PNHP

Opinion: Single-payer health care: dead in Washington, but alive in the states

Opinion: Single-payer health care: dead in Washington, but alive in the states

Insurance companies may be winning the fight in Washington, but California and Vermont are on the cusp of comprehensive reform.

By Michael Corcoran
Opinion
Christian Science Monitor
September 10, 2009 edition

Boston – President Obama delivered a stirring address to Congress last night, but the federal government’s inability to truly overhaul our broken healthcare system — which now leaves more than 46 million uninsured — is becoming all the more apparent.

Speaking before a joint session of Congress, Obama declared that a public option to compete with private insurers, considered vital by many liberals, was merely a “means to an end,” and not essential to healthcare reform. Earlier this summer, a New York Times/CBS poll showed that 72 percent of Americans support a government-run healthcare plan. But Obama’s speech last night indicates that while a bill will probably pass, prospects for comprehensive reform — the kind millions of Americans voted for — have dimmed rapidly. Insurance companies, which have given large donations to both political parties, are winning the fight in Washington.

The inability of a popular president with substantial majorities in Congress to pass a progressive health bill is immensely frustrating to healthcare activists, and to all who gave Obama a mandate for change.

But their cause is not lost — they just need a new strategy.

Given the corporate world’s disproportionate influence over Washington, it is time to take the fight for public healthcare away from Congress and into statehouses across the country.

State governments are typically far more democratic that the federal government and the public has a much greater ability to penetrate the debate. Moreover, in some states there are already legislatures and grass-roots movements that are working to make a statewide “single-payer plan” — similar to Canada’s national health coverage — a reality.

Two state legislatures — Vermont and California — have, in fact, passed single-payer legislation in recent years only to have them vetoed by Republican governors. But California Gov. Arnold Schwarzenegger (R) is ineligible to run for a third term and Gov. Jim Douglas (R) of Vermont has decided not to seek reelection. Either of these states could soon become the first to pass a statewide, public healthcare system that covers everyone.

“I think it makes sense to push for single-payer on a state-wide level,” says Dr. Deb Richter, founder of Vermont Health Care for All. “It looks pretty grim in Washington … so we are mobilizing our forces.”

Healthcare activists in Vermont are now advocating for single-payer bills in the Senate and the House and plan to highlight the issue for the 2010 gubernatorial campaign. The Vermont Workers’ Center is more than a year into a “Healthcare Is a Human Right” campaign that is releasing reports and organizing rallies all over the state.

“We think this could really happen here,” says James Haslam, director of the Vermont Workers’ Center. “There is a lot of excitement around this issue. Vermont could become a model for the rest of the country.”

Indeed, Vermont may be the state best suited to tackle single-payer. According to a study commissioned by the Vermont Legislature in 2006, Vermont would save $51 million a year if it switched to single-payer. The state is also home to a supportive congressional delegation. Sen. Bernie Sanders, an independent who caucuses with the Democrats, has introduced legislation in the Senate that would enable states to have single-payer systems of their own.

There are also strong prospects for single-payer healthcare in California, where the legislature has twice passed single-payer, only to have it vetoed both times by Governor Schwarzenegger.

But Schwarzenegger has served two terms and will be replaced in 2010, a fact that has emboldened grass-roots activists. “The governor’s race is the next stage for the single-payer battle in California,” says Chuck Idelson, a spokesman for the California Nurses Association, which has been fighting for single-payer for years. “We need to elect a candidate that is open to single-payer.”

The California Nurses Association was also instrumental in lobbying for an amendment, added by Rep. Dennis Kucinich (D) of Ohio to a House version of the federal healthcare reform bill, that would remove potential legal impediments for states to pass single-payer bills by waiving federal exemptions that apply to employer-sponsored health plans from the federal Employee Retirement Income Security Act (ERISA).

“Even if we passed single-payer tomorrow, there would still be a protracted legal battle due to ERISA,” Idelson said. “That is why this amendment is so important as we push for single-payer.”

But whatever obstacles to statewide single-payer exist, they are small compared to the barriers faced in Washington, where the option was taken off the table before the national conversation began. And with vibrant single-payer movements taking place, not only in Vermont and California, but also New Mexico, Illinois, Pennsylvania, Montana, and elsewhere, it is clear that as long as Washington is impervious to change, the fight for public healthcare must be waged one state at a time.

Michael Corcoran is a journalist who focuses on business, media, and public affairs. He has written for The Nation, The Boston Globe, Extra!, Alternet, Campus Progress, and other publications.

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

Comment:

By Don McCanne, MD

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.

Uninsured figures show mandate-based health reforms don't work

New uninsured figures show Massachusetts, touted as model for national reform, is failing to cover the uninsured

FOR IMMEDIATE RELEASE
Sept. 10, 2009

Contact:

Quentin Young, M.D., (312) 782-6006
David Himmelstein, M.D.
Steffie Woolhandler, M.D., M.P.H.
Don McCanne, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

Official estimates released this morning by the Census Bureau showing a marginal increase in the number of Americans without health insurance in 2008 – now estimated at 46.3 million, up from 45.7 million in 2007 – masks the true dimensions of the problem, a national doctors’ group said.

Significantly, in Massachusetts, where an individual-mandate health reform law, much like what President Obama is proposing on a national scale, was passed in 2006, at least 352,000 people, or 5.5 percent of the population, remained uninsured in 2008. That number was actually (but non-significantly) higher than the number of uninsured in 2007, before strict enforcement of the individual and employer mandates went into effect.

“The legislation championed by the president and the congressional leadership is a virtual clone of the Massachusetts plan,” said Dr. Steffie Woolhandler, professor of medicine at Harvard Medical School and co-founder of Physicians for a National Health Program (PNHP). “Today’s numbers show that plans that require people to buy private insurance don’t work. Obama’s plan to replicate Massachusetts’ reform nationally risks failure on a massive scale.”

Woolhandler said last year’s job losses in the recession, and the corresponding loss of health coverage by many workers and their families, are inadequately reflected in the new data. An estimated 2.6 million people lost their jobs in 2008, most of them toward the end of the year. Those who lost insurance at the end of the year would probably be counted as insured in the Census data, she said.

Census officials cited a drop of 1.1 million in the number of persons who were covered by employer-based insurance, continuing an 8-year trend. Whereas 64 percent of Americans had employer-based coverage in 1999, only 58.5 percent had such coverage in 2008.

Dr. Quentin Young, national coordinator of PNHP, said had it not been for a leap of approximately 4.4 million people newly covered by government programs like Medicaid and Medicare, the overall uninsured rate would have set a new record.

Young said the “tragic and painful persistence” of tens of millions of uninsured persons in the country is “completely unacceptable” and underscores the urgency of enacting a Medicare-for-all program.

“The only way to solve this problem is to insure everyone,” he said. “And the only way to insure everyone is to enact single-payer national health insurance, an improved Medicare for all. Even President Obama has acknowledged this fact.”Young noted that Rep. Anthony Weiner, D-N.Y., is introducing an amendment to the House leadership’s health reform bill, H.R. 3200, which would essentially delete its present language and substitute the language of Rep. John Conyers’ single-payer bill, H.R. 676. “It’s not too late for Congress to do the right thing,” Young said.

Dr. Don McCanne, senior policy fellow at PNHP, noted that the Census Bureau was once again silent on the pervasive problem of “underinsurance.” People are usually defined as underinsured if they spend 10 percent or more of their income (or 5 percent if they are low-income) on out-of-pocket medical expenses in the course of a year.

“Not having health insurance, or having poor quality insurance that doesn’t protect you from financial hardship in the face of medical need, is a source of mounting stress, anguish and poor medical outcomes for people across our country,” McCanne said. He noted that a recent study showed 62 percent of personal bankruptcies in the U.S. are now linked to medical bills or illness and three-quarters of those who went bankrupt had insurance when they got sick.

*****

State-by-state data on the uninsured from 2005-2009 can be found here: https://pnhp.org/uninsured2008/Uninsured-by-State-2005-2008.pdf

Physicians for a National Health Program (www.pnhp.org), a membership organization of over 17,000 physicians, supports a single-payer national health insurance program. To contact a physician-spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

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.”

Universal Health Care Pts 1 & 2

Two Harvard Medical professors critique our current system and offer a better vision

A downloadable MP3 and streaming version is available here:
http://www.humanmedia.org/catalog/program.php?cPath=40&products_id=276

Even with its dazzling technical advances and sophisticated medicines, health care increasingly frustrates Americans. Patients must contend with a system that won’t pay for some treatments, long waiting lists, rushed visits with doctors, copious paperwork and — of course — the ever-soaring cost of medical coverage and medications. Many doctors and nurses feel trapped in a structure they say sometimes prevents them from providing adequate care to their patients. One couple, both researchers at Harvard Medical School and both internists practicing at Cambridge Hospital in Massachusetts, are leaders in the movement among medical professionals to reform health care in America.

Dr. Steffie Woolhandler and Dr. David Himmelstein lead a campaign by doctors to reform health care which they see as needlessly expensive and corrupt. Together they founded Physicians for a National Health Program in 1987 which aims for a system where everyone is covered. They decry the soaring costs of health care — and how that hurts poor people who are uninsured — and many in the middle class who are under-insured. The doctors pull no punches in describing what they see as enormous waste in health care expenditures.

A National Public Radio program produced by David Freudberg, host of “Humankind,” Human Media / The Network Inc.

Visit www.humanmedia.org

Universal Health Care Pts 1 & 2

Two Harvard Medical professors critique our current system and offer a better vision

A downloadable MP3 and streaming version is available here:
http://www.humanmedia.org/catalog/program.php?cPath=40&products_id=276

Even with its dazzling technical advances and sophisticated medicines, health care increasingly frustrates Americans. Patients must contend with a system that won’t pay for some treatments, long waiting lists, rushed visits with doctors, copious paperwork and — of course — the ever-soaring cost of medical coverage and medications. Many doctors and nurses feel trapped in a structure they say sometimes prevents them from providing adequate care to their patients. One couple, both researchers at Harvard Medical School and both internists practicing at Cambridge Hospital in Massachusetts, are leaders in the movement among medical professionals to reform health care in America.

Dr. Steffie Woolhandler and Dr. David Himmelstein lead a campaign by doctors to reform health care which they see as needlessly expensive and corrupt. Together they founded Physicians for a National Health Program in 1987 which aims for a system where everyone is covered. They decry the soaring costs of health care — and how that hurts poor people who are uninsured — and many in the middle class who are under-insured. The doctors pull no punches in describing what they see as enormous waste in health care expenditures.

A National Public Radio program produced by David Freudberg, host of “Humankind,” Human Media / The Network Inc.

Visit www.humanmedia.org

Implications of growth in health care spending

Increased Spending On Health Care: Long-Term Implications For The Nation

By Michael E. Chernew, Richard A. Hirth and David M. Cutler
Health Affairs
September/October 2009
This paper updates one we published in 2003, describing the implications of continued health care spending growth for the consumption of nonhealth goods and services. Our estimates now show that at approximately long-run average rates of excess health spending growth, 119 percent of the real increase in per capita income would be devoted to health spending over the 2007–2083 projection period. We argue that an alternative scenario, under which health spending grew just one percentage point faster than real per capita income, is “affordable,” although 53.6 percent of real income growth over the period would go to health care. Moreover, even with the more favorable assumption, the nation would still face important challenges paying for care and dividing up the burden. This analysis thus supports the argument that reforms that would dramatically slow the rate of health care spending growth are necessary, especially if the nation hopes to maintain a reasonable amount of consumption of nonhealth goods and services.
… as in our earlier work, we did not capture distributional effects. The impact of health spending growth will likely be more onerous on economically disadvantaged individuals and families who do not qualify for public subsidies.
http://content.healthaffairs.org/cgi/content/abstract/28/5/1253

Average-income Americans – the majority of us – are finding the impact of health spending growth to be onerous, and it will get worse.
President Obama has said that controlling the growth in health care costs is essential if we expect to provide everyone with affordable access to health care. Listen carefully to the president this evening as he addresses the joint session of Congress, and try to identify the specific proposals that will have a significant impact on slowing the rate of cost increases. Be sure to distinguish between sound bites and sound policy.
Unfortunately, the model of reform that the administration and Congress has selected – building on our existing multi-payer public and private systems – is the most expensive model ever devised, and will result in a continuation of excessive cost increases. The only effective measure under consideration to slow the growth will be the increased financial burden placed on individuals which will cause them to forgo necessary care. That is the worst possible choice amongst cost containment policies.
An improved Medicare for all would be the most effective model for slowing the increase in health care costs. And because it’s both automatic in enrollment and equitable in its financing, it would ensure that everyone would have affordable access to health care. The model described tonight, though more expensive, will fall short on these goals.
The September/October issue of Health Affairs is a thematic volume on “Bending the Cost Curve.” If you glance at the webpage at this link, you will understand why this issue is silent on a single payer national health program (and pause for a moment of silence over the demise of the credibility of Health Affairs):
http://www.bendingthecostcurve.com/

British Physicians and Patients Respond to Lies about the NHS

September 7, 2009

Dear Senator Kerry,

Your reported call for “lies” about health care reform to be refuted is essential and requires an urgent response. To that end, may we — British health professionals and patients – respectfully expose those “lies” which are about our National Health Service, a service which our experience shows to work successfully for the benefit of all in this country.

PATIENT CHOICE: There is NO “death panel” in the UK NHS or anywhere else in the UK health care sector.

– Termination of a pregnancy is a personal decision if approved by two doctors. NO board or organization of any kind makes any decision about termination for fetal abnormality. Such decisions are personally made by those seeking such procedures after counselling by medical and other health professionals.

– Elderly people can get counselling and advice to help them determine their requirements for their future care, but only if they wish it. It is a service that provides information about issues such as living wills. This is similar to the US proposed Section 1233, which provides counselling and assistance to those wishing voluntarily to make their own arrangements for their future, medically and physically.

– Patients are normally registered with a family doctor practice of their choice. A patient is able to see a doctor immediately for urgent care in general practice although seeing his or her own family doctor for non-urgent care may require waiting a few days. If the patient requires referral for specialist opinion or treatment, they can choose whichever hospital they prefer.

CARE FOR THOSE WITH PRE-EXISTING CONDITIONS: In the US, people with pre-existing health problems are rarely covered by private insurance companies for those problems. Many do not change jobs for fear of losing cover for such conditions from their new insurers. The NHS is literally a life saver for those with pre-existing health problems – they are not denied care. It is vitally important that the NHS, and any government financed health plan anywhere, undertakes the care of such people.

CARE FOR THE ELDERLY: There is NO cut-off age for health care in the NHS. Senator Kennedy, like anyone else of that age, or older, and with health problems such as his, would have been treated by the NHS with the same high levels of care as someone younger. Care for the elderly includes free flu vaccinations, free medication, free operations as needed, nursing care visits, and help and adaptions for the home. Many hospitals now offer “hospital to home” programs for palliative and end of life care to enable very ill people to remain at home.

CARE FOR THE DISABLED: Professor Stephen Hawking of Cambridge University, recently awarded the Presidential Medal of Freedom by President Obama, is disabled and has always been under the care of the NHS. Professor Hawking is an outspoken admirer of NHS care. Like thousands of others who are disabled, he is entitled to free medical care and medicine, and he can get adaptions, equipment and home care to allow him to live at home.

FREE MEDICATION: NO ONE is denied medicine if they need it. All children up to the age of 16, pregnant women and adults over the age of 60, unemployed people, patients with cancer and many with chronic conditions, don’t pay for their medication from the NHS. 88% of medicines are dispensed without charge. For the minority who pay there is a standard charge of $11 dollars per prescription, regardless of the real cost of the drug. Some parts of the UK have abolished prescription charges altogether.

INSURANCE: Like the Healthy San Francisco medical plan, those in the UK can also take out private insurance, if they can afford it, although less than 1 in 8 currently do so. The co-existence of public and private coverage ensures complete freedom of choice.

THE COST: The NHS is funded by taxes and provides universal coverage while costing 8% of UK GDP. The US system currently costs 16% of GDP but leaves 45 million without insurance and a further 25 million underinsured.

BACKGROUND: The NHS was created in 1948. Its goal was to provide comprehensive medical care through taxation, universal coverage for the population which is free of charge at the point of care. It still does that despite the huge, and increasing, demands on its financial and practical resources.

The NHS is available free of charge to all regardless of ability to pay, and does not discriminate against those with pre-existing conditions. Importantly it gives freedom from fear of the financial consequences of illness.

Survey after survey shows that British patients express a high degree of satisfaction with the care they personally receive from the NHS. On average, British users of the NHS live longer and have a lower infant mortality rate than the US.

The NHS has shown itself to be open to — and often the source of – innovation. How the US manages its own health care reform will doubtless provide us with new ideas about how to improve some aspects of our own NHS service. In the same spirit, we respectfully draw to your attention what evidently works well here

Yours sincerely,

Professor Alan Maryon-Davis FFPH FRCP
President, UK Faculty of Public Health

Professor Anthony Costello FRCP FRCPCH
Professor of International Child Health
Director of Institute of Child Health, UCL

Professor Andrew JM Boulton, MD, FRCP
Professor of Medicine, University of Manchester, UK
Consultant Physician, Manchester Royal Infirmary

Professor Mark B Gabbay MD FRCGP
Professor of General Practice
Head of Division of Primary Care
University of Liverpool

Professor Rodney Grahame CBE MD FRCP FACP
Consultant Rheumatologist, UCH
Honorary Professor at UCL, Department of Medicine

Professor Ian Banks
President of the Men’s Health Forum and member BMA Council

Professor Eileen O’Keefe
Professor of Public Health
London Metropolitan University

Professor Gill Walt
Professor of International Health Policy
Health Policy Unit,
Dept Public Health & Policy,
LSHTM, Keppel Street,

Professor Rosalind Raine
Professor of Health Care Evaluation
UCL Dept of Epidemiology & Public Health
1-19 Torrington Place, London WC1E 6BT

Dr Alex Scott-Samuel
Director, International Health Impact Assessment Consortium
Division of Public Health
University of Liverpool

Sir Alexander Macara
President , National Heart Forum Trustee, Patients’ Association

Dr Jean Taylor
Scottish Patients Association

Dot Gibson
Secretary, National Pensioners’ Convention

Everybody in, nobody out

By Susanne L. King, M.D.
Berkshire Eagle
09/04/2009

The disruptions at town meetings in August were not just the work of conservative hecklers and their corporate backers. The wave of anger also revealed that many Americans feel left out during the current recession. It is not just the 50 million people who are left out because they don’t have health insurance, or the tens of millions who are left out because they have inadequate health insurance, or even the many people who have been bankrupted by their medical bills (the most common cause of bankruptcy in the United States).

Millions of other Americans also feel left out and angry, frustrated by the bailouts for Wall Street and other corporations which profit from the tax dollars of struggling Americans.

The current health insurance reform bill being created in Congress is looking like just another bailout — this time for health insurance and pharmaceutical companies. With their lobbying dollars and influence, these companies are crafting health insurance legislation to expand their profits and power.

A proposed individual mandate to force 47 million citizens to buy health insurance will be a windfall for private health insurance companies, and will be partially paid for with taxpayer dollars for subsidies to support premiums for people who can’t afford health insurance.

And the drug companies pulled a real coup. President Obama agreed to a promise of $80 billion from the pharmaceutical companies over ten years in exchange for an agreement with the government to not bargain down medication prices for Medicare, and to not allow people to buy cheaper drugs from Canada. The drug companies did not give the government $80 billion, nor agree to cut prices, but only to reduce the amount they would otherwise have raised prices. $80 billion over ten years translates into savings of only 2 percent of the projected U.S. spending on prescription drugs. What was Obama thinking?

What ordinary people seem to be thinking is, “We’ve given enough bailouts to the private sector, and we are sick of our government continuing to subsidize private corporations.”

At a “Community Meeting for Healthcare” in New Hampshire during his campaign for president in 2007, Barack Obama talked with 200-plus people about health care reform. He said, “I want to be held accountable for establishing a universal health care plan by the end of my first term, but I have to insist on the voters rallying for this change. When I take office I have to feel I have a mandate for change.”

According to the Associated Press, his audience at the community meeting was “almost single-mindedly focused on a single-payer system.” What we know from polls is that 59 percent of Americans support a single payer national health insurance program, an improved “Medicare for All.” So why have our president and Congress abandoned single payer health care when the majority of Americans support it?

Representatives John Conyers and Dennis Kucinich are sponsoring HR 676, the single-payer, not-for-profit health insurance bill in the house, along with 85 other representatives. Kucinich says, “Insurance companies will stop at nothing to hold on to the American people’s wallet when it comes to health insurance.” He believes that health care reform needs to come from public input, not the special interest groups who are driving the legislation in Congress.

He recommends that we step back and start over on health care reform, and that congressmen should go back to the people and listen to their stories. They need to talk to all their constituents, not just those who scream the loudest. They need to hold town meetings where civil discourse prevails.

For those of us who support single payer health care, we can make it clear to our representatives in Congress that this will be an important issue in their re-election as we go to vote next year.

Since health insurance lobbyists have effectively squelched discussion of single payer bill HR 676 as an option for health care reform in Congress at this time, Rep. Anthony Weiner, a single payer supporter, has filed an amendment to the health reform legislation recently created in the House, HR 3200. Weiner’s amendment would effectively change HR 3200 into a single payer bill.

Speaker Nancy Pelosi has promised an up or down vote on this amendment in September. If you support single payer health care, please call your representative, or go to www.pnhp.org and send an email asking him to support the Weiner amendment to HR 3200.

If we had an improved “Medicare for All” program, everyone would have comprehensive coverage, including medical and dental care, prescription drugs, and long term care, all without deductibles and co-payments. This approach would not add to our burgeoning national deficit, but would save $400 billion in administrative costs alone by eliminating for-profit health insurance companies.

The current Medicare program is financially threatened: Medicare viability would be enhanced by including everyone in the system, rather than siphoning off healthy workers to the for-profit insurance industry. Only with a single payer national health program will we have “everybody in and nobody out.”

There is a moral imperative to providing comprehensive health care to everyone. Health care should be a human right, not a market good. As Senator Teddy Kennedy said, “For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives, and the dream shall never die.”

Susanne L. King is a Lenox-based practitioner.

Implications of growth in health care spending

Increased Spending On Health Care: Long-Term Implications For The Nation

By Michael E. Chernew, Richard A. Hirth and David M. Cutler
Health Affairs
September/October 2009

This paper updates one we published in 2003, describing the implications of continued health care spending growth for the consumption of nonhealth goods and services. Our estimates now show that at approximately long-run average rates of excess health spending growth, 119 percent of the real increase in per capita income would be devoted to health spending over the 2007–2083 projection period. We argue that an alternative scenario, under which health spending grew just one percentage point faster than real per capita income, is “affordable,” although 53.6 percent of real income growth over the period would go to health care. Moreover, even with the more favorable assumption, the nation would still face important challenges paying for care and dividing up the burden. This analysis thus supports the argument that reforms that would dramatically slow the rate of health care spending growth are necessary, especially if the nation hopes to maintain a reasonable amount of consumption of nonhealth goods and services.

… as in our earlier work, we did not capture distributional effects. The impact of health spending growth will likely be more onerous on economically disadvantaged individuals and families who do not qualify for public subsidies.

http://content.healthaffairs.org/cgi/content/abstract/28/5/1253

Comment:

By Don McCanne, MD

Average-income Americans – the majority of us – are finding the impact of health spending growth to be onerous, and it will get worse.

President Obama has said that controlling the growth in health care costs is essential if we expect to provide everyone with affordable access to health care. Listen carefully to the president this evening as he addresses the joint session of Congress, and try to identify the specific proposals that will have a significant impact on slowing the rate of cost increases. Be sure to distinguish between sound bites and sound policy.

Unfortunately, the model of reform that the administration and Congress has selected – building on our existing multi-payer public and private systems – is the most expensive model ever devised, and will result in a continuation of excessive cost increases. The only effective measure under consideration to slow the growth will be the increased financial burden placed on individuals which will cause them to forgo necessary care. That is the worst possible choice amongst cost containment policies.

An improved Medicare for all would be the most effective model for slowing the increase in health care costs. And because it’s both automatic in enrollment and equitable in its financing, it would ensure that everyone would have affordable access to health care. The model described tonight, though more expensive, will fall short on these goals.

The September/October issue of Health Affairs is a thematic volume on “Bending the Cost Curve.” If you glance at the webpage at this link, you will understand why this issue is silent on a single payer national health program (and pause for a moment of silence over the demise of the credibility of Health Affairs):
http://www.bendingthecostcurve.com/