PNHP

Editorial: It's time to think single-payer

Editorial: It's time to think single-payer

Patchwork health proposals show the need to think big.

Minneapolis/St.Paul Star Tribune Editorial
Published: January 28, 2007

For Americans who hope the United States might one day have a health care system that makes sense, this is an exciting time. Massachusetts has adopted a plan to achieve universal coverage, and California Gov. Arnold Schwarzenegger has pledged to do the same in the nation’s most populous state. Last week President Bush committed himself to a radical overhaul of federal tax subsidies in a bid to hold down health care costs and expand insurance coverage.

Yet the closer you look at these ambitious plans, the more you see they are mere patchworks. In Massachusetts, which will require most residents to buy private insurance, policies are coming on the market with higher prices and less coverage than experts hoped. Economist and columnist Paul Krugman points out that the Schwarzenegger plan will require big new state bureaucracies to regulate insurance companies and police individual behavior. As for the president’s plan, even the White House admits it will cover only 5 million of the nation’s 46 million uninsured; that’s because it relies on tax deductions, which aren’t much use to low-income families who represent the bulk of the uninsured population.

It’s good to see political leaders think boldly. But the lesson is that they aren’t thinking boldly enough. It’s time for the United States to think about just making the leap to single-payer insurance.

This radical notion would seem unthinkable, except that every other civilized nation already has thought about it and embraced it — from conservative societies such as Japan and Australia to nanny states such as Germany and France. Every one of them covers more people, produces better medical outcomes, wastes less revenue on overhead and marketing, and spends less money than the United States.

The biggest argument against a single-payer system is it’s “politically unrealistic” in a free-market society like the United States. We think that gives too little credit to the impatience and common sense of American voters. But then we won’t know until a leader has the courage to find out.

Like hospitals, insurance system is also in crisis

Another voice /Health care

By DAVID DYSSEGAARD KALLICK
The Buffalo News
1/29/2007

Tuesday, prominent community leaders in Buffalo will hold a public hearing on the Berger Commission’s proposals to close hospitals as a way to reduce health care spending. The hearing will help sort out what savings are realistic, and at what cost to workers, patients and communities. More important still, the hearing, organized by the Coalition for Economic Justice, will focus attention on solutions to the broader health care crisis.

The current insurance system just isn’t working. There are 2.8 million New Yorkers who don’t have insurance. For people who do have insurance, health care is too expensive; no item in the family budget is rising faster.

As important as the effect on families, though, is the effect on economic growth. The convoluted way we finance health care is one of our nation’s biggest job-killers. Responsible companies that pay for health care are being crushed by the rising cost of insurance.

The best solution would be a national single-payer plan. But if Washington doesn’t move, New York should look into a state-based single-payer system.

Virtually all of the world’s advanced economies have universal coverage. There are models that integrate choice of doctor, private insurance on top of the basic government plan and the ability to pay to skip ahead of a queue.

Can we afford it? The United States spends about 16 percent of gross domestic product on health care. Compare that with 7.7 percent in the United Kingdom, 7.9 percent in Japan and 9.9 percent in Canada. Universal insurance is much less expensive.

It’s encouraging to see states like Massachusetts and California moving forward on universal coverage. But their models cost billions more, while a single-payer system would cost billions less than current spending. According to one estimate, cutting out administrative costs would allow a single-payer system in New York to reduce spending by 19 percent, a savings of $23 billion.

Short of a single-payer plan, there are other sensible ways New York can improve coverage. Bulk purchasing of prescription drugs on behalf of government programs, the uninsured and private groups would help lower one of the most problematic health care costs.

In addition, current law forces businesses that provide insurance to pay a surcharge that helps pay for emergency room visits by uninsured people. Employers who pay for coverage wind up subsidizing employers that don’t. It would be better to reverse that situation, or to pay for uncompensated care out of the state’s general revenues.

Gov. Eliot Spitzer has proposed to guarantee access to health insurance for all uninsured children in the state, and to get all adults who are eligible for Medicaid actually enrolled. At Tuesday’s hearing, local residents, workers and policy experts can push the state to take those first steps, and then to push even further.

David Dyssegaard Kallick is senior fellow at the Fiscal Policy Institute. The hearing is at 6:30 p.m. Tuesday in Trinity Episcopal Church on Delaware Avenue.

Fix the system with Medicare for all

By Marcia Angell
Guest Columnist
Boston Globe
January 29, 2007

Today the Globe launches a rotating seat on the op-ed page. Each guest columnist will appear each Monday for six weeks, before the next columnist takes over.

THE GREATEST source of insecurity for many Americans is the soaring cost of health care. Leaving jobs can mean losing health insurance, and even when insurance is offered, many workers turn it down because they can’t afford their growing share of the premiums.

Businesses are having trouble, too. Those that provide good health benefits see more of their revenues siphoned off by the health insurance industry, with a resulting loss of competitiveness (General Motors spends far more on health benefits than Toyota).

Insurance is not the same thing as health care — not by a long shot. Private insurers maximize profits mainly by limiting benefits or by not covering people with health problems. The United States is the only advanced country in the world with a health care system based on avoiding sick people.

It’s not surprising, then, that health care reform is at the top of the political agenda. Most current proposals de-couple health benefits from employment and encourage individuals to buy their own insurance. The fact that they were ever coupled is a historical accident; there is no logical reason for it. Yet, employment-based insurance has been the only practical option for people not old enough for Medicare or poor enough for Medicaid, since the individual insurance market is notoriously treacherous.

In his State of the Union address, President Bush proposed tax deductions for individuals who venture into that market and buy insurance on their own. Family premiums above $15,000 and single premiums above $7,500 would be taxed. This is a gesture, not a plan. It is just one more example of the conceit, shared by many on the right, that nearly any problem can be solved by jiggering the tax code. In fact, many of the uninsured don’t pay taxes at all, and many more would find their small tax relief greatly outweighed by the price of insurance.

More serious proposals are coming from the states, with Massachusetts in the lead. These aim for universal coverage by requiring uninsured individuals to purchase health insurance, under pain of — you guessed it — tax penalties, with state subsidies for the poor and near poor. In Massachusetts, there will be a token contribution by employers who don’t provide health benefits, but most of the cost will be borne by individuals. A new state agency, the Commonwealth Health Insurance Connector, is charged with seeing that insurers offer adequate benefit packages at reasonable premiums.

Though well-intentioned, plans like these all have the same fatal flaw: They offer no workable mechanism to control costs, mainly because they leave the private insurance industry in place. Yet, soaring costs are the fundamental problem ; lack of coverage follows from that. Already the Massachusetts Connector is having difficulty holding premiums down to the levels forecast when the plan was enacted. Even if they are held down at the start, there is little to stop insurers from raising them afterward , shrinking benefits, or both. It will take a large and costly bureaucracy to ride herd on all the ways to game this system. Perhaps the biggest risk is that failure will give universal care a bad name, just as the failure of the Clinton plan did 13 years ago. (That plan, too, made the mistake of giving the private insurance industry a central role.)

We need to change the system completely and get the insurance industry, as well as employers, out of it. Private insurance companies offer little of value, yet skim off 15 to 25 percent of the health care dollar for profits and overhead. It would make much more sense to extend Medicare to everyone. That could be done gradually by dropping the eligibility age a decade at a time, while phasing out the insurance companies. The loss of insurance jobs would probably be more than offset by job gains in other industries no longer saddled with health costs.

Medicare is not perfect, but its problems are readily fixed. It is far more efficient than private insurance, with overhead of less than 4 percent, and since it is administered by a single public agency, controlling costs would be possible. Unlike private insurers, it cannot select whom to cover or deny care to those who need it most.

It is time to stop tinkering at the margins. Medicare for all is the only reform that has a prayer of providing universal coverage while containing costs.

Dr. Marcia Angell is a senior lecturer at Harvard Medical School and former editor-in-chief of the New England Journal of Medicine.

Single-Payer Health Care Advocates Bring Campaign to D.C.

By Mark Gruenberg
PAI Staff Writer 1/29/2007
PHILADELPHIA (PAI)–At Temple University Hospital in Philadelphia, a 60-year-old woman has been hospitalized for weeks suffering from heart failure. Patricia Eakin says she should not have been in the hospital in the first place.

But the woman is there, at great expense to the hospital and–because she lacked health insurance–ultimately to taxpayers. That’s because with no insurance, she did not have enough money to buy enough medicine to prevent or slow the heart disease.

“She had to take it every other day, and not every day, as the prescription said,” said Eakin, who is also president of the Pennsylvania Association of Staff Nurses and Allied Professionals, an independent statewide nurses union. “Now she’s in the hospital and it’ll cost thousands of dollars.”

It’s cases like that of the woman in Philadelphia, or a 3-year-old hemophiliac child in Colorado whose medical bills are approaching his father’s company’s lifetime limits on health care coverage, that sent advocates of government-run single-payer health care coverage to Washington in late January to raise the visibility of their cause.

And their timing was perfect, as health insurance–or lack of it–rose to the fore again, due to anti-worker GOP President George W. Bush.

That’s because Bush’s Jan. 23 state of the union address called for taxing what he termed “gold-plated” health insurance, but also for giving a tax deduction–more usable by wealthier taxpayers–to individuals for their first $7,500 in yearly health insurance spending and $15,000 for families’ spending.

His scheme drew scorn, and more, the next day from the single-payer advocates. They said it would only throw more people into the ranks of the uninsured, while lining the pockets of the insurance companies. And even Bush’s White House admitted his deductions would only help at most 3 million of the 47 million uninsured–and none of the “underinsured,” like the father of the hemophiliac child.

By contrast, they said, their plan, HR 676, the government-run single-payer health care bill crafted by veteran Rep. John Conyers (D-Mich.), would help everyone. The bill, co-sponsored by Rep. Dennis Kucinich (D-Ohio) and 40 other lawmakers, is one of a raft of competing health care proposals–including Bush’s–floating around Washington.

HR 676, which then had more than 75 backers, died at the end of the last GOP-run Congress without a hearing, but Kucinich told a Jan. 24 press conference that after it is reintroduced, he’ll schedule a House subcommittee hearing on it, possibly in April.

The advocates, led by Deborah Burger, President of the California Nurses Association, and Dr. Oliver Fein of the Physicians for a National Health Plan, contend a government-run single-payer plan would cut costs, eliminate the health insurance companies and their paperwork, denial of coverage and high overhead, and cover everyone, including the uninsured and underinsured. Bush wouldn’t do that, they added. And it wouldn’t help people like the 60-year-old woman in the Temple University Hospital, added Burger, herself a 35-year veteran nurse for California’s Kaiser Permanente, who’s a diabetes case manager.

“We see, in many cases, that one little thing that hasn’t been done has a snowball effect” on patients, their health, their quality of care, and, ultimately, medical costs, Burger explained. “When they can’t take their medicine, for example.”

A single-payer system, Burger said, would also encourage preventive care, stopping individuals’ health problems before they loom large and expensively. “We sent nurses” as volunteers from California “to areas hit by (Hurricane) Katrina and to the Astrodome” in Houston, which housed refugees from Katrina-ravaged New Orleans, she noted. The nurses expected to treat trauma from the hurricane. They were wrong.

“They were treating hypertension and heart conditions. For many of these people, who were poor and without health insurance, it was their first visit by a health care professional, ever. The nurses were doing primary care–and they saw how our patched-up health care system doesn’t work,” Burger added.

Speakers said single-payer government-run health care would save money compared to the present system, by eliminating $500 billion-$600 billion in overhead, duplication, high CEO pay, advertising and other costs the insurers impose. Overall, the U.S. spends $2 trillion, one-sixth of its gross national product, on health care.

More than 220 union groups–the latest being unionists in Oklahoma, and the Minnesota Association of Professional Employees–back HR 676, said Kay Tillow, a spokeswoman for the Louisville-based single-payer campaign, organized by union nurses.

Kucinich said single-payer would be financed by small payroll taxes on employers and employees, elimination of overhead, a surtax on the wealthy, a tax on stock and bond transfers and the end of Bush’s tax cuts for the rich. In return, backers promised single-payer would let people choose their own doctors, guarantee care, and end deductibles, co-payments and high premiums. “We’ll see dramatic savings and redirection of resources from the insurance companies to the general public,” he said.

Editorial: It’s time to think single-payer

Patchwork health proposals show the need to think big.

Minneapolis/St.Paul Star Tribune Editorial
Published: January 28, 2007

For Americans who hope the United States might one day have a health care system that makes sense, this is an exciting time. Massachusetts has adopted a plan to achieve universal coverage, and California Gov. Arnold Schwarzenegger has pledged to do the same in the nation’s most populous state. Last week President Bush committed himself to a radical overhaul of federal tax subsidies in a bid to hold down health care costs and expand insurance coverage.

Yet the closer you look at these ambitious plans, the more you see they are mere patchworks. In Massachusetts, which will require most residents to buy private insurance, policies are coming on the market with higher prices and less coverage than experts hoped. Economist and columnist Paul Krugman points out that the Schwarzenegger plan will require big new state bureaucracies to regulate insurance companies and police individual behavior. As for the president’s plan, even the White House admits it will cover only 5 million of the nation’s 46 million uninsured; that’s because it relies on tax deductions, which aren’t much use to low-income families who represent the bulk of the uninsured population.

It’s good to see political leaders think boldly. But the lesson is that they aren’t thinking boldly enough. It’s time for the United States to think about just making the leap to single-payer insurance.

This radical notion would seem unthinkable, except that every other civilized nation already has thought about it and embraced it — from conservative societies such as Japan and Australia to nanny states such as Germany and France. Every one of them covers more people, produces better medical outcomes, wastes less revenue on overhead and marketing, and spends less money than the United States.

The biggest argument against a single-payer system is it’s “politically unrealistic” in a free-market society like the United States. We think that gives too little credit to the impatience and common sense of American voters. But then we won’t know until a leader has the courage to find out.

Mayes and Berenson on Medicare Prospective Payment

Medicare Prospective Payment and the Shaping of U.S. Health Care

By Rick Mayes, Ph.D. and Robert A. Berenson, M.D.
The Johns Hopkins University Press

From the Introduction

The biggest and most intense battle within the U.S. health care system during the past two decades has been over two interrelated questions: first, who will control the manner in which medical care is paid for, and second, how much will it cost? The primary argument of this book is that – contrary to conventional wisdom and whole libraries of books and articles that point to managed care as the biggest “change agent” in American medicine in the last twenty years – the private sector neither initiated this battle nor provided the critical innovation that transformed health care in the United States. Instead, it was Medicare’s transition to a prospective payment system (PPS) that triggered and repeatedly intensified the economic restructuring of the U.S. health care system. With prospective payment, “Medicare sets prospectively the payment amount (rates) providers will receive for most covered products and services and providers agree to accept them as payment in full,” according to the Medicare Payment Advisory Commission (MedPAC). “Thus, in most instances, providers’ payments are based on predetermined rates and are unaffected by their costs or posted charges.”

Medicare payment reforms have empowered the federal government, making it similar to health care systems in other Western countries. They have given the U.S. government control over the price of most medical care and ended the era – dating back to the 1920s – in which doctors and hospitals’ authority over medical prices and decision making went virtually unquestioned. The key to Medicare’s role as the leading catalyst for change in the U.S. health care system is the program’s immense size and influence. As the single largest buyer of health care and the “first mover” in the annual payment game between those who provide medical care and those who pay for it, Medicare invariably drives the behavior of medical providers and private payers.

From the Conclusion

We think that the Medicare program is well positioned to take on many of the most important stewardship responsibilities for the government, while continuing to serve as a crucial social insurance program for the more than forty-two million seniors and people with disabilities who depend on the program. Medicare’s prospective payment systems have created a stable funding base for the nation’s providers. They have led to important changes in how providers deliver care, producing improved quality and efficiency that have spilled over to better the care provided to Americans. Medicare can shape health care in other ways as well – such as improving access to care, expanding individuals’ protection against the cost of illness, and lowering administrative costs – if allowed to do so.

http://www.press.jhu.edu/books/title_pages/3463.html

And…

Medicare: Not Just an Advantage, But a Stacked Deck

By Rob Cunningham
Health Affairs Blog
January 24, 2007

Are private plans inherently more efficient than government? There is more than a little room for doubt. In a brilliant new book by Rick Mayes of the University of Richmond and the Urban Institute’s Bob Berenson, the success of Medicare’s prospective payment system in holding down cost growth is demonstrated convincingly — findings echoed in a recent Congressional Budget Office monograph.

http://healthaffairs.org/blog/2007/01/24/medicare-not-just-an-advantage-but-a-stacked-deck/

Comment:

By Don McCanne, MD

Getting health care spending right means balancing the need to provide adequate funding to ensure patient access to beneficial services, while limiting spending to covering legitimate costs and fair profits for the delivery system.

Mayes and Berenson have demonstrated that Medicare has been quite effective in this endeavor, whereas the private sector has largely limited its role to following Medicare’s lead. In fact, the private sector’s experiment with managed care demonstrated that they could achieve payment control only by distorting this balance, which impaired patient access and failed to establish compensation tied to legitimate overhead plus fair profit.

The efforts of the Medicare stewards to improve the payment system is and always will be a work in progress, as the current struggle with the Sustainable Growth Rate (SGR) demonstrates. The point is that a government system, as long as it is manned by people who believe in the legitimate stewardship responsibilities of government, will always strive for a system that ensures patient access by adequately funding an effective health care delivery system, while limiting waste. The inefficient, fragmented private insurance system can never do that, but can only add to the waste and inefficiency that has placed such a heavy burden on us.

As academic purists, Mayes and Berenson avoid the political minefield by suggesting that Medicare’s leadership can be advanced while maintaining the status quo of a social insurance program limited to seniors and people with disabilities. I’ll gladly step into that minefield. A tremendous amount of waste, inefficiencies, and inequities result from the dysfunctional private insurance system that follows Medicare’s lead only with an unbelievable amount of imprecision and evasion. We need to dump the private plans and continue to focus on financing reform that provides the best health care value for all of us.

Kucinich renews pitch for universal health care

By THOMAS J. SHEERAN
Associated Press Writer

CLEVELAND — U.S. Rep. Dennis Kucinich, whose anti-war views have gained wider acceptance since he ran for president in 2004, hopes a similar public opinion shift will boost chances for enacting universal health care.

Kucinich, a Cleveland Democrat making another run for the presidency, was one of 42 co-sponsors of a bill reintroduced by Rep. John Conyers Jr., D-Mich., Conyers aide Alexia Smokler said.

Trying to distance himself from fellow Democratic presidential candidates on the issue, Kucinich said the proposal introduced Wednesday would be the “only bill in Congress that would assure universal health-care coverage (and) control cost.”

In 2004, Kucinich posted single digits in most primary elections, including Ohio, but stayed in the race until days before John Kerry was nominated by Democrats at their convention.

Americans are ready for universal health care, Kucinich said in a phone interview after the bill was introduced.

“Now Congress may not be ready, but let me tell you: Congress wasn’t ready to get out of Iraq, but people in November showed they wanted a new direction, so Congress is going to have to pay attention to the will of the people,” he said.

In a “Dear colleague” letter Monday, Conyers and Kucinich said the latest version of the bill had been revised to specify that the payroll tax that would help finance the plan would be progressive, meaning the rich would pay more.

President Bush, facing a Democratic-controlled Congress Tuesday night in his State of the Union address, proposed making health insurance more widely affordable by taxing high-premium, employer-provided health plans while giving a tax deduction to other workers.

Reaction to Bush’s plan split along partisan lines.

Democrats argued the plan could encourage employers to drop insurance or healthy workers to opt out of workplace plans, driving prices higher. Rep. John Shadegg, R-Ariz., said the Bush plan “will enable every American to access affordable health care on the same terms.”

Kucinich said Bush was using tax laws to address health-care issues. “The president should not be looking to the tax code to fix the lack of affordable health care,” Kucinich said.

Kucinich said his proposal, a keystone of his White House campaign, “would provide coverage for all medically necessary procedures including dental care, mental health care, long-term care and prescription drug coverage.”

The business-supported National Association of Manufacturers opposes a universal health-care system. “We believe private-market solutions are superior,” spokeswoman Kat Snodgrass said.

Dale Miller, a Cleveland Democrat who holds the Ohio Senate seat that Kucinich once held, said public opinion was moving in the direction of Kucinich’s universal health-care ideas. “I think sentiment is continually moving in that direction,” he said by phone from Columbus.

Kucinich, who was Cleveland mayor when the city went into default in 1978 in a fight with banks, won a sixth term in the House in November and declared his candidacy for the White House in December. His GOP opponent in the congressional race, Michael Dovilla, said Kucinich had misled voters about his political plans when he ran for re-election to the House.

On the Net:

Rep. Kucinich: http://kucinich.house.gov

Rep. Conyers: http://www.house.gov/conyers

Single-payer health only way to go

By Paul Heise
Lebanon Daily News

The only part of the American health-care system that seems to be working is Medicare and Medicaid. Our employment-based, managed-care system is clearly collapsing from inefficiency, rising costs and loss of the industrial base that paid for it. Now, when we don’t have enough health coverage as it is, President George W. Bush proposes fiddling with the tax code to set up tax incentives for workers to buy less insurance. Not to worry. Bush is simply making political noises. He only means to look responsive to health-care complaints, to make sure he reframes the later debate and, more importantly, to distract us from his Iraq surge. Nothing is going to happen to your health care until after the presidential election of 2008. However, that election could well be decided by the health-care issue.

Until then, everyone will lament the lack of progress; the states will tinker with patchwork solutions; and Bush will muddy the waters with the tax code fiddling we heard about in the State of the Union address.

In the interim, it is important to make sure we properly identify the problem and frame the question so we can address it in a national election.

The health-care crisis is real. As a nation, we spend twice as much as others and get worse outcomes. The U.S. spends $2 trillion per year, or 15 percent of our total output, on health care while other industrialized countries spend only six to 10 percent. Using an outcomes-based test, our infant mortality is higher than even some Latin American countries, our life expectancy is less than other rich countries, 15 percent of our people lack insurance, lawyers are undermining physicians, and medical bills are bankrupting even insured workers.

How bad is it? The U.S. spent $6,102 per person on health care in 2004 while Canada spent $3,165, France $3,159 and Australia $3,120, and 47 million people are not covered at all. We have a broken system.

When we round up the usual suspects, we blame soaring health-care costs on new and expensive technology, an aging population, rising expectations, lawyers and soaring drug costs in an ever-more-drug-focused therapy. The problem, aside from our peculiarly litigious nature, is that the rest of the industrialized world shares these “causes” but does not share anything near America’s cost problems.

To begin an intelligent debate, we have to isolate what is different about the American system that makes it the world’s highest-cost system with some of the world’s worst outcomes.

Two things pop up: the administrative costs of our multi-payer system and the control of prices by our suppliers. According to the New England Journal of Medicine, 30 percent, or $600 billion, of that $2 trillion we spend per year on health care goes for the administration, marketing and profits associated with a multiplicity of insurance collectors and payers. Medicare, a single-payer system, and much of the rest of the world pays as little as two percent in administrative costs.

The provision that forbids Medicare to negotiate prices is probably the most absurd thing in these last six years of this government of the absurd. Maybe even worse, the U.S. government pays for the research then gives the patents to the drug companies and research firms and lets them charge monopoly prices.

Medicare, at least Part A–Hospitalization, is the quintessential single-payer system: you choose your own doctor while medical practices, hospitals and pharmaceutical companies remain privately owned and compete. The government acts only as the payer. Part B–Medical, with its confusion of firms and forms, is an unnecessary concession to the insurance companies.

The point of putting health care into the State of the Union message is to reframe the debate away from the real problem, which is affordable health care, and put the focus on affordable insurance. The president has to get hold of this. If the Congress ever started looking at the sources of the increased health-care costs, the dysfunctional insurance industry could lose billions in profit.

The question has to be framed in terms of an affordable health-care system and not availability of insurance. The best way to do that is simply to take the age provisions and Part B firms out of Medicare and apply to all that single-payer system that we know and love.

I’m over 65; it works for me.

http://www.ldnews.com/portlet/article/html/fragments/print_article.jsp?articleId=5084586&siteId=139

A resident of Mt. Gretna, Heise holds a Ph.D. in economics and is professor emeritus of economics at Lebanon Valley College. His column appears every other Thursday. He maintains a web log at weboped.com, and he can also be reached at:

heise@lvc.edu

On Being Partisan

By PAUL KRUGMAN
Op-Ed Columnist
New York Times
January 26, 2007

American politics is ugly these days, and many people wish things were different. For example, Barack Obama recently lamented the fact that “politics has become so bitter and partisan” — which it certainly has.

But he then went on to say that partisanship is why “we can’t tackle the big problems that demand solutions. And that’s what we have to change first.” Um, no. If history is any guide, what we need are political leaders willing to tackle the big problems despite bitter partisan opposition. If all goes well, we’ll eventually have a new era of bipartisanship — but that will be the end of the story, not the beginning.

Or to put it another way: what we need now is another F.D.R., not another Dwight Eisenhower.

You see, the nastiness of modern American politics isn’t the result of a random outbreak of bad manners. It’s a symptom of deeper factors — mainly the growing polarization of our economy. And history says that we’ll see a return to bipartisanship only if and when that economic polarization is reversed.

After all, American politics has been nasty in the past. Before the New Deal, America was a nation with a vast gap between the rich and everyone else, and this gap was reflected in a sharp political divide. The Republican Party, in effect, represented the interests of the economic elite, and the Democratic Party, in an often confused way, represented the populist alternative.

In that divided political system, the Democrats probably came much closer to representing the interests of the typical American. But the G.O.P.’s advantage in money, and the superior organization that money bought, usually allowed it to dominate national politics. “I am not a member of any organized party,” Will Rogers said. “I am a Democrat.”

Then came the New Deal. I urge Mr. Obama — and everyone else who thinks that good will alone is enough to change the tone of our politics — to read the speeches of Franklin Delano Roosevelt, the quintessential example of a president who tackled big problems that demanded solutions.

For the fact is that F.D.R. faced fierce opposition as he created the institutions — Social Security, unemployment insurance, more progressive taxation and beyond — that helped alleviate inequality. And he didn’t shy away from confrontation.

“We had to struggle,” he declared in 1936, “with the old enemies of peace — business and financial monopoly, speculation, reckless banking, class antagonism, sectionalism, war profiteering. … Never before in all our history have these forces been so united against one candidate as they stand today. They are unanimous in their hate for me — and I welcome their hatred.”

It was only after F.D.R. had created a more equal society, and the old class warriors of the G.O.P. were replaced by “modern Republicans” who accepted the New Deal, that bipartisanship began to prevail.

The history of the last few decades has basically been the story of the New Deal in reverse. Income inequality has returned to levels not seen since the pre-New Deal era, and so have political divisions in Congress as the Republicans have moved right, once again becoming the party of the economic elite. The signature domestic policy initiatives of the Bush administration have been attempts to undo F.D.R.’s legacy, from slashing taxes on the rich to privatizing Social Security. And a bitter partisan gap has opened up between the G.O.P. and Democrats, who have tried to defend that legacy.

What about the smear campaigns, like Karl Rove’s 2005 declaration that after 9/11 liberals wanted to “offer therapy and understanding for our attackers”? Well, they’re reminiscent of the vicious anti-Catholic propaganda used to defeat Al Smith in 1928: smear tactics are what a well-organized, well-financed party with a fundamentally unpopular domestic agenda uses to change the subject.

So am I calling for partisanship for its own sake? Certainly not. By all means pass legislation, if you can, with plenty of votes from the other party: the Social Security Act of 1935 received 77 Republican votes in the House, about the same as the number of Republicans who recently voted for a minimum wage increase.

But politicians who try to push forward the elements of a new New Deal, especially universal health care, are sure to face the hatred of a large bloc on the right — and they should welcome that hatred, not fear it.

Copyright 2007 The New York Times Company

James Winkler's Statement from PNHP/CNA Press Conference

Jim Winkler spoke at a January 24, 2007, press conference hosted by Physicians for a National Health Program and the California Nurses Association at the National Press Club in Washington, D.C. Here is his statement.

How to Get Healthy

by Jim Winkler

I speak today as national co-chair of Healthcare-NOW!, a growing movement committed to a national quality healthcare system with single-payer financing and as general secretary of the General Board of Church and Society of the United Methodist Church. Our denomination supports a single-payer health insurance program.

Last night President Bush highlighted the crisis of affordable and available health care in his State of the Union address. He would not have given this matter as much time and attention as he did if we were not in the middle of an unfolding tragedy. He noted that “many” Americans cannot afford a health insurance policy. “Many” is an interesting word choice. I think we’ve reached a point where the use of phrases such as “tens of millions” and “too many” are the only ones that work.

One could argue that instead he chose to focus on solutions. Very well. It may be that his recommendation for a standard tax deduction for health insurance will help. He says this will mean more than 100 million men, women, and children who are now covered–already covered, that is–will benefit from lower tax bills.

The President also says the tax deduction will put a basic, private health insurance plan within the reach of those Americans who cannot purchase health insurance on their own. The question before us today is whether we say, “Thank you, Mr. President, for giving some help to the American people” or do we say, “This is not the time for half or quarter or one-eighth measures?” The answer to that is clear: we must have a better and comprehensive single-payer solution to this problem.

The President says the best health care decisions are made not by government and insurance companies, but by patients and their doctors. Yet, he remains committed to the insurance companies. They have to get their vig, their cut, of the health care dollar. Every city in the United States has one or more tall buildings dotting its skyline built by the insurance companies from the excess money they have collected from ordinary Americans. This is money that could be used for better and less expensive health care, for clinics and doctors and nurses, for education and prevention.

And yet these skyscrapers stand as monuments to corporate egos, undeserved profits, and greed. This wasted money prevents patients and doctors from making the best health care decisions. What we want is to eliminate the middle man, the corporate paper-pushers who have bought up the politicians of both major parties in our land, so that health care can become efficient and trustworthy.

Just last night, I was reading the February 2007 issue of Money magazine. Allyson Ranallo of Westlake Village, Calif., wrote to Ellen McGirt who pens the “Money Helps” column. Ms. Rannallo said her husband was treated at an urgent-care facility last March. Afterward she and her husband called their health insurer to confirm this was covered and they were told it was. They mailed the receipt and waited to be reimbursed. They followed up repeatedly and did not receive a check.

Ms. McGirt intervened on their behalf. PacifiCare spokeswoman Cheryl Randolph investigated and found their paperwork fell into “a bureaucratic black hole.” Randolph was mystified as to why the claim was refused. Eventually, they received their check. There are far, far too many people facing the same insurance company denials and obfuscation who do not have a magazine ombudsperson to intervene on their behalf.

Throughout the scriptures, God warns us that nations and rulers who do not care for the sick and the poor and the widows and the orphans will fall, that those nations are corrupt and rotten. Ours is a nation filled with people who study and believe the Bible, but too many have been seduced by the false gods of the market ideology.

Private health insurance has failed us. “Surging” private health insurance will fail just as “surging” the war in Iraq will fail. When you are going down the wrong road, the answer is not to continue traveling in the wrong direction more forcefully. It is to go down the right road.

Date: 1/24/2007

(c) 2005-2006

Mass. 'Universal' Health Plan Already Falling Short

Less than a year after Massachusetts’s controversial healthcare initiative was first revealed, evidence is accumulating to bolster critics who said the system is faulty by design.

by Megan Tady
TheNewStandard

Jan. 26 — Members of a panel charged with implementing the Massachusetts “universal” healthcare plan redirected some insurers this week to make their premiums more affordable. But critics of the plan say it’s the government that needs to go back to the drawing board.

In April, the Massachusetts legislature passed what supporters called a universal healthcare initiative: one that forces state residents to obtain health insurance. The plan offers a sliding-scale subsidy for residents who earn up to three times the poverty level. Those who exceed the income-eligibility threshold for subsidies are required to purchase their own health insurance without help or face tax penalties and fines.

Then-Governor Mitt Romney pledged that healthcare plans would be affordable for everyone and predicted that low-cost plans would be offered for about $200 a month. Romney vetoed a provision in the bill that would have penalized employers for not offering affordable healthcare to their employees.

Last Friday, a subcommittee of the Commonwealth Health Insurance Connector Authority (the Connector), reviewed insurance company proposals for Minimum Credit Coverage — plans that are the cheapest consumers can purchase.

Disappointed by the high costs of the minimum insurance plans — which average around $340 to $380 per month — the Connector told insurers to “sharpen their pencils and come back with more affordable options,” said Joe Landolfi, spokesperson for Connector chair Leslie Kirwan.

But critics of the state’s plan have been warning the government that universal health care achieved through the requirement to buy private insurance will lead to bloated premiums and bare-bones coverage for middle-income residents who can only afford the minimum plans.

“We should not let these board members get away with telling us that they’re surprised [about the costs for the minimum plans],” said Steffie Woolhandler, a physician at Cambridge Hospital and the co-founder of Physicians for a National Health Program, a nonprofit organization pushing for comprehensive national health plan.

In an April interview with The NewStandard, Woolhandler predicted: “Many people will be forced to pay thousands of dollars for a policy that is only a piece of paper. If someone actually does get sick, the policy will be so full of gaps — like large co-pays — that they could go bankrupt. They’ll be facing the worst of both worlds: [being] forced to hand over thousands of dollars to the private health-insurance companies, and finding that they’re not actually covered when they get sick.”

Benjamin Day, executive director of Mass-Care, a coalition advocating a single-payer healthcare system for Massachusetts, said making a low-cost but effective private-insurance plan is impossible.

“You can’t just tell insurers to provide more-affordable health insurance,” Day told TNS. “Unless they’re willing to erode the quality of the plan, they’re not going to get an affordable plan because health insurance is just not affordable [through private insurers].”

Day said the US’s fragmented private insurance system keeps administrative costs — such as marketing expenses — too high to offer cheaper insurance. According to analysis by the Kaiser Family Foundation, administrative costs have risen from $85 in 1986 to $421 in 2003.

Day predicted insurers will offset the cheaper plans by raising deductibles and co-payments — the amount consumers have to pay out of pocket before their insurance kicks in. “It’s not making it more affordable,” he said. “It’s just shifting the money around.”

Day and Woolhandler’s predictions are already materializing. At the same time the subcommittee called for lower premium costs, committee members lowered their expectations for what benefits lower-cost plans should offer.

The recommendations include a cap on out-of-pocket medical expenses at $5,000 per year for individual coverage, and between $7,500 and $10,000 for family coverage. According to a chart released by the Connector, in November, the board had discussed a $3,000 – $4,000 cap on out-of-pocket expenses.

However, insurance companies are not even required to follow these downgraded recommendations in order to get a “seal of approval” from the Connector; spokesperson Landolfi said they are simply guidelines for the insurers to follow, not mandates.

Asked what would happen if insurance companies dismissed the guidelines, Landolfi said on behalf of the Connector chair: “We’ll cross that bridge when we come to it. We think everyone wants this plan to succeed.”

He added there were some plans submitted that were affordable and “well within the range that we had anticipated. We’re confident that in the next couple of weeks… the carriers will submit plans that will address most of all of the recommendations.”

But Landolfi would not provide TNS with details of the plans that he said met the recommendations.

Even if insurers follow the Connector’s suggestions, critics say health care will remain unaffordable for many people.

“Most people don’t have $5,000 lying around in a bank account,” said Woolhandler, of the recommended maximum out-of-pocket expenses subscribers could incur.

Judy Dugan, research director of the California-based Foundation for Taxpayer and Consumer Rights (FTCR), predicted that plans like the Massachusetts initiative and one proposed for his state could leave families in dire situations.

“For a family who is just above the limit on subsidized insurance, if they have a family member that falls seriously ill and needs treatment year-after-year, that $10,000 out-of-pocket can be a formula for bankruptcy,” Dugan told TNS.

Several of the committee’s recommendations were not unanimous, possibly giving insurance companies a sense of further discretion on the minimum plans offered. For instance, three members of the committee favored a ceiling on deductibles, while one member opposed such a cap and another member abstained.

The committee also could not decide on a number of covered routine doctor visits the plans should offer.

Critics of the plan say it’s the government, not the insurance companies, that needs to roll up its sleeves to fix the problem, particularly as other states — such as California and Maine — consider copying the Massachusetts model.

FTCR said states implementing individual healthcare mandates need to couple affordable health care with insurer oversight.

“Something has to give: either the big-bucks lifestyle of insurers and the rest of the medical industry or policyholder benefits,” said Carmen Balber, consumer advocate with FTCR, in a press statement. Regulation would rein in “the excesses of the

medical establishment to make benefits affordable,” Balber added.

But both Woolhandler and Day said no matter what controls are in place, states can never achieve meaningful universal health care through the current system of private bureaucracies.
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“It’s asking people to buy their own way out of their predicament — I call it a ‘Marie Antoinette’ policy,” Woolhandler said. “Private insurance is the problem, not the solution.”

James Winkler’s Statement from PNHP/CNA Press Conference

Jim Winkler spoke at a January 24, 2007, press conference hosted by Physicians for a National Health Program and the California Nurses Association at the National Press Club in Washington, D.C. Here is his statement.

How to Get Healthy

by Jim Winkler

I speak today as national co-chair of Healthcare-NOW!, a growing movement committed to a national quality healthcare system with single-payer financing and as general secretary of the General Board of Church and Society of the United Methodist Church. Our denomination supports a single-payer health insurance program.

Last night President Bush highlighted the crisis of affordable and available health care in his State of the Union address. He would not have given this matter as much time and attention as he did if we were not in the middle of an unfolding tragedy. He noted that “many” Americans cannot afford a health insurance policy. “Many” is an interesting word choice. I think we’ve reached a point where the use of phrases such as “tens of millions” and “too many” are the only ones that work.

One could argue that instead he chose to focus on solutions. Very well. It may be that his recommendation for a standard tax deduction for health insurance will help. He says this will mean more than 100 million men, women, and children who are now covered–already covered, that is–will benefit from lower tax bills.

The President also says the tax deduction will put a basic, private health insurance plan within the reach of those Americans who cannot purchase health insurance on their own. The question before us today is whether we say, “Thank you, Mr. President, for giving some help to the American people” or do we say, “This is not the time for half or quarter or one-eighth measures?” The answer to that is clear: we must have a better and comprehensive single-payer solution to this problem.

The President says the best health care decisions are made not by government and insurance companies, but by patients and their doctors. Yet, he remains committed to the insurance companies. They have to get their vig, their cut, of the health care dollar. Every city in the United States has one or more tall buildings dotting its skyline built by the insurance companies from the excess money they have collected from ordinary Americans. This is money that could be used for better and less expensive health care, for clinics and doctors and nurses, for education and prevention.

And yet these skyscrapers stand as monuments to corporate egos, undeserved profits, and greed. This wasted money prevents patients and doctors from making the best health care decisions. What we want is to eliminate the middle man, the corporate paper-pushers who have bought up the politicians of both major parties in our land, so that health care can become efficient and trustworthy.

Just last night, I was reading the February 2007 issue of Money magazine. Allyson Ranallo of Westlake Village, Calif., wrote to Ellen McGirt who pens the “Money Helps” column. Ms. Rannallo said her husband was treated at an urgent-care facility last March. Afterward she and her husband called their health insurer to confirm this was covered and they were told it was. They mailed the receipt and waited to be reimbursed. They followed up repeatedly and did not receive a check.

Ms. McGirt intervened on their behalf. PacifiCare spokeswoman Cheryl Randolph investigated and found their paperwork fell into “a bureaucratic black hole.” Randolph was mystified as to why the claim was refused. Eventually, they received their check. There are far, far too many people facing the same insurance company denials and obfuscation who do not have a magazine ombudsperson to intervene on their behalf.

Throughout the scriptures, God warns us that nations and rulers who do not care for the sick and the poor and the widows and the orphans will fall, that those nations are corrupt and rotten. Ours is a nation filled with people who study and believe the Bible, but too many have been seduced by the false gods of the market ideology.

Private health insurance has failed us. “Surging” private health insurance will fail just as “surging” the war in Iraq will fail. When you are going down the wrong road, the answer is not to continue traveling in the wrong direction more forcefully. It is to go down the right road.

Date: 1/24/2007

(c) 2005-2006