By Susanne L. King, M.D.
Berkshire Eagle,
Thursday, August 31

POWERFUL FORCES have been shaping the new mandated health care insurance bill being developed in the Statehouse in Massachusetts. I was reading a news article this week about health care lobbying in our state legislature, and was astounded by the sums of money being spent by special interest groups to ensure that the new bill will protect their specific interests; i.e. their profits.

For example, Blue Cross Blue Shield of Massachusetts spent $507,056 this year on lobbying, and the Harvard Pilgrim health insurance company was not far behind with $392,631. Other big spenders included Associated Industries of Massachusetts, and Partners Healthcare, the Boston hospital conglomerate.

But who lobbies for patients? Who lobbies for the policemen, firemen, and other essential city employees who are paying more and more for their health care, so that cost of living wage increases are being canceled out? Who lobbies for the increasing numbers of workers who pay for their own insurance premiums, as fewer employers offer health care benefits (down to 60 percent of employers in 2005, from 69 percent in 2000)? And who lobbies for those of us who pay our own health insurance premiums, and have watched them rise by double digits each year for the past five years?

The new mandated health insurance bill will be helpful to those who earn the least — $9,800 per year for an individual and $13,200 for a family, the federal poverty line. And if you earn up to three times the poverty line, you will qualify for a sliding scale subsidy from the government. However, whether the payments will be affordable for poor families, and what will be affordable for Massachusetts, is now the focus of intense debate within the Commonwealth Health Connector Authority board (a new state agency that will add yet more administrative cost to the health care system).

The state has budgeted $160 million for this mandated health care plan. Tapping into the free care pool fund has been suggested when this budget runs out, which is sure to happen. This means that hospitals, which rely on the free care pool for compensation for patients who don’t pay their hospital bills, will just have to make do or fold. This does not bode well for community hospitals, which don’t have the lobbying power of the large hospital conglomerates.

Meanwhile, we spend over $1 billion per week for health care in Massachusetts. That is $62.1 billion per year, 33 percent more than our national average, and more than other state or country in the world.

Where is all that money going? Certainly the health insurance industry’s expenditures for lobbying, paid for with our insurance dollars, increase administrative costs (which are 10 times higher than with the government-administered Medicare). And there are of course, the multi-million dollar salaries for CEOs, also paid for with our premiums. Health care lobbying not only drains our health care dollars, but also ensures that business as usual reigns in the health care world: powerful vested interests are trying to maintain an unsustainable status quo.

Fundamental change in the health care insurance system must occur. Single-payer health care would eliminate profits and the need for lobbying for those profits. (“Single-payer” means that health insurance is administered by the state government instead of multiple for-profit insurance companies). In addition to eliminating the profits of insurance companies, which are increasing the wealth of a few at the expense of the health of many, single-payer health care insurance would also eliminate the other administrative costs that make this system so much more expensive than Medicare.

With single-payer health care, for-profit insurance companies would not exist. Businesses would not have to support health insurance companies with their own hard-earned income, nor worry about health insurance expenditures for their employees. As a result, they could be more competitive in a world where every other industrialized country has single-payer, universal, government-administered health care, and doesn’t rely on employer benefits.

Every patient in a single-payer system — rich or poor, old or young, employed or unemployed, sick or well — would have comprehensive health care coverage, and would not have to worry about rising premiums, deductibles, and co-payments. Doctors would love the simplified paperwork, and have more time to spend with their patients, instead of dealing with insurance-related administrative tasks.

The new mandated health insurance bill is an attempt to provide universal coverage, but it does not address affordability, nor is it sustainable, either for the individual or for our state. And vested interests, which will profit from this bill, have helped to craft it through their lobbying efforts. If you are one of the many patients for whom no one is lobbying, you should call your legislator and let him know how the current mandated health care bill will affect you, and whether it represents progress in addressing your rising health care costs.

Of the candidates for the upcoming Democratic primary election for state Senator Nuciforo’s position, Chris Hodgkins is the long-time supporter of single-payer health care, and has promised he will work to make it a reality. He understands that single-payer health care is not just a single issue that benefits individual lives and livelihoods, but that it also would decrease the cost of doing business in our state and benefit our economy. Vote in the Democratic primary on Sept. 19 with this in mind!

Editorial

Rutland Herald, VT
September 3, 2006

A single-payer health care system would save the state $51 million a year, according to a new study carried out for the Legislature and released last week. It would achieve these savings by reducing the wasteful administrative costs that burden the present system.

The Legislature’s study provides welcome information, but it ran into immediate criticism from the business community and from the office of Gov. James Douglas. The hostile response by officials ready to denounce the idea of a single-payer system is an indication of the difficulties facing any proposal to put such a plan into effect.

Democratic proponents of health care reform are not ready to embrace a single-payer system. They understand the political difficulties and the economic uncertainties that remain. But at least, they are not closed-minded. The principles underlying a single-payer system are important to understand because they help set a direction toward the goal of universal access and cost-containment.

One of the important principles is shared risk. That is the principle behind all insurance, and it applies to health coverage that might be provided by the state. Shared risk means that the cost of health care is shared because we recognize that for most individuals the high costs incurred by most medical procedures are not affordable.

It is the same principle behind auto insurance. The high cost of an auto accident is likely to be unaffordable to an individual driver, so through a system of insurance we share the risk, knowing the driver having the accident may some day be any one of us.

At present the risk pool is limited to those with insurance, who pay high costs because their insurance premiums must incorporate the costs of care provided, often in haphazard fashion, to those without insurance. In a single-payer system, everyone would pitch in, and everyone would be covered.

Another advantage of a single-payer system would be its efficiency. As much as a third of medical costs at present go to the complex, wasteful process of tracking down insurance payments and fighting insurance companies who make their money by finding reasons not to pay.

Sharing the risk broadly would mean that those now enjoying a free ride would have to begin paying for health care. Many small businesses in Vermont do not offer health insurance, and paying the payroll tax needed to fund a single-payer system would be a significant new cost for them and their employees. On the other hand, employers who now offer insurance and their employees would see their costs fall when their present health insurance plans were replaced by a new payroll tax.

The study conducted by the Legislature by consultant Kenneth Thorpe describes this system, but legislative leaders know the state is far from adopting it. It would have its complications. It could not supplant Medicare and Medicaid, the federal programs for the elderly and the needy, and it would have to recognize the private plans of people from out of state receiving care in Vermont.

And there is the political resistance. As soon as the Thorpe plan was released, the Vermont Chamber of Commerce jumped on it, saying that it would “drown” the state in new taxes. Not mentioned was the elimination of the cost of health care premiums, which would actually save money for many businesses and individuals. A spokesman for Douglas also took a potshot at the Legislature, accusing it of looking for ways to raise the payroll tax.

It is apparent to Democratic legislators that paranoia about raising taxes, even if costs to businesses and individuals are lowered, is a political fact of life. Resistance to a single-payer system from the insurance industry and from businesses seeking to prolong their free ride will continue to be tenacious.

But it is useful to remind ourselves of the principles underlying a single-payer system as we move ahead with the reforms associated with the new Catamount Health plan. One question that emerged last week was whether people who leave jobs voluntarily would be eligible for the state-backed Catamount plan without a year’s wait. The state is arguing that barring them for a year was necessary to protect the solvency of the system. Legislators countered that covering them was essential to provide the seamless coverage that is the goal of Catamount Health.

Broad, seamless coverage is what a single-payer system is all about, and it ought to be a goal of less sweeping reforms as well. Locking people in unproductive jobs because they fear to go without health insurance is damaging to individual enterprise and to the state’s economy. Let’s cover everyone. Let’s eliminate unnecessary barriers to the health care that everyone deserves.

By PAUL KRUGMAN
Op-Ed Columnist
New York Times
Published: September 4, 2006

Let me tell you about two government-financed health care programs. One, the Veterans Health Administration, is a stunning success — but the administration and Republicans in Congress refuse to build on that success, because it doesn’t fit their conservative agenda. The other, Medicare Advantage, is a clear failure, but it’s expanding rapidly thanks to large subsidies the administration rammed through Congress in 2003.

I’ve written about the V.A. before; it was the subject of a recent informative article in Time. Some still think of the V.A. as a decrepit institution, which it was in the Reagan and Bush I years. But thanks to reforms begun under Bill Clinton, it’s now providing remarkably high-quality health care at remarkably low cost.

The key to the V.A.’s success is its long-term relationship with its clients: veterans, once in the V.A. system, normally stay in it for life.

This means that the V.A. can easily keep track of a patient’s medical history, allowing it to make much better use of information technology than other health care providers. Unlike all but a few doctors in the private sector, V.A. doctors have instant access to patients’ medical records via a systemwide network, which reduces both costs and medical errors.

The long-term relationship with patients also lets the V.A. save money by investing heavily in preventive medicine, an area in which the private sector — which makes money by treating the sick, not by keeping people healthy — has shown little interest.

The result is a system that achieves higher customer satisfaction than the private sector, higher quality of care by a number of measures and lower mortality rates — at much lower cost per patient. Not surprisingly, hundreds of thousands of veterans have switched from private physicians to the V.A. The commander of the American Legion has proposed letting elderly vets spend their Medicare benefits at V.A. facilities, which would lead to better medical care and large government savings.

Instead, the Bush administration has restricted access to the V.A. system, limiting it to poor vets or those with service-related injuries. And as for allowing elderly vets to get better, cheaper health care: “Conservatives,” writes Time, “fear such an arrangement would be a Trojan horse, setting up an even larger national health-care program and taking more business from the private sector.”

Think about that: they won’t let vets on Medicare buy into the V.A. system, not because they believe this policy initiative would fail, but because they’re afraid it would succeed.

Meanwhile, the Bush administration is pursuing a failed idea from the 1990’s: channeling Medicare recipients into private H.M.O.’s. The theory was that H.M.O.’s, by bringing private-sector efficiency and the magic of the marketplace to health care, would be able to do what the V.A. has achieved in practice: provide better care at lower cost.

But the theory was wrong. Years of experience show that H.M.O.’s actually have substantially higher costs per patient than conventional Medicare, because they add an expensive extra layer of bureaucracy and also spend heavily on marketing. H.M.O.’s for Medicare recipients prospered for a while by selectively covering relatively healthy older Americans, but when the government began paying less for those likely to have low medical costs, many H.M.O.’s dropped out of the Medicare market.

In 2003, however, the Bush administration pushed through the Medicare Advantage program, which offers heavy subsidies to H.M.O.’s. According to the independent Medicare Payment Advisory Commission, Medicare Advantage plans cost the government 11 percent more per person than traditional Medicare. Oh, and mortality rates in these plans are 40 percent higher than those of elderly veterans covered by the V.A. But thanks to the subsidy, membership in Medicare Advantage plans is surging.

On one side, then, the administration and its allies in Congress oppose expanding the best health care system in America, even though that expansion would save taxpayer dollars, because they’re afraid that allowing a successful government program to expand would undermine their antigovernment crusade and displease powerful business lobbies.

On the other side, ideology and fealty to interest groups make them willing to waste billions subsidizing private H.M.O.’s.

Remember that contrast the next time you hear some conservative going on about excessive spending on entitlements, and declaring that we need to cut back on Medicare and Medicaid benefits.

Vermont News – WCAX.com
August 30, 2006

MONTPELIER, Vt. — Vermont could offer health coverage to all its residents and spend $51 million less a year on health care under a single-payer system, according to a legislative consultant’s report released Tuesday.

But while businesses that currently offer health insurance to their employees would save money, those that don’t _ and their workers _ would see a combined new 13.4 percent payroll tax that even some single-payer advocates see as fatal to the plan.

Sen. James Leddy, D-Chittenden, and Rep. John Tracy, D-Burlington, co-chairs of the Legislature’s Vermont Commission on Health Care Reform, joined the consultant, Dr. Kenneth Thorpe of Atlanta’s Emory University, in describing the report’s findings at a news conference.

“I assume employers would pay about 75 percent of the total (10.1 percent payroll tax) and workers the remaining 3.4 percent,” Thorpe said. Those taxes would be a new expense for businesses and their workers that don’t have health coverage now, he said.

“On the other hand, some employers and families currently pay more than 10.1 percent and 3.4 percent of payroll respectively for insurance and would pay less,” he wrote.

For their money, they would get a “a benefit package modeled after the typical plan in the state,” he added, saying that half of those who currently have insurance have more generous coverage.

Thorpe said copays and deductibles would be set very low under his plan. “These low cost sharing obligations will result in substantial reductions in consumer out-of-pocket spending.”

The lawmakers said Thorpe’s report was not a formal proposal, but was merely informational and one option as they pursue the key goal of health care reform legislation passed in each of the last two years: moving Vermont from a state that has an estimated 61,000 uninsured and 180,000 underinsured to one that offers universal coverage.

Leddy called the report “one more step in our ongoing process that will continue.”

Thorpe, Leddy and Tracy acknowledged that the coverage would not be truly universal. It would exclude Medicare beneficiaries, who already get comprehensive health coverage for seniors from the federal government.

Also excluded would be Vermonters who work for out-of-state employers, whether private companies, national nonprofits or the federal government.

Jason Gibbs, a spokesman for Gov. James Douglas, said the single-payer plan envisioned in the Thorpe report would result in less comprehensive health coverage for many teachers, state employees and others whose employers currently offer more generous plans.

Gibbs said the state should concentrate on implementing health care reform already passed, including the Catamount Health plan designed to get coverage to the uninsured. He noted the legislation’s emphasis on managing chronic diseases, which he said account for 80 percent of health care costs.

“From the governor’s point of view our focus should be laserlike as we implement Catamount Health and these new reforms and our focus should not be on ways to increase taxes,” Gibbs said.

Dr. Deborah Richter, a Cambridge-based family physician and president of the single-payer advocacy group Vermont Health Care for All, called the payroll tax a “nonstarter” because of the opposition it would generate among Vermont’s small business owners.

But she called the report “a great way to open the discussion” about moving the state toward a single-payer system.

By George H. Lesser
The Washington Times
Published August 16, 2006

I have problems with our health insurance “provider,” as I suppose some of you reading this do as well.

I had a minor test done in my doctor’s office. He injected a little pain killer, did the test, and I was gone in about half an hour. The insurance company refuses to pay half the costs, because the doctor anesthetized me, rather than having an anesthesiologist come. Of course, that would have dramatically increased the cost, but that’s what the insurance company demands.

Not too long ago, another doctor sent me to a hospital to have two routine tests performed, which required a general anesthetic in an operating room. My wife went through the same thing a few months before, and the insurance company paid only half because the two tests were performed simultaneously. So I scheduled two visits, on separate days, in the full operating room with the doctor, anesthesiologists, nurses, and who knows what else. I missed two days of work. The insurance company paid twice as much, plus twice the administrative costs for processing two claims. And, of course, I had to run twice the risks of two procedures under general anesthetic. The insurance tail wags the medical dog.

The last time I sought medical help in Italy, I suffered from gastrointestinal distress to such an extent I wasn’t eating. If I can’t eat in Italy, that is serious. The night before I was due to fly to Washington, I was in a hotel near the Milan airport. I wanted to see my doctor in Washington as soon as possible, so I telephoned him to make an appointment. He questioned me about my symptoms and told me I was too sick to fly. We argued, and then he said I could fly, but only if I got a doctor to prescribe ciprofloxacin (“Cipro”) and metronidazole (“Flagyl”) for me to start taking that evening.

I asked the hotel for a doctor. They said it would be faster to go to the clinic at the airport. I followed their advice and found a doctor. He wrote out two prescriptions for me, but said the airport pharmacy had just closed. He directed me to the nearest town with an open pharmacy.

I couldn’t find the drug store. I did find a hospital. I parked in the parking lot, walked in, and asked if I could get the prescriptions filled. The lady got testy and informed me this was a hospital not a pharmacy. I asked for her advice. She told me: “This is a hospital. We practice medicine. If you would like us to treat you, take a seat in the waiting room.” Unable to think of a better course, I went out to my car, grabbed my book, went back into the hospital and settled in for a nice, long read.

After at most five minutes, a male nurse interrupted me. I assumed it was to wrestle with insurance forms in Italian. Instead, the fellow escorted me into a hospital room, where we were joined immediately by a doctor. He spoke English about as well as I speak Italian, so we spoke my language until he ran into problems, then switched to his language until I couldn’t find a word. He questioned me closely about my symptoms. He had me lie down on the bed and started poking and asking me how it felt. He had the male nurse draw some blood, and he ran some other tests. He took a medical history and inspected parts of my anatomy that seemed to have nothing to do with the problem.

I was there six hours. The nurse was in the room with me for all but a few minutes. The doctor was there almost all the time. After a while, he got the test results, which showed I did not have food poisoning, but he wanted to observe me a while longer. Eventually, he concluded I had contracted some kind of intestinal bug, and he gave me a couple of days supply of Cipro and Flagyl.

I checked in with the waspish lady at the front desk to ask how much I owed. She asked me if I had parked in the hospital parking lot. I said yes. She said I owed one euro and 50 pence ($2). I asked how much for the medical care and the medicine. She said that was free. When I got back to Washington, I saw my doctor. He had a few tests run in the office, gave me full prescriptions for Cipro and Flagyl, and billed me $1,000.

Most Americans I talk to have a lot of screwy ideas about medical care. They think Americans have “The Best Health-Care System in the World.” They think “socialized medicine” doesn’t work, because people have to wait too long to get care, and the care isn’t very good and they don’t have any choices.

We have many wonderful doctors, hospitals and pieces of equipment in the U.S. However, statistically, we don’t do so well. Life expectancy, infant mortality, how long people live with a disease after it is diagnosed: You name the criterion, and we don’t compare well with any of the countries that have national health care. And we spend a whole lot more for a lot less health care.

Here are a few comparisons between the U.S. and France. According to the Organization for Economic Cooperation and Development: French women live 3-1/2 years longer than American women; French men live just over three years longer than American men. Our infant mortality rate is 72-1/2 percent higher than theirs. And 30 percent more Frenchmen smoke than we do, and they consume almost twice as much alcohol. Who knows how much more butter, cheese and fois gras?

Worried about waiting for a doctor? Or a hospital bed? The French have 37-1/2 percent more doctors than we, and way over twice as many hospital beds, per capita. Worried about choice? French hospitals are 65 percent government run and 35 percent privately run. Take your pick. The health-care system pays. You also get to choose your doctor.

The difference in the quality of service is difficult for Americans to comprehend. In France, doctors routinely make house-calls. Patients aren’t thrown out of hospitals because the insurance companies decide when it is time to go. They stay until doctors decide it is time to go. The French government pays 75 percent of all health care costs. Most of the rest is paid by private insurance. If somebody can’t afford private insurance, the government makes up the difference.

The bottom line: We pay 43 percent more for health care than the French do, and we get a whole lot less for our money.

George H. Lesser has reported for more than 30 years on international political and economic developments for both U.S. and European publications. He has been based in Washington, New York, London and Brussels, and lives in Washington D.C. and Florence, Italy.

By Louis Porter
Vermont Press Bureau
August 30, 2006

MONTPELIER — A Legislative study released Tuesday concludes that Vermont could save money by adopting a single-payer health care system.

But key lawmakers who authorized the study said they want more information before endorsing or rejecting such a system.

Implementing single-payer health care would pose political and financial challenges by forcing a “substantial redistribution of who pays for health care,” said Kenneth Thorpe, a national consultant hired by lawmakers to conduct the study.

Vermonters who lack insurance now and companies that do not offer coverage to their employees would pay more under a single-payer system, the study found. People who already have health insurance, and employers that offer it to their workers, would pay less.

When state lawmakers passed a reform bill last year to change the way health care is delivered and financed in Vermont, they promised to continue examining one alternative — a single-payer system, run by the state, that would pay hospital and doctor bills for all Vermonters.

Such a system would be more complex than it might seem, lawmakers and experts said.

For example, even the single-payer system studied by Thorpe would be funded by at least three sources. In addition to money provided by the state, the federal Medicare program would continue to cover eligible Vermonters. And private insurance companies would keep paying bills on behalf of out-of-staters who receive medical care while visiting the state.

Even with multiple funding sources, such a system could save $51 million in administrative costs, Thorpe said.

A single-payer system in Vermont would be financed by a payroll tax on companies and workers of about 13.5 percent, Thorpe said. Companies would pay about 75 percent of those costs, while employees would pick up the rest.

Companies that offer their employees health insurance, and workers who have coverage, would see a net savings under that system. But the roughly 40 percent of companies that offer no coverage to their workers would pay more, Thorpe said.

Rep. John Tracy, D-Burlington and Sen. James Leddy, D-Chittenden, who run the Legislature’s Health Care Commission, said they aren’t prepared to endorse the single-payer system outlined in Thorpe’s report. They said they need to see additional studies, including an analysis of all the economic effects such a system would have on the state.

Tracy and Leddy said a single-payer system could be a complement, rather than an alternative, to the “Catamount Health” measure lawmakers passed last year to increase the number of Vermonters covered by health insurance and improve care of chronic illnesses.

“We are not at the end of the road,” said Tracy, who is a Democratic candidate for lieutenant governor. His primary opponent is state Sen. Matthew Dunne. “As we continue to go forward we need to look at all the options to finance it.”

The report quickly drew fire from two sides: from those who don’t believe last year’s measure went far enough, and from those who believe it went too far.

“Imposing a payroll tax will drown Vermont’s job providers, who are a backbone of Vermont’s economy,” Vermont Chamber of Commerce President Duane Marsh said in a prepared statement.

Jason Gibbs, a spokesman for Gov. James Douglas, said the governor “negotiated and signed the most comprehensive health care legislation in the country.”

“The governor’s focus is on implementing those reforms, assuring universal access to affordable health insurance and lowering the cost of care for those who currently have health insurance,” Gibbs said. “We find it very troubling that, just a few months after landmark legislation has been passed, the Legislature is contemplating how to raise the payroll tax.”

But Marvin Malek, a Progressive Party candidate running for lieutenant governor, said Vermont’s new law does little to address the problems of information management and administrative waste. Lt. Gov. Brian Dubie, a Republican, also is running for lieutenant governor.

“That bill is hardly the answer,” Malek said. “I don’t even think it is funded.”

Taxpayers fund the health insurance plans provided to federal, state and local government workers, Malek said. “We are already paying so much for these government plans, why not just say all right, everybody is in,” Malek said.

Increasing the number of Vermonters eligible for government-subsidized health insurance fails to go far enough, he said.

Contact Louis Porter at louis.porter@timesargus.com