PNHP

What does a $13,375 premium mean for reform?

What does a $13,375 premium mean for reform?

Employer Health Benefits

2009 Annual Survey
Kaiser Family Foundation
September 15, 2009
Premiums for employer-sponsored health insurance rose to $13,375 annually for family coverage this year.
http://www.kff.org/insurance/ehbs091509nr.cfm
Report (238 pages):
http://ehbs.kff.org/pdf/2009/7936.pdf

Employer-sponsored health plans insure not only the largest sector of our society, but also the healthiest: the healthy workforce and their young healthy families. Because of the greater purchasing leverage of employers, economies of group plans, better regulatory oversight, and the lower average health care needs of the beneficiaries, premiums being paid for employer-sponsored plans represent the greatest value that we can expect in health care financing. Today a working family pays $13,375 for its coverage (which includes the employer contribution paid indirectly by the employee in forgone wage or salary increases).
Keep in mind that, in addition to the $13,375 premium, the family also pays the deductible, co-payments, coinsurance, costs of out-of-network care, and costs of products and services that are not benefits of the plan.
Many perceptive observers of the reform process are beginning to realize that the proposals may have a significant negative impact on the finances of middle-income Americans. What would a $13,375 premium mean to a middle-income family?
The House bill, HR 3200, cuts off premium subsidies at 400% of the federal poverty level, which is $88,200 for a family of four. That family, under the House bill, would have to pay over 15% of its income just for a $13,375 premium. Under the Senate Finance proposal released by Sen. Baucus today, the cutoff is at 300% ($66,150), so that family would pay over 20% of income just for the premium.
But wait, there’s more. The legislative proposals also provide for an annual maximum for out-of-pocket expenses, and they remove the life-time maximum on health care coverage. Since some of the care over those limits represents the 80% of health care that is used by the sickest 20% of the population, those costs can be very significant. The insurers will have no choice but to add those costs to the premiums. But the family also will have to add to its health care bill the costs below the out-of-pocket maximum, plus the costs that are not covered by the plan, even though they exceed the maximum.
One method of controlling premium prices is to strip benefits out of the plans. As an example, the Senate Finance proposal released today would make available a “young invincible” catastrophic plan for young adults. Measures that reduce benefits might make premiums more affordable, but they do so by shifting more costs as out-of-pocket expenses to those who need care, costs which would be unaffordable for many middle-income Americans. For those who say that the out-of-pocket maximums would take care of that problem, keep in mind that the balance would have to be collected in higher premiums.
Anyway you slice or dice it, a $13,375 health care benefit package plus out-of-pocket expenses are no longer affordable for tens of millions of middle-income Americans, even with subsidies. Depending on the final details, that could be over half of our population!
Congress must quit low-balling us. Let’s demand a legitimate analysis using the most credible numbers available and then see what this program will cost each of us.
Once we have those numbers and compare them with what a single payer system would cost each of us, there would be no contest. Of course, similar studies have already been done, and everyone except the wealthiest would pay less. And the wealthy would never know the difference unless their accountants singled out those numbers for their perusal.

Postcard From Canada: Why I Missed Obama's Speech

by Sara Marshall
Orcinius.com
Sunday, September 13, 2009

True confessions: I missed the health care speech. While the whole lefty blogosphere was watching and blogging and tweeting, I was sacked out in my attic bedroom high on a mountainside in Vancouver, sleeping off a narcotic haze and the exhausting aftermath of a long night spent in the emergency room at Lions Gate Hospital.

President Obama tried to remind Americans all over again why health care reform matters. I didn’t need a speech: I’d just had an up-close-and-personal encounter with a rational, not-for-profit, single-payer health care system. And it reminded me all over again (as it does every time we see a doctor here) why health care reform is the most crucial battle of our generation.

The health event was new to me, but pretty garden-variety as ER visits go. I had my first gallbladder attack. Not life-threatening, just the worst pain I can remember being in since the last time I was in labor. It started up just before dinner Tuesday night. At 2 am Wednesday, still awake and in worsening pain, I found my keys and shoes, stumbled down to the car (leaving the rest of the family sleeping), and drove the 25 blocks down to the hospital.

Four things in particular stood out about the hours that followed — things that show just how different medicine is when the patients trump profit as the main priority, things that Americans need to understand if they’re going to see through the chaos of this moment to the kind of future that’s possible.

First, the waiting time between walking in the door and being admitted was literally about 45 seconds. American conservatives have filled people’s heads with images of Canadians packed into old, worn-out, badly-lit, overcrowded emergency rooms bustling and echoing with writhing, moaning souls enduring waits that can stretch to days. Sorry to blow the fantasy, but last night, I walked into a newly-remodeled, gently-lit, serenely quiet lobby that I had completely to myself. There wasn’t another human being in sight. Even the receptionist had apparently taken a break.

I doubled over on the counter, breathing through the pain (those long-ago Bradley childbirth classes are still paying off). Moments later, a nurse appeared to check me in. With a quick swipe of my BC provincial care card, my complete medical files glimmered onto his computer screen. He put a thermometer in my mouth, then confirmed the basic data while a printer spit out my wristband. The whole check-in process took under three minutes.

“It’s really quiet tonight,” I noticed, trying to look nonchalant while clutching my stomach.

“Actually, we’re pretty full.” This was my first visit since a recent remodel created a huge new ER ward. (They’re expecting the world here: this particular hospital is the closest one to the skiing venues for next February’s Winter Olympics, and also one of the province’s major orthopedic centers. It’s where Canada’s athletes come to get put back together.) There were lots of people here — but they were all already comfortably checked in and settled away in beds, rather than milling around the lobby waiting to be tended. In another three minutes, I was settled in, too.

Second: You don’t realize how much politics — in this case, the war on drugs — has warped medical care until you see how differently non-American doctors and nurses deal with pain management. Since Canada sees drug abuse as a social problem, not a law enforcement one, it’s stubbornly resisted several ham-handed attempts by the American government to get it to crack down on doctors who persist in seeing codeine and morphine as useful medications. While Health Canada does keeps tabs on individual doctors’ prescribing habits, docs are given vastly more discretion in managing their patients’ pain than their US counterparts are. If you’re hurting, the docs here will calmly and generously prescribe painkillers — good ones, serious ones, the yummy kind that really do the job. (And yeah, I guess that would explain why the whole ER ward was so eerily quiet, too.)

So it was that, minutes after my arrival, the ward nurse tucked me in and hooked me up to an IV drip with saline and anti-nausea medications. “Would you like some morphine with that?” she asked, in the same casual and pleasant voice with which a waiter might offer you cream for your coffee. My inside voice, battered after a long evening of agony, jumped up and hollered: “YESSS! Oh, HELL yes!” My outside voice sweetly smiled back: “That would be lovely.” In moments, eight hours long hours of accelerating pain finally subsided — and I went to sleep, waking only occasionally from my opiate bliss to find myself being wheeled out for this test or that as night turned to morning.

Third: About those electronic medical records. I am a fan. A big one. Everybody in the BC health care system has their records in one big database, accessible within seconds in every doctor’s office and hospital in the province. The doctors and nurses never have to waste a lot of time taking history, or guessing at the doses of the meds I’m taking (it turns out that dutifully reporting that “I think I’m taking half of that round green pill now” is surprisingly unhelpful) or wondering where those X-rays disappeared to, or cross-testing my blood type. It’s all there — including digital copies of all the X-rays, ultrasounds, mammograms, and EKGs I’ve ever had here. Every doctor that writes a prescription knows exactly what else I’ve been prescribed. It’s hard to overstate how much this improves the level of care, even as it cuts costs.

(It’s also another reason doctors can be so generous with painkillers. Since all the information from everywhere ends up in the same file, the e-records system automatically notices and flags doctor-shoppers and drug-seekers — which, in turn, allows doctors to be much more confident about giving non-addicts what they need without being worried that they’re enabling somebody they shouldn’t be.)

Beyond the vast improvements in individual care, though, there are also huge public health benefits. Qualified public health researchers can get access to the population-level data in the files — though they need special authorization (and a damned good reason) to access individual patients’ names. They use this data to compare the pool of patients who’ve had treatment A against those who got treatment B; and issue impartial advisories as to which is better. They can instantly track emergent epidemics like SARS, or notice geographic anomalies affecting one area or another, or figure out who got a batch of bad vaccine. As genetics-based medicine emerges (and BC is one of the world centers for this), the growing pile of data in this system will eventually become a global asset in the effort to correlate the various genetic and environmental interactions that contribute to illness or health.

Do I worry about privacy? Not in Canada, much. This is a country that has a national Office of Privacy. The privacy laws are strict enough that the prairie provinces are doing a booming business in storing records for assorted American enterprises, where they’re beyond the long snooping noses of Homeland Security and other public and private buttinskis. In theory, only authorized medical personnel get access to my records. Both provincial and national laws (and the general mood of the country) support the idea that we’ve got privacy rights that deserve careful respect.

At the same time, I’m not at all sure Americans are ready for this. Canada’s system works because the country has a strong culture of privacy, and an even stronger bulwark of laws that back that up. Americans have almost no data privacy to speak of compared to most of the rest of the industrialized world, and no real expectation of having any. Frankly, I wouldn’t trust any American e-records system until our whole cultural and legal framework around data privacy is overhauled. I trust the Canadian government to get it mostly right. I don’t trust any American government not to sell my data to ChoicePoint or hand it over to the NSA. Until that changes, y’all be careful.

Finally, the last thing I noticed about last night was something that wasn’t there. I’m talking about that little meter in the back of my head, the one that whirred and spun and ticked off every charge from the minute I walked into an American ER until the minute I walked out again. The IV. The X-rays. The box of Kleenex, the Tylenol, and the barf pan. The crappy food (if you’re lucky enough to get any). Even with good insurance, the co-pays alone on eight hours in the ER could bust the family grocery budget for the next three months. That big number hanging over my head was always a real distraction from dealing with whatever crisis actually put one of us there. No matter what the presenting condition was when we arrived, I always seemed to have a bad case of heartburn when we left.

Contrast that with last night, when my glorious morphine dreams were completely untroubled by the sound of that mental meter. By the time they checked me out at 10:30 am, I’d had a whole bank of diagnostic tests, including a long and detailed ultrasound exam that found twin bouncing baby gallstones. The ER then handed me off to an internist for further exploration of the issue. (I see her next week — it’s already set up.)

No bills. No worrying about how to pay for the surgery, either — that will be covered, too. The morning nurse (the fabulous and charming Trish) pulled the IV. I got dressed, picked up my purse, and left. And that was it. No pain. No worries. No heartburn.

And that’s all it should ever be. And could be. And will be, if we keep leaning on Congress to get this thing done right.

AFL-CIO endorses single payer healthcare

by National Nurses Movement
DailyKos
Wed Sep 16, 2009

The campaign for the most comprehensive healthcare reform of all, single payer, won a huge boost Tuesday as the AFL-CIO voted unanimously at its national convention in Pittsburgh to endorse the enactment of single-payer, universal healthcare.

The vote came shortly after the convention was addressed by President Obama who repeated his call for comprehensive healthcare reform, and will accompany another AFL-CIO resolution supporting other Congressional efforts to pass comprehensive reform.

It marked the first time in some two decades that the AFL-CIO, the leading voice of the American labor movement, which includes 56 unions and more than 10 million members, has been formally on record in support of single-payer, which would essentially expand and improve Medicare to cover all Americans.

National Nurses Movement’s diary :: ::

Statements by a host of delegates on the resolution, which was sponsored by the California Nurses Association/National Nurses Organizing Committee, AFL-CIO, the International Longshore and Warehouse Union, and the Alameda County (California) Central Labor Council, affirmed for many that even after a bill is passed in Congress, the fight will continue.

In urging its support, CNA/NNOC Executive Director Rose Ann DeMoro, an AFL-CIO National Vice-President, noted the recent death of Crystal Lee Sutton, the real-life union organizer from the film Norma Rae who died last week after a long battle with cancer, exacerbated by her own three-year fight with her insurance company.

“No one should spend the last days of their life fighting with their insurance company,” said DeMoro. “We should not make choices of who gets healthcare based on their ethnicity, gender, or economic status. But I am addressing the labor movement, not Wall Street. And we all know what is the right thing — the moral thing — single-payer healthcare.”

The resolution notes that “the experience of Medicare (and of nearly every other industrialized country) shows the most cost-effective and equitable way to provide quality healthcare is through a single-payer system. Our nation should provide a single high standard of comprehensive care for all.” It also sites specific single-payer bills, including HR 676, which has 86 cosponsors in Congress.

It also followed a reception hosted by CNA/NNOC and other unions Monday night featuring filmmaker Michael Moore whose previous film SiCKO presaged the current national debate with its indictment of the healthcare industry, and was on hand to premiere his latest film, Capitalism: A Love Story to the AFL-CIO convention.

Moore recalled that 65 years ago President Franklin Roosevelt proposed a second bill of rights which called for a right to universal medical care, a fight that continues. He noted that every day the healthcare industry spends over $1 million to block reform while thousands of Americans continue to lose coverage, and urged labor and community activists to keep up the fight.

Regardless of the outcome of the current healthcare legislative action, said United Steel Workers President Leo Gerard, “we’re going to continue the fight for single-payer. I’m not in favor of universal insurance, I’m in favor of universal healthcare. We are going to fight to make sure every single American gets high quality healthcare.”

“We know the patient care crisis, we see it every day,” said CNA/NNOC co-president Zenei Cortez, RN at the reception. “We will not rest until we get rid of the private insurance companies that profit off of suffering.”

Greg Junemann, president of International Federation of Professional and Technical Engineers and chair of the HR 676 Labor Caucus, which has won similar endorsements from hundreds of international and local unions and state and local labor federations, noted to the convention the unity of labor in fighting for real reform. He also cited the ongoing fight of workers every day to protect the health coverage many have now.

“The labor movement needs to set our flag on the top of the mountain, and that we will not rest until we have single-payer healthcare for all,” said Junemann.

Clyde Rivers, past president of the California School Employees Association, noted the huge drain of healthcare costs on California schools and school workers. The Los Angeles school district, he noted, “could save $20 billion if we had single payer. Think of all the programs that could be put back in place” if those resources were returned.

Donna DeWitt, president of the South Carolina AFL-CIO, who noted to groans and jeers that her governor is Mark Sanford and her Congress member is Joe Wilson, added that “we understand struggle and that struggle makes us stronger.”

Labor unions around the country have been in the forefront of grassroots actions around the nation in support of single-payer and many labor bodies submitted resolutions to the national convention in support of an endorsement. It was also the culmination of a growing, national push within the labor movement. More than 566 labor organizations, including 22 international unions, 134 central labor councils, and 39 state AFL-CIO federations, have also endorsed HR 676.

Labor has been central to enactment of similar systems around the world, DeMoro noted, in her comments paying tribute as well to the many international guests at the convention.

She pointed out how most of them represent industrial nations where no one dies from lack of health coverage or goes bankrupt or loses homes due to un-payable medical bills.

“The reason? Because they have single-payer or other national healthcare systems, and because your labor movement led the fight for healthcare. Here insurance companies are at the apex of power, controlling our lives. It is not the public option we should be questioning, it is the private option and its horrendous power over our families,” DeMoro said.

“When we meet again in four years, perhaps if we adopt single-payer, we will be like all our international brothers and sisters in this room, and no longer be the richest nation in the world but just 37th in healthcare,” DeMoro said.

What does a $13,375 premium mean for reform?

Employer Health Benefits

2009 Annual Survey
Kaiser Family Foundation
September 15, 2009

Premiums for employer-sponsored health insurance rose to $13,375 annually for family coverage this year.

http://www.kff.org/insurance/ehbs091509nr.cfm

Report (238 pages):
http://ehbs.kff.org/pdf/2009/7936.pdf

Comment:

By Don McCanne, MD

Employer-sponsored health plans insure not only the largest sector of our society, but also the healthiest: the healthy workforce and their young healthy families. Because of the greater purchasing leverage of employers, economies of group plans, better regulatory oversight, and the lower average health care needs of the beneficiaries, premiums being paid for employer-sponsored plans represent the greatest value that we can expect in health care financing. Today a working family pays $13,375 for its coverage (which includes the employer contribution paid indirectly by the employee in forgone wage or salary increases).

Keep in mind that, in addition to the $13,375 premium, the family also pays the deductible, co-payments, coinsurance, costs of out-of-network care, and costs of products and services that are not benefits of the plan.

Many perceptive observers of the reform process are beginning to realize that the proposals may have a significant negative impact on the finances of middle-income Americans. What would a $13,375 premium mean to a middle-income family?

The House bill, HR 3200, cuts off premium subsidies at 400% of the federal poverty level, which is $88,200 for a family of four. That family, under the House bill, would have to pay over 15% of its income just for a $13,375 premium. Under the Senate Finance proposal released by Sen. Baucus today, the cutoff is at 300% ($66,150), so that family would pay over 20% of income just for the premium.

But wait, there’s more. The legislative proposals also provide for an annual maximum for out-of-pocket expenses, and they remove the life-time maximum on health care coverage. Since some of the care over those limits represents the 80% of health care that is used by the sickest 20% of the population, those costs can be very significant. The insurers will have no choice but to add those costs to the premiums. But the family also will have to add to its health care bill the costs below the out-of-pocket maximum, plus the costs that are not covered by the plan, even though they exceed the maximum.

One method of controlling premium prices is to strip benefits out of the plans. As an example, the Senate Finance proposal released today would make available a “young invincible” catastrophic plan for young adults. Measures that reduce benefits might make premiums more affordable, but they do so by shifting more costs as out-of-pocket expenses to those who need care, costs which would be unaffordable for many middle-income Americans. For those who say that the out-of-pocket maximums would take care of that problem, keep in mind that the balance would have to be collected in higher premiums.

Anyway you slice or dice it, a $13,375 health care benefit package plus out-of-pocket expenses are no longer affordable for tens of millions of middle-income Americans, even with subsidies. Depending on the final details, that could be over half of our population!

Congress must quit low-balling us. Let’s demand a legitimate analysis using the most credible numbers available and then see what this program will cost each of us.

Once we have those numbers and compare them with what a single payer system would cost each of us, there would be no contest. Of course, similar studies have already been done, and everyone except the wealthiest would pay less. And the wealthy would never know the difference unless their accountants singled out those numbers for their perusal.

Postcard From Canada: Why I Missed Obama’s Speech

by Sara Marshall
Orcinius.com
Sunday, September 13, 2009

True confessions: I missed the health care speech. While the whole lefty blogosphere was watching and blogging and tweeting, I was sacked out in my attic bedroom high on a mountainside in Vancouver, sleeping off a narcotic haze and the exhausting aftermath of a long night spent in the emergency room at Lions Gate Hospital.

President Obama tried to remind Americans all over again why health care reform matters. I didn’t need a speech: I’d just had an up-close-and-personal encounter with a rational, not-for-profit, single-payer health care system. And it reminded me all over again (as it does every time we see a doctor here) why health care reform is the most crucial battle of our generation.

The health event was new to me, but pretty garden-variety as ER visits go. I had my first gallbladder attack. Not life-threatening, just the worst pain I can remember being in since the last time I was in labor. It started up just before dinner Tuesday night. At 2 am Wednesday, still awake and in worsening pain, I found my keys and shoes, stumbled down to the car (leaving the rest of the family sleeping), and drove the 25 blocks down to the hospital.

Four things in particular stood out about the hours that followed — things that show just how different medicine is when the patients trump profit as the main priority, things that Americans need to understand if they’re going to see through the chaos of this moment to the kind of future that’s possible.

First, the waiting time between walking in the door and being admitted was literally about 45 seconds. American conservatives have filled people’s heads with images of Canadians packed into old, worn-out, badly-lit, overcrowded emergency rooms bustling and echoing with writhing, moaning souls enduring waits that can stretch to days. Sorry to blow the fantasy, but last night, I walked into a newly-remodeled, gently-lit, serenely quiet lobby that I had completely to myself. There wasn’t another human being in sight. Even the receptionist had apparently taken a break.

I doubled over on the counter, breathing through the pain (those long-ago Bradley childbirth classes are still paying off). Moments later, a nurse appeared to check me in. With a quick swipe of my BC provincial care card, my complete medical files glimmered onto his computer screen. He put a thermometer in my mouth, then confirmed the basic data while a printer spit out my wristband. The whole check-in process took under three minutes.

“It’s really quiet tonight,” I noticed, trying to look nonchalant while clutching my stomach.

“Actually, we’re pretty full.” This was my first visit since a recent remodel created a huge new ER ward. (They’re expecting the world here: this particular hospital is the closest one to the skiing venues for next February’s Winter Olympics, and also one of the province’s major orthopedic centers. It’s where Canada’s athletes come to get put back together.) There were lots of people here — but they were all already comfortably checked in and settled away in beds, rather than milling around the lobby waiting to be tended. In another three minutes, I was settled in, too.

Second: You don’t realize how much politics — in this case, the war on drugs — has warped medical care until you see how differently non-American doctors and nurses deal with pain management. Since Canada sees drug abuse as a social problem, not a law enforcement one, it’s stubbornly resisted several ham-handed attempts by the American government to get it to crack down on doctors who persist in seeing codeine and morphine as useful medications. While Health Canada does keeps tabs on individual doctors’ prescribing habits, docs are given vastly more discretion in managing their patients’ pain than their US counterparts are. If you’re hurting, the docs here will calmly and generously prescribe painkillers — good ones, serious ones, the yummy kind that really do the job. (And yeah, I guess that would explain why the whole ER ward was so eerily quiet, too.)

So it was that, minutes after my arrival, the ward nurse tucked me in and hooked me up to an IV drip with saline and anti-nausea medications. “Would you like some morphine with that?” she asked, in the same casual and pleasant voice with which a waiter might offer you cream for your coffee. My inside voice, battered after a long evening of agony, jumped up and hollered: “YESSS! Oh, HELL yes!” My outside voice sweetly smiled back: “That would be lovely.” In moments, eight hours long hours of accelerating pain finally subsided — and I went to sleep, waking only occasionally from my opiate bliss to find myself being wheeled out for this test or that as night turned to morning.

Third: About those electronic medical records. I am a fan. A big one. Everybody in the BC health care system has their records in one big database, accessible within seconds in every doctor’s office and hospital in the province. The doctors and nurses never have to waste a lot of time taking history, or guessing at the doses of the meds I’m taking (it turns out that dutifully reporting that “I think I’m taking half of that round green pill now” is surprisingly unhelpful) or wondering where those X-rays disappeared to, or cross-testing my blood type. It’s all there — including digital copies of all the X-rays, ultrasounds, mammograms, and EKGs I’ve ever had here. Every doctor that writes a prescription knows exactly what else I’ve been prescribed. It’s hard to overstate how much this improves the level of care, even as it cuts costs.

(It’s also another reason doctors can be so generous with painkillers. Since all the information from everywhere ends up in the same file, the e-records system automatically notices and flags doctor-shoppers and drug-seekers — which, in turn, allows doctors to be much more confident about giving non-addicts what they need without being worried that they’re enabling somebody they shouldn’t be.)

Beyond the vast improvements in individual care, though, there are also huge public health benefits. Qualified public health researchers can get access to the population-level data in the files — though they need special authorization (and a damned good reason) to access individual patients’ names. They use this data to compare the pool of patients who’ve had treatment A against those who got treatment B; and issue impartial advisories as to which is better. They can instantly track emergent epidemics like SARS, or notice geographic anomalies affecting one area or another, or figure out who got a batch of bad vaccine. As genetics-based medicine emerges (and BC is one of the world centers for this), the growing pile of data in this system will eventually become a global asset in the effort to correlate the various genetic and environmental interactions that contribute to illness or health.

Do I worry about privacy? Not in Canada, much. This is a country that has a national Office of Privacy. The privacy laws are strict enough that the prairie provinces are doing a booming business in storing records for assorted American enterprises, where they’re beyond the long snooping noses of Homeland Security and other public and private buttinskis. In theory, only authorized medical personnel get access to my records. Both provincial and national laws (and the general mood of the country) support the idea that we’ve got privacy rights that deserve careful respect.

At the same time, I’m not at all sure Americans are ready for this. Canada’s system works because the country has a strong culture of privacy, and an even stronger bulwark of laws that back that up. Americans have almost no data privacy to speak of compared to most of the rest of the industrialized world, and no real expectation of having any. Frankly, I wouldn’t trust any American e-records system until our whole cultural and legal framework around data privacy is overhauled. I trust the Canadian government to get it mostly right. I don’t trust any American government not to sell my data to ChoicePoint or hand it over to the NSA. Until that changes, y’all be careful.

Finally, the last thing I noticed about last night was something that wasn’t there. I’m talking about that little meter in the back of my head, the one that whirred and spun and ticked off every charge from the minute I walked into an American ER until the minute I walked out again. The IV. The X-rays. The box of Kleenex, the Tylenol, and the barf pan. The crappy food (if you’re lucky enough to get any). Even with good insurance, the co-pays alone on eight hours in the ER could bust the family grocery budget for the next three months. That big number hanging over my head was always a real distraction from dealing with whatever crisis actually put one of us there. No matter what the presenting condition was when we arrived, I always seemed to have a bad case of heartburn when we left.

Contrast that with last night, when my glorious morphine dreams were completely untroubled by the sound of that mental meter. By the time they checked me out at 10:30 am, I’d had a whole bank of diagnostic tests, including a long and detailed ultrasound exam that found twin bouncing baby gallstones. The ER then handed me off to an internist for further exploration of the issue. (I see her next week — it’s already set up.)

No bills. No worrying about how to pay for the surgery, either — that will be covered, too. The morning nurse (the fabulous and charming Trish) pulled the IV. I got dressed, picked up my purse, and left. And that was it. No pain. No worries. No heartburn.

And that’s all it should ever be. And could be. And will be, if we keep leaning on Congress to get this thing done right.

Speakers Bureau

Additional speakers are available throughout the United States and Canada. For regional speakers, see separate pages for the Northeast, Midwest, South, and West.

To request a PNHP speaker, please contact us at info@pnhp.org or (312) 782-6006.

Steffie Woolhandler, MD, MPH, FACP – internal medicine, New York/Boston

Dr. Steffie Woolhandler is a practicing primary care physician, distinguished professor of public health and health policy in the CUNY School of Public Health at Hunter College, adjunct clinical professor at Albert Einstein College of Medicine, and lecturer in medicine at Harvard Medical School, where she co-directed the general internal medicine fellowship program and practiced primary care internal medicine at Cambridge Hospital.

Dr. Woolhandler earned her bachelor’s degree from Stanford University; her medical degree from Louisiana State University; and her master’s degree from the University of California. She worked in 1990-1991 as a Robert Wood Johnson Foundation health policy fellow at the Institute of Medicine and the U.S. Congress.

Dr. Woolhandler is a frequent speaker and has written extensively on health policy, administrative overhead and the uninsured. She has authored more than 150 journal articles, reviews, chapters, and books on health policy. A sample of Dr. Woolhandler’s grand rounds at the University of Southern California Keek School of Medicine is available here.

A co-founder and board member of Physicians for a National Health Program, Dr. Woolhandler co-edits PNHP’s newsletter and is a principal author of PNHP articles published in the JAMA and the New England Journal of Medicine in conjunction with Dr. David Himmelstein.

Walter H. Tsou, MD, MPH – internal medicine/public health, Philadelphia

Dr. Walter Tsou is a past president of the American Public Health Association and former health commissioner of Philadelphia. He is a founding member of the National Board of Public Health Examiners and a board adviser to Physicians for a National Health Program. An expert on health reform and health care financing, he frequently briefs members of Congress on health care issues.

Dr. Tsou is a contributing editor of Physician’s News Digest and Pennsylvania Medicine. He is the recipient of numerous awards, including the Public Health Recognition Award from the College of Physicians of Philadelphia, the Leadership Award from the Delaware Valley Healthcare Council, and the Broad Street Pump Award from Physicians for Social Responsibility. He was named Practitioner of the Year by the Philadelphia County Medical Society in 2001.

Dr. Tsou received his medical degree from the University of Pennsylvania and his master’s degree from the Johns Hopkins School of Hygiene and Public Health. He holds an honorary doctorate in medical sciences from Drexel University.

Claudia M. Fegan, MD, CHCQM, FACP – internal medicine, Chicago

Dr. Claudia Fegan is national coordinator of Physicians for a National Health Program. In her current and past leadership roles in PNHP she has appeared on national television and radio programs on behalf of the organization, and has testified before congressional committees on a wide range of health care issues. She has lectured extensively to both medical and community audiences on health care reform in the U.S. and Canada, and is a co-author of the book “Universal Healthcare: What the United States Can Learn from Canada” and a contributor to “10 Excellent Reasons for National Health Care.”

Dr. Fegan is executive medical officer for the Cook County Health and Hospital System and chief medical officer at John H. Stroger Jr. Hospital of Cook County. She is also president of the Chicago-based Health and Medicine Policy Research Group. In 2016, Modern Healthcare named Dr. Fegan one of “10 Minority Executives to Watch,” noting her achievements in the medical profession and her single-payer activism.

Dr. Fegan received her undergraduate degree from Fisk University and her medical degree from the University of Illinois College of Medicine. She is also certified in health care quality and management and is a diplomate of the American Board of Quality Assurance and Utilization Review Physicians.

David U. Himmelstein, MD, FACP – internal medicine, New York/Boston

Dr. David Himmelstein is a distinguished professor of public health and health policy in the CUNY School of Public Health at Hunter College, adjunct clinical professor at Albert Einstein College of Medicine, and lecturer in medicine at Harvard Medical School. He has served as chief of the division of social and community medicine at Cambridge Hospital.

Dr. Himmelstein has authored or co-authored more than 100 journal articles and three books, including widely cited studies of medical bankruptcy and the high administrative costs of the U.S. health care system. His 1984 study of patient dumping led to the enactment of EMTALA, the law that banned that practice.

A co-founder of Physicians for a National Health Program, Dr. Himmelstein co-edits PNHP’s newsletter and is a principal author of PNHP articles published in the JAMA and the New England Journal of Medicine in conjunction with Dr. Steffie Woolhandler. A sample of Dr. Himmelstein’s grand rounds at the University of Southern California Keek School of Medicine is available here.

Dr. Himmelstein received his medical degree from Columbia University and completed internal medicine training at Highland Hospital/University of California San Francisco and a fellowship in general internal medicine at Harvard.

Diljeet K. Singh, MD, DrPH – gynecologic oncology, Washington, D.C.

Dr. Diljeet Singh is a gynecologic oncologist with the Mid-Atlantic Permanante Medical Group in Washington, DC. She recently relocated from Phoenix, AZ, where she was the program director of gynecologic oncology and the program director of Cancer Prevention and Integrative Medicine at the Banner MD Anderson Cancer Center in Gilbert, Arizona.

Dr. Singh received her medical degree from Northwestern University and master’s degree from the Harvard School of Public Health. She completed an obstetrics and gynecology residency at the Johns Hopkins and a gynecologic oncology fellowship at the MD Anderson Cancer Center. She completed her doctoral degree in public health on cost analysis at the University of Texas School of Public Health and an associate fellowship in integrative medicine at the University of Arizona. She is a national board member of Physicians for a National Health Program.

Carol ParisCarol Paris, MD – psychiatry, Nashville

Dr. Carol Paris is the president of Physicians for a National Health Program. She is a recently retired psychiatrist who worked for more than 25 years in private practice, community mental health, prison psychiatry, and academia. In the course of her experience, much of which was in Maryland, she became an outspoken critic of the private-insurance-based U.S. health care system.

In May 2009, she and seven others stood up, one by one, at a U.S. Senate Finance Committee hearing on health care reform chaired by Sen. Max Baucus to ask why there wasn’t a single advocate for single-payer health care on the 41-member panel. In an action that received national media attention, Baucus had all eight peaceful protesters, including Dr. Paris, arrested. (Charges were eventually reduced, requiring only community service.)

Dr. Paris subsequently toured the country as part of the “Mad as Hell Doctors” campaign for single payer, and spent a year as a consultant psychiatrist in New Zealand, where she experienced a single-payer system firsthand. She currently resides in Nashville, Tenn., where her primary interests include strategic activism, recruiting and mentoring medical students and early career physicians for leadership positions within PNHP, and building coalitions to strengthen the single-payer movement’s impact on the national health care debate. Dr. Paris obtained her medical degree from West Virginia University School of Medicine.

Robert L. Zarr, MD, MPH, FAAP – pediatrics, Washington, D.C.

Dr. Robert Zarr is a board-certified pediatrician at Unity Health Care in Washington, DC, where he cares for a low-income and immigrant population. He is the immediate past president of Physicians for a National Health Program.

Dr. Zarr is a past president of the DC Chapter of the American Academy of Pediatrics, and he holds adjunct professorships at Children’s National Medical Center and George Washington University. He also co-directs the Washington, DC chapter of PNHP. He is “physician champion” of DC Park Rx, a community health initiative to prescribe nature to patients and families and encourage time in one of 350 parks and green spaces in Washington, DC.

Dr. Zarr is fluent and literate in Spanish and has worked in the U.S. and abroad with Spanish-speaking populations. He is active in Washington, DC, in a variety of quality improvement initiatives including asthma management, injury prevention, literacy promotion, breastfeeding awareness, youth advocacy, tuberculosis prevention, and compliance with early and periodic screening, diagnostic and treatment standards.

Dr. Zarr received his medical degree from Baylor College of Medicine and completed his pediatric residency at Texas Children’s Hospital in Houston. He also has a master’s degree in public health, specializing in international health, from the University of Texas School of Public Health.

Suan RogersSusan Rogers, MD, FACP – internal medicine, Chicago

Dr. Susan Rogers, recently retired, is a volunteer attending hospitalist and internist at the John H. Stroger Jr. Hospital of Cook County. She previously was co-director of medical student programs for the Department of Medicine. She is also assistant professor of medicine at Rush University, where she is active on the committee of admissions, and assistant professor of medicine at Rosalind Franklin University. She has received numerous teaching awards from Stroger Hospital, Rush University, and Rosalind Franklin University. A sample of Dr. Rogers’ grand rounds at the University of Illinois College of Medicine at Urbana-Champaign is available here.

Dr. Rogers received her medical degree from the University of Illinois College of Medicine and completed her residency at Cook County Hospital, where she served as chief resident. She is a national board member of Physicians for a National Health Program and a past co-president of Health Care for All Illinois. She previously served on the boards of the Near North Health Service Corp, a FQHC in Chicago, and Ancona School. Dr. Rogers is a member of the American College of Physicians, the Society of General Internal Medicine, and the National Medical Association.

Suan RogersPaul Y. Song, MD – radiation oncology, Los Angeles

Dr. Paul Song is a board-certified radiation oncologist, biotech executive, and health care reform activist.
 
He is a national board member of Physicians for a National Health Program and serves as co-chair for the Campaign for a Healthy California. He served as executive chairman of the 1.2 million-member Courage Campaign from 2013 to March 2016. He also served as the very first visiting fellow on health care policy in the California Department of Insurance for 2013.
 
Dr. Song is the chief medical officer of ATGen Global and Cynvenio Biosystems. He recently left the faculty at the Samuel Oschin Cancer Center at Cedars Sinai Medical Center and currently volunteers his time seeing Medicaid and uninsured patients at California Hospital.
 
He attended the University of Chicago where he graduated with honors and received his medical degree from George Washington University. He completed his residency in radiation oncology at University of Chicago Medical Center.
 
Dr. Song serves on the boards of People for the American Way, The Asian Pacific American Institute for Congressional Studies, Liberty in North Korea, and The Eisner Pediatric and Family Medical Center.

Oliver T. Fein, MD, FACP – internal medicine, New York

Dr. Oliver Fein is professor of clinical medicine and clinical public health at Weill Cornell Medical College, where he serves as associate dean responsible for the Office of Affiliations and the Office of Global Health Education. He is a general internist and active in clinical practice.

Dr. Fein is a past president of Physicians for a National Health Program and chair of the New York Metro Chapter of PNHP. He is a past vice president of the American Public Health Association, where he served four years on the executive board.

Much of Dr. Fein’s work has focused on health system delivery reform and access to care for vulnerable populations. His recent writings include a chapter (with Joanne Landy) on the feasibility of fundamental health reform in the new book “10 Excellent Reasons for National Health Care”; an article on ethical issues and global health in Academic Medicine; an editorial in Medical Care; and an article on U.S. health care reform and the presidential candidates in the Journal of Health Services Research and Policy. He has also published opinion pieces in the Philadelphia Inquirer and the Atlanta Journal-Constitution.

Dr. Fein received his medical degree from Western Reserve University in 1967 and completed his internship at Cleveland Metropolitan General Hospital and his residency at Lincoln Hospital in the Bronx. In 1977 he became director of general medicine outpatient services at the Columbia Presbyterian Medical Center and subsequently acting-director of the division of general medicine at the College of Physicians and Surgeons of Columbia University. He was a Robert Wood Johnson health policy fellow in 1993-1994, where he worked as a legislative assistant for the Senate Democratic Majority Leader, George Mitchell.

Dr. Fein received the Elnora M. Rhodes Service award from the Society of General Internal Medicine in 1999; the Haven Emerson Award from the Public Health Association of New York City in 2001; and the Lifetime Achievement Award from the Robert Wood Johnson Health Policy Fellowships Program in 2008.

Speakers by region

Compassion for some; Solidarity for all

Obama’s Mistakes in Health Care Reform

By Vicente Navarro
CounterPunch
September 7, 2009
Error Number Three
Obama plans to cover the uninsured by increasing taxes on the rich (a very popular measure, as shown in all polls) and by transferring funds saved through increased efficiencies in existing programs, including Medicare (an unpopular measure, for the reasons I’ve mentioned). We see here the same problems we’ve seen with other programs targeted to specific, small sectors of the population, such as the poor. Programs that are not universal (i.e., do not benefit everyone) are intrinsically unpopular. This is why antipoverty programs are unpopular. People feel that they are paying, through taxation, for programs that do not benefit them. Compassion is not, and never has been, a successful motivation for public policy. Solidarity is. You support others with the understanding that they will support you when you need it most. The long history of social policy, in the U.S. and elsewhere, shows that universality is a better way to get popular support for a program than means-testing for programs targeted to specific vulnerable groups. The limited popularity of the welfare state in the U.S. is precisely due to the fact that most programs are not universal but means-tested. The history of social policy shows that the best way to resolve poverty is not by developing antipoverty programs, but by developing universal programs to which all people are entitled — for example, job and incomes programs. In the same way, the problem of noncoverage by health insurance will not be resolved without resolving the problem of undercoverage, because both result from the same failing: the absence of government power to ensure universal rights. There is no health care system in the world (including the fashionable Swiss model) that provides universal health benefits coverage without the government intervening, using its muscle to control prices and practices. The various proposals being put forward by the Obama administration are simply tinkering with, not resolving, the problem. You can call this government role “single-payer” or whatever, but our experience in the U.S. has already shown (what other countries have known and practiced for decades) that without government intervention, all the measures now being proposed by this administration will be handsome bailouts for the medical-insurance-pharmaceutical complex.
(Vicente Navarro, M.D., Ph.D. is Professor of Health Policy at The Johns Hopkins University and editor-in-chief of the International Journal of Health Services.)
http://www.counterpunch.org/navarro09072009.html

The subtitle of this article is “Why Obama Needed Single Payer on the Table.” The full article is well worth reading.

Why Obama Needed Single Payer on the Table

Obama's Mistakes in Health Care Reform

By VICENTE NAVARRO
CounterPunch
September 7, 2009

Let me start by saying that I have never been a fan of Barack Obama. Early on, I warned many on the left that his slogan, “Yes, we can,” could not be read as a commitment to the major change this country needs (see “Yes, We Can. Can We? The Next Failure of Health Reform”). Still, I actively supported him against John McCain and was very pleased when he became president — for many reasons, encompassing a broad range of feelings. One reason was that Obama is African-American, and the country needed to have a black president. Another was that his election seemed to signal the end of the Bush era. But, the most important reason was that I saw him as a decent man, surrounded by some good people who could promote change from the center and open up some possibilities for progress, giving the left a chance to influence the administration’s policies. Well, after just over seven months of the Obama White House, I have no reason to doubt that he is a decent man, but I am dismayed by the bad judgment he has shown in the choice of some of his staff and advisors. I really doubt that he is going to be able to make the changes we need. As I said, I never had great expectations about him and his policies, but even the lowest of my expectations have not been met.

Some among the many skeptics on the left might add, “What did you expect?” Well, at least I expected Obama to show the same degree of astuteness that he and his team had shown during the campaign. He seemed to be a brilliant strategist, and his election proves this. But my greatest disappointment is the strategies he is now following in his proposals for health care reform — they could not be worse. I am really concerned that the fiasco of this reform may make Obama a one-term president.

Error number One

One of the two major objectives for health care reform, as emphasized by Obama, is the need to reduce medical care costs. The notion that “the economy cannot afford a medical care system so costly, with the annual increases of medical care running wild” has been repeated over and over — only the tone varies, depending on the audience. An element of this argument is Obama’s emphasis on eliminating the federal deficit. He stresses that most of the government deficit is due to the outrageous growth in costs in federal health programs. Thus, a crucial part of the message he is transmitting is the health care reform objective of reducing costs.

This message, as it reaches the average citizen, seems like a threat to achieve cost reductions by cutting existing benefits. This perception is particularly accentuated among elderly people — which is not unreasonable, given that the president indicates that the funds needed to provide health benefits coverage to the 48 million currently uncovered will come partially from existing programs, such as Medicare, with savings supposedly achieved by increasing efficiency. To the average citizen (who has developed an enormous skepticism about the political process), this call for savings by increasing efficiency sounds like a code for cutting benefits. Not surprisingly, then, one sector of the population most skeptical about health care reform is seniors — the beneficiaries of Medicare. The comment that “government should keep its hands off my Medicare,” as heard at some of the town hall meetings, is not as paradoxical or ridiculous as the liberal media paint it. It makes a lot of sense. An increasing number of elderly people feel that the uninsured are going to be insured at the expense of seniors’ benefits.

Error Number Two

The second major objective of health care reform as presented by Obama is to provide health benefits coverage for the uncovered: the 48 million people who don’t have any form of health benefits coverage. This is an important and urgently needed intervention. The U.S. cannot claim to be a civilized nation and a defender of human rights around the world unless this major human and moral problem at home is resolved once and for all. But, however important, this is not the largest problem we have in the health care sector. The most widespread problem is not being uninsured but underinsured: the majority of people in the U.S. — 168 million, to be precise — are underinsured. And many (32 per cent) are not even aware of this until they need their health insurance coverage. This undercoverage is an enormous human, social, and economic problem. Among people who are terminally ill, 42 per cent worry about how they or their family will pay for medical care. And most of these people are insured — but their insurance does not cover all of their conditions and necessary interventions. Co-payments, deductibles, and other extra expenses — besides the insurance premiums — can amount to 10 per cent or even higher proportion of disposable income.

During the presidential campaign, both Obama and Hillary Clinton, in discussing the need for health care reform, made frequent reference to heart-breaking stories — cases in which families and individuals suffer under our current system of medical care. But none of the proposals that the Obama administration is ready to support would address most of these cases. It will be an embarrassing and uncomfortable moment during the 2012 presidential campaign if someone asks candidate Obama about what has happened to some of the people whose stories he told in the 2008 campaign.

Error Number Three

Obama plans to cover the uninsured by increasing taxes on the rich (a very popular measure, as shown in all polls) and by transferring funds saved through increased efficiencies in existing programs, including Medicare (an unpopular measure, for the reasons I’ve mentioned). We see here the same problems we’ve seen with other programs targeted to specific, small sectors of the population, such as the poor. Programs that are not universal (i.e., do not benefit everyone) are intrinsically unpopular. This is why antipoverty programs are unpopular. People feel that they are paying, through taxation, for programs that do not benefit them. Compassion is not, and never has been, a successful motivation for public policy. Solidarity is. You support others with the understanding that they will support you when you need it most. The long history of social policy, in the U.S. and elsewhere, shows that universality is a better way to get popular support for a program than means-testing for programs targeted to specific vulnerable groups. The limited popularity of the welfare state in the U.S. is precisely due to the fact that most programs are not universal but means-tested. The history of social policy shows that the best way to resolve poverty is not by developing antipoverty programs, but by developing universal programs to which all people are entitled — for example, job and incomes programs. In the same way, the problem of noncoverage by health insurance will not be resolved without resolving the problem of undercoverage, because both result from the same failing: the absence of government power to ensure universal rights. There is no health care system in the world (including the fashionable Swiss model) that provides universal health benefits coverage without the government intervening, using its muscle to control prices and practices. The various proposals being put forward by the Obama administration are simply tinkering with, not resolving, the problem. You can call this government role “single-payer” or whatever, but our experience in the U.S. has already shown (what other countries have known and practiced for decades) that without government intervention, all the measures now being proposed by this administration will be handsome bailouts for the medical-insurance-pharmaceutical complex.

Error Number Four

I can understand that Obama does not want to advocate single-payer. But he has made a huge tactical mistake in excluding it as an option for study and consideration. He needs single-payer to be among the options under discussion. And he needs single-payer to make his own proposal “respectable.” (Keep in mind how Martin Luther King became the civil rights figure promoted by the establishment because, in the background, there was a Malcolm X threatening the establishment.) This was a major mistake made by Bill Clinton in 1993. When Clinton gave up on single-payer, his own proposal became the “left” proposal (unbelievable as that may seem) and was dead on arrival in Congress. The historical function of the left in this country has been to make the center “respectable.” If there is no left alternative, the Obama proposals will become the “left” proposal, and this will severely limit whatever reform he will finally be able to get.

But there’s another reason that Obama has erred in excluding single-payer. He has antagonized the left of his own party that supports single-payer, without which he cannot be reelected in 2012. He cannot win only with the left, of course, but he certainly cannot win without the mobilization of the left. His victory in 2008 is evidence of this. And today, the left is angry at him. It is a surprise to me, but Obama is going to pay the same price Clinton paid in 1994. Clinton antagonized the left by putting deficit reduction (under pressure from Wall Street) at the top of his policies and supporting NAFTA against the wishes of the AFL-CIO and the majority of Democrats. The Gingrich Republican Revolution of 1994 was due to a demobilization of the left. The Republicans got the same (I repeat the same) number of votes in the 1994 congressional election that they got in 1990 (the previous non-presidential election year). Large sectors of the grassroots of the Democratic Party that voted Democratic in 1990 stayed home in 1994. Something similar could happen in 2010 and in 2012. We could see a strong mobilization of the right and a very demoralized left. We are already seeing this. Why aren’t those on the left out in force at the town hall meetings on health care reform? Because the option they want — single-payer — has already been excluded from the debate by a president they fought to get elected.

This is my concern. The alternative to Obama is Sarah Palin or someone like her. Palin has a lot of support among the people who mobilized to support John McCain. And the ridicule heaped on her by the liberal media (which is despised by large sectors of the working class of this country) helps her, or her like, enormously. I am afraid we may have, in the near future, friendly fascism. And I do not use the term lightly. I grew up under fascism, in Franco’s Spain, and if nothing else, I recognize fascism when I see it. And we are seeing a growing fascism with a working-class base in the U.S. This is why we cannot afford to see Obama fail. But his staff and advisors are doing a remarkable job to achieve this. Ideologues such as chief-of-staff Rahm Emanuel (who, when a congressman, was the most highly funded by Wall Street) and his brother, Ezekiel Emanuel (who did indeed write that old people should have a lower priority for health care spending) are leading the country along a wrong path.

I don’t doubt that President Obama, a decent man, wants to provide universal health care to all citizens of this country. But his judgment in developing his strategy to reach that goal is profoundly flawed, and, as mentioned above, it may cost him the presidency — an outcome that would be extremely negative for the country. He should have called for a major mobilization against the medical-industrial complex, to ensure that everyone has the same benefits that their representatives in Congress have, broadening and improving Medicare for all. The emphasis of his strategy should have been on improving health benefits coverage for everyone, including those who are currently uncovered. And to achieve this goal — which the majority of the population supports — he should have stressed the need for government to ensure that this extension of benefits to everyone will occur.

That he has not chosen this strategy touches on the essence of U.S. democracy. The enormous power of the insurance and pharmaceutical industries corrupts the nature of our democracy and shapes the frontiers of what is possible in the U.S. Given this reality, it seems to me that the role of the left is to initiate a program of social political agitation and rebellion (I applaud the health professionals who disrupted the meetings of the Senate Finance Committee), following the tactics of the Civil Rights and anti-Vietnam War movements of the 1960s and 1970s. It is wrong to expect and hope that the Obama administration will change. Without pressure and agitation, not much will be done.

Vicente Navarro, M.D., Ph.D., professor of Health Policy at The Johns Hopkins University and editor-in-chief of the International Journal of Health Services. The opinions expressed here are those of the author and do not necessarily reflect the views of the institutions with which he is affiliated. Dr Navarro can be reached at vnavarro@jhsph.edu

Compassion for some; Solidarity for all

Obama's Mistakes in Health Care Reform

By Vicente Navarro
CounterPunch
September 7, 2009

Error Number Three

Obama plans to cover the uninsured by increasing taxes on the rich (a very popular measure, as shown in all polls) and by transferring funds saved through increased efficiencies in existing programs, including Medicare (an unpopular measure, for the reasons I’ve mentioned). We see here the same problems we’ve seen with other programs targeted to specific, small sectors of the population, such as the poor. Programs that are not universal (i.e., do not benefit everyone) are intrinsically unpopular. This is why antipoverty programs are unpopular. People feel that they are paying, through taxation, for programs that do not benefit them. Compassion is not, and never has been, a successful motivation for public policy. Solidarity is. You support others with the understanding that they will support you when you need it most. The long history of social policy, in the U.S. and elsewhere, shows that universality is a better way to get popular support for a program than means-testing for programs targeted to specific vulnerable groups. The limited popularity of the welfare state in the U.S. is precisely due to the fact that most programs are not universal but means-tested. The history of social policy shows that the best way to resolve poverty is not by developing antipoverty programs, but by developing universal programs to which all people are entitled — for example, job and incomes programs. In the same way, the problem of noncoverage by health insurance will not be resolved without resolving the problem of undercoverage, because both result from the same failing: the absence of government power to ensure universal rights. There is no health care system in the world (including the fashionable Swiss model) that provides universal health benefits coverage without the government intervening, using its muscle to control prices and practices. The various proposals being put forward by the Obama administration are simply tinkering with, not resolving, the problem. You can call this government role “single-payer” or whatever, but our experience in the U.S. has already shown (what other countries have known and practiced for decades) that without government intervention, all the measures now being proposed by this administration will be handsome bailouts for the medical-insurance-pharmaceutical complex.

(Vicente Navarro, M.D., Ph.D. is Professor of Health Policy at The Johns Hopkins University and editor-in-chief of the International Journal of Health Services.)

http://www.counterpunch.org/navarro09072009.html

Comment:

By Don McCanne, MD

The subtitle of this article is “Why Obama Needed Single Payer on the Table.” The full article is well worth reading.

Insurance exchange loopholes

Will U.S. learn its healthcare reform lesson from California?

By Michael Hiltzik
Los Angeles Times
September 14, 2009
The difference between a government program that works and one that fails spectacularly can be razor thin. A few words here, a loophole there, and you can turn a boon for the consumer into a windfall for big business.
That lesson should be fixed in the frontal lobes of everyone in Congress working on the healthcare reform bill, and especially on a piece of the reform puzzle known as the insurance exchange — a key element of the reform plan backed by congressional Democrats and President Obama.
Here in California we know all about the pitfalls of an exchange that doesn’t work, because we established a statewide version in 1992 and attended its funeral in 2006. The state exchange, known originally as the Health Insurance Plan of California and later as PacAdvantage, was designed to give California’s small businesses the collective clout to negotiate with health insurers for lower premiums and consumer-friendly standards.
As written into the benchmark bill in the House of Representatives (H.R. 3200), the federally supervised exchange would be the sole marketplace where individuals and employees of small businesses could buy health insurance. By mandating insurer participation, the exchange would provide customers the choice they don’t get in the market today. By requiring all plans to offer identical base policies it would enable buyers to compare them by price and quality.
But we’re still at the starting line. A lot of mischief can be committed on a bill’s path to enactment. The threat to a functioning exchange will come from vested interests trying to water down the mandates. Insurance companies will want the right to offer catastrophe-only coverage, which is a big moneymaker, or to specialize in the yacht-owning executive market. Lobbyists for health savings accounts, who are carrying water for financial services companies lusting after the fees these accounts generate, will insist on an HSA loophole. And politicians in some states will want to export their bare-bones coverage standards nationwide so they can lure health insurers into headquartering there, the way one-horse states without usury limits, such as South Dakota, made themselves the credit card-issuing capitals of America.
Any loophole will set the stage for others, until the exchange becomes a useless, tattered dream. “If there’s a gap or a loophole, the market will exploit it,” (former president of PacAdvantage John) Grgurina says.
http://www.latimes.com/business/la-fi-hiltzik14-2009sep14,0,7041044.column
A previous qotd also discussed insurance exchange lessons from California:
https://pnhp.org/news/2009/august/health_insurance_exc.php

In health care, we spend more and receive less, and everyone agrees that has to change. The decision has been made that we will do that by regulating our dysfunctional health insurance market, and then mandate that everyone who is not covered by other qualifying programs be required to purchase private health plans. To be certain that everyone has access to a plan, an insurance exchange will be established.
Regulations will require guaranteed issue, guaranteed renewability, the end of rescissions, rules to reduce adverse selection, and other measures to improve the functioning of the markets. In his speech to Congress and to the nation, President Obama provoked laughter when he said, “… there remain some significant details to be ironed out…” The particular details that will need to be ironed out should probably provoke grief, anger, disgust or other negative emotions, but they certainly are not funny.
No matter what rules are established for the exchanges, there will always be loopholes. Michael Hiltzik has suggested some possibilities. Our experience with the larger private insurers has proven that they can find loopholes that the best policy analysts could never see coming. Unlike the European insurers that have a mission of service, our private insurers that dominate most markets have an obligatory mission of enhancing investor value. Their business ethic mandates that they investigate every opportunity to increase revenues and reduce expenses. The invisible loopholes will always be there, and the entrepreneurial mind will always find them.
The insurance exchanges won’t even be established for four years, and then it will be many more years before the policy community passes judgement on their impact. During that time our public stewards will be busy trying to patch the innumerable loopholes penetrated by the entrepreneurs, only to find more opening up.
In future books recording the history of U.S. health care reform, President Obama will have his own chapter on yet another failed effort. He’ll deserve it because he hardly picked up his baton to orchestrate reform. When Obama should have been conducting Beethoven’s Ninth, Congress was busy writing Rap. Rap might work for a few of us, but the nation deserved much more.