PNHP

It’s Medicare’s 44th Birthday!

It’s Medicare’s 44th Birthday!

Dear Healthcare-NOW! Supporter:

Today, single-payer supporters from all over the country are celebrating the 44th birthday of one of the nation’s most popular public programs: Medicare.

On this anniversary of Medicare, we are calling for an end to a wasteful private health financing model based on earning profits through the restriction and denial of needed health care.

Take Action

It’s Medicare’s 44th Birthday! Call Congress today!

Tell them we want improved and expanded Medicare for all (national, single-payer healthcare).

Call the Capitol Switchboard at 866-338-1015.

This could be done through the passage of HR 676, “Expanded and Improved Medicare for All,” or S 703, “American Health Security Act.”

We need your help in telling members of Congress that the people want single-payer now.

Please, call your Senators and Representative today.

If you don’t know your Congress Members, or want to email them rather than call, go to www.VoteSmart.org. Otherwise, call the Capitol Switchboard at 866-338-1015.

Make these four requests:

1. If you haven’t, cosponsor single-payer legislation today. (HR 676 for Reps. and S. 703 for Senators)

2. Join Senators Schumer, Harkin, and Sanders in asking the CBO to score single-payer legislation. Past cost-benefit analyses (including from the CBO) reflect the cost neutrality of a single-payer system, and savings of healthcare dollars overall.

3. Vote for single-payer amendments to current legislation going through House and Senate committees. The grassroots movement is closely watching the outcomes of the votes on single-payer amendments. This will be documented and remembered in the midterm elections.

4. Refuse to accept campaign contributions from the healthcare industry and support publicly funded elections. The receipt of healthcare industry dollars is a conflict of interest as you vote on healthcare policy.

We are greatly concerned that the current legislation will not be universal, protect individuals from bankrupting medical bills, or guarantee needed healthcare to people. Even with proposed private insurance reform, the quality of coverage available will vary significantly depending on ability to pay, which is flagrantly discriminatory. Healthcare is not a product, it is a necessity, and all deserve equal access to care. In addition, there are no realistic cost-containment measures.

A single-payer system of publicly-financed and privately-delivered care solves all of these issues and provides true health security. It is the only proposal that is both socially and fiscally responsible.

Thanks for all that you do,

Healthcare-NOW! National Staff

President Obama's hardship waivers

TIME’s Exclusive Interview with President Obama

By Karen Tumulty
TIME
July 29, 2009
Karen Tumulty: But some things have changed. I mean, for instance you were very much against an individual mandate. Could you describe how your thinking has evolved on this issue…
President Obama: I feel pretty good that I’ve been pretty consistent on this. The individual mandate is probably the one area where I basically changed my mind. The more deeply I got into the issue, the more I felt that the dangers of adverse selection justified us creating a system that shares responsibility, as long as we were actually making health insurance affordable and there was a hardship waiver for those who, even with generous subsidies, couldn’t afford it. And that remains my position.
Karen Tumulty: What about — you mentioned that subsidies have to be there. What’s — you’re hearing now — 300% [that the government would provide assistance to people earning up to 300% of poverty]. Is that enough? Is that really —
President Obama: Until I actually see the numbers, I don’t want to give a definitive answer on that. I do think that if we can figure out what is a fair, appropriate percentage of your income that you’re paying on health care, and peg it — peg subsidies so that it’s meeting that test, potentially with some regional variation then we’ll get it right. And I think that the committees are working on that. That’s the kind of detail that we had anticipated working through in conference. If it turns out that Congress just can’t get there and that’s the holdup, then we’ll give a very definitive idea of where we need to go on it.
http://www.time.com/time/politics/article/0,8599,1913410-1,00.html

Detail? Figuring out how to make insurance affordable if it is to protect families from the financial burden of the $16,771 already being spent on average for health care? 300 percent of poverty? 400 percent of poverty?
Play with the numbers all you want. Using the model of reform selected by the President and Congress automatically limits the total subsidies to an amount that will not increase the deficit in the federal budget. Even if the majority of employers continue to displace wage or salary increases in exchange for health benefits, the number of hardship waivers issued will have to be much larger than most are projecting. If employers finally bail out, the majority of us would require hardship waivers.
You don’t believe me? Do the numbers, starting with the amount of money they propose to spend on subsidies.

President Obama's hardship waivers

TIME's Exclusive Interview with President Obama

By Karen Tumulty
TIME
July 29, 2009

Karen Tumulty: But some things have changed. I mean, for instance you were very much against an individual mandate. Could you describe how your thinking has evolved on this issue…

President Obama: I feel pretty good that I’ve been pretty consistent on this. The individual mandate is probably the one area where I basically changed my mind. The more deeply I got into the issue, the more I felt that the dangers of adverse selection justified us creating a system that shares responsibility, as long as we were actually making health insurance affordable and there was a hardship waiver for those who, even with generous subsidies, couldn’t afford it. And that remains my position.

Karen Tumulty: What about — you mentioned that subsidies have to be there. What’s — you’re hearing now — 300% [that the government would provide assistance to people earning up to 300% of poverty]. Is that enough? Is that really —

President Obama: Until I actually see the numbers, I don’t want to give a definitive answer on that. I do think that if we can figure out what is a fair, appropriate percentage of your income that you’re paying on health care, and peg it — peg subsidies so that it’s meeting that test, potentially with some regional variation then we’ll get it right. And I think that the committees are working on that. That’s the kind of detail that we had anticipated working through in conference. If it turns out that Congress just can’t get there and that’s the holdup, then we’ll give a very definitive idea of where we need to go on it.

http://www.time.com/time/politics/article/0,8599,1913410-1,00.html

Comment:

By Don McCanne, MD

Detail? Figuring out how to make insurance affordable if it is to protect families from the financial burden of the $16,771 already being spent on average for health care? 300 percent of poverty? 400 percent of poverty?

Play with the numbers all you want. Using the model of reform selected by the President and Congress automatically limits the total subsidies to an amount that will not increase the deficit in the federal budget. Even if the majority of employers continue to displace wage or salary increases in exchange for health benefits, the number of hardship waivers issued will have to be much larger than most are projecting. If employers finally bail out, the majority of us would require hardship waivers.

You don’t believe me? Do the numbers, starting with the amount of money they propose to spend on subsidies.

Single-payer system cuts barriers to care

By Beth Cardosi
TheSunNews
Wed, Jul. 29, 2009

I’m a physician in South Carolina. I have firsthand experience regarding our broken, wasteful health care system.

On a daily basis I care for the uninsured who have no jobs (often because of layoffs or illness) and have no money or access to health care providers. These people often come to the emergency departments with minor issues that could be handled simply as an outpatient if there were a place for them to be treated, or they are seen with life-threatening illnesses because they couldn’t receive the proper treatment for their chronic illness (i.e. high blood pressure and diabetes) or couldn’t receive preventive care and now have untreatable cancer. These people show up where the care is the most expensive because they won’t get turned away.

But what I find happening more these days is that these numbers are growing. People often have jobs that don’t cover health care, or it’s too expensive for the small-business owner to afford (small businesses are paying twice what large businesses pay for the same coverage). People can’t afford their medications or even their co-payments for office visits if they are lucky enough to have insurance.

I believe America should join the rest of the developed world and provide a single-payer system. I left private practice because I spent hours doing paperwork for insurance companies, was on the phone trying to get tests paid for and had to change medications all the time because insurance would not pay for them. The amount of bureaucracy is nothing for patients with Medicare compared with private health insurance companies. Insurance companies have entire departments whose only function is to find ways to deny payment. Conversely, hospitals have entire departments trying to get paid from insurance companies – now that is a waste of precious resources. Nonmedical insurance company staff, not government, stand between the doctor and their patient’s care.

So, why are people afraid to change the health care system? Not only do people fear change (even in a dysfunctional system) but because media is bombarding them with how bad and expensive a public option or single-payer program would be. Who pays for those ads and funds our political leaders? The same companies who are making huge profits on the suffering of people – and I ask you: If our health care system is so great, why are we 17th in the world for infant mortality and 30th in the world for life expectancy?

I believe our health care system can be cured by taking the profit motive out of the system – like other countries do. This will make it affordable, cheaper and provide access for all. Imagine a country where you can get care without showing your insurance card first.

The writer lives in Myrtle Beach.

http://www.thesunnews.com/opinion/story/1001358.html

Obama's longtime doctor says healthcare reform plan falls short

Dr. David Scheiner of Chicago advocates a single-payer government system. He calls Obama's plan too timid, saying it reflects politics, not the president's ideals.

By Mike Dorning
Los Angeles Times
July 29, 2009

Reporting from Washington — The Chicago doctor who treated President Obama for more than two decades has a prescription for healthcare reform: a British- or Canadian-style single-payer system.

Dr. David Scheiner, 70, will advocate such a plan at a rally Thursday on the National Mall.

In an interview, he described the president as a “beloved” patient in “superb” health.

“He was always on time,” Scheiner said. “He just sat in the waiting room with everyone else, even when he was a senator. He never went up to the desk and pulled rank.”

But he criticized Obama’s healthcare plan as too timid, arguing that the White House plan reflected politics more than the president’s ideals.

“It’s a bad program. I don’t think it’s what he feels in his heart is necessary. I think it’s what he feels politically is the best way,” said Scheiner, who acknowledged that he had not discussed the subject with Obama directly.

Scheiner argued that the “public option” Obama favors, in which a government-run insurance program would compete with private insurers, does not go far enough. The public option has been one of the most controversial parts of Obama’s plan, with insurers and conservatives vigorously opposing it.

Scheiner said a single-payer government-run system would cut costs by reducing the administrative overhead that doctors and other health providers must maintain to meet complex reimbursement rules from different insurance companies. A government program also would have greater leverage in negotiating lower drug prices with pharmaceutical companies, he said.

He argued that such a system would lead to better care for lower-income people and end what he said was a pernicious insurance-industry practice: discouraging patients from getting necessary treatment by setting up obstacles, and boosting profits in the process.

“They make it frustrating so he doesn’t get it easily and maybe he’ll go away,” Scheiner said.

Critics’ contention that a single-payer system would constrain patient choices is misplaced, he said.

“The government never gets in my way,” he said. “Forty years I’ve been working [with] Medicare, never. Who gets in my way all the time? Private insurance companies. Somehow that message is not getting across.”

mdorning@tribune.com

Obama's Doctor: President's Vision For Health Care Bound To Fail

By Sam Stein
Huffington Post
July 29, 2009

The man Barack Obama consulted on medical matters for over two decades said on Tuesday that the president’s vision for health care reform is bound for failure.

Dr. David Scheiner, a 70-year Chicago-based physician who treated Obama for more than 20 years, said he was disheartened by the health care legislation his former patient is championing, calling it piecemeal and ineffectual.

“I look at his program and I can’t see how it’s going to work,” Scheiner told the Huffington Post. “He has no cost control. There would be no effective cost control in his program. The [Congressional Budget Office] said it’s going be incredibly expensive … and the thing that I really am worried about is, if it is the failure that I think it would be, then health reform will be set back a long, long time.”

Scheiner, who prefers a more progressive approach to reform, was hesitant about trying to divine the president’s motives, although he said he believed that “in his heart of hearts” Obama “may well like a single-payer program.”

“His pragmatism is what is overwhelming him.” Scheiner added: “I think he’s afraid that he can’t get anything through if he doesn’t go through this incredibly compromised program.”

Admitting that he was not a political practitioner, Scheiner said he felt compelled to speak out because of his unique relationship with the president and this critical moment in the health care debate. A champion of a single-payer health care system, Scheiner noted repeatedly that he came to the debate from the perspective of having dealt with the hassles and pitfalls of the current system. His speaking out is part of a larger effort, launched by Physicians for a National Health Program, to push Congress to consider single-payer as an alternative to current reform proposals.

As Scheiner sees it, all alternatives simply fall short. Keeping private insurers in the market, he warns, would simply maintain burdensome administrative costs. He argued further that the pharmaceutical industry is not being asked to make “any kind of significant sacrifices” in the current round of reform negotiations. As for a public health care option, Scheiner insists that the proposal remains vague and inadequate.

“First of all, they haven’t really gone into great detail about the public option,” he said. “How much is it going to cost, are they going to really undercut private health insurance by a considerable amount? Will there be any restriction that you can get for public option?”

Despite his policy critiques, Scheiner’s affection for his long-time patient is quite obvious. He recalled the president as being “gracious” and “never pulling rank” when he came to his office. “Part of my shtick, is I sing songs and I love humor,” Scheiner said. “I remember last time I saw him I told him a joke, he said, ‘Doc, you told me that joke before.’ I was so impressed he can remember my bad jokes — this guy has to be really bright.”

During the course of the campaign, Scheiner became one of the many mini-celebrities in Obama’s orbit. When the then-Senator released a one-page summary documenting his health, criticism for its brevity was laid on the doc’s doorstep.

“The guy was healthy, you know,” Scheiner recalled. “What can you say? His only problem was that he smoked … But there wasn’t that much to say. If I had added anything it would have been pure drivel. There wasn’t anything serious in his record. He’d never had anything. The guy is built like a rock, he could probably bench-press me…

“I think my most impressive time was when Jon Stewart actually mocked my report,” he added. “I thought that was wonderful.”

All of which makes his current criticism of Obama’s health care policies all the more difficult. While Scheiner raved about the president’s intellectual curiosity, he was at loss for words as to why Obama had consulted with private industry executives more than primary care physicians. And while he spoke glowingly about the president’s oratorical talents, he expressed disappointment that Obama had not done more to explain the benefits of single-payer coverage to the American public.

The White House has said that the president moved away from a single-payer approach both because of philosophical objections (consumers should be allowed to keep their coverage) as well as political realities (limited support for the proposal in Congress). The administration’s position increasingly resembles the maxim, Don’t let the perfect be the enemy of the good.

“It’s a good question,” Scheiner said, when asked if having watered-down reform become law was better than getting a single-payer system stalled in Congress. “Is something better than nothing? That is a hard one for me. That is a difficult one, because, in the end, I think [Obama’s] program is going to fail.”

http://www.huffingtonpost.com/2009/07/29/obamas-doctor-presidents_n_246870.html

Obama's health care reform policy is the wrong prescription, say president's former physician and public health groups

President and Congress urged to support legislation for single-payer health reform

For Immediate Release:
July 30, 2009

Contact:
Rick Claypool, Public Citizen, (202) 588-7742
Katie Robbins, Healthcare-NOW! (330) 618-6379
Mark Almberg, PNHP, (312) 782-6006, cell: (312) 622-0996, mark@pnhp.org

WASHINGTON — On the 44th anniversary of Medicare’s creation, President Barack Obama’s former primary care physician has joined leading public health groups in calling on the White House and Congress to solve the health care crisis by instituting a national single-payer health care system.

Dr. David Scheiner served as President Obama’s doctor at a clinic based in Chicago’s Hyde Park neighborhood from 1987 to 2009. A strong Obama supporter, Scheiner nevertheless is secure enough in his convictions to publicly voice his difference with the president’s approach to health care reform.

“Our nation is at a crossroads,” Scheiner said. “We must not give in to the insurance and drug companies and instead do what is right for all Americans,” noting that a single-payer, Medicare-for-All program is the way to go.

The groups at Thursday’s news conference include Healthcare-NOW!, Public Citizen and Physicians for a National Health Program (PNHP), the latter of which will release a letter to President Obama and Congress this morning from more than 3,500 physicians and medical students calling for single payer. Scheiner is a member of the physicians’ group.

The call for reform comes as grassroots single-payer advocates from across the nation, including Scheiner, gather today to rally support and urge the White House and Congress to implement a plan that would cover everyone — expanded and improved Medicare for all. Throughout the recent health care reform push, this type of national reform has been considered “off the table,” even though proposed half-measures, including the so-called public plan option, would still leave millions uninsured and lack the cost-control tools single-payer would offer.

In calling for a national single-payer system, Scheiner points to Medicare, a successfully functioning single-payer program since 1965 that now serves 45 million Americans, as a model. “In the 40 years I have been practicing under Medicare, I have never encountered an instance where Medicare has prevented proper medical care,” Scheiner said. “On the other hand, [private] insurance companies frequently interfere and block appropriate care.”

Recent research in the health policy journal Health Affairs supports Scheiner’s observations, showing that compared with people who receive private health insurance through employers, people covered by Medicare “report fewer problems obtaining medical care, less financial hardship due to medical bills, and higher overall satisfaction with their coverage.”

Added Dr. Sidney Wolfe, acting president of Public Citizen and director of Public Citizen’s Health Research Group, “We should be celebrating the 44th anniversary of Medicare by finally passing legislation that would truly result in everybody in, nobody out, instead of seriously considering legislation that guarantees that millions still will be left out just so the private health insurance industry can stay in.”

Under a national single-payer system, doctors, hospitals and other health care providers are paid from a single fund administered by the government. The high administrative costs and wasteful spending associated with the private health insurance industry would be eliminated, resulting in savings of nearly $400 billion annually and enabling all Americans to receive high-quality care, including those who currently have insurance but still cannot afford medications and treatment.

“As President Obama says, ‘We must build on what works and leave out what doesn’t,'” said Katie Robbins, assistant national coordinator for Healthcare-NOW! “President Obama also stated at a recent press conference in Cleveland that single payer is the only way to cover everyone. We agree and ask that he implement a single-payer system as not only the best way, but the only way, to meet his goals for quality, affordable health care for all Americans.”

In Congress, single-payer proposals have been introduced in both the House of Representatives (H.R. 676, The U.S. National Health Care Act) and the Senate (S. 703, The American Health Security Act of 2009).

“Single-payer reform, as embodied in these bills, would eliminate the bewildering patchwork of private insurance plans with their exorbitant overhead and profits, as well as the costly paperwork burdens they impose on providers,” said Dr. Margaret Flowers of PNHP. “These savings on bureaucracy are sufficient to cover all of the uninsured and to provide first-dollar coverage for all Americans.”

Added Pennsylvania state Sen. Jim Ferlo, “While I commend the president and the 111th Congress for thoroughly addressing this most important domestic issue in terms of its impact on our economic and social well-being, I cannot support the enactment of anything less than a single-payer proposal.” Sen. Ferlo is co-convening sponsor of State Legislators for Single-Payer Healthcare, a nationwide campaign of state lawmakers who advocate for national single-payer.

*****

For more information, go to www.pnhp.org, www.citizen.org/singlepayersolution, or www.healthcare-now.org

July 30, 2009

Statement of David L. Scheiner, M.D.

I am here today because years ago I was practicing medicine in an office on the South Side of Chicago with my partner and friend, Dr. Quentin Young, when a young community organizer came to see me as a patient. I became his personal physician for 22 years and he became president of the United States. I support and admire him and consider him to be the most promising president of my lifetime, which stretches back to 1938. But I respectfully differ with him on his approach to health care reform.

I speak to you today as an advocate for the single-payer approach to health reform, an expanded and improved Medicare for all, but I am hoping that President Obama and Congress will hear me also. As some of you may know, I was supposed to be at the recent town hall meeting at the While House where I was to ask a question of the president, but my visit was cancelled at the last minute, presumably to prevent the national airing of my views on health reform. Is the single-payer message so dangerous that it cannot even be discussed by Congress and the administration?

Yes, there are parties who stand to lose out under a single-payer program — the private, for-profit health insurance companies and their multimillionaire CEOs in the first place. The head of Aetna, for example, received $18.6 million in compensation last year. That’s obscene.

Investor-owned, for-profit hospitals won’t benefit from single payer either. Neither will the big pharmaceutical companies, who will no longer be able to sell their drugs at such outrageous prices. A single-payer system will be able to buy drugs in bulk and negotiate prices.

Some critics attack single-payer, arguing that under such a program, government bureaucrats will be between the patient and the physician. In the 40 years I have been practicing under Medicare, I have never encountered an instance where Medicare has prevented proper medical care. On the other hand, insurance companies frequently interfere and block appropriate care.

There are multiple problems with the present congressional health reform proposals, but allowing private insurance to continue being involved is the most egregious. The insurance companies actually like many of the proposed reforms, including the requirement that every American purchase insurance or suffer a tax penalty, which would be a windfall to the insurance industry. That alone should be a warning.

I mentioned who will lose out under a single-payer program. But who benefits? The American people. But do they matter? Do we really care about the 50 million without health insurance as long as the rest of us have our own coverage? Do we think about the additional tens of millions who are underinsured, who face economic hardship or bankruptcy when serious illness strikes? Single payer will offer secure, comprehensive and quality care to all.

A single-payer program could be implemented comparatively easily, without disruption, as was the case with traditional Medicare. And there are other advantages: with single payer, we can discontinue Medicaid, which is bankrupting states and treats a large number of individuals as second-class citizens.

This is a moral obligation, and we are all responsible for seeing that health care is a right. That’s the view of Physicians for a National Health Program.

Opponents of single-payer say that if the government pays for health care, the system will deteriorate. But we have two single-payer programs already operating that work superbly — Medicare and the Veterans Administration hospital system. Medicare overhead is 3 percent. Private insurance overhead is five times that. Forty years ago, I worked in a public health service hospital in Boston, which delivered excellent care to all comers. Sadly, the system was closed down.

I grew up as a child during World War II and loved my country then as I do now. I grew up revering the ideals of this country. Although there were unsettling periods, our country remains a beacon of hope for life, liberty and the pursuit of happiness. I believe that quality universal health care falls under these watchwords.

Our nation is at a crossroads. We must not squander the opportunity of this momentous time. We must not give in to the insurance and drug companies and instead do what is right for all Americans. Please, Mr. President and Congress — enact an expanded and improved Medicare for all.

July 30, 2009

Statement of Margaret Flowers, M.D.

I am here today, the 44th anniversary of Medicare, on behalf of Physicians for a National Health Program, a national organization representing over 16,000 physicians who advocate for the only health reform that can provide truly universal, comprehensive and affordable care: single-payer national health insurance, expanded and improved Medicare for all.

We are presenting an open letter to President Obama which has been signed by over 3,500 physicians from across the nation and across the spectrum of our profession. Signers include Drs. Marcia Angell and Arnold Relman, former editors of the New England Journal of Medicine and Dr. David Scheiner, President Obama’s personal physician for more than two decades. It has also been signed by medical students who represent the future of medicine in the United States.

We are calling on the president to endorse national single-payer health care. Sound single-payer proposals have been introduced in both the House of Representatives (H.R. 676, The U.S. National Health Care Act) and the Senate (S. 703, The American Health Security Act of 2009).

Single-payer reform, as embodied in these bills, would eliminate the bewildering patchwork of private insurance plans with their exorbitant overhead and profits, as well as the costly paperwork burdens they impose on providers. These savings on bureaucracy — nearly $400 billion annually — are sufficient to cover all of the uninsured and to provide first-dollar coverage for all Americans.

We agree with the president that our nation’s economic recovery depends on effective health care reform. However, it will not be achieved by mandating that individuals and families hand over even more money to the private, for-profit insurance industry. A plan similar to that being proposed by Congress was put in place recently in Massachusetts. This plan, largely written with input from the Blue Cross and Blue Shield Foundation, is already proving to be financially unsustainable. In addition, the Massachusetts plan is dropping 30,000 people from its rolls and is being sued by Boston Medical Center for $180 million for uncompensated care.

We ask why the president is not endorsing a national single-payer system, which is the only reform with inherent cost-controls in the form of global budgeting for hospitals, bulk purchasing of pharmaceuticals and medical devices and decreased administrative costs, to name a few.

We also agree with a recent statement by the president that a single-payer national health system is the only way to provide health care to all people in America: everybody in and nobody out. If the proposed health reform is not going to be universal, we would ask which of our patients do you suggest we leave out?

The simplest and least disruptive solution for our nation, and one that will preserve the legacy of Medicare for generations to come, is to expand and improve our uniquely American and very successful Medicare to everyone. Surveys done this year demonstrate that people with Medicare are more satisfied with their health care than are persons under age 65 who are covered by private insurance. People with Medicare report fewer problems getting access to care, greater confidence about their access, and fewer instances of financial hardship as a result of medical bills. Patients on Medicare choose their doctor and treatment without the restrictions and denials inherent in private insurance. When they need care, they receive it simply and with less worry.

That is why we, the members of Physicians for a National Health Program, celebrate Medicare’s anniversary and why we wish it many more.

****

Physicians for a National Health Program (www.pnhp.org), a membership organization of over 16,000 physicians, supports a single-payer national health insurance program.

President Obama’s hardship waivers

TIME’s Exclusive Interview with President Obama

By Karen Tumulty
TIME
July 29, 2009

Karen Tumulty: But some things have changed. I mean, for instance you were very much against an individual mandate. Could you describe how your thinking has evolved on this issue…

President Obama: I feel pretty good that I’ve been pretty consistent on this. The individual mandate is probably the one area where I basically changed my mind. The more deeply I got into the issue, the more I felt that the dangers of adverse selection justified us creating a system that shares responsibility, as long as we were actually making health insurance affordable and there was a hardship waiver for those who, even with generous subsidies, couldn’t afford it. And that remains my position.

Karen Tumulty: What about — you mentioned that subsidies have to be there. What’s — you’re hearing now — 300% [that the government would provide assistance to people earning up to 300% of poverty]. Is that enough? Is that really —

President Obama: Until I actually see the numbers, I don’t want to give a definitive answer on that. I do think that if we can figure out what is a fair, appropriate percentage of your income that you’re paying on health care, and peg it — peg subsidies so that it’s meeting that test, potentially with some regional variation then we’ll get it right. And I think that the committees are working on that. That’s the kind of detail that we had anticipated working through in conference. If it turns out that Congress just can’t get there and that’s the holdup, then we’ll give a very definitive idea of where we need to go on it.

http://www.time.com/time/politics/article/0,8599,1913410-1,00.html

Comment:

By Don McCanne, MD

Detail? Figuring out how to make insurance affordable if it is to protect families from the financial burden of the $16,771 already being spent on average for health care? 300 percent of poverty? 400 percent of poverty?

Play with the numbers all you want. Using the model of reform selected by the President and Congress automatically limits the total subsidies to an amount that will not increase the deficit in the federal budget. Even if the majority of employers continue to displace wage or salary increases in exchange for health benefits, the number of hardship waivers issued will have to be much larger than most are projecting. If employers finally bail out, the majority of us would require hardship waivers.

You don’t believe me? Do the numbers, starting with the amount of money they propose to spend on subsidies.

Obama’s longtime doctor says healthcare reform plan falls short

Dr. David Scheiner of Chicago advocates a single-payer government system. He calls Obama’s plan too timid, saying it reflects politics, not the president’s ideals.

By Mike Dorning
Los Angeles Times
July 29, 2009

Reporting from Washington — The Chicago doctor who treated President Obama for more than two decades has a prescription for healthcare reform: a British- or Canadian-style single-payer system.

Dr. David Scheiner, 70, will advocate such a plan at a rally Thursday on the National Mall.

In an interview, he described the president as a “beloved” patient in “superb” health.

“He was always on time,” Scheiner said. “He just sat in the waiting room with everyone else, even when he was a senator. He never went up to the desk and pulled rank.”

But he criticized Obama’s healthcare plan as too timid, arguing that the White House plan reflected politics more than the president’s ideals.

“It’s a bad program. I don’t think it’s what he feels in his heart is necessary. I think it’s what he feels politically is the best way,” said Scheiner, who acknowledged that he had not discussed the subject with Obama directly.

Scheiner argued that the “public option” Obama favors, in which a government-run insurance program would compete with private insurers, does not go far enough. The public option has been one of the most controversial parts of Obama’s plan, with insurers and conservatives vigorously opposing it.

Scheiner said a single-payer government-run system would cut costs by reducing the administrative overhead that doctors and other health providers must maintain to meet complex reimbursement rules from different insurance companies. A government program also would have greater leverage in negotiating lower drug prices with pharmaceutical companies, he said.

He argued that such a system would lead to better care for lower-income people and end what he said was a pernicious insurance-industry practice: discouraging patients from getting necessary treatment by setting up obstacles, and boosting profits in the process.

“They make it frustrating so he doesn’t get it easily and maybe he’ll go away,” Scheiner said.

Critics’ contention that a single-payer system would constrain patient choices is misplaced, he said.

“The government never gets in my way,” he said. “Forty years I’ve been working [with] Medicare, never. Who gets in my way all the time? Private insurance companies. Somehow that message is not getting across.”

mdorning@tribune.com

Obama’s Doctor: President’s Vision For Health Care Bound To Fail

By Sam Stein
Huffington Post
July 29, 2009

The man Barack Obama consulted on medical matters for over two decades said on Tuesday that the president’s vision for health care reform is bound for failure.

Dr. David Scheiner, a 70-year Chicago-based physician who treated Obama for more than 20 years, said he was disheartened by the health care legislation his former patient is championing, calling it piecemeal and ineffectual.

“I look at his program and I can’t see how it’s going to work,” Scheiner told the Huffington Post. “He has no cost control. There would be no effective cost control in his program. The [Congressional Budget Office] said it’s going be incredibly expensive … and the thing that I really am worried about is, if it is the failure that I think it would be, then health reform will be set back a long, long time.”

Scheiner, who prefers a more progressive approach to reform, was hesitant about trying to divine the president’s motives, although he said he believed that “in his heart of hearts” Obama “may well like a single-payer program.”

“His pragmatism is what is overwhelming him.” Scheiner added: “I think he’s afraid that he can’t get anything through if he doesn’t go through this incredibly compromised program.”

Admitting that he was not a political practitioner, Scheiner said he felt compelled to speak out because of his unique relationship with the president and this critical moment in the health care debate. A champion of a single-payer health care system, Scheiner noted repeatedly that he came to the debate from the perspective of having dealt with the hassles and pitfalls of the current system. His speaking out is part of a larger effort, launched by Physicians for a National Health Program, to push Congress to consider single-payer as an alternative to current reform proposals.

As Scheiner sees it, all alternatives simply fall short. Keeping private insurers in the market, he warns, would simply maintain burdensome administrative costs. He argued further that the pharmaceutical industry is not being asked to make “any kind of significant sacrifices” in the current round of reform negotiations. As for a public health care option, Scheiner insists that the proposal remains vague and inadequate.

“First of all, they haven’t really gone into great detail about the public option,” he said. “How much is it going to cost, are they going to really undercut private health insurance by a considerable amount? Will there be any restriction that you can get for public option?”

Despite his policy critiques, Scheiner’s affection for his long-time patient is quite obvious. He recalled the president as being “gracious” and “never pulling rank” when he came to his office. “Part of my shtick, is I sing songs and I love humor,” Scheiner said. “I remember last time I saw him I told him a joke, he said, ‘Doc, you told me that joke before.’ I was so impressed he can remember my bad jokes — this guy has to be really bright.”

During the course of the campaign, Scheiner became one of the many mini-celebrities in Obama’s orbit. When the then-Senator released a one-page summary documenting his health, criticism for its brevity was laid on the doc’s doorstep.

“The guy was healthy, you know,” Scheiner recalled. “What can you say? His only problem was that he smoked … But there wasn’t that much to say. If I had added anything it would have been pure drivel. There wasn’t anything serious in his record. He’d never had anything. The guy is built like a rock, he could probably bench-press me…

“I think my most impressive time was when Jon Stewart actually mocked my report,” he added. “I thought that was wonderful.”

All of which makes his current criticism of Obama’s health care policies all the more difficult. While Scheiner raved about the president’s intellectual curiosity, he was at loss for words as to why Obama had consulted with private industry executives more than primary care physicians. And while he spoke glowingly about the president’s oratorical talents, he expressed disappointment that Obama had not done more to explain the benefits of single-payer coverage to the American public.

The White House has said that the president moved away from a single-payer approach both because of philosophical objections (consumers should be allowed to keep their coverage) as well as political realities (limited support for the proposal in Congress). The administration’s position increasingly resembles the maxim, Don’t let the perfect be the enemy of the good.

“It’s a good question,” Scheiner said, when asked if having watered-down reform become law was better than getting a single-payer system stalled in Congress. “Is something better than nothing? That is a hard one for me. That is a difficult one, because, in the end, I think [Obama’s] program is going to fail.”

http://www.huffingtonpost.com/2009/07/29/obamas-doctor-presidents_n_246870.html

Steve Burd's magic elixir

How Safeway Is Cutting Health-Care Costs: Market-based solutions can reduce the national health-care bill by 40%

By Steven A. Burd, CEO of Safeway Inc.
The Wall Street Journal
June 12, 2009
As with most employers, Safeway’s employees pay a portion of their own health care through premiums, co-pays and deductibles. The big difference between Safeway and most employers is that we have pronounced differences in premiums that reflect each covered member’s behaviors. Our plan utilizes a provision in the 1996 Health Insurance Portability and Accountability Act that permits employers to differentiate premiums based on behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.
Safeway’s Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above and receive premium discounts off a “base level” premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families.
During this four-year period, we have kept our per capita health-care costs flat (that includes both the employee and the employer portion), while most American companies’ costs have increased 38% over the same four years.
While comprehensive health-care reform needs to address a number of other key issues, we believe that personal responsibility and financial incentives are the path to a healthier America. By our calculation, if the nation had adopted our approach in 2005, the nation’s direct health-care bill would be $550 billion less than it is today.
http://online.wsj.com/article/SB124476804026308603.html

And…

Preventive health plan may prevent cost increases

By Victoria Colliver
San Francisco Chronicle
February 11, 2007
Safeway chief executive Steve Burd has turned into an evangelist of sorts, spreading the lower-cost, better-health gospel to other business executives around the country.
Starting in January 2006, Safeway began offering a new plan to its 30,000 nonunion employees.
The plan, administered by Cigna Corp., is the lowest-premium option for nonunion employees, but it comes with a high deductible. To encourage enrollment, Safeway offered the plan last year for 22 to 30 percent less than what employees were paying for Cigna’s preferred provider organization option.
The company said its program focuses more on rewards for good behavior than penalties for bad. For example, smokers who agreed to fill out the questionnaire and try to quit smoking saw no increase in their 2007 premiums.
Virtually all the savings generated in the program’s first year came from changing the plan design, Burd said. But even if the company manages to keep spending flat, Burd noted, Safeway will remain ahead of the trend.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/02/11/BUG02O20R81.DTL

And…

Mr. Burd Goes to Washington

By Kimberley A. Strassel
The Wall Street Journal
June 19, 2009
Mr. Burd explains that the “cure for today’s ills is simply removing the obstacles to a free health-care market.”
The Safeway plan has two main parts that work in tandem. The first involves giving employees a financial stake in the system. Safeway demolished the traditional PPOs and HMOs that encourage consumers to be cavalier about costs. The company deposits $1,000 each year into a “health reimbursement account,” which workers can use to pay for care. The next $1,000 in expenses is the employee’s responsibility. After that, employees pay 20% of costs up to a $4,000 maximum.
The second part of Safeway’s plan… Safeway’s “Healthy Measures” program, which is voluntary. Employees are tested for smoking, weight, blood pressure and cholesterol. Every area they “pass” results in a reduction in their premium, of as much as $1,560 for a family, a year.
When I ask Mr. Burd what he hopes to accomplish here, he is blunt that one goal is to prevent a “public option” that would only “piggyback on the experience of Medicare.” It’s a “Trojan Horse” that will steer people to government and ultimately squeeze out innovative programs like his.
He’s also working to ensure that any health-care bill contains provisions that would replicate or encourage Safeway’s success. That includes changing current law so that he can offer even steeper premium discounts for good behavior.
http://online.wsj.com/article/SB124536722522229323.html

And…

Just Rewards? Healthy Workers Might Get Bigger Insurance Breaks

By Mary Agnes Carey
Kaiser Health News
July 28, 2009
The discounts are being pushed by Steve Burd, the chief executive officer of Safeway Inc., who has met with several lawmakers on Capitol Hill and says that rewarding healthy behavior has helped keep his firm’s health care costs flat while other companies’ have skyrocketed.
Health care overhaul legislation passed by the Senate Health, Education, Labor and Pensions Committee would allow employers to increase those discounts to 30 percent and up to 50 percent if the secretaries of Labor, Health and Human Services and Treasury agree. A House proposal would allow employers to charge workers who participate in wellness programs 50 percent less than workers who don’t.
“If you give one person a discount, someone else is going to end up paying more,” said Paul Cotton, senior legislative representative, federal affairs, at AARP, one of more than 60 groups that’s fighting the provision. “So the people who aren’t able to change their behavior or participate in the program will end up paying more. Our fear is that premiums will become unaffordable for people who can’t change their behavior.”
By Safeway’s calculations, “if the nation had adopted our approach in 2005, the nation’s direct health-care bill would be $550 billion less than it is today,” Burd wrote in a June 12 op-ed in the Wall Street Journal. Critics of Burd’s data have said (that) has not been independently verified. A Safeway spokeswoman acknowledged that there has been no independent analysis, but “we were able to see savings clearly and immediately the first year we implemented the program.”
http://www.kaiserhealthnews.org/Stories/2009/July/28/Prevention.aspx

Safeway’s Steve Burd has been making the rounds in Washington and elsewhere claiming that his program would reduce our national health care bill by $550 billion, even though there is absolutely no verification of that.
So what is his program? It has two parts: 1) changing from traditional coverage to a high deductible plan with 20 percent coinsurance, and 2) premium reductions for better health.
Changing to consumer-directed high-deductible plans, with coinsurance replacing copays, reduces the amount that Safeway pays for its health benefit programs, but it does so by shifting more costs to the employees in out-of-pocket expenses, and by reducing the amount of health care received, no matter how beneficial. Since most health care spending is not subject to the negative impact of deductibles, the impact on our total national health spending would be negligible. So where is the $550 billion savings?
Reducing premiums for healthier employees automatically results in higher premiums for employees with health problems who are in the same risk pool. Hypertension, hypercholesterolemia, and a higher body mass index are problems that are much more complex than simple lifestyle choices. Health insurance is already unaffordable for the majority of us, and pushing premiums higher for those who have have greater health care needs is unsound policy, assuming that our goal is affordable health care for everyone.
Even if financial incentives were capable of reversing hypertension, hypercholesterolemia, and obesity, it would take many years – decades – to see a benefit in the form of lower national health care spending. Steve Burd’s claim that he has dramatically reduced costs in just a couple of years by shifting more out-of-pocket expenses to the less healthy employees is a crock!
Let’s say it like it is. When Steve Burd says that his program would save the nation $550 billion, he is lying. And he needs to be called on it.
His primary goal is to convince Congress that it needs to block the public option. The Senate Finance Committee decided this week that the reform bill will exclude the public option. Score one for Burd.
His other goal is to take care of his lower-cost healthy employees while punishing those with health care problems. Both the Senate HELP bill and the House Tri-Committee bill would shift even more of the premiums from the healthy to those with health problems than has Burd with his Safeway program. Score two for Burd!
It’s seems like a waste of time to even talk about Burd’s dishonest bull. But we have to, because Congress is converting his bull into our policy. At the same time, Congress is pushing aside the policies that would enable all of us to have affordable access to health care.
I only wish my anger were more contagious. The nation needs a massive epidemic of anger right now.

Steve Burd's magic elixir

How Safeway Is Cutting Health-Care Costs: Market-based solutions can reduce the national health-care bill by 40%

By Steven A. Burd, CEO of Safeway Inc.
The Wall Street Journal
June 12, 2009

As with most employers, Safeway’s employees pay a portion of their own health care through premiums, co-pays and deductibles. The big difference between Safeway and most employers is that we have pronounced differences in premiums that reflect each covered member’s behaviors. Our plan utilizes a provision in the 1996 Health Insurance Portability and Accountability Act that permits employers to differentiate premiums based on behaviors. Currently we are focused on tobacco usage, healthy weight, blood pressure and cholesterol levels.

Safeway’s Healthy Measures program is completely voluntary and currently covers 74% of the insured nonunion work force. Employees are tested for the four measures cited above and receive premium discounts off a “base level” premium for each test they pass. Data is collected by outside parties and not shared with company management. If they pass all four tests, annual premiums are reduced $780 for individuals and $1,560 for families.

During this four-year period, we have kept our per capita health-care costs flat (that includes both the employee and the employer portion), while most American companies’ costs have increased 38% over the same four years.

While comprehensive health-care reform needs to address a number of other key issues, we believe that personal responsibility and financial incentives are the path to a healthier America. By our calculation, if the nation had adopted our approach in 2005, the nation’s direct health-care bill would be $550 billion less than it is today.

http://online.wsj.com/article/SB124476804026308603.html

And…

Preventive health plan may prevent cost increases

By Victoria Colliver
San Francisco Chronicle
February 11, 2007

Safeway chief executive Steve Burd has turned into an evangelist of sorts, spreading the lower-cost, better-health gospel to other business executives around the country.

Starting in January 2006, Safeway began offering a new plan to its 30,000 nonunion employees.

The plan, administered by Cigna Corp., is the lowest-premium option for nonunion employees, but it comes with a high deductible. To encourage enrollment, Safeway offered the plan last year for 22 to 30 percent less than what employees were paying for Cigna’s preferred provider organization option.

The company said its program focuses more on rewards for good behavior than penalties for bad. For example, smokers who agreed to fill out the questionnaire and try to quit smoking saw no increase in their 2007 premiums.

Virtually all the savings generated in the program’s first year came from changing the plan design, Burd said. But even if the company manages to keep spending flat, Burd noted, Safeway will remain ahead of the trend.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/02/11/BUG02O20R81.DTL

And…

Mr. Burd Goes to Washington

By Kimberley A. Strassel
The Wall Street Journal
June 19, 2009

Mr. Burd explains that the “cure for today’s ills is simply removing the obstacles to a free health-care market.”

The Safeway plan has two main parts that work in tandem. The first involves giving employees a financial stake in the system. Safeway demolished the traditional PPOs and HMOs that encourage consumers to be cavalier about costs. The company deposits $1,000 each year into a “health reimbursement account,” which workers can use to pay for care. The next $1,000 in expenses is the employee’s responsibility. After that, employees pay 20% of costs up to a $4,000 maximum.

The second part of Safeway’s plan… Safeway’s “Healthy Measures” program, which is voluntary. Employees are tested for smoking, weight, blood pressure and cholesterol. Every area they “pass” results in a reduction in their premium, of as much as $1,560 for a family, a year.

When I ask Mr. Burd what he hopes to accomplish here, he is blunt that one goal is to prevent a “public option” that would only “piggyback on the experience of Medicare.” It’s a “Trojan Horse” that will steer people to government and ultimately squeeze out innovative programs like his.

He’s also working to ensure that any health-care bill contains provisions that would replicate or encourage Safeway’s success. That includes changing current law so that he can offer even steeper premium discounts for good behavior.

http://online.wsj.com/article/SB124536722522229323.html

And…

Just Rewards? Healthy Workers Might Get Bigger Insurance Breaks

By Mary Agnes Carey
Kaiser Health News
July 28, 2009

The discounts are being pushed by Steve Burd, the chief executive officer of Safeway Inc., who has met with several lawmakers on Capitol Hill and says that rewarding healthy behavior has helped keep his firm’s health care costs flat while other companies’ have skyrocketed.

Health care overhaul legislation passed by the Senate Health, Education, Labor and Pensions Committee would allow employers to increase those discounts to 30 percent and up to 50 percent if the secretaries of Labor, Health and Human Services and Treasury agree. A House proposal would allow employers to charge workers who participate in wellness programs 50 percent less than workers who don’t.

“If you give one person a discount, someone else is going to end up paying more,” said Paul Cotton, senior legislative representative, federal affairs, at AARP, one of more than 60 groups that’s fighting the provision. “So the people who aren’t able to change their behavior or participate in the program will end up paying more. Our fear is that premiums will become unaffordable for people who can’t change their behavior.”

By Safeway’s calculations, “if the nation had adopted our approach in 2005, the nation’s direct health-care bill would be $550 billion less than it is today,” Burd wrote in a June 12 op-ed in the Wall Street Journal. Critics of Burd’s data have said (that) has not been independently verified. A Safeway spokeswoman acknowledged that there has been no independent analysis, but “we were able to see savings clearly and immediately the first year we implemented the program.”

http://www.kaiserhealthnews.org/Stories/2009/July/28/Prevention.aspx

Comment:

By Don McCanne, MD

Safeway’s Steve Burd has been making the rounds in Washington and elsewhere claiming that his program would reduce our national health care bill by $550 billion, even though there is absolutely no verification of that.

So what is his program? It has two parts: 1) changing from traditional coverage to a high deductible plan with 20 percent coinsurance, and 2) premium reductions for better health.

Changing to consumer-directed high-deductible plans, with coinsurance replacing copays, reduces the amount that Safeway pays for its health benefit programs, but it does so by shifting more costs to the employees in out-of-pocket expenses, and by reducing the amount of health care received, no matter how beneficial. Since most health care spending is not subject to the negative impact of deductibles, the impact on our total national health spending would be negligible. So where is the $550 billion savings?

Reducing premiums for healthier employees automatically results in higher premiums for employees with health problems who are in the same risk pool. Hypertension, hypercholesterolemia, and a higher body mass index are problems that are much more complex than simple lifestyle choices. Health insurance is already unaffordable for the majority of us, and pushing premiums higher for those who have have greater health care needs is unsound policy, assuming that our goal is affordable health care for everyone.

Even if financial incentives were capable of reversing hypertension, hypercholesterolemia, and obesity, it would take many years – decades – to see a benefit in the form of lower national health care spending. Steve Burd’s claim that he has dramatically reduced costs in just a couple of years by shifting more out-of-pocket expenses to the less healthy employees is a crock!

Let’s say it like it is. When Steve Burd says that his program would save the nation $550 billion, he is lying. And he needs to be called on it.

His primary goal is to convince Congress that it needs to block the public option. The Senate Finance Committee decided this week that the reform bill will exclude the public option. Score one for Burd.

His other goal is to take care of his lower-cost healthy employees while punishing those with health care problems. Both the Senate HELP bill and the House Tri-Committee bill would shift even more of the premiums from the healthy to those with health problems than has Burd with his Safeway program. Score two for Burd!

It’s seems like a waste of time to even talk about Burd’s dishonest bull. But we have to, because Congress is converting his bull into our policy. At the same time, Congress is pushing aside the policies that would enable all of us to have affordable access to health care.

I only wish my anger were more contagious. The nation needs a massive epidemic of anger right now.