PNHP

The fundamental flaws in the Massachusetts (and ACA) model

The fundamental flaws in the Massachusetts (and ACA) model

The Massachusetts Model of Health Reform in Practice

Mass-Care & Massachusetts Physicians for a National Health Program
October 2011

The reform has not addressed the health care crisis that most Massachusetts residents face, and that renders our entire health care system increasingly unaffordable. Health care costs – which are straining employer and household budgets, edging out all other spending priorities by the state and municipalities – have increased at even more rapid rates following reform. Administrative waste in the system has grown as a consequence of introducing new payers into an already bureaucratic health care system. Cost shifting under employer-sponsored insurance, particularly for small business employees, has accelerated. Reform has not achieved universal coverage, despite the mandate, largely because the state has been unable to ensure that truly affordable plans are available. Reform has not reduced the burden of medical bills or medical bankruptcy on Massachusetts’ families. The demand for safety net services by the uninsured and underinsured has remained high, and has begun to grow, while reform and subsequent state policy has created a financial crisis for safety net providers serving low-income and minority communities in the state. Reform has not been able to significantly slow the rising use of emergency departments for care.

Most concerning, the modest gains achieved by the reform have come at a high cost – even after the state has successfully shifted many of these costs on to federal taxpayers. The costs of the reform are widely acknowledged to be unsustainable and the state has been forced to restrict benefits and shift costs to residents, employers, and federal taxpayers as a consequence. This may help explain the declining support for reform noted in recent years. Moreover, the costs of the reform have not been born equitably, with low and middle income individuals bearing a disproportionate share of the costs.

The Massachusetts reform has not addressed the fundamental deficiencies in the health care system. The reform contained no proven or robust cost-control measures and thus the state has had to struggle to afford expanded coverage in the face of unsustainable cost increases. The Massachusetts reform introduced new programs and rules to an already complex blend of public and private insurers, leaving the state with increasing administrative complexity – and increasing costs.

There is every reason to believe that the recently passed national reform law based on the Massachusetts reform (The Affordable Care Act) will result in similar mixed outcomes. Our hope is for an equitably financed health care system that serves all Americans in a cost-effective way, without requiring cost-sharing that prohibits needed care. A Massachusetts-style reform will not achieve these goals.

http://masscare.org/wp-content/uploads/2011/10/masshealthreforminpracticefinal.pdf

Comment: 

By Don McCanne, MD

The Massachusetts plan has been successful only in nominally increasing the numbers of individuals insured, but at a trade-off of making almost everything else worse, including the insurance coverage itself. The federal Affordable Care Act (ACA) used the Massachusetts model, and experience with the implementation to date indicates that we can expect the same or similar fundamental deficiencies, making unaffordable under-insurance the new national standard.

In a PNHP press release, Dr. Rachel Nardin, assistant professor of neurology at Harvard Medical School and co-author of this study, stated, “The Massachusetts reform built on a complex blend of public and private insurers, adding to the administrative complexity and cost of the system. To achieve cost-effective, high-quality and truly universal care, we need a single-payer system.”

To better understand why the Massachusetts/ACA model can’t work, it would be worthwhile to read the full 46 page report, accessible at the link above.

Mass. health reform’s impact augurs poorly for federal health law: new report

FOR IMMEDIATE RELEASE
Oct. 25, 2011

Contact:
Benjamin Day, executive director, Mass-Care: The Massachusetts Campaign for Single-Payer Health Care, cell: (617) 777-3422, director@masscare.org
Pat Downs Berger, M.D., co-chair, Mass-Care, patberger@yahoo.com

While the Massachusetts health care reform in 2006 reduced the number of people who are uninsured in the state by about half, it did so at a high price and is unsustainable over the long haul because of skyrocketing costs, a group of Boston-area physicians and researchers say in a new report released today. The results do not augur well for the similarly structured Affordable Care Act, they say.

The report, titled “The Massachusetts Model of Health Reform in Practice,” presents data showing how the Massachusetts law has resulted in a surge in the sale of skimpy, inadequate insurance policies with high deductibles, along with a sharp rise in health care premiums for individuals and small businesses.

The authors also document how the law has created a financial crisis for the state’s safety-net hospitals and community health centers by cutting their public funding and redirecting the money to subsidize the purchase of private insurance policies.

The financial burden of the reform has fallen disproportionately on lower-middle-class families, they say. Meanwhile, the number of uninsured is once again on the rise.

Those are just some of the findings in a new, exhaustively documented report released today by Mass-Care and the Massachusetts chapter of Physicians for a National Health Program. The report, which is extensively illustrated with tables and graphs, draws on hundreds of sources, including academic studies, government statistics and surveys, in the most comprehensive compilation of its kind.
 
Other findings include the following:

– The use of high-deductible health plans more than tripled for residents with private insurance

– Good health insurance coverage at small businesses all but disappeared after the reform

– Most of the gains in the number of insured represented a shift of patients from the state’s former Free Care Pool to costlier private insurance programs, where the patients sometimes face new co-payments and premiums that impede their access to care

– The reform did not reverse the growing use of the state’s emergency departments

– The rate of personal bankruptcies linked to medical debt has not significantly decreased

Benjamin Day, executive director of Mass-Care and the study’s lead author, said, “Based on what we’ve seen in Massachusetts, and given the similarities between our state law and the new federal law, it’s reasonable to expect a similar course for the Affordable Care Act: a significant initial expansion of insurance coverage and a moderate improvement in access to care.

“However, by not addressing any of the underlying problems of the health care system – its uncontrollable costs, high levels of inequality, and high administrative costs associated with having multiple private insurers – we will see a worsening cost crisis for the rest of the population and a failing safety net for the most vulnerable populations,” Day said.

The report finds that small businesses were hit particularly hard by health reform. Quality coverage for small business employees all but disappeared over a few short years after reform – while the share of all insurance plans with high deductibles tripled – and health care premiums for small employers rose more rapidly after the reform than in other states (7 percent faster for individuals and 14 percent faster for families).

Dr. Rachel Nardin, chief of neurology at Cambridge Hospital, assistant professor of neurology at Harvard Medical School and co-author of the study, said, “The Massachusetts reform built on a complex blend of public and private insurers, adding to the administrative complexity and cost of the system. To achieve cost-effective, high-quality and truly universal care, we need a single-payer system.”

Nardin’s views echo those of other Massachusetts doctors. The Massachusetts Medical Society’s newly released 2011 survey of physician attitudes toward health reform showed 41 percent of the respondents would select a single-payer system as their first choice for national reform, versus 17 percent who would prefer the Affordable Care Act model. Support for single-payer reform rose 7 percentage points in the year since the last survey.

****

A PDF of “The Massachusetts Model of Health Reform in Practice” is available here:
http://masscare.org/massachusetts-health-reform-in-practice/

****

Mass-Care, The Massachusetts Campaign for Single-Payer Health Care (masscare.org), is an umbrella organization of more than 100 member groups who represent diverse constituencies including the elderly, low-income people, religious groups, labor unions, teachers, nurses, social workers, doctors, women, immigrants, and local towns and cities. Together these organizations represent over 500,000 Massachusetts residents who are supporters of single-payer reform in Massachusetts.

Physicians for a National Health Program (www.pnhp.org) is an 18,000-member organization of doctors advocating a nonprofit, single-payer national health insurance program for the United States.

Occupy Wall Street Protesters Rally For Health Care Reform

By Erica Ferrari
NY1 News, Oct. 23, 2011

Nurses and doctors joined the Occupy Wall Street protesters Sunday to rally for health care reform, and tourists continued to funnel in and out of Zuccotti Park to witness the demonstrations for themselves. [PNHP note: See video with several PNHP doctors here.]

The event in Zuccotti Park featured speakers demanding significant health care reform across the country.

“If we eliminated some of the profits of pharmaceutical companies, insurance companies, medical device companies, we could provide healthcare to everyone and do it really well,” said Dr. Mary O’Brian of St. Luke’s Columbia Student Health Service.

“The insurance companies don’t wanna provide care because every time they provide care it’s less profit for them. That’s their inherent motto, that’s the fiduciary duty is to deny people care,” said rally participant Dr. Stephen Auerbach.

On Wednesday, healthcare workers say they plan to march from Empire Blue Cross/Blue Shield’s headquarters downtown up to the former site of St. Vincent’s hospital, which closed down last year after filing for bankruptcy.

Meantime, protesters Saturday joined a rally in Union Square against police brutality, and organizers held a teach-in and a march.

They said blacks and Latinos are being brutalized by police officers, and they also spoke out against the police department’s controversial “stop and frisk” policy.

NYPD officials have long said the policy helps reduce crime in the city.

No arrests were reported in the rally.

Meanwhile, with protests now going for more than a month, the Occupy Wall Street encampment at Zuccotti Park is becoming something of a tourist attraction.

More and more visitors from across the country stopped by to take pictures and videos, ask questions and even walk among the protesters.

“Turn back the clock maybe 35 years ago, I was doing the very same thing against the war in Vietnam,” said one tourist.

“This was of great interest to us. I mean, I feel like we’re in sympathy with what they’re doing,” said another.

Protesters say they welcome the out-of-towners because they’re helping to spread the message back home.

http://www.ny1.com/content/top_stories/149489/occupy-wall-street-protesters-rally-for-health-care-reform

Doctors, nurses join Occupy Wall Street

By GLENN WILBURN, MyFoxNY.com
Fox News, Oct. 23, 2011

The Occupy Wall Street protesters used health care reform as a rallying cry and had support in Queens on Sunday.

Nurses and doctors from the groups Physicians for a National Health Program and the National Physicians Alliance joined the protesters in Zucotti Park.

The groups combined to speak out on the need for reform on health care. [PNHP note: Click here to get to the 4-minute video segment featuring doctors and medical students at the Wall Street action; the health care segment is accessible via the smaller video box on the right (the one showing PNHP’s Dr. Mary O’Brien in her white coat) immediately below the larger video still shot.]

In Queens, many immigrant and workers rights organizations gathered in Jackson Heights and marched from 69th to 83rd Street to launch the founding of I.M.A. (International Migrants Alliance) in the U.S.

The organizations say they’re standing shoulder-to-shoulder with the Occupy Wall Street movement.

The Queens protesters called for the immediate legalization for the undocumented and for an end to deportations.

http://www.myfoxny.com/dpp/news/organizations-join-occupy-wall-street-20111023-gjw#ixzz1biZxtdFu

OECD/WHO report on the Swiss health system

NOTE: The Swiss have a universal, highly regulated system of social insurance based on nonprofit private insurance plans. Many consider their system to be superior to ours and one that ours might eventually emulate. Though this message is long, you should save it if you don’t have time to read it now. It explains why an “ideal” system based on private health plans is not such a great idea after all.

OECD Reviews of Health Systems: Switzerland 2011

OECD, World Health Organization
Organization for Economic Cooperation and Development (OECD)
October 18, 2011

Chapter 2 – Health Insurance

(Excerpts)

In 1996, Switzerland implemented the Health Insurance Law (LAMal), which sought to achieve three main objectives: strengthening solidarity in the Swiss health system, containing health spending, and guaranteeing high-quality coverage.

2.1  General trends in the Swiss health insurance market

The Swiss health insurance market relies on regulated competition based on a set of key principles: health insurers cannot make profits on contracts for mandatory health insurance, consumers have free choice of insurer, and insurers are compelled to accept any applicant. The benefit basket covered by health insurance is defined at national level for all insurees and health insurers must offer the same premium to all enrollees with the same health insurance contract provided they are in the same age category and same region. Health insurers can propose optional health insurance contracts which provide lower premiums in exchange for higher deductibles or “managed care” contracts. Insurers can also offer “bonus” contracts, where insurees receive premium reductions if they do not claim any reimbursement from their insurance fund.

#  Swiss health insurance offers comprehensive coverage of health care

In principle, all medical treatments and diagnostics prescribed by doctors and dispensed by licensed professionals are covered, unless they are explicitly excluded from the benefit basket. Mandatory health insurance also covers the costs of medical care provided to patients receiving long-term care in institutions or at home.

After paying a deductible, patients contribute to the cost of care through coinsurance rates – usually 10% of costs – up to an annual ceiling.

“Rationing” has not been part of the political agenda. The level of user charges, however, is one of the highest in the OECD.

#  Consumers can choose between different options for health insurance plans

Ordinary contracts offer the highest level of financial protection against health care spending but also have the highest level of premiums. Other forms of health insurance contracts offer lower premiums with either higher deductibles or restrictions in the choice of doctor or hospital.

The take-up of ordinary plans has been continuously declining, first to the benefit of high-deductible health plans. However, since 2004, the popularity of plans with restricted choice of provider has increased dramatically, with the share of insurees choosing such plans (36.9%) now higher than ordinary plans (35.2%), high-deductible plans (27.9%) and bonus plans (0.1%).

#  Consumer choice has increased at cantonal level, in spite of market concentration nationally

#  Private supplementary health insurance covers one third of the population

2.2  The 1996 Health Insurance Law has strengthened solidarity, but health financing inequalities remain

#  Switzerland has reached universal coverage

Health insurers have been required to refuse payment for health care bills presented by negligent defaulters (366,000) until they have fully recovered unpaid premiums and related interests. In March 2010, the parliament revised the law with the objective of protecting people facing serious financial problems for paying premiums.

#  Health insurance premiums vary widely across and within cantons

These intra-cantonal premium differences persist because of insurers’ risk-selection activities and also because relatively few insurees switch insurers from year to year, although this number has been rising recently.

#  Public subsidies help some individuals and families pay health insurance premiums

By nature, non-income related premiums are very regressive. In 2008, premiums accounted for 11.8% of household income for the lowest income quartile and 3.4% for the highest income quartile.

The LAMal requires premium reductions of at least 50% for children and young adults in training in low and middle income households, but lets cantonal authorities define the thresholds used to define “low and middle income.”

Sixteen cantons fix a maximum percentage of households’ income to be spent on premiums and subsidise any additional amounts. While this limits the households’ effective burden, premium payments remain regressive.

It is worth noting that achieving horizontal equity in health financing is not an explicit policy goal in providing premium subsidies in Switzerland. Furthermore, subsidies do not address health financing inequities resulting in out-of-pocket expenditure, such as copayments and deductibles which are independent of household incomes.

#  Swiss patients face relatively high out-of-pocket payments for health care

Per capita out-of-pocket payments in Switzerland are significantly higher than in all other OECD countries: they are 60% higher than the United States and almost three times as high as the OECD average.

#  Out-of-pocket payments are usually regressive and thus the least equitable means to finance health care.

The fact that an increasing number of consumers are opting for high-deductible plans is very likely to increase user charges for “essential care” and weaken the solidarity of the health insurance system.

#  Contributions to the financing of health spending are inequitable

#  Financing health care is a high burden for low-income families

There is some indication that people forego health services due to high out-of-pocket expenditure, and that this is related to socio-economic status.

2.3  Competition in health insurance markets does not deliver all its promises

#  Switching rates are still low, though increasing in the recent period

#  Fragmentation increases administrative costs and premiums

Multiple fund systems, especially with small pools, often coincide with relatively higher administrative costs. Moreover, a risk equalisation mechanism also creates additional administrative costs. Switzerland has relatively higher administrative costs for both social and private health insurance. Those accounted for respectively 5.9% and 17.0% of total health insurance costs.

#  Health insurers mainly compete on risk-selection

Van de Ven et al. (2007) listed possible strategies for insurers to select good risks despite their obligation to accept any applicant. The list includes:

*  Marketing through targeted advertisements aimed at the healthier.
*  Selective contracting with providers (i.e., in managed care contracts) likely to attract the healthier who are more willing to accept limited provider choice.
*  Designing complementary insurance benefits packages and setting premiums such that low-risk individuals are attracted.
*  Exclusively offering contracts with high deductibles, which will offset higher risk individuals.
*  Establishing insurance conglomerates to channel new enrollees to specific contracts depending on their
health risks; this strategy most often works due to the huge number of different contracts on offer, limiting the consumer’s ability to be fully informed.
*  Identifying high risks via a health status declaration for those seeking complementary insurance.
*  Delaying reimbursements for chronically ill persons in order to make them leave the insurance.
*  Terminating insurance activity in areas with any high-cost patients.

Many of these strategies are indeed manageable options for Swiss health insurers. The extent to which they really use them is not easy to determine.

#  Managed care plans have taken off since 2006 but insurers only modestly “manage care”

The extent to which current managed care networks increase quality and efficiency in health care delivery is not well known. By nature, the impact of managed care is difficult to assess and disentangle from risk-selection, since these specific forms of contracts are known to attract people with good health risk profiles. Thus, age and gender adjusted comparisons of health care spending of managed care policy holders and other insurees are not sufficient to estimate savings achieved through managed care.

#  The inclusion of another risk factor into the risk-equalisation formula is a good step but may not be enough

Initially, the risk equalisation mechanism was based on two simple risk factors only: age and gender.

A new and third risk factor – hospitalisation beyond three days in the previous year – has been included in the risk equalisation formula and will be applied from January 2012 onwards. While this new factor will not fully avoid risk selection, it will now also be profitable for insurers to invest in product innovation, i.e. further develop managed care contracts.

(Single payer)

The high levels of fragmentation in a country with a small population raises questions about a single health insurer. In theory, a single insurer could pool risks more effectively. In light of risk equalisation mechanisms that are imperfect as long as there remain incentives for risk selection, a single insurer might in principle better ensure health financing equity across the population and strong purchasing, in addition to a tendency for lower administrative costs. Moreover, it provides incentives to focus more on prevention. A single insurer system thus has some important advantages. However, it has also its drawbacks, since it eliminates consumer choice, may inhibit innovation in insurance products or risk under-provision and rationing care when negotiated prices are too low.

Shifting from a multiple insurer system to a single insurer system is with no doubt a tremendous challenge, although Korea demonstrated that a step-wise merging into a single fund is possible. However, this is likely to be particularly difficult for Switzerland, which has a very long history of multiple insurers for over 100 years, a strong preference for choice, and as a reflection of its federalism, an attachment to cantonal organisation. Moreover, there are considerable transaction costs to consider, not least the question about where to place all staff from the current health insurers. Any such reform option thus needs to be critically assessed as to its overall financial implications, its practical implementation as well as political feasibility. In fact, the option of a single insurer in Switzerland has already been rejected several times so far by the population, although a new initiative was launched in 2011.

OECD Reviews of Health Systems: Switzerland 2011 (160 pages):
http://www.oecdbookshop.org/oecd/display.asp?sf1=identifiers&st1=9789264120907

Comment: 

By Don McCanne, MD

It is not clear why so many in the U.S. are enamored of the Swiss health insurance system when this OECD/WHO report confirms that it is highly inefficient and fragmented, with profound administrative waste, inequitably funded, with regressive financing and with wide variations in premiums, has the highest out-of-pocket costs, has an increasing prevalence of managed care intrusions, and is controlled by a private insurance industry that has learned how to game risk selection at significant cost to those on the losing end.

There is one bit of good news buried in this report. A single payer system would correct these deficiencies. Although the report mentions the drawbacks of eliminating consumer choice and inhibiting innovation in insurance products, these are actually advantages. The loss in consumer choice is the loss in the ability to choose from a large market of private health plans which often take away provider choice. Eliminating the plans returns choice of providers to the patient. Innovations in insurance products are designed to benefit the private insurers by gaming the system to the detriment of the patients. That’s innovation that they can do without.

The report also cautions that a single payer could “risk under-provision and rationing care when negotiated prices are too low.” This is a criticism of single payer systems that does have some merit, but it ignores the fact that this risk is even greater in privately insured managed care models. All systems face capacity and access problems, but the public stewards of a single payer system are in a position to act in the public interest, whereas private insurers use tools to deliberately obstruct access in order to reduce spending. Public single payer stewards are much more capable than private insurers of using capacity refinement and queue management to reduce the risk of under-provision (rationing) of care. It is true that conservative fiscal hawks, when they are in control, continually threaten excessive budget constraints, but the behavior in the private sector is much worse as ever more of the costs are shifted to those with greater health care needs, creating a formidable financial barrier to care. Our U.S. system of inhumanely rationing care by ability to pay is far worse than systems that struggle with capacity and queues because of budgetary limitations, especially when you consider that we already have by far the largest per capita health care spending of all nations.

The important take-home point is that an “ideal” social insurance program based on the mandatory purchase of highly regulated, nonprofit private health plans, such as that in Switzerland, is far from ideal in that it fails to prevent the flaws inherent in the private insurance model – including segmentation and fragmentation, costly administrative excesses and inefficiency, inequitable regressive financing, excessive premium variation, shifting of costs (risks) to patients in order to protect insurance plans, and, perhaps most fundamentally, rejecting a public service model in favor of a private business model that intrudes in the relationship of patients and their health care professionals and institutions by gaming the system for the primary purpose of achieving success as a business, while relegating serving patients to a secondary role.

In 2007, even though the Swiss understood the advantages of a single payer system, they rejected it in a ballot measure. The predominant reason was that 70 percent of the Swiss were not willing to trade their private insurance plans, which were perceived to be functioning fairly well except for high premiums, for a public program for everyone that they feared would be like their existing health welfare program for the poor, which most believed was plagued by bureaucratic inefficiency and cost overruns. They feared that they would be worse off in such a public program. In their campaign against the single payer proposal, the organization representing Switzerland’s private health insurers, santésuisse, deliberately mislead the public by modeling the single payer proposal as a welfare program that would be funded primarily by middle-inc
ome citizens, creating this widely held misperception that resulted in the measure’s defeat.

The Swiss voters will get another chance with a new initiative launched this year. The question is, when will we get our chance?

The Republican Debates, The President’s Solutions, And The Need for A Progressive Alternative

By Robert Reich
Nation of Change Op-ed, Tuesday 18 October 2011

Re­pub­li­cans are de­bat­ing again to­mor­row night. And once again, Amer­i­cans will hear the stan­dard re­gres­sive litany: gov­ern­ment is bad, Medicare and Med­ic­aid should be cut, “Oba­macare” is killing the econ­omy, un­doc­u­mented im­mi­grants are tak­ing our jobs, the mil­i­tary should get more money, taxes should be low­ered on cor­po­ra­tions and the rich, and reg­u­la­tions should be gut­ted.

Four years ago the most widely-watched TV de­bate among Re­pub­li­can as­pi­rants at­tracted 3.2 mil­lion view­ers. This year it’s al­most twice that num­ber. And for every viewer as­sume a mul­ti­plier ef­fect as he or she shares what’s heard with friends and fam­ily.

Amer­i­cans are lis­ten­ing more in­tently this time around be­cause they’re hurt­ing and they want an­swers. But the an­swers they’re get­ting from Re­pub­li­can can­di­dates – trip­ping over them­selves try­ing to ap­peal to hard-core re­gres­sives – are the wrong ones.

The cor­rect ones aren’t being aired.

That’s partly be­cause there’s no pri­mary con­test in the De­mo­c­ra­tic party. So Re­pub­li­cans au­to­mat­i­cally get loads of free broad­cast time to air their re­gres­sive non­sense while the De­moc­rats get none.

But even if the Pres­i­dent had equal time, the de­bate about what to do about the cri­sis would still be fright­en­ingly nar­row.

That’s be­cause the Pres­i­dent’s an­swers don’t nearly match up to the mag­ni­tude of the cri­sis.

With­out bold al­ter­na­tives, Amer­i­cans des­per­ate for big so­lu­tions are at­tracted to bold crack­pot ideas like Her­man Cain’s “9-9-9” pro­posal, which would raise taxes on the poor and cut them for the rich.

This is where the in­choate Oc­cupy Wall Street move­ment could come in. What’s needed isn’t just big ideas. It’s peo­ple ful­mi­nat­ing for them – mak­ing enough of a ruckus that the ideas can’t be ig­nored. They be­come part of the de­bate be­cause the pub­lic de­mands it.

The biggest thing the Pres­i­dent has pro­posed is a plan to cre­ate 2 mil­lion jobs. But that’s not nearly big enough. Today, 14 mil­lion Amer­i­cans are out of work, and 11 mil­lion more are work­ing part-time who’d rather be work­ing full time.

The na­tion needs a real jobs plan, one of suf­fi­cient size and scope to do the job – in­clud­ing a WPA and a Civil­ian Con­ser­va­tion Corps, to put the mil­lions of long-term un­em­ployed and young un­em­ployed to work re­build­ing Amer­ica.

I’m not crit­i­ciz­ing the Pres­i­dent. With­out en­er­gized, mo­bi­lized, and or­ga­nized pro­gres­sives, even the best peo­ple in Wash­ing­ton can’t over­come the monied in­ter­ests.

For ex­am­ple, Amer­ica’s long-term debt needs to be ad­dressed, but not the way the Pres­i­dent is doing it. He wants to lop $4 tril­lion off the bud­get over the next ten years. This al­most cer­tainly means sac­ri­fic­ing ed­u­ca­tion, job train­ing, food stamps, and every­thing else now listed in the so-called “non-de­fense dis­cre­tionary” bud­get, as well as cuts in Medicare and Med­ic­aid.

What about halv­ing the mil­i­tary bud­get in­stead? It dou­bled after 9/11, and mil­i­tary con­trac­tors are in­tent on keep­ing it in the stratos­phere. So is Sec­re­tary of De­fense Leon Panetta. Re­sult: De­fense cuts this size won’t be on the table un­less pro­gres­sives vo­cif­er­ously de­mand it.

And what about re­ally rais­ing taxes on the rich to fi­nance what the na­tion should be doing to cre­ate a world-class work­force with world-class wages?

Here again, the Pres­i­dent’s pro­posal is pal­try com­pared to what should be done. He wants to raise taxes on the rich by end­ing the Bush tax cut for in­comes over $250,000 and lim­it­ing cer­tain de­duc­tions.

Yet in­come and wealth are now more con­cen­trated than they’ve been in 70 years. The top 1 per­cent gets over 20 per­cent of total in­come and holds over 35 per­cent of na­tional wealth; the rich­est 400 Amer­i­cans have more wealth than the bot­tom 150 mil­lion Amer­i­cans put to­gether.

Mean­while, ef­fec­tive tax rates on the rich are lower than they’ve been in three decades.

We need to push for higher mar­ginal taxes on the top, and more brack­ets. In­comes of more than $5 mil­lion should be sub­ject to a 70 per­cent rate. (The top mar­ginal rate was never below 70 per­cent be­tween 1940 and 1980.) And these rates should apply to all in­come re­gard­less of source, in­clud­ing cap­i­tal gains.

This would allow for a big­ger Earned In­come Tax Credit (that is, a wage sub­sidy) for lower-in­come work­ers. And lower taxes on mid­dle-in­come work­ers.

There should be a 2 per­cent an­nual sur­tax on all for­tunes over $7 mil­lion. This would only hit the rich­est half a per­cent of Amer­i­cans at the very top of the heap. And would yield $70 bil­lion a year – enough to im­prove our schools and make col­lege af­ford­able to every­one.

And a tax on fi­nan­cial trans­ac­tions. Even a tiny one of one-half of one per­cent would gen­er­ate $200 bil­lion a year. That’s enough to make a major con­tri­bu­tion to­ward early child­hood ed­u­ca­tion for every Amer­i­can tod­dler.

The Pres­i­dent’s health­care law is a good start but it’s not the so­lu­tion, ei­ther. We need Medicare for all. Medicare has lower ad­min­is­tra­tive costs than pri­vate in­sur­ers. And it has the bar­gain­ing heft to re­duce drug and hos­pi­tal costs as well as shift the sys­tem from fee-for-ser­vices to pay­ments for healthy out­comes.

The Pres­i­dent’s fi­nan­cial re­forms are also a be­gin­ning but they’re way too weak to stop Wall Street depre­da­tions. (At this mo­ment, for ex­am­ple, no one even knows the ex­po­sure of Wall Street banks to Eu­ro­pean banks and, through them, Eu­rope’s debt cri­sis.)

We need to res­ur­rect the Glass-Stea­gall Act and break up the biggest banks.

The Pres­i­dent has talked about fix­ing So­cial Se­cu­rity by rais­ing the re­tire­ment age. But the best way to en­sure the pro­gram’s long-term sol­vency is to lift the ceil­ing on in­come sub­ject to So­cial Se­cu­rity pay­roll taxes (now $106,800.) Yet this, too, is off the table.

Work­ers also need more bar­gain­ing power. The ratio of cor&
shy;po­rate prof­its to wages is now higher than it’s been since be­fore the Great De­pres­sion. Work­ers should be able to form unions through a sim­ple up-or-down vote, with­out delay.

None of this is pos­si­ble with­out strong and con­sis­tent pres­sure from the pro­gres­sive side. Re­gres­sives are set­ting the agenda.

The Pres­i­dent isn’t even talk­ing about the en­vi­ron­ment any more. Yet cli­mate change is a re­al­ity, and our sur­vival de­pends on re­duc­ing car­bon emis­sions.

We should tax car­bon-based fuels, and di­vide the rev­enues equally among all Amer­i­cans. It’s the best way to get us to switch to non-car­bon fuels, and stim­u­late re­search and de­vel­op­ment of them. And by di­vid­ing the rev­enues, the typ­i­cal Amer­i­can would come out ahead even though some prices would in­crease.

Fi­nally, we need pub­lic fi­nanc­ing of elec­tions and strict lim­its on so-called “in­de­pen­dent” ex­pen­di­tures. Cor­po­ra­tions should have to get the ap­proval of every share­holder be­fore spend­ing cor­po­rate funds – the share­hold­ers’ money – on pol­i­tics.

I have no idea whether the Oc­cu­piers will morph into the kind of pro­gres­sive force nec­es­sary to put these ideas into play. But if Amer­i­cans stand to­gether and de­mand real re­form, we can have a real na­tional de­bate in 2012.

To­mor­row’s Re­pub­li­can de­bate may at­tract lots of view­ers. It need not cap­ture their minds.

This ar­ti­cle was orig­i­nally posted on Robert Reich’s blog.

http://www.nationofchange.org/meagerness-republican-debates-smallness-president-s-solutions-and-need-progressive-alternative-13189

Medical Triage at Encampment

By JESSICA FIRGER and SUMATHI REDDY
The Wall Street Journal, October 22, 2011

[PNHP note: The following article mentions the involvement of Dr. Mary O’Brien and several other members of the New York Metro chapter of PNHP in the Occupy Wall Street actions. For a more complete picture of the chapter’s participation in the OWS movement in New York, visit their blog.]

As temperatures dip and the Occupy Wall Street protesters head into their sixth week of camping at Zuccotti Park, health professionals say they are treating activists for ailments ranging from hypothermia to skin infections, the effects of living outside in crowded conditions with little more than sleeping bags and tarps.

At a medic tent at the Lower Manhattan encampment volunteer doctors and nurses treated more than 100 patients one day this week for a variety of conditions, many of which were related to the rainy and increasingly chilly weather.

“One person had a dislocated shoulder, another with asthma,” said Mary O’Brien, a member of Physicians for a National Health Program who volunteered Tuesday evening at the tent. Another had a seizure disorder and no medication, she said.

Daniel Todd, a member of the protesters’ “street medic” committee, said he saw 25 cases of hypothermia on Wednesday.

The 21-year-old CPR-certified Brooklyn resident was mincing garlic and ginger on Thursday. “I’m the herbalist here,” he said, explaining he would combine the ginger and garlic with apple cider and cayenne pepper to make what he calls fire water. The concoction, he said, is “for congestions and colds.”

Protesters had formed their own medic committee, whose members wear reflective vests with stickers that say “99 percent ER.” Now they are working with National Nurses United, which has established more formal first-aid tents at Occupy movements across the country.

The group also has circulated a petition to city officials seeking permission for protesters to erect tents to sleep in to protect them from the increasingly cold weather. City rules say tents and other structures can’t be put up on public spaces. Still, on Friday night, a dozen or more personal tents began appearing.

A spokeswoman for Mayor Michael Bloomberg didn’t respond to a request for comment.

At the National Nurses United tent, three nurses work six-hour shifts. Four doctors from PNHP also have signed up to volunteer, and several more have expressed interest. The city had threatened to dismantle the tent earlier in the week, according to the nurses group, but has allowed it to remain standing in recent days. Outside the tent, there is a “help yourself” first-aid station with bandages, antacid, witch hazel, calamine lotion and vitamins.
George Machado, 20 years old, was among the protesters who have sought medical assistance. Mr. Machado said he sprained his ankle at a protest at Washington Square Park. “There was some swelling,” he said. “I went in the tent and they elevated it and iced it. This is great, I don’t have health insurance.”

Mr. Machado’s case isn’t unusual.

“Everyone I saw yesterday had no health insurance,” said Maria Fehlig, an NNU member who left her family and hospital job in Las Vegas to volunteer for three weeks.

Some protesters have been directed to the nearby Access Community Health Center on Maiden Lane, which largely serves residents without health insurance.

Debra Sorkin, executive director of the center, said they have seen a steady flow of protesters. Most prevalent are fungal and skin infections and respiratory illnesses “from the torrential downpours,” said Ms. Sorkin. “The first ones came to us about two weeks ago,” she said, adding that they hope to make flu shots available soon.

Health care at Zuccotti Park extends beyond unions and formal organizations. Jack Berall, 70, visits Zuccotti Park about four or five times a week. A doctor with a private practice, he also works at a clinic.
In a rumpled suit and with a copy of the Occupied Wall Street Journal in his jacket pocket and a stethoscope around his neck, Dr. Berall surveys the park to see if anyone needs medical help. His main piece of advice: that protesters and visitors refrain from shaking hands. He suggests they do a “fist bump” instead.

http://online.wsj.com/article/SB10001424052970204485304576645531217538502.html

Is medical care a good business?

By Philip Caper
OpEd, Bangor Daily News, Oct. 20, 2011

For the past several decades, America has been experimenting with applying the principles of business to our health care system. Many believed that by unleashing the power of markets, health care costs would be controlled and access and quality improved.

That experiment has been a spectacular failure. Today, a larger percentage of Americans lack health insurance or are seriously under-insured than at any time since the enactment of Medicare and Medicaid 46 years ago. That number is increasing every day.

Health care costs are at levels never before seen anywhere in the world and are increasing in an uncontrolled and unsustainable way. Despite our high per-person costs — double those of other developed countries — tens of thousands of Americans die every year from lack of timely access to health care.

The degree of interference with doctors’ and patients’ health care decisions that exists in America today would not be tolerated anywhere else in the world. “Death panels” do exist in America, but they are run not by government but by private corporations. Their purpose is to maximize profits.

Americans are unique in the world in thinking about health care as a business. In no other country is that notion so widely and unquestioningly accepted.

In his landmark 1983 book about the sociology of American medicine, Paul Starr describes its evolution throughout much of the 19th and 20th centuries as being driven primarily by mission — preventing illness when it could and diagnosing, treating, curing and comforting patients when it couldn’t. In the early 20th century, George Merck, founder of the large pharmaceutical company bearing his name, provided an example of this approach when he said “If we develop good medicine that cures people, money will take care of itself.” Mission, not money, motivated most of those involved in medical care.

Starr’s book describes the successful efforts of physicians to block the creation of health care as a right of all Americans during the first half of the 20th century. They were afraid of a government takeover of medicine. But, Starr warned, the real threat to the autonomy of American doctors was not government, but corporations.

Now, almost thirty years later, Starr’s warning has come true. Large corporations, many of them for-profit and publicly traded now dominate the financing and delivery of American medical care. As Melody Petersen has documented in her book “Our Daily Meds,” instead of embracing George Merck’s philosophy, pharmaceutical companies have become huge marketing machines. They now are focused far more on their profitability than on their healing mission. Producing medicine that cures diseases instead of just treating symptoms has become a bad business model. Once a disease is cured the customer disappears and profits decline.

It was not always this way. Thinking about medicine shifted during the late 1970s due to the belief that what was needed to cure the rising costs and increasing numbers of uninsured was a more businesslike approach. Business schools began to offer courses in health care and doctors began to acquire MBAs.

The culture and vocabulary of health care underwent a remarkable change. Where hospital directors used to be called “administrators,” they became CEOs. What used to be called “hospital services” became “product lines.” Those who used to be called “patients” became “market share.” Advertising by doctors and hospitals, once considered unethical, became commonly accepted.

Although these changes resonated with many Americans, there was one huge problem. The mission of health care is very different from the mission of business. Health care is about keeping people healthy or returning them to health when they become ill. Business is about generating wealth for its owners. In investor-owned businesses, wealth comes in the form of profits. In nonprofit businesses, it is in the form of unchecked expansion and high executive compensation.

Both health and wealth are missions that have their places. But in health care they often conflict. In Maine, 80 percent of doctors are now corporate employees. In too many cases, corporate executives, not caregivers, are calling the shots. In today’s corporate health care industry, physician “productivity” is often measured not by patient health but by profit.

That conflict explains why so many doctors are becoming so frustrated with their profession. Likewise, many patients are becoming distrustful of our increasingly corporatized and bottom-line-driven health care system and of their own doctors. But trust is crucial to healing.

The corporate takeover of health care in America is one of the most important factors driving the explosion in health care costs and the rising number of Americans without timely access to medical care. This change in the culture of American health care from a mission of healing to a mission of profit has had profoundly damaging consequences.

Physician Philip Caper of Brooklin is a founding board member of Maine AllCare, a nonpartisan, nonprofit group committed to making health care in Maine universal, accessible and affordable for all. He can be contacted at pcpcaper21@gmail.com.

http://bangordailynews.com/2011/10/20/health/is-medical-care-a-good-business/

OECD/WHO report on the Swiss health system

NOTE: The Swiss have a universal, highly regulated system of social insurance based on nonprofit private insurance plans. Many consider their system to be superior to ours and one that ours might eventually emulate. Though this message is long, you should save it if you don’t have time to read it now. It explains why an “ideal” system based on private health plans is not such a great idea after all.

OECD Reviews of Health Systems: Switzerland 2011

OECD, World Health Organization
Organization for Economic Cooperation and Development (OECD)
October 18, 2011

Chapter 2 – Health Insurance

(Excerpts)

In 1996, Switzerland implemented the Health Insurance Law (LAMal), which sought to achieve three main objectives: strengthening solidarity in the Swiss health system, containing health spending, and guaranteeing high-quality coverage.

2.1  General trends in the Swiss health insurance market

The Swiss health insurance market relies on regulated competition based on a set of key principles: health insurers cannot make profits on contracts for mandatory health insurance, consumers have free choice of insurer, and insurers are compelled to accept any applicant. The benefit basket covered by health insurance is defined at national level for all insurees and health insurers must offer the same premium to all enrollees with the same health insurance contract provided they are in the same age category and same region. Health insurers can propose optional health insurance contracts which provide lower premiums in exchange for higher deductibles or “managed care” contracts. Insurers can also offer “bonus” contracts, where insurees receive premium reductions if they do not claim any reimbursement from their insurance fund.

#  Swiss health insurance offers comprehensive coverage of health care

In principle, all medical treatments and diagnostics prescribed by doctors and dispensed by licensed professionals are covered, unless they are explicitly excluded from the benefit basket. Mandatory health insurance also covers the costs of medical care provided to patients receiving long-term care in institutions or at home.

After paying a deductible, patients contribute to the cost of care through coinsurance rates – usually 10% of costs – up to an annual ceiling.

“Rationing” has not been part of the political agenda. The level of user charges, however, is one of the highest in the OECD.

#  Consumers can choose between different options for health insurance plans

Ordinary contracts offer the highest level of financial protection against health care spending but also have the highest level of premiums. Other forms of health insurance contracts offer lower premiums with either higher deductibles or restrictions in the choice of doctor or hospital.

The take-up of ordinary plans has been continuously declining, first to the benefit of high-deductible health plans. However, since 2004, the popularity of plans with restricted choice of provider has increased dramatically, with the share of insurees choosing such plans (36.9%) now higher than ordinary plans (35.2%), high-deductible plans (27.9%) and bonus plans (0.1%).

#  Consumer choice has increased at cantonal level, in spite of market concentration nationally

#  Private supplementary health insurance covers one third of the population

2.2  The 1996 Health Insurance Law has strengthened solidarity, but health financing inequalities remain

#  Switzerland has reached universal coverage

Health insurers have been required to refuse payment for health care bills presented by negligent defaulters (366,000) until they have fully recovered unpaid premiums and related interests. In March 2010, the parliament revised the law with the objective of protecting people facing serious financial problems for paying premiums.

#  Health insurance premiums vary widely across and within cantons

These intra-cantonal premium differences persist because of insurers’ risk-selection activities and also because relatively few insurees switch insurers from year to year, although this number has been rising recently.

#  Public subsidies help some individuals and families pay health insurance premiums

By nature, non-income related premiums are very regressive. In 2008, premiums accounted for 11.8% of household income for the lowest income quartile and 3.4% for the highest income quartile.

The LAMal requires premium reductions of at least 50% for children and young adults in training in low and middle income households, but lets cantonal authorities define the thresholds used to define “low and middle income.”

Sixteen cantons fix a maximum percentage of households’ income to be spent on premiums and subsidise any additional amounts. While this limits the households’ effective burden, premium payments remain regressive.

It is worth noting that achieving horizontal equity in health financing is not an explicit policy goal in providing premium subsidies in Switzerland. Furthermore, subsidies do not address health financing inequities resulting in out-of-pocket expenditure, such as copayments and deductibles which are independent of household incomes.

#  Swiss patients face relatively high out-of-pocket payments for health care

Per capita out-of-pocket payments in Switzerland are significantly higher than in all other OECD countries: they are 60% higher than the United States and almost three times as high as the OECD average.

#  Out-of-pocket payments are usually regressive and thus the least equitable means to finance health care.

The fact that an increasing number of consumers are opting for high-deductible plans is very likely to increase user charges for “essential care” and weaken the solidarity of the health insurance system.

#  Contributions to the financing of health spending are inequitable

#  Financing health care is a high burden for low-income families

There is some indication that people forego health services due to high out-of-pocket expenditure, and that this is related to socio-economic status.

2.3  Competition in health insurance markets does not deliver all its promises

#  Switching rates are still low, though increasing in the recent period

#  Fragmentation increases administrative costs and premiums

Multiple fund systems, especially with small pools, often coincide with relatively higher administrative costs. Moreover, a risk equalisation mechanism also creates additional administrative costs. Switzerland has relatively higher administrative costs for both social and private health insurance. Those accounted for respectively 5.9% and 17.0% of total health insurance costs.

#  Health insurers mainly compete on risk-selection

Van de Ven et al. (2007) listed possible strategies for insurers to select good risks despite their obligation to accept any applicant. The list includes:

*  Marketing through targeted advertisements aimed at the healthier.
*  Selective contracting with providers (i.e., in managed care contracts) likely to attract the healthier who are more willing to accept limited provider choice.
*  Designing complementary insurance benefits packages and setting premiums such that low-risk individuals are attracted.
*  Exclusively offering contracts with high deductibles, which will offset higher risk individuals.
*  Establishing insurance conglomerates to channel new enrollees to specific contracts depending on their health risks; this strategy most often works due to the huge number of different contracts on offer, limiting the consumer’s ability to be fully informed.
*  Identifying high risks via a health status declaration for those seeking complementary insurance.
*  Delaying reimbursements for chronically ill persons in order to make them leave the insurance.
*  Terminating insurance activity in areas with any high-cost patients.

Many of these strategies are indeed manageable options for Swiss health insurers. The extent to which they really use them is not easy to determine.

#  Managed care plans have taken off since 2006 but insurers only modestly “manage care”

The extent to which current managed care networks increase quality and efficiency in health care delivery is not well known. By nature, the impact of managed care is difficult to assess and disentangle from risk-selection, since these specific forms of contracts are known to attract people with good health risk profiles. Thus, age and gender adjusted comparisons of health care spending of managed care policy holders and other insurees are not sufficient to estimate savings achieved through managed care.

#  The inclusion of another risk factor into the risk-equalisation formula is a good step but may not be enough

Initially, the risk equalisation mechanism was based on two simple risk factors only: age and gender.

A new and third risk factor – hospitalisation beyond three days in the previous year – has been included in the risk equalisation formula and will be applied from January 2012 onwards. While this new factor will not fully avoid risk selection, it will now also be profitable for insurers to invest in product innovation, i.e. further develop managed care contracts.

(Single payer)

The high levels of fragmentation in a country with a small population raises questions about a single health insurer. In theory, a single insurer could pool risks more effectively. In light of risk equalisation mechanisms that are imperfect as long as there remain incentives for risk selection, a single insurer might in principle better ensure health financing equity across the population and strong purchasing, in addition to a tendency for lower administrative costs. Moreover, it provides incentives to focus more on prevention. A single insurer system thus has some important advantages. However, it has also its drawbacks, since it eliminates consumer choice, may inhibit innovation in insurance products or risk under-provision and rationing care when negotiated prices are too low.

Shifting from a multiple insurer system to a single insurer system is with no doubt a tremendous challenge, although Korea demonstrated that a step-wise merging into a single fund is possible. However, this is likely to be particularly difficult for Switzerland, which has a very long history of multiple insurers for over 100 years, a strong preference for choice, and as a reflection of its federalism, an attachment to cantonal organisation. Moreover, there are considerable transaction costs to consider, not least the question about where to place all staff from the current health insurers. Any such reform option thus needs to be critically assessed as to its overall financial implications, its practical implementation as well as political feasibility. In fact, the option of a single insurer in Switzerland has already been rejected several times so far by the population, although a new initiative was launched in 2011.

OECD Reviews of Health Systems: Switzerland 2011 (160 pages):
http://www.oecdbookshop.org/oecd/display.asp?sf1=identifiers&st1=9789264120907

It is not clear why so many in the U.S. are enamored of the Swiss health insurance system when this OECD/WHO report confirms that it is highly inefficient and fragmented, with profound administrative waste, inequitably funded, with regressive financing and with wide variations in premiums, has the highest out-of-pocket costs, has an increasing prevalence of managed care intrusions, and is controlled by a private insurance industry that has learned how to game risk selection at significant cost to those on the losing end.

There is one bit of good news buried in this report. A single payer system would correct these deficiencies. Although the report mentions the drawbacks of eliminating consumer choice and inhibiting innovation in insurance products, these are actually advantages. The loss in consumer choice is the loss in the ability to choose from a large market of private health plans which often take away provider choice. Eliminating the plans returns choice of providers to the patient. Innovations in insurance products are designed to benefit the private insurers by gaming the system to the detriment of the patients. That’s innovation that they can do without.

The report also cautions that a single payer could “risk under-provision and rationing care when negotiated prices are too low.” This is a criticism of single payer systems that does have some merit, but it ignores the fact that this risk is even greater in privately insured managed care models. All systems face capacity and access problems, but the public stewards of a single payer system are in a position to act in the public interest, whereas private insurers use tools to deliberately obstruct access in order to reduce spending. Public single payer stewards are much more capable than private insurers of using capacity refinement and queue management to reduce the risk of under-provision (rationing) of care. It is true that conservative fiscal hawks, when they are in control, continually threaten excessive budget constraints, but the behavior in the private sector is much worse as ever more of the costs are shifted to those with greater health care needs, creating a formidable financial barrier to care. Our U.S. system of inhumanely rationing care by ability to pay is far worse than systems that struggle with capacity and queues because of budgetary limitations, especially when you consider that we already have by far the largest per capita health care spending of all nations.

The important take-home point is that an “ideal” social insurance program based on the mandatory purchase of highly regulated, nonprofit private health plans, such as that in Switzerland, is far from ideal in that it fails to prevent the flaws inherent in the private insurance model – including segmentation and fragmentation, costly administrative excesses and inefficiency, inequitable regressive financing, excessive premium variation, shifting of costs (risks) to patients in order to protect insurance plans, and, perhaps most fundamentally, rejecting a public service model in favor of a private business model that intrudes in the relationship of patients and their health care professionals and institutions by gaming the system for the primary purpose of achieving success as a business, while relegating serving patients to a secondary role.

In 2007, even though the Swiss understood the advantages of a single payer system, they rejected it in a ballot measure. The predominant reason was that 70 percent of the Swiss were not willing to trade their private insurance plans, which were perceived to be functioning fairly well except for high premiums, for a public program for everyone that they feared would be like their existing health welfare program for the poor, which most believed was plagued by bureaucratic inefficiency and cost overruns. They feared that they would be worse off in such a public program. In their campaign against the single payer proposal, the organization representing Switzerland’s private health insurers, santésuisse, deliberately mislead the public by modeling the single payer proposal as a welfare program that would be funded primarily by middle-income citizens, creating this widely held misperception that resulted in the measure’s defeat.

The Swiss voters will get another chance with a new initiative launched this year. The question is, when will we get our chance?

Why I won’t give up in the fight for single payer

By Robert Peck, M.D.

Dr. Robert Peck is the honorary chair of the Los Angeles Chapter of PNHP California. The following is a brief autobiography of a physician who has dedicated his life to patient advocacy.

Nineteen-twenty-six was a great year to be born. I have been part of all that has happened since. From ’26 to 1934 we were living pretty well in Canton, Ohio. My father, Sam Peck, managed a department in the local department store. My parents were inordinately happy to have this only child. We had a maid, spent three winter months in Miami Beach every winter. My Uncle Si rented a big house and invited his four siblings and their families to join him. My father voted for Hoover in 1932.

But our status came to a sudden end in ’34 when my father lost his job in the deepening Depression. We came to Los Angeles “to starve in the sunshine.” He became an ardent partisan of Franklin Roosevelt and the New Deal. So did I, and I still am. I started my public career speaking for School Bonds when I was 10. L.A. schools were unsafe after a big earthquake. People did not have money but they voted yes for school bonds.

I became radicalized when I was 14 and Uncle Si gave me a subscription to The Nation. When I was 15, in December 1941, Japan bombed Pearl Harbor. Two months later, my junior high school pal Jiro was ordered to leave his home along with all people of Japanese descent on the West Coast and were held in relocation centers. This further radicalized me.

In medical school at USC, I organized a chapter of the Association of Interns and Medical Students. AIMS worked for universal health care, which was proposed in the Murray Wagner Dingell Act at the time, for admission of all colors and varieties of applicants to med schools, end to the Cold War and other peace and justice issues. We in AIMS were clearly “subversive” in the lexicon of the FBI and the House Un-American Activities Committee. Fueled by the Cold War and then the hot war in Korea, they swooped down on AIMS and many progressive organizations. AIMS was driven off medical campuses one after another.

I was a medical resident at the University of Chicago in 1951 and ’52. I worked like hell, night and day, as I had as an intern at L.A. County Hospital the year before. I also circulated a petition urging Cedars of Lebanon Hospital in Los Angeles to reinstate three prominent physicians who had been dropped from the staff for being alleged Communists. The last national convention of AIMS was held in Chicago in 1951. Quentin Young and I and other house staff and medical students fought a rearguard action to save AIMS but the Korean War, the FBI and frightened medical school administrators shut us down. A few months later I was fired from my residency. On balance, Chicago and AIMS, working with my fellow radical activists, were great human experiences.

My wife, baby daughter, and I moved from Chicago to Harlan County, Ky. There I joined a three-man group providing care to coal miners and their families under the United Mine Workers Welfare Fund. I was the internist of the group and I also delivered babies. I loved it. But then as now you have to understand, “There’s a war on.”

In 1953 I was drafted into the Air Force illegally. The Doctors Draft Law required that drafted doctors had to be given officers commissions. Thirty-two of us refused to sign Cold-War-generated loyalty oaths and were held as “doctor privates.” As always I worked hard taking care of my patients, talking to other Air Force members about the evils of the AF loyalty oath. A year later a conservative federal judge granted my petition for a writ of habeas corpus and I was out of the Air Force.

Back home to Los Angeles, I joined the Community Medical Center (CMC), a small group medical practice which provided good quality health care to patients who could not afford usual fees. Soon after, the Un-American Activities Committee held hearings on “Communism in the medical profession.” The star witness was an alleged former member of the CMC medical staff whom I had never seen. She testified, “Those doctors are not working for patients, they are working for the Communist Party.” That was the headline in the L.A. Examiner and the “red meat” lead on TV. We gained patients after this “expose.” By contrast the CMC failed a year later because of internal rifts. The group practice survived.

From 1953 to 1974 I practiced as internist in our small medical group and then left for three more years of training and emerged as a cardiologist and assistant clinical professor of medicine at UCLA, later at Keck/USC medical school where I teach part time. Every week I take six first-year medical students from the medical school, across the street to the L.A. County General Hospital where they interview and examine patients, one-on-one, and begin the process of becoming physicians.

Achieving the universal human right to health care is a lifelong commitment. But it is not a single life issue. For example in 1961 the Civil Defense Agency urged homeowners to dig “fallout shelters” in their backyards to survive an anticipated Russian nuclear attack. School children did “duck and cover” exercises. They ducked and got under their desks to stay safe in case of an atom bomb. This widespread paranoia was produced by the U.S. government and amplified by the media. This mendacious campaign was considered essential to convince the public to support nuclear war fighting; for “defense,” of course.

In 1961, Dr. Bernard Lown, a Harvard cardiologist, and several other Boston academics, analyzed Civil Defense data supporting the premise of survivability after a single Hiroshima size bomb exploded over Boston. Their study demonstrated conclusively that no one would survive for miles around Boston. They published their results in the New England Journal of Medicine. The Civil Defense Agency didn’t survive much longer. (Now we have a federal Department of “Homeland Security.”)

But in 1961, Physicians for Social Responsibility (PSR) was born. Lown was its obstetrician and cardiologist. I began organization of the first local chapter, LAPSR. PSR is now a large, well-established national organization. For 50 years we have published, testified and demonstrated against nuclear war preparation and the nuclear industry which underpins it. PSR issues have broadened to include the environment, and others.

Two other organizations were formed by leaders of PSR. One was the International Physicians for Prevention of Nuclear War (IPPNW): “What cannot be treated must be prev
ented.” IPPNW grew rapidly among physicians in many countries including the Soviet Union. All worked to prevent nuclear weapons in their own countries. Lown worked with his counterpart, Dr. Chazov, cardiologist to the general secretary of the Soviet Communist Party, against nuclear war. In 1985, Lown and Chazov, on behalf of IPPNW, were awarded the Nobel Prize for Peace.

Soon after the founding of PSR the struggle for civil rights mobilized Americans to a degree not seen since the great Depression. Dr. Quentin Young and some other progressive doctors in Chicago organized the Medical Committee for Human Rights. We in Los Angeles organized the L.A. chapter of MCHR. Later we merged LAPSR and LAMCHR. Issues of Peace and Human Rights cannot be separate. During the Freedom Summer, 1964 LAPSR/MCHR sent MDs to Mississippi for short stays to support SNCC and others who were registering Black citizens to vote. My brief sojourn with Mississippians and the civil rights workers, who came to register them, was one of the most inspiring of my life.

An outgrowth of PSR was the Committee of Responsibility for War Injured Vietnamese children (COR). This organization grew in cities across the U.S. I was the Los Angeles board member of COR. We brought war injured Vietnamese children to U.S. medical centers for complex surgeries. In L.A., Dr. Leonard Linde, a UCLA pediatric cardiologist, organized with UCLA faculty surgeons to treat two VN children at UCLA Medical Center by the hospital and the doctors without charge. Dr. Linde was their attending pediatrician. He had to confront the medical school dean who opposed our plan. The dean rightly believed that exposing the U.S. public to the effects of our VN war on children would adversely affect public support of the war. The children underwent multiple surgeries and postoperative rehabilitation services. They lived with a member of COR and her family when they were not in the UCLA Hospital. One of the children came back to Los Angeles at age 20, a lovely young woman transformed from her grotesque face when she first arrived at UCLA.

In the U.S., there was growing resistance to the draft and widespread revulsion over the nightly TV pictures of U.S. forces killing women and children, including by napalm. Of course we organized to stop the war. In 1967, we joined several thousand other people to confront President Johnson at the Century Plaza Hotel over his escalating war in Vietnam. The police used excessive force against us. Ruth Peck confronted a policeman who was threatening a person with epilepsy who was on the ground and could not “Move On!” Next day, Ruth arranged a press conference at our house. Doctors who had been at Century City the day before testified about what they saw, an entirely peaceful demonstration with policemen attacking demonstrators. Soon after, Johnson announced that he would not run for reelection.

Ruth also organized large successful fund-raising parties to benefit the Committee of Responsibility for War Injured Vietnamese Children. At one if these events our featured speaker was renowned pediatrician and antiwar activist Dr. Benjamin Spock. A footnote that evening was the meeting of Dr. Spock and Mr. Spock, Leonard Nimoy, of “Star Trek.” Another speaker was Howard Levy, M.D., who was ordered when he was in Indochina to teach indigenous men to do first aid to win their tribes people over to fight for the Americans.

This order clearly violated the Hippocratic Oath. Levy refused and was court marshaled and sent to Leavenworth prison. He had just been released before our party. Dr. Levy told the gathering that he was a super patriot because he helped make the U.S. do right and get out of Vietnam.

On the other hand, the demands for civil rights gave Lyndon Johnson the ammunition he needed to push civil rights and Medicare through Congress. Opposition to Medicare from the Right was powerful. I debated against officers of the L.A. County Medical Association who invariably declaimed that Medicare was socialism and would put a government agent in every examining room. Some reactionary MDs pledged that they would never treat patients who wanted their services under Medicare. A few months later, all of them were treating seniors and billing Medicare, and doing very nicely, thank you. Medicare established health care as a right, but only when you reach 65 or are totally disabled.

Medicare provides seniors with a physician of their choice, has greatly expanded medical education. It has funded research which led to treatments we could only dream of before 1965. It has created millions of well-paying jobs which cannot be exported overseas. Medicare is a not-for-profit system that runs on 3 percent overhead. It is the best thing that has happened to patients and physicians. HMOs run on 20 percent overhead and are the worst thing that has happened to us and our patients.

Now we are in the long bitter struggle to improve Medicare and extend it to everyone By the mid-’70s I had been an activist for 30 years. If I had stayed in the service for 30 years, a ghastly hypothetical, I could have retired with full pension. I gave myself an honorable discharge from leadership positions in our organizations. In 1992, I helped organize CAPA, now Physicians for a National Health Program-California, and worked diligently for Proposition 186 to establish an expanded Medicare-type program for California. The authors of this bill were Dr. Kevin Grumbach, UC-San Francisco Medical School professor and CAPA leader, and a few others. Prop. 186 started out ahead in the polls but then, was defeated. For the details, please google “Buying An Election – California’s Universal  Health Care Initiative – 1994” by Gordon Skene on Jan. 30, 2010.

Greed succeeded. The insurance industry used appealing actors. Remember Harry and Louise, the lovable couple who told us innumerable times on TV how they loved their HMO and feared government intervention? They overwhelmed us. Prop. 186 went down in defeat.

Now I limit my organizational activism to PNHP-CA, and serve on the board of directors. I am not available for any executive position. I serve in the new position of PNHP representative in the 29th Congressional District of Congressman Adam Schiff. Since Franklin Roosevelt was president, we always had Republican congressmen in Pasadena. In 2000, we finally defeated the last Republican troglodyte and elected Adam Schiff. I have met with him often to urge he support single-payer health care. He never does. He does cast some liberal votes and we progressives in the district compliment him on these.

In CD 29 I work in coalition with other organizations. We have lobbied in meetings with Rep. Schiff, our state senators and Assembly members and the Pasadena City Council. A leading organize
r of this coalition is Irma Stranz, chairperson in Pasadena of Health Care for All, a member of the League of Women Voters, and an active member of PNHP in Los Angeles. Other organizations we work with include the Teachers Union, other unions and the Presbyterian Church. I go to rallies, march and write, for universal humane health care and for justice and to end all our imperial wars.

I also participate with Veterans for Peace in the weekly Arlington West memorial events, remembering all of U.S. war dead in Iraq and Afghanistan, when I can. We set out 6,000-plus crosses and Mogen Davids and crescents one for each of our servicepersons killed in Iraq and Afghanistan on the sand north of the Santa Monica pier each Sunday morning and take them down Sunday evenings.

Keep working for the changes we know are right and remember the 2,000-year-old Roman adage, Illegitimi non carborundum: “Don’t let the bastards wear you down.” In this case, the bastards who stole health care.

What Has Obama Done for Poor People?

By Cynthia Gordy
The Root, Oct. 19, 2011

He’s done a lot, says the White House in a new report. Anti-poverty advocates weigh in on their progress.

Anger and disillusionment over the widening wealth gap may have reached a national tipping point, as evidenced by the Occupy Wall Street movement. Yet leading politicians rarely mention poor folks.

“It’s almost as if poverty is a dirty word,” economist Julianne Malveaux, president of Bennett College for Women, told The Root. “Joe Biden is leading the Middle Class Task Force, and I think they’re doing some good work — but what about the poor?”

Perhaps the Obama administration has taken heed. Last week the White House released “Creating Pathways to Opportunity,” a report that confronts the country’s dismal unemployment rates and the growing ranks of Americans below the poverty line. The 44-page document makes its case for numerous actions that the administration has taken to deliver help to low-income communities, from targeted job-training programs to expanded Pell Grants. It also contends that President Obama’s American Jobs Act — which he continues to push, despite its failure to pass in the Senate — is needed to build upon their progress.

But does the scale of the president’s policies match the scale of the challenges? And with the economy struggling and African Americans facing a record 16 percent unemployment, can the administration really afford to rest on its accomplishments?

The Root will pose these questions and others to Domestic Policy Council Director Melody Barnes and Senior Adviser Valerie Jarrett in a special “Open for Questions” event hosted by the White House on Thursday. The 45-minute discussion, in front of a live audience, will be streamed on The Root and whitehouse.gov/live; it will also allow questions from the audience and readers on Facebook and Twitter.

For this article, The Root posed the questions to experts outside of the White House on six core areas.

Health Care

On Day 16 of Obama’s presidency, he signed legislation expanding health coverage to 4 million uninsured children. The law added to the 7 million kids already covered under the Children’s Health Insurance Program in part by allowing the children of documented immigrants to enroll (instead of requiring them to wait five years after entering the country, as was done previously).

“This bill is only a first step,” the president vowed at the signing ceremony. “Providing coverage to 11 million children through CHIP is a down payment on my commitment to cover every single American.” As the administration sees it, Obama kept his promise. They claim that 2010’s Affordable Care Act will ensure coverage for 34 million uninsured people when fully implemented, with the poor being eligible for either Medicaid or tax credits to buy insurance.

Claudia Fegan, a physician serving low-income patients in Chicago and a spokesperson for Physicians for a National Health Program, says that Obama’s initiatives have good intentions. “But the process is too complicated for most poor people, who have fairly chaotic lives, to access,” she said, citing the bureaucratic application process for CHIP as an example. “It’s hard enough to get people the care they need without making them prove that the need it, requiring documentation and jumping through hoops to get it.”

Fegan has similar “good intentions” concerns about the Affordable Care Act: “As this program goes forward, more people will be insured, but at what cost? We provide more people access to care, but we lose by decreasing funding for safety-net providers and cutting back on some of the Medicare reimbursement. But poor patients need more than just a doctor to prescribe medication — they need social services and assistance navigating the system, resources that other providers don’t necessarily have.”

If Obama hadn’t given up on the single-payer system from the start of 2009’s health care debate, Fegan thinks the resulting compromise might have been easier to administer. “People say that the Affordable Care Act is socialized medicine, but nothing could be further from the truth,” she said. “We’re pushing people into the private insurance industry. We did what was politically expedient, but we put in place a very complicated system.”

Safety Net

The president often points out that when he first took office, each month we were bleeding nearly 750,000 jobs. Tax cuts from his American Recovery Act, the administration says, kept 1.6 million Americans out of poverty and gave relief to more than 100 million others. The stimulus measure also expanded the Supplemental Nutrition Assistance Program, which, despite increasing poverty, staved off a rise in child hunger.

Pitching the Recovery Act in February 2009, at his first joint session of Congress, Obama said, “I reject the view that says our problems will simply take care of themselves, that says government has no role in laying the foundation for our common prosperity.”

Economist Malveaux, president of Bennett College for Women, says there’s no doubt that Obama has provided assistance to the poor, but cites challenges. “There are some really good things that the administration has done around poverty, but they have not been proportionate to the extent to which the problem has increased,” she said.

“You’re nibbling around the edge when you say there’s a little program here and there’s a tax cut there,” she continued. “I think this should have been more central two years ago because, while doing health care was great, the first thing people want to do is be fed and know they’ll have a secure situation. And many Americans just don’t know that anymore.”

Housing Crisis

With 4 million Americans seriously behind on mortgage payments or in foreclosure, and a continued drop in housing prices, the president says that he has taken critical steps to meet historic needs. Through its loan-adjustment programs, the administration takes credit for more than 4 million loan modifications and touts the Hardest Hit Fund, which provides $7.6 billion for anti-foreclosure plans in states hurting most from the crisis.

“Creating Pathways to Opportunity” claims that the Homeless Prevention and Rapid Re-Housing Program, connecting families to supportive services like rental assistance and credit counseling, has averted or ended homelessness for more than 1 million Americans. And the administration’s $126 million Choice Neighborhood grant funds coordinated efforts to transform poor neighborhoods, including mixed-income housing, transit and job opportunities.

“The foreclosure crisis hit the African-American and Latino communities in 2002, so we’re talking about a problem that is really entrenched,” said Lisa Rice, vice president of the National Fair Housing Alliance. “I think the administration has done some things well, but we’re playing catch-up to a large degree.”

Rice clarifies the report’s “4 million loan modifications” figure — a baffling number, since, as of August, Obama’s floundering mortgage-modification program had served only about 816,000 homeowners. The number refers to a range of efforts not necessarily initiated by the administration, such as private modifications by loan servicers and pre-existing Federal Housing Administration programs.

“The question now becomes whether or not those modifications are sustainable and successful, because we’re seeing high re-default rates,” she said. “Another concern is around the administration being led by the industry instead of leading the industry. These are banks and institutions that received TARP bailout funds, and I think the administration can do more to make their loan-modification program more effective.”

Rashad Robinson, executive director of ColorOfChange, expressed his concern more sharply. “The decimation of black we
alth through predatory lending and foreclosures has been a major factor in the widening of the racial wealth gap in this country. What’s been really disappointing is that the administration is advocating for a settlement with some of the biggest banks that amounts to a slap on the wrist for the widespread deception and fraud against investors and homeowners,” he said, arguing that these firms should be prosecuted, or at least investigated. “Big banks are getting off, while everyday black people in communities all across the country are left holding the bag.”

Relief for the Unemployed

Obama’s immediate response to the ever-rising unemployment rate — which officially stands at 16 percent for African Americans — has been repeated extensions of unemployment benefits. While pushing a contested bill last summer, he said, “We need to pass it for all the Americans who haven’t been able to find work in an economy where there are five applicants for every opening.”

According to census data, extended unemployment insurance in 2010 kept 3.2 million people above the poverty line. The American Jobs Act calls for another extension, as well as legislation making it illegal to refuse to hire out-of-work job applicants.

“I commend the Obama administration for beginning to put the pieces of the economic puzzle back together — but when they talk about ‘long-term unemployed,’ the longest of the long-term unemployed are not a part of that conversation,” said Gregg Rosen, president of the American 99ers Union, an organization representing individuals who have been unemployed for longer than 99 weeks and have exhausted all state and federal unemployment insurance benefits. These workers are not included in Obama-backed legislation, effectively having disappeared from the government’s notice.

Rosen contends that extending benefits to the millions of Americans who make up “the 99ers” would have a stimulating effect on the economy. “You’re looking at more than 7 million Americans, and the average unemployment insurance check is $303 per week. If you put those dollars into the hands of the 99er community, you’re looking at a return investment of billions of dollars every week in economic spending. That, to me, is a solid stimulus.”

Education

“In the 21st century, one of the best anti-poverty programs is a world-class education,” Obama said in his 2010 State of the Union address. Calling for changes in public education, his $4.3 billion Race to the Top competition rewards states with funding if they present innovative plans for turning around their lowest-performing schools.

Modeled after the successful Harlem Children’s Zone — which provides charter schools, parenting workshops and weekend community centers to support education from “cradle through college” — the administration’s Promise Neighborhoods grant program helps cities jump-start their own neighborhood interventions. On the higher-education front, the president has more than doubled Pell Grants for low-income college students.

Education advocate and author Steve Perry pounces on Obama’s reform agenda. “I think the idea behind Race to the Top is a solid one, but with the country in a tremendous deficit, and a recession on top of that, there’s not enough money to sustain the changes,” he said. “We’re borrowing from our children’s future with the expectation that it will improve their future?”

Perry, principal of the Capital Preparatory Magnet School in Hartford, Conn. — and outspoken school-voucher campaigner — says that instead of investing money in schools, federal education money should go directly to families and let them choose the best place for them. “I have more faith in families to pick good schools than I do administrators and Board of Education members, who keep failed schools open. Parents always choose the best schools in the community. If we let them pick them, we’d only have the best ones stay open. I’m not for education reform; I’m for education revolution.”

Jobs

Plugging several provisions from the Recovery Act, the administration says that its youth summer jobs program for low-income youths employed 367,000 young adults — approximately 40 percent of them African American — in 2009 and 2010. The legislation’s Temporary Assistance for Needy Families emergency contingency fund hired 260,000 low-income adults in subsidized jobs.

In June the Department of Labor announced $39.7 million in grants to help low-income noncustodial parents and ex-offenders gain job skills (and boost their employability) by placing them in temporary, paid work experiences. And the American Job Act’s infrastructure investment reserves $50 million for transportation-related job training for minorities, women and low-income workers.

“Independent economists have looked at this jobs bill, and they’ve said it will create nearly 2 million jobs,” Obama said on Tuesday at a Virginia high school during his three-day bus tour promoting the American Jobs Act, expressing confusion over why Republicans would vote it down. “I don’t want us to be playing politics all the time. I want us to meet this moment. I want us to get to work. “

Despite the administration’s current efforts, there’s still that stubborn 9 percent national unemployment rate. Rep. Keith Ellison (D-Minn.), chair of the Congressional Progressive Caucus, is reluctant to say that the president hasn’t done all he can. “It’s important to understand that the administration is not making decisions in an unconstrained environment where the president can do whatever he wants,” said Ellison, referring to the Republican blockade in Congress. “The bottom line is, the president has been fighting to fully invest in jobs and alleviate poverty, and he’s trying to do the same thing now.”

Ellison’s primary quibble with the president is not with his policies so much as his political tactics. “I think his orientation toward consensus, and trying to bring two sides together, has been a miscalculation. He’s always started out the conversation with the spirit of compromise, and the Republicans are not,” he said.

“I think he could have been a lot more combative with them from the beginning, but I’ve noticed a shift in the president’s rhetoric with the American Jobs Act,” Ellison continued. “I think it’s an acknowledgment that he’s dealing with unreasonable people, and he doesn’t have to negotiate.”

Cynthia Gordy is The Root’s Washington reporter.

http://www.theroot.com/views/pathways-progress-opinion-roundup?page=0,0

The Root is the leading online source of news and commentary from an African-American perspective. Founded in 2008 under the leadership of Prof. Henry Louis Gates Jr. of Harvard University, The Root offers a unique take on breaking news, provides solid analysis and presents dynamic multimedia content. The Root raises the profile of black voices in mainstream media and engages anyone interested in black culture around the world. The Root is owned by the Washington Post Company. Visit us at www.theroot.com, on Twitter @TheRoot247 and on Facebook.

Health care policy: faith- or evidence-based?

By Philip Caper, M.D.
The Ellsworth American (Maine), Oct. 20, 2011

Sen. Brian Langley’s recent commentary praising the newly enacted law (PL 90) that replaces Maine’s carefully crafted system of health insurance regulation with a more “market-based solution” [“Health Insurance Reform Shows Signs of Promise,” Ellsworth American, Oct. 13] deserves comment.

He evidently has a great deal of faith in the role of markets and competition in health care. He is apparently unaware that we in the U.S. have been conducting the world’s leading experiment in market-based health care for over 30 years. No other developed country in the world relies as heavily as we do on market forces to provide access to affordable health care for their people.

That experiment has been a spectacular failure. It has resulted in by far the highest health care costs in the world that continue to spiral out of control. Despite our high costs, we suffer from having the highest proportion of uninsured citizens of any developed country. Medical costs are a leading cause of personal bankruptcy in America, and it is reliably estimated that over 45,000 Americans die unnecessarily each year due to impaired access to medical care.

Sen. Langley’s confusion is understandable. LDI1333, the legislation leading to the enactment of PL 90, was rammed through the Legislature along party lines without adequate time for study (except perhaps by those who crafted it), without hearings, without meaningful debate, and without giving the superintendent of insurance the chance to assess its likely impact on the people of Maine. It was the most irresponsible exercise of political brute force I have witnessed in my 45 years in health care.

Although a few relatively young, healthy and employed people may we a slowing in the rate of increases in their health insurance premiums, many older and less healthy Mainers, especially those living in rural areas, will pay a heavy price.

They will see massive increases in their costs of health insurance to the point of unaffordability, or will be dumped into a publicly administered “high risk pool” that will likely soon become underfunded. The new law has created open season for insurance companies to sell skimpy policies to unsuspecting Mainers that will prove to be inadequate when the time comes to use them.

This law does nothing to slow the explosion in the costs of medical care. These costs are driven by inappropriate overuse of expensive (and lucrative) diagnostic and therapeutic technologies (often without any clear evidence of benefit), windfall profiteering due to unnecessarily high prices by corporations selling health care products and services, and massive inefficiencies in the way we finance and pay for health care. These factors are not unique to Maine, but we certainly suffer from them.

We need less, not more competition among health insurance companies. Competition does not work in medical care as it does in normal markets. The proof is in the fact that our current market-based system is failing.

We need to learn a lesson from our Canadian neighbors who have a single publicly managed insurance system, yet retain free choice of provider. Despite the fact that Canadians’ may have to wait somewhat longer for elective procedures than people with good health insurance in the U.S., they apparently believe the advantages outweigh a little inconvenience. Their system is far more popular than is ours. If you ask Canadians whether they would trade our system for theirs, most simply laugh. No Canadian politician who wants to stay in office, including their current conservative government, dares to propose tinkering with its fundamentals.

Virtually every Canadian is covered, and bankruptcy due to medical costs is essentially nonexistent. Almost every measurable health outcome of their system exceeds ours in quality. What’s not to like?

All other wealthy countries have similar systems. Their overall health care costs average about half of ours.

It’s time to change the way we think about health care in America. We need to move away from faith-based policy and toward policy based on evidence. It’s time for an improved Medicare-like system for all Mainers.

Dr. Philip Caper resides in Brooklin, Maine.

Wal-Mart squeezes employee health benefits

Wal-Mart Cuts Some Health Care Benefits

By Steven Greenhouse and Reed Abelson
The New York Times, October 20, 2011

After trying to mollify its critics in recent years by offering better health care benefits to its employees, Wal-Mart is substantially rolling back coverage for part-time workers and significantly raising premiums for many full-time staff.

Citing rising costs, Wal-Mart, the nation’s largest private employer, told its employees this week that all future part-time employees who work less than 24 hours a week on average will no longer qualify for any of the company’s health insurance plans.

In addition, any new employees who average 24 hours to 33 hours a week will no longer be able to include a spouse as part of their health care plan, although children can still be covered.

Wal-Mart also significantly reduced the amount of money it contributes to the savings accounts workers can use to pay for medical bills that are not covered under their plan. Last year, the company put $1,000 into accounts for families but it will cut the amount by half for next year to just $500.

Barbara Collins, a sales associate at the Wal-Mart in Placerville, Calif., said that the premiums for the H.M.O. plan for herself and her 5-year-old son would rise to $18 every two weeks from $10. Her big concern, she said, was that her deductible would jump to $5,000 a year, from $1,000 — a daunting amount considering she earns $19,000 a year.

Dan Schlademan, director of Making Change at Walmart, a union-backed campaign, condemned the changes.

“No wonder people are protesting in the streets,” he said. “This is another example of corporations putting profits ahead of what’s good for everyday Americans. It’s outrageous and damaging to many hard-working families that the biggest corporation in America is increasing health care costs for many employees by 40 percent.”

http://www.nytimes.com/2011/10/21/business/wal-mart-cuts-some-health-care-benefits.html?_r=1&hp=&pagewanted=all

And…

The Richest People in America

Forbes
September 21, 2011

#6 Christy Walton $24.5B

#9 Jim Walton $21.1B

#10 Alice Walton $20.9B

#11 S. Robson Walton $20.5B

http://www.forbes.com/forbes-400/#p_2_s_arank_All%20industries_All%20states_All%20categories_

And…

Wage Statistics for 2010

Social Security Online
October 21, 2011

By definition, 50 percent of wage earners had net compensation less than or equal to the median wage, which is estimated to be $26,363.55 for 2010.

http://www.ssa.gov/cgi-bin/netcomp.cgi?year=2010

Comment:

By Don McCanne, MD

A fundamental principle in the Affordable Care Act is that we would continue to rely very heavily on employer sponsored plans for the majority of health care coverage in America. How is that working? Wal-Mart, the nation’s largest private employer, is increasing the insurance deductible to $5,000 for an employee earning $19,000 per year.

Yet look at her employers. Four members of the Walton family are amongst the eleven wealthiest individuals in America, each worth over $20 billion. (Compare that with the Koch brothers, who own Congress, each worth $25 billion.) This is in a nation with a median wage of $26,364.

Relying on employers to do the right thing no longer cuts it. Not only do they fail to pay enough, they can no longer be relied upon to see that their employees and their families receive adequate health benefits.

It’s time to enact an improved Medicare for all, even if we have to “Occupy Congress” to accomplish that.