PNHP

A singular solution for healthcare

A singular solution for healthcare

By Judy Norsigian and Jennifer Potter
The Boston Globe
June 15, 2009

A single-payer healthcare system would more effectively control costs than any other plan that Congress is considering as it moves toward a reform bill. And by controlling costs, existing resources could be allocated more equitably, especially for the benefit of women.

First, single-payer plans eliminate the $300 billion to $400 billion that insurance companies spend annually in administrative overhead and waste. Second, single-payer plans are best positioned to take on the enormous challenge of reducing or eliminating the financial incentives that have led to so much overtreatment and undertreatment.

Maternity care illustrates this phenomenon: We spend far more per capita than any other industrialized country and yet do worse on most birth outcome measures than most of these other countries. So-called best practices – medical practices already demonstrated to improve outcomes – are well described in the medical literature, but they are not widely implemented, even though doing so would lower costs and improve the health of mothers and babies.

For example, nearly one-third of all US women deliver their babies by caesarean section, a rate that is far higher than medically necessary. One of the reasons is that most obstetricians and hospitals are paid far more for a surgical delivery than for a vaginal birth. Such incentives not only raise costs, but ironically often produce worse health outcomes.

By reducing the ability of for-profit companies to siphon off huge sums of money for private gain, a single payer system is better able to expand best practices. Why? Because the motivations to over-treat those who are well-insured and to undertreat those with limited or no insurance coverage will no longer be built into the medical care system.

Women in particular have much to gain from single-payer healthcare. Our country has an excess of medical specialists, and is in desperate need of more primary caregivers – such as general internists, family practice physicians, nurse practitioners, and licensed midwives – who are often more aptly trained than specialists to provide the comprehensive services women need. A single payer plan would eliminate the financial incentives that have been obstacles to training more primary care professionals. It would also eliminate the need for so many medical malpractice lawsuits, as people would not have to worry about paying for medical care whenever they experienced bad outcomes.

The only national plan for healthcare reform that explicitly includes women’s reproductive health services, including abortion, is one sponsored by Representative Barbara Lee, a California Democrat. Other sponsors of single-payer plans are also amenable to including women’s reproductive health services.

Coverage with a single-payer plan is independent from employment. Because women are more likely to be self-employed, to work part time, and to move in and out of employment outside the home, they are now more likely either to lack coverage through work or to lose insurance when changing jobs.

Medical debt is an enormous concern for many women, and single-payer plans effectively address the cost issues that send women into debt and even bankruptcy. A 2009 Commonwealth Fund study found that 45 percent of women accrued medical debt or reported problems with medical bills in 2007 compared with 36 percent of men. Under Rep. John Conyers’ single-payer bill, a family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs – with no deductibles or copays or concerns about catastrophic costs.

Since a single-payer plan may be the only approach that will successfully contain costs, it was a good sign that Congress finally held hearings on a single-payer system last week.

Although many progressive members of Congress now support a proposal that includes a “public insurance option” as an alternative to private insurance industry plans, numerous critiques demonstrate how this approach could fail. Unless designed to mirror the effective Medicare system – by automatically enrolling the majority of the population and using Medicare’s cost control levers – the public option will not be affordable for all.

When polled, a majority of physicians as well as the public support a single-payer plan. For example, a 2007 AP-Yahoo poll asked respondents whether they agreed with this statement: “The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers.”

A whopping 65 percent said yes to that question. By political standards, this is a landslide. It is time for Congress to pay attention to the voters, not the well-funded lobbyists.

Judy Norsigian is executive director of Our Bodies Ourselves. Jennifer Potter, MD, is director of the Women’s Health Center at Beth Israel Deaconess Medical Center and director of women’s health at Fenway Health.

Australian immigrant’s health insurance struggles may send him back

By Alison Knezevich
The Charleston Gazette
June 14, 2009

CHARLESTON, W.Va. — Moving boxes are stacked in the living room of Andrew and Rita Watson’s Kanawha City apartment.

The Australian immigrants are preparing for a trip neither wants to make.

“I don’t have any insurance, and I’m uninsurable,” 65-year-old Andrew Watson said.

And that could send him back to Australia.

In 1989, Australian surgeons replaced his right hip. He never got a hospital bill.

Since 1984, the country has offered universal health care through a program called Medicare, a government-operated system funded by taxes. Australians can also choose to use private insurance.

Last October, Watson’s hip replacement gave out. It was 19 years to the day he got it, he said.

He believes it’s wearing its way into the bone of his pelvic girdle. He’s sore all the time and walks with a cane.

Surgery would cost more than $50,000, he said.

In 1993, the couple settled in Charleston to be closer to Rita Watson’s children. In America, they’ve never had health insurance.

Watson pointed to his plastic green Australian Medicare card. He has dual American-Australian citizenship.

When he gets to Australia, “I’m just going to present that and say nothing.”

He plans to go by himself. If he must stay for a long period of time, he says his wife will follow.

The Watsons’ struggles come as health-care reform takes center stage in Washington, D.C. President Barack Obama and Congress are preparing legislation to overhaul the nation’s health-care system, though many questions remain unanswered.

The Watsons say their experience has given them a unique perspective. For the past seven months, they’ve worked with the state chapter of a national group called Physicians for a National Health Program to promote “single-payer” health care.

“The American people deserve it,” said Rita Watson, 71. “They’re very, very hardworking.”

They know many Americans don’t like the idea. Critics say it would lead to long waits and poor care.

Many others haven’t heard of it. A few weeks ago, Rita Watson’s son visited from Elkview.

“I brought up single-payer,” she said. “He said, ‘What’s that?'”

The single-payer system would work like America’s Medicare program for the elderly. A government-run agency, financed by taxes on employers and employees, would collect fees and pay them out to providers.

Everyone would be covered, and no one would pay co-payments or deductibles.

Proponents say the current for-profit insurance system denies people the care they need and is mired in administrative waste that drives up costs.

In December, the couple attended a meeting for Obama supporters. The conversation turned to health care.

They met Dr. Hedda Haning, an anesthesiologist with Physicians for a National Health Program.

“He got up with an obvious accent,” Haning said. “People were very interested to hear, because he was someone from elsewhere.”

Now retired, Andrew Watson has worked as an industrial plant maintenance mechanic, and maintained machines for a records management company, among other jobs. He never made enough money to pay insurance premiums.

Rita Watson has worked for a gas company, the state, and a behavioral health agency.

“I was in temporary work, and I always got 39 hours,” an hour short of qualifying for benefits, she said.

In 2004, a blood infection sent Andrew Watson to Charleston Area Medical Center for 11 days. After that, he needed bandages, saline solution and other supplies to take care of his wounds at home. His bill: $26,000.

The CAMC doctors “saved my life,” he said.

“There’s nothing wrong with the health care,” he said. “It is the way the funding and the billing is managed. And that is the trouble in the Untied States.”

Last month, the Watsons visited Washington, D.C., with Physicians for a National Health Program to lobby representatives.

When they visit the grocery store, they wear “Single Payer” buttons with the slogan, “Everybody in, nobody out.”

“It’s about equity,” he said.

Much of the debate in Washington now centers around whether a “public option” — a government-sponsored insurance plan to compete with the private industry — will be available. Obama supports such a plan. Critics say it’s a backdoor to a single-payer system.

“There are various things that have been talked about in the last week or so, but what happens next is anybody’s guess,” said Haning, who’s been pushing for a single-payer system for about 20 years. “It seems that Congress wants to protect the insurance companies.”

In Kanawha City, Rita Watson said she and her husband are “hoping and praying” that somehow, they won’t have to leave the United States.

“The American people are tops,” she said. “There’s no one like them…. Australia is a beautiful country. But it’s not America. This is home.”

President Obama's proposal to pay for reform

Paying for Health Care Reform

The White House
June 13, 2009
Health Care Reserve Fund ($ in billions – over 10 years)
$635 – FY 2010 Budget
$309 – Medicare and Medicaid Savings
$326 – Revenues
$313 – Additional Medicare and Medicaid Savings
$110 – Incorporate productivity adjustments into Medicare payment
$106 – Reduce hospital subsidies for treating the uninsured as coverage increases
$75 – Pay better prices for Medicare Part D drugs
$22 – Other
Total: $948
http://www.whitehouse.gov/MedicareFactSheetFinal/

What does President Obama mean when he says that this is how we’re going to pay for most of his health care reform proposals? Is he referring to savings in the actual costs of health care that would offset the increased spending that would result from expanding coverage? Or is he merely referring to a decrease in government spending that helps with government budgets, but doesn’t really have much impact on our total national health expenditures (NHE)?
Two-thirds of the proposed funding already appears in his FY 2010 budget. He would reduce overpayments to Medicare Advantage plans, reduce Medicare and Medicaid fraud (sure), reduce hospital readmissions (block the entrances?), and reduce Medicare hospital payments by measuring quality (hmmm). In this fact sheet, the only revenue increase mentioned is limiting the value of itemized deductions for families making over a quarter-million dollars a year, a proposal that has proven to be quite controversial.
The new proposals in this fact sheet include a reduction in spending based on improved productivity, extrapolating the improved productivity in the entire U.S. economy and applying it to health care (not exactly noted for assembly lines, displacing health care with information technology systems, etc.). It includes a reduction in payments to Disproportionate Share Hospitals (excess share of uninsured) which would be made possible by providing insurance to those currently uninsured. This is more of an accounting gimmick since it merely moves government spending from the hospitals to the insurance plans. Also proposed is a reduction in drug reimbursement for beneficiaries dually eligible for Medicare and Medicaid, a minute fraction of what could be saved by negotiating fair prices for all of us under a universal national health program.
Merely playing with numbers does not provide us with the comprehensive structural reform that we would need to accomplish our two primary goals: 1) health care for everyone, and 2) slowing health care cost escalation to sustainable levels. As long as the politicians can continue to distract us with cat fights over the public option, or whatever, we will never have what we really need: a new and improved Medicare for all.

President Obama's proposal to pay for reform

Paying for Health Care Reform

The White House
June 13, 2009

Health Care Reserve Fund ($ in billions – over 10 years)

$635 – FY 2010 Budget
$309 – Medicare and Medicaid Savings
$326 – Revenues

$313 – Additional Medicare and Medicaid Savings
$110 – Incorporate productivity adjustments into Medicare payment
$106 – Reduce hospital subsidies for treating the uninsured as coverage increases
$75 – Pay better prices for Medicare Part D drugs
$22 – Other

Total: $948

http://www.whitehouse.gov/MedicareFactSheetFinal/

Comment:

By Don McCanne, MD

What does President Obama mean when he says that this is how we’re going to pay for most of his health care reform proposals? Is he referring to savings in the actual costs of health care that would offset the increased spending that would result from expanding coverage? Or is he merely referring to a decrease in government spending that helps with government budgets, but doesn’t really have much impact on our total national health expenditures (NHE)?

Two-thirds of the proposed funding already appears in his FY 2010 budget. He would reduce overpayments to Medicare Advantage plans, reduce Medicare and Medicaid fraud (sure), reduce hospital readmissions (block the entrances?), and reduce Medicare hospital payments by measuring quality (hmmm). In this fact sheet, the only revenue increase mentioned is limiting the value of itemized deductions for families making over a quarter-million dollars a year, a proposal that has proven to be quite controversial.

The new proposals in this fact sheet include a reduction in spending based on improved productivity, extrapolating the improved productivity in the entire U.S. economy and applying it to health care (not exactly noted for assembly lines, displacing health care with information technology systems, etc.). It includes a reduction in payments to Disproportionate Share Hospitals (excess share of uninsured) which would be made possible by providing insurance to those currently uninsured. This is more of an accounting gimmick since it merely moves government spending from the hospitals to the insurance plans. Also proposed is a reduction in drug reimbursement for beneficiaries dually eligible for Medicare and Medicaid, a minute fraction of what could be saved by negotiating fair prices for all of us under a universal national health program.

Merely playing with numbers does not provide us with the comprehensive structural reform that we would need to accomplish our two primary goals: 1) health care for everyone, and 2) slowing health care cost escalation to sustainable levels. As long as the politicians can continue to distract us with cat fights over the public option, or whatever, we will never have what we really need: a new and improved Medicare for all.

Are you one big illness away from bankruptcy?

By Dean Calbreath
San Diego Union-Tribune
June 14, 2009

“The greatest health is wealth,” the classical Roman poet Virgil once said.

But to keep your health can cost you your wealth. In fact, it can drive you into bankruptcy.

A survey this month showed that in 2007, on the eve of the current recession, roughly two-thirds of bankruptcies in the United States involved people who were driven into insolvency because they could not keep up with their medical bills.

Although health care has been eclipsed by overdue mortgages and credit card debt as the primary cause of bankruptcy, it remains a potent driver of debt. And once the current wave of foreclosures abates, it could quickly regain its No. 1 status in the bankruptcy courts, unless something is done to fix the medical system first.

“Unless you’re Warren Buffett, your family is just one serious illness away from bankruptcy,” said David Himmelstein, an associate professor of medicine at Harvard.

“For middle-class Americans, health insurance offers little protection. Most of us have policies with so many loopholes, co-payments and deductibles that illness can put you in the poorhouse,” Himmelstein said.

The study by Himmelstein and a team of researchers at Harvard Law School, Harvard Medical School and Ohio University shows that 62 percent of bankruptcies in 2007 were at least partly caused by problems involving health care. That’s up from 55 percent in 2001.

More than three-quarters of the people who were bankrupted for medical reasons had health insurance at the start of the “bankrupting illness,” according to the study, which will be published in The American Journal of Medicine in August. Most of them “were solidly middle class before financial disaster hit.” Two-thirds were homeowners, and three-fifths had gone to college.

“In many cases, high medical bills coincided with a loss of income as illness forced breadwinners to lose time from work,” the study reported. “Often illness led to job loss, and with it the loss of health insurance.”

Even filers who retained their insurance often faced high out-of-pocket medical costs, because of co-payments, deductibles and services that the insurers declined to cover.

Among the health-related bankruptcy cases, the medical debt averaged $17,749 for filers who retained their insurers; $22,568 for filers who initially had insurance coverage but lost it through the course of their illness; and $26,971 for the uninsured.

Hospital bills were the largest single expense for about half of all medically bankrupt families, according to the survey. Prescription drugs were the largest expense for 19 percent of those families.

Of course, if the Harvard researchers were to examine bankruptcy filings today, the results would be much different. These days, bankruptcy courts are crowded with real estate brokers, speculators and home-equity borrowers. But health care cases continue to show up in the bankruptcy system.

“Mortgage problems, job losses, credit card debt and health care bills can all be a part of the economic stew in a bankruptcy filing,” said Barry Lander, clerk at the U.S. Bankruptcy Court in San Diego. “Sometimes a person can handle two or three problems but not all at once, so that if you’re unemployed or facing credit card debt and then get sick, it can push you over the edge.”

Len Ackerman, who heads American Debt Relief, a law firm in downtown San Diego, said one of his clients was pushed into bankruptcy because of her bills from fighting a series of health-related problems. She was already in debt from treatment for diabetes and high blood pressure when she was diagnosed with breast cancer this spring.

“We had to postpone her bankruptcy filing because she was in surgery,” Ackerman said. “She’s been in the hospital for the past month.”

Mark Reed, a bankruptcy attorney in Kearny Mesa, tells of a client who filed for bankruptcy after incurring a couple hundred-thousand dollars in medical bills. Because of her medical problems, she could not find work. But because she was receiving spousal-support payments from her ex-husband, she was making too much money to qualify for government assistance.

“What I’ve seen is mostly people who don’t have insurance or people who have insurance but don’t have enough to cover their medical bills,” Reed said. He worries that the current rise in unemployment will lead to more health-related bankruptcies.

“A lot of people losing their jobs end up with no insurance,” Reed said. “Many can’t afford COBRA (a government-created program that allows laid-off workers to temporarily retain their former insurance at full cost). They end up paying for their health care on credit cards. A lot of the credit card bankruptcies we’re seeing these days include bills related to health care.”

A recent poll by the Deloitte Center for Health Solutions, part of the Deloitte LLP international consulting firm, shows that 94 percent of respondents believe health care costs are a threat to their personal financial security.

According to the poll, one of eight had serious problems paying or were unable to pay their medical bills. A similar percentage had to choose between paying for health care and paying for other essentials, such as food and rent. Nearly one household in four has a person who has postponed paying their medical bills by 90 days or more.

“The results of this study are conclusive: Consumers want better performance from their health care system,” said Paul Keckley, executive director of the Deloitte center.

“They think (the system) is wasteful, inefficient, complex and expensive,” Keckley said. “They want better value for the dollars they spend and believe fundamental changes are necessary to achieve these goals.”

These studies would seem to provide ammunition for forces in the White House and on Capitol Hill that are now pushing to reform the Medicare system.

But Steffie Woolhandler, a Harvard doctor who helped conduct the bankruptcy study, said that some of the proposed reforms – such as requiring uninsured people to pay for insurance or face a fine – might be worse than the current system.

Woolhandler notes that such a system, as currently envisioned, could include a monthly payment amounting to hundreds of dollars combined with deductions in the thousands of dollars – enough to push some patients into bankruptcy.

“With that kind of system, you may get the numbers of uninsured people down, but it won’t solve the affordability problems in health care,” she said.

Woolhandler, like many other members of the Harvard team, advocates a Canada-style single-payer system. That idea has not gained much traction on Capitol Hill, although Congress has recently begun discussing the idea.

Just last week, at a House subcommittee hearing on health affairs, San Diego registered nurse Geri Jenkins, co-president of the California Nurses Association/National Nurses Organizing Committee, was on a panel of speakers testifying on behalf of a single-payer system.

Regardless of what form the health care reform eventually takes, the Harvard study should inspire Congress to craft a program that will mean fewer people have to imperil their wealth in order to save their health.

http://www3.signonsandiego.com/stories/2009/jun/14/1b14dean211442-are-you-one-big-illness-away-bankru/

Insurance interests total 1/4 of Baucus' fundraising

By Mike Dennison
The Montana Standard
06/14/2009

HELENA — As Sen. Max Baucus has taken the lead on health-reform legislation in the U.S. Senate, he’s also become a leader in something else: Campaign money received from health- and insurance-industry interests.

In the past six years, nearly one-fourth of every dime raised by Baucus, D-Mont., and his political-action committee has come from groups and individuals associated with drug companies, insurers, hospitals, medical-supply firms, health-service companies and other health professionals.

These donations total about $3.4 million, or $1,500 a day, every day, from January 2003 through 2008.

Baucus, who chairs the Senate Finance Committee that is drafting a major health-care reform bill this month, insists this cavalcade of money is not unduly influencing his work.

“No matter the issue, Max always puts Montana first,” said his spokesman, Ty Matsdorf. “Max will continue to do what’s right for our state, and groups like SEIU (a union representing thousands of health-care workers) and AARP (a senior citizens’ group) wouldn’t line up in support of his health-care reform effort if this wasn’t true.” Baucus’ office also lists numerous examples of how his proposed reforms are challenging the health-care and insurance industries, such as requiring insurers to accept all customers, regardless of health condition.

Yet some reform activists and others who watch the political system say it’s foolish to think this money doesn’t hold some sway.

“When you spend so much of your time raising money, as members of Congress do, from those who have a compelling interest in the outcome of legislation, it has to change what you think about it, and the viewpoints that you have,” says David Donnelly, director of Campaign Money Watch, a Washington, D.C., group that tracks money in politics. “It’s just human nature. … and members of Congress are human.” Advocates of national, public health insurance for all — a proposal largely excluded from the health-reform debate — say their exclusion points to the power of moneyed interests in Congress.

“I’m convinced that this (money) has a profound influence,” says Quentin Young, national coordinator for Physicians for a National Health Program. “Otherwise, how could Baucus, an otherwise respected and wise politician, say categorically that single-payer (national health insurance) is off the table?” Since 2003, perhaps no other member of Congress has received more money from health and insurance interests than Baucus. Only his Republican counterpart on the Finance Committee, Sen. Charles Grassley of Iowa, rivals him in terms of percentage of funds from these business sectors.

The Lee Newspapers State Bureau examined fundraising data for Baucus, Grassley, Sen. Ted Kennedy (who chairs the Senate Health Committee, which is drafting health-reform legislation), the other two members of Montana’s congressional delegation, and President Barack Obama.

The data are compiled by the Center for Responsive Politics, a nonprofit group that tracks and sorts campaign donors by profession and industry. Here’s a summary of what the State Bureau discovered:

* From 2003-2008, the Baucus campaign and his Glacier PAC, which raises money and distributes it to other candidates, received 23 percent of their $14.8 million from health-care and insurance interests.

The $3.4 million from these sectors includes $853,000 from pharmaceutical and health-products, $851,000 from health professionals; $467,000 from hospitals and nursing homes, $466,000 from health-service and HMO interests, and $784,000 from insurance.

The insurance-sector money includes donations from all types of insurance-company interests, including health insurance.

* Five of the top 10 specific donor sources for Baucus were drug companies, health insurers or health-related firms. For example, employees of Schering-Plough Corp., a major drug firm, gave him $92,000 over the period, more than any other single source.

* Grassley, the highest-ranking Republican on the Finance Committee, received 23.5 percent of his funds from health and insurance interests, but a lesser dollar amount than Baucus ($2.3 million out of $9.8 million total funds).

* Sen. Kennedy, D-Mass, a longtime advocate of health-care reforms, received only 7.5 percent of his funds from health and insurance interests, or about $1.2 million.

* Sen. Jon Tester, D-Mont., and Rep. Denny Rehberg, R-Mont., had minimal contributions from the health and insurance sectors.

* President Obama, whose campaign raised a whopping $745 million in 2007 and 2008, received a relatively small share from health-care interests ($19 million, or 2.5 percent) and insurance interests ($2 million, or 0.3 percent).

Baucus has been leading the charge on health-care reform in the U.S. Senate since early 2008, holding numerous hearings and Finance Committee meetings on the issue. He released a lengthy “white paper” last November, outlining his reform ideas, and a major bill is expected to be introduced this month.

The general thrust of his proposals is to require all citizens to buy health insurance, while also forcing the private insurance industry to stop practices that make coverage unaffordable for many. He supports subsidies to those who may have trouble affording insurance.

However, on a reform bitterly opposed by the insurance industry and most health-care interests — a public, nonprofit insurance plan offered by the government — Baucus has been more ambivalent, saying he supports the idea, but declining to say in what form.

Baucus’s office supplied nearly 20 examples of stances he’s taken in direct opposition to drug, insurance and banking interests that have donated to his campaign funds.

For example, he has supported importing lower-cost prescription drugs from Canada, allowing the government to negotiate for lower drug prices for Medicare recipients, funding research that would show when generic drugs are a better deal than brand-name drugs and reducing Medicare payments to private insurers by $13 billion over five years.

His office also points to an April 2007 Wall Street Journal article in which Baucus was quoted as telling medical-industry contributors at a fundraiser that “You should worry about me coming after you.” Donnelly, the Campaign Money Watch director, says the proof on health-care reform will be in the final product — and that he’s not terribly optimistic.

Health and insurance interests are clearly targeting Baucus and his Finance Committee, which often have shown themselves to be receptive to their influence, he says.

“This debate on health care is a microcosm … that even after a ‘change’ election, how much the special interests view (Washington) as their fiefdom,” Donnelly says.

Supporters of national health insurance are even less optimistic, noting how Baucus, President Obama and leaders in Congress won’t even consider their proposal, which they believe would have broad public support.

“I can’t think of any reason other than fidelity to your donors, to explain why they would keep us out of the debate,” says Dr. Young of the physicians group. “Until we get campaign-finance reform, it will be very difficult to do anything to challenge the status quo (in health care), and the status quo had better be challenged, because it’s a very bad status quo.”

President Obama’s proposal to pay for reform

Paying for Health Care Reform

The White House
June 13, 2009

Health Care Reserve Fund ($ in billions – over 10 years)

$635 – FY 2010 Budget
$309 – Medicare and Medicaid Savings
$326 – Revenues

$313 – Additional Medicare and Medicaid Savings
$110 – Incorporate productivity adjustments into Medicare payment
$106 – Reduce hospital subsidies for treating the uninsured as coverage increases
$75 – Pay better prices for Medicare Part D drugs
$22 – Other

Total: $948

http://www.whitehouse.gov/MedicareFactSheetFinal/

Comment:

By Don McCanne, MD

What does President Obama mean when he says that this is how we’re going to pay for most of his health care reform proposals? Is he referring to savings in the actual costs of health care that would offset the increased spending that would result from expanding coverage? Or is he merely referring to a decrease in government spending that helps with government budgets, but doesn’t really have much impact on our total national health expenditures (NHE)?

Two-thirds of the proposed funding already appears in his FY 2010 budget. He would reduce overpayments to Medicare Advantage plans, reduce Medicare and Medicaid fraud (sure), reduce hospital readmissions (block the entrances?), and reduce Medicare hospital payments by measuring quality (hmmm). In this fact sheet, the only revenue increase mentioned is limiting the value of itemized deductions for families making over a quarter-million dollars a year, a proposal that has proven to be quite controversial.

The new proposals in this fact sheet include a reduction in spending based on improved productivity, extrapolating the improved productivity in the entire U.S. economy and applying it to health care (not exactly noted for assembly lines, displacing health care with information technology systems, etc.). It includes a reduction in payments to Disproportionate Share Hospitals (excess share of uninsured) which would be made possible by providing insurance to those currently uninsured. This is more of an accounting gimmick since it merely moves government spending from the hospitals to the insurance plans. Also proposed is a reduction in drug reimbursement for beneficiaries dually eligible for Medicare and Medicaid, a minute fraction of what could be saved by negotiating fair prices for all of us under a universal national health program.

Merely playing with numbers does not provide us with the comprehensive structural reform that we would need to accomplish our two primary goals: 1) health care for everyone, and 2) slowing health care cost escalation to sustainable levels. As long as the politicians can continue to distract us with cat fights over the public option, or whatever, we will never have what we really need: a new and improved Medicare for all.

Insurance interests total 1/4 of Baucus’ fundraising

By Mike Dennison
The Montana Standard
06/14/2009

HELENA — As Sen. Max Baucus has taken the lead on health-reform legislation in the U.S. Senate, he’s also become a leader in something else: Campaign money received from health- and insurance-industry interests.

In the past six years, nearly one-fourth of every dime raised by Baucus, D-Mont., and his political-action committee has come from groups and individuals associated with drug companies, insurers, hospitals, medical-supply firms, health-service companies and other health professionals.

These donations total about $3.4 million, or $1,500 a day, every day, from January 2003 through 2008.

Baucus, who chairs the Senate Finance Committee that is drafting a major health-care reform bill this month, insists this cavalcade of money is not unduly influencing his work.

“No matter the issue, Max always puts Montana first,” said his spokesman, Ty Matsdorf. “Max will continue to do what’s right for our state, and groups like SEIU (a union representing thousands of health-care workers) and AARP (a senior citizens’ group) wouldn’t line up in support of his health-care reform effort if this wasn’t true.” Baucus’ office also lists numerous examples of how his proposed reforms are challenging the health-care and insurance industries, such as requiring insurers to accept all customers, regardless of health condition.

Yet some reform activists and others who watch the political system say it’s foolish to think this money doesn’t hold some sway.

“When you spend so much of your time raising money, as members of Congress do, from those who have a compelling interest in the outcome of legislation, it has to change what you think about it, and the viewpoints that you have,” says David Donnelly, director of Campaign Money Watch, a Washington, D.C., group that tracks money in politics. “It’s just human nature. … and members of Congress are human.” Advocates of national, public health insurance for all — a proposal largely excluded from the health-reform debate — say their exclusion points to the power of moneyed interests in Congress.

“I’m convinced that this (money) has a profound influence,” says Quentin Young, national coordinator for Physicians for a National Health Program. “Otherwise, how could Baucus, an otherwise respected and wise politician, say categorically that single-payer (national health insurance) is off the table?” Since 2003, perhaps no other member of Congress has received more money from health and insurance interests than Baucus. Only his Republican counterpart on the Finance Committee, Sen. Charles Grassley of Iowa, rivals him in terms of percentage of funds from these business sectors.

The Lee Newspapers State Bureau examined fundraising data for Baucus, Grassley, Sen. Ted Kennedy (who chairs the Senate Health Committee, which is drafting health-reform legislation), the other two members of Montana’s congressional delegation, and President Barack Obama.

The data are compiled by the Center for Responsive Politics, a nonprofit group that tracks and sorts campaign donors by profession and industry. Here’s a summary of what the State Bureau discovered:

* From 2003-2008, the Baucus campaign and his Glacier PAC, which raises money and distributes it to other candidates, received 23 percent of their $14.8 million from health-care and insurance interests.

The $3.4 million from these sectors includes $853,000 from pharmaceutical and health-products, $851,000 from health professionals; $467,000 from hospitals and nursing homes, $466,000 from health-service and HMO interests, and $784,000 from insurance.

The insurance-sector money includes donations from all types of insurance-company interests, including health insurance.

* Five of the top 10 specific donor sources for Baucus were drug companies, health insurers or health-related firms. For example, employees of Schering-Plough Corp., a major drug firm, gave him $92,000 over the period, more than any other single source.

* Grassley, the highest-ranking Republican on the Finance Committee, received 23.5 percent of his funds from health and insurance interests, but a lesser dollar amount than Baucus ($2.3 million out of $9.8 million total funds).

* Sen. Kennedy, D-Mass, a longtime advocate of health-care reforms, received only 7.5 percent of his funds from health and insurance interests, or about $1.2 million.

* Sen. Jon Tester, D-Mont., and Rep. Denny Rehberg, R-Mont., had minimal contributions from the health and insurance sectors.

* President Obama, whose campaign raised a whopping $745 million in 2007 and 2008, received a relatively small share from health-care interests ($19 million, or 2.5 percent) and insurance interests ($2 million, or 0.3 percent).

Baucus has been leading the charge on health-care reform in the U.S. Senate since early 2008, holding numerous hearings and Finance Committee meetings on the issue. He released a lengthy “white paper” last November, outlining his reform ideas, and a major bill is expected to be introduced this month.

The general thrust of his proposals is to require all citizens to buy health insurance, while also forcing the private insurance industry to stop practices that make coverage unaffordable for many. He supports subsidies to those who may have trouble affording insurance.

However, on a reform bitterly opposed by the insurance industry and most health-care interests — a public, nonprofit insurance plan offered by the government — Baucus has been more ambivalent, saying he supports the idea, but declining to say in what form.

Baucus’s office supplied nearly 20 examples of stances he’s taken in direct opposition to drug, insurance and banking interests that have donated to his campaign funds.

For example, he has supported importing lower-cost prescription drugs from Canada, allowing the government to negotiate for lower drug prices for Medicare recipients, funding research that would show when generic drugs are a better deal than brand-name drugs and reducing Medicare payments to private insurers by $13 billion over five years.

His office also points to an April 2007 Wall Street Journal article in which Baucus was quoted as telling medical-industry contributors at a fundraiser that “You should worry about me coming after you.” Donnelly, the Campaign Money Watch director, says the proof on health-care reform will be in the final product — and that he’s not terribly optimistic.

Health and insurance interests are clearly targeting Baucus and his Finance Committee, which often have shown themselves to be receptive to their influence, he says.

“This debate on health care is a microcosm … that even after a ‘change’ election, how much the special interests view (Washington) as their fiefdom,” Donnelly says.

Supporters of national health insurance are even less optimistic, noting how Baucus, President Obama and leaders in Congress won’t even consider their proposal, which they believe would have broad public support.

“I can’t think of any reason other than fidelity to your donors, to explain why they would keep us out of the debate,” says Dr. Young of the physicians group. “Until we get campaign-finance reform, it will be very difficult to do anything to challenge the status quo (in health care), and the status quo had better be challenged, because it’s a very bad status quo.”