PNHP

Subcommittee Members Spar Over Cost Control Tactics

Subcommittee Members Spar Over Cost Control Tactics

By Jane Norman
CQ HealthBeat Associate Editor
CQ HEALTHBEAT NEWS
April 23, 2009

The lack of a middle ground among lawmakers on an approach to the health care overhaul was on full display Thursday as the Health, Employment, Labor and Pensions Subcommittee of the House Education and Labor Committee probed witnesses on how to cut U.S. health insurance costs now exceeding $2 trillion annually.

“We spend too much on our health care system relative to our national income and do not get the results we should,” said Subcommittee Chairman Robert E. Andrews, D-N.J. He said that he wanted to encourage a “dynamic interchange” at the hearing on how to curb costs that are rising for workers at three times the rate of their paychecks, and keeping many Americans from obtaining insurance at all.

Andrews and the subcommittee heard solutions offered that included a single-payer system similar to Canada’s; a system of “employee benefit cooperatives” that would allow small employers, employees and families to band together to buy access to affordable coverage; choices between private and public plans within a national insurance exchange; expansion of Medicaid; and making changes to increase affordability while continuing traditional group employer plans.

But Democrats John Tierney of Massachusetts and Dennis J. Kucinich of Ohio, both of whom back a single-payer plan, strongly objected that not enough time was being spent discussing private insurers and their role in rising costs. “The 800-pound gorilla in this room is unspoken, and it’s insurance companies,” said Tierney. “Everybody’s trying to find a way to keep insurance companies in business.” Congress should “find the gumption” to order insurers to spend a set percentage on providing care as opposed to administrative costs, he said.

Kucinich said that “our effort in Congress should be about health care, not insurance care,” and pointed out 70 members of the House have signed on to the single-payer plan. Yet he said from all he is hearing and reading about the debate over an overhaul, “I am deeply concerned Congress is going to miss a rare opportunity to adopt a single payer health plan.”

Ron Pollack, executive director of liberal-leaning Families USA, said it is “not likely” that insurance companies will vanish but more could be done to rein them in, including establishment of standardized benefits and reforms in the ways pre-existing conditions among patients are treated.

Another witness, David U. Himmelstein, a primary care doctor and associate professor of medicine at Harvard University who testified in favor of a single-payer plan like Canada’s, retorted: “The problem is actually the private insurer wants not to pay.” Himmelstein said lesser reforms, including a widely discussed public option accompanying private plans, could not realize the same kind of savings in administrative costs as a single-payer plan.

“While reforms that maintain a major role for private insurers may be politically attractive, they are economically and medically nonsensical,” he said.

On the Republican side, Rep. John Kline of Minnesota said, “we have wonderful health care in this country” and Canadians who can’t get health care they need wind up in his border state. Group employer plans cover 160 million Americans, he said. “We may be changing the paradigm, but we need to be very careful to do no harm and pull a thread on the sweater that is ERISA,” he said, referring to the Employee Retirement Income Security Act, which covers employee benefit plans.

Rep. Phil Roe, R-Tenn., said he wants to see access to health care improved, and care should be made portable and less costly. But he expressed the fear that’s heard often among Republicans that a public plan will lead private employers to drop their own coverage, and the government will become the primary player in health care. “If you like the way government has managed AIG, you’re going to love the way they manage your health care,” said Roe, a physician.

Rep. Phil Hare, an Illinois Democrat, extracted some agreement from the witnesses that most Americans like their health care.

“They’re happy generally until they get sick,” said Himmelstein.

Hare expressed interest in Himmelstein’s point of view and praised the veterans’ health care system as a model, while also observing “at times you swear the federal government can’t do anything right.” Whatever is done, “we’ve got to be bold and we better do it right,” he said.

Rep. David Wu, an Oregon Democrat, said it would be difficult to change health care “in a way that’s perceived as taking these health plans away.”

The discussion was a beginning, said Andrews, of how to provide a system with high quality and access for all. “This committee, the House, the Congress, the country are going to struggle with these questions,” he said.

Kline said, “There is obviously a great deal of disagreement and diversity here. . .we’ve got a long way to go here.”

Source: CQ HealthBeat News
Same-day coverage of the people and events shaping health care policy from Washington.
(c) 2009 Congressional Quarterly Inc. All Rights Reserved.

Mass. Model for Health Overhaul 'Not Viable,' Expert Tells Lawmakers

By Alex Wayne, CQ Staff
CQ TODAY ONLINE NEWS — HEALTH
April 23, 2009

A Massachusetts doctor and health policy expert told Congress on Thursday that he believes his state’s 2006 overhaul of its health system — legislation that may be a model for a national overhaul — “will fail.”

The physician, David Himmelstein, told the House Education and Labor panel’s health subcommittee that based on his experience working in the Cambridge Health Alliance, Harvard University’s hospital system, Massachusetts’ health overhaul won’t work in the long term because it is too expensive.

“I think it’s economically not viable and I see from my patients it’s not viable,” Himmelstein said after Rep. Dennis J. Kucinich, D-Ohio, asked him if he thought the overhaul would fail.

“I think it will fail,” said Himmelstein, who is an associate professor of medicine at Harvard and a well known advocate for a single-payer health system, in which the government would provide everyone health care.

His observations might be important as lawmakers in Washington move toward a Massachusetts-style overhaul of the nation’s health system. Many Democrats have expressed admiration for the Massachusetts system, in which a government agency called the Commonwealth Connector helps state residents obtain private health insurance if they can’t get it through their employers or government programs such as Medicare.

The overhaul has greatly boosted insurance coverage in Massachusetts; the state says that less than 3 percent of its residents lack insurance, and the U.S. Census says the state has the lowest rate of uninsurance in the country.

But the overhaul has also been more expensive than expected. Massachusetts legislators have been criticized for doing little, when the overhaul was written, to try to control health care costs.

State legislators predicted when the law was written that the new system would cost the state $400 million in fiscal 2008; it actually cost $628 million. Fiscal 2009 spending was forecasted to be $725 million; the budget for the system is $869 million this year, though the state expects to spend less.

Long-term cost problems in the state are even worse, according to the Urban Institute, which published a study on the Massachusetts overhaul in January. Massachusetts has some of the highest health costs in the nation, in part because its hospital, physician and insurance markets are all highly concentrated and lack serious competition, according to the Urban Institute. For those and other reasons, premiums for insurance offered through the Connector are often unaffordable if residents make too much money to qualify for subsidies, the Urban Institute says.

“The way we’re increasing coverage is by buying additional insurance from [private insurers] on top of already high costs,” Himmelstein said. “We’ve had no means of cost containment.”

Kucinich, a single-payer advocate himself, thinks Congress is too concerned about preserving a role for private insurers within the health care system.

“Our efforts in Congress should be about health care, not insurance care,” Kucinich said. “What we know, and what Dr. Himmelstein was talking about is, the insurance companies make money not providing health care.”

But a single-payer system is not supported by President Obama or many Democratic leaders. That is because previous efforts at health care overhauls, particularly former President Bill Clinton’s effort in 1993-94, failed after people with insurance became worried they would lose their coverage and be forced into a government-run system.

“As we go forward, we need be mindful of those 160 million people getting insurance from their employers and we not pull that string unless and until we’re ready to replace the paradigm,” warned Rep. John Kline, R-Minn.

Source: CQ Today Online News
Round-the-clock coverage of news from Capitol Hill.
(c) 2009 Congressional Quarterly Inc. All Rights Reserved.

Dr. Chaoulli’s private clinic waiting room death

Waiting-room death triggers review of Quebec private clinic rules

Canadian Medicine
April 22, 2009

Quebec coroner Catherine Rudel-Tessier’s report released today on the death of Jean-Jacques Sauvageau, who died January 11, 2008, in the waiting room of a private Montreal urgent-care clinic, demands that the Collège des médecins du Québec refine its regulations on such clinics to better protect patients.

Ms Rudel-Tessier said the 2007 Collège guidelines on private clinic administration should be “more precise” on certain points and must help administrators “offer a safe environment to their patients and permit them to adequately deal with emergencies.”

The Collège’s president and CEO, Dr Yves Lamontagne, said the guidelines would be either revised or replaced, depending on the results of the Collège’s investigation of the incident. He said he expects two new measures will be incorporated into the guidelines. “One, every physician or nurse working in that type of clinic should follow a course on cardiopulmonary resuscitation. And two, all clinics should have equipment — a defibrillator.”

Ms Rudel-Tessier also recommended that the Collège investigate the doctor or doctors who attended to Mr Sauvageau.

Dr Jacques Chaoulli — the same crusading Jacques Chaoulli whose high-profile 2005 Supreme Court case against the government of Quebec forced the province to overturn some of its restrictions on private health insurance — examined Mr Sauvageau minutes after he stopped breathing and decided not to attempt resuscitation, instead leaving Mr Sauvageau’s body in his waiting room seat until an ambulance arrived. An autopsy later revealed that Mr Sauvageau died of massive bilateral pulmonary embolisms and would not have been saved by resuscitation but Ms Rudel-Tessier concluded that Dr Chaoulli could not have known that at the time and should have tried to save Mr Sauvageau.

http://canadianmedicine.blogspot.com/2009/04/waiting-room-death-triggers-review-of.html

Rapport d’enquête sur LE DÉCÈS DE M. JEAN-JACQUES SAUVAGEAU
http://qgov.newswire.ca/gouvqc/communiques/GPQF/Avril2009/22/c4034.html?slang=en

Comment:

By Don McCanne, MD

In the Canadian Supreme Court case of Chaoulli v. Quebec, Justice Deschamps wrote, “The evidence in this case shows that delays in the public health care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care.”

This decision has resulted in intense efforts to privatize both the Canadian health insurance system and the Canadian health care delivery system. The outspoken proponents of privatization would have you believe that only the private sector is capable of saving lives that would be lost by neglect in the public sector.

Dr. Chaoulli’s patient did not die while on a waiting list for an elective orthopedic procedure. He collapsed and died in Dr. Chaoulli’s private waiting room. Dr. Chaoulli withheld cardiopulmonary resuscitation – a standard of care that surely would have been provided in any public health care facility – with questions over whether or not he had adequately trained staff and appropriate equipment to initiate such care. Dr. Chaoulli then asked his nurse to call 911 (to have the body removed), and he returned to his work. Only after the ambulance team arrived was cardiopulmonary resuscitation instituted.

The lesson of the tragic death of Jean-Jacques Sauvageau is simply that Crusader Dr. Jacques Chaoulli and the other privatizers have no credibility when they claim that the private system has a special capability of saving lives that the public system lacks.

AFL-CIO’s Health-Care Survey Ignores ‘Single Payer’ Plan Favored by Unions

By Harry Kelber
Labor’s Voice for Change (31)
April 30, 2009

An AFL-CIO-sponsored on line health care survey of 26,419 respondents, more than half of them union members, reveals a widespread discontent with the cost, benefits and operating procedures of current health insurance plans. The survey, taken between Jan. 14 and March 3, shows that “ninety-four percent of the insured say the health care system needs fundamental change or to be rebuilt.”

Curiously, the survey makes no mention of the Single Payer (H.R. 676) health care system or Medicare as possible options that the respondents were never asked. Those questions were left out, says Amaya Smith, survey director, “for no particular reason.”

H.R. 676, introduced in Congress by Representative John Conyers (Dem.-Mich, has been gathering sensational support from unions across the country. It has already been endorsed by 512 union organizations in 49 states. That includes 39 AFL-CIO-affiliated State Federations and 125 Central Labor Councils. The Service Employees International Union and other Change to Win internationals have also endorsed it.

Surely, Single Payer is worth at least an occasional story on the AFL-CIO’s Web, but none has appeared. Instead, it has been totally ignored. The health care advantages that H.R, 676 has to offer have been given only limited coverage in the labor media, despite the strong record of union endorsements. Why? The short answer is that AFL-CIO President John Sweeney and his close associates are supporting a universal health care plan that would include profit-making insurance companies and HMOs.

Under H.R. 676, a single public payer would replace the many hundreds of private, for profit insurance companies, each with an expensive bureaucracy and a different set of rules, that is focused on making money for the company rather than the health of their customers. The billions that could be saved from the continuing increases in premiums, co-payments and deductibles could be used to cut costs or improve health care services.

For those who are unfamiliar with Single Payer, H.R. 676 would provide every resident in the United States with an expanded and greatly improved Medicare system. It would cover every person for all necessary medical care, including prescription drugs, hospital, surgical, outpatient services, as well as dental, substance abuse, mental and other health problems. No insurance company bureaucrat would come between you and your doctor.

Let’s Have an Open Dialogue on the AFL-CIO’s Web Site

Health care insurance, particularly for the tens of millions of people who don’t have any, is one of the most important issues worrying working families. It is a good sign that there is general agreement among our unions that our current health care system needs to be reformed. There is also consensus that some form of universal health care insurance is necessary, but which plan?

The Sweeney camp believes that Congress won’t pass a bill for universal coverage without a clear role for the powerful insurance companies. On the other hand, the Single Payer advocates say that the insurance companies are part of the problem, not the solution. Letting them participate in any eventual health care plan would retain the abuses and shortcomings that working families currently encounter in protecting their health.

It will be interesting to see how the health care issue is debated and voted upon at the AFL-CIO’s 2009 convention in Pittsburgh, less than five months away.. The odds are that there will be a general resolution of support for universal health care insurance, but it will stop short of making a specific recommendation..

Strange things have happened before at AFL-CIO conventions, where a vote called for at a critical time on a particular issue can decide the outcome of an election of officers… It will be worth watching how the health care issue is played out at this convention.

Mass. Model for Health Overhaul ‘Not Viable,’ Expert Tells Lawmakers

By Alex Wayne, CQ Staff
CQ TODAY ONLINE NEWS — HEALTH
April 23, 2009

A Massachusetts doctor and health policy expert told Congress on Thursday that he believes his state’s 2006 overhaul of its health system — legislation that may be a model for a national overhaul — “will fail.”

The physician, David Himmelstein, told the House Education and Labor panel’s health subcommittee that based on his experience working in the Cambridge Health Alliance, Harvard University’s hospital system, Massachusetts’ health overhaul won’t work in the long term because it is too expensive.

“I think it’s economically not viable and I see from my patients it’s not viable,” Himmelstein said after Rep. Dennis J. Kucinich, D-Ohio, asked him if he thought the overhaul would fail.

“I think it will fail,” said Himmelstein, who is an associate professor of medicine at Harvard and a well known advocate for a single-payer health system, in which the government would provide everyone health care.

His observations might be important as lawmakers in Washington move toward a Massachusetts-style overhaul of the nation’s health system. Many Democrats have expressed admiration for the Massachusetts system, in which a government agency called the Commonwealth Connector helps state residents obtain private health insurance if they can’t get it through their employers or government programs such as Medicare.

The overhaul has greatly boosted insurance coverage in Massachusetts; the state says that less than 3 percent of its residents lack insurance, and the U.S. Census says the state has the lowest rate of uninsurance in the country.

But the overhaul has also been more expensive than expected. Massachusetts legislators have been criticized for doing little, when the overhaul was written, to try to control health care costs.

State legislators predicted when the law was written that the new system would cost the state $400 million in fiscal 2008; it actually cost $628 million. Fiscal 2009 spending was forecasted to be $725 million; the budget for the system is $869 million this year, though the state expects to spend less.

Long-term cost problems in the state are even worse, according to the Urban Institute, which published a study on the Massachusetts overhaul in January. Massachusetts has some of the highest health costs in the nation, in part because its hospital, physician and insurance markets are all highly concentrated and lack serious competition, according to the Urban Institute. For those and other reasons, premiums for insurance offered through the Connector are often unaffordable if residents make too much money to qualify for subsidies, the Urban Institute says.

“The way we’re increasing coverage is by buying additional insurance from [private insurers] on top of already high costs,” Himmelstein said. “We’ve had no means of cost containment.”

Kucinich, a single-payer advocate himself, thinks Congress is too concerned about preserving a role for private insurers within the health care system.

“Our efforts in Congress should be about health care, not insurance care,” Kucinich said. “What we know, and what Dr. Himmelstein was talking about is, the insurance companies make money not providing health care.”

But a single-payer system is not supported by President Obama or many Democratic leaders. That is because previous efforts at health care overhauls, particularly former President Bill Clinton’s effort in 1993-94, failed after people with insurance became worried they would lose their coverage and be forced into a government-run system.

“As we go forward, we need be mindful of those 160 million people getting insurance from their employers and we not pull that string unless and until we’re ready to replace the paradigm,” warned Rep. John Kline, R-Minn.

Source: CQ Today Online News
Round-the-clock coverage of news from Capitol Hill.
(c) 2009 Congressional Quarterly Inc. All Rights Reserved.

State legislators launch effort to push H.R. 676

By All Unions Committee for Single Payer Health Care — H.R. 676

A group of state legislators has initiated a nationwide effort to publish an appeal to President Obama and members of the 111th Congress to support H.R. 676, single-payer health care legislation introduced in Congress by Rep. John Conyers Jr. and presently co-sponsored by 75 other House members.

Last week, 24 state legislators from 16 states sent a copy of the appeal to all 7,500 state legislators in the United States asking them to add their names to the appeal which will be published in Roll Call, a widely read Capitol Hill publication, in late May or in June.

The legislators, in their letter, cite the growing “economic crisis” and “badly strained” state budgets as the reason why they are asking “the U.S. Congress … to heal our hemorrhaging state budgets while bringing comprehensive, quality health care to all our people by passing H.R. 676.”

Co-conveners of the campaign are state Sen. Jim Ferlo of Pittsburgh and Assemblyman Richard Gottfried of New York. State senators and representatives from Colorado, Georgia, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, New Jersey, Texas, Virginia and Wisconsin also signed the letter.

Kay Tillow, coordinator of the All Unions Committee for Single Payer Health Care — H.R. 676, welcomed the effort by the state legislators and urged everyone to contact their own state senator and representative and ask them to sign the appeal.

“State legislators are caught in a vise of escalating health care costs, driven largely by the for-profit insurance industry and declining revenues,” Tillow said. “Without a national single-payer system, state budgets will continue in crisis and health needs will not be met.”

The “Dear Colleague” letter, the appeal and other materials can be found at:

http://www.healthcare-now.org/campaigns/state-legislators/

Ed Show: Bernie Sanders on single payer

Bernie Sanders on the Need for a Single Payer Health Care System

Ed Show
April 28, 2009
(Clip courtesy of Video Cafe)
Bernie Sanders: … We can guarantee every man, woman and child health care with a single payer system.
Ed Schultz: Senator, that is what just boggles my mind. We have, right now, a political moment in this country. The president has high approval ratings; you have the people out there; town hall after town hall I hear it, they want single payer; you’re close to the super majority depending on how…
Sanders: Ed, what are you forgetting in that equation?
Schultz: Well, I’m forgetting the filibuster I guess.
Sanders: And you’re forgetting the power of the insurance companies…
Schultz: Yes. Right.
Sanders: The huge amounts of money they spend; the power of the drug companies, and if you think that every member of the Democratic caucus is prepared to stand up to those guys, you’re mistaken.
****
Sanders: But the bottom line here, Ed, is, you’re absolutely right; we have a Democratic president, a strong majority in the House, sixty votes in the Senate. If we can’t deliver on energy, on health care, on workers’ rights, then what’s the sense of it all. The answer is people have got to put pressure on Congress to have the guts to stand up to the insurance companies, the drug companies, the banks, the military-industrial complex.
Schultz: Well, who’s going to put pressure on them?
Sanders: We’re going to need a strong grassroots movement to make that happen.
Schultz: So you think the people can be heard on this.
Sanders: Absolutely. Absolutely they can.
****
Schultz: I think this is a real moment for the president. What if the president comes out tomorrow night at the press conference… I would love to hear President Obama come out and say, “Look, I don’t have all the answers, but everything is on the table.” And this idea that single payer is not politically achievable, Mr. President, respectfully, I think you’re wrong on that. I think it is politically achievable, because the people want it.
Video clip (7 minutes, 41 seconds):
http://videocafe.crooksandliars.com/heather/ed-show-bernie-sanders-need-single-payer-health

When the people lead, Congress will follow.

Ed Show: Bernie Sanders on single payer

Bernie Sanders on the Need for a Single Payer Health Care System

Ed Show
April 28, 2009

(Clip courtesy of Video Cafe)

Bernie Sanders: … We can guarantee every man, woman and child health care with a single payer system.

Ed Schultz: Senator, that is what just boggles my mind. We have, right now, a political moment in this country. The president has high approval ratings; you have the people out there; town hall after town hall I hear it, they want single payer; you’re close to the super majority depending on how…

Sanders: Ed, what are you forgetting in that equation?

Schultz: Well, I’m forgetting the filibuster I guess.

Sanders: And you’re forgetting the power of the insurance companies…

Schultz: Yes. Right.

Sanders: The huge amounts of money they spend; the power of the drug companies, and if you think that every member of the Democratic caucus is prepared to stand up to those guys, you’re mistaken.

****

Sanders: But the bottom line here, Ed, is, you’re absolutely right; we have a Democratic president, a strong majority in the House, sixty votes in the Senate. If we can’t deliver on energy, on health care, on workers’ rights, then what’s the sense of it all. The answer is people have got to put pressure on Congress to have the guts to stand up to the insurance companies, the drug companies, the banks, the military-industrial complex.

Schultz: Well, who’s going to put pressure on them?

Sanders: We’re going to need a strong grassroots movement to make that happen.

Schultz: So you think the people can be heard on this.

Sanders: Absolutely. Absolutely they can.

****

Schultz: I think this is a real moment for the president. What if the president comes out tomorrow night at the press conference… I would love to hear President Obama come out and say, “Look, I don’t have all the answers, but everything is on the table.” And this idea that single payer is not politically achievable, Mr. President, respectfully, I think you’re wrong on that. I think it is politically achievable, because the people want it.

Video clip (7 minutes, 41 seconds):
http://videocafe.crooksandliars.com/heather/ed-show-bernie-sanders-need-single-payer-health

Comment:

By Don McCanne, MD

When the people lead, Congress will follow.

Big health care rally planned Friday

By DANIEL BARLOW
Times Argus, Barre, Vt.
Published: April 28, 2009

MONTPELIER — During her years working for non-profit organizations, Peg Franzen saw the same story over and over again.

First, a person gets hit with a surprise medical problem — and they have no insurance. Then they lose their job. And finally, they lose their home.

Franzen, a retired resident of Montpelier, said she has witnessed many Vermonters between 40 and 60 years old suddenly have their entire lives derailed by the financial burdens of a medical illness because they lack health insurance.

“We really need to have a health care system that is based on moral values rather than the market economy,” she said Monday.

Health care has received little attention in this year’s legislative session in Vermont. But residents worried about the future of the system will gather at the Statehouse on Friday for what promises to be a massive rally.

Organized by the Vermont Worker’s Center and sponsored by more than 100 other organizations and groups in Vermont, Friday’s “Health Care is a Human Right” rally will draw attention to two bills that would institute a single-payer health care system in the state.

James Haslam, the director of the Worker’s Center, said the estimate is that more than 1,000 people will turn out for the rally, which begins at noon on the Statehouse lawn.

“We believe that this will be the largest political rally for health care reform in the history of the state of Vermont,” Haslam said. “It may be one of the biggest rallies in Vermont ever.”

The Vermont Worker’s Center launched its Health Care is a Human Right campaign last year, and this Friday’s rally will be its first major step toward building a grassroots coalition around health care reform.

Speakers at the rally include Dr. Deb Richter, a Montpelier resident who has been a force for single-payer health care at the Statehouse, and U.S. Sen. Bernard Sanders, who has sponsored legislation at the federal level.

The rally will also include street theater, giant puppets and a “dump-the-insurance-companies” dunk tank.

“There has been resistance to single-payer because of how invested those who make money off health care are in the political system,” Haslam said, “The pharmaceutical companies, the insurance companies … they make their profit off of our health.”

Sen. Doug Racine, D-Chittenden, the chairman of the Senate Health and Welfare Committee, said Monday that he is a supporter of single-payer health care, but added that creating such a system is never as easy as simply passing a bill.

His committee held a hearing last week on a Senate bill that would begin to create such a health care system. Racine said even supporters who testified in favor of the bill said Vermont would require waivers from the federal government.

“For a true single-payer system in Vermont, we would need to opt out of programs such as Medicaid and Medicare,” Racine said. “And that can’t happen without a waiver from the federal government , and I doubt it would happen under the administration of Gov. Douglas.”

Racine said he’s hoping that President Barack Obama’s health care reforms, which are expected to be unveiled later this year, will include provisions to allow states such as Vermont to begin testing certain reforms.

“I think there is a lot of interest in seeing what Vermont can do,” Racine said.

Contact Daniel Barlow at Daniel.Barlow@timesargus.com.

http://www.timesargus.com/article/20090428/NEWS02/904280338/1003/NEWS02

The Public Option Con

Selling Out Single-Payer

By HELEN REDMOND
Counterpunch
April 26, 2009

“As we roll out new products we will continue to price businesses for appropriate margins. We will not sacrifice profitability for membership.”

— Angela Braly, Wellpoint CEO

At the Health Care for America Now (HCAN) and Citizen Action Illinois sponsored rally in Chicago last weekend, single-payer advocates confronted HCAN leadership and Democratic Congresswoman Jan Schakowsky (D-Illinois) who instead of working to pass HR 676, John Conyers single-payer bill titled the United States National Health Insurance Act, are supporting the so called “public option.”

What the public option plan is, no one can exactly say. There are no concrete proposals spelling out what the plan would include, who could join it, how much it would cost, or how it would be funded. But the details don’t matter, they advocated for it anyway.

In a heated exchange with Schakowsky before the rally, she argued HR 676 (she is a cosponsor of the bill, yes that’s right) has no chance of passing and something has to be passed this year. She lied and said there isn’t enough support for single-payer, but there is for a public option. I and other activists challenged Schakowsky on every assertion and demanded she fight to pass HR 676. We said the insurance industry is going to fight just as hard against a public option as it will single-payer so let’s have a smackdown for single-payer. We argued the passage of HR 676 would guarantee an end to the crisis and finally make health care a human right that could never be taken away. She got pissed and complained loudly to her staff as she walked into the building, “Can you believe she is lecturing me?” I yelled after her, “I’m just expressing my opinion, I’m your constituency.”

The rally was a slick “Sell out single-payer and confuse em’ show” from start to finish, replete with retro 70’s song Ain’t no Stoppin’ Us Now blasting into the auditorium.

HCAN staffers, state representatives, Tom Balanoff – President of SEIU Local 1, small business owners, patients, doctors and medical students all took the stage, outlined different aspects of the crisis, and rightfully denounced the insurance and pharmaceutical companies. Their solution: the creation of a public plan to compete against the private insurance industry they despise. Speaker after speaker projected a wish list of health care reforms onto the nonexistent public option plan: benefits must be comprehensive, coverage must be affordable, no denial of care, and equal access to quality care. Who could disagree if a plan like that could actually be enacted? The problem is the United States will never, ever get a plan like that while the private insurance industry is still breathing. HCAN and liberal Democrats have to engage in this “magical thinking” in order to convince a skeptical public that a public option embedded in a for-profit system can work. Only a single-payer system, one that drives a stake through the heart of the insatiably greedy insurance corporations once and for all, can deliver on those promises.

A little history is in order.

The American health insurance system is based on the avoidance of the elderly and sick so insurers didn’t care much when Medicare was created: seniors have complex and costly health care needs that cut into profit margins. Let the government and taxpayers foot the bill for old people. Plus, people aren’t eligible for Medicare until they turn 65 so the vampires would have decades of opportunity to bleed Americans into medical bankruptcy. A similar dynamic was at work with Medicaid: poor people tend to have chronic health problems and that cuts into profit margins. Let the government and the taxpayers take care of them, but the minute they are healthy enough to work, kick ‘em out of the program and into the clutches of the vampires or the ranks of the uninsured. Whose left? Everybody in between. That’s what is driving the insurance industry and Karen Ignagni, the Chief Evil Officer (CEO) of America’s Health Insurance Plans (AHIP), into a frenzy. They fear a public plan will snatch away “their” market: the millions of people who don’t fall into the above categories of old and poor, especially the young and the healthy. It’s the profits, stupid!

Ignagni and the industry are whining that if a new government insurance program is created to compete with them, like Medicare, that’s unfair competition and they’d be driven out of business. Ohhh, don’t you feel sorry for Ignagni and all the other millionaire CEOs?

They think a government health plan would be unfair to them. But they’re exaggerating the effects a public plan would have on their pursuit of profit. Just look at how they have sunk fangs into Medicare.

Doctors Himmelstein and Woolhandler from Physicians for a National Health Program (PNHP) explain:

“A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan — which started as single-payer for seniors and now has become a funding mechanism for HMOs — and a place to dump the unprofitably ill. A public plan option doesn’t lead toward single-payer, but toward the segregation of patients, with profitable ones in private plans and unprofitable ones in the public one.”

Private Medicare Advantage plans cost the government 13 percent more per beneficiary on average in 2008, and overhead for private plans is also much higher, at 13 percent, compared to 2-3 percent in traditional Medicare. Of the 45 million Medicare recipients, 23 percent are in private plans. Most Americans aren’t aware of the extent of privatization of Medicare.

What is the lesson HCAN draws from the privatization of Medicare? On their website an article is posted titled, Will Government Give Public Health Insurance an Unfair Advantage? Experience Tells Us No. Experience shows the government has given an unfair advantage to private insurers when it comes to the Medicare program, which HCAN acknowledges. In twisted logic that is hard to follow, HCAN thinks that’s a good thing, it’s proof the government won’t lower reimbursement rates or impose cost controls on private insurers. Now HCAN is all about reassuring the insurance industry they claim to loathe so much they only want a public plan to compete against them on a level playing field: the goal is not to drive them out of business.

This is the logic that confuses people mightily. One minute HCAN is calling out the insurance industry for the profit-hungry killers they are, then they argue the companies need to stay in business to compete against a public plan honestly in the marketplace — even though they agree they never compete fairly, Medicare being the prime example.

The health care reform proposals advocated by Jacob Hacker from the University of California at Berkeley are suddenly all the rage, but there is nothing new about them. He proposes a national health exchange of private plans with the addition of a public option (essentially Obama’s position.) Hacker, like HCAN, is careful to assuage the fears of the private insurers and says under his scheme, “More Americans have private insurance after reform than do before — either through their employer or through the national exchange.” Smells a bit like Massachusetts where 200,000 people remain uninsured and the costs to subsidize the program have doubled from $630 million to $1.3 billion.
Single-payer advocates oppose the creation of a public plan for a different set of reasons.

1. It doesn’t make health care a human right that can never be taken away.

2. It continues to divide, devalue, and define people by their health status.

3. It can’t address the endemic racial and gender disparities in the system, including the 12 million undocumented.

4. It leaves the employer based system of health care provision intact. That link has to be broken so workers are free to change jobs, go on strike and not fear loss of coverage.

5. The system would continue to have multiple payers and therefore the complexity and gaps in coverage that are inevitable when there are numerous bureaucracies to navigate.

6. Where will the money come from to finance the plan, especially in a time of economic recession, like right now? A public plan is not fiscally sustainable because it’s rooted in a multiple payer system that foregoes at least 84% of administrative savings.

Single-payer on the other hand, would immediately inject 400 billion into the system by eliminating bureaucracy, billing apparatus, administrative waste, advertising, corporate profits, and CEO compensation. That’s enough money to bring everyone into the system with no co-pays or deductibles.

We don’t need any more feasibility studies or examinations of single-payer in other countries. It’s a proven fact that a single-payer system can cover everyone and control costs. Period, end of discussion.

So the question becomes why don’t the Democrats and HCAN fight to get rid of the parasitic private health insurance industry (the source of the crisis) once and for all instead of constantly and unsuccessfully, decade after decade, trying to rein in, regulate, and do an end run around them?

For the Democrats, with the exception of John Conyers and a few others, they simply don’t want to abolish the private insurance industry. They are capitalists and believe in the capitalist system that makes health care a commodity to be bought and sold. For them, health care is not a human right. And importantly, they don’t want to take on President Obama who is opposed to single-payer. Like the true cowards they are, they will not oppose Obama on health care reform even though they disagree with him.

HCAN thinks it’s impossible to get rid of the insurance companies, they’re too powerful, and they have too much money and influence. They don’t believe a large social movement can be built to take on and win against the insurers and the government. The leadership of HCAN are the ones who would have said under slavery, “We can’t win abolition, so let’s settle for a few reforms that make the lives of slaves more bearable.”

This attitude is astonishing given the sea change in consciousness around health care. A number of events have coalesced to make winning a single-payer system possible. No longer does the invoking of “socialized medicine” scare people, not after the government has socialized billions of dollars of losses in the financial sector. If the government can bail out AIG, why not the health care system? Poll after poll shows the majority of Americans want a government run health care system that guarantees health care. People often express this by saying, “I want what they have in Canada.” Physicians used to be an obstacle to single-payer, now 59% support single-payer.

Employment-based health care is collapsing and employers want to get out of the business of providing health care to workers: it costs too much. Millions of laid off workers now realize tying insurance to employment status is a disaster; lose your job, lose coverage. Those with jobs are paying staggering premium increases for less coverage. Single-payer legislation has been introduced into the House HR 676, and SB 703 in the Senate. There is a grassroots movement, including unions, all over the country organizing and fighting for single-payer. And most significantly, people are ANGRY and want change.

HCAN and Democrats like Schakowsky are deceiving and leading people down yet another dead end alley of incremental reform. We’ve had decades of incremental reform and now there are 50 million uninsured, 25 million underinsured and between 18,000 to 100,000 people die every year because they lack access to health care. For spineless Democrats like Schakowsky and HCAN, the day will never come when single-payer is “politically feasible,” because if now isn’t the time, when will it be?

The fight to make health care a human right is the new civil rights struggle. We are standing on the shoulders of all the great social movements that have come before us.

The time to win single-payer has never been better. We are going to keep fighting like hell to destroy the corporate killers, not create a faux option that allows them to live another day.

Sí se puede, yes we can!

Helen Redmond is a member of the Chicago Single-Payer Action Network and a Licensed Clinical Social Worker. She works in the emergency room at Cook County Hospital and blogs at http://helenredmond.wordpress.com She can be reached at redmondmadrid@yahoo.com

Single-payer system and Florida's budget are linked

Ray Bellamy
Tallahassee Democrat
My View
April 29, 2009

No to offshore drilling in a state that depends on pristine beaches and an attractive environment to attract a vibrant tourist industry. No to Seminole gaming, which would siphon money from those least able to afford it and create a number of other social problems.

What to do? Say yes to single-payer national health insurance. How would this help, you ask? The single largest expenditure in Florida’s budget is the $16 billion for Medicaid. And this Medicaid cost goes up annually at an unsustainable rate. That item, the entire Medicaid budget, would disappear if we had single payer national health insurance, such as HR 676 in the U.S. House, or S703 in the U.S. Senate. Since everyone would have comprehensive health coverage, including long-term care, dental, pharmacy and mental health — think a very comprehensive “Medicare for All” from the day of birth — state Medicaid expenditures would vanish from the budget. Also eliminated would be Leon County’s costs for providing employee and retiree health care, the same costs for the city of Tallahassee, and also for state employees and state retirees. Now this is sustainable improvement for our state’s budget number-crunchers to love.

Single payer is the only health care reform proposal that is revenue neutral in our $2.4 trillion national health care cost equation. It achieves universal coverage by saving an estimated $380 billion a year in wasted profit for the insurance industry and counter-productive administrative excess caused by that industry. These savings would go toward covering all of us with comprehensive coverage, free choice of physician and free choice of hospital, just as Medicare would be if it were much better funded.

Single payer is the only proposal for covering the uninsured that is fiscally responsible, the only proposal that covers all citizens, and the only proposal that utilizes a successful business model: Medicare. Australia, Canada, Taiwan and other countries with better-rated health care quality at half the per-capita costs of the U.S. patchwork system have greater success with the single payer model at far less cost than we. There is no successful model in the world experience for a private, for-profit insurance system such as proposed by those opposed to single payer.

We have a unique opportunity to achieve this needed reform in health care and solve our Florida budget crisis. Our own congressman, Allen Boyd, has stated his support for “universal health coverage.” But if the Obama administration is successful in shepherding through the Obama plan, Boyd is likely to be presented with a bill that will subsidize the health coverage for the uninsured at an additional national cost of $150 billion to $200 billion, but leave in place the 31-percent overhead and excessive insurance company profits within the present system. In fact, additional administrative costs would be added.

Boyd, as a leader of the Blue Dog caucus in Congress, is in a position to lead the redirection of health care reform toward single payer and take a true leadership role in Congress. The more than $18 billion saved from our state budget would go a long way toward helping our education, law enforcement, state worker salaries and other pressing social needs. Let Congressman Boyd know how you feel.

ABOUT THE AUTHOR: Ray Bellamy is a physician practicing in Tallahassee. Contact him at ray.bellamy@med.fsu.edu.

Congressman predicts single-payer health plan

By John Sammon
The Herald, Monterey County (Calif.)
April 27, 2009

National health care for all Americans is an idea whose time has come, a visiting lawmaker said Sunday at CSU- Monterey Bay.

“It’s in our face,” Rep. Jim McDermott, D-Wash., said. “We can’t avoid it. That’s why something is going to happen.”

A physician serving his 11th term in the House, McDermott has long championed health care reform and supports “single-payer” legislation guaranteeing affordable coverage to all Americans.

McDermott said the election of Barack Obama is among the most fundamental change in the effort to get all Americans health care.

“The first thing that has to happen, is that you have to have a president who will lead,” he said.

McDermott spoke to about 100 people in the CSUMB University Center at an event sponsored by the Compassionate Care Alliance.

He said 45 million Americans do not have medical insurance, while another 30 million are underinsured. But, he said, several influential groups, including doctors and unions, recognize the need for national health coverage.

“Industry also wants a national health plan,” he said. “They want to divest themselves of health costs. Health care costs are the number one cause of bankruptcies.”

McDermott predicted that drug and insurance companies will resist change.

“People never had a problem with taking care of roads and schools,” he explained. “But some of them still have the idea that when it comes to health care, it’s your private responsibility.”

An earlier attempt to institute national coverage bogged down when the Clinton administration tried to sponsor a 1,600-page plan, he said.

“The president (Obama) is saying this time, if you’ve got good coverage, if you like it, it’s OK, there won’t be any change in your system,” he said. “But the problem is, we’ve got too many people today who have no coverage at all, and they’re just crossing their fingers hoping nothing happens to them until they can find a job.”

McDermott described a dysfunctional health care system beset by soaring costs. As an example, he noted a patient who during a one-day visit, had an MRI and two CAT scans costing $11,000. The reading of a couple of X-rays generated another $1,500 charge.

“You can’t tolerate a system that operates that way,” he said.

Added to high costs is the often bewildering array of separate payment plans, resulting in a mountain of wasteful, time-consuming paperwork, McDermott said

New doctors, McDermott said, face a make-big-money-or- else quandary.

“You’ve got a medical student who comes out of college $150,000 in debt, maybe $250,000. This doctor has a family with children and says to himself, ‘I’ve got to make a lot of money.’ … You don’t go into primary care in an underserved (poor) area because it isn’t sufficient to pay off the debt.”

He said a possible solution would be to give free or low-cost tuition to medical students if they agreed to provide primary care in an underserved area for four years.

McDermott indicated that part of the problem is America’s reverence for the free-market system: It’s hard for us to visualize a national system.

He cited France as an example of an effective health care system. “The French are rated the best in the world, and we’re No. 18,” he said. “In this country, it depends on who you are and what plastic (credit card) you have. The idea of us learning from other countries is a hard concept for the U.S. We say to ourselves, ‘how could they know more.'”

Nevertheless, McDermott said single-payer national health care will be adopted here.

“There will be a campaign to support this from the grass roots. You need to place pressure on your congressman. They will react to people asking them, why don’t you do something? There’s no question people can make a real impact.”

http://www.montereyherald.com/local/ci_12236288