PNHP

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

‘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.

Virginia Information

Contact Information

Virginia PNHP
Website: http://va.pnhp.org/

Steering Committee

Monthly Meeting

The Virginia chapter of PNHP meets bi-monthly on the first Wednesday of the month at 7:30 p.m. Eastern. Interested in joining? Fill out our Virginia PNHP Interest Form HERE to receive the Zoom link.

Local Unions Endorsing Medicare for All

  • Local 2222 Communications Workers of America (CWA), Annandale, VA
  • Northern Virginia Central Labor Council, Annandale, VA
  • Public Service Workers Union, UE Local 160, Williamsburg, VA

Sarah Palin feeds the fact checkers

Obama and the Bureaucratization of Health Care

By Sarah Palin
The Wall Street Journal
September 9, 2009
Some 45 years ago Ronald Reagan said that “no one in this country should be denied medical care because of a lack of funds.” Each of us knows that we have an obligation to care for the old, the young and the sick. We stand strongest when we stand with the weakest among us.
Common sense tells us that the government’s attempts to solve large problems more often create new ones. Common sense also tells us that a top-down, one-size-fits-all plan will not improve the workings of a nationwide health-care system that accounts for one-sixth of our economy.
… many of the sick and elderly are concerned that the Democrats’ proposals will ultimately lead to rationing of their health care by — dare I say it — death panels?
http://online.wsj.com/article/SB20001424052970203440104574400581157986024.html

And…

A Time for Choosing

By Ronald Reagan
October 27, 1964
A young man, 21 years of age, working at an average salary — his Social Security contribution would, in the open market, buy him an insurance policy that would guarantee 220 dollars a month at age 65. The government promises 127. He could live it up until he’s 31 and then take out a policy that would pay more than Social Security. Now are we so lacking in business sense that we can’t put this program on a sound basis, so that people who do require those payments will find they can get them when they’re due — that the cupboard isn’t bare?
Barry Goldwater thinks we can.
At the same time, can’t we introduce voluntary features that would permit a citizen who can do better on his own to be excused upon presentation of evidence that he had made provision for the non-earning years? Should we not allow a widow with children to work, and not lose the benefits supposedly paid for by her deceased husband? Shouldn’t you and I be allowed to declare who our beneficiaries will be under this program, which we cannot do? I think we’re for telling our senior citizens that no one in this country should be denied medical care because of a lack of funds. But I think we’re against forcing all citizens, regardless of need, into a compulsory government program, especially when we have such examples, as was announced last week, when France admitted that their Medicare program is now bankrupt. They’ve come to the end of the road.
http://www.reagan.utexas.edu/archives/reference/timechoosing.html

The heated debate over health care reform was certainly not unexpected. What has been a surprise to many of us is the intensity of the nastiness of the opponents of reform.
In the past, politicians often supported their ideological positions through distortions created by carefully selecting favorable facts and discarding the unfavorable. In the current debate it seems like the ideologues opposed to reform are creating rhetoric that does not carry the burden of factual support. That flexibility allows an introduction of nastiness like we’ve never seen. That has extended all the way to Congress where we heard during President Obama’s address the shout from a Congressman, “You lie!”
The rhetoric is so bad that we have now introduced fact checkers – a problem in itself since since some dispute the facts that the fact checkers are using. Risking the possibility that my comments might be challenged based on my ideology (supporting health care for all), I’ll do my best to provide a little bit of honest fact checking here.
* Sarah Palin selected a quote from Ronald Reagan suggesting that we as a nation will stand together to see that no one in this country “be denied medical care because of a lack of funds.” It would be difficult to interpret this as representing anything other than unambiguous support for the concept of social insurance. Of course then she dispels that notion with her own anti-government rhetoric.
* Placing that same quote of Ronald Reagan in context, it was actually buried in his attack on Social Security, rejecting social insurance as a “compulsory government program.” Although he did say that no one should be denied medical care because of lack of funds, he did not tell us what the source of those funds would be.
* Ronald Reagan said, “… France admitted that their Medicare program is now bankrupt. They’ve come to the end of the road.” That was in 1964. This year, 2009, the conservative leaders in France have again stated that their health care program is bankrupt. Regardless, their health care system has been ranked number one by the World Health Organization, and it is funded at a fraction of what we spend per capita in the United States. The “bankrupt” rhetoric will always be with us, but what really counts is whether or not the system is providing everyone with the health care that they need.
* To prove what a bad deal Social Security is, Ronald Reagan used the example of a 21 year old with average wages. He said that a privately purchased insurance policy would provide a guarantee of 220 dollars a month at age 65, whereas Social Security would guarantee him only 127 dollars per month. As it happens, that 21 year old would be 66 now, and the average Social Security benefit for a retired worker is 1,153 dollars per month (SSA.gov). (I can hear the conservative actuaries saying, “But… but… you lie!”)
* Sarah Palin dared to repeat once again: “death panels.” Although we’ve been saturated with the fact checkers’ “pants on fire” ratings of this comment, that is no problem for the conservatives – the fact checkers lie.
The nastiness of this dialogue has seemed to lock us into a nonsensical “True! Lie!” debate over relatively peripheral issues. This is a debate that the conservatives will always win because it diverts us from the fundamentals of reform. In the meantime, behind the scenes the insurance industry has manipulated its own jackpot win while the noisy public debate has been taking place.
The tragedy is that the Democrats allowed themselves to be maneuvered into a position of a pseudo-bipartisan compromise that is based on a mandate to purchase private health plans that many middle-income Americans cannot afford.
Here is where the debate should have been:
* A Medicare for all program that automatically enrolls everyone is a truly universal program. TRUE!
* A mandate to purchase private health plans is a truly universal program. FALSE!
* The single payer model of reform includes policies that are effective in slowing the increase in health care costs to a sustainable level. TRUE!
* The current Democratic model of reform contains measures that are effective in slowing the increase in health care costs to a sustainable level. FALSE!
* A single universal risk pool that is funded through equitable tax policies will make health care affordable for each and every individual. TRUE!
* A multi-payer system of public and private programs funded from multiple sources, including a mandate to pay partially subsidized premiums for some, will make health care affordable for each and every individual. FALSE!
Come on! Let’s start debating the TRUTH, based on actual FACTS. Let’s advocate for affordable health care for everyone. A fact checker can’t challenge simple human decency.

Health reform should start with moral question

The Missoulian
Letter to the editor
Thursday, September 10, 2009

Amidst the give and take of the health care reform discussion is an underlying basic moral imperative: Does a wealthy country like the United States have an ethical obligation to provide access to health care to everybody?

If the U.S. made the moral choice to provide universal coverage, like other industrialized nations, then we too could design a fair, efficient and high-quality health care system for all Americans.

So the first question that must be answered by policy makers is, “Do we want to live in a society that lets tens of thousands of our neighbors die each year, and hundreds of thousands face financial ruin, because they can’t afford medical care when they are sick?”

Once answered that morally everybody should have a basic human right to health, aided through a system of health care, that is comprehensive, simple to administer, of lower cost, and universally available, we can move to the next step.

The concept of a unified system that works the same for everybody doesn’t necessarily equate to a single-payer system, although this seems to be the simplest and best. There are multi-payer systems that provide fairness and the administrative simplicity of a single payer structure: all patients treated the same and all the payers follow a coordinated set of rules and forms, and all providers fees adhere to a unified payment schedule. A unified system makes it easier to use digital record keeping. It eliminates cost shifting and an incentive for preventive health measures.

The fragmented system we have hasn’t worked. Financing health care must be a non-profit endeavor. A unified system creates a powerful political dynamic for managing cost. Universal coverage enhances health care results by improving the overall health of a nation. Incomplete coverage is a key reason 22,000 die every year from diseases that could have been treated if they’d had health insurance.

Because administrative costs and unnecessary care, combined with perverse incentives, are the major causes of the expense, the concept of a single payer system is mandatory. This is an anathema to free-market people, who are misleading the public by negative advertising, with denigration by politicians and others, labeling it “socialized medicine,” and “government interference.”

To get the truth out, there should be a new intense advertising campaign to educate the public about the benefits of this approach. A single payer system could be run by a federal board, independent of the government, appointed by the president and confirmed by the Senate. It could function with assistance of health care experts and be immune to political interference. Regional entities under the board’s aegis could manage the delivery of health care. Unnecessary care could be monitored so the link between income and generated procedures and tests could be curbed. There are many options for reimbursement to providers: capitation, global payments, salary system, pay for episodes of care, rewards for improved outcomes, and pay according to episodes of care. It’s interesting that 30 % of U.S. physicians are already on salary. Tort reform must also be addressed to eliminate the high cost of liability insurance, through a review panel of peers for malpractice claims.

All of this could be done by not spending any more than what we do now. It is more likely there would be a huge reduction in health care spending. It just doesn’t make sense to continue the partisan pursuit of complicated individual interests. Everyone needs to proclaim that there exists a moral imperative; that it does mean providing access to health care for everyone. It is relatively common sense to then formulate a government funded, unified system, with nonprofit financing and coverage for every citizen – a single-payer system.

Richard A. Damon, MD
Bozeman

Over 70 Labor Organizations Call on AFL-CIO Convention to Endorse HR 676

Kay Tillow
All Unions Committee For Single Payer Health Care–HR 676
09/10/09

Pittsburgh, PA — More than seventy labor organizations have submitted resolutions to the AFL-CIO Convention calling for the labor federation to endorse HR 676, single payer healthcare legislation introduced by Congressman John Conyers (D-MI).

Resolutions were submitted by five national and international unions including the International Longshore & Warehouse Union (ILWU), the International Alliance of Theatrical & Stage Employees (IATSE), the California Nurses Association/National Nurses Organizing Committee (CNA/NNOC), California School Employees Association (CSEA), and the International Federation of Professional & Technical Engineers (IFPTE).

Seven state AFL-CIO Federations submitted resolutions including Wisconsin, South Carolina, Maine, Michigan, Kentucky, California and Vermont.

The remaining resolutions were submitted by Central Labor Councils and Area Labor Federations in twenty states.

All resolutions, including one expected to be submitted by the Executive Council, will be referred to the Convention’s Legislative Policy Committee which is chaired by Leo Gerard, President of the United Steelworkers.

Healthcare is expected to be discussed on Tuesday September 15th after President Obama addresses the Convention.

HR 676 would institute a single payer health care system by expanding a greatly improved Medicare system to everyone residing in the U. S.

HR 676 would cover every person for all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, dental, mental health, home health, physical therapy, rehabilitation (including for substance abuse), vision care, hearing services including hearing aids, chiropractic, durable medical equipment, palliative care, and long term care.

HR 676 ends deductibles and co-payments. HR 676 would save hundreds of billions annually by eliminating the high overhead and profits of the private health insurance industry and HMOs.

In the current Congress, HR 676 has 86 co-sponsors in addition to Conyers. Vermont Senator Bernie Sanders has introduced SB 703, a single payer bill in the Senate.

HR 676 has been endorsed by 566 union organizations in 49 states including 134 Central Labor Councils and Area Labor Federations and 39 state AFL-CIO’s (KY, PA, CT, OH, DE, ND, WA, SC, WY, VT, FL, WI, WV, SD, NC, MO, MN, ME, AR, MD-DC, TX, IA, AZ, TN, OR, GA, OK, KS, CO, IN, AL, CA, AK, MI, MT, NE, NY, NV & MA).

For further information, a list of union endorsers, or a sample endorsement resolution, contact:

c/o Nurses Professional Organization (NPO)
1169 Eastern Parkway, Suite 2218
Louisville, KY 40217
(502) 636 1551
Email: nursenpo@aol.com
http://unionsforsinglepayerHR676.org

Access to medical care a basic human right

Guest column
The Missoulian
Friday, September 11, 2009

The commercial aspects of restructuring the health care industry are receiving much attention. Those of us who have been involved in the actual delivery of medical care believe there is a principle underlying the entire enterprise. Understanding this principle provides perspective that helps to evaluate the business details in reform plans as they emerge in coming weeks.

We believe that the United States needs to join the vast majority of the developed world and acknowledge the principle that medical care is a basic human right.

Nations recognizing this truth include Australia, Austria, Britain, Canada, Denmark, France, Germany, Ireland, Japan, the Netherlands, New Zealand, Switzerland and Taiwan. The United States is unique among major industrialized nations in not recognizing health care as a basic right for all its citizens.

Here’s the choice: If you consider health care a market-driven commodity, you will be content to make modest changes around the edges of our present profit-driven system. If you consider health care to be a business, you will tolerate the perverse incentives that increase business volume and you will be content to continue our current method of rationing on the basis of purchasing power.

However, if you understand medical practice to be a profession responding to a basic human need, and hospital services to be a critical element of health care, you will insist on genuine, far-reaching reform with a goal of achieving universal access.

While we understand that there may be many ways to achieve meaningful reform, we endorse a strong public health insurance option as the centerpiece of an effective strategy that can provide for the general welfare and at the same time retain the freedom of choice that citizens desire.

We know that our country will be more productive, our businesses stronger and our futures brighter if all of us have access to care.

This guest column was signed by Drs. Randale Sechrest, Herbert Swick, Stephen Speckart, Megan Sarnecki, George Risi, Liz Rantz, Roger Munro, William Nichols, Jan B. Newman, Judy Olson, Byron Olson, Al Gabster, Patrick Davis, N. Nelle Cotton, Henry W. Busey, John Brown, Hal Braun, Ned Vasquez, Alison Fortney-Gorman, David Gorman and by Elizabeth Oleson and Lee Ann Bradley, PharmD.

Sarah Palin feeds the fact checkers

Obama and the Bureaucratization of Health Care

By Sarah Palin
The Wall Street Journal
September 9, 2009

Some 45 years ago Ronald Reagan said that “no one in this country should be denied medical care because of a lack of funds.” Each of us knows that we have an obligation to care for the old, the young and the sick. We stand strongest when we stand with the weakest among us.

Common sense tells us that the government’s attempts to solve large problems more often create new ones. Common sense also tells us that a top-down, one-size-fits-all plan will not improve the workings of a nationwide health-care system that accounts for one-sixth of our economy.

… many of the sick and elderly are concerned that the Democrats’ proposals will ultimately lead to rationing of their health care by — dare I say it — death panels?

http://online.wsj.com/article/SB20001424052970203440104574400581157986024.html

And…

A Time for Choosing

By Ronald Reagan
October 27, 1964

A young man, 21 years of age, working at an average salary — his Social Security contribution would, in the open market, buy him an insurance policy that would guarantee 220 dollars a month at age 65. The government promises 127. He could live it up until he’s 31 and then take out a policy that would pay more than Social Security. Now are we so lacking in business sense that we can’t put this program on a sound basis, so that people who do require those payments will find they can get them when they’re due — that the cupboard isn’t bare?

Barry Goldwater thinks we can.

At the same time, can’t we introduce voluntary features that would permit a citizen who can do better on his own to be excused upon presentation of evidence that he had made provision for the non-earning years? Should we not allow a widow with children to work, and not lose the benefits supposedly paid for by her deceased husband? Shouldn’t you and I be allowed to declare who our beneficiaries will be under this program, which we cannot do? I think we’re for telling our senior citizens that no one in this country should be denied medical care because of a lack of funds. But I think we’re against forcing all citizens, regardless of need, into a compulsory government program, especially when we have such examples, as was announced last week, when France admitted that their Medicare program is now bankrupt. They’ve come to the end of the road.

http://www.reagan.utexas.edu/archives/reference/timechoosing.html

Comment:

By Don McCanne, MD

The heated debate over health care reform was certainly not unexpected. What has been a surprise to many of us is the intensity of the nastiness of the opponents of reform.

In the past, politicians often supported their ideological positions through distortions created by carefully selecting favorable facts and discarding the unfavorable. In the current debate it seems like the ideologues opposed to reform are creating rhetoric that does not carry the burden of factual support. That flexibility allows an introduction of nastiness like we’ve never seen. That has extended all the way to Congress where we heard during President Obama’s address the shout from a Congressman, “You lie!”

The rhetoric is so bad that we have now introduced fact checkers – a problem in itself since since some dispute the facts that the fact checkers are using. Risking the possibility that my comments might be challenged based on my ideology (supporting health care for all), I’ll do my best to provide a little bit of honest fact checking here.

* Sarah Palin selected a quote from Ronald Reagan suggesting that we as a nation will stand together to see that no one in this country “be denied medical care because of a lack of funds.” It would be difficult to interpret this as representing anything other than unambiguous support for the concept of social insurance. Of course then she dispels that notion with her own anti-government rhetoric.

* Placing that same quote of Ronald Reagan in context, it was actually buried in his attack on Social Security, rejecting social insurance as a “compulsory government program.” Although he did say that no one should be denied medical care because of lack of funds, he did not tell us what the source of those funds would be.

* Ronald Reagan said, “… France admitted that their Medicare program is now bankrupt. They’ve come to the end of the road.” That was in 1964. This year, 2009, the conservative leaders in France have again stated that their health care program is bankrupt. Regardless, their health care system has been ranked number one by the World Health Organization, and it is funded at a fraction of what we spend per capita in the United States. The “bankrupt” rhetoric will always be with us, but what really counts is whether or not the system is providing everyone with the health care that they need.

* To prove what a bad deal Social Security is, Ronald Reagan used the example of a 21 year old with average wages. He said that a privately purchased insurance policy would provide a guarantee of 220 dollars a month at age 65, whereas Social Security would guarantee him only 127 dollars per month. As it happens, that 21 year old would be 66 now, and the average Social Security benefit for a retired worker is 1,153 dollars per month (SSA.gov). (I can hear the conservative actuaries saying, “But… but… you lie!”)

* Sarah Palin dared to repeat once again: “death panels.” Although we’ve been saturated with the fact checkers’ “pants on fire” ratings of this comment, that is no problem for the conservatives – the fact checkers lie.

The nastiness of this dialogue has seemed to lock us into a nonsensical “True! Lie!” debate over relatively peripheral issues. This is a debate that the conservatives will always win because it diverts us from the fundamentals of reform. In the meantime, behind the scenes the insurance industry has manipulated its own jackpot win while the noisy public debate has been taking place.

The tragedy is that the Democrats allowed themselves to be maneuvered into a position of a pseudo-bipartisan compromise that is based on a mandate to purchase private health plans that many middle-income Americans cannot afford.

Here is where the debate should have been:

* A Medicare for all program that automatically enrolls everyone is a truly universal program. TRUE!

* A mandate to purchase private health plans is a truly universal program. FALSE!

* The single payer model of reform includes policies that are effective in slowing the increase in health care costs to a sustainable level. TRUE!

* The current Democratic model of reform contains measures that are effective in slowing the increase in health care costs to a sustainable level. FALSE!

* A single universal risk pool that is funded through equitable tax policies will make health care affordable for each and every individual. TRUE!

* A multi-payer system of public and private programs funded from multiple sources, including a mandate to pay partially subsidized premiums for some, will make health care affordable for each and every individual. FALSE!

Come on! Let’s start debating the TRUTH, based on actual FACTS. Let’s advocate for affordable health care for everyone. A fact checker can’t challenge simple human decency.

Census Bureau report on health insurance coverage

Health Insurance Coverage: 2008

U.S. Census Bureau
September 10, 2009
* The percentage of people without health insurance in 2008 was not statistically different from 2007 at 15.4 percent. The number of uninsured increased to 46.3 million in 2008, from 45.7 million in 2007.
* The number of people with health insurance increased to 255.1 million in 2008 — up from 253.4 million in 2007. The number of people covered by private health insurance decreased to 201.0 million in 2008 — down from 202.0 million in 2007. The number of people covered by government health insurance increased to 87.4 million — up from 83.0 million in 2007.
* The percentage of people covered by private health insurance was 66.7 percent in 2008 — down from 67.5 percent in 2007. The percentage of people covered by employment-based health insurance decreased to 58.5 percent in 2008, from 59.3 percent in 2007. The number of people covered by employment-based health insurance decreased to 176.3 million in 2008, from 177.4 million in 2007.
* The percentage of people covered by government health insurance programs increased to 29.0 percent in 2008, from 27.8 percent in 2007. The percentage and the number of people covered by Medicaid increased to 14.1 percent and 42.6 million in 2008, from 13.2 percent and 39.6 million in 2007. The percentage and number of people covered by Medicare increased to 14.3 percent and 43.0 million in 2008, from 13.8 percent and 41.4 million in 2007.
* In 2008, the percentage and number of children under 18 without health insurance were 9.9 percent and 7.3 million, lower than they were in 2007 at 11.0 percent and 8.1 million. The uninsured rate and the number of uninsured for children are the lowest since 1987, the first year that comparable health insurance data were collected. Although the uninsured rate for children in poverty decreased to 15.7 percent in 2008, from 17.6 percent in 2007, children in poverty were more likely to be uninsured than all children.
* The uninsured rate and number of uninsured for non-Hispanic Whites increased in 2008 to 10.8 percent and 21.3 million, from 10.4 percent and 20.5 million in 2007. The uninsured rate and number of uninsured for Blacks in 2008 were not statistically different from 2007, at 19.1 percent and 7.3 million.
* The percentage of uninsured Hispanics decreased to 30.7 percent in 2008, from 32.1 percent in 2007. The number of uninsured Hispanics was not statistically different in 2008, at 14.6 million.
http://www.census.gov/hhes/www/hlthins/hlthin08.html

President Obama, in his speech before the joint session of Congress last evening, did not break new ground on the current proposal for reform being developed by Congress and the administration. So, based on the framework that has been advanced, what impact will the current proposal have on the numbers of uninsured?
* The primary reason for the excessive numbers of uninsured is that health care costs are now so high that premiums for adequate health plans are no longer affordable for low and middle income individuals. The policies in the current proposal designed to reduce health care spending are inadequate and will not have an impact on reducing the numbers of uninsured since it will be impossible to create less expensive plans that have adequate benefits.
* Although lower-income individuals will have greater access to Medicaid/CHIP and to larger subsidies to purchase private plans, the subsidies for average-income Americans will be inadequate to make the premiums and cost sharing affordable.
* Most small businesses will be exempt from the employer mandate and thus will not be a factor in increasing the rate of insurance coverage amongst their employees.
* Initially only uninsured individuals and small businesses will have access to the insurance exchange. Thus most Americans will not be able to select from an FEHBP-like menu of plans similar to the program that members of Congress now have.
* Because of a reluctance to increase revenues through the tax system and an insistence that the program not add to our budget deficits, Congress has restricted the amount of funds that will be available to expand Medicaid and to finance the premium subsidies for the private plans.
* Middle-income individuals will be mandated to purchase private health plans. Affordability of these plans for individuals and families will be determined by income levels, by the amount of the government subsidies used to purchase the plans, by adequacy of plan benefits, and by the amount of cost sharing required of those accessing care. Based on the preliminary numbers provided, serious affordability issues will be faced by a far greater number of middle-income individuals than are being projected by the architects of the proposal.
* Because of affordability issues, consideration is being given to allowing the purchase of underinsurance plans like those designed for the young invincibles. Because of the adverse health and financial impacts of relying on these deficient plans, these individuals should be counted amongst the uninsured from a policy design perspective.
* It has been agreed that the inadequacy of the government subsidies will require the issuance of hardship waivers for those who cannot afford their portion of the insurance premium, based on their incomes. Hardship waivers will become commonplace for those caught between low-income, where government support is generous, and high-income, where affordability is not a consideration. Those in the middle are the majority of Americans. Hardship waivers which relieve individuals of paying fines for the crime of being uninsured could become the standard for middle-income Americans.
An improved Medicare for all single payer program would automatically include everyone, and would be affordable for all of us. President Obama’s program will leave far too many out, and will fail to adequately address the high costs of health care.
Many believe that President Obama effectively used his address to set the stage for the final phases of the reform process, with no turning back. We desperately do need to push on with reform, but it needs to be reform that works.
When President Obama mentioned single payer last evening, there was an embarrassing smattering of applause. Democrats were there to support the president who supports a mandate to purchase private plans that you can’t afford. How embarrassing. Supporting a plan that serves the private insurance industry so well, at great cost to the American people.
So you disagree? You think that this will serve middle-income Americans well? Prove it! Demand a full study that calculates premiums for private plans with adequate benefits and adequate financial protection in the face of medical need and includes all risks in the pools, that determines the premiums as a percent of income at various income levels, that determines the size of the subsidy that would be required to make the balance of the premiums affordable at each income level, that determines the level of cost sharing that would be required of those with needs, that determines the true amount of public funding that would be necessary to support those premiums and cost sharing, and then describes precisely the sources of that public funding.
Those crafting reform can’t make the numbers work. If you can’t either, then join us in a march on Washington to demand that they enact reform with numbers that do work in providing all of us with the health care that we need. Sacrificing the insurers should not be an embarrassment to any of us. It should be a matter of pride.

Iowa reaction to Obama's speech

University psychiatrist: ‘Step back and start over’ 

Des Moines Register
Sept.10

Dr. Jess Fiedorowicz, a University of Iowa psychiatrist: He was not won over. Fiedorowicz favors a single-payer health care system, in which government insurance would cover everyone.

“President Barack Obama continues his struggle to foster what is likely to be an ineffective compromise between uncompromising parties,” he wrote after the speech. “Instead, we should step back and start over on health reform.”

Fiedorowicz called Obama’s proposal “a handout to the health-insurance industry.”

“A single-payer system is the only proposal to address the unnecessarily convoluted and complex system, which spends 31 cents of every health care dollar on overhead. … President Obama, however, dismissed single payer as ‘from the left’ and ‘a radical shift.’ However, a radical shift is necessary to reduce the overhead in our system.”