PNHP

Single-payer reduces waste dramatically

Single-payer reduces waste dramatically

By Jeremy B. Stern
SouthCoastToday.com
July 07, 2009

I am an orthopedic surgeon who has been practicing in this community over the past 16 years and may be familiar to many of your readers. As our Congress debates the future of our health-care system, I am writing to urge my fellow citizens to get involved in the process. The debate in Congress is being framed largely by the insurance companies. This is problematic because of the large sums of money donated by the insurance lobby to the same senators who are crafting the reform.

What is not being considered fairly is H.R. 676, a single-payer health-care system.

In the U.S. today we spend approximately two times as much as other industrialized nations, over $7,000 per person per year, yet have nearly 50 million uninsured residents. What causes this waste of health-care dollars? We are the only industrialized nation that does not have a single-payer system. Instead our system is based on privately owned for-profit insurance companies.

In the average private health insurance company, one-third of the money paid in premiums is used for “administrative costs.” That means that one-third of all the money you and I now pay for our insurance is used to pay for things like salaries, marketing, overhead and, of course, profits and bonuses. Not to provide health care.

In addition, hospitals, nursing homes and physicians need to employ large staffs just to negotiate the maze of rules and regulations from multiple insurance companies. By eliminating these multiple insurance companies, the cost savings to the system would be more than a staggering $350 billion each year.

Many people are scared to have a single-payer system run by the federal government for two main reasons. First, there is a general impression that the government is inefficient and will be unable to manage the system well, and second, people fear that the government would limit their choice of providers. Most people don’t realize that the government plan we all know best, Medicare, runs at about 3 percent overhead while most HMOs run 15 to 20 percent overhead, and the Canadian system has 1 percent overhead. The government, then, is more efficient than the private sector.

As to the second fear, lack of choice, in the single-payer plan being talked about for the United States, the majority of the health-care system would run just as it does today. That means that most people would have greater choice of providers because they would no longer have an HMO telling them who they could see. Unlike the VA or Army system where the doctors and hospitals are run directly by the government, in a single-payer system here in the United States there would be no change in the providers; only the payers would change.

What would happen is that we and our employers would all pay taxes instead of premiums. These taxes would amount to a fraction of what we used to pay in insurance premiums. For those taxes we would have insurance that would pay for literally all of our health needs, from glasses to dental care to medical and surgical care.

The large cost savings of a single-payer system would come in various ways. By buying in bulk and demanding volume discounts, the single-payer plan would greatly decrease the cost of medication. The VA system in the United States gets a 40 percent reduction in medicine costs over what we all pay. A single-payer system would also greatly increase the country’s access to preventative care. This in turn would reduce the inappropriate overuse of highly costly emergency rooms. Having diseases diagnosed earlier and treated appropriately vastly decreases the overall cost of treatment of that disease. For example, by treating high cholesterol early with medicine, you may well eliminate the need for a very costly coronary artery bypass later in life.

While doctors and hospitals would be paid somewhat less, their costs of doing business would be drastically reduced since there would be a very low cost to billing and administration, and providers would get paid more quickly and reliably.

Lastly, but perhaps most importantly, there would be improvements to our actual patient care with a single-payer system. Having only one payer would allow us to use a unified computer system. With this single computer system, whenever you went for health care of any kind, the health-care provider would have all the information needed to treat you safely, such as the medications you take and the allergies you have. There would be fewer medical errors and a greater awareness of interrelated medical problems.

I strongly encourage you all to call, write, text or otherwise contact your congressmen and senators, and encourage them to strongly consider H.R. 676, the single-payer system that will fundamentally eliminate a huge waste of health-care dollars and restore our health-care system.

Dr. Jeremy B. Stern is an orthopedic surgeon. He lives in Marion.

http://www.southcoasttoday.com/apps/pbcs.dll/article?AID=/20090707/OPINION/907070310/-1/NEWS10

ECONOMIC SCENE: The missing piece of the healthcare debate

The idea of a government-paid national healthcare system hasn’t gotten very far in the Washington debate.

By David R. Francis
Staff Writer
The Christian Science Monitor
July 1, 2009 edition

If no one is paying any attention, create a fuss.

Maybe that explains why 13 doctors and nurses got arrested last month when they disrupted a Senate hearing. Their protest: The committee wasn’t considering a single-payer solution to fix America’s healthcare system.

In fact, as healthcare reform works its way through Congress, the idea of a government-paid national health-insurance system hasn’t gotten very far in the Washington debate.

Perhaps it’s too politically radioactive. Or too difficult to pass. For whatever reason, neither the most Democratic Congress in decades nor the most liberal president since Jimmy Carter have opted for a sweeping national health-insurance system, as exists in Europe and Canada, where private insurers disappear and government pays the tab.

“There are countries where a single-payer system works pretty well,” President Obama, a onetime single-payer supporter, told the American Medical Association June 15. “But I believe … that it’s important for our reform efforts to build on our traditions here in the United States.”

That stance leaves single-payer advocates in a political quandary.

“We haven’t yet applied enough pressure to get done what has to be done,” says David Himmelstein, cofounder of Physicians for a National Health Program (PNHP). Maybe, he added, “we will have to give strong consideration to civil disobedience.”

Why are single-payer advocates so passionate? For one thing, many of them see medical healthcare as a civil right for all Americans.

Call up the Internet home page of Rep. John Conyers (D) of Michigan and immediately, without further clicking, a video shows the congressman talking on the House floor about one of “the biggest challenges of the 21st century” — healthcare reform. His bill would provide national health insurance to every person with no deductibles or copayments for medical treatment. Uncle Sam — via citizens — would pay the bill.

Prospects for his bill in Congress don’t appear strong, although 80 House members have signed on to his bill and 59 percent of physicians back national health insurance, according to a new poll.

Public support has also grown over the years. In 1979, 40 percent of Americans thought the federal government should provide national insurance; last month, 72 percent supported the idea, according to CBS News/New York Times polls.

“Things have gone very well for us,” says Quentin Young, PHNP’s national coordinator. “There has been a new surge of support in the last few months.”

Economic stress may explain some of that shift. In 2007, even before the recession, medical bills were the cause for more than 60 percent of bankruptcies, a new Harvard study finds. More than 75 percent of these bankrupt families had health insurance, but it wasn’t enough, Dr. Young points out.

Reformers of every stripe figure that today’s system is unsustainable in the long run. The Congressional Budget Office projects national healthcare costs to rise from today’s 18 percent of gross domestic product, the total output of goods and services in the nation, to more than 30 percent in 2030 and 50 percent by 2080. That assumes modest cost-cutting measures are imposed. Without them, healthcare costs would consume nearly the entire economy by 2080, an impossibility.

Compromise reforms under consideration in Congress are economically “not feasible,” Dr. Himmelstein says, “The likelihood we can afford what they are offering is nil.”

So he figures a single-payer plan is essential. Just cutting the system’s bureaucratic overhead from today’s 31 percent of total expenditures to Canada’s level (1 percent) would save nearly $400 billion annually, more than enough to cover the 48 million now uninsured, he argues.

So why hasn’t Congress moved toward a single-payer system? The financial and political clout of health industries, charges Himmelstein.

And who was the top recipient of their largess in the 2008 election cycle? Mr. Obama.

Health care reform, front and center

Cantwell, health care officials discuss issue at Vancouver forum

By Kathie Durbin
The Columbian
Thursday, July 2

A boisterous audience of more than 100, including a large contingent of seniors, packed a Vancouver hospital auditorium Wednesday to hear U.S. Sen. Maria Cantwell, D-Wash., and a panel of health care providers dissect national health care reform.

People saved their loudest applause for speakers who expressed support for a single-payer system of national health insurance, such as Dr. David Baughan, a family care physician with Group Health Cooperative in the Puget Sound area.

Citing the battles that preceded passage of the 1965 Voting Rights Act, Baughan said, “Political will was mobilized after a lot of people died. In 2009, people die every day because they don’t have health insurance.”

The public would not tolerate a police or fire department that serves only two-thirds of a city, he said, but the nation continues to accept a system in which one-third of Americans lack adequate health coverage.

Some in the audience tried to pin Cantwell down on where she stands on a government-run “public option” that would compete with private health insurance and cover the uninsured.

“We need something like a public plan to purchase health care,” said Cantwell, who has sent mixed signals on the issue over the past two weeks. Members of Congress are still wrestling with how such a public plan would work and how to pay for it, she said.

Cantwell sits on the Senate Finance Committee, which is drafting a bill to spell out how the federal government would pay for a plan to cover the nation’s 47 million uninsured while reducing health care costs through efficiencies and a focus on disease prevention.

Single payer

Asked “what happened” to the single-payer option, which would cut private insurers out of the picture altogether, Cantwell said, “I don’t think that single payer has vanished from the discussion.”

She said she expects amendments to the Senate bill calling for a single-payer system to be introduced on the Senate floor.

A single-payer bill introduced in the House by Rep. John Conyers, D-Michigan, has 79 co-sponsors but has stalled and has little support from House leaders or President Obama. Conyers’ bill would create a publicly financed health care program, modeled on Medicare and funded through a payroll tax, that would cover all Americans without charging co-pays or deductibles.

“I think a public plan represents many of the same elements” as a single-payer system, Cantwell said. For example, she said, both would use the power of the federal government to drive down health care costs through its power to negotiate with hospitals, doctors and drug companies.

However, a government plan would not guarantee that people could find physicians, she added. Cantwell is pushing for financial incentives to train more primary care physicians, who are in short supply in many parts of the country.

Diverse views

Speakers at Wednesday’s panel at Southwest Washington Medical Center represented a range of views on how health care reform should be structured. Most agreed, however, that the nation no longer can afford an open-ended “fee for services” system in which insurance companies pay doctors for whatever drugs and procedures they prescribe, without, they contend, regard to cost or effectiveness.

Ross Baker, a lobbyist for Regence Blue Shield, which insures more than 1 million Washington residents, said his company is moving to control costs.

“We would all admit that the system has major problems and change is needed,” Ross said. Regence supports improved primary care, evidence-based medicine, more use of generic drugs, and elimination of medically unnecessary tests and procedures, he said.

But whether the nation chooses a public plan or tweaks the current plan, he said, real reform won’t happen until Americans take responsibility for their health through changes in diet and exercise.

Dr. George J. Brown, chief executive officer of Legacy Health Systems, said his concern is the growing burden hospitals are shouldering in treating the uninsured. Legacy treats 75,000 people annually in six hospitals in Oregon and Southwest Washington.

“The economic crisis facing our nation has drastically increased the demand for charity care,” Brown said. Further cutting Medicare reimbursements to hospitals, as some in the Obama administration have proposed, is not a solution, he said. “National health care reform is the ultimate solution.”

Charles E. Reed of AARP said his organization, with 40 million members, insists that any health care reform bill address coverage for people in the 50-to-64 age range. Those people are vulnerable, he said, because they are not yet eligible for Medicare, and if they lose employer-provided coverage, they’re often unable to buy private insurance because they have pre-existing conditions.

AARP also supports programs to keep seniors out of expensive nursing homes and development of generic versions of expensive drugs such as those used to treat cancer.

Lack of will

Dr. David Ruiz, a board-certified family physician who now directs a residency program that trains others in his specialty, offered some historical perspective on health care reform. He said the failure of the nation’s leaders to pass universal health coverage is a story of a lack of political will. Presidents Franklin D. Roosevelt, Harry Truman and Lyndon B. Johnson all were afraid to tackle it, he said, and President Bill Clinton’s reform never came to a vote in Congress.

“You have a window of opportunity that opens infrequently,” Ruiz said. But he admitted his skepticism, borrowing from the 15th-century Italian writer Niccolo Machiavelli, who wrote in “The Prince:” “He who innovates will have for his enemies all those who are well off under the existing order of things, and only lukewarm supporters in those who might be better off under the new.”

Community health

Dawn Doutrich, who teaches in the community master’s program for nursing at Washington State University Vancouver, urged a greater investment in public health to prevent disease and reduce the wide disparity in health care that exists between rich and poor.

“We need to re-examine the assumption that health care fits into a corporate model,” she said.

Barbe West, the new executive director of the Free Clinic of Southwest Washington, urged a shared community responsibility for health care. Every major public decision, from whether to close a community grocery store to whether to site a school where all children will have to ride the bus to school, should be analyzed for its impact on public health, she said.

Joe Kortum, president and chief executive officer of Southwest Washington Medical Center, summed things up by urging Americans to have a “dramatic cultural conversation” about what health care means to them.

People in other industrialized countries find it immoral that millions of Americans have no health coverage, Kortum said.

The United States has the capacity to deliver world-class health care, he said, “and yet we have a shipwreck in this system.”

Can Medicaid fill the gap?

To: Sen. Judd Gregg, Ranking Member, Senate Budget Committee
From: Douglas W. Elmendorf, Director
Congressional Budget Office
Letter
July 7, 2009
In response to your request, the Congressional Budget Office (CBO) has considered the likely effects on federal spending and health insurance coverage of adding a substantial expansion of eligibility for Medicaid to the Affordable Health Choices Act, a draft of which was recently released by the Senate Committee on Health, Education, Labor, and Pensions (HELP).
CBO has not yet had time to produce a full estimate of the cost of incorporating any specific Medicaid expansion in the HELP committee’s legislation. However, our preliminary analysis indicates that such an expansion could increase federal spending for Medicaid by an amount that could vary in a broad range around $500 billion over 10 years. Along with that increase in federal spending would come a substantial increase in Medicaid enrollment, amounting to perhaps 15 million to 20 million people. Such an expansion of Medicaid would also have some impact on the number of people who obtain coverage from other sources (including employers). All told, the number of non-elderly people who would remain uninsured would probably decline to somewhere between 15 million and 20 million. (For comparison, CBO’s analysis of the draft legislation that was released by the HELP committee found that, absent any expansion of Medicaid or other change in the legislation, about 33 million people would ultimately remain uninsured if it were to be enacted.)
http://www.cbo.gov/ftpdocs/104xx/doc10445/07-07-2009-ExpandingMedicaid.pdf

From the start it was recognized that insurance exchanges, even if they included a public option, could never provide affordable coverage for low-income individuals. The Medicaid program would have to be expanded to cover this more vulnerable population.
It was also recognized that, even with subsidies, there are many individuals who could not afford to purchase plans through an exchange yet have incomes above the thresholds that would qualify them for Medicaid.
That has led to the new definition of universal coverage as being “close to 95 percent.” This CBO analysis provides support for that view. Leaving only 15 to 20 million people without coverage has become one of the parameters that will define “success” in the reform efforts.
And costs? This Medicaid expansion can be accomplished for only half a trillion dollars (federal component), that is if it is agreed that the program will continue to be chronically underfunded. If it is eventually decided that Medicaid must cover actual health care costs, then add those costs to this half a trillion dollars plus to the funds already obligated for the 60 million people now covered by Medicaid. Once 75 to 80 million people are on Medicaid – over one-fourth of our population – adequate funding will be essential if there are to be enough willing providers to be there to give care when needed.
Keep in mind that all health care costs still must be met one way or another in a fragmented multi-payer system, but with the inevitability of inequitable cost shifting. This inequity potentially can have an adverse impact on the health and finances of tens of millions of Americans. However the total costs are much higher than they need to be because of the profound inefficiencies of this dysfunctional financing system which Congress has elected to protect and expand.
Under a single payer system – a reformed Medicare for all – everyone would be included automatically and without the projected cost overruns that are plaguing the current reform process. Those were the goals of reform, but they seem to have been chewed up in the legislative sausage machine of Congress.

Can Medicaid fill the gap?

To: Sen. Judd Gregg, Ranking Member, Senate Budget Committee

From: Douglas W. Elmendorf, Director

Congressional Budget Office
Letter
July 7, 2009

In response to your request, the Congressional Budget Office (CBO) has considered the likely effects on federal spending and health insurance coverage of adding a substantial expansion of eligibility for Medicaid to the Affordable Health Choices Act, a draft of which was recently released by the Senate Committee on Health, Education, Labor, and Pensions (HELP).

CBO has not yet had time to produce a full estimate of the cost of incorporating any specific Medicaid expansion in the HELP committee’s legislation. However, our preliminary analysis indicates that such an expansion could increase federal spending for Medicaid by an amount that could vary in a broad range around $500 billion over 10 years. Along with that increase in federal spending would come a substantial increase in Medicaid enrollment, amounting to perhaps 15 million to 20 million people. Such an expansion of Medicaid would also have some impact on the number of people who obtain coverage from other sources (including employers). All told, the number of non-elderly people who would remain uninsured would probably decline to somewhere between 15 million and 20 million. (For comparison, CBO’s analysis of the draft legislation that was released by the HELP committee found that, absent any expansion of Medicaid or other change in the legislation, about 33 million people would ultimately remain uninsured if it were to be enacted.)

http://www.cbo.gov/ftpdocs/104xx/doc10445/07-07-2009-ExpandingMedicaid.pdf

Comment:

By Don McCanne, MD

From the start it was recognized that insurance exchanges, even if they included a public option, could never provide affordable coverage for low-income individuals. The Medicaid program would have to be expanded to cover this more vulnerable population.

It was also recognized that, even with subsidies, there are many individuals who could not afford to purchase plans through an exchange yet have incomes above the thresholds that would qualify them for Medicaid.

That has led to the new definition of universal coverage as being “close to 95 percent.” This CBO analysis provides support for that view. Leaving only 15 to 20 million people without coverage has become one of the parameters that will define “success” in the reform efforts.

And costs? This Medicaid expansion can be accomplished for only half a trillion dollars (federal component), that is if it is agreed that the program will continue to be chronically underfunded. If it is eventually decided that Medicaid must cover actual health care costs, then add those costs to this half a trillion dollars plus to the funds already obligated for the 60 million people now covered by Medicaid. Once 75 to 80 million people are on Medicaid – over one-fourth of our population – adequate funding will be essential if there are to be enough willing providers to be there to give care when needed.

Keep in mind that all health care costs still must be met one way or another in a fragmented multi-payer system, but with the inevitability of inequitable cost shifting. This inequity potentially can have an adverse impact on the health and finances of tens of millions of Americans. However the total costs are much higher than they need to be because of the profound inefficiencies of this dysfunctional financing system which Congress has elected to protect and expand.

Under a single payer system – a reformed Medicare for all – everyone would be included automatically and without the projected cost overruns that are plaguing the current reform process. Those were the goals of reform, but they seem to have been chewed up in the legislative sausage machine of Congress.

Why Fiscal Conservatives Should Love Medicare-for-All

Good, Old-Fashioned U.S. Socialized Medicine

By CAROL MILLER
CounterPunch
June 29, 2009

Call me old fashioned, but a true conservative is someone who conserves, dislikes wasting money and is offended by endless corporate bailouts by hard-working taxpayers. A fiscal conservative like me. As a public health professional, I want to see health dollars used to keep people healthy through public health and wellness programs, as well as provide medical care when it’s needed.

We have a health care crisis in the United States. Nearly 50 million people do not have health insurance, and they are our family and neighbors.

There are 500,000 medical bankruptcies every year. Most of these half million families had health insurance; at least they thought they did because every month they paid for insurance. Millions of people have learned the hard way that for-profit sickness insurance does not prevent financial ruin during a health crisis.

One of the worst lies thrown around every time Congress debates health care is that the U.S. will end up with socialized medicine. Socialized medicine is when the government owns and operates health facilities as well as pays the salaries of the doctors, nurses and the rest of the healthcare work force.

Let me say as clearly as possible — President Obama and the Congress are not discussing, introducing or enacting socialized medicine.

Good old-fashioned U.S. socialized medicine

Today, the U.S. already has socialized medical systems serving more than 20 million people. The current U.S. socialized medicine systems are very popular. The largest in terms of numbers of people is the Military Health System. The largest in terms of numbers of facilities owned and operated is the Veterans Administration health system. Two additional smaller U.S. socialized medical systems are the Indian Health Service and the federal Bureau of Prisons.

Despite being socialized medicine, the VA is ranked the highest in a national survey of patient satisfaction by the University of Michigan. U.S. taxpayers own the 155 VA hospitals and 881 clinics; we employ 289,000 people working in the VA including 16,000 doctors and 42,000 nurses.

Even the bastion of capitalism, Fortune magazine, is impressed by VA health care, stating, “The seamless integration of science, information, and compassion is the dream of modern health care. Scenes like these are not fantasies, however, but daily realities at the Veterans Health Administration.” (Fortune, May 2006.)

Let me repeat, President Obama and the Congress are not discussing, introducing, or enacting socialized medicine. Unlike the socialized system military and veterans enjoy, most health care services are provided through a private delivery system. All reforms will build on the existing private delivery system.

2009 health reform debate

So now that we all agree that the President and Congress are not expanding socialized medicine in the U.S., what are they proposing? There are two basic options and neither creates a nationalized or socialized health care system.

Medicare for all: The first choice expands Medicare eligibility beyond its current limitation to elderly (over 65) and disabled individuals of any age. This is the most conservative, least-disruptive and cost-effective way to cover more people; it only takes a simple change to an existing, very popular program. Every time the Congressional Budget Office scores the cost of Medicare-for-all type programs, they pay for themselves through two key business principles, the power of bulk purchasing and administrative savings though the elimination of waste in the system.

Mandated insurance: The second choice forces taxpayers to buy for-profit insurance despite a wasteful administrative cost of $1 billion a day. Yes, a trillion dollars every two and a half years just for paperwork, not a penny of that for health care. As a fiscal conservative, I do not want to pay a secret corporate bailout so that greedy CEOs make bonuses based on how good they are at rationing care to sick people.

In this expansion of the current failed system, the U.S. spends more than twice as much per person than any other country and the excess cost does not result in better outcomes. The U.S. is about 37th in the world for life expectancy, infant mortality, and other indicators of health status.

We have to walk away from corporate rationing to create a seamless system with the highest quality services for the best price. The easiest way to hold down costs is to have the largest purchasing group possible to get bulk prices — this is the single-risk pool.

Especially in this economic downturn it is essential to help people get access to health care. Being creative now gives us the chance to create a brand-new system, an All-American plan.

False conservatives will parrot the corporate line and continue to bail out the failed sickness insurance system. True fiscal conservatives who want to eliminate waste, hold down costs and improve outcomes will support Senate Bill 703 and House Bill 676. All the other bills transfer tax dollars first into needless paperwork and corporate profits and then dole out whatever is left for medical bills.

The choice is clear. We keep our doctors and hospitals in the current private delivery system but let one public insurance plan handle the paperwork and pay the bills.

Carol Miller is a New Mexico public and rural health expert. She has public service in Washington, D.C., in both Republican and Democratic administrations, including the Clinton White House. In 1994 she was the health reform policy adviser for the National Rural Health Association and the New Mexico Secretary of Health. Miller, a former Commissioned Officer in the US Public Health Service, has used both the uniformed services and veterans health care systems.

Single payer health care gets nod from UCC assembly

By Jeff Woodard
Worldwide Faith News
July 2, 2009

Citing both specificity and urgency, the General Synod of the United Church of Christ (UCC) passed without amendment a resolution titled “Calling for the Support of H.R. 676 — Single Payer National Health Care Reform to Advance Health Equity for All and to Eliminate Health Disparities” on June 30.

Mary Beth Cross, a delegate from the Nebraska Conference, said after a unanimous vote out of committee the day before that the time to rally is now. “This is a Gospel-mandated mission of faith for everyone to make sure that universal health care becomes a reality,” she said.

Several delegates expressed an urgency for action within the next four months, before another election cycle begins. They concurred that it was crucial for the resolution to support a specific action – H.R. 676, in this case – rather than a general endorsement of universal health care.

The resolution was submitted by the Council on Racial and Ethnic Ministries (COREM). Key among its proponents has been Barbara Baylor, UCC minister for health care justice.

“We lift up our (belief) that all persons deserve and must have quality, accessible, affordable health care and related social services, including mental-health services and full accessibility for the disabled,” Baylor said.

H.R. 676 (the U.S. National Health Care Act) is a bill introduced by Rep. John Conyers of Michigan to create a single-payer, publicly financed, privately delivered universal health care program. Its goal is to cover all Americans without charging co-pays or deductibles and guarantees access to the highest quality and most affordable health care services regardless of employment, ability to pay or pre-existing health conditions.

In a single-payer system established by the government, one entity handles all billing and payment for health care services. The current system involves several thousand payers. Reports suggest that administrative waste accounts for roughly 31 percent of the money spent on health care.

http://www.wfn.org/2009/07/msg00026.html

Pay-go that builds rather than destroys

A pay-go option for health-care reform

By John Geyman
The Seattle Times
July 6, 2009
As Congress recessed for the July Fourth holiday, the debate over health-care reform was reaching a fever pitch. Now the top domestic issue for the Obama administration, the biggest questions are how much a reform bill will cost and how to pay for it, quite aside from how effective a “reform package” will be.
Skyrocketing costs that are out of control are the hallmark of our present system. Yet legislators have already acceded to pressures and dollars from stakeholders in the present system (within which costs are revenue) and are only considering options that “build on the present system.”
After months of work, legislative committees in Congress have brought forth drafts of proposals that the Congressional Budget Office (CBO) is starting to score in terms of cost and effectiveness. As expected, the costs of these incremental proposals are high — the first number of $1.6 trillion over 10 years (while still leaving 36 million Americans uninsured) sent these committees back to the drawing board. At the moment, leading Senate Democrats are hailing $1 trillion over 10 years as potentially doable.
After presiding over huge deficits during their eight years in power, Republicans are now demanding “pay as you go” (pay-go) policies. Together with Blue Dog Democrats, they are threatening to act as spoilers of any health-care-reform bill on its price tag alone.
Given the dimensions of these difficult economic times — including a $1.8 trillion deficit for 2009, $5 trillion in new federal debt over this year and next, and rising unemployment — pay-go makes good sense. And the president is making the case that his health-care plan must pay for itself.
Conventional “wisdom” (as generated by the mainstream corporate media) says that any health-care reform will cost a lot, and that there is no pay-go option. But there is.
Single-payer financing (public financing coupled with a private delivery system, a reformed “Medicare for All”), as embodied in Rep. John Conyers’ bill (HR 676 in the House) with its 83 co-sponsors, will yield savings of some $400 billion a year. That’s enough to assure universal coverage for all Americans while eliminating all co-pays and deductibles — the ultimate pay-go. Single-payer will give us far more efficient, affordable, effective and reliable health care than our present multipayer system. Health insurers have known for years that they can’t compete on a level playing field with single-payer, and have only been surviving by favorable tax policies and other subsidies from the government.
This recent testimony before the U.S. Senate Committee on Commerce, Science and Transportation by Wendell Potter, former head of corporate communications at Cigna, says it all: “I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand — or even to obtain — information we need.”
Many studies over the past two decades, including those by the CBO, the Government Accountability Office (GAO) and the nonpartisan Economic Policy Institute, have concluded that single-payer can assure universal coverage and still save money. HR 676 needs to be brought out of the closet and put on the table for CBO scoring against other options being considered in Congress, all of which cost much more and fail to provide universal coverage.
President Obama has brought forward the concept of audacity of hope. Is it too audacious now to hope that the legislators we elect to Congress can see beyond their campaign contributions and the lobbying efforts by corporate stakeholders to require that single-payer be scored?
(Dr. John Geyman is professor emeritus of Family Medicine at the University of Washington, past president of Physicians for a National Health Program, and a member of the Institute of Medicine.)
http://seattletimes.nwsource.com/html/opinion/2009424809_guest07geyman.html

As expected, Congress ran into problems when they tried to figure out how to pay for health care reform. They stubbornly adhered to the principle that reform must be built on our dysfunctional system of profitable private plans for the healthy and taxpayer-financed public programs for the sick, even though numerous studies have shown that this is the most expensive model of reform.
Before the process began it was already understood that health care has now become so expensive that a health plan with adequate benefits would require massive public subsidies to make it affordable for average-income individuals and families. It is the size of the subsidies that would be required for them to work that would be the budget busters. Now that they are at the point that decisions must be made, they are relying on a process analogous to innovation in the marketplace, shunning their obligation to be responsible public stewards.
For the average American, they are establishing a standard of a bottom-tier package of benefits (a bizarre concept that requires greater out-of-pocket spending for those needing health care than that required of the wealthy with their higher-tiered plans). They are paring back the income eligibility levels such that there would be no subsidy above 300 percent of the poverty level ($32,500 for an individual or $66,000 for a family of four). These numbers simply do not make health care affordable for middle-income Americans when you consider that the Milliman Medical Index is now $16,771 (the average cost of family health care for the healthier sector covered by employer-sponsore plans). That doesn’t even count the taxes that middle-income Americans pay to support the massive government spending on health care programs.
Congress’s “market innovation” for pay-go is to fully fund the waste built into the private insurance model of health care financing, and pay for it out of the pockets of middle Americans who happen to need health care – defeating the very purpose of health care reform.
John Geyman is right. Single payer financing, a reformed Medicare for all, is precisely the pay-go solution that Congress desperately needs if reform is to accomplish the goal of making health care affordable for all. All we need is for President Obama to meet with Baucus, Kennedy, Dodd, Waxman, Reid, Pelosi and a few others to see who is going to give Karen Ignagni the bad news – bad news for her and her industry, but great news for America.

Pay-go that builds rather than destroys

A pay-go option for health-care reform

By John Geyman
The Seattle Times
July 6, 2009

As Congress recessed for the July Fourth holiday, the debate over health-care reform was reaching a fever pitch. Now the top domestic issue for the Obama administration, the biggest questions are how much a reform bill will cost and how to pay for it, quite aside from how effective a “reform package” will be.

Skyrocketing costs that are out of control are the hallmark of our present system. Yet legislators have already acceded to pressures and dollars from stakeholders in the present system (within which costs are revenue) and are only considering options that “build on the present system.”

After months of work, legislative committees in Congress have brought forth drafts of proposals that the Congressional Budget Office (CBO) is starting to score in terms of cost and effectiveness. As expected, the costs of these incremental proposals are high — the first number of $1.6 trillion over 10 years (while still leaving 36 million Americans uninsured) sent these committees back to the drawing board. At the moment, leading Senate Democrats are hailing $1 trillion over 10 years as potentially doable.

After presiding over huge deficits during their eight years in power, Republicans are now demanding “pay as you go” (pay-go) policies. Together with Blue Dog Democrats, they are threatening to act as spoilers of any health-care-reform bill on its price tag alone.

Given the dimensions of these difficult economic times — including a $1.8 trillion deficit for 2009, $5 trillion in new federal debt over this year and next, and rising unemployment — pay-go makes good sense. And the president is making the case that his health-care plan must pay for itself.

Conventional “wisdom” (as generated by the mainstream corporate media) says that any health-care reform will cost a lot, and that there is no pay-go option. But there is.

Single-payer financing (public financing coupled with a private delivery system, a reformed “Medicare for All”), as embodied in Rep. John Conyers’ bill (HR 676 in the House) with its 83 co-sponsors, will yield savings of some $400 billion a year. That’s enough to assure universal coverage for all Americans while eliminating all co-pays and deductibles — the ultimate pay-go. Single-payer will give us far more efficient, affordable, effective and reliable health care than our present multipayer system. Health insurers have known for years that they can’t compete on a level playing field with single-payer, and have only been surviving by favorable tax policies and other subsidies from the government.

This recent testimony before the U.S. Senate Committee on Commerce, Science and Transportation by Wendell Potter, former head of corporate communications at Cigna, says it all: “I know from personal experience that members of Congress and the public have good reason to question the honesty and trustworthiness of the insurance industry. Insurers make promises they have no intention of keeping, they flout regulations designed to protect consumers, and they make it nearly impossible to understand — or even to obtain — information we need.”

Many studies over the past two decades, including those by the CBO, the Government Accountability Office (GAO) and the nonpartisan Economic Policy Institute, have concluded that single-payer can assure universal coverage and still save money. HR 676 needs to be brought out of the closet and put on the table for CBO scoring against other options being considered in Congress, all of which cost much more and fail to provide universal coverage.

President Obama has brought forward the concept of audacity of hope. Is it too audacious now to hope that the legislators we elect to Congress can see beyond their campaign contributions and the lobbying efforts by corporate stakeholders to require that single-payer be scored?

(Dr. John Geyman is professor emeritus of Family Medicine at the University of Washington, past president of Physicians for a National Health Program, and a member of the Institute of Medicine.)

http://seattletimes.nwsource.com/html/opinion/2009424809_guest07geyman.html

Comment:

By Don McCanne, MD

As expected, Congress ran into problems when they tried to figure out how to pay for health care reform. They stubbornly adhered to the principle that reform must be built on our dysfunctional system of profitable private plans for the healthy and taxpayer-financed public programs for the sick, even though numerous studies have shown that this is the most expensive model of reform.

Before the process began it was already understood that health care has now become so expensive that a health plan with adequate benefits would require massive public subsidies to make it affordable for average-income individuals and families. It is the size of the subsidies that would be required for them to work that would be the budget busters. Now that they are at the point that decisions must be made, they are relying on a process analogous to innovation in the marketplace, shunning their obligation to be responsible public stewards.

For the average American, they are establishing a standard of a bottom-tier package of benefits (a bizarre concept that requires greater out-of-pocket spending for those needing health care than that required of the wealthy with their higher-tiered plans). They are paring back the income eligibility levels such that there would be no subsidy above 300 percent of the poverty level ($32,500 for an individual or $66,000 for a family of four). These numbers simply do not make health care affordable for middle-income Americans when you consider that the Milliman Medical Index is now $16,771 (the average cost of family health care for the healthier sector covered by employer-sponsore plans). That doesn’t even count the taxes that middle-income Americans pay to support the massive government spending on health care programs.

Congress’s “market innovation” for pay-go is to fully fund the waste built into the private insurance model of health care financing, and pay for it out of the pockets of middle Americans who happen to need health care – defeating the very purpose of health care reform.

John Geyman is right. Single payer financing, a reformed Medicare for all, is precisely the pay-go solution that Congress desperately needs if reform is to accomplish the goal of making health care affordable for all. All we need is for President Obama to meet with Baucus, Kennedy, Dodd, Waxman, Reid, Pelosi and a few others to see who is going to give Karen Ignagni the bad news – bad news for her and her industry, but great news for America.

Single-payer system could remove burden from employers

By Jack Lohman
Milwaukee Small Business Times
Posted on July 06, 2009 6:22 AM

Think about it. They now have a filibuster-proof Congress, and if health care fails in 2009, it’s the Democrats’ fault. They can’t even blame the Republicans for their normal obstruction, as they no longer need a bipartisan bill.

President Barack Obama didn’t count on that when he was making all those campaign promises, but now it’s 100-percent his baby. He supported a single-payer plan, though he left some wiggle room in case Congress split. But it didn’t. The Dems now have total control and they don’t want it!

Single-payer is the most cost efficient system for our nation and is the most humane. You get sick, you get care and the caregiver gets paid. Nothing could be simpler. And though Medicare is not perfect it is indeed the least costly system of all with full physician choice, no wait times and no rationing.

But our politicians have a problem. Both Democrats and Republicans have shared in the $46 million in campaign contributions from the insurance industry. Needless to say, what is in the best interest of the nation is exactly opposite to the best interest of the for-profit insurers. The 22-percent saved comes right out of their pocket.

The question is how do we pay for it as a universal program? But first let’s understand who’s paying for it now.

Everybody is. We pay in cost-shifting, bankruptcy costs, and lastly, when businesses add their employee health costs to their product price and we reimburse them at the cash register.

In the process we make our businesses highly uncompetitive with foreign products, which often forces employers to build their products in countries that do not burden them with health care. We make more cars in Canada than in Michigan because their health care costs are $800 per employee per year and ours is $6,500. That adds $1,500 per car.

Flat out, businesses should not be involved in providing employee health care at all, but that leaves either individual insurance or a public pool. Our politicians should create a single-payer Medicare-for-all system that is funded by our national infrastructure instead of the mish-mash of payments and non-payments. That’s what most advanced nations have done, and it works.

Over 31 percent of health care costs are consumed by the make-work insurance bureaucracy; as compared with the 9 percent needed for a single-payer. A huge savings to the public could be had.

With a single-payer system you see your same doctor and go to the same hospital as before. The only thing that changes is where they send the bill, and most people could care less about whose logo is on the invoice.

The beauty of Medicare is its simplicity. Everybody gets care, everybody pays into it through progressive taxation, companies are freed of the expense, jobs are increased, 100 percent of the public is covered, and consumers save $400 billion per year in reduced overhead.

The current for-profit system includes extra premiums to offset high CEO salaries and bonuses, broker sales commissions, shareholder profits, actuarial and gatekeeper costs, and even their lobbying and campaign contributions which are passed on to the patient.

Isn’t it nice to know that your politician is getting a piece of your private health care dollar? That’s why politicians always prefer private companies over government entities; one can give campaign cash and the other can’t. That’s why they choose to leave insurers in the loop.

Bottom line; most people would rather spend $500 per month in taxes to pay for an all-inclusive system than $700 per month for an exclusive system that doesn’t give better care and drives jobs out of the U.S.|

And all doctors and hospitals will be privately run and you’ll have 100-percent choice. What’s not to like about that?

But get this: our problem today is not health care, it’s political. Your politicians need to hear from you, and your voice must be loud if it is to drown out the moneyed interests. Your politicians work for you, not them.

Jack Lohman is a retired business owner from Wisconsin and publishes http://MoneyedPoliticians.net. He authored “Politicians – Owned and Operated by Corporate America.”

http://www.biztimes.com/blogs/milwaukee-biz-blog/2009/7/6/single-payer-system-could-remove-burden-from-employers