PNHP

Martin Luther King, Jr. – A Proper Sense of Priorities

Martin Luther King, Jr. – A Proper Sense of Priorities

A Proper Sense of Priorities

A speech by Martin Luther King, Jr.
Washington, D.C.
February 6, 1968

Closing remarks:

As we were marching today, some 5,000 strong, I thought about Selma because I could look around and see so many who have marched with us in Selma, and from Selma to Montgomery. And we are still marching and we are still moving. And I give you my commitment today that I plan to continue.

Someone said to me not long ago, it was a member of the press, “Dr. King, since you face so many criticisms and since you are going to hurt the budget of your organization, don’t you feel that you should kind of change and fall in line with the Administration’s policy. Aren’t you hurting the civil rights movement and people who once respected you may lose respect for you because you’re involved in this controversial issue in taking the stand against the war.”

And I had to look with a deep understanding of why he raised the question and with no bitterness in my heart and say to that man, “I’m sorry sir, but you don’t know me. I’m not a consensus leader. [Laughter – Applause] I don’t determine what is right and wrong by looking at the budget of the Southern Christian Leadership Conference or by taking….[Applause] Nor do I determine what is right and wrong by taking a Gallup poll of the majority opinion.” [Applause] Ultimately a genuine leader is not a searcher of consensus but a molder of consensus. [Applause]

On some positions cowardice asks the question, is it safe? Expediency asks the question, is it politic? Vanity asks the question, is it popular? But conscience asks the question, is it right? And there comes a time when one must take a position that is neither safe, nor politic, nor popular but he must take it because conscience tells him it is right. [Applause]

http://www.aavw.org/special_features/speeches_speech_king04.html

Comment: 

By Don McCanne, MD

Yes… truly a proper sense of priorities… and especially apropos now for us and our friends and colleagues at PNHP.

Further comment on Martin Luther King, Jr.’s speech, “A Proper Sense of Priorities”

By Don McCanne, MD

The speech of Martin Luther King, Jr., “A Proper Sense of Priorities,” was, as the title states, a speech on the proper sense of priorities. As a central theme he expressed his opposition to the war in Vietnam.

For those who believe that it was a stretch to use a quote from an anti-war speech of Martin Luther King, Jr. to advance the cause of health care justice, the following excerpt from the same speech should clarify the intent of my message:

“I’m still convinced that the struggle for peace and the struggle for justice or the struggle for civil rights, we call it in America, can be tied together. These two issues….[Applause] They are tied together in many many ways. And I feel the people who are working for civil rights should be working for peace and I feel that those who are working for peace should be working for civil rights and justice.”

Justice in health care is what Physicians for a National Health Program is all about (and many of us incidentally are pacifists as well).

I apologize to those who perceived my communication to be deficient, though the stand-alone words of Martin Luther King, Jr. certainly require no clarification.

More (or Less) on Reform of Health Care

By Seth Sandronsky
truthout | Op-Ed
Friday, 15 January, 2010

Claudia Chaufan, MD, is an Argentine physician and assistant adjunct professor in the Institute for Health and Aging and Social and Behavioral Sciences at the University of California, San Francisco. She is also vice president of the California Chapter of Physicians for a National Health Program. According to its web site, PNHP supports “single-payer national health insurance – a system in which a single public or quasi-public agency organizes health financing, but delivery of care remains largely private.” Dr. Chaufan talks to, and writes for, lay and expert audiences on the social dimensions of the diabetes epidemic and on single-payer health care reform. This is a recent email interview with her.

Seth Sandronsky: What is at stake for minority groups in the upcoming reconciliation of the Senate and House version of health-care reform?

Claudia Chaufan: It is a bit hard to talk about what’s at stake for “minority groups” generally, but I can certainly tell you what is at stake according to people’s income and health status (whatever their ethnicity). The bill will make it a federal crime not to buy a policy – and there are no “public options” to choose among (that would not have been necessarily cheaper anyway), so for the first time in American history you have a legal obligation to buy a private product. So then the question becomes: is this good or bad for us? Will it eliminate financial barriers to medically necessary care and will it control costs so that the country can guarantee health care for all?

What’s the case against mandating Americans to buy private health-care insurance?

This private product is likely to be insufficient to eliminate financial barriers to health care, because what it counts as “acceptable” to be sold is very unclear. Policies will be allowed to have high deductibles and out-of-pocket expenses that many, including middle-income Americans, will not be able to afford. This is likely to affect minorities more, because the rates of disease are generally higher among them (again, one needs to discriminate within these groups, because the very rich will always be better off, whatever their ethnicity).

What about President Obama’s case for people being able to keep their health-insurance policies with his approach to health-care reform?

The reason offered by President Obama that this approach is good is because “it will allow you to keep your plan if you like it.” This is a very poor reason. The fact of the matter is you are very likely to lose your plan as soon as you lose your job, and the price of your plan is very likely to increase, so even if it is there you won’t be able to pay for it. And what is worse, even if you don’t like your plan, if it is offered by an employer you will have to keep it because it will be illegal for you not to do so, and you won’t have other alternatives.

How will the president’s reform affect the affordability of health-care insurance?

The presumed lifetime maximum in health care expenses is unclear as well, and at any rate will only be operative for whatever counts as “covered services.” Put another way, if your policy does not cover services x, y or z, and you happen to need them because they are otherwise medically necessary, paying for them is likely to bankrupt you, as it has up to now.

There will be a huge increase in public expenditures in health care (i.e., your taxes) going into financing the sale of a very bad product, i.e., private health care policies. This is because in both bills there is almost half a trillion dollars of public money going into subsidizing your buying these policies. This huge transfer of money from our pockets into the for-profit corporate sector is likely to increase the power – economic and political – of private health care interests for years to come, and get in the way of the only approach that can both control costs and guarantee real (not near) universal coverage of medically necessary services, i.e., improved and expanded Medicare for All (Senate Bill 810 in California).

The so-called “improvements” to control costs (e.g., electronic medical records, comparative effectiveness research, menu labels, wellness, etc) are worthless to that effect. They are absolutely unrelated to the policy principle of pooling risk in a single financing pool, which allows systems elsewhere (Canada, UK, etc.) to cut costs through reducing paper-pushing (administrative overhead), bulk purchases and cross-subsidizing.

The good things (e.g., Medicaid expansions) could have been implemented anyway without the grandiose title of “reform” and without implementing the individual mandate. Of course, the mandate was what industry has wanted all along, because it gives them, by law, millions of new customers (they still complain because they want to get rid of the very minor constraints they might be subject to).

What percent of people’s income will health care insurance cost under the current multiple-payer system after its House-Senate reform versus a single-payer system?

With a single-payer system, anywhere from four to eight percent of your paycheck in the form of a health tax (at any rate no more than 10 percent, depending on calculations) total, whether or not you are sick, old or young, etc. What matters is that this amount would be predictable.

With the House and Senate bills, God only knows…. Your taxes will go up to pay for subsidies, public program expansions, and new regulations of industry (we’re already paying around 10 percent of our income in public health care, covering the bad customers that industry does not want – very old, very poor or disabled).

To this, you will have to add an unspecified amount for private policies and out-of-pocket costs. To the ordinary American, it does not (or should not) matter what you call the money you spend in health care, whether taxes or out-of-pocket – money is money.

In sum, the current bills will make health care far more expensive that the reasonable alternative (a social insurance system, with no profit allowed for medically necessary services) would.

To make matters worse, they will also constrain your choices. The bills will force you to “choose” from within constrained lists of “preferred providers,” euphemisms for constrained choices. What social insurance, including single-payer systems allow for is the sort of choices that really matter: of doctors and medical establishments (like Canada, France, Switzerland, and even Taiwan, have).

http://www.truthout.org/article/more-or-less-reform-health-care

California's lesson on promptness of corrective legislation

California limits HMO wait times

By Duke Helfand
Los Angeles Times
January 19, 2010
Seeking to reduce the long waits many people endure to see a doctor, California regulators are implementing new rules that specify how quickly patients in health maintenance organizations must be seen.
The regulations by the California Department of Managed Health Care, in the works for much of the last decade, will require that patients be treated by HMO doctors within 10 business days of requesting an appointment, and by specialists within 15.
The managed healthcare department acted in response to a 2002 law that mandated more timely access to medical care. The law left it to state officials to work out the details, which became subject to protracted negotiations with HMOs, doctors, hospitals, consumer groups and other healthcare activists.
In all, it took seven years to finally reach agreement amid intensive talks, bureaucratic hurdles and a lengthy rule-writing process, participants said.
HMOs will be given until January 2011 to comply.
http://www.latimes.com/news/la-fi-health-access19-2010jan19,0,3456276,full.story

Remember the managed care revolution in the latter part of the last century? Remember how angry everyone became over the interventions designed to control spending by preventing patents from having timely access to care?
As a leader in managed care, California, very early on, began the process to enact corrective legislation to reduce some of the abuses. However it took them until 2002 to pass a law as simple as limiting the delays for appointments for medical care, and the law won’t even apply until 2011.
What have they done to correct other abuses such as the refusal to pay after bungled prior authorization requests, or the refusal to even authorize recommended care, or gouging made possible by tiering of benefits, or exposing patients to high out-of-pocket expenses through innovations in insurance product design, especially high deductibles, or, one of the worst, taking away patents’ choice of physicians and hospitals by limiting care within contracted networks of providers?
Our legislators initially jumped on the managed care bandwagon by enacting laws establishing the enabling regulatory framework that the managed care entities required. Those of us who raised alarms about the flawed policies were told that any problems could be fixed later. They never were fixed, and we’re still living with that mess.
And now we’re shouting as loud as we can that the policies contained the current legislation will leave too many uninsured, many more underinsured, and health care costs will keep increasing at intolerable rates. And what are we told now? Let’s pass this and we can fix the problems later.
We already know what the problems are, but they will not be officially acknowledged until many years after the program formally begins a few years from now. Then we will see many more years of fighting over tweaks to the system, but with no substantial reform.
Everyone understands the problems of managed care, and this reform theoretically should be replacing that flawed system with substantial reform. But what is this reform proposal? More managed care! And now with a mandate to purchase these plans or be assessed penalties.
Really. Think of what they would be doing many years from now to fix this system. Pass a federal law to specify the maximum number of days that can elapse before your provider must grant you an appointment? Come on!
This system can’t be fixed. It will have to be replaced with an improved Medicare for everyone. Why delay for maybe decades, prolonging the physical and financial suffering of those who need care now? We need to replace the system now – in 2010!

California’s lesson on promptness of corrective legislation

California limits HMO wait times

By Duke Helfand
Los Angeles Times
January 19, 2010

Seeking to reduce the long waits many people endure to see a doctor, California regulators are implementing new rules that specify how quickly patients in health maintenance organizations must be seen.

The regulations by the California Department of Managed Health Care, in the works for much of the last decade, will require that patients be treated by HMO doctors within 10 business days of requesting an appointment, and by specialists within 15.

The managed healthcare department acted in response to a 2002 law that mandated more timely access to medical care. The law left it to state officials to work out the details, which became subject to protracted negotiations with HMOs, doctors, hospitals, consumer groups and other healthcare activists.

In all, it took seven years to finally reach agreement amid intensive talks, bureaucratic hurdles and a lengthy rule-writing process, participants said.

HMOs will be given until January 2011 to comply.

http://www.latimes.com/news/la-fi-health-access19-2010jan19,0,3456276,full.story

Remember the managed care revolution in the latter part of the last century? Remember how angry everyone became over the interventions designed to control spending by preventing patents from having timely access to care?

As a leader in managed care, California, very early on, began the process to enact corrective legislation to reduce some of the abuses. However it took them until 2002 to pass a law as simple as limiting the delays for appointments for medical care, and the law won’t even apply until 2011.

What have they done to correct other abuses such as the refusal to pay after bungled prior authorization requests, or the refusal to even authorize recommended care, or gouging made possible by tiering of benefits, or exposing patients to high out-of-pocket expenses through innovations in insurance product design, especially high deductibles, or, one of the worst, taking away patents’ choice of physicians and hospitals by limiting care within contracted networks of providers?

Our legislators initially jumped on the managed care bandwagon by enacting laws establishing the enabling regulatory framework that the managed care entities required. Those of us who raised alarms about the flawed policies were told that any problems could be fixed later. They never were fixed, and we’re still living with that mess.

And now we’re shouting as loud as we can that the policies contained the current legislation will leave too many uninsured, many more underinsured, and health care costs will keep increasing at intolerable rates. And what are we told now? Let’s pass this and we can fix the problems later.

We already know what the problems are, but they will not be officially acknowledged until many years after the program formally begins a few years from now. Then we will see many more years of fighting over tweaks to the system, but with no substantial reform.

Everyone understands the problems of managed care, and this reform theoretically should be replacing that flawed system with substantial reform. But what is this reform proposal? More managed care! And now with a mandate to purchase these plans or be assessed penalties.

Really. Think of what they would be doing many years from now to fix this system. Pass a federal law to specify the maximum number of days that can elapse before your provider must grant you an appointment? Come on!

This system can’t be fixed. It will have to be replaced with an improved Medicare for everyone. Why delay for maybe decades, prolonging the physical and financial suffering of those who need care now? We need to replace the system now – in 2010!

Martin Luther King, Jr. – A Proper Sense of Priorities

A Proper Sense of Priorities

A speech by Martin Luther King, Jr.
Washington, D.C.
February 6, 1968
Closing remarks:
As we were marching today, some 5,000 strong, I thought about Selma because I could look around and see so many who have marched with us in Selma, and from Selma to Montgomery. And we are still marching and we are still moving. And I give you my commitment today that I plan to continue.
Someone said to me not long ago, it was a member of the press, “Dr. King, since you face so many criticisms and since you are going to hurt the budget of your organization, don’t you feel that you should kind of change and fall in line with the Administration’s policy. Aren’t you hurting the civil rights movement and people who once respected you may lose respect for you because you’re involved in this controversial issue in taking the stand against the war.”
And I had to look with a deep understanding of why he raised the question and with no bitterness in my heart and say to that man, “I’m sorry sir, but you don’t know me. I’m not a consensus leader. [Laughter – Applause] I don’t determine what is right and wrong by looking at the budget of the Southern Christian Leadership Conference or by taking….[Applause] Nor do I determine what is right and wrong by taking a Gallup poll of the majority opinion.” [Applause] Ultimately a genuine leader is not a searcher of consensus but a molder of consensus. [Applause]
On some positions cowardice asks the question, is it safe? Expediency asks the question, is it politic? Vanity asks the question, is it popular? But conscience asks the question, is it right? And there comes a time when one must take a position that is neither safe, nor politic, nor popular but he must take it because conscience tells him it is right. [Applause]
http://www.aavw.org/special_features/speeches_speech_king04.html

Yes… truly a proper sense of priorities… and especially apropos now for us and our friends and colleagues at PNHP.
The speech of Martin Luther King, Jr., “A Proper Sense of Priorities,” was, as the title states, a speech on the proper sense of priorities. As a central theme he expressed his opposition to the war in Vietnam.
For those who believe that it was a stretch to use a quote from an anti-war speech of Martin Luther King, Jr. to advance the cause of health care justice, the following excerpt from the same speech should clarify the intent of my message:
“I’m still convinced that the struggle for peace and the struggle for justice or the struggle for civil rights, we call it in America, can be tied together. These two issues….[Applause] They are tied together in many many ways. And I feel the people who are working for civil rights should be working for peace and I feel that those who are working for peace should be working for civil rights and justice.”
Justice in health care is what Physicians for a National Health Program is all about (and many of us incidentally are pacifists as well).
I apologize to those who perceived my communication to be deficient, though the stand-alone words of Martin Luther King, Jr. certainly require no clarification.

Upcoming events with Dr. Oliver Fein, PNHP president

We invite you to join us at the at following events with Dr. Oliver Fein, president of PNHP, during his visit to Portland, Oregon.

Single-Payer Soiree
Fundraiser for Portland PNHP
The McMenamins Kennedy School
Sunday, January 31, 7-10 p.m.
5736 Northeast 33rd Ave, Portland

Keynote speaker: Oliver Fein, M.D., PNHP president

Entertainment provided by the Mad As Hell Doctors Tour in Review, OHSU medical student Project on the Uninsured, Bob Wickline, Al Bradbury, The Nurses Band and the Post Riders

Health Reform 2010:
Where do we go from here?
Providence Cancer Center, 4805 Northeast Glisan Street
Monday, February 1, 7-9 p.m.
A special event co-sponsored by Providence Portland Internal Medicine Residency Population Based Health Elective and City Club of Portland

Panelists include:
Robert Dannenhoffer, M.D., immediate past president of the Oregon Medical Association
Oliver Fein, M.D., president of Physicians for a National Health Program
Eric Fruits, Ph.D., Cascade Policy Institute
Rajiv Sharma, Ph.D., associate professor of economics, Portland State University

Moderated by Paul Gorman, M.D.

If you have any questions about either event, contact Dr. Peter Mahr at peter.n.mahr@gmail.com.

 Washington Politics and Single-Payer Health Care
Monday, Feb. 1, 12-1 p.m.
Doernbecher Children’s Hospital, Vey Auditorium (11th floor), 3181 Southwest Sam Jackson Park Road

Sponsored by OSHU PNHP

Click here for the flier

National Health Insurance in the U.S.: Real Health Care Reform
Monday, Feb. 1, 2:30-3:30 p.m.
Smith Memorial Student Union, Room 327 at Portland State University

Sponsored by Portland Pre-Health Society


 

Health professional students restore hope

(Note: This event occurred earlier this week, before the tragic earthquake in Haiti.)

The future of healthcare reform came to Sacramento yesterday

by Shockwave
Daily Kos
January 12, 2010

I joined the California Health Professionals Students Alliance at the Embassy Suites about a mile from the Capitol building.

Students from every medical school in California came in buses the night before.  I was impressed by their enthusiastic support of SB 810 and their ability to explain the advantages of Single Payer and this pivotal legislation which will be re-introduced at the Senate floor next month.

We then marched about a mile toward the Capitol building.

Shockwave’s diary and a 3 minute video of the event:
http://www.dailykos.com/storyonly/2010/1/12/824274/-The-future-of-healthcare-reform-came-to-Sacramento-yesterday

California Health Professional Student Alliance
http://www.calauhc.org/

Comment: 

By Don McCanne, MD

This week medical students and other health professional students and colleagues marched on Sacramento in support of Sen. Mark Leno’s SB 810, a reintroduction of Sen. Sheila Kuehl’s single payer bill that was passed and vetoed twice in prior legislative sessions.

Reading Shockwave’s diary and watching the brief video can give you renewal. California’s health professional students understand that Congress abandoned so many important policies that they are ending up with legislation that ostensibly achieves a political victory, but one that is reform in name only, while leaving most of our dysfunctional system in place.

These students know what real reform is. They hold our future in their hands. Thanks to them and to all of the rest of the single payer activists, the process will continue until every single one of us can have the health care that we need.

Federal unions release two reports on the detrimental impact of the Senate Excise tax on FEHBP health plans

Reports find that excise tax will have reduce benefits and raise costs for employees

The American Federation of Government Employees (AFGE)
Press Release, December 8, 2009
Contact: Christina Erling, (202) 639-6419

WASHINGTON – Two reports released today by federal unions found that the so-called “Cadillac” tax on higher-cost health plans contained in the U.S. Senate health care bill would actually affect average plans like those under the Federal Employees Health Benefits Program (FEHBP). The reports suggest that the excise tax would result in significant health benefit cuts and shifting of costs to employees, as plans try to avoid the tax.

The reports were released by the American Federation of Government Employees (AFGE), American Postal Workers Union (APWU), National Association of Letter Carriers (NALC) and the Communications Workers of America (CWA). They were joined by Rep. Chris Van Hollen (D-Md.) and Rep. Gerry Connolly (D-Va.). 

“These studies show us that the excise tax will further drive up the skyrocketing health care costs and will make it impossible for federal workers to achieve the health security they need.  If FEHBP premiums continue to increase at the rate they have, we are on course for insurance premiums to grow at almost triple the rate that the excise tax threshold is set to grow,” said AFGE President, John Gage. “The excise tax is a direct tax on our members’ benefits and will result in a huge benefit cut and increased co-pays and deductibles. We have a no-win scenario here; it’s the wrong direction for health care. Other alternatives must be put on the table to remedy it.”

One report released by the unions found that Blue Cross/Blue Shield Standard plans, which nearly half of all federal employees belong to, will face an excise tax in the first year if it serves individuals and in the third year if it serves families. Over the first 10 years, the family plan will face an excise tax of more than $20,000 per worker, or about $2,000 a year. The individual plan will face an excise tax of more than $16,000 per worker, or about $1,600 a year. By 2022, the report projects that the family plan could face an excise tax of $5,500 per worker that year alone; the tax on an individual plan could be $3,500 per worker.

A second report is a White Paper prepared for the Office of Personnel Management by the Association of Federal Health Organizations, which is a trade association of FEHBP plans sponsored by unions and employee associations. It examined 11 FEHBP plans covering 75 percent of all federal employees and found that for individual coverage, 5 of the 11 FEHBP plans would face the Senate excise tax within the first three years and that for those with family coverage, 4 of the 11 plans would face the tax in the first six years.

“The Senate Excise tax was intended to target luxurious Cadillac plans, but it will inevitably hit the Chevy plans that make up the Federal Employee’s Health Benefit Program, including the federal Blue Cross plan and the NALC plan, my unions Health Benefit Plan,” Fred Rolando, President of NALC said. “Worse, as currently drafted, the tax will turn our Chevy plans into Yugo plans over time.”

William Burrus, President of APWU noted, “These studies offer further proof that the excise tax will in fact raise costs and reduce coverage. We need health care reform now more than ever, but federal and postal employees and middle class Americans across the country should not be asked to shoulder the burden of paying for it. The Senate should find other solutions – such as those offered in the House version of the health reform bill – to pay for the reform that Americans deserve.”

“I’ve said it before, and I’ll say it again: I oppose a tax on so-called ‘Cadillac plans,’ said U.S. Senator Barbara A. Mikulski (D-Md.) “I think it’s a clunker of an idea. America’s union workers and federal employees are on the front lines every day, working hard for America. That’s why I’ll fight to slam the door on a back-door tax on Middle America.”

“We can no longer delay action to address America’s health care crisis – middle class families, small businesses, and our entire nation cannot afford to wait.  The Senate has made significant progress in passing health care reform, but I remain steadfast in my commitment to the House’s mechanism for paying for this critical reform.  I am dedicated to ensuring that American workers, including federal employees, retain access to quality health care that they can afford,” said Rep. Chris Van Hollen (D-Md.).

“Throughout this year, we and Members of the Administration, have assured the public, including more than two million federal employees, that if individuals or families like their current coverage, they will not have to change it.  The current excise tax proposal in the Senate could undermine that tenet of health insurance reform,” said Rep. Gerry Connolly, (D-Va.).

The unions all oppose the Senate excise tax, which would raise $150 billion over 10 years, much of it by taxing the middle class. Instead, they support health reform legislation approved by the House of Representatives (H.R. 3962) that raises revenue by requiring all employers to provide coverage, which would raise $135 billion, and by assessing a surtax on the richest 0.3 percent of Americans, which would raise $460 billion.

“This tax is the opposite of health care reform – it represents a benefits cut and a middle class tax increase,” said Larry Cohen, president of CWA. “The Senate should look to the House version of the bill for alternative ways to fund health care reform.”

Both studies are available at www.healthcarevoices.org/fehbp.

###

The American Federation of Government Employees (AFGE) is the largest federal employee union, representing 600,000 workers in the federal government and the government of the District of Columbia.

Health professional students restore hope

(Note: This event occurred earlier this week, before the tragic earthquake in Haiti.)

The future of healthcare reform came to Sacramento yesterday

by Shockwave
Daily Kos
January 12, 2010
I joined the California Health Professionals Students Alliance at the Embassy Suites about a mile from the Capitol building.
Students from every medical school in California came in buses the night before.  I was impressed by their enthusiastic support of SB 810 and their ability to explain the advantages of Single Payer and this pivotal legislation which will be re-introduced at the Senate floor next month.
We then marched about a mile toward the Capitol building.
Shockwave’s diary and a 3 minute video of the event:
http://www.dailykos.com/storyonly/2010/1/12/824274/-The-future-of-healthcare-reform-came-to-Sacramento-yesterday
California Health Professional Student Alliance
http://www.calauhc.org/

This week medical students and other health professional students and colleagues marched on Sacramento in support of Sen. Mark Leno’s SB 810, a reintroduction of Sen. Sheila Kuehl’s single payer bill that was passed and vetoed twice in prior legislative sessions.
Reading Shockwave’s diary and watching the brief video can give you renewal. California’s health professional students understand that Congress abandoned so many important policies that they are ending up with legislation that ostensibly achieves a political victory, but one that is reform in name only, while leaving most of our dysfunctional system in place.
These students know what real reform is. They hold our future in their hands. Thanks to them and to all of the rest of the single payer activists, the process will continue until every single one of us can have the health care that we need.

Cato on implicit taxes of the individual mandate

Obama's Prescription for Low-Wage Workers: High Implicit Taxes, Higher Premiums

by Michael F. Cannon
Cato Institute
January 13, 2010

Executive Summary

House and Senate Democrats have produced health care legislation whose mandates, subsidies, tax penalties, and health insurance regulations would penalize work and reward Americans who refuse to purchase health insurance. As a result, the legislation could trap many Americans in low-wage jobs and cause even higher health-insurance premiums, government spending, and taxes than are envisioned in the legislation.

Those mandates and subsidies would impose effective marginal tax rates on low-wage workers that would average between 53 and 74 percent — and even reach as high as 82 percent — over broad ranges of earned income. By comparison, the wealthiest Americans would face tax rates no higher than 47.9 percent.

Over smaller ranges of earned income, the legislation would impose effective marginal tax rates that exceed 100 percent. Families of four would see effective marginal tax rates as high as 174 percent under the Senate bill and 159 percent under the House bill. Under the Senate bill, adults starting at $14,560 who earn an additional $560 would see their total income fall by $200 due to higher taxes and reduced subsidies. Under the House bill, families of four starting at $43,670 who earn an additional $1,100 would see their total income fall by $870.

In addition, middle-income workers could save as much as $8,000 per year by dropping coverage and purchasing health insurance only when sick. Indeed, the legislation effectively removes any penalty on such behavior by forcing insurers to sell health insurance to the uninsured at standard premiums when they fall ill. The legislation would thus encourage “adverse selection” — an unstable situation that would drive insurance premiums, government spending, and taxes even higher.

http://www.cato.org/pubs/pas/pa656.pdf

Comment: 

By Don McCanne, MD

Since the numbers and policy details in the final reform legislation have not yet been released, the results presented here by Michael Cannon of the Cato Institute may be modified, but unchanged will be the conclusion that the complex, jerry-rigged method of paying for health care premiums will not eliminate inequities.

It is almost impossible to get right the amount that each person or family should pay with so many variables moving in different directions: insurance premiums, actuarial values, premium subsidies, cost-sharing subsidies, income levels, family sizes, age rating, bracketed income cliffs of eligibility, and other factors. Financing health care by using a fixed premium for a given private insurance plan no longer works because premiums for adequate plans are no longer affordable for the majority. Trying to make health care affordable by applying corrections for the many variables increases the administrative complexity while falling short on equity.

Financing would be greatly simplified and much more equitable if we established a single risk pool that covered everyone and funded it through progressive taxes. (That likely would not be the conclusion of the libertarians at Cato, but they offered no alternative suggestions in this report, and we wouldn’t agree with them anyway.)

You say you want a revolution?

Letter to the editor, Pacific Sun (San Rafael, Calif.)
Jan. 8, 2010

I couldn’t agree more with the sentiment expressed in the letter-to-the-editor by Geraldine Caldarola [“What’s It All About?” Jan. 1] as she lamented the blockage of real healthcare reform by “moneyed interests” and asked, “Do we need another revolution?” The answer is a resounding, “Yes!”

If we had real healthcare reform, a single-payer system such as Medicare for all, all Americans would have access to healthcare, we would be able to choose our own doctors, doctors would be able to practice the way they want and would be paid fairly on a fee-for-service basis.

We would save money. The insurance industry admits that they spend about 30 percent of premiums on something other than healthcare. It would also be good for the economy. American companies, no longer burdened with the high cost of providing healthcare for their employees, would be more competitive with those of other developed nations, and smaller businesses would be able to hire more workers, creating more jobs and generating more tax revenue. So, how do we make this happen?

First, consciousness raising. Every other developed nation provides healthcare for all its citizens for less than half per capita what we spend. We are the only country that allows its insurance industry to rule healthcare and rule its legislators—to the detriment of us all. Second, we need to elect legislators who are more interested in our well-being than in catering to lobbyists. Third, we need campaign finance reform to make this feasible.

If every other developed nation can do it, so can we.

Ann Troy, M.D.
San Anselmo

http://www.pacificsun.com/story.php?story_id=3658

Keep your doc, ditch Wall Street

Letter to the editor, Concord (N.H.) Monitor   
January 11, 2010

Republican strategist Bob Luntz wrote it’s not what you say but what people hear. He was correct. I keep hearing the phrase, “government-run health care,” which is purposely vague and undefined. However, it frightens people who think that they will be forced to leave their current doctor and report to a dull gray building where they will receive poor treatment from a government doctor who graduated at the bottom of the class.

There is no bill proposing this. There is, however, a bill that addresses America’s health care issues at a price we can afford, individually and as a nation. It provides universal full health care coverage for all medically necessary treatment, mental health, vision, prescription drugs, long-term care, dental, substance abuse and other services, and it pays your doctor fairly. A poll by the New Hampshire Medical Society found that over 80 percent of primary care physicians favor such a bill. However, Congress is not even actively considering the bill, the United States National Health Care Act, H.R. 676, although it is significantly cheaper and provides far greater benefits than what is being proposed. Proposed instead is a bill favorable not to you but to the Wall Street-owned corporations who pay our legislators to continue using these corporations to process the payments for health care.

Contact your legislators, have them fairly evaluate H.R. 676, which covers everyone, is affordable, comprehensive and sustainable. Keep your doctor, ditch Wall Street. Speak up or suffer for generations to come.

JOHN R. SWARTZ
Wilmot

http://www.concordmonitor.com/article/20100111/OPINION/1110334