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A Push For A National Health Service?

by Sue Wilson
October, 2003

Since this health column last reported on the plight of the millions of uninsured and under-insured people in New York and across America, the situation has, unfortunately, gotten worse.

Health care costs are soaring once again; insurance premiums are rising at double-digit rates; the economy, despite all the current administration’s talk of a recovery, seemingly remains stalled in the doldrums; states are in fiscal crisis; and continuing layoffs have yanked from millions more Americans the employer-provided health insurance they once took for granted. A September 30 report from the U.S. Census Bureau revealed that, between 2001 and 2002, the number of uninsured Americans rose sharply (by 2.4 million) for the third year in a row. That means 43.6 million Americans, or more than 15 percent of the population, now lack even basic health coverage. Millions more are underinsured. In New York State, the percentage of uninsured is higher than the national average and the total well over three million people, most of them in New York City. According to the Institute of Medicine, already 18,000 Americans die every year because of inadequate insurance; as more lose their coverage, the numbers will rise.

But advocates of a universal national health system – at least, the optimists among them — see promise amidst the general catastrophe. They are allowing themselves to hope that the erosion of health coverage among Americans who until recently considered themselves comfortably middle-class – and thought the lack of health insurance the problem mostly of a limited subclass of the impoverished, the disadvantaged, and the marginal — will have real political repercussions in the forthcoming presidential elections and in the halls of Congress.

Voices ranging from liberal politicians to middle-class consumer groups to physicians can now be heard saying the same thing: that after decades of misfires – most famously Bill Clinton’s messy failure ten years ago to achieve his campaign promise of universal health care – America, the last holdout, may finally join all the other countries of the industrialized world in adopting some form of national health insurance.

An NBC News/Wall Street Journal poll done in July did indeed find that health care costs ranked as Americans’ top economic concern, cited by 24 percent of respondents. By contrast, only 16 percent cited high taxes as their main concern. The incumbent and the other would-be candidates in the next presidential election clearly feel pressure to respond. President George W. Bush and most of the major Democratic presidential contenders have each proposed health care reforms, ranging from Bush’s plan for tax credits to help the uninsured buy insurance to the Democrats’ various proposals to expand health coverage by rolling back Bush’s tax cuts.

But all of these plans retain the basic forms of our current health insurance system — for-profit hospitals and HMOs; private insurance companies that reap high profits and also spend considerable amounts (subsidized by the premiums of the insured) for marketing, overhead, executive salaries, and profit-sharing with investors; and great influence wielded by the hugely powerful and profitable pharmaceutical industry.

But a group of doctors has come up with a far more sweeping and radical plan, one which calls for a true one-payer, nationalized health service that would cover everybody, and that would (theoretically at least) redirect our vast health care expenditures from corporate coffers and back into health care services.

According to one of the proposal’s authors, Chicago physician Dr. Quentin Young, American doctors have traditionally been conservatives when it comes to health care reforms, and they almost reflexively tend to oppose anything that smacks of government-administered health insurance. “But now even doctors are realizing that there’s something worse than the government, and that’s corporations,” Dr. Young said. “Even people who have insurance, so-called ‘good’ insurance, are now finding their charges and coverage being questioned, because the insurance companies have discovered that simply not paying out claims is the best way to maximize their profits. Doctors can’t provide their patients with the care they know is needed, and they’re being harassed to death to justify what they do provide.”

The plan was developed by Physicians for a National Health Service (PNHP), an organization of 11,000 doctors, many of them prominent. Two former Surgeons General and a former editor of the New England Journal of Medicine lead the group, which went public with its so-called “Proposal of the Physicians’ Working Group for Single-Payer National Health Insurance” at a press conference in New York in August. The next day, the proposal appeared in the Journal of the American Medical Association (JAMA 8/13/03), which some in the group see as a victory in and of itself, although a spokesman for the (generally conservative) American Medical Association said that the AMA itself still opposes a single-payer health care system. (The AMA has a long history of battling government-administered health insurance; for example, it opposed the creation of Medicaid in 1965.)

The plan, which has now been endorsed by more than 10,000 physicians, calls for a government-financed national health insurance system that would cover every American for all necessary medical care from infancy to death. (In essence, it would be like an improved, expanded version of Medicare, but available to all, not just the elderly and disabled.) Prescription drugs, mental health care, and long-term care would be covered. The government would administer the plan, but most doctors and hospitals would remain private, and patients would be free to choose any physician or hospital they wished. Health professionals would decide what services should be covered, based on the latest medical evidence. Private insurance companies would still exist, but could only provide insurance for services such as elective surgeries that would not be covered by the government plan.

The full text of the proposal, which contains further details and cost-savings analyses, can be read online here (In PDF format).

The proposal criticizes the incremental, piecemeal health reform plans offered by Bush and the main Democratic presidential hopefuls.

“Proposals that call for tax credits or that push seniors into private HMOs all retain the role of private insurers. They are doomed to failure, because they perpetuate administrative waste, and make universal coverage unaffordable,” said Dr. Oliver Fein, chairman of the New York Metro Chapter of PNHP, who presented the proposal at the New York press conference.

The plan’s authors claim that single-payer national health insurance, far from increasing health care costs, would save at least $200 billion each year by eliminating the high overhead, marketing, profits, and administrative costs that private, for-profit insurers divert money to (rather than spending it on actual health care services).

“We spend $1.6 trillion on health care each year, which is one-seventh of our Gross National Product. That would be a very high cost for an excellent health care system; and what we have is a rather poor one,” Dr. Young said. “Compared to countries that spend far less than we do, America scores very poorly on the standard, accepted indices of public health.”

But is America, the sole holdout among industrialized countries in terms of adopting a national health plan, ready for such sweeping change?

“Well, I’m old enough to remember the civil rights movement, and anybody who predicted that before it happened would have been laughed at as some utopian dreamer,” said Young. “I would say that the conditions for mass social change are ripening. There’s a vast discontent out there with the current system, whose weaknesses are being starkly exposed right now. It will take a monumental effort, and a change of administration, for this to happen, but I think in the end it will.”

Sue Wilson is a journalist who writes frequently on health and science topics for such outlets as the New York Times, WNET, and UNICEF.

Caregivers, seniors, patients, labor leaders and citizens to promote universal health care plan at statehouse hearing on October 8, 2003.

Boston – From all across the state and from all walks of life, proponents of health care reform will descend on the statehouse Wednesday for a hearing in Gardner Auditorium to promote a comprehensive solution to the burgeoning crisis in both cost and delivery that is affecting everyone.  

“A successful health care reform plan has to guarantee coverage to everyone, maintain high quality, and keep costs under control,” said Peggy O’Malley a nurse who chairs MASS-CARE.  “Our plan to set up a statewide health care trust is the best approach to do that.  It would provide secure coverage for everyone while saving money by consolidating payments and eliminating most insurance company paperwork and bureaucratic red tape.”

The hearing is on Senate Bill No. 686 – the Massachusetts Health Care Trust – that would create a state insurance fund to replace the current patchwork of public and private insurance plans.

Buses are bringing people to attend the hearing from New Bedford, Fall River, Dartmouth, Bridgewater, Brockton, Northampton, Springfield, Lynn and Cambridge.

Leaders of nursing, senior, labor, medical and patient advocacy organizations are expected to testify.  They will be joined by many elected officials and a number of nationally recognized experts including Dr. Marcia Angell, former editor of the New England Journal of Medicine.

With costs soaring and coverage dropping, no one is immune from becoming uninsured.  Last week, the US Census Bureau reported that 2.4 million people lost their health insurance, the largest single jump in the number of uninsured in the past decade.  In Massachusetts, an average of 9.1 percent of residents lacked health insurance, with many more uninsured for part of the year.  

A survey by the Kaiser Family Foundation showed that health insurance premiums for employees rose by an average of 13.9 percent this year, the third straight double-digit increase.   
 
Separately, the US Bureau of Labor Statistics reported that the number of Americans who receive health insurance through their employers has dropped to less than one-half of all workers from about two-thirds a decade ago.

The Massachusetts Campaign For Single Payer Health Care (MASS- CARE), is a coalition of over 80 organizations working for a universal, single payer health care plan in Massachusetts.

Contact: Rand Wilson: (617) 989-8039

Common rhetoric in presidential campaigns asks “Are you better or worse off than you were four years ago.” As we close in on the anniversary of the Measure 23 initiative campaign, to enact universal single payer health care in Oregon, a similar question comes to mind.  The answer falls out pretty easily from data recently released by the Kaiser Family foundation, and from the US census Bureau.

Looking at the surface information, health insurance premiums have gone up an average of 14%, the worst in five years and more than double the ’99 increase of 5.3%.  This at a time when the FED expresses concern about DEFLATION of the rest of the economy.   This high level of premium inflation, is expected to continue into the foreseeable future, doubling every 5 years. The predictable result is, according to  The Census Bureau, that in the last year the number Americans without health insurance jumped by 2.4 million to a total of 43.6 million people. This is the largest increase in more than a decade.

As a primary speaker for the Measure 23 campaign for several years, I made presentations, responded to questions and concerns from citizens, and debated the opposition, representing insurance companies, insurance agents, and employer groups. Through this activity I became aware of most of the relative questions.  I believe it will be informative to look at the irony of the aftermath of this campaign by sighting where all the opposing forces find themselves ten months later.

*  The employee with employer provided family coverage is paying 12.9% more for premiums with less coverage.
* The Employer is paying 14% more in premiums.
* Members of the Oregon Health Plan, who wouldn’t support the measure because they believed they were secure with health care provided to them without cost.  Now many of them have no coverage, many more have coverage which no longer meets their needs.
*  The employees whose jobs and benefits disappeared in the economic downturn now finds that because of the high cost of providing benefits employers are not rehiring.
* Employers who would not support the plan because they were afraid they could not afford its costs find they are paying far more or having to reduce or terminate their coverage.
* Insurance companies and agents who believed they could remain fat and happy skimming the cream off the top of the insurance premiums are now seeing that fewer and fewer people can afford insurance, so their customer base is actually shrinking (of course this does not compare to being eliminated by a single payer plan so they remain happy if not quite as fat).
* Doctors find that more and more of their patients are without insurance.  8,000 of them have signed onto a proposal for a universal single payer plan put forth by Physicians for National Health Care.
* The AFL-CIO leadership adamantly opposed our campaign and now finds, as we predicted, that an increasing number of union workers are without both jobs and benefits.
* Those on Medicare find that prescription drug coverage,promised them in the last presidential campaign remains elusive with its need serving as a means for the current administration to privatize Medicare so that its resources will provide profits for the insurance industry instead of health care for Seniors.
* Finally, as predicted, hospitals, which universally opposed the plan, find the very viability of their emergency rooms threatened by an inundation of uninsured patients.   The cost of this expensive care is then passed on to those who do pay for care.  This is a major factor in the increased cost of medical care and insurance for those who do pay.

It is hard to find many who can say that their position with respect to health care is better than it was a year ago. Certainly, looking at the overall society the picture is pretty bleak.   If the deteriorating situation causes you to ask, “what can we do now (beside kick ourselves)?”, the answer is certainly not simple.  For all practical purposes, we will unlikely be able to deal with this crisis through the initiative process.  

The two major reasons are:  a) The same organizations who poured unlimited funds into the campaign to defeat measure 23 would do it again, and b) the AFL-CIO sponsored initiative to prohibit paying signature gatherers by the signature will effectively prevent grass roots movements from being able afford to put initiatives on the ballot.  That leaves only the possibility of a political solution. Unfortunately, the insurance industry directs so much money toward the legislature, that we may expect it will only respond to thecomplete and total collapse of the system (perhaps not far away).  

On the national front, while Dennis Kucinich has consistently supported universal single payer health care, those who control the media have decided to ignore his presidential campaign.  However, he stands as our best chance for reform on a federal level.

In the wake of the demise of measure 23 the basic parameters remain the same.  Virtually all studies show that only a universal single payer health plan has any hope of reversing the disintegration of the American health care delivery system.  It is time for the US to catch up with the rest of the western industrialized world.  If you believe in representative democracy, then it is time you to let your respective representatives know that the health care crisis requires their attention and that a UNIVERSAL SINGLE PAYER SYSTEM appears to be only one viable solution.

Marc Shapiro was the Lane County Chair for the campaign to enact Measure 23

To the Editor:

The Census Bureau data showing 43.6 million uninsured for 2002 (front page, Sept. 30) illustrate an ugly side of the United States that most Americans and politicians would rather ignore.

At people’s time of most need, when physical or mental illness is eroding all other aspects of their life, our society does not guarantee help.

People must choose between caring for themselves or their children and paying for schooling, housing and food. As the Institute of Medicine documented last year, this is estimated to lead to 18,000 premature deaths every year.

It is no wonder that other countries question our ability to build a civil society in Iraq; we have not even built one in the United States.

JEREMIAH SCHUUR, M.D.
Providence, R.I., Sept. 30, 2003

To the Editor:

The big increase in the uninsured (front page, Sept. 30) is only part of the problem with our health care system. The nominally insured whose policies exclude pre-existing conditions also face substantial medical and financial risk.

These problems are inherent in a perverse health care system in which a profit-driven health insurance industry sustains itself by denying the very services the system is intended to provide.

RICHARD PLEVIN
Chiang Mai, Thailand

Sept. 30, 2003

To the Editor:

Your Sept. 30 front-page article about the increase in number of people without health insurance comes one day after I received notice that my own policy, which I pay for entirely, will increase by 17.5 percent this month.

It is no wonder that the middle class, which I consider myself a part of, is being forced out of the health care market. What other item in the marketplace increases in price at this rate in today’s down economy?

MARK SIEGEL
New York, Sept. 30, 2003

To the Editor:
“Big Increase Seen in People Lacking Health Insurance” (front page, Sept. 30) is only the tip of the iceberg. An accompanying news analysis mentions increases in
co-payments and deductibles.

Many people have inadequate or insufficient insurance. A tax credit will not help the millions who pay sales and payroll taxes but no income tax.

Health care and prescription drug costs continue to rise sharply. Our politicians – our leaders – refuse to recognize that other developed countries have universal
health care and much lower prescription drug prices.

If Americans are not bright enough or motivated enough to develop a more efficient and more economical health care system, why not just copy and improve an existing system that works better?

MORT GOODMAN
Longboat Key, Fla., Sept. 30, 2003

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