PNHP

New York HMO/POS death spiral

New York HMO/POS death spiral

Consumer Guide to HMOs

New York State Department of Insurance
Choices Available for Individual Coverage
Under New York State Insurance Law, New Yorkers purchasing health insurance on their own can choose either an HMO or an HMO/POS plan option at any time during the year. You cannot be denied coverage if you have health problems, but you may be subject to a waiting period of up to one year for certain pre-existing conditions.
HMOs deliver health care to members using provider networks, which are groups of doctors, hospitals and other health care providers that have agreed to serve members of a particular HMO. Health benefits are covered if the member uses providers that are in-network.
All New York HMOs also offer a point of service (POS) option that allows members to seek care from providers that are out-of-network. Services provided by out-of-network providers generally cost members more in out-of-pocket expenses.
http://www.ins.state.ny.us/consumer/cg_hmo2008.pdf

And…

Premium Rates for Standard Individual Health Plans

April 2009
New York County
Monthly family premium rates for Point of Service Plans (POS)
$4450 – Aetna Health. Inc.
$3776 – Atlantis Health Plan, Inc.
$4066 – Empire BlueCross BlueShield HMO
$6824 – GHI HMO Select, Inc.
$4187 – Health Insurance Plan of Greater New York, Inc.
$3816 – Health Net of New York, Inc.
$3500 – Managed Health, Inc.
$4208 – Oxford Health Plans (NY), Inc.
HMO family rates for these same insurers range from $2266 to $5686
http://www.ins.state.ny.us/hmorates/html/hmonewyo.htm

So in New York County, for a premium of about $50,000 per year, you can have a choice of physicians and hospitals for your family, although you will have to pay more in out-of-pocket expenses if you select out-of-network providers. If you don’t mind losing choice by staying within the HMO for all of your care, you can have your family covered for under $40,000 per year.
What is going on here? Why are the premiums so high?
Well, first of all, New York has addressed the problem of underinsurance by requiring, through regulation, that insurers provide adequate benefits. Also, they must accept anyone, regardless of health status (though they can enforce a waiting period to prevent individuals from waiting until they need care to apply for coverage). Innovative insurance products that keep premiums competitive by shifting significant costs to the insured are prohibited in New York. Health care is very expensive in the United States, so premiums that reflect the true costs will be quite high.
Per capita spending for health care is already at $8,100 per year. For a family of four, that would be about $32,000, but these numbers in New York are even higher. What explains that? If you had an income of $80,000 per year, and you and your family are healthy, and you are told that your insurance premium will be $50,000, what would you do? You really don’t have much choice; you’d wing it. If you had ongoing medical expenses of maybe $250,000 per year, what would you do? You would try to stay in the plan and somehow pay that $50,000.
This is the classic “death spiral” of health insurance. A ever increasing number of individuals who are healthy would leave the plan, leaving within the risk pool the very high cost patients. Premiums skyrocket and become unaffordable for most.
The private insurance industry has an answer for this. They are asking Congress to require everyone, through an individual mandate, to purchase insurance so that the risk pools remain diluted with the large numbers of people who are healthy. That might take care of the death spiral, but it glosses over a very important point.
In most states, plans in the individual market are underinsurance products, and true reform must bring an end to their underinsurance innovations, otherwise people who need medical care will continue to face financial hardship. The New York experiment has demonstrated that well regulated individual plans (which Congress promises us) are too expensive. Congress understands this so they say that we should be able to chose our plans through a “connector” so that we don’t have to pay broker fees. Come on! It’s health care costs that are breaking us!
At today’s costs, private plans that are adequate to prevent financial hardship in the face of medical need must have unaffordable premiums, whether or not in a connector. We need to eliminate this obsolete system of premiums tied to a private package of health benefits. We desperately need an equitable, efficient, single payer national health program. Each person pays his or her fair share, and everyone gets health care.
And what is Congress preparing for us behind those closed doors? Look again at the premiums for New York County. At least you will have a choice of plans with perhaps $40,000 premiums, and for another $10,000 plus out-of-pocket cost sharing, you can have your choice of providers as well.
You say that premiums won’t be that high if we eliminate the death spiral? President Obama has already said that you can’t mandate people to buy an insurance plan they can’t pay for. That keeps the death spiral in play.

New York HMO/POS death spiral

Consumer Guide to HMOs

New York State Department of Insurance

Choices Available for Individual Coverage

Under New York State Insurance Law, New Yorkers purchasing health insurance on their own can choose either an HMO or an HMO/POS plan option at any time during the year. You cannot be denied coverage if you have health problems, but you may be subject to a waiting period of up to one year for certain pre-existing conditions.

HMOs deliver health care to members using provider networks, which are groups of doctors, hospitals and other health care providers that have agreed to serve members of a particular HMO. Health benefits are covered if the member uses providers that are in-network.

All New York HMOs also offer a point of service (POS) option that allows members to seek care from providers that are out-of-network. Services provided by out-of-network providers generally cost members more in out-of-pocket expenses.

http://www.ins.state.ny.us/consumer/cg_hmo2008.pdf

And…

Premium Rates for Standard Individual Health Plans

April 2009

New York County

Monthly family premium rates for Point of Service Plans (POS)

$4450 – Aetna Health. Inc.
$3776 – Atlantis Health Plan, Inc.
$4066 – Empire BlueCross BlueShield HMO
$6824 – GHI HMO Select, Inc.
$4187 – Health Insurance Plan of Greater New York, Inc.
$3816 – Health Net of New York, Inc.
$3500 – Managed Health, Inc.
$4208 – Oxford Health Plans (NY), Inc.

HMO family rates for these same insurers range from $2266 to $5686

http://www.ins.state.ny.us/hmorates/html/hmonewyo.htm

Comment:

By Don McCanne, MD

So in New York County, for a premium of about $50,000 per year, you can have a choice of physicians and hospitals for your family, although you will have to pay more in out-of-pocket expenses if you select out-of-network providers. If you don’t mind losing choice by staying within the HMO for all of your care, you can have your family covered for under $40,000 per year.

What is going on here? Why are the premiums so high?

Well, first of all, New York has addressed the problem of underinsurance by requiring, through regulation, that insurers provide adequate benefits. Also, they must accept anyone, regardless of health status (though they can enforce a waiting period to prevent individuals from waiting until they need care to apply for coverage). Innovative insurance products that keep premiums competitive by shifting significant costs to the insured are prohibited in New York. Health care is very expensive in the United States, so premiums that reflect the true costs will be quite high.

Per capita spending for health care is already at $8,100 per year. For a family of four, that would be about $32,000, but these numbers in New York are even higher. What explains that? If you had an income of $80,000 per year, and you and your family are healthy, and you are told that your insurance premium will be $50,000, what would you do? You really don’t have much choice; you’d wing it. If you had ongoing medical expenses of maybe $250,000 per year, what would you do? You would try to stay in the plan and somehow pay that $50,000.

This is the classic “death spiral” of health insurance. A ever increasing number of individuals who are healthy would leave the plan, leaving within the risk pool the very high cost patients. Premiums skyrocket and become unaffordable for most.

The private insurance industry has an answer for this. They are asking Congress to require everyone, through an individual mandate, to purchase insurance so that the risk pools remain diluted with the large numbers of people who are healthy. That might take care of the death spiral, but it glosses over a very important point.

In most states, plans in the individual market are underinsurance products, and true reform must bring an end to their underinsurance innovations, otherwise people who need medical care will continue to face financial hardship. The New York experiment has demonstrated that well regulated individual plans (which Congress promises us) are too expensive. Congress understands this so they say that we should be able to chose our plans through a “connector” so that we don’t have to pay broker fees. Come on! It’s health care costs that are breaking us!

At today’s costs, private plans that are adequate to prevent financial hardship in the face of medical need must have unaffordable premiums, whether or not in a connector. We need to eliminate this obsolete system of premiums tied to a private package of health benefits. We desperately need an equitable, efficient, single payer national health program. Each person pays his or her fair share, and everyone gets health care.

And what is Congress preparing for us behind those closed doors? Look again at the premiums for New York County. At least you will have a choice of plans with perhaps $40,000 premiums, and for another $10,000 plus out-of-pocket cost sharing, you can have your choice of providers as well.

You say that premiums won’t be that high if we eliminate the death spiral? President Obama has already said that you can’t mandate people to buy an insurance plan they can’t pay for. That keeps the death spiral in play.

Only patients should profit

By MARK A. DUNLEA
Albany Times Union
Tuesday, April 28, 2009

America’s pundits used to deride the old Soviet Union for propping up obsolete factories and industries in the name of jobs.

We don’t hear such criticisms about President Barack Obama and the Democrats’ decision to prop up health insurance companies in the debate over universal health care. Yet our system of health insurance is costing us hundreds of billions of dollars annually, tying up the health care system in paperwork, and contributing to the deaths of tens of thousands of Americans annually.

An April 20th news article (“Health reform tough call”) focuses on whether Congress will agree to the Democrats’ call for a public option, allowing Americans the choice of obtaining insurance through a government-sponsored plan. The other major change, with more bipartisan support, is to mandate that everyone has to obtain or purchase insurance.

Nowhere does the article, from The Associated Press, mention the universal health care systems that most of the industrial world already has. A single-payer system merely means that one program pays all bills — just like Medicare — eliminating the need for private health insurance companies. Most serious health policy experts, starting with Obama, admit that single payer would be the best system, in terms of covering everyone, controlling costs and ensuring both quality of care and freedom of choice in choosing doctors and providers. The politicians just don’t believe they can stand up to the insurance companies, so they want to hide this solution from the public debate.

Presidents Franklin Delano Roosevelt, Harry Truman, John F. Kennedy, Lyndon Johnson, Richard Nixon and Bill Clinton all tried but failed to enact some sort of universal health care. Obama’s demand that private health insurance continue to play a major role will kill universal health care once again.

In recent decades, many states have proudly announced that they have enacted “universal health care” systems. The media tends to dutifully report that these reforms are a model for the rest of the country. In a short period of time, each of these proposals — in Vermont, Massachusetts, Tennessee, Oregon, Minnesota, Florida — collapsed because costs escalated much faster than anticipated while the number of uninsured people declined much slower than expected. They failed to control costs out of a desire to avoid taking on the insurance and drug companies as well as other special interests. And the “subsidized” insurance plans they created offered inferior coverage at prices still too high for many Americans.

Obama and the rest of the Democrats seem committed to repeating these mistakes. They have pulled up chairs at the table for the insurance and drug companies to make sure they are happy with the final solution. Obama also has sought to exclude single-payer advocates.

About one in five dollars in the America economy are spent on health care — much more than the rest of the industrial countries, all of which arguably have better performing health care systems. Reforming one-fifth of the economy means that money has to be moved around. No special interest will willingly agree to a smaller share of the pie. There is where political leadership is needed.

Failure to eliminate for-profit health insurance would doom us once again to lose the struggle for universal health care. We need to define universal health care as meaning that everyone has a right to such services, period — no discussions about creating “affordable policies.” Obama needs to start listening to the American people and have the courage to stand up for real change.

Mark A. Dunlea is co-chair of Single Payer New York and executive director of the Hunger Action Network of New York State.

Paperwork, profits clog health care's efficiencies

By DEAN CALBREATH
San Diego Union Tribune
April 26, 2009

It’s been nearly three decades since White House Chief of Staff John Ehrlichman floated the idea of creating a health care system based on health maintenance organizations.

President Richard Nixon at first balked at the idea. “You know, I’m not too keen on any of these damn medical programs,” he said on June 17, 1971, as recorded by his secret White House taping system.

Ehrlichman, who would later serve jail time for his role in the Watergate affair, patiently explained that privately run HMOs could be profitable, since “all of the incentives are for less medical care. Because the less care they give, the more money they make.”

“Not bad,” Nixon replied. The next day, he proposed “a new national health strategy” based on HMOs, saying that “the purpose of this program is simply this: I want Americans to have the finest health care in the world.”

In the years since, it’s an open question whether the United States has created the world’s finest health care system, but it’s definitely the costliest. In 2006, the United States spent $6,714 per person on health care.

In comparison, Japan — which, like most other industrialized countries, offers a largely socialized health care system — spent $2,474; the United Kingdom, $2,760; Sweden, $3,202; Germany, $3,371; and France, $3,449. We devote more than 15 percent of our gross domestic product to health care, while most other industrialized countries spend less than 10 percent.

What has that bought us? There are few areas where we do noticeably better than other countries — our hospital waiting times, for instance, are shorter than in other countries, and we provide greater access to advanced technologies.

But over the past decade, the United States has consistently ranked last on patient access, safety, efficiency and equity when compared with countries such as Germany, Australia, Canada, New Zealand and the United Kingdom in a biannual survey of the Commonwealth Fund, a New York-based health advocacy group.

By a number of other measures, such as infant mortality and life span, we lag behind most industrialized nations. And we still are a nation where nearly one out of four residents is uninsured. In fact, the number of uninsured is rising each day as more employees get laid off. Every 1 percent increase in the jobless rate translates into more than 1 million people losing health coverage nationwide, according to the Kaiser Family Foundation.

Why are our health care costs so high? Why aren’t we getting broader coverage, considering the amount of money we’re putting into the system?

There are a number of reasons, ranging from our fondness for CT scans and MRIs to the high profits of the drug industry. But some critics recently have focused on two other major factors: profits — as Nixon alluded to — and paperwork.

In testimony on Capitol Hill last week, David Himmelstein, national spokesman for Physicians for a National Health Program, argued that one reason for the high cost of health care in the United States is that American hospitals and clinics spend much more money on administrative services than other countries do, partly because U.S. doctors have to devote such a large portion of their time responding to questions and challenges from insurers.

Himmelstein, an associate professor at Harvard and doctor at Cambridge Hospital, said 31 cents out of every dollar that Americans spend on health care goes for administrative expenses. That compares with less than 17 cents in neighboring Canada, which uses a single-payer system.

“If we cut our bureaucratic costs to Canadian levels, we’d save nearly $400 billion annually — more than enough to cover the uninsured and to eliminate co-payments and deductibles for all Americans,” Himmelstein told the House Subcommittee on Health, Employment, Labor and Pensions.

Jim G. Kahn, health economist at the Institute for Health Policy Studies at the University of California San Francisco, found a similar pattern during a study of California hospitals, clinics and doctors’ groups. He found the doctors’ groups were spending an average of 14 cents per dollar related to legal, accounting and processing costs involved with health insurance.

“You have to have teams of lawyers and accountants to negotiate contracts and to figure out who pays for what,” Kahn said. “You have to have whole teams in place to figure out what errors there are (in the paperwork) and how to fix them.”

Kahn said that in a single-payer system like Canada’s, the data are centralized, resulting in less time, money and effort being spent on administrative tasks. “And then you could apply that savings to provide better health coverage,” he said.

Critics of a single-payer concept worry that a government-run system would end up being too costly and too bureaucratic, without providing the benefits of innovation and cost-cutting that competition is supposed to bring. But if that were true, why does our system cost more than those abroad?

The entities that seem to benefit most from the current system are the major pharmaceuticals, which are among the nation’s most profitable companies, and the life insurers, which have also done well.

Donald Cohen, executive director of San Diego’s Center for Policy Initiatives, a liberal think tank, said the top seven for-profit health insurers made a combined $12.6 billion in 2007, an increase of more than 170 percent from 2003. Part of those profits go toward paying high salaries for the top executives. The seven chief executives received an average compensation of $14.3 million in 2007, with pay packages ranging from $3.7 million to $25.8 million.

Cohen suggested that one way of lowering costs would be to create more competition, by having a government health plan competing with the private insurers. Government-run programs, he said, typically run with low administrative expenses, often with overhead running at 1 percent to 3 percent of their expenses. In contrast, the privately run insurance firms have overhead costs as high as 20 percent, partly because of their high salaries.

As Cohen noted, conservative think tanks like the Reason Foundation, Heritage Foundation and others have argued that allowing the private sector to compete with the public sector can benefit the taxpayer. Why shouldn’t the reverse be true?

“Public-private competition in health insurance will squeeze overhead and profits from the middlemen in the system so we can put more money into actual health care,” Cohen said.

Dean Calbreath: (619) 293-1891; dean.calbreath@uniontrib.com

PNHP's Fein Delights Ohio Single-payer Supporters

By Michael Carano
PDA OH State Coordinator
April 28, 2009, Columbus, OH

On April 25, 2009, over one hundred and twenty-five Ohio healthcare advocates converged at the Ramada Plaza Hotel in the State’s capital for the Sixth Annual Single-Payer Action Network of Ohio conference (SPAN Ohio). SPAN Ohio is a single-payer coalition working to enact “The Health Care For All Ohioans Act” in the Ohio legislature and, should that fail, through a petition initiative to put the single-payer bill on the Ohio ballot.

The conference attendees, a mix of new and long-time activists, came to elect officers for the coming year, to participate in workshops, and to hear an address by one of the leading, long-time proponents of a national single-payer healthcare plan, keynote speaker Oliver Fein, M.D., president of Physicians for a National Health Program (PNHP).

The purpose of the annual conference is to bring together supporters of healthcare for all–unions, healthcare providers, faith groups, community groups, women’s organizations, businesses and others–to discuss how best to build the campaign to win publicly-funded, privately-provided, not-for-profit universal healthcare guaranteeing coverage for all Ohioans. The conference also serves as the time when SPAN democratically elects its board, regional coordinators, and constituency leadership.

Dr. Fein eloquently laid out how agents for change must work to move single-payer health care forward in the new political environment brought about by the election of Barack Obama. As recently reported in the national press, Dr. Fein, along with Congressman John Conyers, author of the single-payer resolution in Congress, both received invitations to the White House for the Stakeholders Conference convened by the president only hours before the meeting in Washington was to take place. Dr. Fein said their late inclusion in the D.C. meeting was made possible by the efforts of the grassroots, groups like the Leadership Conference for Guaranteed Health Care. With a smile on his face, he also stated that the threat of direct action by PNHP doctors had some small effect. It seems the Obama Administration did not like the idea of having doctors in white coats picketing outside the White House for the initial kickoff of his healthcare campaign.

In his explanation of what is being discussed and considered by the powers that be in Washington, Fein pointed out the deficiencies of the much-touted “public plan.” Dr. Fein
explained that 10-15% of public employees cannot afford the coverage. It is a menu of premium-based rather than income-based private insurance plans. An office clerk pays the same as a senator–one more example as to why single-payer healthcare is the answer.

Dr. Fein also noted the contingent of members of Progressive Democrats of America activists in the crowd, commending them for their work in the Leadership Conference and their focused effort on the part of single-payer healthcare. He suggested that the movement must begin to engage in direct actions to raise the pressure on Congress to the next level to ensure healthcare reform results in a single-payer plan–sooner rather than later. Dr. Fein encouraged those in attendance to lobby their members of Congress to gain support for HR 676.

Dr. Fein’s activism dates back to his college days while attending medical school in Cleveland, Ohio. He was an organizer of the Cleveland Community Project (CCP), one of the more successful endeavors of Students for Democratic Society’s Economic Research and Action Project. (Coincidentally, SPAN Ohio’s own Bob Smiddie, a social justice activist from Athens, Ohio, was also involved in the community theater component of the CCP at the time of Dr. Fein’s leadership.)

Attendees swelled the breakout sessions, which focused on ways to move true health care reform forward. John Ross, a Toledo, Ohio physician and a founding member of SPAN, spoke to those interested in learning more about the Health Care for All Ohioans Act in a session heavily attended by those relatively new to the cause. Dr. Fein’s breakout session centered on the methods his group has used in PNHP chapter-building efforts in New York. Nuts and bolts organizing tools, which will be useful in promoting SPAN’s efforts in the coming year, were presented. Mary Nichols-Rhodes, Summit County SPAN member and PDA Ohio’s Congressional District Organizer, held a workshop on lobbying at both the state and federal levels. All the workshops produced enthusiastic interactions and discussions by fuly engaged participants.

Deb Silverstein, founder of the Portage County SPAN chapter and an activist from the Steering Committee of Portage County’s PDA chapter, the Portage Democratic Coalition, was elected SPAN’s Region 6 Coordinator. Her thirteen-county area includes the major cities of Akron, Canton, and Youngstown.

Kurt Bateman, retired UAW worker and an effective organizer for the recent Sick Days Ohio campaign, was elected as SPAN Coordinator of Region 5, the Columbus and surrounding areas. Kurt is also part of PDA’s lobby efforts in the Columbus region.

Members of labor, healthcare workers, faith-based organizers, and community groups met after lunch in groups to discuss expanding their reach to other members of their constituency groups so that the single-payer movement will continue to strengthen and grow.

Single-payer is not off the table, regardless of Senator Baucus’s insistence that it is. Judging from the energy of those present in the Columbus Ramada that day, those seeking the best option for health care reform–HR 676–will not cease their work until a system is established that finds everyone in, and nobody out–nobody except the blood-sucking healthcare corporations, the main impediment to real reform.

Progressive Democrats of America continues to work for a single-payer system on both the national (HR676) and state levels. If you are interested in joining the movement, please contact pdaohio@gmail.com.

Paperwork, profits clog health care’s efficiencies

By DEAN CALBREATH
San Diego Union Tribune
April 26, 2009

It’s been nearly three decades since White House Chief of Staff John Ehrlichman floated the idea of creating a health care system based on health maintenance organizations.

President Richard Nixon at first balked at the idea. “You know, I’m not too keen on any of these damn medical programs,” he said on June 17, 1971, as recorded by his secret White House taping system.

Ehrlichman, who would later serve jail time for his role in the Watergate affair, patiently explained that privately run HMOs could be profitable, since “all of the incentives are for less medical care. Because the less care they give, the more money they make.”

“Not bad,” Nixon replied. The next day, he proposed “a new national health strategy” based on HMOs, saying that “the purpose of this program is simply this: I want Americans to have the finest health care in the world.”

In the years since, it’s an open question whether the United States has created the world’s finest health care system, but it’s definitely the costliest. In 2006, the United States spent $6,714 per person on health care.

In comparison, Japan — which, like most other industrialized countries, offers a largely socialized health care system — spent $2,474; the United Kingdom, $2,760; Sweden, $3,202; Germany, $3,371; and France, $3,449. We devote more than 15 percent of our gross domestic product to health care, while most other industrialized countries spend less than 10 percent.

What has that bought us? There are few areas where we do noticeably better than other countries — our hospital waiting times, for instance, are shorter than in other countries, and we provide greater access to advanced technologies.

But over the past decade, the United States has consistently ranked last on patient access, safety, efficiency and equity when compared with countries such as Germany, Australia, Canada, New Zealand and the United Kingdom in a biannual survey of the Commonwealth Fund, a New York-based health advocacy group.

By a number of other measures, such as infant mortality and life span, we lag behind most industrialized nations. And we still are a nation where nearly one out of four residents is uninsured. In fact, the number of uninsured is rising each day as more employees get laid off. Every 1 percent increase in the jobless rate translates into more than 1 million people losing health coverage nationwide, according to the Kaiser Family Foundation.

Why are our health care costs so high? Why aren’t we getting broader coverage, considering the amount of money we’re putting into the system?

There are a number of reasons, ranging from our fondness for CT scans and MRIs to the high profits of the drug industry. But some critics recently have focused on two other major factors: profits — as Nixon alluded to — and paperwork.

In testimony on Capitol Hill last week, David Himmelstein, national spokesman for Physicians for a National Health Program, argued that one reason for the high cost of health care in the United States is that American hospitals and clinics spend much more money on administrative services than other countries do, partly because U.S. doctors have to devote such a large portion of their time responding to questions and challenges from insurers.

Himmelstein, an associate professor at Harvard and doctor at Cambridge Hospital, said 31 cents out of every dollar that Americans spend on health care goes for administrative expenses. That compares with less than 17 cents in neighboring Canada, which uses a single-payer system.

“If we cut our bureaucratic costs to Canadian levels, we’d save nearly $400 billion annually — more than enough to cover the uninsured and to eliminate co-payments and deductibles for all Americans,” Himmelstein told the House Subcommittee on Health, Employment, Labor and Pensions.

Jim G. Kahn, health economist at the Institute for Health Policy Studies at the University of California San Francisco, found a similar pattern during a study of California hospitals, clinics and doctors’ groups. He found the doctors’ groups were spending an average of 14 cents per dollar related to legal, accounting and processing costs involved with health insurance.

“You have to have teams of lawyers and accountants to negotiate contracts and to figure out who pays for what,” Kahn said. “You have to have whole teams in place to figure out what errors there are (in the paperwork) and how to fix them.”

Kahn said that in a single-payer system like Canada’s, the data are centralized, resulting in less time, money and effort being spent on administrative tasks. “And then you could apply that savings to provide better health coverage,” he said.

Critics of a single-payer concept worry that a government-run system would end up being too costly and too bureaucratic, without providing the benefits of innovation and cost-cutting that competition is supposed to bring. But if that were true, why does our system cost more than those abroad?

The entities that seem to benefit most from the current system are the major pharmaceuticals, which are among the nation’s most profitable companies, and the life insurers, which have also done well.

Donald Cohen, executive director of San Diego’s Center for Policy Initiatives, a liberal think tank, said the top seven for-profit health insurers made a combined $12.6 billion in 2007, an increase of more than 170 percent from 2003. Part of those profits go toward paying high salaries for the top executives. The seven chief executives received an average compensation of $14.3 million in 2007, with pay packages ranging from $3.7 million to $25.8 million.

Cohen suggested that one way of lowering costs would be to create more competition, by having a government health plan competing with the private insurers. Government-run programs, he said, typically run with low administrative expenses, often with overhead running at 1 percent to 3 percent of their expenses. In contrast, the privately run insurance firms have overhead costs as high as 20 percent, partly because of their high salaries.

As Cohen noted, conservative think tanks like the Reason Foundation, Heritage Foundation and others have argued that allowing the private sector to compete with the public sector can benefit the taxpayer. Why shouldn’t the reverse be true?

“Public-private competition in health insurance will squeeze overhead and profits from the middlemen in the system so we can put more money into actual health care,” Cohen said.

Dean Calbreath: (619) 293-1891; dean.calbreath@uniontrib.com

PNHP’s Fein Delights Ohio Single-payer Supporters

By Michael Carano
PDA OH State Coordinator
April 28, 2009, Columbus, OH

On April 25, 2009, over one hundred and twenty-five Ohio healthcare advocates converged at the Ramada Plaza Hotel in the State’s capital for the Sixth Annual Single-Payer Action Network of Ohio conference (SPAN Ohio). SPAN Ohio is a single-payer coalition working to enact “The Health Care For All Ohioans Act” in the Ohio legislature and, should that fail, through a petition initiative to put the single-payer bill on the Ohio ballot.

The conference attendees, a mix of new and long-time activists, came to elect officers for the coming year, to participate in workshops, and to hear an address by one of the leading, long-time proponents of a national single-payer healthcare plan, keynote speaker Oliver Fein, M.D., president of Physicians for a National Health Program (PNHP).

The purpose of the annual conference is to bring together supporters of healthcare for all–unions, healthcare providers, faith groups, community groups, women’s organizations, businesses and others–to discuss how best to build the campaign to win publicly-funded, privately-provided, not-for-profit universal healthcare guaranteeing coverage for all Ohioans. The conference also serves as the time when SPAN democratically elects its board, regional coordinators, and constituency leadership.

Dr. Fein eloquently laid out how agents for change must work to move single-payer health care forward in the new political environment brought about by the election of Barack Obama. As recently reported in the national press, Dr. Fein, along with Congressman John Conyers, author of the single-payer resolution in Congress, both received invitations to the White House for the Stakeholders Conference convened by the president only hours before the meeting in Washington was to take place. Dr. Fein said their late inclusion in the D.C. meeting was made possible by the efforts of the grassroots, groups like the Leadership Conference for Guaranteed Health Care. With a smile on his face, he also stated that the threat of direct action by PNHP doctors had some small effect. It seems the Obama Administration did not like the idea of having doctors in white coats picketing outside the White House for the initial kickoff of his healthcare campaign.

In his explanation of what is being discussed and considered by the powers that be in Washington, Fein pointed out the deficiencies of the much-touted “public plan.” Dr. Fein
explained that 10-15% of public employees cannot afford the coverage. It is a menu of premium-based rather than income-based private insurance plans. An office clerk pays the same as a senator–one more example as to why single-payer healthcare is the answer.

Dr. Fein also noted the contingent of members of Progressive Democrats of America activists in the crowd, commending them for their work in the Leadership Conference and their focused effort on the part of single-payer healthcare. He suggested that the movement must begin to engage in direct actions to raise the pressure on Congress to the next level to ensure healthcare reform results in a single-payer plan–sooner rather than later. Dr. Fein encouraged those in attendance to lobby their members of Congress to gain support for HR 676.

Dr. Fein’s activism dates back to his college days while attending medical school in Cleveland, Ohio. He was an organizer of the Cleveland Community Project (CCP), one of the more successful endeavors of Students for Democratic Society’s Economic Research and Action Project. (Coincidentally, SPAN Ohio’s own Bob Smiddie, a social justice activist from Athens, Ohio, was also involved in the community theater component of the CCP at the time of Dr. Fein’s leadership.)

Attendees swelled the breakout sessions, which focused on ways to move true health care reform forward. John Ross, a Toledo, Ohio physician and a founding member of SPAN, spoke to those interested in learning more about the Health Care for All Ohioans Act in a session heavily attended by those relatively new to the cause. Dr. Fein’s breakout session centered on the methods his group has used in PNHP chapter-building efforts in New York. Nuts and bolts organizing tools, which will be useful in promoting SPAN’s efforts in the coming year, were presented. Mary Nichols-Rhodes, Summit County SPAN member and PDA Ohio’s Congressional District Organizer, held a workshop on lobbying at both the state and federal levels. All the workshops produced enthusiastic interactions and discussions by fuly engaged participants.

Deb Silverstein, founder of the Portage County SPAN chapter and an activist from the Steering Committee of Portage County’s PDA chapter, the Portage Democratic Coalition, was elected SPAN’s Region 6 Coordinator. Her thirteen-county area includes the major cities of Akron, Canton, and Youngstown.

Kurt Bateman, retired UAW worker and an effective organizer for the recent Sick Days Ohio campaign, was elected as SPAN Coordinator of Region 5, the Columbus and surrounding areas. Kurt is also part of PDA’s lobby efforts in the Columbus region.

Members of labor, healthcare workers, faith-based organizers, and community groups met after lunch in groups to discuss expanding their reach to other members of their constituency groups so that the single-payer movement will continue to strengthen and grow.

Single-payer is not off the table, regardless of Senator Baucus’s insistence that it is. Judging from the energy of those present in the Columbus Ramada that day, those seeking the best option for health care reform–HR 676–will not cease their work until a system is established that finds everyone in, and nobody out–nobody except the blood-sucking healthcare corporations, the main impediment to real reform.

Progressive Democrats of America continues to work for a single-payer system on both the national (HR676) and state levels. If you are interested in joining the movement, please contact pdaohio@gmail.com.

Barack Obama on single payer in 2003

Full quote from Obama in 2003:

“I happen to be a proponent of a single payer universal health care program.” (applause) “I see no reason why the United States of America, the wealthiest country in the history of the world, spending 14 percent of its Gross National Product on health care cannot provide basic health insurance to everybody. And that’s what Jim is talking about when he says everybody in, nobody out. A single payer health care plan, a universal health care plan. And that’s what I’d like to see. But as all of you know, we may not get there immediately. Because first we have to take back the White House, we have to take back the Senate, and we have to take back the House.”

Obama speaking to the Illinois AFL-CIO, June 30, 2003.

Marie Cocco on insurers' definition of reform

Health care reform with no reform

By Marie Cocco
denverpost.com
April 25, 2009
Maintaining what amounts to a monopoly on insurance for the working-age population has become a central goal of the insurance industry, which rightly fears that the government will provide more comprehensive coverage at a lower cost. This is, of course, the whole point of overhauling the insurance system. But never mind.
The industry worries that Americans will find out not only that government-supported health insurance isn’t a socialist catastrophe (see, for example, Medicare) but a fairer, lower cost and more efficient system than the expensive, inefficient – and failing – market-based system we have now.
Insurers have gone so far as to offer to stop charging people with existing medical conditions more for coverage, if only Congress and the Obama administration would continue to go along with a system more like the one we have now than the one that we actually need.
In essence, this is what the proponents of such a system want: a new and “reformed” health insurance system that works essentially like ours does today.
But the very reason we are again going down the politically treacherous path of attempting reform is that the system we have doesn’t work, not by any standard.
So far we have “reformed” the health insurance system by reinforcing precisely what’s wrong with it. To do this again would yield precisely the same result.
It wouldn’t be a reformed system. It would be just another way for the insurance industry to game the one we already have.
http://www.denverpost.com/opinionheadlines/ci_12220918

Everyone is in agreement that health care financing must be reformed. Most believe that the goal of reform should be to provide everyone with all necessary health care under a payment system that will prevent financial hardship for each one of us.
For the insurance industry, reform means expanding their successful business model to include more individuals in their plans while shifting the higher costs to the government (taxpayers). Most people do not want to be required to purchase health plans at premiums they cannot afford, and then be stuck with inadequate coverage designed to keep premiums from climbing even higher. Yet, as Marie Cocco makes clear, the insurance industry’s version of reform would reinforce precisely what is wrong with our health care financing.
So members of Congress continue to insist that a public insurance program that would achieve our goals is off the table, while they meet behind closed doors with representatives of the insurance industry, crafting reform that will cost much more but leave far too many of us without the protection we need.
Is complacency our problem?
complacency: “A feeling of contentment or self-satisfaction, especially when coupled with an unawareness of danger, trouble, or controversy.” (American Heritage Dictionary)

Marie Cocco on insurers' definition of reform

Health care reform with no reform

By Marie Cocco
denverpost.com
April 25, 2009

Maintaining what amounts to a monopoly on insurance for the working-age population has become a central goal of the insurance industry, which rightly fears that the government will provide more comprehensive coverage at a lower cost. This is, of course, the whole point of overhauling the insurance system. But never mind.

The industry worries that Americans will find out not only that government-supported health insurance isn’t a socialist catastrophe (see, for example, Medicare) but a fairer, lower cost and more efficient system than the expensive, inefficient – and failing – market-based system we have now.

Insurers have gone so far as to offer to stop charging people with existing medical conditions more for coverage, if only Congress and the Obama administration would continue to go along with a system more like the one we have now than the one that we actually need.

In essence, this is what the proponents of such a system want: a new and “reformed” health insurance system that works essentially like ours does today.

But the very reason we are again going down the politically treacherous path of attempting reform is that the system we have doesn’t work, not by any standard.

So far we have “reformed” the health insurance system by reinforcing precisely what’s wrong with it. To do this again would yield precisely the same result.

It wouldn’t be a reformed system. It would be just another way for the insurance industry to game the one we already have.

http://www.denverpost.com/opinionheadlines/ci_12220918

Comment:

By Don McCanne, MD

Everyone is in agreement that health care financing must be reformed. Most believe that the goal of reform should be to provide everyone with all necessary health care under a payment system that will prevent financial hardship for each one of us.

For the insurance industry, reform means expanding their successful business model to include more individuals in their plans while shifting the higher costs to the government (taxpayers). Most people do not want to be required to purchase health plans at premiums they cannot afford, and then be stuck with inadequate coverage designed to keep premiums from climbing even higher. Yet, as Marie Cocco makes clear, the insurance industry’s version of reform would reinforce precisely what is wrong with our health care financing.

So members of Congress continue to insist that a public insurance program that would achieve our goals is off the table, while they meet behind closed doors with representatives of the insurance industry, crafting reform that will cost much more but leave far too many of us without the protection we need.

Is complacency our problem?

complacency: “A feeling of contentment or self-satisfaction, especially when coupled with an unawareness of danger, trouble, or controversy.” (American Heritage Dictionary)

Experts Call For Immediate Health Care Reform In Subcommittee Hearing

by RTT Staff Writer
4/23/2009

(RTTNews) – A panel of experts told the House Subcommittee on Health, Education, Labor, and Pensions Thursday recommended potential reforms to reduce the cost of health care for employees, employers and their families.

Michael J. Langan of Principal at Towers Perrin manages a group of employee benefits attorneys who analyze legislative and regulatory issues affecting employer benefit and compensation programs, including retirement, health and welfare, executive compensation and other human resource issues. He urged immediate action be taken on health reform.

“These are times of extraordinary economic turmoil and challenges,” he said in prepared remarks. “Some have even suggested that health reform may need to wait until we address other more urgent economic recovery priorities.”

“We take the opposite view,” Langan continued. “Addressing the nation’s health policy challenges is an integral element of — rather than an obstacle to — economic recovery and personal financial security.”

Dr. David Himmelstein, a Harvard professor, proposed a single-payer plan that would cover all Americans and save taxpayers $400 billion annually.

The approach itself is controversial, and President Obama has suggested that it is off the table. However, Majority Leader Harry Reid has said that the Congressional Progressive Caucus “prefers a single-payer approach to health care reform.”

Under a single-payer system, doctors, hospitals and other health care providers are paid from a single fund administered by the government, which eliminates the wasteful spending and high administrative costs of private insurance, saving almost $400 billion annually. This is enough to provide every American with high-quality care, including those who currently have insurance but still cannot afford medications and treatment.

“[A] single-payer reform would make universal, comprehensive coverage affordable by diverting hundreds of billions of dollars from bureaucracy to patient care,” Himmelstein said in his testimony today. “Lesser reforms – even those that include a public plan option – cannot realize such savings. While reforms that maintain a major role for private insurers may be politically attractive, they are economically and medically nonsensical.”

President Barack Obama has made health care reform one of the five pillars of his path to economic recovery. In addition, his budget director Peter Orszag has said that “the path to fiscal responsibility must run directly through health care…the single most important thing we can do to put the nation back on a sustainable (fiscal) course is slow healthcare costs.”

“It is the key to our fiscal future,” Orszag added.

In his $3.55 trillion budget proposal, Obama requested $635 billion to be set aside for an overhaul of the nation’s health care system.

Montanans for Single Payer forms to promote universal coverage

The Clark Fork Chronicle
Wednesday, April 22 2009

A new statewide group has formed to affect the current national debate on health care reform. Montanans for Single-Payer is committed to true universal health care, a Medicare-type system where everyone is in and no one is out, according to the group’s spokesman, Phil Campbell.

Campbell said that Montanans for Single-Payer is convinced the only way to assure quality health care for all Montanans and all Americans is to implement a single-payer system that can contain costs, allow individuals to choose their own doctors, hospitals and other health care providers, and integrate wellness programs throughout the nation’s health care. “Currently we have an inefficient, wasteful, and expensive patchwork, not a true health care system,” Campbell said. “Only a single-payer approach can provide a true system for health care delivery.”

Montanans for Single-Payer is reaching out to Montanans providing information about the single-payer approach and how it can bring real change to American health care. The group has a contact person in all 56 counties and can already notify 14,000 Montanans of developments in health care reform, with plans to increase that number by a third every two weeks.

Campbell said, “We recognize Montanans have a unique opportunity to help shape the future of health care in America because Senator Max Baucus is a key player in that effort. We believe he will listen to the voices of Montanans so Montanans must make clear that we want a single-payer health care system. We plan to activate a network of Montanans whenever there is a decision on health care reform coming up in Washington, D.C. urging Montana citizens to contact Senators Baucus and Tester, Representative Denny Rehberg, and President Barack Obama.”

Campbell concluded, “There are many single-payer grassroots efforts throughout Montana who share the belief that a national, single-payer system is the reform most likely to solve our current health care crisis. We are reaching out to all single-payer advocates, groups and individuals, in order to unify Montana’s single-payer voice.”

For more information, to promote single-payer in your community or to find out how you or your group can join efforts with Montanans for Single-Payer, see http://www.montanansforsinglepayer.org.