PNHP

Uninsured by choice

Uninsured by choice

Wealth, Income, And The Affordability Of Health Insurance

By Didem M. Bernard, Jessica S. Banthin and William E. Encinosa
Health Affairs
May/June 2009
There have been debates over how many uninsured people can afford insurance but refuse to purchase it.
The difference in purchasing power between the insured and the uninsured is not fully revealed by income comparisons. Median income of the privately insured was 2.9 times the median income of the uninsured in 2002-03 ($53,130 versus $18,404). However, median net wealth among those with private insurance was 23.2 times that of the uninsured ($78,472 versus $3,384). This discrepancy is even larger when we focus on families in the individual market. Median net wealth among those with nongroup insurance was 34.6 times that of the uninsured without access to employer coverage ($105,819 versus $3,057). Our results suggest that assets are an important determinant of effective affordability, undermining the notion that many people are uninsured by choice.
http://content.healthaffairs.org/cgi/content/abstract/28/3/887

By now you must be annoyed by those on the right who repeatedly claim that we do not have a problem with uninsured individuals. They say that the actual problem is that we are not counting them properly. Most of the uninsured would be insured, if only they showed a little more personal responsibility.
Many of the uninsured have incomes that are low enough to establish their eligibility for public programs. But those denying the problem would exclude these individuals from the count because they are “technically insured,” but merely too lazy to enroll. This ignores the multiple logistical barriers that make it impossible to enroll everyone who is eligible.
Many others without insurance are “illegals” who do not have their immigration papers in order. As long as we continue with national policies that include these individuals in our workforce, regardless of immigration status, then we have to accept the fact that they are part of our intrinsic economy and will access our health care system. Excluding them from the count would understate the issues we face when trying to figure out how to finance the care of uninsured individuals.
Although these undercounters dismiss most of the uninsured as failures of personal responsibility, they do remain conflicted on higher-income individuals who elect not to purchase insurance. Some consider these to be individuals who are exercising their right to freedom of choice – the freedom to self-insure instead of purchasing an insurance plan. Others consider these to be free riders who transfer the risk of catastrophic costs to the rest of us who are already paying our share.
But are these really individuals who are simply declining to purchase coverage they can afford? With health care costs now averaging $16,700 for an employed worker with a family of four, that takes quite a bit out of a typical income of $60,000. Many of theses families have little in the way of assets, living paycheck to paycheck, and really don’t have enough money to purchase a reasonable health plan.
This Health Affairs study demonstrates that not only income but also net wealth are important determinants of whether or not health insurance is affordable. Expanding net wealth requires both a higher level of discretionary income and a longer interval to accumulate assets. Thus both income margins and time are variables that influence the affordability of health insurance.
Since current proposals for reform would use tax subsidies to help individuals and families purchase private health plans, does this mean that we need to establish an eligibility grid that includes both income and net assets as variables? If we did, we might see an epidemic of personal failure based on the inability of so many to master the logistical requirements of the eligibility grid. (Have you tired calculating your precise net wealth recently?)
Why do we keep playing these games with all of the variables that go into determining our insurance status? Why don’t we simply make it automatic for everyone? If you exist, you’re covered.

Uninsured by choice

Wealth, Income, And The Affordability Of Health Insurance

By Didem M. Bernard, Jessica S. Banthin and William E. Encinosa
Health Affairs
May/June 2009

There have been debates over how many uninsured people can afford insurance but refuse to purchase it.

The difference in purchasing power between the insured and the uninsured is not fully revealed by income comparisons. Median income of the privately insured was 2.9 times the median income of the uninsured in 2002-03 ($53,130 versus $18,404). However, median net wealth among those with private insurance was 23.2 times that of the uninsured ($78,472 versus $3,384). This discrepancy is even larger when we focus on families in the individual market. Median net wealth among those with nongroup insurance was 34.6 times that of the uninsured without access to employer coverage ($105,819 versus $3,057). Our results suggest that assets are an important determinant of effective affordability, undermining the notion that many people are uninsured by choice.

http://content.healthaffairs.org/cgi/content/abstract/28/3/887

Comment:

By Don McCanne, MD

By now you must be annoyed by those on the right who repeatedly claim that we do not have a problem with uninsured individuals. They say that the actual problem is that we are not counting them properly. Most of the uninsured would be insured, if only they showed a little more personal responsibility.

Many of the uninsured have incomes that are low enough to establish their eligibility for public programs. But those denying the problem would exclude these individuals from the count because they are “technically insured,” but merely too lazy to enroll. This ignores the multiple logistical barriers that make it impossible to enroll everyone who is eligible.

Many others without insurance are “illegals” who do not have their immigration papers in order. As long as we continue with national policies that include these individuals in our workforce, regardless of immigration status, then we have to accept the fact that they are part of our intrinsic economy and will access our health care system. Excluding them from the count would understate the issues we face when trying to figure out how to finance the care of uninsured individuals.

Although these undercounters dismiss most of the uninsured as failures of personal responsibility, they do remain conflicted on higher-income individuals who elect not to purchase insurance. Some consider these to be individuals who are exercising their right to freedom of choice – the freedom to self-insure instead of purchasing an insurance plan. Others consider these to be free riders who transfer the risk of catastrophic costs to the rest of us who are already paying our share.

But are these really individuals who are simply declining to purchase coverage they can afford? With health care costs now averaging $16,700 for an employed worker with a family of four, that takes quite a bit out of a typical income of $60,000. Many of theses families have little in the way of assets, living paycheck to paycheck, and really don’t have enough money to purchase a reasonable health plan.

This Health Affairs study demonstrates that not only income but also net wealth are important determinants of whether or not health insurance is affordable. Expanding net wealth requires both a higher level of discretionary income and a longer interval to accumulate assets. Thus both income margins and time are variables that influence the affordability of health insurance.

Since current proposals for reform would use tax subsidies to help individuals and families purchase private health plans, does this mean that we need to establish an eligibility grid that includes both income and net assets as variables? If we did, we might see an epidemic of personal failure based on the inability of so many to master the logistical requirements of the eligibility grid. (Have you tired calculating your precise net wealth recently?)

Why do we keep playing these games with all of the variables that go into determining our insurance status? Why don’t we simply make it automatic for everyone? If you exist, you’re covered.

Health care vs. sick care

A significant difference

By Dr. M. Joycelyn Elders
United Methodist News Service
6/25/09

LITTLE ROCK, Ark. (UMNS) — The United States has the best “sick-care” system in the world, but our “health-care” delivery system is lacking. We have the best doctors, the best hospitals, best academic health centers, best nurses, the best drugs, and we are leaders in research.

Our problem is that the system is not available to all of our citizens. In addition, our health care is not equitable, coherent, comprehensive and cost-effective, nor do we have choice. The United States has 5% of the people of the world and 25% of the world’s wealth. We are the richest country in the world and the only industrialized country that does not provide health care for its entire people.

Health care now consumes 17% of the U.S. Gross Domestic Product, or $2.4 trillion in 2007. Health care continues to grow in its appetite for our economic resources. At the same time, the United States continues to fall in overall health care for its citizens in comparison with the remainder of the industrialized world.

We do not have the best health, ranking 46th in life expectancy, 42nd in infant mortality and 57th in overall goodness and fairness as compared to 192 other members of the Organization for Economic Development & Cooperation.

If the rest of the industrialized world can manage to serve all its citizens on less, why can we not?
Lives at risk

The lack of access to health care for so many is literally bankrupting our people and endangering all our lives.

Lack of access to health care for so many is literally bankrupting our people and endangering all our lives.

We have depended upon employers to carry much of the burden of health insurance over the years. Now we find in this global economy, however, that they are at a disadvantage trying to compete with countries that have a public health-care system.

Health insurance expenses are the fastest-growing cost component for employers. Unless something changes dramatically, health insurance costs will overtake profits.

President Obama desires a health-care plan that improves coverage for the 45 million to 50 million uninsured citizens, contains costs, and offers high-quality, cost-effective, equitable, portable and affordable care for everyone.

We must simultaneously address, integrate and solve the three major components of health-care reform: financing, organizing the delivery system, and educating patients and community, in order to facilitate behavioral and lifestyle changes.

Quality of care would improve if every patient had access to a medical home and an accountable care organization with electronic medical records where care was patient-centered, coordinated and cost-effective.

Monitoring of many of our procedures, techniques, new technologies and drugs needs to be evaluated. We need to replace our inefficient, inequitable financing system with one that works. It needs to include everybody with subsidies for the young, poor and sick. It must require all to pay their fair share.

Physicians must have the information (electronic medical records), infrastructure and incentives they need to improve quality and control cost.
Physicians, heal this system

Physicians must become involved in population health, which is influenced by factors in five domains: genetic, social circumstances, environmental exposures, behavioral patterns and health care. The single greatest opportunity to improve health and reduce premature death lies in personal behavior.

We can do more to improve our own health than all the medical discoveries in the past 100 years.

On an individual level, we can do more to improve our own health than all the medical discoveries in the past 100 years.

We must dream big: Our vision is for healthy people in healthy communities with a health-care system that is right for all of our citizens. It needs to be available, affordable, accessible, patient-centered, prevention-focused, purpose-driven and solution-oriented. It must empower individuals to take care of themselves, foster responsibility and human dignity, improve health and enhance quality of life.

Any new health-care system must contain a provision for a public health-care policy: This is a single-payer system. People who prefer private insurance can always purchase it instead of purchasing a public health-care policy. In this public health-care policy, we must provide every person with access to basic health care, including physical and cultural access through transportation and language sensitivity.

We also must provide education to promote health maintenance, preventive measures in order to thwart disease, basic dental health care, mental health care, emergency services and necessary medicines.
A public option

Ask Medicare patients if they would like to give up their insurance. I think few would answer in the affirmative. Public health care is well liked in the United States.

A public health-care policy would likely be similar to purchasing Medicare.

People who do not receive Medicare may not know that each person pays almost $100 per month for the insurance, which is deducted from Social Security checks automatically. After a yearly deductible, Medicare pays 80% of most medical care but not dental care. There is a prescription Medicare (Part D) that is separate from other Medicare and has a variety of plans.

A public health-care policy would likely be similar to purchasing Medicare. With Medicare, about 98 cents of every dollar paid in payroll taxes are spent on actually providing health care. When you look at the private insurance companies, it is more like 80 cents. The rest goes to administrative expenses and profits.

There are many additional costs imposed on the doctors and health-care providers themselves. They must deal with a fragmented, complex system in which they have to negotiate, amend, or cajole payment from many different insurers.

Both business and individuals are breaking under the strain of our very expensive health-care system. We must overhaul our system now; its condition is beyond tweaking to make it function for our people.

We have tried to tweak the way we perform health care for many decades with disastrous results. We have tried HMOs, PPOs, indemnity with an assortment of public health systems to catch some of our people who fall between the cracks. It has failed while costing us precious lives, health and money of our people along the way.

We need an overhaul of the health-care system to save lives, money and U.S. business.

Let Medicare cover all Americans

Letter to the Editor
St. Petersburg Times
Friday, June 26, 2009

Re: What health reform must do | June 21, editorial

The three guiding principles espoused in your editorial are certainly laudable, but our current direction toward health care “reform” will not, unfortunately for the American people, make any of them come to pass.

Universal coverage is essential to any true reform, but the current plans being debated in Congress fall woefully short of that goal. As you note, the Congressional Budget Office estimates that current plans in the Senate come with a price tag of $1 trillion over the next 10 years, while still leaving 36 million without any coverage.

We already spend enough to insure everyone right now and it’s 2 1/2 times what the average industrialized country spends. To pump additional monies into a system that over the last 50 years has proven itself wasteful, expensive, complicated and which produces poorer health outcomes than other countries is as absurd as it is reckless.

Medical cost increases dramatically outpace inflation and wages year after year. The only way we will ever control these costs is to utilize the purchasing power of the federal government to negotiate with suppliers, pharmaceutical companies, doctors and hospitals on behalf of all taxpayers and demand quality, efficiency and effectiveness for our health care dollars.

We currently lose more than 30 percent of each dollar spent for private insurance companies’ overhead, profits and bonuses. That’s $600 billion annually that should be spent on providing health care. The current plans look to cutting Medicare and Medicaid funding and taxing the health benefits of workers to pay for more private plans. Those “solutions” can only exacerbate the current problems and inequities in our system.

I agree that we need to build on what works in our current system, but that is not private insurance. It’s Medicare, a program that already provides care to more than 44 million seniors with higher satisfaction ratings than employer-sponsored private insurance plans. Medicare enrollees have more choice of doctors and hospitals than those in “network” limited private plans. And with only a 3 percent overhead, the savings of a “Medicare for All” program would be more than enough to cover all of the uninsured without any additional benefit cuts or spending.

Greg M. Silver, M.D., Clearwater

State cuts its health coverage by $115m

Board to slow enrollment in Commonwealth Care

By Kay Lazar
Boston Globe
June 24, 2009

Overseers of Massachusetts’ trailblazing healthcare program made their first cuts yesterday, trimming $115 million, or 12 percent, from Commonwealth Care, which subsidizes premiums for needy residents and is the centerpiece of the 2006 law.

The board of the Connector Authority made the cuts as officials confronted two side effects of the recession: the state budget crisis and a surge in enrollment by the recently unemployed.

The largest share of the savings will come from slowing enrollment. An estimated 18,000 poor residents who qualify for full subsidies, but who forget to designate a health plan, will no longer be automatically assigned a plan and enrolled and thus could face delays in getting care.

Savings will also come from eliminating dental coverage for the poorest residents enrolled in Commonwealth Care, roughly 92,000 people who currently are the only ones in the program who receive that care. This $10 million cut was included in Governor Deval Patrick’s revised budget proposal, but then was restored in the budget lawmakers approved last week. It now falls to the governor to decide the program’s fate.

Also hanging in the balance is the health insurance status of 28,000 legal immigrants whose Commonwealth Care coverage was dropped in the budget lawmakers approved for the fiscal year that begins July 1. Patrick has until Monday to decide whether to veto any of that budget, which set aside $116 million less for Commonwealth Care than he proposed.

“No decision has been made’’ on restoring immigrant coverage, said Leslie Kirwan, chairwoman of the Connector Authority board and Patrick’s secretary of administration and finance. “It’s certainly going to be at the top of our list’’ of items the governor is considering adding back to the budget, she said.

But Kirwan said the $115 million in cuts the Connector Authority board approved yesterday were merely to deal with shrinking state revenues and the rapid growth in enrollment in Commonwealth Care, which has 177,000 members and was projected to grow to 212,000 in the next year.

These cuts do not provide any wiggle room for adding back the 28,000 immigrants who are facing elimination. If the governor decides to restore coverage for the immigrants, Kirwan said, he would have to find other areas to cut in the already razor-thin budget.

Patrick Holland, the Connector Authority’s chief financial officer, said enrollment spiked during the last three months, from 165,000 to nearly 177,000 members, because so many workers are losing their jobs and, with that, employer-provided health insurance.

The progress of the Massachusetts healthcare initiative is being closely watched in Washington, where Congress is crafting national legislation to extend coverage to more Americans. The Massachusetts law, cited as one model in the national debate, requires nearly everyone to have health insurance or pay a tax penalty.

The residents affected by yesterday’s cuts earn too little to be subject to the penalty. They also would be eligible for free emergency care for three months under the state’s Health Safety Net.

Leaders of Health Care for All, one of the state’s largest consumer groups, said the changes will be especially hard on residents whose first language is not English and who have difficulty understanding the complex enrollment paperwork.

But the group said state officials appear to have made the best of a bad situation. “There’s no other place to go for money,’’ said Lindsey Tucker, the organization’s healthcare reform manager. “. . . My concern is people will not get the care that they need.’’

While the group’s leaders are resigned to that cut, they said they will continue to lobby the governor to restore coverage for legal immigrants. Lawmakers said they cut this class of legal immigrants because they do not qualify for matching federal subsidies. Thus, they are more expensive for the state to insure. The move has enraged advocates for the immigrant community.

Much of the rest of the $115 million in savings, $32 million, comes from slowing payments to the managed-care health insurance companies that won bids to offer insurance through the Commonwealth Care program. Regulators said that by slowing enrollment growth, the companies would receive less money than they had banked on when they submitted their bids earlier this year.

Kirwan stressed that when the economy improves, the changes made by the authority can be revisited. She also said the changes still protect the basic eligibility rules for the program and benefits that members receive, but put the brakes only on enrollment growth during an “unprecedented time.’’

While the emergency changes approved by the Connector Authority go into effect July 1, Kirwan said the board will schedule a hearing, probably in late July, to seek public comments on the issues.

Kay Lazar can be reached at klazar@globe.com.

Correction: Because of a reporting error, a Page One story yesterday incorrectly described the decision to cut dental coverage for the poorest residents enrolled in the Commonwealth Care subsidized health insurance program. Dental care for this population was eliminated in Governor Deval Patrick’s revised state budget proposal but was restored in the budget lawmakers approved last week. The Connector Authority board did not vote to cut this coverage.

The Prescription From Obama's Own Doctor

By NICHOLAS D. KRISTOF
Op-Ed Columnist
New York Times
Published: June 24, 2009

As a society, we trust doctors to be more concerned with the pulse of their patients than the pulse of commerce. Yet the American Medical Association is using that trust to try to block a robust public insurance option as part of health reform.

In fact the A.M.A. now represents only 19 percent of practicing physicians (that’s my calculation, which the A.M.A. neither confirms nor contests). Its membership has declined in part because of its embarrassing historical record: the A.M.A. supported segregation, opposed President Harry Truman’s plans for national health insurance, backed tobacco, denounced Medicare and opposed President Bill Clinton’s health reform plan.

So I hope President Obama tunes out the A.M.A. and reaches out instead to somebody to whom he’s turned often for medical advice. That’s Dr. David Scheiner, a Chicago internist who was Mr. Obama’s doctor for more than two decades, until he moved into the White House this year.

“They’ve always been on the wrong side of things,” Dr. Scheiner told me, speaking of the A.M.A. “They may be protecting their interests, but they’re not protecting the interests of the American public.

“In the past, physicians have risked their lives to take care of patients. The patient’s health was the bottom line, not the checkbook. Today, it’s just immoral what’s going on. It’s abominable, all these people without health care.”

Dr. Scheiner, 70, favors the public insurance option and would love to go further and see Medicare for all. He greatly admires Mr. Obama but worries that his health reforms won’t go far enough.

Dr. J. James Rohack, the president of the A.M.A., insisted to me that his group is committed to making health insurance accessible for all Americans, and that its paramount concern is patient health.

“When you don’t have health insurance, you live sicker and you die younger,” he said. “And that’s not something we’re proud of as Americans.”

He added that the A.M.A. is not necessarily opposed to a public option, and I have the impression that it might accept a pallid one built on co-ops. Dr. Rohack wouldn’t repudiate his association’s letter to the Senate Finance Committee warning against a new public plan. That letter declared: “The introduction of a new public plan threatens to restrict patient choice by driving out private insurers.”

I don’t mind the A.M.A. lobbying on behalf of doctors in the many areas where physicians and patients have common interests. The association is dead right, for example, in calling for curbs on lawsuits, which raise medical costs for everyone.

An excellent study published in 2006 in The New England Journal of Medicine found that for every dollar paid in compensation as a result of lawsuits against doctors, 54 cents goes to legal and administrative costs.

That’s an absurd waste of money. Moreover, aggressive law leads to defensive medicine, in the form of extra medical tests that waste everybody’s money. Tort reform should be a part of health reform.

Yet when the A.M.A. uses its lobbying muscle to oppose major health reform — yet again! — that feels like a betrayal. Doctors work hard to keep us healthy when we’re in their offices, and that’s why they win our trust and admiration — yet the A.M.A.’s lobbying has sometimes undermined the health of the very patients whom the doctors have sworn to uphold.

I might expect the American Association of Used Car Dealers to focus exclusively on wallet-fattening, but we expect better of physicians.

In fairness, most physicians expect better as well, which is why the A.M.A. is on the decline.

“It’s what has led to the decline of the A.M.A. over the last half century,” said Dr. David Himmelstein, a Massachusetts physician who also teaches at Harvard Medical School. “At this point only one in five practicing doctors are in the A.M.A., and even among its members about half disagree with its policies.” To back that last point, Dr. Himmelstein pointed to surveys showing a surprising number of A.M.A. members who support a single-payer system.

For his part, Dr. Himmelstein co-founded Physicians for a National Health Program, which now has more than 16,000 members. The far larger American College of Physicians, which is composed of internists and is the second-largest organization of doctors, is also open to a single-payer system and a public insurance option. It also quite rightly calls for emphasizing primary care.

The American Medical Student Association has issued a sharp statement disagreeing with the A.M.A.

The student association declared that it “not only supports but insists upon a public health insurance option.”

Look, a public option is no panacea, and it won’t automatically set right the many shortcomings in our health system. But if that option is killed in gestation, then we’re back to Square 1 and there’s little hope of progress in solving the vast challenges confronting us.

So, President Obama, don’t listen to the A.M.A. on this issue. Instead, for starters, call your doctor!

The Prescription From Obama’s Own Doctor

By NICHOLAS D. KRISTOF
Op-Ed Columnist
New York Times
Published: June 24, 2009

As a society, we trust doctors to be more concerned with the pulse of their patients than the pulse of commerce. Yet the American Medical Association is using that trust to try to block a robust public insurance option as part of health reform.

In fact the A.M.A. now represents only 19 percent of practicing physicians (that’s my calculation, which the A.M.A. neither confirms nor contests). Its membership has declined in part because of its embarrassing historical record: the A.M.A. supported segregation, opposed President Harry Truman’s plans for national health insurance, backed tobacco, denounced Medicare and opposed President Bill Clinton’s health reform plan.

So I hope President Obama tunes out the A.M.A. and reaches out instead to somebody to whom he’s turned often for medical advice. That’s Dr. David Scheiner, a Chicago internist who was Mr. Obama’s doctor for more than two decades, until he moved into the White House this year.

“They’ve always been on the wrong side of things,” Dr. Scheiner told me, speaking of the A.M.A. “They may be protecting their interests, but they’re not protecting the interests of the American public.

“In the past, physicians have risked their lives to take care of patients. The patient’s health was the bottom line, not the checkbook. Today, it’s just immoral what’s going on. It’s abominable, all these people without health care.”

Dr. Scheiner, 70, favors the public insurance option and would love to go further and see Medicare for all. He greatly admires Mr. Obama but worries that his health reforms won’t go far enough.

Dr. J. James Rohack, the president of the A.M.A., insisted to me that his group is committed to making health insurance accessible for all Americans, and that its paramount concern is patient health.

“When you don’t have health insurance, you live sicker and you die younger,” he said. “And that’s not something we’re proud of as Americans.”

He added that the A.M.A. is not necessarily opposed to a public option, and I have the impression that it might accept a pallid one built on co-ops. Dr. Rohack wouldn’t repudiate his association’s letter to the Senate Finance Committee warning against a new public plan. That letter declared: “The introduction of a new public plan threatens to restrict patient choice by driving out private insurers.”

I don’t mind the A.M.A. lobbying on behalf of doctors in the many areas where physicians and patients have common interests. The association is dead right, for example, in calling for curbs on lawsuits, which raise medical costs for everyone.

An excellent study published in 2006 in The New England Journal of Medicine found that for every dollar paid in compensation as a result of lawsuits against doctors, 54 cents goes to legal and administrative costs.

That’s an absurd waste of money. Moreover, aggressive law leads to defensive medicine, in the form of extra medical tests that waste everybody’s money. Tort reform should be a part of health reform.

Yet when the A.M.A. uses its lobbying muscle to oppose major health reform — yet again! — that feels like a betrayal. Doctors work hard to keep us healthy when we’re in their offices, and that’s why they win our trust and admiration — yet the A.M.A.’s lobbying has sometimes undermined the health of the very patients whom the doctors have sworn to uphold.

I might expect the American Association of Used Car Dealers to focus exclusively on wallet-fattening, but we expect better of physicians.

In fairness, most physicians expect better as well, which is why the A.M.A. is on the decline.

“It’s what has led to the decline of the A.M.A. over the last half century,” said Dr. David Himmelstein, a Massachusetts physician who also teaches at Harvard Medical School. “At this point only one in five practicing doctors are in the A.M.A., and even among its members about half disagree with its policies.” To back that last point, Dr. Himmelstein pointed to surveys showing a surprising number of A.M.A. members who support a single-payer system.

For his part, Dr. Himmelstein co-founded Physicians for a National Health Program, which now has more than 16,000 members. The far larger American College of Physicians, which is composed of internists and is the second-largest organization of doctors, is also open to a single-payer system and a public insurance option. It also quite rightly calls for emphasizing primary care.

The American Medical Student Association has issued a sharp statement disagreeing with the A.M.A.

The student association declared that it “not only supports but insists upon a public health insurance option.”

Look, a public option is no panacea, and it won’t automatically set right the many shortcomings in our health system. But if that option is killed in gestation, then we’re back to Square 1 and there’s little hope of progress in solving the vast challenges confronting us.

So, President Obama, don’t listen to the A.M.A. on this issue. Instead, for starters, call your doctor!

Dear President Obama: endorse single payer

Tell President Obama that single-payer health reform is the only practicable way to achieve his stated goal of universal, comprehensive coverage at an affordable price.

Only single payer, by redirecting the vast sums wasted annually on bureaucracy and paperwork back into care, can assure high-quality coverage for everyone with no net increase in U.S. health spending. Only single payer can rein in costs.

Lesser reforms, with or without a “public option,” won’t fix our broken system.

Read and sign the Open Letter

Single-payer Advocates Make Case in Health Reform

NewsHour with Jim Lehrer
June 26, 2009

JUDY WOODRUFF: The business of passing health care legislation also remained front and center in Washington this week. Health correspondent Betty Ann Bowser has our update. The Health Unit is a partnership with the Robert Wood Johnson Foundation.

BETTY ANN BOWSER, NewsHour Correspondent: Health care reform moved on two fronts this week in Washington: on Capitol Hill and at the White House, where President Obama was once again in campaign mode, this time pushing for elements he wants in health care reform legislation.

Yesterday, Democratic Senator Max Baucus announced his Finance Committee had found a way to cut the projected 10-year cost of its health care reform draft, saying, “We have options that would enable us to write a $1 trillion bill fully paid for.” But the senator did not spell out where the money would come from.

The bill reportedly would tax workers on their insurance benefits and cut the number of low-income people who would qualify for government subsidies to buy insurance.

The other Senate committee working on a bill, the Health Committee, spent the week marking up its draft. But by week’s end, lawmakers were still behind in their original timeline for completion and still worried about how much it was going to cost.

SEN. TOM COBURN (R), Oklahoma: Why is it that we’re writing a bill that increases the cost for health care when, in fact, 50 percent — the cost of health care in this country is 50 percent higher than anywhere else in the world?

Differing views on reform

BETTY ANN BOWSER: The lawmakers also talked about ways to make Americans healthier.

SEN. TOM HARKIN (D), Iowa: We have to change not just the way we do medicine, but the medicine we do, not just the way we pay our bills, but, really, the medicine we do. And the medicine we do ought to be more preventative, and more upfront, and more wellness types of programs, and interventions.

But it has to be comprehensive. You can’t just do a little bit here and say, “Well, we’ve taken care of it in the workplace or we have clinical and we take care of it in the clinical.” It has to broad. It has to be pervasive in our society that we gear ourselves towards a wellness structure.

BETTY ANN BOWSER: On Thursday, several hundred people rallied in the shadow of the Capitol Dome, making it clear they were growing impatient for legislation.

PROTESTORS: We want, we want health care.

BETTY ANN BOWSER: Included in the group health care providers.

EDIE FALCO, Actress: Hi. I’m a nurse.

BETTY ANN BOWSER: Actress Edie Falco.

EDIE FALCO: We can no longer wait for a health care system that every individual, business, family in this country can afford.

BETTY ANN BOWSER: And union workers from across the country.

UNION WORKER: I’m here to support health care for everyone.

UNION WORKER: I’m worried about them taxing my health care.

BETTY ANN BOWSER: Most Republicans and moderate Democrats also oppose taxing employer-sponsored benefits. And the House Republican leadership has consistently hammered away at the House’s so called tri-committee bill drafted by Democrats.

Minority Leader John Boehner.

REP. JOHN BOEHNER (R-OH), House Minority Leader: When it comes to the issue of health care, the Congress shouldn’t rush through health care like we did with the stimulus plan several months ago. A Washington takeover of health care I think will limit the flexibility of our states and hurt working families around our country.

Single-payer system

BETTY ANN BOWSER: This spring, a group of people who support the concept of a single-payer plan were ejected from a hearing and arrested. But this week, they got a chance to be heard in a House committee.

Harvard Professor Dr. Steffie Woolhandler spoke on behalf of the organization Physicians for a National Health Plan.

DR. STEFFIE WOOLHANDLER, Physicians for a National Health Program: Our 16,000 physician members support nonprofit, single-payer national health insurance because of overwhelming evidence that lesser reforms, even with a robust public plan option, lesser reforms will fail. Private insurance is a defective product.

BETTY ANN BOWSER: A single-payer plan would make the federal government the sole payer for all health care services using revenue from taxes. Dr. Woolhander says that would fix the broken U.S. health care system.

DR. STEFFIE WOOLHANDLER: A single-payer lets you have administrative simplification that saves you about $400 billion a year. And then you take that $400 billion and use it to cover the uninsured and plug the gaps in coverage for people who now have private coverage so you can improve coverage for everyone without increasing total health care spending by a single penny.

Single-payer system debate

BETTY ANN BOWSER: But a hearing is all single-payer advocates got. No committee writing health care reform legislation is considering including it.

LEN NICHOLS, New America Foundation: They’re just not willing to spend time debating it since they know it cannot pass.

BETTY ANN BOWSER: Len Nichols directs health policy at the New America Foundation.

LEN NICHOLS: If you actually did single-payer, you would be outlawing private insurance, you would be outlawing any form of nonprofit health insurance, you would be ending health insurance as we know it all across the country, so, A, there would be a lot of capital that would have to be disposed of that would at some level become worthless overnight. Second, an awful lot of people would lose their jobs.

BETTY ANN BOWSER: Nichols says there might be initial cost reductions, but…

LEN NICHOLS: You would take a big chunk out of our current costs, probably 15 percent, maybe 20 percent, but that’s a one-year, one-time kind of thing.

The president’s argument

BETTY ANN BOWSER: At the White House, President Obama ramped up his public profile on health care reform, devoting almost an entire day to national television coverage on ABC, including a live town hall meeting where he once again pressed his argument for a public insurance plan.

BARACK OBAMA, President of the United States: Unfortunately, government, whether you like it or not, is going to already be involved. You know, we pay for Medicare and we pay for Medicaid. There are a whole host of rules both at the state and federal level governing how health care is administered.

And so the key is for us to try to figure out, how do we take that involvement, not to completely replace what we have, but to build on what works and stop doing what doesn’t work? And I think that we can do that through a serious health care reform initiative.

BETTY ANN BOWSER: Lawmakers will resume their work on health care reform after they return from next week’s July 4th recess.

An insurance insider speaks up

Consumer Choices and Transparency in the Health Insurance Industry

Testimony of Wendell Potter, formerly head of corporate communications at CIGNA
United States Senate Committee on Commerce, Science and Transportation
June 24, 2009
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. As you hold hearings and discuss legislative proposals over the coming weeks, I encourage you to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world. I hope you get a real sense of what life would be like for most of us if the kind of so-called reform the insurers are lobbying for is enacted.
When I left my job as head of corporate communications for one of the country’s largest insurers, I did not intend to go public as a former insider. However, it recently became abundantly clear to me that the industry’s charm offensive – which is the most visible part of duplicitous and well-financed PR and lobbying campaigns – may well shape reform in a way that benefits Wall Street far more than average Americans.
http://commerce.senate.gov/public/_files/PotterTestimonyConsumerHealthInsurance.pdf

Wendell Potter, a former CIGNA executive, provides an insider’s view as to what type of behavior we can expect from the private insurance industry after reform is enacted. No matter the details of the reform legislation, the industry will always find innovative ways to advance the interests of their executives and their investors. It is absolutely inevitable that these innovations will be to the detriment of patients and payers.
Many suggest that we can control these abuses through regulation, but states that are already highly regulated have failed to counter the ingenuity of the insurers and their perverse innovations. Think of New York and the UnitedHealth/Ingenix scam, or WellPoint’s perpetuation of the rescission abuses. As regulators patch holes in the private insurance infrastructure, the industry will always find other innovations designed to punch even larger holes in the system. If we think underinsurance is a problem now, just wait until Congress has enacted reform and moved on to other issues.
The private insurance industry isn’t looking out for us. Congress shouldn’t be looking out for them. We need our own universal financing system designed specifically to take care of all of us. The private insurers are pulling us down; Congress needs to cut them loose.

An insurance insider speaks up

Consumer Choices and Transparency in the Health Insurance Industry

Testimony of Wendell Potter, formerly head of corporate communications at CIGNA
United States Senate Committee on Commerce, Science and Transportation
June 24, 2009

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. As you hold hearings and discuss legislative proposals over the coming weeks, I encourage you to look very closely at the role for-profit insurance companies play in making our health care system both the most expensive and one of the most dysfunctional in the world. I hope you get a real sense of what life would be like for most of us if the kind of so-called reform the insurers are lobbying for is enacted.

When I left my job as head of corporate communications for one of the country’s largest insurers, I did not intend to go public as a former insider. However, it recently became abundantly clear to me that the industry’s charm offensive – which is the most visible part of duplicitous and well-financed PR and lobbying campaigns – may well shape reform in a way that benefits Wall Street far more than average Americans.

http://commerce.senate.gov/public/_files/PotterTestimonyConsumerHealthInsurance.pdf

Comment:

By Don McCanne, MD

Wendell Potter, a former CIGNA executive, provides an insider’s view as to what type of behavior we can expect from the private insurance industry after reform is enacted. No matter the details of the reform legislation, the industry will always find innovative ways to advance the interests of their executives and their investors. It is absolutely inevitable that these innovations will be to the detriment of patients and payers.

Many suggest that we can control these abuses through regulation, but states that are already highly regulated have failed to counter the ingenuity of the insurers and their perverse innovations. Think of New York and the UnitedHealth/Ingenix scam, or WellPoint’s perpetuation of the rescission abuses. As regulators patch holes in the private insurance infrastructure, the industry will always find other innovations designed to punch even larger holes in the system. If we think underinsurance is a problem now, just wait until Congress has enacted reform and moved on to other issues.

The private insurance industry isn’t looking out for us. Congress shouldn’t be looking out for them. We need our own universal financing system designed specifically to take care of all of us. The private insurers are pulling us down; Congress needs to cut them loose.

Oliver Fein, of Physicians for a National Health Program, at St. Kate's: Give single-payer a chance

By Kathlyn Stone
TC Daily Planet
June 25, 2009

The American Medical Association has come out against President Obama’s “public option” for health care reform, but the AMA doesn’t represent all physicians. Some physicians’ groups support the public option but others think it doesn’t go far enough to fix changes in a badly broken system. Dr. Oliver Fein, president of the progressive Physicians for a National Health Program (PNHP), found a warm welcome in the Twin Cities last week. Fein was here to present PNHP’s vision for a national single payer health program. PNHP has 16,000 members, including 300 in Minnesota.

Fein, a general internist and professor at the Weill Cornell Medical College in New York, had a full schedule last week speaking at public forums and to physicians at Regions Hospital, the University of Minnesota, and Hennepin County Medical Center.

He was joined by Elizabeth Frost, MD, a family practice physician in St. Paul and co-chair of PNHP Minnesota, at a June 17 forum at the University of St. Catherine’s in St. Paul.

Fein said opponents to single payer mischaracterize the proposal as the government “taking over” the delivery of health care. Instead, single payer is a concept whereby health care services would be paid by a single source.

It’s “an improved Medicare for all,” said Fein. Medicare is much less costly to manage compared to insurance and HMOS. Overhead costs for managing Medicare are 3.1 percent of total costs compared to the 26.5 percent associated with investor-owned insurers, according a study published in the Journal of the American Board of Family Practice.

Opponents claim that single-payer would be too costly. Fein disagrees. A single-payer system would save the nation $400 billion in overhead costs, he said, while giving the 45 million uninsured access to care, and filling in the gaps in care encountered by underinsured people.

Maintaining the status quo will be much more costly than doing nothing, says Fein.

A recent study published by the American Journal of Medicine bears this out. Researchers from Harvard and Ohio University found that over 60 percent of all U.S. bankruptcies in 2007 were driven by medical incidents. The rate reflects a 50 percent increase since 2001.

Whereas the public option proposed by Obama would offer a government-managed alternative alongside for-profit health insurance, a single-payer system would eliminate private insurance companies entirely. Private insurance companies have denounced the public option, fearing that they could not compete with a lower-cost public option plan.

Both Fein and Frost assert that single-payer has not been given a fair hearing during the national health care reform debate. Advocates of the plan were repeatedly denied an opportunity to speak at Congressional hearings presided over by Sen. Max Baucus, chair of the Senate Finance Committee. When advocates, including some doctors and nurses, protested at the hearing room, they were arrested.

The public option still has an uphill battle, but Obama insisted at his June 23 press conference, that “yes, we can” pass health care reform with a public option this year. Frost views the public option backed by Obama as “a compromise” that would be more costly than single-payer since it keeps the market-based health insurance industry intact.

Many legislators have looked to Massachusetts’s mandatory health insurance law as a national model for reform; but a study published May 28 in Health Affairs found that the Massachusetts law requiring all to show proof of health insurance has resulted in higher costs for those least able to afford it. People still pay premiums to private insurers, with 25 percent or more of their premiums going toward overhead and profit.

“The worst that could happen,” said Frost, “would be the passage of a bad public option like the Massachusetts plan, and people consider[ing] health reform [to be] done.”

Kathlyn Stone is an independent journalist in St. Paul. She maintains a health and science news site at fleshandstone.net.