PNHP

Group Proposes Single-Payer Insurance Plan in Georgia

Group Proposes Single-Payer Insurance Plan in Georgia

Group Proposes Single-Payer Insurance Plan in Georgia

Georgians for a Common Sense Health Plan is proposing a single-payer plan to provide health insurance coverage to all state residents, the Atlanta Journal-Constitution reports. The SecureCare program would offer residents a comprehensive benefits package that includes long-term care and prescription drug coverage. It would be financed by a combination of payroll taxes, increased tobacco and alcohol taxes, a 1% sales tax and an individual tax, according to the Journal-Constitution. Emory University professor Kenneth Thorpe said the proposal would require more federal funding to lower the employer payroll tax, which has been suggested at 9.1%. According to a study released Monday by the Lewin Group, a Virginia-based health care consulting firm, the proposal would decrease the state’s total health care spending by about $716 million per year. Rita Valenti, founder of Georgians for a Common Sense Health Plan and a former state legislator, said, “Health care needs to be viewed as a necessary infrastructure, like roads or police services. I don’t think anyone is doing well under the current system, except for the private insurance industry and the pharmaceutical industry.” Thorpe said, “On paper there’s a lot of merit to [the proposal].” He added, “The politics is always the thing that bottles it up. You’re moving money from the private sector to the public sector.” Charlie Harman, a vice president of Blue Cross Blue Shield of Georgia, said, “We believe that Americans want their leaders and all health stakeholders to work together to improve what is already a very good system without the tax and fee increases suggested in this proposal.” Susan Pisano of America’s Health Insurance Plans added that single-payer systems in other countries have long waits for care and can be slow to adapt to change and medical innovations (Miller, Atlanta Journal-Constitution, 6/22).

Kuehl’s Statewide Health Coverage Bill Takes Historic Step Forward In Assembly Health Committee

FOR IMMEDIATE RELEASE
June 22, 2004

Kuehl’s Statewide Health Coverage Bill Takes Historic Step Forward In Assembly Health Committee

CONTACT: Sara Rogers (916) 445 1353 or Robin Podolsky (310) 441 9084

Senate Bill 921, authored by State Senator Sheila Kuehl (D-23) which would provide comprehensive health benefits to every Californian at no new cost to California’s general fund, has been passed by the State Assembly Health Committee by a vote of 12 to 5.

SB 921 would create a single, streamlined reimbursement system for medical care in California that has been projected to save the state about $14 billion dollars in administrative healthcare costs alone. These and other substantial savings make it possible to insure every resident of California with a comprehensive health plan that would include medical, dental, vision, mental health and prescription drug coverage among benefits.

Because SB 921 would cover every Californian, it would offer each patient the freedom to choose among all healthcare providers. Healthcare provision would remain subject to competition and in private hands. The legislation would also require the State of California to use its purchasing power negotiate directly with pharmaceutical companies to buy prescription drugs in bulk, thus drastically lowering their cost.

“I’m very grateful to my colleagues in the Assembly Health Committee for voting to extend healthcare coverage to every Californian,” said Senator Kuehl. “SB 921 will make it possible for every Californian to keep their health care coverage even if they change jobs; start a business; family; continue our education; or travel out of state. Our important relationships with the doctors we trust will not be interrupted. People with undetected chronic illnesses will get the care they need to avert the heartache and economic burden of medical catastrophes. This bill will save our state money and improve the quality of life for all of us.”

Today, approximately 1 out of 5 Californians is uninsured, and, nationally, catastrophic medical illness remains the leading cause of personal bankruptcy. Most uninsured Californians are employed but either cannot afford the medical insurance offered to them at work or are not offered healthcare benefits through their job. Analysts agree that the costs of healthcare are propelled upward by the overuse of emergency room care (the most expensive kind of healthcare delivery) by people who are not insured and do not receive regular medical attention. Doctors and hospitals also report that, as insurance premiums rise in cost, the reimbursements paid by private insurance companies to medical providers are shrinking.

Cost Controls in SB 921 would mean that businesses would not be burdened with suddenly rising health care premiums; would no longer have the responsibility for negotiating complicated health care benefits packages for their employees; and would also insure the self-employed.

SB 921 would also relieve doctors and hospitals of the administrative costs associated with multiple insurance plans. Since all patients will be insured, healthcare providers will not have to worry about uninsured patients being unable to pay for the care they receive. Physicians will have a direct voice in the amount of reimbursement they receive. Those reimbursements will reflect the actual costs, on a regional basis, of providing care, and they will come on time. Doctors, not insurance companies, will be in charge of deciding what is medically appropriate for patients.

SB 921 will be funded with those federal and state dollars already earmarked for healthcare, along with a means-based, equitable tax. Individuals and employers will pay into the plan based on what they can afford, not what insurance companies want to charge. This tax will replace all premiums, deductibles, co-pays and out-of-pocket expenses. For most taxpayers and businesses, this will lead to sizeable savings.

Rules to Expose Long-Term Cost of Health Plans

New York Times
Rules to Expose Long-Term Cost of Health Plans
By ROBERT PEAR

Published: June 21, 2004

WASHINGTON, June 20 — New accounting standards will require state and local governments to acknowledge the full cost of health benefits promised to retirees, putting immense pressure on public employers to reduce their liabilities by scaling back benefits or shifting more of the cost to retirees, government officials and accountants say.

Supporters say the rules will help state and local officials, investors and taxpayers understand the magnitude of these commitments to current and future retirees.

But public employees — civil servants, police officers, firefighters, judges, teachers and state university professors — predict that the rules, combined with the soaring cost of health care, will speed the erosion of health insurance in the public sector, as happened at many private companies in the early 1990’s.

The rules, developed by the Governmental Accounting Standards Board, an independent nonprofit organization, apply to all state and local governments. They require employers to measure and report the long-term costs of retiree health benefits while employees are still working. Under current practice, most public employers do not report such costs until they pay for the promised benefits, often many years after employees have retired.

“State and local governments have generally been looking at the tip of the iceberg,” said Karl D. Johnson, project manager for development of the new rules. “Our standards require them to measure the iceberg. Many public employers have never looked under the water. They just looked at what they could see on the surface — what they have to pay this year for current retirees — without measuring the cost of their commitment to provide retiree benefits to large numbers of active workers.”

In large states, Mr. Johnson said, such unfunded liabilities for retiree health benefits total billions of dollars.

The standards are set forth in two documents. In April, the seven-member board issued financial reporting standards for health plans that cover state and local government employees. It is scheduled to give final approval this week to a companion document, which sets accounting standards for public employers that sponsor such plans.

The board, formed in 1984, is a private entity, but accountants and auditors accept its pronouncements as authoritative. State and local governments have a strong incentive to follow its standards because compliance helps them borrow money in the bond market at favorable rates.

Most public employers finance retiree health benefits on a pay-as-you-go basis, as bills come due. Experts on employee benefits said the new standards would encourage state and local officials to set aside money in trust funds for the purpose of providing health benefits to retirees.

The cost of such contributions would be a new, immediate expense for state and local governments, many of which are already struggling with severe financial problems.

Labor unions and health plan administrators said the standards could jeopardize health benefits for millions of retired public employees. Moreover, they said, the standards will cause a fiscal shock to state and local government agencies and could harm their bond ratings.

“We are concerned that a lot of our retirees will end up losing their health benefits,” said Frederick H. Nesbitt, executive director of the National Conference on Public Employee Retirement Systems.

The Financial Accounting Standards Board, a sister organization, issued similar standards for private employers in 1990. Many companies have cited those standards as a reason for cutting retiree health benefits.

“What’s going to happen in the public sector is exactly what happened in the private sector,” Mr. Nesbitt said.

Daniel C. Givens, a Florida firefighter who is chairman of the Miami Firefighters Relief and Pension Fund, said: “The new standards will suddenly put a strain on the city for a long-term liability that has been developing for years and years. Retirees will feel the brunt of the impact. They can expect to see reductions in benefits and increases in costs.”

Public employers are more likely than most industries to offer health benefits, but the prevalence of retiree coverage in general has been declining. In a survey of large private and public employers, the Kaiser Family Foundation found that 38 percent offered retiree benefits last year, down from 66 percent in 1988. When coverage is still available, premiums, co-payments and deductibles are increasing.

Melvyn Aaronson, treasurer of the United Federation of Teachers in New York, said, “The new accounting standards will accelerate those trends.”

The board sets accounting standards for 80,000 state and local governments, affecting more than 15 million employees. About three-fourths of state governments and more than half of local governments provide health benefits to retirees.

Many of the arrangements were adopted years ago, when costs were relatively low, but “times have changed, and many employers now spend 5 percent to 10 percent of payroll, or more, on retiree health benefits,” said Paul Zorn, a consultant at Gabriel, Roeder, Smith & Company, which advises more than 400 state and local government entities.

Under the standards, public employers will have to disclose the assets and long-term liabilities of their health plans. They will also have to calculate the amount of annual contributions that would be needed, over many years, to provide the promised benefits.

Cynthia B. Green, a member of the governmental standards board, said: “Historically, government employees have sacrificed salary increases for promises of enhanced benefits. These governments rarely calculate the price tag. They almost never consider whether the promises are affordable. A retiree may have been promised generous benefits, but if the employer can’t honor the promise, what good is it?”

Ms. Green, a former vice president of the Citizens Budget Commission, a watchdog group in New York, said she did not know if the critics’ “dire predictions” would come true. “If governments find out they have big liabilities,” she said, “some may cut spending, some may raise taxes and others may change the benefit package. Or they could combine these options.”

Unions contend that the standards will force public employers to overstate their liabilities for retiree health benefits, because the standards ignore the fact that employers can reduce or eliminate health benefits in the face of fiscal pressures.

But the board refused to let employers take credit for savings that might result from benefit cuts in the future. Such bookkeeping techniques “lack objectivity and would give recognition to changes that have not occurred and may not occur,” the board said.

Cathie G. Eitelberg, senior vice president of the Segal Company, a benefits consulting firm, said the new disclosures would draw attention from taxpayers and elected officials.

“When taxpayers see the magnitude of the unfunded liability,” Ms. Eitelberg said, “there will be changes in the way benefits are financed and delivered, because ultimately the taxpayer pays the bill.”

Sick, and Tired of the Endless Paperwork

Sick, and Tired of the Endless Paperwork

We’ve been charged for seeing doctors we never met, and even for the armrests on my wife’s wheelchair.
By Doug GarrNewsweek, June 21, 2004

When my wife, Meg, suffered a severe stroke that immobilized her left side, I knew we would be facing a grueling odyssey involving several hospitals, dozens of doctors and countless therapy sessions. What I wasn’t prepared for was the American Way of Managed Health Care, a system that is bureaucratic and often dysfunctional. Yes, medical practitioners in the United States are generally considered among the best in the world, and my wife primarily had first-rate care, but their back-office practice—a business dominated by third-party payers—is badly run at worst and woefully confusing at best.

Meg’s stroke occurred while we were vacationing in the south of France last summer. After being stabilized in the emergency room of a small hospital, she was transferred immediately to a large teaching hospital, where she received excellent treatment in a world-renowned stroke pavilion. When I received the bill for her 2-1/2-week stay at the Pasteur Hospital in Nice, I asked the deputy administrator for an itemized statement. I knew I’d need to show it to our health-insurance company—the one-page invoice for more than 20,000 euro wouldn’t do. The administrator was puzzled. There were only two daily rates, he explained, one for soins intensifs—or intensive care—and another for non-acute care. There were no extra charges; the numerous ambulance transfers, MRI brain scans, X-rays and assorted tests associated with any serious injury or illness were all-inclusive. In fact, the only supplement was 10.67 euros—about $13—a day for food which, although not three-star bistro quality, was certainly a bargain, and better than anything you can eat in a U.S. hospital.

I’m not arguing that the French health-care system should be a world benchmark, but compared with what we faced when we returned home, it was a model of simplicity and efficiency. Of course, everything in American medical care is a la carte, and the invoices are so dense with codes and abbreviations, it’s a wonder anyone can decipher them. I often wonder, how much does this cost the American public annually?

At one New York hospital, we received bills from doctors we’d never heard of, including one who charged for an office visit when Meg couldn’t even get out of bed. The managed care provider’s computer sent him a check without question. Had he not billed us for the co-payment I never would have noticed the error. Over the past few months, I spent hours clearing up these kinds of mistakes. A doctor friend who heads a department in a large hospital admitted that these kinds of complaints are all too common.

Meg’s medical tab has reached nearly $300,000, which seems monumental, even given the nature of her catastrophic injury. Thankfully, we were covered for most of it. Yet $90,000 of that figure had little or nothing to do with patient care. Roughly 30 cents of each health-care dollar goes to administration, or the processing of paperwork. If that figure could be reduced by a third, even $30,000 would go a long way toward extending her rehab treatments. (Meg’s 2004 benefits have run out.)

When Meg was finally discharged after spending 56 days in hospitals, we received co-payment bills for her medical equipment, including an itemized statement for every extra on her wheelchair (no, the brake extensions, foot pedals, armrest, anti-tip bars, seat and seat belt are not included). But the provider billed us two ways, one for leasing the chair and another for purchase. Even now, after numerous phone calls, I still don’t know whether we own or are renting the wheelchair.

The outpatient rehab therapy sessions presented their own set of challenges. The hospital sent a number of bills—printed in alphanumeric codes—for additional thousands of dollars even though we made the proper co-payments at the time of treatment. Billing administrators barely raised an eyebrow when I told them I had spent too much time on hold and would no longer bother calling to dispute the charges. (We have since received automated early-morning phone calls asking us to contact the hospital.)

I’ve checked with others who have had protracted negotiations with health-care providers and insurers over complex medical treatment. They echo my frustration. Why is it incumbent on the recipient to spend countless hours rectifying the medical administration’s mistakes? How much extra does this process add to the nation’s annual health-care bill?

Medicare—our government-subsidized system that cares for the elderly—has a much better record in administrative costs. It spends between three and four cents of every dollar on paperwork and processing. A single-payer system is easier and cheaper to run. We’ve had a two-tier health-care system in the United States for a while, and only one tier works. Isn’t it time for managed care to slim down and help its patients get better instead of burdening them with needlessly expensive paperwork?

Garr is a writer living in New York City.–

Rally hopes to bridge gap in health insurance

Rally hopes to bridge gap in health insurance

By Rob Daniel
Iowa City Press-Citizen

Health care was the focus Saturday at Hubbard Park as about 300 people rallied for improved access to health care insurance for all.

Bridge the Gap, highlighted by a march across the Iowa Avenue bridge, was one of several events across the country that highlighted the lack of medical coverage for about 82 million Americans, as a Family USA survey found. That includes 637,000 Iowans, most coming from working families, the survey said.

Iowa Lt. Gov. Sally Pederson highlighted the lack of health care coverage for some Iowans, saying people cannot be satisfied with numbers of those who do have coverage.

“If you don’t have health care insurance you can die,” Pederson said. “I believe it’s a right. You believe it’s a right.”

A speaking highlight was by Pat Swancutt of Spencer, who spoke of her 18-year-old granddaughter Janelle Polson dying in 2001 after not being able to get tests for an unknown medical condition. Her daughter and Janelle’s mother, Lisa Scott, was speaking at a similar rally at San Francisco’s Golden Gate bridge, she said.

“If we get this health care affordable, then we’ll feel we’ve done Janelle justice,” Swancutt said, flanked by Janelle’s sisters, Carly and Stevie.

The rally began with a march across the bridge, with marchers shouting phrases such as “Affordable health care – bridge the gap.” They also vowed to “remember in November” in a song sung to the tune of the “Battle Hymn of the Republic,” a shot at Republicans and the Bush administration, who they said did not back more universal health care coverage.

Bret McFarlin, a doctor and member of Physicians for a National Health Policy, a group that backs a government-backed universal health care system, said the Medicaid Reform Act approved by Congress last fall was a $500 billion giveaway to pharmaceutical companies.

“We’re already paying for universal health care,” McFarlin said. “We’re just not getting it. We see this as the surest route to affordable health care for all.”

The march and rally was designed to be non-partisan, said Sarah Swisher, state director of Iowa for Health Care, with no political candidates speaking.

“We’re anxious to get people excited about equal health care,” said Swisher, who also serves as the chairwoman of the Johnson County Democratic Party.

An outside group, Billionaires for Bush, also criticized the Bush administration before the march. Ten people dressed in tuxedos and evening gowns, carried glasses of champagne and signs that read “Less health care, more wealth care.”

“The thing we want people to know is Bush always has ulterior motives,” said Tom Garner, a Des Moines resident backing the group though not dressed up.

Iowans without health insurance

• More than one of every four people (25.2 percent) in Iowa under age 65 went without health insurance for all or part of the past two years.

• Of the 637,000 uninsured Iowans, nearly 60 percent were without insurance for six months or longer.

• Whites were the largest group – about 504,000 people- of uninsured.

• About 55 percent of Hispanics were uninsured, compared to 22.3 percent of white, non-Hispanic people.

• Most uninsured Iowans (82.4 percent) were members of working families.

• Families living at or below 200 percent of the federal poverty level were more likely to be uninsured.

Source: Families USA

The Associated Press contributed to this report.

Reach Rob Daniel at 339-7360 or rdaniel@press-citizen.com.

Protesters march for universal health care 

Sunday, June 20, 2004
By GREGORY A. HALL
ghall@courier-journal.com

The Courier-Journal
Protesters march for universal health care Local rally allies with national movement for single system

[sidebar photos:  Psychiatrist Sue Bentley held a sign yesterday during a Bridge the Gap for Healthcare rally in Waterfront Park.   Melanie Phillips, right, and her husband, Aaron Phillips, held a banner reading “$32 million Athem CEO bonus”  as they marched from Waterfront Park]

About 42 million Americans do not have health insurance and 30 million to 40 million are underinsured, said Dr. Adewale Troutman, Louisville With purple signs saying, “I’m a health care voter,” a collection of activists, union members and health care professionals rallied yesterday in support of a national health care system.

Universal access to a single system of health care is “a long struggle,” said Dr. Adewale Troutman, director of the Louisville Metro Health Department. “It’s not a new struggle.”

Troutman, who said he was only representing his personal views, recalled am similar rally on the steps of the U.S. Supreme Court in 1978 when he was president of the Student National Medical Association.

About 42 million Americans are without health insurance and an additional 30 million to 40 million are underinsured, Troutman said.

Both Troutman and Dr. Garrett Adams, the keynote speaker and retired University of Louisville Medical School professor, said that a national system could provide health care without any more money than is currently being spent.

Such a national system would include allowing patients to choose their hospitals and doctors, “taking these decisions back from insurance companies,” Adams said.

Adams said the current system has failed and is experiencing spiraling costs.

“We’re not getting what we’re paying for,” Adams said.

About 80 people, including about a dozen children, and a couple of dogs took part in the march, which started at Waterfront Park, went across the Clark Memorial Bridge and returned to Louisville’s riverfront.

The Louisville event was part of a number of similar rallies and walks planned across the country. The national effort was sponsored by Americans for Health Care, Jobs With Justice, Rock the Vote and the Service Employees International Union.

The Louisville version had a decidedly Democratic Party flavor, with signs and supporters of the party’s presumptive nominee for president, Sen. John Kerry, and a speech by state Rep. Mary Lou Marzian, who is a registered nurse.

Republicans “are letting the health insurance industry run health care,” Marzian said.

Shelton Talbott, a Louisville Metro Housing Authority employee and service employees union member, said his wife recently lost her job and had to be put on his health care.

“The costs of it are just continually going up,” Talbott said.

And his son, Shelton Talbott Jr., 18, is in danger of losing coverage under his father’s health insurance because he recently graduated from Atherton High School and will be looking for a job.

One of the organizers, Sandra Limpert, said in an interview that the march and rally were important to her because she is uninsured.

“This is a very personal issue for me,” said Limpert, who lives near Churchill Downs.

Limpert said she is a University of Louisville student and single parent who can’t get Medicaid because the support payments she gets for her child count as income.

Neither the proposals of President Bush nor Kerry go far enough, she said.

“The people have to stand up and demand of their legislators that they listen and (that) something be done,” she said.

Kay Tillow, a member of the Nurses Professional Organization, said that American health insurance is “a disaster.” Deductibles are so high for a number of people that they make health insurance unaffordable, particularly when it comes to regular checkups and preventative treatment.

“We have to fix it,” she said

Profit motive is health's loss

Editorial page, Atlanta Journal-Constitution
June 20, 2004

Profit motive is health’s loss

In a country where capitalism is the state religion, it’s hard to get people to admit that the profit motive doesn’t improve every enterprise. Americans seem to think there is no problem that cannot be solved by some resourceful entrepreneur.

But we’re experiencing a crisis of faith in at least one area — health care. The soaring cost of hospitals and medicines suggests that capitalism is sometimes at odds with the common good.

Not many of us have the nerve to say that aloud yet. It’s heresy.

Besides, the last time any public figure made a serious effort to reform health care, the result was near excommunication. Hillary Clinton’s complex system of rules and regulations was easily caricatured by opponents, and the blowback was enough to keep any self-respecting politician away from health care for years. But in the coming decade, the soaring cost will force Congress and state legislatures to confront the problem.

We now have a health care system whose primary mission is not delivering
health care. Instead, insurance companies, pharmaceutical companies, medical device manufacturers and, in fact, many hospitals exist to make money. That’s their first priority, and also their second and third priority. The product they sell happens to be improved health. But they jack up the prices on the product and restrict it to those who can afford it.

In this enterprise, a little profit motive goes a long way. And in health care, it has gone too far.

Just take a look at what has happened recently to prices of some pharmaceuticals used by elderly patients. The prices shot up just as the new drug discount cards were released, ensuring that drug companies will earn just as much on products for ailments such as hypertension and arthritis as they did before. So those retirees who have struggled to pay for their medications will be no better off — even with discount cards. The prices of the 30 drugs used most often by retirees rose more than four times the rate of inflation from January 2003 to January 2004, according to consumer advocacy group Families USA.

In the United States, capitalism works as well as it does because businesses compete for customers. And there is usually a business willing to make any product available for a cheaper price. If a motorist can’t afford a Mercedes, he can buy a Mazda. If you can’t afford the $15,000 plasma TV, you can settle for the $500 cathode-ray tube model. But who wants to see the discount cancer doc?

Insurance companies have tried to hold down costs by reimbursing physicians at a standard rate for common procedures. But that has not kept health care costs from rising faster than the rate of inflation. Perhaps that’s because medicine is one of those mysterious enterprises where the average consumer can never be sophisticated enough to know what he’s actually buying. Most of us find a physician we like and do what he or she dictates. It’s simply not the same as buying a toaster or a dining room table. You don’t wait for a good sale to get your angioplasty.

There is also this difference with the average consumer product: Most Americans believe that access to doctors and hospitals is a right, not a privilege that comes with money. We don’t say that out loud either. Not yet. But federal regulations already guarantee treatment in case of an emergency. If you have pneumonia and need to see a doctor, a public hospital may not turn you away, even if you don’t have insurance.

But guaranteeing access to emergency room treatment has helped to push the cost of medicine even higher. It would be far cheaper to guarantee every American preventive care — regular check-ups for hypertension and diabetes, immunizations for school-age children, medications for routine illnesses such as ear infections.

As more and more working Americans find themselves without health insurance, our faith in the ability of capitalism to provide a fundamental asset of American life is being sorely tested. Sometime in the next decade, we’ll be forced to admit that government will have to step in and shore up the safety net by guaranteeing basic health care to all Americans.

The old-time religion will have some new hymns.
———————————————————————————-

Cynthia Tucker is the editorial page editor. Her column appears Sundays
and Wednesdays.

Profit motive is health’s loss

Editorial page, Atlanta Journal-Constitution
June 20, 2004

Profit motive is health’s loss

In a country where capitalism is the state religion, it’s hard to get people to admit that the profit motive doesn’t improve every enterprise. Americans seem to think there is no problem that cannot be solved by some resourceful entrepreneur.

But we’re experiencing a crisis of faith in at least one area — health care. The soaring cost of hospitals and medicines suggests that capitalism is sometimes at odds with the common good.

Not many of us have the nerve to say that aloud yet. It’s heresy.

Besides, the last time any public figure made a serious effort to reform health care, the result was near excommunication. Hillary Clinton’s complex system of rules and regulations was easily caricatured by opponents, and the blowback was enough to keep any self-respecting politician away from health care for years. But in the coming decade, the soaring cost will force Congress and state legislatures to confront the problem.

We now have a health care system whose primary mission is not delivering
health care. Instead, insurance companies, pharmaceutical companies, medical device manufacturers and, in fact, many hospitals exist to make money. That’s their first priority, and also their second and third priority. The product they sell happens to be improved health. But they jack up the prices on the product and restrict it to those who can afford it.

In this enterprise, a little profit motive goes a long way. And in health care, it has gone too far.

Just take a look at what has happened recently to prices of some pharmaceuticals used by elderly patients. The prices shot up just as the new drug discount cards were released, ensuring that drug companies will earn just as much on products for ailments such as hypertension and arthritis as they did before. So those retirees who have struggled to pay for their medications will be no better off — even with discount cards. The prices of the 30 drugs used most often by retirees rose more than four times the rate of inflation from January 2003 to January 2004, according to consumer advocacy group Families USA.

In the United States, capitalism works as well as it does because businesses compete for customers. And there is usually a business willing to make any product available for a cheaper price. If a motorist can’t afford a Mercedes, he can buy a Mazda. If you can’t afford the $15,000 plasma TV, you can settle for the $500 cathode-ray tube model. But who wants to see the discount cancer doc?

Insurance companies have tried to hold down costs by reimbursing physicians at a standard rate for common procedures. But that has not kept health care costs from rising faster than the rate of inflation. Perhaps that’s because medicine is one of those mysterious enterprises where the average consumer can never be sophisticated enough to know what he’s actually buying. Most of us find a physician we like and do what he or she dictates. It’s simply not the same as buying a toaster or a dining room table. You don’t wait for a good sale to get your angioplasty.

There is also this difference with the average consumer product: Most Americans believe that access to doctors and hospitals is a right, not a privilege that comes with money. We don’t say that out loud either. Not yet. But federal regulations already guarantee treatment in case of an emergency. If you have pneumonia and need to see a doctor, a public hospital may not turn you away, even if you don’t have insurance.

But guaranteeing access to emergency room treatment has helped to push the cost of medicine even higher. It would be far cheaper to guarantee every American preventive care — regular check-ups for hypertension and diabetes, immunizations for school-age children, medications for routine illnesses such as ear infections.

As more and more working Americans find themselves without health insurance, our faith in the ability of capitalism to provide a fundamental asset of American life is being sorely tested. Sometime in the next decade, we’ll be forced to admit that government will have to step in and shore up the safety net by guaranteeing basic health care to all Americans.

The old-time religion will have some new hymns.
———————————————————————————-

Cynthia Tucker is the editorial page editor. Her column appears Sundays
and Wednesdays.

Appeals court upholds "living wage" law that includes health benefits

Los Angeles Times
June 17, 2004
Berkeley’s Living Wage Ordinance Is Upheld in Federal Appeals Court
By Henry Weinstein

A federal appeals court in San Francisco on Wednesday upheld Berkeley’s authority to require higher minimum wages for some workers, the first appellate ruling in the country on whether local governments have that power.

Berkeley’s law, enacted in June 2000, is fairly typical of living wage ordinances adopted nationally. The law mandated minimum hourly wages and employee benefits for certain companies that received financial benefits from the city such as city contracts, leases on city property or certain tax exemptions.

The Berkeley law set a minimum wage of $9.75 plus health benefits for those companies. Firms covered by the law but that did not provide health benefits were required to pay $11.37 an hour. The figures have risen with inflation.

http://www.latimes.com/news/nationworld/politics/scotus/la-me-wage17jun17,1,1268555.story?coll=la-news-politics-supreme_court

Comment: This U.S. 9th Circuit Court of Appeals ruling was split along ideological lines with two Clinton appointees supporting it and a Bush appointee opposing it. This is a minute and tenuous increment on the path toward universal health care coverage and access.

The political process remains dominated by forces that have only increased the numbers of uninsured, and have increased the risk of medical debt for those who are insured.

It is inappropriate to stop and celebrate a tiny victory when the health financing infrastructure is crumbling around us. We know how to build a financing infrastructure that would ensure affordable, comprehensive coverage and access for everyone. Let’s get on with it!

Scrooge & Marley, Inc. — The True Conservative Agenda

Scrooge & Marley, Inc. — The True Conservative Agenda
by Thom Hartmann
 
“That liberty [is pure] which is to go to all, and not to the few or the rich alone.”
–Thomas Jefferson to Horatio Gates, 1798.

There is nothing “normal” about a nation having a middle class, even though it is vital to the survival of democracy.

As twenty-three years of conservative economic policies have now shown millions of un- and underemployed Americans, what’s “normal” in a “free and unfettered” economy is the rapid evolution of a small but fabulously wealthy ownership class, and a large but poor working class. In the entire history of civilization, outside of a small mercantilist class and the very few skilled tradesmen who’d managed to organize in guilds (the earliest unions) like the ancient Masons, the middle class was an aberration.

If a nation wants a middle class, it must define it, desire it, and work to both create and keep it.

This is because a middle class is the creation of government participation (conservatives call it “interference”) in the marketplace, by determining the rules of the game of business and of taxation, and by providing free public education to all. And it wasn’t until 1776, when Thomas Jefferson replaced John Locke’s right to “life, liberty and property” with “life liberty, and the pursuit of happiness” that the idea of a large class of working people having the ability to “pursue happiness” – the middle class – was even seriously considered as a cornerstone obligation of government.

(That was also the first time in history that “happiness” had ever appeared in any nation’s formative documents. As Jefferson wrote in 1817 to Dr. John Manners, “The evidence of this natural right, like that of our right to life, liberty, the use of our faculties, the pursuit of happiness is not left to the feeble and sophistical investigations of reason, but is impressed on the sense of every man.”)

Thomas Jefferson laid out in an 1816 letter to Samuel Kerchival what today would be a blistering attack on the conservative/corporate war on labor and Bush’s union-busting planned privatization of over 700,000 government positions.

“Those seeking profits,” Jefferson wrote, “were they given total freedom, would not be the ones to trust to keep government pure and our rights secure. Indeed, it has always been those seeking wealth who were the source of corruption in government. No other depositories of power have ever yet been found, which did not end in converting to their own profit the earnings of those committed to their charge.”

He added: “I am not among those who fear the people. They, and not the rich, are our dependence for continued freedom. … We must make our election between economy and liberty, or profusion and servitude. … [Otherwise], as the people of England are, our people, like them, must come to labor sixteen hours in the twenty-four, … and the sixteenth being insufficient to afford us bread, we must live, as they now do, on oatmeal and potatoes; have no time to think, no means of calling the mismanagers to account; but be glad to obtain subsistence by hiring ourselves to rivet their chains on the necks of our fellow sufferers.”

A totally “free” market where corporations reign supreme, just like the oppressive governments of old, Jefferson said could transform America “…until the bulk of the society is reduced to be mere automatons of misery, to have no sensibilities left but for sinning and suffering. Then begins, indeed, the bellum omnium in omnia, which some philosophers observing to be so general in this world, have mistaken it for the natural, instead of the abusive state of man.”

As Jefferson realized, with no government “interference” by setting the rules of the game of business and fair taxation, there will be no middle class.

Although this may come as a sudden realization to many, we’ve really known it all our lives.

For example, every year, millions of Americans revisit Charles Dickens “A Christmas Carol” about Ebenezer Scrooge and Bob (and Tiny Tim) Cratchit. Yet somehow Americans fail to realize the subtext of the story (and so many of Dickens’ other works). That subtext is that the middle class is not a normal thing: exploited workers are the norm. In fact, in the six-thousand-year history of the “civilized” world, a middle class emerging in any nation has been such a rarity as to be historically invisible.

As Dickens pointed out, Cratchit lived the typical life of that day’s English working poor. He couldn’t afford medical care for Tim, dooming his son to death or a lifetime of deformity. He had no idea where his Christmas dinner may come from, let along how to get gifts for his children, and always lived on the edge of the terror of unemployment and homelessness. Although he had a full-time job at Scrooge & Marley, Inc., he was so desperately anxious to keep his job that he worked weekends and evenings and put up with years of daily abuse from his employer.

This demonstrates the true liberal/conservative divide. Conservatives believe what business does is business’s business, and government should keep its nose out of it, even when it leads to centuries of Tiny Tims and terrified-of-job-loss employees. As the Wall Street Journal noted in 1997, Alan Greenspan sees one of his main jobs as being to maintain a high enough level of “worker insecurity” that employees won’t demand pay raises and benefits increases, thus provoking “wage inflation.” (“CEO inflation” is fine with the cons.)

Liberals, on the other hand, subscribe to the notions of the founder of today’s Democratic Party — Thomas Jefferson — that if the government doesn’t actively participate in regulating how the game of business is played, the middle class (what in Jefferson’s day were the “yeomanry”) would vanish.

The United States has had two great periods of what we today call a middle class. The first was from the 1700s to the mid-1800s, and was fueled by virtually free land for settlers. People owned the means of their production (their farms), could sell their surplus, and had time to be among (as deTocqueville pointed out) the most well-educated, politically active “non-aristocrats” in the world.

As big business grew in the 1800s after the Civil War, the farm-based middle class collapsed, in large part because the early progenitors of companies like today’s Cargill or ADM came to control the sale and distribution of farm produce. Middle class farmers rose up, created the Grange movement as part of their own way of competing with the big ag companies, and — seeing that their “representative government” was being taken over by the largest corporate interests — launched the Populist and Progressive movements.

Step one was to limit the size of corporations to limit their power — thus the Sherman Anti-Trust Act of 1881 (still law, but unenforced for all practical purposes since Reagan.)

Step two was to take Teddy Roosevelt’s advice that, “We must drive the special interests out of politics. The citizens of the United States must effectively control the mighty commercial forces which they have themselves called into being. There can be no effective control of corporations while their political activity remains.” Progressives pushed hard, and in 1907 a law was passed (still on the books) making it illegal for corporations to give money to politicians. It needs to be expanded.

The last parts of the progressive agenda included a direct election of the U.S. Senate (Senators had been pointed by political machines in the states) so the progressives may get more democracy and representation, and the hope that when women voted (besides it being the morally right thing) they may help break up the old boy’s club of big business. (These goals were achieved in 1913 and 1920.) And, even in the face of corporate violence that often escalated to murder, Americans struggled to bring together the budding union movement.

But the middle class of the farmers never really again recovered their middle class status in America (although there are dying pockets of it still about, supported by Willie Nelson, Farm Aid, and other groups), and the Gilded age saw a very Dickens-like America — a small group of very wealthy business and land owners and a very large class of desperately poor workers.

It took the leadership of FDR for government to again take a hand in creating a middle class, this time via industrialized labor instead of land (times change, and we’d taken about all the land we could from the Native Americans).

The Wagner Act of 1935 guaranteed Americans the right to form a union and bargain collectively with their corporate employers. Combined with the later G.I. Bill that sent millions of young men and women to college and technical schools in the late 1940s and early 1950s, not only did America recover its prosperity, but a second great middle class began forming. A middle class that wouldn’t have existed without “government interference” in the game of big business.

(Some say WWII was the stimulus out of the depression, and it was an economic stimulus from which many, like the Bush family benefited [even to the extent of helping out Hitler], but the real events of the 1930s and 1940s that set the stage for a second American Middle Class were primarily the Wagner Act, the G.I. Bill, and tax changes ranging from raising the top rate on the most rich to 90 percent to offering an emerging middle class home interest tax deductions. Spending money on weapons that serve no useful purpose after they’re used doesn’t stimulate an economy the way building roads, bridges, houses, or domestic consumer industries, which “keep on giving,” does.)

And to stimulate that domestic economy, we instituted progressive taxation, which gave workers more to spend, thus stimulating demand for more goods and services.

Progressive taxation has a long history: As Jefferson said in a 1785 letter to James Madison, “Another means of silently lessening the inequality of property is to exempt all from taxation below a certain point, and to tax the higher portions of property in geometrical progression as they rise.”

But the conservatives — who since the days when John Adams called working people “the rabble” and Alexander Hamilton suggested they should play no (or only a token) role in government — fought back. A true middle class represented a threat to the aristocrats and pseudo-aristocrats of America’s conservatives. They may have to give up some of their power, and some of the higher end of their wealth may even be “redistributed” – horror of horrors – for schools, parks, libraries, and other things that support a healthy middle-class society but are not needed by the rich who live in a parallel, but separate, world among us.

At the height of early participation in the newly empowered union movement (at one point 35 percent of American workers were union members), in 1947, over Truman’s veto, congress passed the Taft-Hartley Law that significantly weakened union protections defined (and working well) under the 1935 Wagner Act. Taft-Hartley was (and still is) a powerful weapon for employers over employees (banning sympathy strikes, etc.), and was used, although most aggressively in the southern states (who declared themselves “right to work” states under another provision of Taft-Hartley) until Reagan declared a national war on unionization with his attack on PATCO in 1981.

The cons had first launched their attack on labor in 1947, and Reagan brought it to full fruition: education was next.

Today, although there are still some educational benefits to GI’s (Jessica Lynch joined the army to get financial aid to go to college to become an elementary school teacher, for example), they’re minimal and hard to both accumulate, track, and take advantage of (and must be paid for in most cases). Although Jefferson started the University of Virginia with the notion that part of building a middle class (necessary to a democracy, he said) would require people with some education, and advocated a national program of free education up to and including university levels, the last state to fall from that ideal was when Governor Ronald Reagan ended free enrollment in the University of California system.

Jefferson said, in an 1824 letter: “This degree of [free] education would … give us a body of yeomanry, too, of substantial information, well prepared to become a firm and steady support to the government.”

The attack on higher education was being won (and continues with cuts in college grant programs), and the cons moved to attack the third requirement for a society to produce a middle class: progressive taxation. This, of course, infuriates the elite cons who seem to truly believe that a CEO actually works 500 times harder than his employees (or is 500 times smarter).

But history shows that the third pillar of creating a middle class requires a modest control of how wealth is distributed. The richest, who benefit the most from our society, pay proportionately more, so the middle class can have home interest deductions, child tax credits, free public education, and health care. Progressive taxation has helped create every middle class in the First World, and without it the middle class will vanish (to Steve Forbes delight, apparently).

As Thomas Jefferson wrote to James Madison in 1784, “Taxes should be proportioned to what may be annually spared by the individual.” And, as earlier noted, as wealth rises, so should taxes — “geometrically.”

But as president, Reagan cut the top tax rate for billionaires from 70 percent to 28 percent, while effectively raising taxes on working people via the payroll tax and using inflation against a non-indexed tax system. It was another hit to the already-beginning-to-shrink middle class, to be followed by more “tax cut” bludgeons during the first three years of the W. Bush administration.

Nonetheless, a never-ending parade of conservative economists and commentators march through our living rooms daily via radio and TV, assuring us that it is good for American workers to go along with the Wal-Martization of America, accept lower pay and few benefits, and fear for their health, so multinational corporations can “level the playing field” for labor.

They say it will create winners in the system, and they are right. The winners are the multinational corporations, and the losers are the rest of us. No matter, say the TV commentators — nearly all millionaires themselves. “Free trade” sounds sexy; “protectionism” sounds downright selfish. And it’s all too complicated to explain in 20 seconds, even quoting Jefferson.

But, unless we repeal Taft-Hartley; start enforcing the Sherman act, provide free education for Americans (and not just Iraqis); abandon WTO/GATT and NAFTA; restore progressive taxation (including on dividend income); force corporations to pay their fair share; and go back to selective tariffs to protect domestic industries and stop offshoring to explicitly bring home the ability for us to make our own clothes, furniture, autos, and electronics, the conservatives will have won and the middle class — and, thus, democracy — will lose.

As Jefferson warned in an 1826 letter to Will B. Giles, even then some conservatives “now look to a single and splendid government of an aristocracy, founded on banking institutions, and moneyed incorporations under the guise and cloak of their favored branches of manufactures, commerce and navigation, riding and ruling over the plundered ploughman and beggared yeomanry. This will be to them a next best blessing to the monarchy of their first aim, and perhaps the surest steppingstone to it.”

Jefferson’s vision rose to fruition in the Gilded age, was fought back by FDR, and again rose its antidemocratic head under Reagan, the first Bush, GATT/NAFTA Clinton, and Dubya.

If conservative economics are allowed to continue, and we fully revert to the way life was lived by the average person in America in 1890 or Dickens’ England (over 40 million in America already have, by the way, many in the past 3 years), there will be no more middle class, just a few more rich CEOs and Bushies, and a lot more terrified workers living in slavery to debt and terrified of unemployment or a serious health crisis.

It’ll be a marvelous thing for the profits of the multinationals (including those who supply our “news”), but the end of a way of life in America, and possibly around the world, since so many nations imitate our lead. And only you and I – the ploughman and yeomanry – can stop them and restore an America where it’s possible to raise a family on one income and still have enough for housing, transportation, food, education, vacations, health care, and a decent retirement.

The middle class is not a “normal” thing: it’s just the core that holds together democracy and an informed, healthy, and active citizenry.

To bring it back from its steady decline since the Reagan era is going to take a lot of active work spreading the word (call talk radio, blog, forward this article and similar ones, write a letter to the editor to your local paper), and participation in or contact with elected officials at all levels (writing elected officials, joining and volunteering to help your favorite local political party or activist organization, showing up for rallies, etc.). We must get out the vote and remove the whole con bunch from the White House and Congress, repeal Taft-Hartley, get corporate money and lobbyists out of our governmental processes, restore progressive taxation, rebuild our schools, return to the tariff system that protected American industries (and jobs and communities) from 1786 until 1996, strengthen Social Security, and turn Medicare into a universal single-payer health system (among other things).

Are you willing to join? Or would you prefer to re-read “A Christmas Carol” to your children, so they can understand the future America that conservatives have in mind for them?

Thom Hartmann (thom at thomhartmann.com) is a Project Censored Award-winning best-selling author and host of a nationally syndicated daily progressive talk show that runs in 57 markets from coast-to-coast. www.thomhartmann.com. His most recent books are “Unequal Protection: The Rise of Corporate Dominance and the Theft of Human Rights,” “The Last Hours of Ancient Sunlight,” “We The People: A Call To Take Back America,” and “What Would Jefferson Do?: A Return To Democracy.”

Appeals court upholds “living wage” law that includes health benefits

Los Angeles Times
June 17, 2004
Berkeley’s Living Wage Ordinance Is Upheld in Federal Appeals Court
By Henry Weinstein

A federal appeals court in San Francisco on Wednesday upheld Berkeley’s authority to require higher minimum wages for some workers, the first appellate ruling in the country on whether local governments have that power.

Berkeley’s law, enacted in June 2000, is fairly typical of living wage ordinances adopted nationally. The law mandated minimum hourly wages and employee benefits for certain companies that received financial benefits from the city such as city contracts, leases on city property or certain tax exemptions.

The Berkeley law set a minimum wage of $9.75 plus health benefits for those companies. Firms covered by the law but that did not provide health benefits were required to pay $11.37 an hour. The figures have risen with inflation.

http://www.latimes.com/news/nationworld/politics/scotus/la-me-wage17jun17,1,1268555.story?coll=la-news-politics-supreme_court

Comment: This U.S. 9th Circuit Court of Appeals ruling was split along ideological lines with two Clinton appointees supporting it and a Bush appointee opposing it. This is a minute and tenuous increment on the path toward universal health care coverage and access.

The political process remains dominated by forces that have only increased the numbers of uninsured, and have increased the risk of medical debt for those who are insured.

It is inappropriate to stop and celebrate a tiny victory when the health financing infrastructure is crumbling around us. We know how to build a financing infrastructure that would ensure affordable, comprehensive coverage and access for everyone. Let’s get on with it!