PNHP

Health Debate: Costs and Benefits

Health Debate: Costs and Benefits

Letter to the Editor
New York Times
August 5, 2009

To the Editor:

Universal coverage and cost control are not conflicting aims.

Canada spends 10 percent of gross domestic product on health care, and everyone is covered. The United States spends 16 percent of G.D.P., but tens of millions lack coverage. The cost difference is almost entirely due to higher administrative costs and higher prices, which are directly related to the economics of a multi-payer system.

The lessons from Canada and other countries are clear. If you focus on cost control, you will fail. If you cover everyone because it’s decent and just, you will also achieve economic sustainability.

America, it’s time to do the right thing and then reap the rich rewards of moral public policy.

Michael M. Rachlis
Toronto, Aug. 2, 2009

The writer, a doctor, is a health policy consultant.

House vote on single payer will be historic first, doctors group says

Physicians call on lawmakers to 'do the right thing' on health reform

FOR IMMEDIATE RELEASE Aug. 5, 2009 Contact: Quentin Young, M.D., (312) 782-6006, info@pnhp.org Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org David Lerner or Karmen Ross, Riptide Communications, (212) 260-5000 Hailing last week’s pledge by House Speaker Nancy Pelosi to hold a floor debate and vote on single-payer health reform this fall, a group of 16,000 physicians is launching an intensified campaign to educate lawmakers about the urgency of a “Medicare-for-All” solution to the nation’s health care crisis. Leaders of Physicians for a National Health Program (PNHP) say their campaign includes a stepped-up program of visits by doctors to House members in their home districts during the August recess. Last Friday’s commitment by Pelosi (D-Calif.) to Rep. Anthony Weiner (D-N.Y.) to put his single-payer amendment to H.R. 3200, the House leadership’s health reform bill, to an up-or-down vote before the full House has set the stage for first-ever floor vote of its kind. The House debate on the amendment could begin as early as September. “Single payer has gone from being ‘off the table’ to ‘on the floor,'” said Dr. Quentin Young, national coordinator of PNHP. “This dramatic turn of events is a striking indicator of our success. It shows the House leadership recognizes the strong public support – including among doctors – for removing the wasteful insurance company middlemen from our health system and redirecting the resultant savings into care.” Weiner’s amendment would delete most of the language in the House bill and instead substitute language from H.R. 676, the single-payer bill introduced by Reps. John Conyers Jr. (D-Mich.) and Dennis Kucinich (D-Ohio). The Weiner amendment, unlike the House leadership’s bill, assures universal, comprehensive, and high-quality coverage, free choice of doctor and hospital, and no co-pays or deductibles through a publicly financed system similar to Medicare. Young said that because of massive savings on private insurance overhead and paperwork, the amendment would entail no increase in U.S. health spending, in contrast to the House bill’s $1 trillion price tag over 10 years. “By recapturing the administrative waste associated with our present multi-payer, for-profit private insurance system, estimated to be $400 billion annually, a single-payer program would have more than enough resources to cover everyone who lacks insurance now and to upgrade everyone else’s coverage,” he said. “A single-payer system would also possess strong cost-control tools like bulk purchasing of drugs, negotiation of fees and global hospital budgeting, controls that are notably absent in the House bill,” he said. Young says many union, civic and faith-based groups will be watching how lawmakers vote with an eye to the 2010 election cycle. “Lawmakers now have a golden opportunity to stand up for the best interests of their constituents, to rebuff the private, for-profit health insurance industry, and to assure the health of our nation,” he said. He continued: “Many members of Congress – including Speaker Pelosi – have told constituents that they personally support a single-payer, Medicare-for-all approach, but claim they can’t vote for it because it’s not politically feasible. Yet polls that show they would have the public’s support for such a stand. Now we’ll be watching to see whether their votes match their words.” Single-payer bills have been introduced in Congress repeatedly over the past 60 years – starting with the Wagner-Murray-Dingell bill in the 1940s, and including the Kennedy-Griffiths bill of the 1970s and the Wellstone, McDermott and Russo bills of the 1990s – but none has ever reached the floor of the House or Senate.

Physicians for a National Health Program (www.pnhp.org) is an organization of 16,000 doctors who advocate for single-payer national health insurance. Several leaders of PNHP have testified before congressional committees in the current health reform debate. (See links below). To interview any of these or other spokespersons, please call (312) 782-6006. Testimony of Steffie Woolhandler, M.D., M.P.H., on medical bankruptcy and health reform before the House Judiciary Committee’s Subcommittee on Administrative and Commercial Law, July 28, 2009 https://pnhp.org/news/2009/july/testimony_of_steffie.php Testimony of Dr. Woolhandler before the Health Subcommittee of the House Energy and Commerce Committee, July 24 https://pnhp.org/news/2009/june/testimony_of_steffie.php Testimony of Quentin Young, M.D., M.A.C.P., before the House Ways and Means Committee, June 24 https://pnhp.org/news/2009/june/testimony_of_quentin.php Testimony of Margaret Flowers, M.D., before the Senate Health, Education, Labor and Pensions Committee, June 11 https://pnhp.org/news/2009/june/testimony_of_margare.php Testimony of Dr. Walter Tsou before the House Subcommittee on Health, Employment, Labor and Pensions, June 10 https://pnhp.org/news/2009/june/single_payer_bold_.php Testimony of David U. Himmelstein, M.D. before the Health, Employment, Labor and Pensions Subcommittee of the House Committee on Education and Labor, April 23 https://pnhp.org/news/2009/april/testimony_of_david_u.php

Why Single Payer Advocacy Matters Now More Than Ever

John Nichols
The Beat, a Nation blog
08/04/2009

How should serious supporters of health-care reform spend the month of August?

Not by getting trapped in the narrow “debate” between “party of no” Republicans who favor no reform at all, and Blue Dog Democrats, whose “reform” is to make a bad system worse.

And not by campaigning for “buzz words — “public option,” “employer mandates” — or whatever President Obama or Speaker Pelosi happen to favor this week. There will be plenty of advertising and organizing to that end, including a $15 million expenditure by the AFL-CIO.

Americans who want to tip the debate in the most progressive direction should take advantage an opening provided at the last minute during negotiations to get a bill approved by the House Energy and Commerce Committee.

And they should do so by advocating even more aggressively for single-payer health care.

One of the many side deals that House Speaker Nancy Pelosi, D-California, and Energy and Commerce chair Henry Waxman, D-California, had to cut to get the votes they needed for the compromise reform measure that was approved before the House broke for its August recess will allow a floor vote on real reform.

Waxman sidetracked a move by New York Congressman Anthony Weiner to replace his proposal with a single-payer plan by agreeing — with Pelosi’s approval — to schedule a vote by the full House on the plan to replace the current for-profit system with a Medicare-style plan that covers all Americans and controls costs.

“A lot of members on our committee want a vote on that,” Waxman, a California Democrat who has worked closely with the Speaker to advance a moderate reform agenda, said of single-payer. “I believe their wishes will be accommodated.”

Weiner is declaring a sort of victory, saying that: “Single-payer is a better plan and now it is on center stage. Americans have a clear choice. Their Member of Congress will have a simpler, less expensive and smarter bill to choose. I am thrilled that the Speaker is giving us that choice.”

Of course, getting a September vote on single-payer does not mean that single-payer will get the votes.

With the Obama administration and congressional leaders determined to compromise rather than fight, it is unlikely in the extreme that the current debate will end with the adoption of a single-payer plan. Even if the House approved one, it would still face a fight in the Senate.

But just as Republicans are willing to just say “no” to any reform, progressives should just say “yes” to real reform.

Campaigning for single-payer in August — by demanding that members of the House agree to support such a plan when it comes up for a vote, and by urging senators to schedule and support a similar vote in their chamber — is the best was to assure that whatever reform ultimately comes will err on the side of Americans who need health care rather than insurance companies that would deny them that care.

At the very least, single-payer advocacy should preserve an amendment sponsored by Congressman Dennis Kucinich, D-Ohio, which would allow states to experiment with single-payer programs even if the federal government refuses to do so. That’s a significant matter, since Canada’s national health care program began with single-payer experiments at the provincial level.

The worst mistake that progressives could make in August would be to put their time and energy into getting members of Congress to agree to back a barely-acceptable compromise that could end up being unacceptable by the time the lobbyists and their political handmaidens finish with it.

Better to get representatives and senators to commit to back single-payer bills.

That does not prevent them from ultimately agreeing to compromise measures.

But it gets them to begin on the side of real reform, and lessens the likelihood that the eventual deals will be as bad as the schemes that the Blue Dogs tried to impose before the break.

Perhaps just as importantly, a strong vote for single-payer will remind the Obama administration that the president was right when he said six years ago that single-payer was the right response to the mess that private insurers and their allies have made of our health-care system.

Groups that back single-payer are gearing up for August activism.

Keep track of the most important advocacy on the health care issue by following the work of Physicians for a Natonal Health Program at www.pnhp.org, the California Nurses Association at http://www.pdamerica.org.

Activist David Swanson is suggesting that this should be “Single-Payer Summer.”

Swanson’s right.

Only if Americans who favor real reform make this “Single-Payer Summer” will we have anything worth considering in the fall.

http://www.thenation.com/blogs/thebeat/458046/why_single_payer_advocacy_matters_now_more_than_ever

We need a single payer

By Laura McClure
The Daily Star (Oneonta, NY)
Published: August 01, 2009

People in our area, and across the country, desperately need health-care reform. If the reforms President Obama is urging pass Congress, many uninsured people will get access to some kind of insurance, and that could be a great thing for them. But it’s hard to exaggerate what a hash Congress and Obama have made of fixing our famously dysfunctional health-care system.

What we need is a single federal insurance plan that covers everyone from birth to death. An improved version of Medicare that stays with you no matter where you work — and once you’ve retired. We’d have complete choice of doctors and the full range of private and public hospitals to choose from.

What we wouldn’t have is 1,200 private insurance companies feeding off our need for health care — forcing hospitals and doctors to hire paper-pushers instead of people who actually provide care. Almost a third of the money we spend on health care in the U.S. can be attributed to insurance industry-generated waste.

One of the great virtues of such a “single-payer” system is that it would actually be cheaper than what we have now — and way cheaper than the trillion-dollar plan our politicians are now cooking up. Every industrialized country with a version of single-payer spends about half what we do — or less — for health care, and they have better health outcomes and more satisfied citizens.

Obama knows this. He used to be a vocal supporter of single-payer health care. He still says it would be the best system if we were starting from scratch. Instead, we’re starting with an antiquated employment-based system, a cobbled together mishmash of private and public health plans.

The sheer bureaucracy of it is driving us all insane. Yet now we’re thinking we should shovel a trillion more into this system to prop it up for awhile.

This is a staggering failure of political leadership. What are the politicians so afraid of? Well, the insurance industry. Republicans and Democrats, including Obama (big-time), were elected in part through the massive support of the insurance companies and other corporate interests with a stake in our current system. The guy who is ferrying legislation through the Senate to finance health-care reform, Max Baucus of Montana, a Democrat, is swimming in a sea of health industry money.

But I think it’s more than just money. It’s timidity — fear of real change. And that’s not just a problem politicians have. We’ve all got it. We get locked into our mind-sets and can’t get out.

Republicans tend to be imprisoned by their idea that government can’t do anything right and that all it does it waste money. Dear Republicans: If you are concerned about fiscal responsibility, please examine single-payer health care. It’s a bargain — and it’s the only way to cover everyone well without spending more money.

Republicans and some Democrats are also stuck on the idea that “competition” is always good.

They hope that competition _ including between private insurance companies and a public insurance plan — will save us money. Hmm. Don’t we already have plenty of insurance company competition — and a health-care system that costs way more than any other on the planet?

As for private-public competition, we’ve got that in the Medicare Advantage program, which allows private companies to pick off some Medicare recipients. This has caused the cost of Medicare to spiral up. Two international agencies _ the World Health Organization and the Organization for Economic Cooperation and Development — did studies of what happened when different countries tried introducing private competition into their health care systems with the aim of reducing cost. Both studies found that it increased costs and decreased the level of fairness in the system.

But there’s a larger philosophical problem here, Republicans. (I’ll get to Democrats soon!) Imagine someone is breaking into your house. You flip desperately through the yellow pages for private cops who will accept your crime insurance plan. You call seven of them. Unfortunately, they’ve all got data on you, and it turns out you were recently laid off from your job and aren’t that great a prospect. So only one private cop shows up (way too late), and makes a bid to provide some law enforcement — for a huge sum you can’t afford.

Thank goodness for our publicly funded, universal police force! There’s only one number to call, and the service is free at point of use. Yes, we pay taxes to support our cops. But we’re glad to, because they help keep us safe. Everyone’s covered. And nobody is making a calculation about whether you “deserve” police protection or not.

So what’s so different about a medical crisis? Instead of someone breaking into your house, you’ve got cancer or heart disease stalking you. You need care. You don’t need bills, deductibles, co-pays, or competing private companies angling for your money — or worse, denying you care.

But Republicans aren’t the only ones locked inside an ideological box. Many Democrats have the idea that any amount of money is okay to spend on “human needs.” We just need to swallow that bitter trillion-dollar pill in the interests of health care for all.

But this is one case where spending more money is not the answer. We need to spend less money — or at least no more than we are right now. The average family health care premium has jumped to almost $13,000. How much higher can it go? Health care is literally eating up the budget on the national level as well: The U.S. now spends 16 percent of its GDP on health care — compared to, say, less than 6 percent for education. By comparison, Canada spends 10 percent. Taiwan, which adopted a single-payer system in 1995 after a lot of shopping around, spends 6 percent of GDP on health care and has better health outcomes than we do. I wish we were that smart!

We’ve got to ask where all our money will be going. The current health-care proposals will use our tax dollars to help people buy private health insurance. This may increase the number of people who are considered “insured,” but it will also increase exponentially the profits and paper-pushing of insurance companies — which is why the insurance industry largely supports this reform. Providing more money for this system is like continually putting change in a pocket with a hole.

Another question we have to ask: Who suffers most from continually spiraling health-care costs? Even if the plan is partly financed through a tax on the very rich (which I’d be for), the real victims of rising costs will be poor and working class people. Just look at the state of Massachusetts, which passed a health reform bill not unlike the ones Congress is now considering. More people now have some kind of insurance coverage, but the plan is busting the budget.

The state has had to cut social services and ramped up premiums and co-pays for the health plan. The out-of pocket costs are so high, many of the newly “insured” can’t afford to go to the doctor or get their prescriptions filled. In a 2009 survey, 44 percent of low-income residents said they were hurt by the plan; 33 percent said they were helped. (Question: Are you “insured” if you don’t get that lump in your breast checked out because you just can’t swing the $1,000 deductible?)

Obama and others maintain that their reform plans will lower costs through things like computerized record-keeping and moving away from a fee-for-service approach. These are good ideas, but there’s little evidence they will save money any time soon. And unfortunately trying to implement any rational money-saving plan under our current system is like herding cats. There are so many players, many of whom are in it for themselves, and no one has sufficient clout to enforce the rules. Under a single-payer plan, money-saving reforms would be a lot easier to implement and ultimately more effective.

Some people — both Democrats and Republicans — just can’t fathom a reform that would involve eliminating an entire industry, namely the health insurance industry. What would happen to all those workers?

It’s a good question, and one that has been raised by Obama and many others, including local Rep. Michael Arcuri. Any Medicare-for-All program we enact needs to include a major transition plan for workers in this industry. The bill I support, HR 676, would give displaced insurance workers first dibs on jobs in the new health-care system and two years of unemployment benefits if they don’t find one. (Note: Even a more generous transition plan would be a drop in the bucket compared to the costs the insurance industry now imposes on us all.)

But is that really what our fear of true reform comes down to? An insistence on a jobs program for health insurance industry workers? Personally, I would support a major jobs program. But I’d want the jobs to be useful ones. And though I’m sure most insurance company employees are good people who do the best job they can, their role in our health-care system is to help their company make a profit off people’s desperate need for medical care. And we just can’t have that. We can’t afford it, and it’s wrong.

Whether the current health-care reform plans pass or fail, when it’s all over, we’re still going to have a big health-care mess on our hands. Someday we’re going to have to summon up all our courage and go for the real thing.

Laura McClure is a member of the Healthcare Work Group of the Coalition for Democracy of Central New York.

QOTD: A Canadian doctor diagnoses U.S. health care

A Canadian doctor diagnoses U.S. healthcare

By Michael M. Rachlis
Los Angeles Times
August 3, 2009
Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians’ services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.
The U.S.’ and Canada’s different health insurance decisions make up the world’s largest health policy experiment. And the results?
On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.
On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.
Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.
Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.
Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.
The Canadian system does have its problems, and these also provide important lessons.
However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas.
On closer examination, most of these problems have little to do with public insurance or even overall resources.
Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.
U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada’s, or any other nation’s, experience than ever. Why?
American democracy runs on money.
Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our “socialized” system doesn’t let us choose our own doctors. In fact, Canadians have free choice of physicians. It’s Americans these days who are restricted to “in-plan” doctors.
Unfortunately, many Americans won’t get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.
(Michael M. Rachlis is a physician, health policy analyst and author in Toronto.)
http://www.latimes.com/news/opinion/la-oe-rachlis3-2009aug03,0,538126.story

August will be the month of sound bites on health care reform.
One of these sound bites is “unfair competition.” It is really a silly argument designed to suppress even the most feeble of reform efforts.
But the really unfair competition this month will be between those who can explain the relatively complex health policies that can benefit everyone (except those who are wasting our resources), and those who have at their command the very effective tool of simple sound bites. These sound bites relieve the listener of any responsibility to try to understand these complex issues.
Should the dialogue on reform move into discussions of effective health policies, the opponents will be ready with their sound bite diversions, including those based on the caricature of the Canadian experience suggesting that their government takeover of health care has caused Canadians to flee to the United States should they need health care – a lie supposedly “proven” by rare, bizarre anecdotes.
When the distortions and lies about Canada are brought up, interrupt (they do) with the response that Canada has a health care financing system that includes everyone and keeps health care affordable.
The United States needs the same. We need to include everyone in a system that is affordable. The problem for single payer advocates is that the program that the administration is trying to sell us will leave five percent of us out and make affordability even worse.
The real tragedy is that this war on health care financing reform will be settled by sound bites. On that war, the bad guys always win.

QOTD: A Canadian doctor diagnoses U.S. health care

A Canadian doctor diagnoses U.S. healthcare

By Michael M. Rachlis
Los Angeles Times
August 3, 2009

Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians’ services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.

The U.S.’ and Canada’s different health insurance decisions make up the world’s largest health policy experiment. And the results?

On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.

On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.

Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.

Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.

Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.

The Canadian system does have its problems, and these also provide important lessons.

However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas.

On closer examination, most of these problems have little to do with public insurance or even overall resources.

Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.

U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada’s, or any other nation’s, experience than ever. Why?

American democracy runs on money.

Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our “socialized” system doesn’t let us choose our own doctors. In fact, Canadians have free choice of physicians. It’s Americans these days who are restricted to “in-plan” doctors.

Unfortunately, many Americans won’t get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.

(Michael M. Rachlis is a physician, health policy analyst and author in Toronto.)

http://www.latimes.com/news/opinion/la-oe-rachlis3-2009aug03,0,538126.story

Comment:

By Don McCanne, MD

August will be the month of sound bites on health care reform.

One of these sound bites is “unfair competition.” It is really a silly argument designed to suppress even the most feeble of reform efforts.

But the really unfair competition this month will be between those who can explain the relatively complex health policies that can benefit everyone (except those who are wasting our resources), and those who have at their command the very effective tool of simple sound bites. These sound bites relieve the listener of any responsibility to try to understand these complex issues.

Should the dialogue on reform move into discussions of effective health policies, the opponents will be ready with their sound bite diversions, including those based on the caricature of the Canadian experience suggesting that their government takeover of health care has caused Canadians to flee to the United States should they need health care – a lie supposedly “proven” by rare, bizarre anecdotes.

When the distortions and lies about Canada are brought up, interrupt (they do) with the response that Canada has a health care financing system that includes everyone and keeps health care affordable.

The United States needs the same. We need to include everyone in a system that is affordable. The problem for single payer advocates is that the program that the administration is trying to sell us will leave five percent of us out and make affordability even worse.

The real tragedy is that this war on health care financing reform will be settled by sound bites. On that war, the bad guys always win.

Single payer plan the only solution that will work

By Dorothy Sistrom
Opinion
The Register Guard
Thursday, Jul 30, 2009

Our health care system has failed. Church Women United of Eugene/Springfield has endorsed “single payer” health care for America. We have asked our members to contact our congressional representatives and the president to support House Resolution 676 and Senate Bill 703.

Our Church Women United board believes the biblical imperative to heal the sick and to serve the least of us and the call for the common good demand a single payer system where everyone receives health care. We agree with the resolution on health care reform by the United States Conference of Catholic Bishops that “Every person has the right to adequate health care. This right flows from the sanctity of human life and the dignity of all persons, who are made in the image of God.”

A single payer plan such as HR 676 takes health care out of the hands of profit-driven insurance plans and puts it in the hands of a public agency such as the one that runs Medicare so efficiently. Medicare operates with overhead costs of less than 3 percent, compared with 30 percent in private insurance plans. By doing so patient care and health care come before insurance company profit.

Under HR 676 every resident is covered, regardless of income, job status, age or health status. You may have your choice of doctor without co-payments, deductibles or premiums. All health care services are covered: hospital stays, doctor visits, lowered prescription costs, mental health, long term care, dental care. A doctor, not the insurance companies, will be in charge of your care. Every person will receive a national health card.

Who will pay for this? If we were living in any other industrial country, our current taxes would have paid for it. American taxpayers already pay more than 60 percent of our health care costs, and this is twice the amount needed to pay for those sick in other countries. HR 676 would eliminate spending to private insurers and reduce out-of-pocket costs to consumers by 75 percent.

To replace current sources, revenue is needed: a modest 4.5 percent employer payroll tax and a 3.3 percent employee tax (average workers now pay 24 percent of their health care insurance premium). There would also be a 5 percent health tax on the top 5 percent of income earners and a 10 percent tax on the top 1 percent, plus a 0.1 percent tax on stock and bond transfers as well as a repeal of the tax cut for the highest 1 percent of income earners. Savings will amount to $350 billion in the first year due to reduced administration and marketing costs, removal of for-profit interests, and bulk purchasing of drugs.

Single payer is not socialized medicine. Doctors and hospitals can remain in private practice. You can choose your own doctor or health care provider, without having an insurance company limit your choice. Providers will send claims to one national office using one accepted form, not the thousands of forms required by insurance companies today.

Our current U.S. health care system is too expensive and inefficient, and leaves 47 million people with no health care and 80 million underinsured. Every day, 14,000 workers lose their employee health care. Despite the fact that we spend twice as much for health care as any other industrialized country (equal to 16 percent of all goods and services), we have a lower life expectancy and higher infant mortality. Thirty cents of every U.S. health care dollar go toward insurance paperwork, marketing and profits, not health care. The more than 1,000 insurance companies involved have different plans, rules and reimbursement plans. Doctors’ offices and hospitals must hire more clerical workers than nurses to manage the complex paperwork.

The United States is the only advanced country in the world without universal health care, and as a consequence 101,000 die every year.

Physicians for a National Health Program endorses HR 676. Spokesperson David Himmelstein, M.D., of Harvard Medical School and Sidney Wolfe of Public Citizen featured on the May 22 “Bill Moyer’s Journal” on PBS argued that passage of anything but a single payer plan will bankrupt the United States. Such a plan will save $400 billion a year ($4 trillion over 10 years). They cited the Canadian system as an excellent model where everyone is covered and can choose their own care-givers. They acknowledge there must be some restrictions or delays in receiving nonemergency procedures. Americans are far more likely to forgo treatment because they can’t afford it, and 40 percent fail to fill prescriptions because of costs. Canadians have care regardless of employment, illness, disability or rising costs.

The health insurance industry routinely spends half a billion dollars per year lobbying Congress and currently is spending $1.4 million a day against a single payer or a public option. Oregon Sen. Ron Wyden was among the top 10 percent of the health care industry’s beneficiaries of campaign contributions ($1.4 million). Sen. Max Baucus of Montana, current chairman of the Senate Finance committee, received the third largest campaign support. Neither senator favors a single payer plan. In fact, Baucus has refused to schedule a committee hearing on HR 676 or SB 703 saying he “won’t waste time debating a plan which Congress cannot pass.” President Obama received $19 million in campaign contributions from the health industry.

We must act immediately. Call your congressmen and the president: Sen. Ron Wyden, 431-0229; Sen. Jeff Merkley, 465-6750; Rep. Peter DeFazio, 465-6732; President Obama, (202) 456-1414. Tell your friends and relatives to call and join us in demanding HR 676, the U.S. national health insurance “Improved Medicare for All” plan.

Dorothy Sistrom is co-president of Church Women United.

http://www.registerguard.com/csp/cms/sites/web/opinion/17507763-47/story.csp

Obama's Personal Doctor Speaks Against Health Plan

Dr. David Scheiner Was President's Physician For 22 Years

CBS News, Channel 2, Chicago
Jul 31, 2009

WASHINGTON (CBS) — President Obama’s very own doctor thinks his proposed health care reform pushing government-run insurance is “a bad program,” according to media reports.

Dr. David Scheiner, Obama’s personal physician for 22 years when the then-senator lived in Illinois, told the Chicago Tribune, “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.”

The 70-year-old doctor based in the Chicago area is an advocate of single-payer health care systems — through which a single entity, like the federal government, pays fees to hospitals and doctors.

He said he is troubled the president has consulted with private industry executives more than primary care physicians and has not talked more about the benefits of single-payer coverage, according to CBS News.

Obama years ago said he was a proponent of a single-payer system but has since said such a program is not feasible given the current, employer-based structure of the nation’s health care system. The president has left many of the details of health care reform up to Congress, encouraging them to come up with a bipartisan plan.

Scheiner issued a statement July 30 arguing for a single-payer approach to health care reform:

“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.”

In the meantime, lawmakers were still trying to hammer out a plan that would please all parties. Democrats sought to limit increases in the cost of insurance sold under the sweeping health care bill Friday as they labored to clear the final obstacle to a September showdown on President Obama’s top domestic priority.

Several officials said a last-minute agreement among Democrats on the Energy and Commerce Committee also included authority for the federal government to negotiate directly with pharmaceutical companies for lower drug prices under Medicare.

The changes were part of an intensive effort Democrats have made in recent days to satisfy the conflicting demands of liberals and conservatives on the panel. “We have agreed we need to pull together,” said Rep. Henry Waxman, D-Calif., the committee chairman. He said he hoped for a vote by early evening.

Several officials said the cost of insurance to be sold widely under the bill could not rise by more than 4 percent a year unless the government approved.

The officials who disclosed the terms of the last-minute agreement did so on condition of anonymity, saying they were not authorized to discuss private deliberations.

The White House declined to state a position on the changes.

Top Ten Ways To Tell Your President & His Party Aren't Fighting For Health Care For Everybody

by Bruce Dixon, Managing Editor
Black Agenda Report
July 29, 2009

With the corporate media relentlessly distorting the public discussion around health care reform, it time for some clear, bright lines to help us tell who is doing what to whom, and whether any of it leads to health care for all of us. Here are ten of them.

Barack Obama and Democratic majorities in the House and Senate were swept into office on a promise they would deliver affordable and accessible health care for all Americans. But the corporate media journalism limits the national health care conversation to what insurance companies, drug companies, for-profit health care professionals, their executives, lobbyists and politicians of both parties and other hirelings have to say. So it isn’t as easy as it ought to be to tell what the politicians are doing about accomplishing health care for everybody. Hence we offer these ten points. This is how you can tell whether your president and his party are fighting for the health care you deserve.

1. Their plan doesn’t cover the uninsured till at least 2013.

2013 isn’t “day one.” It’s not even after the midterm election. It’s clear after the president’s second term, if he gets one. Congress passed Medicare in 1965 and president Lyndon Johnson rolled out coverage for millions of seniors in eleven months, back in the days before they even had computers.

22,000 Americans now perish each year because they can’t get or can’t afford medical care, and this year three quarter million personal bankruptcies will be triggered by unpayable medical bills. Why this president and these Democrats are in such a hurry to pass health care now that doesn’t take effect till two elections down the road doesn’t make sense in any kind of good way.

2.Their “public option” isn’t Medicare, won’t bring costs down and will only cover about 10 million people.

The “public option” was sold to the American people as Medicare-scale plan open to anybody who wants in that would compete with the private insurers and drive their costs downward. But in their haste not to bite the hands that feed them millions in campaign contributions each hear, the president and his party have scaled the public option back from a Medicare-sized 130 million to a maximum of 10 million, too small to put cost pressure in private insurers. Worse still, the president and his party are playing bait-and-witch, not telling the public they have reduced the public option, to nearly nothing.

This remnant of a public option is not Medicare, as Howard Dean insists, and it will not lead to the sort of everybody-in-nobody-out health care system that most Americans, whenever they are surveyed say they want.

Some Senate and House Democrats want to ditch even the pretense of a “public option” in favor of something they’re calling a private insurance “co-op”, which as near as anybody can tell has the same relationship to an actual cooperative that clean coal has to actual coal.

3. The president and his party have already caved in to the drug companies on reimporting Canadian drugs, on negotiating drug prices downward and on generics.

This explains why Big Pharma, the same people who ran the devastatin g series of anti-reform “Harry and Louise” ads to spike the Clinton-era drive to fix health care are spending $100 million to run Obama ads using the president’s language about “bipartisan” solutions to health care reform.

4. The president and his party have received more money from private insurers and the for-profit health care industry than even Republicans, with the president alone taking $19 million in the 2008 election cycle alone, more than all his Repubican, Democratic and independent rivals combined.

Democratic senator Max Bacaus got $1.1 million in 2008. Democratic senators Harkin, Landreau and Rockerfeller each got over half a million, and Senator Durbin got just under half a million. Other Democratic senators got a little less. Four Democrats in the House, Rangel, Dinglell, Udall and Hoyer got over half a million apiece in 2008, with other Democrats not far behind.

Is there any wonder that the insurance companies, like the drug companies are also running “bipartisan health care reform” commercials using the president’s exact language?

5. The president’s plan, and those of Republicans and Democratic blue dogs too, will require families to purchase health insurance policies from private insurers.

This is something the policy wonks call an ‘individual mandate”, under which Individuals will be “mandated” to purchase affordable insurance, though companies would not be required to offer it. In Massachusetts, the prototype state for the Obama plan, a family with an income of $33,000 can be required to spend $9,000 in deductibles and out-of-pocket expenses before the insurance company is obligated to pay a dime. As in Massachusetts, public money is used to purchase private insurance for the very poorest citizens. With the revenues of insurance companies on the decline, individual mandate programs are a welcome bailout for the private insurance industry.

6. The president’s plan, and those of Republicans and Democratic blue dogs too, could force you to buy junk insurance.

Think about an insurance policy that costs a lot, but is full of loopholes, exceptions and steep deductibles and co-payments. That’s junk insurance, and for many it’s the only insurance companies offer. Even more pernicious is the widespread practice among insurance companies of “recission” in which claimants are routinely investigated and disqualified in the event that they finally make a claim. Insurance companies admit they do this to half of one percent of policies per year. That means if you hold a health insurance policy twenty years, you don;t have insurance Ć¢ā‚¬ā€œ you have a ninety percent chance of having insurance.

7. The president’s plan, as well as those of Democratic “blue dogs” and Republicans, are to be funded in part with cuts in Medicare and Medicaid.

Private insurance companies have always hated Medicare because it is far more efficient than they are. Medicare’s administrative expenses are under five percent, as compared with the one third of every health care dollar taken by the for-profit insurance companies for their advertising, bad investments, billing and denial machinery, executive salaries and bonuses. Private insurers have, over the years, purchased enough influence in Congress and previous White Houses to restrict Medicare’s payment rates and partially privatize it. But president Obama’s plan, perhaps the most friendly to Medicare and Medicaid, calls for over $300 billion in cuts to the programs that now provide medical care to those with the fewest options, while failing to guarantee that care will come from elsewhere. In Massachusetts right now, hospitals are turning away poor people they used to be able to provide care for because funding that used to go to those institutions is now plowed into the state’s “individual mandate” system.

8. The president, with the cooperation of corporate media and the Republicans is trying to make the argument about himself instead of a discussion on the merits of his policy.

The president and his critics are happy to talk about whether this will be “his Waterloo”, or his Dien Bien Phu, as if that matters more than the 22,000 Americans who die each year from lack of medical care, or the three quarter million who will go bankrupt because of unpayable medical bills. The concentration on whether the president looks good or bad takes up air, ink, and coverage time that might otherwise be spent explaining what is and isn’t in the various proposals, and why.

If the president were not afraid of his own supporters publicly examining the merits and demerits of his proposals, he would mobilize those 13 million emails and phone numbers collected during the campaign. The reason he has not sone so already is that most of his own supporters favor a Medicare-For-All single payer health care system, HR 676.

9. The president and his party, and the corporate media have spent more time and energy silencing and excluded the advocates of single payer health care, mostly the president’s own supporters, than they have fighting blue dogs and Republicans.

But no matter how diligently the spokespeople for single payer are excluded from media coverage and invitations to Obama’s policy forums and round tables, no matter how many times the White House cuts their questions from transcripts and video of public events, the calls, emails and letters keep pouring into Congress and the White House demanding the creation of a publicly funded, everybody-in-nobody-out system, a Medicare-for-All kind of single payer health care plan.

10. Despite the president’s own admission that only a single payer health care system will deliver what Americans want, he and the leaders of his party insist that Medicare For All, HR 676, us utterly off the table.

Before he became a presidential candidate, Barack Obama identified himself as a proponent of a single payer health care system. All we had to do, he told us, was elect a Democratic congress and senate, and a different president. Now that this has been done, he insists that “change” is just not possible, and we have to settle for less. The president continues to admit that only a single payer health care system will cover everybody, but insists that America just can’t handle that much change.

The truth is that Barack Obama campaigned as the candidate of change, and a health care system that covers everybody from day one with no exceptions is what people imagined they voted for when they swept him and an overwhelming number of Democrats into office.

A single payer Medicare-For-All system will eliminate 500,000 insurance company jobs and replace them with 3.2 million new jobs in health care for a net gain of 2.6 million new jobs according to a study by the National Nurses Organization. That’s as many jobs as the US economy lost in all of 2007. Single payer will create hundreds of billions in annual wages and local and state tax revenues for cash strapped cities and towns. It will lift the shadow of bankruptcy for medical reasons from two thirds of a million American families yearly. It’s what we deserve.

It’s what we voted for, and we won’t stop demanding it.

Bruce Dixon is based in Atlanta GA and is managing editor at Black Agenda Report. He can be reached at bruce.dixon@blackagendareport.com.

http://www.blackagendareport.com/?q=content/top-ten-ways-tell-your-president-his-party-arent-fighting-health-care-everybody

A Canadian doctor diagnoses U.S. healthcare

The caricature of 'socialized medicine' is used by corporate interests to confuse Americans and maintain their bottom lines instead of patients' health

By Michael M. Rachlis
Los Angeles Times
August 3, 2009

Universal health insurance is on the American policy agenda for the fifth time since World War II. In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospitals and physicians’ services. As a policy analyst, I know there are lessons to be learned from studying the effect of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.

Our countries are joined at the hip. We peacefully share a continent, a British heritage of representative government and now ownership of GM. And, until 50 years ago, we had similar health systems, healthcare costs and vital statistics.

The U.S.’ and Canada’s different health insurance decisions make up the world’s largest health policy experiment. And the results?

On coverage, all Canadians have insurance for hospital and physician services. There are no deductibles or co-pays. Most provinces also provide coverage for programs for home care, long-term care, pharmaceuticals and durable medical equipment, although there are co-pays.

On the U.S. side, 46 million people have no insurance, millions are underinsured and healthcare bills bankrupt more than 1 million Americans every year.

Lesson No. 1: A single-payer system would eliminate most U.S. coverage problems.

On costs, Canada spends 10% of its economy on healthcare; the U.S. spends 16%. The extra 6% of GDP amounts to more than $800 billion per year. The spending gap between the two nations is almost entirely because of higher overhead. Canadians don’t need thousands of actuaries to set premiums or thousands of lawyers to deny care. Even the U.S. Medicare program has 80% to 90% lower administrative costs than private Medicare Advantage policies. And providers and suppliers can’t charge as much when they have to deal with a single payer.

Lessons No. 2 and 3: Single-payer systems reduce duplicative administrative costs and can negotiate lower prices.

Because most of the difference in spending is for non-patient care, Canadians actually get more of most services. We see the doctor more often and take more drugs. We even have more lung transplant surgery. We do get less heart surgery, but not so much less that we are any more likely to die of heart attacks. And we now live nearly three years longer, and our infant mortality is 20% lower.

Lesson No. 4: Single-payer plans can deliver the goods because their funding goes to services, not overhead.

The Canadian system does have its problems, and these also provide important lessons. Notwithstanding a few well-publicized and misleading cases, Canadians needing urgent care get immediate treatment. But we do wait too long for much elective care, including appointments with family doctors and specialists and selected surgical procedures. We also do a poor job managing chronic disease.

However, according to the New York-based Commonwealth Fund, both the American and the Canadian systems fare badly in these areas. In fact, an April U.S. Government Accountability Office report noted that U.S. emergency room wait times have increased, and patients who should be seen immediately are now waiting an average of 28 minutes. The GAO has also raised concerns about two- to four-month waiting times for mammograms.

On closer examination, most of these problems have little to do with public insurance or even overall resources. Despite the delays, the GAO said there is enough mammogram capacity.

These problems are largely caused by our shared politico-cultural barriers to quality of care. In 19th century North America, doctors waged a campaign against quacks and snake-oil salesmen and attained a legislative monopoly on medical practice. In return, they promised to set and enforce standards of practice. By and large, it didn’t happen. And perverse incentives like fee-for-service make things even worse.

Using techniques like those championed by the Boston-based Institute for Healthcare Improvement, providers can eliminate most delays. In Hamilton, Ontario, 17 psychiatrists have linked up with 100 family doctors and 80 social workers to offer some of the world’s best access to mental health services. And in Toronto, simple process improvements mean you can now get your hip assessed in one week and get a new one, if you need it, within a month.

Lesson No. 5: Canadian healthcare delivery problems have nothing to do with our single-payer system and can be fixed by re-engineering for quality.

U.S. health policy would be miles ahead if policymakers could learn these lessons. But they seem less interested in Canada’s, or any other nation’s, experience than ever. Why?

American democracy runs on money. Pharmaceutical and insurance companies have the fuel. Analysts see hundreds of billions of premiums wasted on overhead that could fund care for the uninsured. But industry executives and shareholders see bonuses and dividends.

Compounding the confusion is traditional American ignorance of what happens north of the border, which makes it easy to mislead people. Boilerplate anti-government rhetoric does the same. The U.S. media, legislators and even presidents have claimed that our “socialized” system doesn’t let us choose our own doctors. In fact, Canadians have free choice of physicians. It’s Americans these days who are restricted to “in-plan” doctors.

Unfortunately, many Americans won’t get to hear the straight goods because vested interests are promoting a caricature of the Canadian experience.

Michael M. Rachlis is a physician, health policy analyst and author in Toronto.