of dishonest insurance agents is negligible compared to the problems inherent in the way individual plans are marketed and sold. It is the honest, ethical agents who are trying to do their best for their clients who are the real problem, though through no fault of their own.

Insurance agents have a difficult task. They must help their clients purchase plans that are affordable, that provide adequate financial protection, that will cover preexisting disorders, that will ensure that providers are accessible, and they must be certain that the insurer is reliable and capable of assuming risk. Truth told, there are no health insurance products that meet all of these standards. So the agent is in a position of assisting his/her client in selecting a compromised product, and may not even be able to provide any product if costs are prohibitive or medical underwriting prevents coverage.

Insurer administrative costs are already outrageous, yet the insurance agents add still another layer of pure administrative costs that provide no medical benefit. Under our fragmented system of financing health care, the services of an agent are essential whether that function is performed by an independent agent or an agent of the insurance company. It’s simply more waste. But worse, the need for competitive premiums results in products that fall short on the goals of comprehensive, affordable coverage for any and all applicants.

What we need is a single insurance product that covers all reasonable, beneficial services, and one in which enrollment is automatic for everyone for life. We wouldn’t need brokers to help us do that if we had a single payer program of national health insurance.

Robert Gumbiner on single payer

A Solution to America’s Health Care Crisis: Curing Our Sick Health Care System

By Robert Gumbiner, M.D., with Alis Gumbiner

I am proposing the federal government as the single payer of health care in this country. Only the federal government has the ability to fund one large risk pool through a payroll deduction. As the single payer, the federal government could negotiate hospital and physician payments even more effectively than it does now with Medicare. In addition, the federal government could negotiate prices for prescription drugs.

A single pool of funds, collected and administered by the government, would expand Medicare and replace Medicaid, SCHIP, the Veteran’s Administration, and private health insurance, including the health care aspect of Worker’s Compensation Insurance. Also eliminated would be the tax credit – or subsidy – given to companies for providing private health insurance to their employees. In other words, the current, inefficient patchwork of payment systems would disappear, to be replaced by one nationwide program available to every citizen.

http://www.healthcarecure.org/

Comment:

By Don McCanne, MD

What is remarkable about this quote in support of single payer is its source: Robert Gumbiner was the founder of FHP, one of the nation’s largest managed care companies.

Dr. Gumbiner received fame (some might say infamy) for his innovations in developing systems that controlled health care costs. In his book, he describes his successes and failures, and his evolving thoughts about how to best address the problem of affordability, currently the nation’s leading concern about health care. His bottom line is that we must enact a national single payer program, and that conclusion is coming from a manager’s perspective.

No funds for children's insurance, only for HSAs for the rich

Congress Punts on Children’s Health Care in Favor of Tax Shelter for Wealthy Statement of Robert Greenstein, Executive Director

Center on Budget and Policy Priorities
December 7, 2006

It is stunning that as one of its final acts, Congress chose to attach to the tax extenders bill a provision making Health Savings Accounts more lucrative as tax shelters for wealthy individuals even as Congress refused to provide funds needed to ensure that up to 600,000 low-income children keep their health insurance through the State Children’s Health Insurance Program in 2007.

It has been known all year that without additional SCHIP funding, 17 states would face SCHIP shortfalls in 2007. The Administration included a proposal in its budget to address these shortfalls.
Various bills to resolve the problem were introduced in Congress. But when decision time came, Congressional leaders declined to act.
Coverage for up to 600,000 low-income children will be at risk as a result.

When it came to making HSAs more lucrative as tax shelters, by contrast, Congressional negotiators charted a different course. They took a special-interest HSA bill that had never been considered on the floor of either the Senate or House and attached it to the same bill to which they declined to attach the needed SCHIP resources.

To say this is disappointing would be an understatement. Congress has provided another windfall for Uncle Scrooge — and a lump of coal for Tiny Tim.

http://www.cbpp.org/12-7-06health-stmt.htm

Background on SCHIP shortfall:
http://www.cbpp.org/6-5-06health2.htm

Background on HSA expansion:
http://www.cbpp.org/9-26-06health2.htm

Comment:

By Don McCanne, MD

Is this really the message that voters sent Congress last month?

Inside Track: An Irreverent Read on Vermont Politics

by Peter Freyne
Vermont Political History
12.06.06
Seven Days

Health Care Reform Hero? — Full disclosure: This writer admits to being an AARP member. Aging gracefully. That means we get the magazine. And the latest edition, which arrived last Thursday, was a hot one!

It had nothing to do with actor Robert DeNiro on the cover. It had everything to do with the full-page photo of Vermont Gov. Jim Douglas inside. Seated in blue business suit and red tie, the Green Mountain guv was surrounded by a half-dozen Holsteins.

Face it, the guy is on a roll. GOP Jim just won a third consecutive term at the top in the land where America’s left shines the brightest with the likes of Bernie Sanders, Patrick Leahy and Howard Dean, the Democratic party chairman.

The Vermont governor, along with actors DeNiro, Marlo Thomas and David Hyde Pierce, was chosen by AARP for a 2007 IMPACT Award as one of “10 People Who Make the World a Better Place.”

What a life! How does he do it? In leftist, Democratic/ Progressive Vermont, how does a Republican who supported Richard Nixon as a Middlebury College senior and Vermont House candidate in 1972, and George W. Bush in 2000 and 2004, keep winning elections in Vermont, year after year? And guess what Douglas won the AARP IMPACT Award for? Sitting down, are you?

Vermont’s Gov. Douglas was recognized for his leadership on health-care reform! Hello?

Writes veteran New York magazine writer Joe Treen for the January/February 2007 edition of AARP, which bills itself as the “World’s Largest Circulation Magazine”:

. . . in May, after two years of negotiations, Governor Jim Douglas signed groundbreaking legislation that makes affordable health insurance available to everyone in the state. The new universal health care law, considered the most progressive in the country, also includes a series of cost-saving reforms. It is particularly important in the Green Mountain State, which has 61,000 uninsured citizens and a growing senior population. While the bill was clearly a bipartisan effort, much of the credit goes to Douglas, 55, for refusing to give up. “This was such a key issue,” he says. “The need was so great in terms of containing costs and providing coverage to uninsured Vermonters that we just couldn’t fail.”

Yes, indeed. There’s no business like show business, is there? A few other AARP readers in the Green Mountains couldn’t believe it, either. One was Bruce Cunningham of Hinesburg. Bruce has been an independent advocate and Statehouse regular for decades. His issues include antismoking and underage drinking. OK, a bit of a health nut. Nothing wrong with that, right? He gave Joe Treen a call at his New Jersey residence.

Cunningham told yours truly he politely informed the AARP freelancer that he had gotten the story on the IMPACT award-winning Vermonter terribly wrong. That anyone in Vermont could tell him Gov. Jim Douglas’ real impact was as the leading opponent of health-care reform.

Cunningham later told “Inside Track” that Treen “seemed very happy to talk to me.” Heck, one senior citizen to another, right? None of us is getting any younger.

“He also sounded appreciative of my pointing out that Gov. Jim Douglas was mainly an obstructionist,” said Bruce. “My overall impression was that [Treen] was interested in finding the truth.”

Cool.

We let the weekend pass and then gave him a call on Monday. Joe Treen appears to be a successful magazine-writing pro and, indeed, sounded like a decent baby-boom-generation kind of guy when we gave him a jingle.

However, he wasn’t exactly exuding enthusiasm for getting the story right. Rather, Ol’ Joe was a bit defensive.

Treen told “Inside Track” that after getting the call from Cunningham he “went back and re-looked at the story to make sure it was not off the mark.”

By that he meant he was not considering Gov. Douglas’ veto of the landmark health-care reform bill the Democrats and Progressives passed in 2005. He was only focusing, he said, “within the narrow focus of 2006.” Republican Gov. Jim Douglas may have vetoed reform in 2005, but in 2006, argued Treen, “he kept negotiators at the table.”

By the way, Treen didn’t come to Vermont and did not speak to the Vermont reform advocates.

One of those is “Vermont Health Care for All” activist Deb Richter M.D. Dr. Deb said she first howled in disbelief when she saw that AARP gave our guv a national award for his leadership on health-care reform.

“Is that a scream?” she asked.

But once Richter, like others, got over the initial shock, it made perfect sense to her. Perfect sense, that is, for AARP to find Jim Douglas so likable.

After all, the insurance industry has no greater friend in Vermont than our Republican governor, who, if he had his way, would open Vermont’s borders to every last cherry-picking one of them. In fact, close your eyes, and Jim Douglas could turn into a friendly insurance salesman in about two seconds flat!

As it is, Americans pay the highest portion of earnings of any workforce in the modern world on health care and for-profit health insurance. That’s because in the good ol’ USA, there’s a big fat layer of cost added to our medical bills in order to keep the insurance companies happy. It’s called profit.

“Does it surprise you,” asked Dr. Richter, “that AARP would endorse someone who keeps the insurance industry in good health?” Remember, she pointed out, “AARP sells health insurance.” Lots of health insurance. And AARP “stands to gain billions” from the “4 percent kickback” they get from the Medicare Part D portion of every insurance policy they’ll sell.

Good point, eh?

The modest, watered-down 2006 legislation that the Democrats defend as progress, and the guv won the big award and the big reelection for signing, “was a temporary solution for some folks. I wouldn’t begrudge that,” said Dr. Richter. “The point is, they had the opportunity to do something even bigger. The tragedy,” she told “Inside Track,” “is the fact that they stopped the conversation with this bill.”

And that may be its greatest accomplishment of all — stopping the health-care reform conversation. Congratulations, Guv. Well done!

“For some of my patients,” said Richter, “this will be a good thing. But the problem is, the other 95 percent, who have unbelievable premiums and high co-pays and deductibles, are left hanging.”

OneCare single payer video

OneCareNow.org

Teams in more than 365 California cities are conducting grassroots educational and public awareness “action” events–one event per day, in a different city, for one year–to demand quality, affordable healthcare for all Californians.

http://www.onecarenow.org/index.html

Comment:

By Don McCanne, MD

The OneCareNow campaign is designed to inform the citizens of California about the advantages of single payer reform and Sen. Sheila Kuehl’s legislation to enact it. Although SB 840 was vetoed by Gov. Schwarzenegger, it will be re-introduced in the next legislative session.

The OneCareNow campaign has produced a 22 minute video explaining the advantages of single payer reform. The video is of value not only for Californians, but for the entire nation in that it describes the imperative for a single payer solution, albeit from the California perspective.

The video, The Healthcare Solution: California OneCare, can be viewed on YouTube at the following link (save this link to share with others):

http://youtube.com/watch?v=jB0Vn_BppwM