PNHP

Call for single payer, universal coverage from Puerto Rico

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.

Doctors protest exclusion of single-payer at Senate Finance Committee

For Immediate Release
May 5, 2009

Contact:
Russell Mokhiber, Single Payer Action, (202) 468-8868, russellmokhiber@gmail.com
Katie Robbins, Healthcare-NOW! (330) 618-6379, healthcarenow08@gmail.com
Margaret Flowers, M.D., Physicians for a National Health Program – Maryland chapter, (410) 591-0892, nose1@aol.com
Kevin Zeese, ProsperityAgenda.us, (301) 996-6582, kzeese@earthlink.net
Mark Almberg, PNHP, (312) 782-6006, (312) 622-0996, mark@pnhp.org

VIDEO footage:
Sen. Max Baucus (D-Mont.) reacts to protesters,
http://www.youtube.com/watch?v=XKP05AyfRsI

Russell Mokhiber, Single Payer Action, speaks at hearing
http://www.youtube.com/watch?v=G5vhTtxad30

Margaret Flowers, MD & Katie Robbins, Healthcare-NOW
http://www.youtube.com/watch?v=1zOShsL4UJo

Carol Paris, MD, PNHP
http://www.youtube.com/watch?v=RdIUcrVxGwA

Mark Dudzic, Labor Campaign for Single-Payer Healthcare
http://www.youtube.com/watch?v=r1nl32aAh7M

Adam Schneider
http://www.youtube.com/watch?v=I26EkvnjZuQ

Pat Salomon, MD & Kevin Zeese
http://www.youtube.com/watch?v=iDHJH7W-ZEo

WASHINGTON – Doctors and other advocates of a national single-payer health system – also known as an improved Medicare for All – directly confronted senators at a Senate Finance Committee “roundtable” on health reform today.

One-by-one, eight single-payer advocates in the audience stood up during the opening comments of the hearing and asked why single-payer experts were being excluded from the proceedings. They each spoke out in turn until they were removed from the committee hearing room and arrested, one-by-one, by U.S. Capitol police.

The doctors and others said that a publicly funded, privately delivered single-payer system is the only solution to the crisis plaguing our nation’s non-system of health care, noting that single-payer national health insurance would guarantee coverage for everyone and contains costs.

Despite polling that shows a clear majority of public and physician support for a single-payer system, Sen. Max Baucus (D-Mont.), chair of the Senate Finance Committee, has stated on multiple occasions that single payer is “off the table” of health reform.

Today’s round table, the second of three, consisted of 15 witnesses with no single-payer advocates among them. By contrast, several witnesses have direct ties to the for-profit, private health insurance industry.

The doctors and activists were dressed in black, which they said was in memory of the 22,000 people who die every year due to lack of health insurance. They represented a coalition of single-payer advocacy organizations including Physicians for a National Health Program (PNHP), Healthcare-NOW, Single Payer Action, Private Health Insurance Must Go, the Campaign for Fresh Air and Clean Politics, Prosperity Agenda, and Health Care for the Homeless.

“Health insurance administrators are practicing medicine without a medical license,” said Dr. Margaret Flowers, co-chair of Maryland chapter of PNHP. “The result is the suffering and death of thousands of patients for the sake of private profit. The private health insurance industry has a solid grip on patients, providers and legislators. It is time to stand up and declare that health care is a human right.”

Much to the frustration of Baucus, the multiple disruptions demanding single-payer be on the table set the tone for the second of three roundtables on Health Reform by the Senate Finance Committee.

Katie Robbins, assistant national coordinator of Healthcare-NOW, said: “The current discussion on health reform is political theater at its best. Our elected officials are hosting these events to go through the motions of what developing effective national health policy should look like. There is a big difference between getting health policy experts in the room and the witnesses here today who would profit the most from reform. That difference means our hard-earned dollars will go to further insurance industry profits, not to guarantee health care to the American people.”

“It’s a pretty spectacular display of raw political power,” said Russell Mokhiber of Single Payer Action. “The health insurance industry demands that not one of the 15 people who testified today shall be a single-payer advocate. And the industry gets what it wants. It’s time for the American people to storm the gates and demand – put single payer on the table.”

Single payer is successfully implemented in the United States’ own Medicare system providing comprehensive care to the elderly, as well as in many of the best health care systems in the world. A single-payer system, as embodied in legislation H.R. 676 and S. 703, would provide guaranteed, quality care to all Americans with no increase in U.S. health spending.

The single-payer advocates said they will continue to use direct actions and nonviolent civil disobedience to urge the inclusion of a publicly funded, privately delivered system.

Other methods of communication with elected officials have failed in delivering the demand for single-payer national health care as evidenced by the exclusion of single-payer advocates from official hearings on health reform.

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Healthcare-NOW! is a national grassroots advocacy organization in support of single-payer national health care with a network of activists in 42 states. More information can be found at www.healthcare-now.org

Single Payer Action is a nonprofit activist fueled organization. Find out more at www.singlepayeraction.org

Maryland Chapter Physicians for a National Health Program is a chapter of Physicians for a National Health Program (www.pnhp.org), a nonprofit research and education organization of 16,000 physicians, medical students and health professionals who support single-payer national health insurance. More information can be found at www.md.pnhp.org

Prosperity Agenda includes single payer national health care as one of the policy changes needed to create an economy that benefits all Americans, not just the wealthiest. www.prosperityagenda.us. Prosperity Agenda is an economic justice project associated with The Campaign for Fresh Air & Clean Politics (www.FreshAirCleanPolitics.net).

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

Medical student debt and specialty selection

Where Did All the Doctors Go?

The New York Times
May 3, 2009
Letters
To the Editor:
Re “Shortage of Doctors Proves Obstacle to Obama Goals” (front page, April 27), about a lack of primary care providers :
As those of us responsible for delivering health care know, the battle between specialists and primary care doctors has been going on for years, and one side has been winning.
The marketplace has rewarded specialists financially, and like any other special interests, they are amply financed for this conflict. Still, I don’t fault them. They have studied and worked hard, and are responding to market incentives, like good red-blooded Americans.
What we really need is a European-style single-payer system, with primary care doctors who emerge from their training with European-style debt loads: zero.
Georganne Chapin
Tarrytown, N.Y.
The writer is president and chief executive of the Hudson Health Plan, a not-for-profit managed care organization.
http://www.nytimes.com/2009/05/04/opinion/l04doctors.html

And…

Subject: Graduate Medical Education: Trends in Training and Student Debt

GAO (Government Accountability Office)
May 4, 2009
In summary, we found that medical students prefer surgical and procedural specialties, and physician subspecialization is increasing. Relative to the number of available residency positions, more medical students have preferred surgical and procedural specialties over primary care specialties since 1999, according to national data.
Some factors may also lead students to pursue certain specialties while avoiding others. For example, the desire for a controllable lifestyle — a predictable schedule and fewer on-call hours — and high salary may lead students to pursue procedural specialties such as anesthesiology, and avoid other specialties such as primary care.
Medical school tuition and fees have increased significantly since 1998. Medical students can borrow up to $40,500 per year through the federal Stafford loan program with additional funding available through other federal loan programs; these loan programs can cover the full cost of medical school. The median amount of educational debt for indebted medical students graduating in 2008 was $155,000 — a 53 percent increase since 1998, controlling for inflation. Once out of medical school, residents earn stipends ā€” on average about $3,729 a month for a 1st year resident. With $155,000 in debt, a resident’s monthly loan payment could reach over $1,700 (about 48 percent of pretax income). However, residents have repayment options that can reduce their monthly debt payment until they complete postgraduate training.
http://www.gao.gov/new.items/d09438r.pdf

This statement from a highly respected executive of a not-for-profit managed care organization, and this new GAO report, both further confirm what we already knew. Medical students are graduating with excessive debt, and this is likely contributing to the decline in the numbers choosing the primary care specialties.
Without increasing total health care spending, a few policies could be adopted which would realign incentives to improve our primary care infrastructure, while relieving students of the necessity of accumulating debt. That would be much easier to accomplish through a single payer monopsony than through a dysfunctional, fragmented, multi-payer, health care financing system.

Medical student debt and specialty selection

Where Did All the Doctors Go?

The New York Times
May 3, 2009
Letters

To the Editor:

Re “Shortage of Doctors Proves Obstacle to Obama Goals” (front page, April 27), about a lack of primary care providers :

As those of us responsible for delivering health care know, the battle between specialists and primary care doctors has been going on for years, and one side has been winning.

The marketplace has rewarded specialists financially, and like any other special interests, they are amply financed for this conflict. Still, I don’t fault them. They have studied and worked hard, and are responding to market incentives, like good red-blooded Americans.

What we really need is a European-style single-payer system, with primary care doctors who emerge from their training with European-style debt loads: zero.

Georganne Chapin
Tarrytown, N.Y.

The writer is president and chief executive of the Hudson Health Plan, a not-for-profit managed care organization.

http://www.nytimes.com/2009/05/04/opinion/l04doctors.html

And…

Subject: Graduate Medical Education: Trends in Training and Student Debt

GAO (Government Accountability Office)
May 4, 2009

In summary, we found that medical students prefer surgical and procedural specialties, and physician subspecialization is increasing. Relative to the number of available residency positions, more medical students have preferred surgical and procedural specialties over primary care specialties since 1999, according to national data.

Some factors may also lead students to pursue certain specialties while avoiding others. For example, the desire for a controllable lifestyle — a predictable schedule and fewer on-call hours — and high salary may lead students to pursue procedural specialties such as anesthesiology, and avoid other specialties such as primary care.

Medical school tuition and fees have increased significantly since 1998. Medical students can borrow up to $40,500 per year through the federal Stafford loan program with additional funding available through other federal loan programs; these loan programs can cover the full cost of medical school. The median amount of educational debt for indebted medical students graduating in 2008 was $155,000 — a 53 percent increase since 1998, controlling for inflation. Once out of medical school, residents earn stipends Ć¢ā‚¬ā€ on average about $3,729 a month for a 1st year resident. With $155,000 in debt, a resident’s monthly loan payment could reach over $1,700 (about 48 percent of pretax income). However, residents have repayment options that can reduce their monthly debt payment until they complete postgraduate training.

http://www.gao.gov/new.items/d09438r.pdf

Comment:

By Don McCanne, MD

This statement from a highly respected executive of a not-for-profit managed care organization, and this new GAO report, both further confirm what we already knew. Medical students are graduating with excessive debt, and this is likely contributing to the decline in the numbers choosing the primary care specialties.

Without increasing total health care spending, a few policies could be adopted which would realign incentives to improve our primary care infrastructure, while relieving students of the necessity of accumulating debt. That would be much easier to accomplish through a single payer monopsony than through a dysfunctional, fragmented, multi-payer, health care financing system.