PNHP

Frank Luntz's "The Language of Healthcare 2009"

Frank Luntz's "The Language of Healthcare 2009"

THE LANGUAGE OF HEALTHCARE 2009

By Dr. Frank I. Luntz

This document is based on polling results and Instant Response dial sessions conducted in April 2009. It captures not just what Americans want to see but exactly what they want to hear. The Words That Work boxes that follow are already being used by a few Congressional and Senatorial Republicans. From today forward, they should be used by everyone.

You simply MUST be vocally and passionately on the side of reform. The status quo is no longer acceptable. If the dynamic becomes “President Obama is on the side of reform and Republicans are against it,” then the battle is lost and every word in this document is useless. Republicans must be for the right kind of reform that protects the quality of healthcare for all Americans. And you must establish your support of reform early in your presentation.

THE 10 RULES FOR STOPPING THE “WASHINGTON TAKEOVER” OF HEALTHCARE

(1) Humanize your approach.

(2) Acknowledge the “crisis” or suffer the consequences.

(3) “Time” is the government healthcare killer.

(4) The arguments against the Democrats’ healthcare plan must center around “politicians,” “bureaucrats,” and “Washington” … not the free market, tax incentives, or competition.

(5) The healthcare denial horror stories from Canada & Co. do resonate, but you have to humanize them.

(6) Healthcare quality = “getting the treatment you need, when you need it.”

7) “One-size-does-NOT-fit-all.”

(8) WASTE, FRAUD, and ABUSE are your best targets for how to bring down costs.

(9) Americans will expect the government to look out for those who truly can’t afford healthcare.

(10) It’s not enough to just say what you’re against. You have to tell them what you’re for.

http://www.politico.com/static/PPM116_luntz.html

Comment:

By Don McCanne, MD

This is an important document. It is Frank Luntz’s recommendation to the Republican politicians on how to frame the debate over health care reform. If you have been listening to the Republicans speak on reform, you have already heard some of the rhetoric, and you will recognize it as you read this report.

This is not a report on health policy. If you read it as if it were a policy paper, you will likely become angered over the liberties that Luntz takes with policy concepts. You will recognize a great many distortions and, worse, many instances in which his statements are not supported by the facts (i.e., “lies” in common parlance).

This is a report on political framing of the debate. It is designed to provide Republicans with political rhetoric that theoretically would shift support to the Republican positions for reform, and away from the Democratic positions. As you read it, you will see that there is a very strong emphasis on the latter, and very little on the former since the Republicans have almost nothing to offer in the way of substantial reform.

A note of caution: As you read the report, you will tend to fall into the trap of responding based on their framing of the issues. Do not do that. Always address the issues within our own framing structure. When you identify rhetoric that is blatantly untrue, you will tend to say, “That’s a lie.” Such ’tis so/’tis not debates are never productive and tend to favor the smooth talkers (predominantly Republicans). Instead, respond with highly credible facts that use the framing from our own arena.

Another word about lies. You will see that Frank Luntz does not have an issue with this. What counts is a strong message that appears to be credible, regardless of whether or not it is. On our side, we must never lie, nor even distort our message. We have established unblemished credibility with our message, and we must never do anything that might impair that credibility. That makes our task more difficult because we must be very careful that anything we say is supported by sound health policy science. But it also makes the Republicans vulnerable since they tend to concentrate on sound bites that are not based on sound policies. That risks exposing them as charlatans; we can do that with our carefully framed messages.

Some parts of the report actually provide good advice not only for the Republicans, but for the Democrats as well. In fact, you will identify some recommendations that have been lifted from our camp. We can continue to use these, and we should not attack them when they use the same rhetoric. Only when they twist it unfairly should we counter with our rhetoric describing the beneficial impacts of our policies.

Look at this example from the report: “What Americans are looking for in healthcare that your ‘solution’ will provide is, in a word, more: ‘more access to more treatments and more doctors…with less interference from insurance companies and Washington politicians and special interests.'”

What Luntz left unsaid is that these are features that more closely describe the progressive position. Most of the Republican policies would make these worse. Again, you wouldn’t respond by saying, “That’s not true.” You would respond by providing accurate sound bites on how the single payer proposal provides improved access by eliminating financial barriers to care, and single payer would eliminate the private insurance industry so it could no longer interfere with your care.

Wait. Progressive? Single payer? Isn’t my comment supposed to be talking about the framing to be used the Democrats? Well, we have a problem here.

Look at another example from Luntz’s report: “We suggest ratcheting up the rhetoric against insurance companies to almost the same degree as you do against Washington bureaucracy. Call the Democratic plan a ‘bailout for the insurance industry’ — both because it is, and because it will build lasting credibility by going after the two things the American people hate most: Washington bureaucracy and insurer greed.”

Wow! Luntz is right! The Democratic plan IS a “bailout for the insurance industry.” In fact, the Democrats have lost all credibility on this one when they have AHIP’s Karen Ignagni front and center at every hearing, every forum, every summit, and her operatives providing input to the closed-door sessions, while they have excluded from the process those who most vigorously attack the insurance companies – the single payer advocates.

Read Luntz’s report. Be prepared to respond using our framing. Attack their credibility when they provide us with obvious openings.

What is sobering is that we have to use the truth to attack both the Republican and the Democratic politicians. And this was to have been our great opening to provide high quality care for everyone.

But don’t give up. The Democrats’ plan won’t work. They’ll still need us to fix our system when their failure becomes painfully obvious.

Frank Luntz’s “The Language of Healthcare 2009”

THE LANGUAGE OF HEALTHCARE 2009

By Dr. Frank I. Luntz

This document is based on polling results and Instant Response dial sessions conducted in April 2009. It captures not just what Americans want to see but exactly what they want to hear. The Words That Work boxes that follow are already being used by a few Congressional and Senatorial Republicans. From today forward, they should be used by everyone.

You simply MUST be vocally and passionately on the side of reform. The status quo is no longer acceptable. If the dynamic becomes “President Obama is on the side of reform and Republicans are against it,” then the battle is lost and every word in this document is useless. Republicans must be for the right kind of reform that protects the quality of healthcare for all Americans. And you must establish your support of reform early in your presentation.

THE 10 RULES FOR STOPPING THE “WASHINGTON TAKEOVER” OF HEALTHCARE

(1) Humanize your approach.

(2) Acknowledge the “crisis” or suffer the consequences.

(3) “Time” is the government healthcare killer.

(4) The arguments against the Democrats’ healthcare plan must center around “politicians,” “bureaucrats,” and “Washington” … not the free market, tax incentives, or competition.

(5) The healthcare denial horror stories from Canada & Co. do resonate, but you have to humanize them.

(6) Healthcare quality = “getting the treatment you need, when you need it.”

7) “One-size-does-NOT-fit-all.”

(8) WASTE, FRAUD, and ABUSE are your best targets for how to bring down costs.

(9) Americans will expect the government to look out for those who truly can’t afford healthcare.

(10) It’s not enough to just say what you’re against. You have to tell them what you’re for.

http://www.politico.com/static/PPM116_luntz.html

Comment:

By Don McCanne, MD

This is an important document. It is Frank Luntz’s recommendation to the Republican politicians on how to frame the debate over health care reform. If you have been listening to the Republicans speak on reform, you have already heard some of the rhetoric, and you will recognize it as you read this report.

This is not a report on health policy. If you read it as if it were a policy paper, you will likely become angered over the liberties that Luntz takes with policy concepts. You will recognize a great many distortions and, worse, many instances in which his statements are not supported by the facts (i.e., “lies” in common parlance).

This is a report on political framing of the debate. It is designed to provide Republicans with political rhetoric that theoretically would shift support to the Republican positions for reform, and away from the Democratic positions. As you read it, you will see that there is a very strong emphasis on the latter, and very little on the former since the Republicans have almost nothing to offer in the way of substantial reform.

A note of caution: As you read the report, you will tend to fall into the trap of responding based on their framing of the issues. Do not do that. Always address the issues within our own framing structure. When you identify rhetoric that is blatantly untrue, you will tend to say, “That’s a lie.” Such ’tis so/’tis not debates are never productive and tend to favor the smooth talkers (predominantly Republicans). Instead, respond with highly credible facts that use the framing from our own arena.

Another word about lies. You will see that Frank Luntz does not have an issue with this. What counts is a strong message that appears to be credible, regardless of whether or not it is. On our side, we must never lie, nor even distort our message. We have established unblemished credibility with our message, and we must never do anything that might impair that credibility. That makes our task more difficult because we must be very careful that anything we say is supported by sound health policy science. But it also makes the Republicans vulnerable since they tend to concentrate on sound bites that are not based on sound policies. That risks exposing them as charlatans; we can do that with our carefully framed messages.

Some parts of the report actually provide good advice not only for the Republicans, but for the Democrats as well. In fact, you will identify some recommendations that have been lifted from our camp. We can continue to use these, and we should not attack them when they use the same rhetoric. Only when they twist it unfairly should we counter with our rhetoric describing the beneficial impacts of our policies.

Look at this example from the report: “What Americans are looking for in healthcare that your ‘solution’ will provide is, in a word, more: ‘more access to more treatments and more doctors…with less interference from insurance companies and Washington politicians and special interests.'”

What Luntz left unsaid is that these are features that more closely describe the progressive position. Most of the Republican policies would make these worse. Again, you wouldn’t respond by saying, “That’s not true.” You would respond by providing accurate sound bites on how the single payer proposal provides improved access by eliminating financial barriers to care, and single payer would eliminate the private insurance industry so it could no longer interfere with your care.

Wait. Progressive? Single payer? Isn’t my comment supposed to be talking about the framing to be used the Democrats? Well, we have a problem here.

Look at another example from Luntz’s report: “We suggest ratcheting up the rhetoric against insurance companies to almost the same degree as you do against Washington bureaucracy. Call the Democratic plan a ‘bailout for the insurance industry’ — both because it is, and because it will build lasting credibility by going after the two things the American people hate most: Washington bureaucracy and insurer greed.”

Wow! Luntz is right! The Democratic plan IS a “bailout for the insurance industry.” In fact, the Democrats have lost all credibility on this one when they have AHIP’s Karen Ignagni front and center at every hearing, every forum, every summit, and her operatives providing input to the closed-door sessions, while they have excluded from the process those who most vigorously attack the insurance companies – the single payer advocates.

Read Luntz’s report. Be prepared to respond using our framing. Attack their credibility when they provide us with obvious openings.

What is sobering is that we have to use the truth to attack both the Republican and the Democratic politicians. And this was to have been our great opening to provide high quality care for everyone.

But don’t give up. The Democrats’ plan won’t work. They’ll still need us to fix our system when their failure becomes painfully obvious.

Sen. Schumer kills reform

Schumer Offers Middle Ground on Health Care

By Robert Pear
The New York Times
May 5, 2009
In an effort to defuse the most explosive issue in the debate over comprehensive health care legislation, a top Senate Democrat has proposed that any new government-run insurance program comply with all the rules and standards that apply to private insurance.
The proposal was made Monday by Senator Charles E. Schumer of New York, the third-ranking member of the Senate Democratic leadership, in a bid to address fears that a public program would drive private insurers from the market.
Democrats in Congress hope to shift the debate from the question of whether to create a public health insurance plan to the question of how it would work.
“The public plan,” Mr. Schumer said Monday, “must be subject to the same regulations and requirements as all other plans” in the insurance market.
The chairman of the Senate Finance Committee, Max Baucus, Democrat of Montana, asked Mr. Schumer to seek a solution. In his response, Mr. Schumer set forth these principles:
* The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.
* The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.
* The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.
* To prevent the government from serving as both “player and umpire,” the officials who manage a public plan should be different from those who regulate the insurance market.
In addition, Mr. Schumer said, the public plan should be required to establish a reserve fund, just as private insurers must maintain reserves for the payment of anticipated claims. And he said the public plan should be required to provide the same minimum benefits as private insurers.
Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, said, “We are very, very grateful that members of Congress have been thoughtfully looking at our concerns.” But she said she still saw no need for a public plan “if you have much more aggressive regulation of insurance,” which the industry has agreed to support.
http://www.nytimes.com/2009/05/05/health/policy/05health.html?ref=politics

The success of the effort to reform health care seemed to be threatened by the disagreement over whether or not a public insurance option should be offered to compete with private health plans. All Republicans have expressed opposition to the public option, indicating that it would be a deal breaker if included. The Progressive Caucus in the House, which actually wants single payer, has taken a position that leaving the public option out of the reform legislation would be a deal breaker.
To prevent gridlock, Sen. Charles Schumer offers the simple solution of “public option light” so that it would not be a deal breaker for either side. The progressives would have a government-sponsored plan in the mix of private plans, and the Republicans would have government-sponsored plan that is indistinguishable from private plans, creating a level playing field. Thus each side could move forward with reform without having to implement their deal-breaking rhetoric.
This is not simply Sen. Schumer’s personal effort defuse this bomb. His public option compromise was prepared at the request of Sen. Max Baucus who has been working closely with Sen. Charles Grassley to craft truly bipartisan reform legislation. In fact, at yesterday’s Senate Finance Committee hearing on expanding health care coverage, in addition to the fifteen scheduled witnesses, Sen. Baucus called on committee member Schumer to present the public option compromise.
Look at the history of what has happened here. The progressives were told by the moderates that the votes for single payer were not there. So negotiations began from a position that single payer was off the table. The progressive community then decided to concede that the Republicans and the insurance industry could have their market of private plans, and that the compromise position that all could accept would be the addition of a public insurance option.
In the compromise process, the Republicans and the insurance industry finally made their move. That was, “drop dead.” The Progressive Caucus responded with, “we’ve already come more than half way, so now you drop dead.” So now we have the Schumer compromise of public option light, which now has been blessed as the current, official Democratic position, even though it moves even closer to the Republican position.
What have the Republicans conceded so far? Nothing. What is the insurance industry’s position on a competing public plan that looks just like their private plans? Karen Ignagni of AHIP says that she still sees “no need for a public plan.” No concession.
The Democrats have already conceded on an effective public plan option. They have conceded that universal coverage is not possible so we should merely “aim for universal.” They have admitted that they have not figured out a way to pay for plans with adequate benefits for working families. They have abandoned support of policies that would improve value while controlling costs.
The Democrats have already given away all major policies for reform, and the Republicans haven’t had to budge the least. Why should they when the Democrats are rushing in their direction?
It is ironic that yesterday, at the Senate Finance hearing, one by one, eight individuals, including physicians from PNHP, stood up and offered to present policies that would work.
One of them stated, “… single payer national health care; we want a seat at the table.”
Sen. Baucus responded, “We want police,” and he got them. Each was arrested in turn.
That allowed enough time for Sen. Baucus to add Sen. Schumer as an additional pseudo-witness so that they could kill the last, but all-too-feeble effort at real reform – the public option.

Sen. Schumer kills reform

Schumer Offers Middle Ground on Health Care

By Robert Pear
The New York Times
May 5, 2009

In an effort to defuse the most explosive issue in the debate over comprehensive health care legislation, a top Senate Democrat has proposed that any new government-run insurance program comply with all the rules and standards that apply to private insurance.

The proposal was made Monday by Senator Charles E. Schumer of New York, the third-ranking member of the Senate Democratic leadership, in a bid to address fears that a public program would drive private insurers from the market.

Democrats in Congress hope to shift the debate from the question of whether to create a public health insurance plan to the question of how it would work.

“The public plan,” Mr. Schumer said Monday, “must be subject to the same regulations and requirements as all other plans” in the insurance market.

The chairman of the Senate Finance Committee, Max Baucus, Democrat of Montana, asked Mr. Schumer to seek a solution. In his response, Mr. Schumer set forth these principles:

* The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

* The public plan should pay doctors and hospitals more than what Medicare pays. Medicare rates, set by law and regulation, are often lower than what private insurers pay.

* The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

* To prevent the government from serving as both “player and umpire,” the officials who manage a public plan should be different from those who regulate the insurance market.

In addition, Mr. Schumer said, the public plan should be required to establish a reserve fund, just as private insurers must maintain reserves for the payment of anticipated claims. And he said the public plan should be required to provide the same minimum benefits as private insurers.

Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, said, “We are very, very grateful that members of Congress have been thoughtfully looking at our concerns.” But she said she still saw no need for a public plan “if you have much more aggressive regulation of insurance,” which the industry has agreed to support.

http://www.nytimes.com/2009/05/05/health/policy/05health.html?ref=politics

Comment:

By Don McCanne, MD

The success of the effort to reform health care seemed to be threatened by the disagreement over whether or not a public insurance option should be offered to compete with private health plans. All Republicans have expressed opposition to the public option, indicating that it would be a deal breaker if included. The Progressive Caucus in the House, which actually wants single payer, has taken a position that leaving the public option out of the reform legislation would be a deal breaker.

To prevent gridlock, Sen. Charles Schumer offers the simple solution of “public option light” so that it would not be a deal breaker for either side. The progressives would have a government-sponsored plan in the mix of private plans, and the Republicans would have government-sponsored plan that is indistinguishable from private plans, creating a level playing field. Thus each side could move forward with reform without having to implement their deal-breaking rhetoric.

This is not simply Sen. Schumer’s personal effort defuse this bomb. His public option compromise was prepared at the request of Sen. Max Baucus who has been working closely with Sen. Charles Grassley to craft truly bipartisan reform legislation. In fact, at yesterday’s Senate Finance Committee hearing on expanding health care coverage, in addition to the fifteen scheduled witnesses, Sen. Baucus called on committee member Schumer to present the public option compromise.

Look at the history of what has happened here. The progressives were told by the moderates that the votes for single payer were not there. So negotiations began from a position that single payer was off the table. The progressive community then decided to concede that the Republicans and the insurance industry could have their market of private plans, and that the compromise position that all could accept would be the addition of a public insurance option.

In the compromise process, the Republicans and the insurance industry finally made their move. That was, “drop dead.” The Progressive Caucus responded with, “we’ve already come more than half way, so now you drop dead.” So now we have the Schumer compromise of public option light, which now has been blessed as the current, official Democratic position, even though it moves even closer to the Republican position.

What have the Republicans conceded so far? Nothing. What is the insurance industry’s position on a competing public plan that looks just like their private plans? Karen Ignagni of AHIP says that she still sees “no need for a public plan.” No concession.

The Democrats have already conceded on an effective public plan option. They have conceded that universal coverage is not possible so we should merely “aim for universal.” They have admitted that they have not figured out a way to pay for plans with adequate benefits for working families. They have abandoned support of policies that would improve value while controlling costs.

The Democrats have already given away all major policies for reform, and the Republicans haven’t had to budge the least. Why should they when the Democrats are rushing in their direction?

It is ironic that yesterday, at the Senate Finance hearing, one by one, eight individuals, including physicians from PNHP, stood up and offered to present policies that would work.

One of them stated, “… single payer national health care; we want a seat at the table.”

Sen. Baucus responded, “We want police,” and he got them. Each was arrested in turn.

That allowed enough time for Sen. Baucus to add Sen. Schumer as an additional pseudo-witness so that they could kill the last, but all-too-feeble effort at real reform – the public option.

Call for single payer, universal coverage from Puerto Rico

May 3, 2009
Honorable Barack Obama
President of the United States
Dear Mr. President:

The College of Physicians and Surgeons of Puerto Rico strongly believes that your presidency constitutes an historical call from the people of the United States of America for a better World; not only for us, but for all humanity. Your presidency represents a new level of social justice, a major step in our continuing journey to achieve fundamental Human Rights for all citizens of the United States and, through our leadership, the world.

The Right to the enjoyment of the highest attainable standard of physical and mental health is a supreme Right of all Human Beings. This Right is the one and only that truly allows a person the empowerment and enjoyment with plenitude of all other Rights and prerogatives, the one that lets a human being live and die with dignity. Universal Health Care, with identical availability and accessibility to all of the inhabitants of a state or country, constitutes a courageous and transcendental step toward the achievement of this Right. It embraces profound humanitarian wisdom, and recognizes the positive obligation to care and to promote the right that all of us live and die with dignity.

For this reason, the College of Physicians and Surgeons of Puerto Rico supports the implementation of a Universal Health Care Plan with a single payer system that will finally bring social justice to all people. We know that for decades the realization of such an important objective, undertaken by many presidents, has been impeded by exceptionally strong forces who oppose it. However, we believe in your courage and leadership. We believe that the foundations and moral underpinnings of such enterprise are in your mind and soul, just as they are in the minds and souls of millions of Americans who cherish such a plan as one of their most precious hopes and expectations. We are ready to assist and support such a noble objective.

The College of Physicians and Surgeons of Puerto Rico proposes that a pilot program of a Universal Health Plan with a single payer system should be implemented on the island of Puerto Rico. Hawaii and Alaska, given their contained environments and other social and economical characteristics, should also be considered to partake in any projected pilot program. However, as Puerto Rico is the poorest area in the United States, we feel that it will benefit more than any other area from such a program.

The reasons for choosing Puerto Rico for such a pilot program are many.

* Puerto Rico has a geographical area of only 9,104 km2, with a population of nearly 4 million people. The population density of 438 people per square kilometer is the second highest in the US after New Jersey.

* Puerto Rico has an unemployment rate of 14.7 percent, which is rapidly growing.

* Puerto Ricans had a median household income of $17,741 for 2007, making it the poorest state of the Union. Puerto Rico has an alarming 45.5% of the population living below the poverty line, compared to 12% in mainland USA.

* Puerto Rico’s public debt has grown faster than its economy, reaching approximately $46.7 billion in 2008.

* Approximately 500,000 Puerto Ricans have no health insurance at all.

* By comparison with the 50 states of the nation, Puerto Rico has the highest incidence of Diabetes mellitus (12.8 per 1,000 people versus 9.0 per 1,000 in the mainland USA). Among persons younger than 45 years of age, the prevalence of hypertension in Puerto Rico is twice the rate observed in the United States (8.1% versus 4.2%).

* AIDS cases per each 100,000 population are 21.5 versus a US National average of 12.4. Notably the Age-Adjusted Death Rate for HIV Disease in 2005 was 14.4 for 100,000 inhabitants for Puerto Rico versus an average of 4.2 for mainland USA.

* The Influenza vaccination rate for people older than 65 years is 32% in Puerto Rico versus 72% in mainland USA.

On April 17th 2009, the University of Puerto Rico’s Humacao Campus became the home of a Community Conclave. This Community Conclave is composed of the leadership of a wide variety of local and national organizations representing over 50% of the citizens of Puerto Rico. On that occasion, a Universal Health Plan was declared a top priority for the people of Puerto Rico. This declaration is now being taken to all local and national authorities, in order to support its implementation by the year 2010.

Recently WHO Director-General Dr. Margaret Chan stated: “A world that is greatly out of balance in matters of health is neither stable nor secure…the core strategy for tackling inequalities is to move towards universal coverage in a spirit of equity, social justice, and solidarity. Fairness and efficiency in service delivery are overarching goals…with the costs of health care rising and systems for financial protection in disarray, personal expenditures on health now push more than 100 million people below the poverty line each year…” A pilot program of a Universal Health Insurance Plan with a single payer run in Puerto Rico is an excellent opportunity to demonstrate the benefits of universal coverage.

Please let Puerto Rico be the front line of a noble endeavor. Let the fifty states learn through the Puerto Rican experience how a Universal Health Care Plan with a single payer system can bring social justice to all citizens, regardless of their income, age, gender or health conditions.

Please let Puerto Rico be an important player in the implementation of universal coverage, an accomplishment of your administration that will become an historical milestone toward the achievement of social justice for all American People.

Eduardo Ibarra MD
President
Puertorican College of Physicians and Surgeons

The Only Humane and Affordable Option: Single Payer Health Care

By Marvin Malek Byrne
Times Argus and Rutland Herald
April 19, 2009

It looks like the federal stimulus money will be bailing out Vermont, so the health care cuts Governor Douglas proposed won’t be implemented.

So that will allow us to return to the status quo. Let’s all breathe a sigh of relief.

Now we can contentedly return to preexisting condition clauses, businesses unable to afford coverage for their employees, bankruptcies brought on by gaping holes in health coverage, high deductibles, vanishing access to primary care, 50,000 + Vermonters lacking coverage altogether, a dysfunctional system in which no one really knows what their health coverage will be like in 3 years.

A pretty sad state of affairs. Governor Douglas and his legislative collaborators characterize the Catamount program as a major advance. Remarkable, since it barely deserves to be looked on as a finger in the dike–it’s insuring only 0.8% of Vermont’s population.

The health care crisis is caused primarily by unsustainable levels of medical cost inflation. During Douglas’ tenure in office, health costs in Vermont have risen from $2.8 billion in 2002 to $4.2 billion in 2007–an unsustainable rate of increase, greater than the US as a whole nearly every year.

This has occurred despite the much touted “Chronic Care Initiative”–the lynchpin of Jim Douglas’ health care cost control strategy. This strategy has not and will not control costs. I have yet to meet a single doctor who believes it will control costs. And curiously, BISHCA–the state government’s prime financial department–doesn’t appear to believe in the chronic care initiative either: BISHCA predicts continued very high increases in health costs as far as the eye can see.

Four years ago, the governor was an unyielding obstacle to the enactment of single payer health care–the one type of health reform that would cover everyone in Vermont while actually reducing health care costs

When you try to tell most Americans that the act of providing quality health coverage to everyone in the population can reduce health costs, their skepticism is overwhelming. How could covering people who aren’t currently covered, while eliminating deductibles, preexisting condition clauses and other insurance company dodges actually reduce costs?

Here’s how costs are reduced:

First, when our entire population is in the same insurance pool, we are then in a strong position to negotiate better prices for wheel chairs, drugs, etc. This is why citizens in every other developed country spend so much less than we do for the same drugs.

Second, there is better planning of resources to meet population needs. Throughout the US, there are innumerable examples of proliferation of high cost services adding to overall costs—these includes centers which only perform elective surgery (emergency surgery is a money loser for hospitals), excessive numbers of MRI and CT scanners, etc. On the other hand, the US has allowed basic services to deteriorate–we have a severe deficiency of primary care practitioners, and have seen the closure of emergency departments throughout the country, leading to life threatening crises.

Third, the care of individuals with chronic illnesses is better in the other developed countries: Single-payer systems have truly comprehensive databases to serve as a starting point, and people with chronic illnesses aren’t facing huge deductibles, inability to afford their medication, and even periods of no coverage at all as we face in the US. Vermont’s Chronic Care Initiative is a mere shadow of what we could have were we to create a single-payer system.

Finally–and most importantly–the absurd level of administrative costs in the US could be brought down to a reasonable level rather than eating up more than 30% of every health care dollar.

The possibility of providing lifelong coverage at far lower cost by bringing everyone into a single risk pool is not some ivory tower theory. Some version of this is the status quo in every other developed country. And that is why every other developed country provides universal health care for every citizen from cradle to grave at half of our per capita spending. And virtually all of these countries have far better health outcomes for their populations. It is also notable that despite fiscal crises as great or greater than what we’re facing in the US during the current economic downturn, not one country with a single-payer system is even considering cutting coverage.

Since achieving any health reform would be a massive political undertaking, it is tragic that Obama seems intent on achieving universal health coverage by building on the existing “system”. This is an error of historic proportion.

If President Obama implements universal insurance coverage with this model, within 4 – 6 years, we will see levels of federal debt that will make George W Bush’s deficits look like a minor car loan. We’ll see cuts in coverage, and the re-ascendancy of the Republicans–who will be able to correctly characterize the Democrats as irresponsible, and undoubtedly implement further cut backs (though they will offer no viable alternative approach to achieve universal coverage). We could be set back many years if the public at large develops the impression that universal coverage is inherently too expensive.

Senator Kent Conrad (D- N.D.) correctly refers to health cost inflation as the 800 pound gorilla threatening the long-term stability of our economy, forcing continued unsustainable borrowing from China, Japan, and other countries, leading to debt burdens that threaten our children’s and grandchildren’s well-being.

If Obama and the Washington Democrats pass universal health care using the existing system, we will all be eaten by the 800 pound gorilla.

Regardless of what health reform legislation is ultimately enacted in Washington, it will doubtless be financed jointly by federal and state governments. And if it actually does provide coverage to every Vermonter, it would do so at a vastly higher cost than the single-payer reform I described in this article. I don’t believe that we in Vermont can afford this much redundancy and waste.

Even though it will not be enacted nationally, there is good reason to believe that the Obama administration will adopt a supportive stance toward states attempting to create statewide single payer systems. The president has stated on many occasions that if he could start over creating a health system for the US, it would be a single payer system. Well, let’s let the president know that that is exactly what we want as well.

There are now bills in both houses of Vermont’s legislature (H100 and S88) and the US Congress (HR 676 and S703) which would give us single-payer health reform. Vermonters should contact their legislators to get them on board.

It’s time to broaden our vision and create an affordable and humane health care system.

We’ve waited long enough.

Marvin Malek Byrne, MD MPH is a general internist working in Barre, Vermont.

Sen. Baucus respects our views

Hearing on “Expanding Health Care Coverage”

Senate Committee on Finance
May 5, 2009
The opening of the hearing was disrupted by a passionate protest from the audience…
Person from audience: (at end of the protest)… We need health care now! Put single payer on the table now!
Sen. John Kerry: Is there anyone in the audience who didn’t come to…
(Laughter)
Sen Max Baucus: Let me say this. I think I speak for everybody on the committee and everybody in the Congress… deeply, deeply respect the views of all members of the audience and of all Americans who feel deeply about health care reform, especially those who are worried about single pay system, public option, who really do fervently believe that is the proper result. That is a view that many people have. It’s a view which I respect. There are other approaches to health care reform which also I respect. The whole point of this hearing and other hearings is to try to determine the best route, the best option, in determining how to best reform our country’s health care system. So for those of you who remain in the audience who may be inclined to stand up and, out of order, to state your views, I encourage you to not do so, because I want you to know that I personally care deeply about your views. I deeply respect your views. I hear what you say. I talk to a lot of people in my home state of Montana who have the exact same views. I represent 900,000 of the world’s best bosses, Montanans, and many of them have the very same view. But we aren’t going to get the best result here… the more we can have an orderly discussion of how we should best reform the health care system. So I want to say to everyone, especially those of you who might be inclined to stand up, that I urge you not to so we can proceed with the hearing holding your views also deeply in mind as we proceed. Thank you.
http://finance.senate.gov/sitepages/hearing050509.html (includes the list of witnesses and their testimonies)

Apparently the single payer views must have been held very deeply, hidden in the minds of the Senators and the witnesses, since at no time during the hearing was single payer discussed as an option for reform.
It is one thing to respect the views of those who support a model of reform that actually would provide all necessary health care for everyone and make it affordable for each and every individual, but it is quite something else to restrict the discussion to options that cannot ever achieve those goals.
This hearing represents the the framework of reform that is being crafted behind closed doors. The tragedy is that any bill that results from this process will delay further the reform that we desperately need. In the meantime, tens of millions or more will face unnecessary physical suffering and financial hardship, and many will die.
The epitaph: BUT MY VIEWS WERE RESPECTED

Sen. Baucus respects our views

Hearing on "Expanding Health Care Coverage"

Senate Committee on Finance
May 5, 2009

The opening of the hearing was disrupted by a passionate protest from the audience…

Person from audience: (at end of the protest)… We need health care now! Put single payer on the table now!

Sen. John Kerry: Is there anyone in the audience who didn’t come to…

(Laughter)

Sen Max Baucus: Let me say this. I think I speak for everybody on the committee and everybody in the Congress… deeply, deeply respect the views of all members of the audience and of all Americans who feel deeply about health care reform, especially those who are worried about single pay system, public option, who really do fervently believe that is the proper result. That is a view that many people have. It’s a view which I respect. There are other approaches to health care reform which also I respect. The whole point of this hearing and other hearings is to try to determine the best route, the best option, in determining how to best reform our country’s health care system. So for those of you who remain in the audience who may be inclined to stand up and, out of order, to state your views, I encourage you to not do so, because I want you to know that I personally care deeply about your views. I deeply respect your views. I hear what you say. I talk to a lot of people in my home state of Montana who have the exact same views. I represent 900,000 of the world’s best bosses, Montanans, and many of them have the very same view. But we aren’t going to get the best result here… the more we can have an orderly discussion of how we should best reform the health care system. So I want to say to everyone, especially those of you who might be inclined to stand up, that I urge you not to so we can proceed with the hearing holding your views also deeply in mind as we proceed. Thank you.

http://finance.senate.gov/sitepages/hearing050509.html (includes the list of witnesses and their testimonies)

Comment:

By Don McCanne, MD

Apparently the single payer views must have been held very deeply, hidden in the minds of the Senators and the witnesses, since at no time during the hearing was single payer discussed as an option for reform.

It is one thing to respect the views of those who support a model of reform that actually would provide all necessary health care for everyone and make it affordable for each and every individual, but it is quite something else to restrict the discussion to options that cannot ever achieve those goals.

This hearing represents the the framework of reform that is being crafted behind closed doors. The tragedy is that any bill that results from this process will delay further the reform that we desperately need. In the meantime, tens of millions or more will face unnecessary physical suffering and financial hardship, and many will die.

The epitaph: BUT MY VIEWS WERE RESPECTED

A 'public plan option' won't ensure quality care

By QUENTIN D. YOUNG
Politico
Letter to the editor
5/5/09 4:29 AM EDT

While Carrie Budoff Brown accurately reflects some of the arguments for single-payer health reform, such as the vast savings in administrative costs our nation stands to reap from national health insurance (“Groups strategize for single-payer plan,” April 28), a casual reader might mistakenly get the impression that single-payer advocates are pressing their case merely as a bargaining chip to win a lesser reform — specifically, the creation of a “public plan option.”

Not true. Single-payer advocates, including our 16,000-member Physicians for a National Health Program, are still pressing full-bore for single-payer national health insurance. A public plan option simply can’t deliver the savings and other efficiencies we need to ensure universal, quality care. Nor is it a “stepping stone” toward single payer.

As my colleague Dr. David Himmelstein told a congressional subcommittee last week, “A health reform plan that includes a ‘public plan option’ might realize some savings on insurance overhead. However, as long as multiple private plans coexist with the public plan, hospitals and doctors would have to maintain their costly billing and internal cost-tracking apparatus. Indeed, my colleagues and I estimate that even if half of all privately insured Americans switched to a public plan with overhead at Medicare’s level, the administrative savings would amount to only 9 percent of the savings under single payer.”

Only a true single-payer system (“Everybody in, nobody out”) can yield the administrative savings — estimated at $400 billion annually — needed to provide comprehensive, affordable care to everyone.

Placebos that preserve the role of the private health insurance industry, such as the reform measures proposed by the Obama administration and key lawmakers like Sens. Max Baucus (D-Mont.) and Ted Kennedy (D-Mass.), with or without a public option, can’t even come close to these results.

Adoption of a publicly financed health care system has become an economic and moral imperative.

Quentin D. Young, M.D., M.A.C.P.
National coordinator
Physicians for a National Health Program

The Uninsured Are the Symptom, Not the Disease

By Claudia Chaufan, M.D., Ph.D.
KQED Radio Healthy Ideas
April 28, 2009

I was invited to join the [KQED] health care reform debate by addressing a set of questions falling under the general theme “Covering the Uninsured.” The problem is that to answer these questions I have to challenge fundamental assumptions underlying them — if one asks the wrong question or misunderstands the nature of a problem, the chances of getting the right answer or solving the problem are slim.

And this is precisely what happens with the three questions I was asked, namely, should all Americans be required to purchase health insurance; what options for coverage should the uninsured and underinsured have; and how do you assess when coverage is affordable. They all assume that the problem is the uninsured or the underinsured. But these are only the “symptom.” The real “disease” is the financial organization of our system.

In all industrialized economies, but ours, individuals do not “purchase” insurance as you “purchase” shoes or cell phone plans. Rather, they contribute to a system whose goal is to eliminate financial barriers to health care. Those systems, to varying degrees, pool risks and are financed by compulsory cooperative contributions.

What does this mean? Well, pooling risk simply means putting everybody into large pools, the bigger the better, and budgeting for people’s medical needs in the same way families budget for their members’ nutritional or educational needs. And why would they do this? They do this because given that the goal of the system is to eliminate financial barriers to care universally and according to medical need, these systems seek to optimize the use of members’ money.

And pooling risk does so in three ways. First, it allows the system to cross-subsidize, which means that at any given moment the healthy or least costly majority pays for the medical care of the less healthy and most costly minority. Cross-subsidizing is critical for any insurance system to be sustainable: if a system includes only sick people it will quickly go bankrupt (this, incidentally, is the problem of our American Medicare, because it enrolls only the elderly, who tend to have higher medical costs, and the disabled, whose costs are the greatest. This problem would be resolved by putting all of us into Medicare, and of course getting rid of all the private middle-men that have corrupted it, e.g. “private fee for service Medicare,” “part D,” etc.).

The second thing that pooling risk does is to dramatically reduce administrative overhead, i.e., waste that comes from pushing paper around — to separate people into plans, to market those plans, or to underwrite policies (essentially to deny paying for care). While paper-pushing is the lifeblood of private or liability insurance, because it helps it achieve its ultimate goal, which is not to provide a social service but to make a profit, from the point of view of systems whose goal is to eliminate financial barriers to health care paper-pushing is waste.

Third and last, pooling risks gives those systems important market leverage, precisely the leverage Americans lack, which is why we pay the highest prices on the planet for services and goods (e.g. pharmaceuticals) that cost a fraction elsewhere. (And don’t worry: doctors and pharmaceutical companies elsewhere do just fine!)

What about cooperative compulsory financing? Well, this means that participation is not optional and is based on cooperation, or solidarity, if you will. And by making participation compulsory those systems have a guaranteed supply of money. But the cooperative dimension means that nobody is forced to pay what they cannot afford, because that would defeat the very purpose of the system. So contributions are a proportion of income, a mix of taxes or payroll deductions, and align, more or less, with the World Health Organization’s requirement pertaining to “financial fairness”. For the WHO, a system that forces you to forgo health care, or to have to choose between health care, rent or food, or that pushes you to bankruptcy (as we do) is decidedly unfair. The rule of thumb is that any system into which people pay over 10 percent of their income in medical bills (including monthly contributions and out of pocket, extra costs) is “financially unfair.” And mind you, we pay at least that much to finance an extremely dysfunctional system, even this system leaves you on the cold when you need health care (Remember that your taxes foot the bill of all public programs, for the elderly, the disabled, or those who qualify as “poor,” even before you are eligible for any services yourself. In truth, you are “cleaning” the market of “bad customers” and leaving all the “good customers” to the private health insurance sector.)

But what about the questions posed by KQED? Well, let me rephrase them.

Should Americans be required to purchase health insurance? As I said, the concept of “purchase” does not fit the systems I just described, which is the one I believe we should have in America, because people elsewhere do not “purchase” health insurance the way we do.

And what “options” should the uninsured and underinsured have? Again, others do not “shop around” for “options,” which implies that you need to second guess if you will need an appendectomy, diabetes care, or one week rather than two days in a given operation. Whatever expenses others have for care that the system has considered “medically necessary” will be paid for out of the common pot. If they want over and above that, they pay for it as you do for that pair of shoes that no reasonable person considers is your “right” to have, or is a “basic human need” (especially if like me, you have more than you will ever be able to wear!).

And last, how do you assess your coverage is affordable? Well, if you consider that unpaid medical bills are our first cause of personal bankruptcy, you know where we stand in that one.

Last, will the Obama plan solve our mess? I wish I could believe so, but I do not. For one, it sticks to the wrong conception about how to finance a health care system, assuming of course that the goal of the system is to eliminate financial barriers to health care universally rather than to create a profitable “illness market” or appease the folks who finance your political campaigns. And any system that sends people “shopping around” for policies while leaving the for-profit motive at the center of the system intact is likely to fail. It has repeatedly, for reasons studied ad-infinitum (yes, health policy is not rocket science!) and we have no reason in the world to believe it will be different this time.

http://blogs.kqed.org/healthyideas/2009/04/28/the-uninsured-are-the-symptom-not-the-disease/

Doctors, Single Payer Activists Arrested, Make History at Senate Finance Roundtable

By Donna Smith
California Nurses Association/National Nurses Organizing Committee
May 5, 2009

It has finally happened right here in the United States. Citizens who believe healthcare is a human right have been arrested and are being processed like criminals through the Southeast District of Columbia police station. Their crime? Asking for single payer healthcare reform — publicly funded, privately delivered healthcare — to be discussed during the Congressional hearings on reform.

Doctors and other single payer activists were handcuffed and went to jail today speaking up for single payer to be at the table in the Senate finance Committee’s roundtable discussion on healthcare access and coverage. In stark contrast, Karen Ignagni, head of the industry lobby group American Health Insurance Plans (AHIP) was escorted into the room like royalty by staff members of the Senate committee. Clearly, the position of the United States Senate is not with the majority of Americans who support a national, public insurance system.

It made me physically ill to see Maryland pediatrician Margaret Flowers cuffed like a criminal and pushed out the door as the Senators waited to begin their staged roundtable discussion. It made me want to scream. It made me proud of them for being bold but ashamed that not one Senator spoke up for their own citizen-protestors and asked that they at least be allowed to speak. But the insistence that the citizens rising in protest be arrested continued from the chair with each incident.

Simply asking to have single payer be included and fully vetted is a crime. Profiting as the for-profit health insurance companies do at the expense of 22,000 American lives every year, however, gets you a run of the table in this healthcare reform discussion. Just ask the Senators who are drafting what this nation’s health system will look like — and watch their behavior today — if you want evidence of how your voice will be heard in the process.

The protestors were stoic and respectful but direct. One by one they stood. One by one they asked why single payer reform was not “at the table” of 15 witnesses Senator Max Baucus and his finance Committee gathered to map out what sort of coverage Americans might expect in the Senate reform bill now being crafted.

Sen. Baucus eventually spoke and indicated that he was respectful of those who believe in single payer — as he acknowledged many of his constituents in Montana do — but he made no attempt to explain why no single payer voice has been included in any Senate discussion to date. He urged any others in the audience who might have any designs on speaking up like the protestors did to not do so, and then he moved on to his roundtable discussion.

The press seated comfortably at the press table first looked amused and then puzzled by the procession of protest in the chamber. The C-SPAN cameras fixed on both the Committee’s table at the front of the room and the witness table directly across from them could have easily picked up the protests but the network chose to keep their cameras fixed only on Chairman Baucus — though the protestors’ words could be heard in the audience. Only two reporters of the 20 or so assembled were curious enough or industrious enough to rise and exit the room to see the arrests being carried out in the hallway.

While neither the Finance Committee or the press allowed their proceedings to be disrupted for very long, the air in the room and the atmosphere had changed — the giddy and gleeful assembly of industry lobbyists who had been chattering in rapt anticipation of the coming of their carefully chosen witnesses could not deny that some brave and patriotic fellow citizens had just been hauled out for arrest for nothing more than demanding that a point of view held by a majority of patients, nurses, physicians and other healthcare providers be included in the national discussion.

While this Congress may pass something very different than single payer reform, it will not do so without hearing the cries of the people left so openly exposed to personal health and financial ruin by the corrupt system that celebrates only profit. The citizens who stood for the thousands and thousands of dead today will not let this democracy give itself completely over to the big money interests in healthcare. Not without a fight. Not on their lives or yours or mine.

Single-payer

Best health insurance

Editorial
Charleston Gazette
May 1, 2009

President Obama wants to create universal health insurance covering all Americans, a safety net of the sort that already exists in other advanced democracies. President Harry Truman first sought this reform in the 1940s, and other Democrats have pursued it intermittently, but each attempt has been scuttled by big-money interests that enjoy the current for-profit medical system.
Best health insurance

President Obama wants to create universal health insurance covering all Americans, a safety net of the sort that already exists in other advanced democracies. President Harry Truman first sought this reform in the 1940s, and other Democrats have pursued it intermittently, but each attempt has been scuttled by big-money interests that enjoy the current for-profit medical system.

It’s disgraceful that U.S. medical care is the world’s most expensive, yet 45 million Americans are left without insurance and the nation’s health levels are inferior to those elsewhere. High overhead costs among hundreds of competing U.S. insurance firms wastes billions – money that could pay to cover the left-out families, if it weren’t squandered. The for-profit corporations employ high-paid “subrogation” specialists who try to duck payment of medical bills, shifting them to other insurers or leaving them unpaid.

Sen. Jay Rockefeller, D-W.Va., is fighting for universal coverage. Earlier this month, he came to Charleston to receive a “Champion of Health Care Reform” award from a labor and activist coalition.

“This seems like the year when we can get it all done,” he told the group. He pointed out that “I have never seen many Republicans for health- care reform,” but the new Democratic control of Congress opens a window of opportunity. “We are on a sacred journey to remake America.”

Half of all West Virginia bankruptcies stem from uncovered medical bills, Rockefeller said, and the state’s economy loses $8 billion a year from lost work productivity caused by inadequate care. But commercial insurers don’t care, as long as they can manipulate rates to keep profits high.

“Insurance companies are making you pay more, and they pay less, so they can make more money,” the senator said.

On Capitol Hill in Washington, battle lines are drawn between Democrats who want government-run national health coverage and Republicans trying to protect the profits of private insurance corporations. Negotiators hope to draft a plan that would accommodate commercial insurers, but the firms say they can’t compete against low premiums that could be attained through savings in a governmental system. They fear that federal coverage would put them out of business.

Well, good riddance. Universal, government-run, “single payer” national health insurance is the most frugal and sensible method. The immense size of a governmental system can force price reductions and eliminate the paperwork costs of competing private insurers.

Almost half of Americans already fall under tax-paid systems: Medicare, Medicaid, the Children’s Health Insurance Program, veterans treatment, public employees coverage, etc. Why not consolidate and expand this principle to serve the whole society?

AARP protested that Americans pay more for medical care than for food. This extreme expense puts a severe burden on employers, who must insure workers. In nations with universal coverage, businesses aren’t singled out for this cost, thus they have an advantage over U.S. firms in the global marketplace.

President Obama says horrendous costs of the current medical system damage this country. It’s long past time for America to join the rest of the world in attaining universal insurance.