Chapter – Page 748

Health Care Reform Victory Comes with Tragic Setback for Women’s Rights

Statement of NOW President Terry O’Neill
March 21, 2010

As a longtime proponent of health care reform, I truly wish that the National Organization for Women could join in celebrating the historic passage of the Patient Protection and Affordable Care Act. It pains me to have to stand against what many see as a major achievement. But feminist, progressive principles are in direct conflict with many of the compromises built into and tacked onto this legislation.

The health care reform bill passed by Congress today offers a number of good solutions to our nation’s critical health care problems, but it also fails in many important respects. After a full year of controversy and compromise, the result is a highly flawed, diminished piece of legislation that continues reliance on a failing, profit-driven private insurance system and rewards those who have been abusive of their customers. With more than 45,000 unnecessary deaths annually and hundreds of thousands of bankruptcies each year due to medical bills, this bill is only a timid first step toward meaningful reform.

Fact: The bill contains a sweeping anti-abortion provision. Contrary to the talking points circulated by congressional leaders, the bill passed today ultimately achieves the same outcome as the infamous Stupak-Pitts Amendment, namely the likely elimination of all private as well as public insurance coverage for abortion. It imposes a bizarre requirement on insurance plan enrollees who buy coverage through the health insurance exchanges to write two monthly checks (one for an abortion care rider and one for all other health care). Even employers will have to write two separate checks for each of their employees requesting the abortion rider.

This burdensome, elaborate system must be eliminated. It is there because the Catholic bishops and extremist abortion rights opponents know that it will result in greatly restricting access to abortion care, currently one of the most common medical procedures for women.

Fact: President Obama made an eleventh-hour agreement to issue an executive order lending the weight of his office to the anti-abortion measures included in the bill. This move was designed to appease a handful of anti-choice Democrats who have held up health care reform in an effort to restrict women’s access to abortion. This executive order helps to cement the misconception that the Hyde Amendment is settled law rather than what it really is — an illegitimate tack-on to an annual must-pass appropriations bill. It also sends the outrageous message that it is acceptable to negotiate health care reform on the backs of women.

Fact: The bill permits age-rating, the practice of imposing higher premiums on older people. This practice has a disproportionate impact on women, whose incomes and savings are lower due to a lifetime of systematic wage discrimination.

Fact: The bill also permits gender-rating, the practice of charging women higher premiums simply because they are women. Some are under the mistaken impression that gender-rating has been prohibited, but that is only true in the individual and small-group markets. Larger group plans (more than 100 employees) sold through the exchanges will be permitted to discriminate against women — having an especially harmful impact in workplaces where women predominate.

We know why those gender- and age-rating provisions are in the bill: because insurers insisted on them, as they will generate billions of dollars in profits for the companies. Such discriminatory rating must be completely eliminated.

Fact: The bill imposes harsh restrictions on the ability of immigrants to access health care, imposing a 5-year waiting period on permanent, legal residents before they are eligible for assistance such as Medicaid, and prohibiting undocumented workers even to use their own money to purchase health insurance through an exchange. These provisions are counterproductive in terms of controlling health care costs; they are there because of ugly anti-immigrant sentiment, and must be eliminated.

Fact: The bill covers only 32 million of the 47 million uninsured in this country, does not contain a meaningful public option and provides no pathway to a single payer system like Medicare for all. Democratic negotiators crumpled before powerful business interests and right-wing extremists, and until they get a spine there will be no true competition to help rein in costs.

The bottom line is that everyone — citizen and non-citizen, undocumented immigrant and visitor — has a fundamental human right to health care. This right has been denied in the U.S. for far too long, while the rest of the industrialized world moved ahead to assure universal and affordable care for their people.

We call upon President Obama and elected officials in both houses to commit to a process of steady improvement of our health care system that will result in true reform with universal coverage, realistically affordable rates and no discrimination. We still have a lot of work to do before we can genuinely celebrate.

http://www.now.org/press/03-10/03-21b.html

We'll see if the insurance industry can be ‘reformed'

Letters
South Maryland Newspapers, March 24, 2010

I can’t pretend to be even cautiously optimistic that the health insurance reform legislation passed by Congress on Sunday will accomplish its goal of making health insurance more affordable. More importantly, I understand that having health insurance doesn’t mean a patient can afford health care. I want my patients to be freed from the burden of worrying about how to pay for the care they need. I’m tired of having patients get tears in their eyes, or become embarrassed and feel ashamed because they can’t afford the care I recommend.

The president and his Democratic leadership want us to believe that this legislation will, eventually, help ease that burden. We’ll see. From my vantage point as a practicing physician, what I see is legislation that solidifies the stranglehold private, for-profit health insurance companies now have on the health insurance market. We will mandate that citizens purchase a defective product and subsidize the premiums with our tax dollars. I don’t want my tax dollars going to the coffers of health insurance companies that take those dollars and turn around and pay them to the president and Congress in the form of campaign contributions, or pay them to themselves in the form of multimillion dollar salaries and bonuses. I don’t want my tax dollars helping to purchase insurance products that I know darn well won’t protect the holder of the insurance from going broke if he or she becomes seriously ill and actually has to use the insurance.

Every other developed country in the world can’t be wrong. They have all figured out their own unique way to provide universal health care and are accomplishing it at half the cost per capita as we are and they have better health outcomes. None of them include a profit-driven health insurance industry.

We’ll see if the insurance industry can be “reformed” and if that reformed industry can provide useful health insurance that is affordable and actually improves our health statistics.

While we’re waiting, I plan to keep advocating for Improved Medicare for All. You can learn more about it at www.healthcare-now.org and join Southern Marylanders for Single Payer by contacting me at caparis52 (at) hotmail.com.

Dr. Carol A. Paris, Leonardtown

The writer is a member of Physicians for a National Health Program.

We’ll see if the insurance industry can be ‘reformed’

Letters
South Maryland Newspapers, March 24, 2010

We’ll see if the insurance industry can be “reformed” and if that reformed industry can provide useful health insurance that is affordable and actually improves our health statistics.

Dr. Carol A. Paris, Leonardtown

The writer is a member of Physicians for a National Health Program.

Reconciliation Act includes wealth transfer

Health Care and Education Reconciliation Act of 2010

H.R.4872
The Library of Congress

SEC. 1402. UNEARNED INCOME MEDICARE CONTRIBUTION.

(a) Investment Income-
(1) IN GENERAL- Subtitle A of the Internal Revenue Code of 1986 is amended by inserting after chapter 2 the following new chapter:
CHAPTER 2A–UNEARNED INCOME MEDICARE CONTRIBUTION

Sec. 1411. Imposition of tax.

(a) In General- Except as provided in subsection (e)–
(1) APPLICATION TO INDIVIDUALS- In the case of an individual, there is hereby imposed (in addition to any other tax imposed by this subtitle) for each taxable year a tax equal to 3.8 percent of the lesser of–
(A) net investment income for such taxable year, or
(B) the excess (if any) of–
(i) the modified adjusted gross income for such taxable year, over
(ii) the threshold amount.
(2) APPLICATION TO ESTATES AND TRUSTS- In the case of an estate or trust, there is hereby imposed (in addition to any other tax imposed by this subtitle) for each taxable year a tax of 3.8 percent of the lesser of–
(A) the undistributed net investment income for such taxable year, or
(B) the excess (if any) of–
(i) the adjusted gross income (as defined in section 67(e)) for such taxable year, over
(ii) the dollar amount at which the highest tax bracket in section 1(e) begins for such taxable year.
(b) Threshold Amount- For purposes of this chapter, the term `threshold amount’ means–
(1) in the case of a taxpayer making a joint return under section 6013 or a surviving spouse (as defined in section 2(a)), $250,000,
(2) in the case of a married taxpayer (as defined in section 7703) filing a separate return, 1/2 of the dollar amount determined under paragraph (1), and
(3) in any other case, $200,000.

—-

SEC. 1409. CODIFICATION OF ECONOMIC SUBSTANCE DOCTRINE AND PENALTIES.

(a) In General- Section 7701 of the Internal Revenue Code of 1986 is amended by redesignating subsection (o) as subsection (p) and by inserting after subsection (n) the following new subsection:
(o) Clarification of Economic Substance Doctrine-
(1) APPLICATION OF DOCTRINE- In the case of any transaction to which the economic substance doctrine is relevant, such transaction shall be treated as having economic substance only if–
(A) the transaction changes in a meaningful way (apart from Federal income tax effects) the taxpayer’s economic position, and
(B) the taxpayer has a substantial purpose (apart from Federal income tax effects) for entering into such transaction.

http://thomas.gov

And…

Is Single-Payer Health Care The Best Option?

By Don McCanne
The New Republic
July 16, 2008

Because of our very high costs, we must accept the fact that the insurance function is no longer simply a transfer from the many who are healthy to the fewer with health care needs, but it now must also include a partial transfer from the wealthy to middle- and lower-income individuals with needs. There is no alternative to this wealth transfer.

https://pnhp.org/news/2008/july/response-to-tnrs-jonathan-cohn

Comment:

By Don McCanne, MD

The easiest way to accomplish that transfer would be to establish a single national risk pool that covered everyone, and fund that pool through progressive taxes. Unfortunately, Congress and the President selected a much more complex financing scheme for their health reform program. Nevertheless, there was no way that they could escape the necessity of including a wealth transfer mechanism. So what did they do?

The most obvious transfers are contained in the bill signed yesterday that is now law. Individuals purchasing their health plans from the state exchanges will receive federal subsidies in an amount inversely related to their incomes. Individuals with very low incomes will be enrolled in Medicaid and will not have to contribute any premium. Since the taxes collected to support these programs are progressive, the wealth transfer is automatic.

The Reconciliation Act that is still under consideration in the Senate provides additional measures that acknowledge the need for a wealth transfer, including the unearned income Medicare contribution, and the codification of the economic substance doctrine.

Our current tax policies extract both income taxes and payroll taxes from hard-earned wages, but passive unearned income such as interest, dividends and capital gains may receive favorable treatment for income taxes, and totally escape payroll taxes. It seems unfair to tax individuals who are contributing to society by their personal work effort at a higher level than wealthy individuals who contribute little more than conversation at the nineteenth hole of the golf course. The common argument that those funds shouldn’t be taxed so that they can be invested in the economy holds little water when you consider that increased productivity comes from the workforce and not from passive investors.

In recognition of this imperative of wealth transfer, the Reconciliation Act includes a Medicare tax of 3.8 percent on passive income over $200,000 for individuals or $250,000 for couples. Although that is a relatively modest tax for wealthy individuals, it is a giant step forward in solidifying the principle of wealth transfer.

The codification of the economic substance doctrine is simply locking into law the principle that wealthy individuals can no longer establish sham transactions that have the sole function of reducing income tax liability. Although this is not a wealth transfer in the same sense as the Medicare tax on passive income, it does ensure that the rightful transfer can no longer be avoided by these devious transactions, subject to an extra 40 percent penalty if attempted.

Although the decision of Congress and the President to continue to use private health insurers to finance health care was a terrible decision that we will continue to attempt to upend by pushing for a single payer system, nevertheless we can celebrate some of the beneficial features of the legislation such as the expansion of community health centers and the reinforcement of primary care.

One of the most important beneficial features of all is the firm establishment of the principle that the transfer will not come only from the healthy but must also come from the wealthy. That is a policy bridge that we will have already crossed on our march to an improved Medicare for all.

Reconciliation Act includes wealth transfer

Health Care and Education Reconciliation Act of 2010

H.R.4872
The Library of Congress
SEC. 1402. UNEARNED INCOME MEDICARE CONTRIBUTION.
(a) Investment Income-
(1) IN GENERAL- Subtitle A of the Internal Revenue Code of 1986 is amended by inserting after chapter 2 the following new chapter:
CHAPTER 2A–UNEARNED INCOME MEDICARE CONTRIBUTION
Sec. 1411. Imposition of tax.
(a) In General- Except as provided in subsection (e)–
(1) APPLICATION TO INDIVIDUALS- In the case of an individual, there is hereby imposed (in addition to any other tax imposed by this subtitle) for each taxable year a tax equal to 3.8 percent of the lesser of–
(A) net investment income for such taxable year, or
(B) the excess (if any) of–
(i) the modified adjusted gross income for such taxable year, over
(ii) the threshold amount.
(2) APPLICATION TO ESTATES AND TRUSTS- In the case of an estate or trust, there is hereby imposed (in addition to any other tax imposed by this subtitle) for each taxable year a tax of 3.8 percent of the lesser of–
(A) the undistributed net investment income for such taxable year, or
(B) the excess (if any) of–
(i) the adjusted gross income (as defined in section 67(e)) for such taxable year, over
(ii) the dollar amount at which the highest tax bracket in section 1(e) begins for such taxable year.
(b) Threshold Amount- For purposes of this chapter, the term `threshold amount’ means–
(1) in the case of a taxpayer making a joint return under section 6013 or a surviving spouse (as defined in section 2(a)), $250,000,
(2) in the case of a married taxpayer (as defined in section 7703) filing a separate return, 1/2 of the dollar amount determined under paragraph (1), and
(3) in any other case, $200,000.
—-
SEC. 1409. CODIFICATION OF ECONOMIC SUBSTANCE DOCTRINE AND PENALTIES.
(a) In General- Section 7701 of the Internal Revenue Code of 1986 is amended by redesignating subsection (o) as subsection (p) and by inserting after subsection (n) the following new subsection:
(o) Clarification of Economic Substance Doctrine-
(1) APPLICATION OF DOCTRINE- In the case of any transaction to which the economic substance doctrine is relevant, such transaction shall be treated as having economic substance only if–
(A) the transaction changes in a meaningful way (apart from Federal income tax effects) the taxpayer’s economic position, and
(B) the taxpayer has a substantial purpose (apart from Federal income tax effects) for entering into such transaction.
http://thomas.gov

And…

Is Single-Payer Health Care The Best Option?

By Don McCanne
The New Republic
July 16, 2008
Because of our very high costs, we must accept the fact that the insurance function is no longer simply a transfer from the many who are healthy to the fewer with health care needs, but it now must also include a partial transfer from the wealthy to middle- and lower-income individuals with needs. There is no alternative to this wealth transfer.
https://pnhp.org/news/2008/july/response-to-tnrs-jonathan-cohn

The traditional role of health insurance has been to transfer funds from the many who are healthy to the few who are sick. But now health care costs in the United States are so high that if we expect everyone to have the health care that they need, a transfer of funds from the wealthy down would be absolutely mandatory if we are to be able to finance that care.
The easiest way to accomplish that transfer would be to establish a single national risk pool that covered everyone, and fund that pool through progressive taxes. Unfortunately, Congress and the President selected a much more complex financing scheme for their health reform program. Nevertheless, there was no way that they could escape the necessity of including a wealth transfer mechanism. So what did they do?
The most obvious transfers are contained in the bill signed yesterday that is now law. Individuals purchasing their health plans from the state exchanges will receive federal subsidies in an amount inversely related to their incomes. Individuals with very low incomes will be enrolled in Medicaid and will not have to contribute any premium. Since the taxes collected to support these programs are progressive, the wealth transfer is automatic.
The Reconciliation Act that is still under consideration in the Senate provides additional measures that acknowledge the need for a wealth transfer, including the unearned income Medicare contribution, and the codification of the economic substance doctrine.
Our current tax policies extract both income taxes and payroll taxes from hard-earned wages, but passive unearned income such as interest, dividends and capital gains may receive favorable treatment for income taxes, and totally escape payroll taxes. It seems unfair to tax individuals who are contributing to society by their personal work effort at a higher level than wealthy individuals who contribute little more than conversation at the nineteenth hole of the golf course. The common argument that those funds shouldn’t be taxed so that they can be invested in the economy holds little water when you consider that increased productivity comes from the workforce and not from passive investors.
In recognition of this imperative of wealth transfer, the Reconciliation Act includes a Medicare tax of 3.8 percent on passive income over $200,000 for individuals or $250,000 for couples. Although that is a relatively modest tax for wealthy individuals, it is a giant step forward in solidifying the principle of wealth transfer.
The codification of the economic substance doctrine is simply locking into law the principle that wealthy individuals can no longer establish sham transactions that have the sole function of reducing income tax liability. Although this is not a wealth transfer in the same sense as the Medicare tax on passive income, it does ensure that the rightful transfer can no longer be avoided by these devious transactions, subject to an extra 40 percent penalty if attempted.
Although the decision of Congress and the President to continue to use private health insurers to finance health care was a terrible decision that we will continue to attempt to upend by pushing for a single payer system, nevertheless we can celebrate some of the beneficial features of the legislation such as the expansion of community health centers and the reinforcement of primary care.
One of the most important beneficial features of all is the firm establishment of the principle that the transfer will not come only from the healthy but must also come from the wealthy. That is a policy bridge that we will have already crossed on our march to an improved Medicare for all.

Ernestine: Blind? Read the fine print!

Campaign for SB 810 - Single Payer Universal Health Care

California OneCare

Lily Tomlin as Ernestine

30 second video:

http://californiaonecare.org/365-ad-campaign/365-ad-archive/365-ad-35-2/

Comment:

By Don McCanne, MD

We have been saturated with commentary since the passage and signing of the trillion dollar Private Insurance Industry Stimulus legislation. Lily Tomlin provides us with a much needed break as she reminds us, in her own incomparable style, of the industry that Congress and the President have so richly rewarded.

Politicians didn’t get it right

Seattle Times (print edition only)
March 22, 2010

Editor, The Times:

Regarding the insurance albatross the politicians just hung around our neck [“Historic health-care overhaul passes,” Seattle Times, page one, March 22]:

An estimated 23,000 unnecessary deaths annually will result from 23 million still uninsured nine years out;

Millions of middle-income people will be pressured to buy commercial policies that cost up to 9.5 percent of income but cover an average of only 70 percent of medical expenses;

Insurance firms [which give no care to anyone] will get at least $447 billion in taxpayer money in subsidies;

The bill will drain about $40 billion from Medicare payments to safety-net hospitals;

People with employer-based coverage will be locked into their plan’s limited network of providers;

Health-care costs will continue to skyrocket, like they did in Massachusetts;

There are loopholes in the pre-existing conditions regulations;

Women’s reproductive rights will be further eroded.

We needed and still need a single-payer, equal-access-for-all plan. Physicians for A National Health Program and United for Single Payer locally will continue to work on this until we get it right.

— Linda Jansen, Seattle

Louisville doctors, Humana react to healthcare bill

By Janelle MacDonald
WAVE NBC 3
Mar 22, 2010

LOUISVILLE, KY (WAVE) – The sweeping reform of the nation’s health care system has passed the House of Representatives and is ready for President Obama to sign into law. In Kentuckiana, reaction from doctors is mixed. Supporters showed a long list of healthcare professional organizations that backed the bill, but some doctors fear what it will do to their business and profession. Others say this bill didn’t go far enough to address the problems.

Dr. Adewale Troutman, director of Louisville Metro Health & Wellness, said there were obvious problems with the healthcare system as it stood.

“People are dying at unacceptably high rates due to the fact they don’t have health insurance,” said Troutman.

With coverage to 30 million more Americans, Troutman sees a lot of things to like in the newly passed healthcare reform bill.

“Removing a cap for a lifetime cap on what insurance money you spend, the preexisting condition piece is extremely important, not being able to drop somebody from coverage because now they’ve got something that costs money,” Troutman said.

But to call it comprehensive healthcare reform, Troutman said, “I think that the bill that was passed is a step in the right direction but we have a long, long, long way to go to turn this ship around so that we have equity, health equity for all populations.”

His former colleague, now retired Dr. Garrett Adams, puts it even more bluntly. According to Adams, it’s, “aspirin for cancer.”

Adams says the healthcare reform bill as passed won’t do anything to control costs.

“The bills will continue to go up,” said Adams. “The premiums will have to go up, there’s no way they won’t go up.”

As for the mandates for insurance coverage, Adams said, “people will buy the least expensive coverage that they can get and it’s not going to be enough. It’s skimpy coverage.”

In addition, Adams agrees with critics who say the new bill takes some healthcare decisions out of the hands of doctors and places it in the hands of the government.

“There are so many controls,” Adams said. “It’s very unfriendly, I think to physicians … It’s awkward, it’s complicated.”

Adams is a member of Physicians for a National Healthcare Program, which advocates for getting rid of the private, for-profit, insurance company system all together. Troutman says he is also in favor of a not-for-profit system. However, here in Louisville, a lot of jobs depend on the insurance industry.

Jim Turner, a spokesperson for Louisville-based Humana, said the bill could be good for the company because requiring everyone to get health insurance will add customers to the market and that could help Humana.

Turner also said the company is worried because the bill doesn’t do much to reduce healthcare costs and the cost of not having insurance – a government imposed penalty – isn’t strict enough.

“People could just say, ‘I’m not going to pay my fair share of premium,'” Turner said. “They could say, ‘I’m going to wait until I get sick, pay an extremely modest penalty, and then I’ll sign up,’ and if that does come to pass, that will actually destroy the whole basis of insurance.”

Turner also told us the bill will hurt the young and old more than others by putting new taxes on the young, and reducing Medicare advantage payouts for the elderly.

Information for this story also provided by Ryan Nash.

http://www.wave3.com/Global/story.asp?S=12185064

Research by Physicians for a National Health Program

Over the past two decades, PNHP research has influenced health policy and focused debate on the need for fundamental health care reform.

Administrative costs consume 31 percent of US health spending, most of it unnecessary. The US could save enough on administrative expenses (nearly $400 billion annually) with a single payer to cover all the uninsured.
Medical bills contribute to more than 60 percent of all bankruptcies. Three-fourths of those bankrupted had health insurance at the time they got sick.
Taxes already pay for over 60 percent of US health spending. Americans pay the highest health care taxes in the world. We pay for national health insurance, but don’t get it.
Despite spending far less per capita for health care, Canadians and residents of other developed countries are healthier and have better measures of access to health care than Americans.
Alternative health proposals for “universal coverage” do not work. State health reforms containing the key elements of the Obama health plan have failed to reduce the number of uninsured.
Computerized medical records and chronic disease management do not save money. The only way to slash administrative overhead and improve quality is with a single payer system.
Business pays less than 20 percent of our nation’s health bill. It is a misnomer that our health system is “privately financed” (60 percent is paid by taxes and the remaining 20 percent is out-of-pocket payments).
For-profit, investor-owned hospitals, HMOs and nursing homes have higher costs and score lower on most measures of quality than their non-profit counterparts.
Immigrants and emergency department visits by the uninsured are not the cause of high and rising health care costs.
Nearly 45,000 Americans die each year for lack of health insurance. The uninsured do not receive all the medical care they need – they live sicker and die younger. Those most in need of preventive services are least likely to receive them.
The US could save enough on administrative costs (over $400 billion annually) with a single payer to cover all the uninsured.

Full text and citations for each finding are available on our web site at www.pnhp.org/research.

Campaign for SB 810 – Single Payer Universal Health Care

California OneCare
Lily Tomlin as Ernestine
30 second video:

http://californiaonecare.org/365-ad-campaign/365-ad-archive/365-ad-35-2/

US healthcare law 'poses long-term threats'

Al Jazeera English

Al Jazeera interviewed Matt Hendrickson, a doctor from California and PNHP member, who said the recently signed healthcare law is good for the short-term, but in the long run it could prove disastrous.

US healthcare law ‘poses long-term threats’

Al Jazeera English

Is Single-Payer Health Care The Best Option?

Comment:

Health Care and Education Reconciliation Act of 2010

Is Single-Payer Health Care The Best Option?

Comment:

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