PNHP

A note from Rabbi Michael Lerner

A note from Rabbi Michael Lerner

Tikkun Daily
September 11, 2009

[Passage omitted] President Obama knows that a single-payer program — extending Medicare to everyone — is far more rational than what he has proposed to Congress, but he also believes that eliminating the insurance companies, hospital chains, and other medical profiteers would require a battle beyond his current capacities.

To address any of these problems fully would require a fundamental challenge to the old Bottom Line. Obama would have to call for a New Bottom Line — to advocate for defining governmental and private corporate policies as “rational,” “productive” or “efficient” not only to the extent that they maximize money and power, but also to the extent that they maximize love and caring, kindness and generosity, ethical and ecological sensitivity, enhance our capacities to respond to other human beings as embodiments of the sacred and our capacities to respond to the universe with awe, wonder and radical amazement at the grandeur mystery of the universe.

He actually reached in that direction momentarily at the end of his health care speech to Congress by seeming to endorse Senator Ted Kennedy’s “large-heartedness: a concern and regard for the plight of others” which he defined as “our ability to stand in other people’s shoes; a recognition that we are all in this together, and when fortune turns against one of us, others are there to lend a helping hand.”

Yet over and over again in the details of his plan it was not this large-heartedness that he championed, but a belief in the positive outcomes of the competitive marketplace. What Obama omitted from mention is that the ethos of that marketplace, which rewards selfishness and materialism and “looking out for number one,” as the “common sense” that guides individual as well as governmental behavior, is a product of the fear that we cannot count on others, that there will be no one there to take care of us, and that we must therefore maximize our own advantage lest someone else do so for themselves in ways that will permanently hurt or undermine us.

Obama can’t help us overcome that fear until he does so himself. He has to allow himself to know, and then help Americans to understand, that most people actually do want to help each other, get delight in being caring and loving, feel fulfilled when they are able to improve the well-being of others. Most people already know this about themselves, but are unsure whether its true of their neighbors or others. Obama’s most important contribution would be to fight for policies based on this understanding and to challenge those who believe the world is filled with people who are primarily self-seeking and aggressive. Unfortunately, he can’t do that while remaining loyal to the centrist ideology and its insistence that the aggressiveness manifested in the current competitive marketplace, is what will produce the greatest good for the greatest number.[passage omitted]

Imagine, for instance, if Obama had started his speech with the idea of “we are all in this together” that he ended it with, and then applied that to each specific part of his program. Sadly, that was impossible precisely because his actual program is in conflict with this at several points. He won’t support health care reform that raises the deficit. How can that be justified by a President who raised the deficit to help bail out the people who caused the banks and investment companies to fail all of us! He promises not to give any benefits to immigrants-but then “we” are not “all in it together!” He is willing to use government to coerce people into his plan those who would not voluntarily join, but not to force insurance companies to lower the prices (for example, by regulating their prices at the expense of lowering their profit rates or simply by creating Medicare for All. He tries to make a public option plausible by comparing it to public community and state colleges, but also assures the insurance companies that they have nothing to worry about from his plan because “the public insurance option would have to be self-sufficient and rely on the premiums it collects.” Yet the public option will not be open to those of us who already have private health care insurance. These limitations guarantee that the public option will not achieve the goal of lowering prices or obscene levels of profits. Public universities and community colleges have never been able to sustain themselves on the tuitions of those who use them. If that had been the requirement from the start, tens of millions of Americans would never have obtained the benefits of a public education that enabled them to get better jobs and go on to make valuable contributions to society in turn. If the principle had been that these colleges could not contribute to state or federal deficits, they would long ago have folded. So where is the “we” who are “all in it together” when crippling the only part of his plan that really makes an attempt at a universal solidarity? [passage omitted]

Rabbi Michael Lerner is editor of Tikkun Magazine (www.tikkun.org) , chair of the interfaith Network of Spiritual Progressives (www.spiritualprogressives.org) and rabbi of Beyt Tikkun synagogue in San Francisco (www.beyttikkun.org).

It's Simple: Medicare for All

By George S. McGovern
Washington Post
Sunday, September 13, 2009

For many years, a handful of American political leaders — including the late senator Ted Kennedy and now President Obama — have been trying to gain passage of comprehensive health care for all Americans. As far back as President Harry S. Truman, they have urged Congress to act on this national need. In a presentation before a joint session of Congress last week, Obama offered his view of the best way forward.

But what seems missing in the current battle is a single proposal that everyone can understand and that does not lend itself to demagoguery. If we want comprehensive health care for all our citizens, we can achieve it with a single sentence: Congress hereby extends Medicare to all Americans.

Those of us over 65 have been enjoying this program for years. I go to the doctor or hospital of my choice, and my taxes pay all the bills. It’s wonderful. But I would have appreciated it even more if my wife and children and I had had such health-care coverage when we were younger. I want every American, from birth to death, to get the kind of health care I now receive. Removing the payments now going to the insurance corporations would considerably offset the tax increase necessary to cover all Americans.

I don’t feel as though the government is meddling in my life when it pays my doctor and hospital fees. There are some things the government does that I don’t like — most notably getting us into needless wars that cost many times what health care for all Americans would cost. Investing in the health of our citizens will enhance the well-being and security of the nation.

We know that Medicare has worked well for half a century for those of us over 65. Why does it become “socialized medicine” when we extend it to younger Americans?

Taking such a shortsighted view would leave nearly 50 million Americans without health insurance and without the means to buy it. It would leave other Americans struggling to pay the rising cost of insurance premiums. These private insurance plans are frequently terminated if the holder contracts a serious long-term ailment. And some people lose their insurance if they lose their jobs or if the plant where they work moves to another location — perhaps overseas.

We recently bailed out the finance houses and banks to the tune of $700 billion. A country that can afford such an outlay while paying for wars in Iraq and Afghanistan can afford to do what every other advanced democracy has done: underwrite quality health care for all its citizens.

If Medicare needs a few modifications in order to serve all Americans, we can make such adjustments now or later. But let’s make sure Congress has an up or down vote on Medicare for all before it adjourns this year. Let’s not waste time trying to reinvent the wheel. We all know what Medicare is. Do we want health care for all, or only for those over 65?

If the roll is called and it goes against those of us who favor national health care, so be it. If it is approved, the entire nation can applaud.

Many people familiar with politics in America will tell you that this idea can’t pass Congress, in part because the insurance lobby is too powerful for lawmakers to resist.

As matters now stand, the insurance companies claim $450 billion a year of our health-care dollars. They will fight hard to hold on to this bonanza. This is a major reason Americans pay more for health care per capita than any other people in the world. The insurance executives didn’t cry “socialism” when their buddies in banking and finance were bailed out. But to them it is socialism if the government underwrites the cost of health care.

Consider the campaign funds given to the chairman and ranking minority member of the Senate Finance Committee, which has jurisdiction over health-care legislation. Chairman Max Baucus of Montana, a Democrat, and his political action committee have received nearly $4 million from the health-care lobby since 2003. The ranking Republican, Charles Grassley of Iowa, has received more than $2 million. It’s a mistake for one politician to judge the personal motives of another. But Sens. Baucus and Grassley are firm opponents of the single-payer system, as are other highly placed members of Congress who have been generously rewarded by the insurance lobby.

In the past, doctors and their national association opposed Medicare and efforts to extend such benefits. But in recent years, many doctors have changed their views.

In December 2007, the 124,000-member American College of Physicians endorsed for the first time a single-payer national health insurance program. And a March 2008 study by Indiana University — the largest survey ever of doctors’ opinions on financing health-care reform — concluded that 59 percent of doctors support national health insurance.

To have the doctors with us favoring government health insurance is good news. As Obama said: “We did not come to fear the future. We came here to shape it.”

George S. McGovern, a former senator from South Dakota, was the Democratic nominee for president in 1972.

The virtues of single-payer

BY JOHN KAY
News & Observer (Raleigh, NC)
Sep 11, 2009

CHAPEL HILL – Opponents of health-care reform have tried to twist the idea of a single-payer system into some sort of threat to the American way of medicine. They are wrong. As someone who spent half my working life in Canada and half in the United States, I’ve been covered by two single-payer health systems, one in Canada and now under Medicare. They both work.

I have yet to meet my first Canadian who would exchange his or her health-care system for what we have. I have also given a number of talks at retirement communities in North Carolina, and I usually ask for a show of hands of those who would like to give up Medicare. I have yet to see a hand go up.

The Canadian system is based on four cornerstones:

* Universality — everyone is covered.

* Portability — one is covered no matter where one lives, and one can move anywhere with little change in coverage.

* Availability — one has access to basic health care everywhere, and if it is necessary to go to a major center for specialized care, that is where one goes.

* Comprehensiveness — there are no exclusions from reasonable coverage.

All this is done under a single-payer system. If this looks very much like Medicare, it is.

Health care is costly. This is one area in which we Americans are undisputed world leaders. Our costs average $7,290 per person per year. Our Canadian neighbors, who on average live almost three years longer than we do, pay out only $3,895 per person per year. To put this in perspective, if we could ever achieve the Canadian number, we would save $1 trillion per year.

Over the course of a lifetime, we spend an extra $265,000 per person on health care and get three fewer years to show for it.

Much discourse is afoot these days on how we don’t want the government involved in our health care. We are told that we don’t want “socialized” medicine like Canada has even though Canada’s system is not socialist. We are told that Canadian health care is rationed and that there are long lines to see doctors. The one place there are no lines is at the border waiting to enter the U.S. to obtain health care.

Yes, we have good care here, but ours is rationed, reserved for those who can pay and for those lucky enough to work for a company that still provides subsidized insurance for its employees.

Here in the Research Triangle we live in the shadow of two of the top teaching hospitals in the country. There are few places in the entire world with better access to care. But imagine for a moment that you are a single, unemployed mother with three young children living in rural North Carolina.

Where do you go when someone gets sick, and how do you pay for it if you do go?

There are other ways our health-care system affects us in this global economy. Not too long ago, Toyota, after looking throughout North America for two years, put a new Lexus plant in Cambridge, Ontario. One of the primary reasons was the lower health-care costs that manufacturers enjoy in Canada versus in the U.S.

And curing the problem of our uninsured through private for-profit health-care insurance is virtually impossible. According to a study by the Rand Group, a 50 percent reduction in health insurance premiums would reduce the number of uninsured only by 3 percent.

Universal health care should be a right, not a privilege, in this the richest country in the world. If a criminal in our country has the right to a lawyer, shouldn’t someone who is sick have the right to a doctor?

John Kay of Chapel Hill is a recently retired business executive.

'Mad as Hell' caravan tours Montana, touts health care for all

By MIKE DENNISON The Missoulian Friday, September 11, 2009

HELENA – Retired internist Robert Seward, a self-described “Mad as Hell” doctor who wants a publicly funded health system that covers all Americans, told a Helena crowd Thursday that he had a telling conversation with a Canadian citizen a day earlier.

As Seward checked into his motel in Spokane, he told the Canadian about the “Mad as Hell” cross-country caravan, meant to publicize how a Medicare-for-all system is the best way to reform health care in America – a system like Canada’s, where all citizens are covered equally with taxpayer-financed health insurance.

The Canadian man was perplexed as to why Americans wouldn’t embrace such a system, Seward said, and why America allows citizens to go bankrupt because of personal health care costs.

“He asked, ‘Why don’t you Americans take care of your own people?’ ” Seward said. “We don’t. It’s embarrassing. That’s why I’m mad as hell.”

Seward and some of his physician colleagues from Oregon and Washington are in Helena until Saturday, as part of their three-week tour to promote a Medicare-for-all system of health coverage as the best reform for the nation. The nation’s health-care system is “far more broken than you could possibly imagine,” said emergency room physician Paul Hochfield of Corvallis, Ore., and the only way to fix it is get rid of private, for-profit health insurance and replace it with a public system.

“It’s being hijacked by the industry for profits instead of for the public good,” he said.

The doctors, who said they used their own money to start the tour, say health reforms being advanced by President Barack Obama, Sen. Max Baucus, D-Mont., and others simply serve to entrench profitable private interests that are making health care unaffordable for the average person.

The tour is scheduled to end Sept. 30 in Washington, D.C., where the doctors will be part of a rally for a single-payer, Medicare-for-all system.

They’re stopping for three days in Helena, including a rally held Thursday on the Capitol steps, a town meeting on Saturday at Carroll College, and, on Friday, a panel/debate at the Montana Medical Association convention.

At the MMA convention, the Mad as Hell doctors will square off against physicians with a conservative group, the Coalition to Protect Patients’ Rights, which opposes more government involvement in health care and is dead-set against a single-payer system.

Mike Huntington, a retired radiation oncologist from Corvallis, Ore., said the Mad as Hell group believes the country would be better off with Congress passing no reform this year, as opposed to the reforms being considered now, so the public could become more familiar with the benefits of Medicare-for-all.

Huntington also commented on Obama’s Wednesday speech to Congress, in which the president talked about the myriad of problems with the current health care system and then said he won’t support Medicare-for-all because we need to build on the current system. “That’s political doublespeak for, ‘The health-and-insurance industry has told me I might not be re-elected unless I include them and I write laws that satisfy them,’ ” Huntington said.

Congress is not seriously considering a Medicare-for-all system, although there is supposed to be a vote this month on a House amendment that would enact such a system. Baucus, a key figure in health-reform legislation, has declared Medicare-for-all “off the table” from the beginning.

Some liberals in Congress are pushing for a so-called “public option” as part of reforms, which is a government-run health insurance plan that’s supposed to compete with private insurance.

Huntington said the public option is a joke, because the only people covered by it would be the people that the private insurers don’t want: The poor, the unemployed and people with health problems. It might struggle along for a few years and eventually die, overburdened by high costs, and then conservatives would use it as an example of how government can’t run anything, he said.

http://www.missoulian.com/news/local/article_e6432836-9e8f-11de-85f3-001cc4c002e0.html

Experience argues for "Medicare for All"

By Lara Wright, M.D.
Guest Commentary
Contra Costa Times
09/12/2009

I AM a family physician who has firsthand experience about the need for health insurance reform. In 1999, after completing a residency in family practice, I was diagnosed with a brain tumor. Fortunately, I had use COBRA to continue my health benefits for 18 months. When my diagnosis was made, I still had health insurance, as well as supportive family, friends and colleagues who worked in health care.

Even with so much help, I experienced much difficulty navigating the health insurance system. As someone with a history of a brain tumor, my options for insurance after my COBRA coverage expired were minimal and expensive. Many of the options would cover all medical problems except those relating to the brain tumor.

The difficulties with health insurance compounded the stress for me and my family in dealing with treatment of and recovery from my brain tumor.

During the next few years, I worked as a patient advocate for a health insurance plan. In that job, I sometimes heard patients referred to as “product lines,” a surprising and disturbing experience.

Now, 10 years later, I again work as a doctor. The prognosis from my rehabilitation physician immediately after my surgery included a lifetime of permanent disability. Thankfully, I have far exceeded the prognosis of my physician. Instead of receiving benefits, I am able to work, treat patients and pay taxes.

I work in a county clinic, where I see patients who are faced with the difficult decision to pay for rent and food for their families, or pay for their health care. Many are unable to afford health insurance and risk running up hospital bills for emergency care that will drive them into debt and possibly into bankruptcy.

A recent study shows that more than half of personal bankruptcies are linked to medical bills, and 75 percent of people filing those bankruptcies had health insurance when they got sick.

The insight into my patients’ experiences with illness combined with my own experiences as a patient and patient advocate give me a unique perspective on our medical and insurance systems.

My experiences have led me to realize that the best solution is single-payer health care, an improved Medicare for All. This alternative has been largely neglected in the present health reform debate.

The California Senate and Assembly have twice passed a single-payer health insurance plan, but Gov. Arnold Schwarzenegger vetoed it both times. On the national front, HR 676 and SB 703 are two bills in the U.S. House and Senate that include single-payer health insurance plans, funded by the government but delivered through the existing private and public hospital system.

A recent study showed that 59 percent of physicians now support a national health insurance program. Such a system would meet their patients’ needs best, as well as eliminate many of the wasteful administrative costs with the current private health insurance industry. Moving to a single-payer system would enable our nation to save $400 billion annually, enough to provide comprehensive, quality care to all.

Critics say single-payer health insurance is socialized medicine. Not so, single-payer is insurance for everyone. A good example of socialized medicine is the Veterans Affairs: hospitals are owned by the government and doctors and nurses are on the federal payroll.

Under single-payer, however, doctors and hospitals remain largely private. You go to whichever doctor or hospital you choose. Instead of private insurers, a nonprofit government agency pays all the bills, similar to how traditional Medicare operates today. Private insurance includes wasteful administrative costs, sometimes up to 20-30 percent, a significant portion of which is spent to deny care that is not covered and decide who will make for a profitable consumer, or “product line.”

The United States is the only developed country without a national health insurance plan. The U.S. ranks number 29 in infant mortality and number 30 in expected life span among countries in the world, while far outspending all other countries.

We desperately need real health insurance reform. The best option is single-payer Medicare for All.

Wright is a member of Physicians for a National Health Program (www.pnhp.org), an organization of 17,000 doctors and health professionals who support single-payer national health insurance. She practices in Contra Costa County.

Health Care Reform and 'American Values'

By PAULINE W. CHEN, M.D.
New York Times
September 10, 2009

I was born, raised and live in the United States, but recently a neighbor asked me, “What are you?”

As the daughter of Taiwanese immigrants, I have gone through this line of inquiry my entire life, so I understood that while well-intentioned, my neighbor’s question carried the assumption that I was not, at least in his eyes, entirely American.

On that day, however, I decided not to elaborate on my family’s immigration history. Instead, I threw the question back to him, hoping in part that he would tell me about the countries from which his family originated.

“Well,” I said, “tell me first, what are you?”

“I’m an American!” he replied without a moment’s thought. But then he asked once again, “So what are you?”

According to a recent editorial in The New England Journal of Medicine, my neighbor is not the only one who holds erroneous assumptions about the meaning of “American.” Dr. Allan S. Brett, a professor of medicine and bioethicist at the University of South Carolina, argues that politicians and pundits from both sides of the aisle are now doing the same, using incorrect beliefs about “American values” as a smokescreen in the health care reform debate. Phrases like “uniquely American” have become high praise, while “Canadian” and “British” are fighting words or frank defamation.

As Dr. Brett writes, “[T]he underlying premise is that an identifiable set of American values point incontrovertibly to a health care system anchored by the private insurance industry. . . .Discussions dominated by references to uniquely American individualism, uniquely American solutions, or narrowly defined conceptions of choice tell us more about the political and economic interest of the discussants than about the interest of the Americans they claim to represent.”

I spoke to Dr. Brett recently and asked him about the notion of “American values,” the assumptions made in the health care debate, and what system, if any, might come close to representing what is American.

Q. What assumptions do public figures have when they use the term “American values”?

A. They assume several things. First, that you can take just about any American walking down the street and reliably make an inference about what their views will be and what they deem important in health care. But anyone with his or her eyes open knows just how heterogeneous we’ve become in this country.

They also assume that these “American values” can be predictably translated into organizational structures. But that’s not true. One cannot assume, for instance, that if a person prizes liberty and freedom, he or she will prefer private insurance. Instead, maybe what that person wants is freedom from worries about what will happen should he or she suddenly became ill. Maybe that person wants the liberty to accomplish what he or she wants to accomplish. Those goals are better served by a seamless health care system where the individual doesn’t have to worry about what is coming from around the corner.

The concept of American values is used to tell people what they should be wanting rather than objectively trying to understand what Americans are all about.

Q. What about freedom of choice in health care? Isn’t that uniquely American?

A. There are three types of choice in health care.

The first is the choice of your preferred physician. In the most popular health plans, the choices are virtually unlimited; people can chose whom they want to see and where they want to go. But a single-payer system, for example, does not necessarily change that, since all the facilities and practices as we know them today are left in place. In fact, if you take away all the insurance restrictions we have today on whom you can see, your choice is increased.

A second type of choice is the freedom to choose a health care plan. We do want to choose our hospitals and doctors. But do we really look forward every November to choosing between one of five plans with permutations and combinations of physicians, providers in network and providers out of network? What people really want is a user-friendly system to get what they need.

Finally, the third kind of choice has to do with deciding on whatever tests and treatments you might want as a patient. But that element of choice has to be carefully handled no matter what kind of system we have because those choices affect cost. Over the last 10 to 20 years, the pendulum has swung toward patient autonomy — which is a good thing — but it has also swung to the point where doctors sometimes feel they must give patients whatever they want without thinking critically about the risks and benefits. That has led to a huge proportion of money being spent on care that is not only marginally beneficial but is also of no benefit at all. I think that if we had a way to eliminate that — which means using our clinical decision-making skills and saying no when appropriate — we would have more money to spend on care that does matter and that makes a difference.

No matter what system we ultimately decide upon, there will have to be mechanisms in place to insure that we spend money wisely.

Q. So is there anything that is uniquely “American” about our way of approaching health care?

A. Yes. We are unique almost worldwide in that we deny health care coverage to a proportion of our population.

I do not believe there are pivotally important distinctions between our “American values” and those of other Western European and North American countries, and certainly not the kind of distinctions that would prevent us from sorting out our health care system. I don’t think we are as unique as politicians make us out to be. Even if we were that unique, the important thing is to get health care right and not to harp on the uniqueness of the system we come up with.

Q. How would you envision a health care system that is imbued with “American values”?

A. In virtually every opinion poll conducted in recent years, a majority of Americans favor government guaranteed health insurance. While a single-payer system isn’t the only way for the government to guarantee coverage for all, I think one way to think of such a system is to consider it “Medicare for all.”

But such a system would have to be accompanied by a really hard look, led by medical experts and members of the community, at what works and what doesn’t, an assessment of how we can best budget our health care dollars to achieve the best possible health care outcomes. Such a system would take time and there would be hard choices, and not everyone would be happy. But we might come closer than we are to representing the interests of most Americans.

Public Option Fades From Debate Over Health Care

By ROBERT PEAR
New York Times
September 13, 2009

WASHINGTON — It was just one line in a campaign manifesto, and it hardly seemed the most significant or contentious. As a presidential candidate, Barack Obama said he would “establish a new public insurance program” alongside private health care plans.

That proposal took on a life of its own, but it now appears to be dying, a victim of an ineffectual White House strategy, the president’s failure to argue passionately for the “public option” and all-out opposition by the insurance industry and much of the health care industry.

In the campaign, Mr. Obama said the public plan would compete with private insurers on the price and quality of care, thus benefiting consumers. What Mr. Obama did not foresee is that, to some people on the right and the left, it would become the most important issue in the debate over health care, touching off a battle over the role of government in one of the nation’s biggest, fastest-growing industries.

Once in office Mr. Obama and his advisers have sent conflicting signals about how critical a government-run health plan would be. He prefers a public plan but is open to other ideas.

Dancing around the issue for eight months, Mr. Obama has seemed, at various times, pragmatic, flexible or indecisive.

“I just want to figure out what works,” Mr. Obama said in March at a White House forum. If he could drive down health costs and expand coverage “entirely through the market,” he said, “I’d be happy to do it that way.” And “if there was a way of doing it that involved more government regulation and involvement, I’m happy to do it that way, as well,” he added.

Champions of the public plan said it could save money by using Medicare rates and fee schedules to pay hospitals and doctors. In a book last year, one of Mr. Obama’s top advisers, former Senator Tom Daschle, said consumers should have the option of enrolling in “a government-run insurance program modeled after Medicare, a proven and popular program.”

That is exactly what worries health care providers, who say Medicare pays them less than market rates paid by private insurers. And they have pressed their concerns on Capitol Hill with a small army of lobbyists.

Conservatives have another concern. They see the public option as a step toward a single-payer system in which the government would pay most of the nation’s health care bill and could supplant private insurers.

“A public plan is essentially a stalking horse for a single-payer plan,” said Senator Judd Gregg, Republican of New Hampshire. “It is more than the camel’s nose under the tent. It is the camel’s neck, and probably front legs, under the tent. There is no way the private sector will be able to compete.”

In trying to answer this charge, Democrats feel torn. Mr. Obama and many Democrats deny that they want to drive private insurers from the market. But others embrace the ultimate goal of “Medicare for all.”

The American Federation of State, County and Municipal Employees, which supports Mr. Obama and the public option, has long supported a single-payer system.

In a memorandum to union leaders last year, Gerald W. McEntee, president of the 1.6-million-member federation, said a public plan would “create a competitive check on the private market and build both public support and the infrastructure for a single-payer system.”

Then in April, Representative Jan Schakowsky, Democrat of Illinois, said insurers were right to fear that a public plan could “put the private insurance industry out of business.”

That might happen because of “the superiority of the public health care option,” said Ms. Schakowsky, one of 86 co-sponsors of a bill to establish a single-payer system.

Such comments provided new ammunition to Republicans already worried about the costly commitments undertaken by the federal government to stave off an economic collapse.

Senator Jon Kyl of Arizona, the No. 2 Republican in the Senate, voiced this sense of bailout fatigue in June when he said, “We have the takeover of the auto companies and banks and A.I.G. and student loans — and now health care.”

In battering the proposal for a public option, Republicans have made effective use of estimates by the Lewin Group, a consulting concern, which said that more than 100 million people might sign up for the government-run insurance plan.

By contrast, the Congressional Budget Office has estimated that 11 million to 12 million people might enroll.

Mr. Obama cited the lower estimate in a speech to a joint session of Congress on Wednesday, to buttress his assertion that fears of a public plan were overblown. “We believe that less than 5 percent of Americans would sign up,” Mr. Obama said.

But a leader of the Congressional Progressive Caucus, Representative Lynn Woolsey, Democrat of California, predicted that over time “more and more people will select the public option.”

If only 5 percent of people will enroll, she asked, “Why are the private insurance companies so worried?”

The different estimates by Lewin and the Congressional Budget Office are based on different assumptions about who would be permitted to enroll in the public plan — workers in all companies or just those in smaller businesses.

Many people who cite studies by the Lewin Group do not know it is a unit of Ingenix, a wholly owned subsidiary of UnitedHealth, one of the nation’s largest insurers. John F. Sheils, a vice president of the Lewin Group, said the parent company had no influence over its research.

Momentum for the public option has waned, in part, because senators have been focusing on an alternative: nonprofit member-owned insurance cooperatives.

Apart from the question of whether co-ops would be workable or effective, they provide a politically convenient middle ground for centrists. With no immediate prospect of getting the votes for a public option in the Senate, some liberals have said they too are willing to consider the idea — if it enables them to pass a bill, and if the co-ops are strong enough to put competitive pressure on insurance companies.

Senator Kent Conrad, Democrat of North Dakota, who floated the idea in early June, said co-ops would accomplish “much of what those who want a public option are calling for — something to compete with private for-profit insurance companies.”

At the same time, Mr. Conrad said, co-ops address Republican concerns because they are not controlled by the government.

Liberal Democrats are not giving up. Senator Tom Harkin, Democrat of Iowa, said the president and Senate Democratic leaders had not made a serious effort to round up votes for a public option. If they did, he said, it could pass.

While the White House has struggled to define its position, insurance companies have never wavered. Starting two weeks after the 2008 election, they have said they would accept greater federal regulation of their market practices if Congress also required everyone to have health insurance.

These may have been tactical concessions, to abate public wrath, but they were well received in Congress. While making these offers, the industry conserved its resources for the bigger battle over a public option.

Single-payer health reform: the feasible alternative

By Dr. Oliver Fein
The Progressive
September 10, 2009

President Obama sold single-payer health care short in his speech to Congress. It’s actually the only sensible solution to our health care crisis.

Obama said that a single-payer health care system would require us to “build an entirely new system from scratch.”

Not true.

We already have a working single-payer system.

For more than 40 years, single payer has served millions of American patients in the form of traditional Medicare. In essence, single payer is an improved Medicare for all.

Obama touted his plan as a way to reduce the escalating costs of health care in this country. But he’s exaggerating the amount of waste and inefficiency he can wring out of Medicare and Medicaid. And the Congressional Budget Office estimated that his plan would actually end up costing hundreds of billions of dollars.

But if we implemented single payer, the savings would be enormous. Medicare incurs approximately 3 percent in administrative overhead annually, compared to at least five times that figure in private insurance plans. If you factor in all the bureaucracy and paperwork inflicted on physicians and hospitals by the insurance industry, the administrative waste in our present system amounts to $400 billion annually.

By replacing the for-profit insurance companies with a streamlined Medicare for all, that $400 billion could be put back where it belongs: providing health care. The new system would basically pay for itself.

Insurance companies play no constructive role in providing health care. They do not give you a physical exam; they do not perform your surgery. What they do instead is fight claims, issue denials and screen out the sick, diverting huge sums away from much-needed care.

The savings rendered by cutting out private insurance companies and establishing a single-payer plan would be sufficient to cover everyone who lacks insurance now and to upgrade insurance for everyone else.

Our nation spends twice per person on health care as other industrialized countries do, but our health outcomes are significantly worse.

What gives? How can we spend more and get less than the rest of the world?

The answer is that most these countries have taken a fundamental step that we haven’t: the elimination of U.S.-style, for-profit private health insurance.

We should take that step.

Obama should have proposed a single-payer plan in the first place. Not that the path would have been politically easy. But single payer would have been easier to defend than the expensive, overly bureaucratic, patchwork mess that he is trying to sell to the American public.

It’s time for Congress acknowledge what patients and doctors across the country already know, that single-payer Medicare for all is the only way to achieve affordable and effective health care.

Dr. Oliver Fein is professor of clinical medicine and public health at Weill Cornell Medical College in New York. He is also president of Physicians for a National Health Program (www.pnhp.org).

EXCLUSIVE: UnitedHealth Lobbyist Announces Pelosi Fundraiser As She Begins Backing Off Pub Option

By David Sirota
OpenLeft Blog
Fri Sep 11, 2009

House Speaker Nancy Pelosi for the first time yesterday suggested she may be backing off her support of the public option. According to CNN, Pelosi and Senate Majority Leader Harry Reid “said they would support any provision that increases competition and accessibility for health insurance – whether or not it is the public option favored by most Democrats.” When “asked if inclusion of a public option was a non-negotiable demand – as her previous statements had indicated Pelosi ruled out any non-negotiable positions,” according to CNN. This was also corroborated by the Associated Press, and by Pelosi’s own words, as quoted in those stories.

This announcement came just hours before Steve Elmendorf, a registered UnitedHealth lobbyist and the head of UnitedHealth’s lobbying firm Elmendorf Strategies, blasted this email invitation throughout Washington, D.C. I just happened to get my hands on a copy of the invitation from a source – check out this OpenLeft exclusive:

From: Steve Elmendorf [mailto:steve@elmendorfstrategies.com]
Sent: Friday, September 11, 2009 8:31 AM
Subject: event with Speaker Pelosi at my home

You are cordially invited to a reception with

Speaker of the House
Nancy Pelosi

Thursday, September 24, 2009
6:30pm ~ 8:00pm

At the home of
Steve Elmendorf
2301 Connecticut Avenue, NW
Apt. 7B
Washington, D.C.

$5,000 PAC
$2,400 Individual

To RSVP or for additional information please contact
Carmela Clendening at (202) 485-3508 or clendening@dccc.org

Steve Elmendorf
ELMENDORF STRATEGIES
GOVERNMENT AFFAIRS SOLUTIONS
900 7th Street NW Suite 750 Washington DC 20001
(202) 737-1655

Again, Elmendorf is a registered lobbyist for UnitedHealth, and his firm’s website brags about its work for UnitedHealth on its website (Elmendorf was also a chief of staff for Democratic Minority Leader Dick Gephardt).

The sequencing here is important: Pelosi makes her announcement and then just hours later, the fundraising invitation goes out. Coincidental? I’m guessing no – these things rarely ever are.

I wrote a book a few years ago called Hostile Takeover whose premise was that corruption and legalized bribery has become so widespread that nobody in Washington even tries to hide it. This is about as good an example of that truism as I’ve ever seen.

http://www.openleft.com/showDiary.do?diaryId=21

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

Comment:

By Don McCanne, MD

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.

It’s Simple: Medicare for All

By George S. McGovern
Washington Post
Sunday, September 13, 2009

For many years, a handful of American political leaders — including the late senator Ted Kennedy and now President Obama — have been trying to gain passage of comprehensive health care for all Americans. As far back as President Harry S. Truman, they have urged Congress to act on this national need. In a presentation before a joint session of Congress last week, Obama offered his view of the best way forward.

But what seems missing in the current battle is a single proposal that everyone can understand and that does not lend itself to demagoguery. If we want comprehensive health care for all our citizens, we can achieve it with a single sentence: Congress hereby extends Medicare to all Americans.

Those of us over 65 have been enjoying this program for years. I go to the doctor or hospital of my choice, and my taxes pay all the bills. It’s wonderful. But I would have appreciated it even more if my wife and children and I had had such health-care coverage when we were younger. I want every American, from birth to death, to get the kind of health care I now receive. Removing the payments now going to the insurance corporations would considerably offset the tax increase necessary to cover all Americans.

I don’t feel as though the government is meddling in my life when it pays my doctor and hospital fees. There are some things the government does that I don’t like — most notably getting us into needless wars that cost many times what health care for all Americans would cost. Investing in the health of our citizens will enhance the well-being and security of the nation.

We know that Medicare has worked well for half a century for those of us over 65. Why does it become “socialized medicine” when we extend it to younger Americans?

Taking such a shortsighted view would leave nearly 50 million Americans without health insurance and without the means to buy it. It would leave other Americans struggling to pay the rising cost of insurance premiums. These private insurance plans are frequently terminated if the holder contracts a serious long-term ailment. And some people lose their insurance if they lose their jobs or if the plant where they work moves to another location — perhaps overseas.

We recently bailed out the finance houses and banks to the tune of $700 billion. A country that can afford such an outlay while paying for wars in Iraq and Afghanistan can afford to do what every other advanced democracy has done: underwrite quality health care for all its citizens.

If Medicare needs a few modifications in order to serve all Americans, we can make such adjustments now or later. But let’s make sure Congress has an up or down vote on Medicare for all before it adjourns this year. Let’s not waste time trying to reinvent the wheel. We all know what Medicare is. Do we want health care for all, or only for those over 65?

If the roll is called and it goes against those of us who favor national health care, so be it. If it is approved, the entire nation can applaud.

Many people familiar with politics in America will tell you that this idea can’t pass Congress, in part because the insurance lobby is too powerful for lawmakers to resist.

As matters now stand, the insurance companies claim $450 billion a year of our health-care dollars. They will fight hard to hold on to this bonanza. This is a major reason Americans pay more for health care per capita than any other people in the world. The insurance executives didn’t cry “socialism” when their buddies in banking and finance were bailed out. But to them it is socialism if the government underwrites the cost of health care.

Consider the campaign funds given to the chairman and ranking minority member of the Senate Finance Committee, which has jurisdiction over health-care legislation. Chairman Max Baucus of Montana, a Democrat, and his political action committee have received nearly $4 million from the health-care lobby since 2003. The ranking Republican, Charles Grassley of Iowa, has received more than $2 million. It’s a mistake for one politician to judge the personal motives of another. But Sens. Baucus and Grassley are firm opponents of the single-payer system, as are other highly placed members of Congress who have been generously rewarded by the insurance lobby.

In the past, doctors and their national association opposed Medicare and efforts to extend such benefits. But in recent years, many doctors have changed their views.

In December 2007, the 124,000-member American College of Physicians endorsed for the first time a single-payer national health insurance program. And a March 2008 study by Indiana University — the largest survey ever of doctors’ opinions on financing health-care reform — concluded that 59 percent of doctors support national health insurance.

To have the doctors with us favoring government health insurance is good news. As Obama said: “We did not come to fear the future. We came here to shape it.”

George S. McGovern, a former senator from South Dakota, was the Democratic nominee for president in 1972.

‘Mad as Hell’ caravan tours Montana, touts health care for all

By MIKE DENNISON The Missoulian Friday, September 11, 2009

HELENA – Retired internist Robert Seward, a self-described “Mad as Hell” doctor who wants a publicly funded health system that covers all Americans, told a Helena crowd Thursday that he had a telling conversation with a Canadian citizen a day earlier.

As Seward checked into his motel in Spokane, he told the Canadian about the “Mad as Hell” cross-country caravan, meant to publicize how a Medicare-for-all system is the best way to reform health care in America – a system like Canada’s, where all citizens are covered equally with taxpayer-financed health insurance.

The Canadian man was perplexed as to why Americans wouldn’t embrace such a system, Seward said, and why America allows citizens to go bankrupt because of personal health care costs.

“He asked, ‘Why don’t you Americans take care of your own people?’ ” Seward said. “We don’t. It’s embarrassing. That’s why I’m mad as hell.”

Seward and some of his physician colleagues from Oregon and Washington are in Helena until Saturday, as part of their three-week tour to promote a Medicare-for-all system of health coverage as the best reform for the nation. The nation’s health-care system is “far more broken than you could possibly imagine,” said emergency room physician Paul Hochfield of Corvallis, Ore., and the only way to fix it is get rid of private, for-profit health insurance and replace it with a public system.

“It’s being hijacked by the industry for profits instead of for the public good,” he said.

The doctors, who said they used their own money to start the tour, say health reforms being advanced by President Barack Obama, Sen. Max Baucus, D-Mont., and others simply serve to entrench profitable private interests that are making health care unaffordable for the average person.

The tour is scheduled to end Sept. 30 in Washington, D.C., where the doctors will be part of a rally for a single-payer, Medicare-for-all system.

They’re stopping for three days in Helena, including a rally held Thursday on the Capitol steps, a town meeting on Saturday at Carroll College, and, on Friday, a panel/debate at the Montana Medical Association convention.

At the MMA convention, the Mad as Hell doctors will square off against physicians with a conservative group, the Coalition to Protect Patients’ Rights, which opposes more government involvement in health care and is dead-set against a single-payer system.

Mike Huntington, a retired radiation oncologist from Corvallis, Ore., said the Mad as Hell group believes the country would be better off with Congress passing no reform this year, as opposed to the reforms being considered now, so the public could become more familiar with the benefits of Medicare-for-all.

Huntington also commented on Obama’s Wednesday speech to Congress, in which the president talked about the myriad of problems with the current health care system and then said he won’t support Medicare-for-all because we need to build on the current system. “That’s political doublespeak for, ‘The health-and-insurance industry has told me I might not be re-elected unless I include them and I write laws that satisfy them,’ ” Huntington said.

Congress is not seriously considering a Medicare-for-all system, although there is supposed to be a vote this month on a House amendment that would enact such a system. Baucus, a key figure in health-reform legislation, has declared Medicare-for-all “off the table” from the beginning.

Some liberals in Congress are pushing for a so-called “public option” as part of reforms, which is a government-run health insurance plan that’s supposed to compete with private insurance.

Huntington said the public option is a joke, because the only people covered by it would be the people that the private insurers don’t want: The poor, the unemployed and people with health problems. It might struggle along for a few years and eventually die, overburdened by high costs, and then conservatives would use it as an example of how government can’t run anything, he said.

http://www.missoulian.com/news/local/article_e6432836-9e8f-11de-85f3-001cc4c002e0.html