PNHP

Why "chocolate or vanilla"? Put Single Payer on the table!

Why "chocolate or vanilla"? Put Single Payer on the table!

by Claudia Chaufan
www.opednews.com
April 3, 2009

With 100,000 monthly foreclosures, 700,000 jobs lost every month, and the number of uninsured, underinsured, and deaths for lack of health insurance not getting any smaller, if the time for healthcare reform is not now, when then? And private health insurers know this too well, which is why they claim to have become “team players”, and to support “change”. But the question remains: which change?

As New York Times reporter Robert Pear recently noted, the only two options receiving any serious consideration in the halls of power of Washington D.C. are a “public option” (Medicare-like plan) or no public option, both within a “tightly-regulated-healthcare-marketplace”. In other words, our house is burning, and Washington, once again, gives us two options, “vanilla or chocolate”, both of which involve “comparative-shopping” (as if with health insurance, much like with Ipods, we could increase our market power if we wait for the next sale!).

That private insurers are fighting the public option on the grounds that competing with government is “unfair” should come to nobody’s surprise: clearly, they are in the business for the money, not to provide a social service to the American people. And they win when they collect premiums and deny payments for health care, and when they dump “bad customers” (sick, old, poor, or “not-wealthy-enough-to-pay-for-our-products”) on taxpayers.

And from their point of view of course, a government-financed, privately-delivered, healthcare plan is “unfair competition:” who can compete against a publicly financed option — whose goal is to eliminate financial barriers to health care — with its demonstrable administrative efficiency, capacity to set high quality standards, and huge market power that could dramatically reduce the absurd prices Americans pay for services and goods (e.g. pharmaceuticals) that cost a fraction elsewhere?

And defenders of the public option, the “other side” of the “chocolate-or-vanilla” equation, are also very familiar with the strengths of publicly-financed systems, such as single payer. Indeed, renowned Berkeley professor Jacob Hacker has extolled the virtues of a Medicare-like plan, and argued that including it is critical to successful healthcare reform.

What is less clear is why Hacker, who clearly understands the advantages of social insurance (what his Medicare-type “option” is) — advantage, that is, from the point of view of prospective patients — when compared to for-profit liability insurance (what private for-profit plans are), would suggest a Medicare-like plan only as an “option”, and in so doing undermine its critical strengths – by chipping away its administrative efficiency, weakening its market leverage, and forcing it to compete against folks whose ultimate goal is not to meet a social need, but to make a buck, the bigger the better.

Why would Hacker not recommend extending the benefits of Medicare to all Americans (what Congressman John Conyers’ HR676 bill proposes for the nation and Senator Mark Leno’s SB 810 proposes for California), while extricating the profit motive, which created the current mess, from health insurance altogether?

To this, Hacker replies that Americans are “deeply divided” when it comes to health insurance — after all, have we not been struggling with this while the rest of the world moved on? — and that “polls” (two exactly, one of them conducted by himself) indicate that Americans prefer “choice”, not only of doctors but also of insurance plans (hmm…does it follow that pushing single payer off the table represents “the people’s will”?). And that anyway, Americans don’t trust government (very well…does it follow that we trust insurance CEOs more than our elected officials?).

This coming Monday April 6th, in Los Angeles, Californians will host the last of five, White-House-sponsored, highly scripted Healthcare Forums. So far, key legislators and their corporate friends have gone out of the way to exclude single payer from the “menu of options” (unsuccessfully as it turned out). It is up to Californians to say “enough:” why settle for less than all other industrialized nations in the world have?

No more “shopping” for our rights. Let us demand single payer. Now.

Let Americans speak, and they will demand single payer now

by Claudia Chaufan
Santa Cruz Sentinel
04/05/2009

What are we to expect from the last of five White House-sponsored Regional Health Care Forums in Los Angeles on Monday? Moderators will attempt to garner support for a “public option” that will compete with private plans in a “highly regulated health care marketplace.”

Is there any reason to hope that this public option will take us from “here” the current mess to “there” eliminating financial barriers to health care universally? Sadly, there is not. And there is not because this public option will operate within the same flawed structure that led us where we are. This structure, unlike publicly financed systems such as single payer, has no capacity to control the escalating costs of health care that are eroding the fiscal and economic health of our state and our nation.

So what does single payer, a publicly financed, privately delivered, system do that a “health care marketplace,” with or without a public option, does not?

First, it pools risk, by including everybody into one single “plan” that pays for comprehensive medical care. Risk-pooling is a powerful, well-documented cost-control strategy. It purchases care on behalf of all participants, which gives the system great market leverage. An example of such leverage is the price of Lanzoprasol, a widely used drug to reduce acidity. In Spain it costs $9. In Maryland the cost is $329 for the same dose.

It also cuts administrative waste — from marketing, underwriting, claims adjusting, shareholders’ profits, and CEOs salaries, the life-blood of private health insurance — that eats up no less than 30 cents of each health care dollar in contrast to 3 to 5 cents in publicly financed systems like Medicare.

Last, it cross-subsidizes, which means that the least costly 80 percent always pays for the care of the most costly 20 percent. Nobody knows who will be on which side at any given moment, but we know that the division between the most and least costly patients gravitates toward those proportions. Cross-subsidizing also eliminates the “special categories” — the too sick, too old, or too poor — shunned by private insurers, ultimately financed by taxpayers, whether or not they qualify for those subsidies.

The second thing single payer does is financing health care through cooperative compulsory contributions, which simply means that everybody has to pay. This meets the criterion of “shared responsibility,” popular among policy experts these days. Yet because of the cooperative dimension of the obligation to pay, contributions are always a predictable proportion of income, unrelated to health status, which makes them affordable to individuals and families. And by combining public financing with private delivery, cooperative compulsory financing is the “public-private partnership” that gives people meaningful choices, not of undecipherable policies with obscure clauses or restricting “preferred providers” lists, but choices of providers, who have the healthy incentive to compete for clients by providing better services

But the Obama administration insists that Americans prefer a “public option” as part of a “menu” of insurance “choices” Maybe the president has listened to renowned Berkeley professor Jacob Hacker, who has argued for the numerous benefits of a Medicare-like plan — its low administrative overhead, its great market leverage, and its ability to set high quality standards — and the convenience of including it in a “menu” of “insurance choices.” Maybe he overlooked the obvious fact that Hacker has yet to offer a good reason to favor this “health care-marketplace-with-a-public-option” over single payer aside from a vague “Americans prefer choice,” according a poll conducted by Professor Hacker that does not ask participants whether their “love of choice” refers to plans or doctors.

Let us hope that on Monday the honest intention of the Obama administration is to let Americans speak. If so, the president might be able to hear what California Sen. Mark Leno, who recently introduced a single payer bill, the California Universal Health Care Act of 2009, noted was a growing social movement. And he might learn why single payer is not merely the only rational policy option, but also the one Americans prefer.

Claudia Chaufan, MD, PhD, is an assistant professor of sociology and health policy at the UC San Francisco. She received her doctorate in sociology at the UC Santa Cruz, where until recently she lectured.

If health insurance companies ran the postal service…

George Harris
Kansas City Star
April 2, 2009

Could health insurance companies opting to get into mail delivery make the current single deliverer postal service worse? Let’s speculate.

If medical insurance companies ran postal services, citizens would pay a monthly premium to get mail delivery. The premium would vary by age, sex and region of the country.

To enhance competition, multiple health insurance companies would compete for mail delivery business. Some companies would provide service only to citizens in cities with populations over 2 million and would deliver only to comparable cities with populations exceeding 2 million. To conserve costs, subscribers would be permitted to post mail only at selected in-network post offices.

People with preexisting high junk mail volume would pay a 300% surcharge.

Citizens with dogs would be required to get mail delivery through the state high risk mail pool.

It would cost $.42 to send a letter across town. Delivery to rural areas would cost $20. Delivery to another state would cost $40. However, the actual allowable charge paid to subcontractors would vary by company.

Any citizen with mail volume exceeding 30% of average mail delivery could be denied mail service. However, the percentage cut-off point would vary by company. Appeals of denial would be submitted to a specialist who is unemployable in any other business available in the western hemisphere. The specialist would work in an undisclosed location with no direct telephone access and would not respond to e-mail.

Pre-authorization would be obtained to mail packages with breakable objects. Requests would have to be submitted to the corporate office in Connecticut and reviewed by teams of disgruntled employees (much like the present system.)

Western Kansas, Wyoming, Nevada (except Las Vegas), the Texas panhandle and select counties of Mississippi, Alabama, Arkansas and New Mexico would not receive daily mail. 40 million people would go without regular mail delivery. However, the Federal government would legislate that emergency mail must be delivered at no cost to the citizen.

Illegal aliens would receive mail at no charge at emergency mail stations.

Citizens away from home would pay out of network rates to send mail.

Postal employees would become independent contractors and would be prohibited from forming guilds to maintain payment levels from companies. Average incomes would decline 45%.

The CEO of one former health insurance company (now postal delivery service) would make $1.5 billion by selling his stock in the company. The average pay of CEO’s would be $400 million annually.

Citizens would receive group mail delivery rates by applying through their employer and could join the group at time of employment or on predetermined sign-up dates without regard for preexisting mail volume overages. The cost of letter delivery to a citizen who belongs to a group would be discounted as much as 75%.

In some states, groups could comprise 2 or more unrelated people, not living in the same household. In all other states a group be be required to comprise 30 to 40 people.

The Federal government would legislate that citizens leaving a group would be able to take his/her postal privileges with him for a period not to exceed 18 months. However, the health insurance company could charge any fee it desired.

Advocates for a single company to organize mail delivery to everyone at a sensible rate would be branded as socialists and sent to Canada. However, shipment would be delayed because no one could calculate the postage.

http://voices.kansascity.com/node/4186

Something is Rotten at PBS

By RUSSELL MOKHIBER
April 2, 2009

Last year, former Washington Post reporter T.R. Reid made a great documentary for the PBS show Frontline titled Sick Around the World.

Reid traveled to five countries that deliver health care for all — UK, Japan, Switzerland, Germany, Taiwan — to learn about how they do it.

Reid found that the one thing these five countries had in common — none allowed for-profit health insurance companies to sell basic medical coverage.

Frontline then said to Reid — okay, we want you to go around the United States and make a companion documentary titled Sick Around the America.

So, Reid traveled around America, interviewing patients, doctors, and health insurance executives.

The documentary that resulted — Sick Around America — aired Monday night on PBS.

But even though Reid did the reporting for the film, he was cut out of the film when it aired this week.

And the film didn’t present Reid’s bottom line for health care reform — don’t let health insurance companies profit from selling basic health insurance.

They can sell for-profit insurance for extras — breast enlargements, botox, hair transplants.

But not for the basic health needs of the American people.

Instead, the film that aired Monday pushed the view that Americans be required to purchase health insurance from for-profit companies.

And the film had a deceptive segment that totally got wrong the lesson of Reid’s previous documentary — Sick Around the World.

During that segment, about halfway through Sick Around America, the moderator introduces Karen Ignagni, president of America’s Health Insurance Plans, the lead health insurance lobby in the United States.

Moderator: Other developed countries guarantee coverage for everyone. We asked Karen Ignagni why it can’t work here.

Karen Ignagni: Well, it would work if we did what other countries do, which is have a mandate that everybody participate. And if everybody is in, it’s quite reasonable to ask our industry to do guarantee issue, to get everybody in. So, the answer to your question is we can, and the public here will have to agree to do what the public in other countries have done, which is a consensus that everybody should be in.

Moderator: That’s what other developed countries do. They make insurers cover everyone, and they make all citizens buy insurance. And the poor are subsidized.

But the hard reality, as presented by Reid in Sick Around the World, is quite different than Ignagni and the moderator claim.

Other countries do not require citizens buy health insurance from for-profit health insurance companies — the kind that Karen Ignagni represents.

In some countries like Germany and Japan, citizens are required to buy health insurance, but from non-profit, heavily regulated insurance companies.

And other countries, like the UK and Canada, don’t require citizens to buy insurance. Instead, citizens are covered as a birthright — by a single government payer in Canada, or by a national health system in the UK.

The producers of the Frontline piece had a point of view — they wanted to keep the for-profit health insurance companies in the game.

TR Reid wants them out.

“We spent months shooting that film,” Reid explains. “I was the correspondent. We did our last interview on January 6. The producers went to Boston and made the documentary. About late February I saw it for the first time. And I told them I disagreed with it. They listened to me, but they didn’t want to change it.”

Reid has a book coming out this summer titled The Healing of America: A Global Quest for Better, Cheaper and Fairer Health Care (Penguin Press, August 2009.)

“I said to them — mandating for-profit insurance is not the lesson from other countries in the world,” Reid said. “I said I’m not going to be in a film that contradicts my previous film and my book. They said — I had to be in the film because I was under contract. I insisted that I couldn’t be. And we parted ways.”

“Doctors, hospitals, nurses, labs can all be for-profit,” Reid said. “But the payment system has to be non-profit. All the other countries have agreed on that. We are the only one that allows health insurance companies to make a profit. You can’t allow a profit to be made on the basic package of health insurance.”

“I don’t think they deliberately got it wrong, but they got it wrong,” Reid said.

Reid said that he now wants to make other documentaries, but not for Frontline.

“Frontline will never touch me a again — they are done with me,” Reid said.

Reid says that “it’s perfectly reasonable for people to disagree about health policy.”

“We disagreed, and we parted ways,” Reid says.

It might be perfectly reasonable for people to disagree about health policy.

But it’s not perfectly reasonable to mislead the American people on national television in the middle of a health care crises when Congress is shaping legislation that will mean life or death for the for-profit health insurance industry.

http://atheonews.blogspot.com/2009/04/something-is-rotten-at-pbs.html

McClellan asks, “What would be the point?”

Democrats seek compromise on health care plan

By Ricardo Alonso-Zaldivar
The Washington Post
April 2, 2009

Democrats are seeking a compromise on a bigger government role in insurance coverage as part of President Barack Obama’s proposed health care overhaul.

At issue is whether middle-class workers and families should have the option of a government-sponsored plan that would compete with private insurers.

Sen. Charles Schumer, who is working on the issue for the Senate Finance Committee, said Thursday one potential compromise is based on insurance plans that most states already offer their employees. Obama’s health secretary nominee, Kansas Gov. Kathleen Sebelius, likes the idea.

Schumer, D-N.Y., said such a plan would avoid expanding a federal program like Medicare and that a private insurer possibly could run it. Sebelius already administers that type of plan in Kansas.

The insurance lobby fears that a federally backed plan could drive companies out of business.

“We are taking a look at the different state employee plans to get a better understanding of how they operate,” said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans.

GOP lawmakers “are going to need to know what’s in the fine print,” said Craig Orfield, a spokesman for Sen. Mike Enzi, R-Wyo., a leading lawmaker in the debate.

“My goal is to find a plan that would be acceptable to large numbers of senators,” Schumer said in an interview. “Right now, the private insurers are totally opposed, but maybe there’s room.”

In California, the state sponsors three medical network plans for employees and retirees. These plans are offered alongside traditional insurance plans. The state-sponsored plans, administered by Anthem Blue Cross, account for about one-fourth of the 1.3 million people in the state employee health program, said Karen Perkins, a spokeswoman for the California Public Employees Retirement System, known as CalPERS.

The idea of using the state employee plans as a model came last month from two policy experts, Len Nichols and John Bertko.

“We were just trying to avoid nuclear war,” said Nichols, director of health policy for the nonpartisan New America Foundation. “We saw advocates of Medicare for all pushing to put the country into Medicare. And we saw the right using that to push the moderates out of engagement in the health reform debate.”

Schumer said he is looking at Nichols’ idea as a possible compromise and is beginning to sound out other Democrats and policy experts. He has room to maneuver because Obama and many Democrats did not spell out what they mean by a “public” insurance option.

But Schumer said other Democrats insist that option should look like Medicare, in which the government directly sets benefits and payment rates.

Mark McClellan, a health policy expert who ran Medicare under President George W. Bush, said Nichols’ proposal was “well meaning,” but that the government is much bigger than any state, so the effects of a federally backed plan on the insurance market would be far greater.

“At this point, I don’t know many Republicans who are confident a public option could work without making it look like another private sector choice,” said McClellan. “And then what would be the point?”

http://www.washingtonpost.com/wp-dyn/content/article/2009/04/02/AR2009040202804.html

Comment:

By Don McCanne, MD

The progressives in the House of Representatives have stated that they “will only support comprehensive health care reform legislation which includes a public plan option on a level playing field with private health insurance plans.” (http://cpc.grijalva.house.gov/index.cfm?ContentID=351&ParentID=0&SectionID=66&SectionTree=66&lnk=b&ItemID=349)

The Republicans will not support a government-run plan that competes “unfairly” with the private health plans. Specifically, they will not support a Medicare-like option.

But look at the wording of the statement from the Progressive Caucus. The public plan option must be “on a level playing field with the private plans.” The model that meets that definition is a PPO that is sponsored by the government but administered by private insurers, with a firewall separating the PPO from the government. Thus the government option will be simply another PPO, with all of its perverseness, competing in a market of private plans. The line in the sand drawn by the Progressive Caucus was washed away by their carefully worded release.

Mark McClellan has it right. The only hope for gaining the support of Republicans is to make the government option “look like another private sector choice, and then what would be the point?”

With the concession of the progressives, the strategy for a Medicare-like public option has already failed. Moving forward with what amounts to another private PPO with a government seal of approval means that the private insurance industry will maintain control of health care financing for the majority of Americans.

We have in the making yet one more example of where the Republicans will extract enough concessions from the Democrats to ruin the legislation, and then when it comes time to vote, the Republicans will vote against it anyway.

The Democrats have to give up the fantasy of a bipartisan solution since Congressional bipartisanship is a total fiction. The Democrats have to move forward with honest health care reform that works for everyone. They shouldn’t look for help from the party of NO.

Why “chocolate or vanilla”? Put Single Payer on the table!

by Claudia Chaufan
www.opednews.com
April 3, 2009

With 100,000 monthly foreclosures, 700,000 jobs lost every month, and the number of uninsured, underinsured, and deaths for lack of health insurance not getting any smaller, if the time for healthcare reform is not now, when then? And private health insurers know this too well, which is why they claim to have become “team players”, and to support “change”. But the question remains: which change?

As New York Times reporter Robert Pear recently noted, the only two options receiving any serious consideration in the halls of power of Washington D.C. are a “public option” (Medicare-like plan) or no public option, both within a “tightly-regulated-healthcare-marketplace”. In other words, our house is burning, and Washington, once again, gives us two options, “vanilla or chocolate”, both of which involve “comparative-shopping” (as if with health insurance, much like with Ipods, we could increase our market power if we wait for the next sale!).

That private insurers are fighting the public option on the grounds that competing with government is “unfair” should come to nobody’s surprise: clearly, they are in the business for the money, not to provide a social service to the American people. And they win when they collect premiums and deny payments for health care, and when they dump “bad customers” (sick, old, poor, or “not-wealthy-enough-to-pay-for-our-products”) on taxpayers.

And from their point of view of course, a government-financed, privately-delivered, healthcare plan is “unfair competition:” who can compete against a publicly financed option — whose goal is to eliminate financial barriers to health care — with its demonstrable administrative efficiency, capacity to set high quality standards, and huge market power that could dramatically reduce the absurd prices Americans pay for services and goods (e.g. pharmaceuticals) that cost a fraction elsewhere?

And defenders of the public option, the “other side” of the “chocolate-or-vanilla” equation, are also very familiar with the strengths of publicly-financed systems, such as single payer. Indeed, renowned Berkeley professor Jacob Hacker has extolled the virtues of a Medicare-like plan, and argued that including it is critical to successful healthcare reform.

What is less clear is why Hacker, who clearly understands the advantages of social insurance (what his Medicare-type “option” is) — advantage, that is, from the point of view of prospective patients — when compared to for-profit liability insurance (what private for-profit plans are), would suggest a Medicare-like plan only as an “option”, and in so doing undermine its critical strengths – by chipping away its administrative efficiency, weakening its market leverage, and forcing it to compete against folks whose ultimate goal is not to meet a social need, but to make a buck, the bigger the better.

Why would Hacker not recommend extending the benefits of Medicare to all Americans (what Congressman John Conyers’ HR676 bill proposes for the nation and Senator Mark Leno’s SB 810 proposes for California), while extricating the profit motive, which created the current mess, from health insurance altogether?

To this, Hacker replies that Americans are “deeply divided” when it comes to health insurance — after all, have we not been struggling with this while the rest of the world moved on? — and that “polls” (two exactly, one of them conducted by himself) indicate that Americans prefer “choice”, not only of doctors but also of insurance plans (hmm…does it follow that pushing single payer off the table represents “the people’s will”?). And that anyway, Americans don’t trust government (very well…does it follow that we trust insurance CEOs more than our elected officials?).

This coming Monday April 6th, in Los Angeles, Californians will host the last of five, White-House-sponsored, highly scripted Healthcare Forums. So far, key legislators and their corporate friends have gone out of the way to exclude single payer from the “menu of options” (unsuccessfully as it turned out). It is up to Californians to say “enough:” why settle for less than all other industrialized nations in the world have?

No more “shopping” for our rights. Let us demand single payer. Now.

How many doctors support single payer?

U.S. Physicians’ Views on Financing Options to Expand Health Insurance Coverage: A National Survey

By Danny McCormick, Steffie Woolhandler, Anjali Bose-Kolanu, Antonio Germann, David H. Bor and David U. Himmelstein
Journal of General Internal Medicine
April 2009
We asked respondents (physicians engaged in direct patient care) to choose the single option they preferred: 1) “The current health care system, in which most people get their health insurance from private employers, but some people have no insurance”; 2) “A universal insurance program in which everybody is covered under a program like Medicare that is run by government and financed by taxpayers”; or 3) “The current health care system, with the addition of new tax credits for buying, or tax penalties for failing to buy, health insurance”.
9% – The Current Health Care System
42% – Single-Payer National Health Insurance Program
49% – The Current System With Addition of Tax Credits or Penalties
Conclusions: The vast majority of physicians surveyed supported a change in the health care financing system. While a plurality support the use of financial incentives, a substantial proportion support single payer national health insurance. These findings challenge the perception that fundamental restructuring of the U.S. health care financing system receives little acceptance by physicians.
http://www.springerlink.com/content/g6m4153528pq2712/fulltext.html

This study supports the findings of other surveys that confirm that almost all physicians want reform of our current health care system, but they remain divided over whether or not we should replace the private insurance system with a government-run, taxpayer-financed program.
One interesting subset of this study suggests an answer to the question as to whether or not the AMA supports single payer reform. Although official positions of the AMA are decided by their House of Delegates, this survey helps us determine if the views of AMA members are different from a cross-section of practicing physicians. AMA members support the current system with the addition of tax credits or penalties over single payer by a ratio of 55 to 36. Physicians who are not AMA members are evenly divided with a ratio of 46 to 45.
When the physicians were asked if they agreed that people without health insurance have access to the medical care they need, single payer supporters disagreed at a ratio of 5 to 1. Supporters of the current system with added tax credits/penalties were more evenly divided. There is a fundamental difference, even if with fuzzy divisions.
Please forgive me for a moment of introspection, which seems apropos here. When I retired from practice and set up my home office to work on health care reform, I put all of my framed certificates, awards and other documents in a box in the garage, except for one that I received on graduation from medical school: The Oath of Hippocrates. My desk faces it. Frankly, much of the rhetoric doesn’t particularly resonate with me. I mean… pessary for abortion? … mischief and corruption? … seduction of females, males and slaves?
But there are two lines in the Oath that I hold sacred:
“I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.”
“With purity and holiness I will pass my life and practice my art.”
I have been very thankful for having had the opportunity to have known and worked with physicians who share these values – roughly one-half of the physicians whom I’ve met through the years. And the single payer supporters in PNHP with whom I continue to work? All of them, 100 percent, understand the sanctity of the healing arts. That’s what we’re all about.

FRONTLINE's "Sick Around America"

Sick Around America

FRONTLINE
March 31, 2009
Investigating the stories of Americans whose lives have become a quest to find and keep health insurance…
Join the Discussion
Dear FRONTLINE,
I am disappointed that this long-awaited special on healthcare did not address the single payer option. There were ample interviews with insurance company lobbyists but no discussion of this obvious choice. Our nation’s people are in crisis and the shameful greed displayed in other industries is replicated in the for profit hospital corporations, insurance companies and pharmceutical industries. We cannot afford profit in healthcare, as we will continue to have a chaotic, threadbare system riddled with donut holes and pitfalls for those who can least navigate: patients and their families. I’d like to see equal time — a Frontline on the single payer option.
Grace Gifford
Conway, SC
FRONTLINE’s editors respond:
Many viewers have written criticizing this report for not looking at solutions, in particular, a single payer system. Certainly, the topic is another important piece of any examination into the health care system and how it can be improved. And it would warrant a separate program of its own. We would like to point out that we did examine how the single payer system works in many European countries in our program last season, Sick Around the World. You can view this online.We believe that our report this week, Sick Around America, was equally of value in focusing on our current private health insurance system and showing how many Americans are only one or two events away from financial disaster or total ruin because they can’t afford this insurance, or because it offers inadequate coverage, or because it suddenly can be rescinded by the insurer for alleged omissions or errors. We also felt it important in this report to look at another major problem with the private insurance system: America’s for-profit medical system means that insurers have a fiscal duty to avoid risk and make profits for investors. Thus, insuring people who already have serious, chronic illnesses works against the interests of stockholders.
FRONTLINE: Sick Around America
http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/
Join the Discussion
http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/talk/
PNHP: “‘Sick Around America’ disappoints” – selected responses
https://pnhp.org/blog/2009/04/01/‘sick-around-america’-disappoints/
Columbia Journalism Review: “Sick Around America” by Trudy Lieberman
http://www.cjr.org/campaign_desk/sick_around_america.php?page=all

T.R. Reid had hosted FRONTLINE’s “Sick Around the World,” an important documentary describing successful health programs in several other nations that provide care for everyone at a fraction of the costs of our fragmented, inefficient health care system that leaves so many out.
We were looking forward to T.R. Reid’s sequel, “Sick Around America,” describing the problems with our private insurance system. Many of us were disappointed with the format of the program, believing that they missed a great opportunity to educate the nation on several health policies that would work well for all of us. Thus it was no surprise to us that T.R. Reid was not mentioned during the program, nor in the credits.
What happened? Reid left the show this February in a dispute with FRONTLINE. Trudy Lieberman of Columbia Journalism Review quotes Reid as saying, “When I saw it, I didn’t agree with it. It took a different view of health policy than I have.”
The program did use anecdotes effectively, demonstrating some of the problems with private insurance. Examples included medical underwriting, rescission, lapses in coverage, financial burdens due to underinsurance, and other deficiencies that most Americans now understand.
Watching this program, it is very clear that change is required. But the message for reform was outrageous. Throughout the program, many executives of the private insurance industry were featured, and they confirmed that these deficiencies were very real and needed to be addressed. That’s good. What was outrageous is that they were in no way contrite, but instead they implied that they would provide the leadership to make sure that private insurance will continue to manage the financing for health care in America, beginning with an individual mandate for every American to buy their lousy products.
We can only speculate on the motives of the producers. My opinion is that they wanted to provide support for the current efforts of the Democrats in Congress and in The White House to build reform based on private health plans. A publicly-administered and publicly-financed program would require a total restart on the reform process, and so it wasn’t offered as a potential solution. In deference to the insurance executives, the producers didn’t even promote a public Medicare-like option.
Remember, these insurance executives are not contrite. They can never provide the moral leadership that we need to create a health care system that serves all of us well.

FRONTLINE's "Sick Around America"

Sick Around America

FRONTLINE
March 31, 2009

Investigating the stories of Americans whose lives have become a quest to find and keep health insurance…

Join the Discussion

Dear FRONTLINE,

I am disappointed that this long-awaited special on healthcare did not address the single payer option. There were ample interviews with insurance company lobbyists but no discussion of this obvious choice. Our nation’s people are in crisis and the shameful greed displayed in other industries is replicated in the for profit hospital corporations, insurance companies and pharmceutical industries. We cannot afford profit in healthcare, as we will continue to have a chaotic, threadbare system riddled with donut holes and pitfalls for those who can least navigate: patients and their families. I’d like to see equal time — a Frontline on the single payer option.

Grace Gifford
Conway, SC

FRONTLINE’s editors respond:

Many viewers have written criticizing this report for not looking at solutions, in particular, a single payer system. Certainly, the topic is another important piece of any examination into the health care system and how it can be improved. And it would warrant a separate program of its own. We would like to point out that we did examine how the single payer system works in many European countries in our program last season, Sick Around the World. You can view this online.We believe that our report this week, Sick Around America, was equally of value in focusing on our current private health insurance system and showing how many Americans are only one or two events away from financial disaster or total ruin because they can’t afford this insurance, or because it offers inadequate coverage, or because it suddenly can be rescinded by the insurer for alleged omissions or errors. We also felt it important in this report to look at another major problem with the private insurance system: America’s for-profit medical system means that insurers have a fiscal duty to avoid risk and make profits for investors. Thus, insuring people who already have serious, chronic illnesses works against the interests of stockholders.

FRONTLINE: Sick Around America
http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/

Join the Discussion
http://www.pbs.org/wgbh/pages/frontline/sickaroundamerica/talk/

PNHP: “‘Sick Around America’ disappoints” – selected responses
https://pnhp.org/blog/2009/04/01/‘sick-around-america’-disappoints/

Columbia Journalism Review: “Sick Around America” by Trudy Lieberman
http://www.cjr.org/campaign_desk/sick_around_america.php?page=all

Comment:

By Don McCanne, MD

T.R. Reid had hosted FRONTLINE’s “Sick Around the World,” an important documentary describing successful health programs in several other nations that provide care for everyone at a fraction of the costs of our fragmented, inefficient health care system that leaves so many out.

We were looking forward to T.R. Reid’s sequel, “Sick Around America,” describing the problems with our private insurance system. Many of us were disappointed with the format of the program, believing that they missed a great opportunity to educate the nation on several health policies that would work well for all of us. Thus it was no surprise to us that T.R. Reid was not mentioned during the program, nor in the credits.

What happened? Reid left the show this February in a dispute with FRONTLINE. Trudy Lieberman of Columbia Journalism Review quotes Reid as saying, “When I saw it, I didn’t agree with it. It took a different view of health policy than I have.”

The program did use anecdotes effectively, demonstrating some of the problems with private insurance. Examples included medical underwriting, rescission, lapses in coverage, financial burdens due to underinsurance, and other deficiencies that most Americans now understand.

Watching this program, it is very clear that change is required. But the message for reform was outrageous. Throughout the program, many executives of the private insurance industry were featured, and they confirmed that these deficiencies were very real and needed to be addressed. That’s good. What was outrageous is that they were in no way contrite, but instead they implied that they would provide the leadership to make sure that private insurance will continue to manage the financing for health care in America, beginning with an individual mandate for every American to buy their lousy products.

We can only speculate on the motives of the producers. My opinion is that they wanted to provide support for the current efforts of the Democrats in Congress and in The White House to build reform based on private health plans. A publicly-administered and publicly-financed program would require a total restart on the reform process, and so it wasn’t offered as a potential solution. In deference to the insurance executives, the producers didn’t even promote a public Medicare-like option.

Remember, these insurance executives are not contrite. They can never provide the moral leadership that we need to create a health care system that serves all of us well.

How many doctors support single payer?

U.S. Physicians' Views on Financing Options to Expand Health Insurance Coverage: A National Survey

By Danny McCormick, Steffie Woolhandler, Anjali Bose-Kolanu, Antonio Germann, David H. Bor and David U. Himmelstein
Journal of General Internal Medicine
April 2009

We asked respondents (physicians engaged in direct patient care) to choose the single option they preferred: 1) “The current health care system, in which most people get their health insurance from private employers, but some people have no insurance”; 2) “A universal insurance program in which everybody is covered under a program like Medicare that is run by government and financed by taxpayers”; or 3) “The current health care system, with the addition of new tax credits for buying, or tax penalties for failing to buy, health insurance”.

9% – The Current Health Care System

42% – Single-Payer National Health Insurance Program

49% – The Current System With Addition of Tax Credits or Penalties

Conclusions: The vast majority of physicians surveyed supported a change in the health care financing system. While a plurality support the use of financial incentives, a substantial proportion support single payer national health insurance. These findings challenge the perception that fundamental restructuring of the U.S. health care financing system receives little acceptance by physicians.

http://www.springerlink.com/content/g6m4153528pq2712/fulltext.html

Comment:

By Don McCanne, MD

This study supports the findings of other surveys that confirm that almost all physicians want reform of our current health care system, but they remain divided over whether or not we should replace the private insurance system with a government-run, taxpayer-financed program.

One interesting subset of this study suggests an answer to the question as to whether or not the AMA supports single payer reform. Although official positions of the AMA are decided by their House of Delegates, this survey helps us determine if the views of AMA members are different from a cross-section of practicing physicians. AMA members support the current system with the addition of tax credits or penalties over single payer by a ratio of 55 to 36. Physicians who are not AMA members are evenly divided with a ratio of 46 to 45.

When the physicians were asked if they agreed that people without health insurance have access to the medical care they need, single payer supporters disagreed at a ratio of 5 to 1. Supporters of the current system with added tax credits/penalties were more evenly divided. There is a fundamental difference, even if with fuzzy divisions.

Please forgive me for a moment of introspection, which seems apropos here. When I retired from practice and set up my home office to work on health care reform, I put all of my framed certificates, awards and other documents in a box in the garage, except for one that I received on graduation from medical school: The Oath of Hippocrates. My desk faces it. Frankly, much of the rhetoric doesn’t particularly resonate with me. I mean… pessary for abortion? … mischief and corruption? … seduction of females, males and slaves?

But there are two lines in the Oath that I hold sacred:

“I will follow that system of regimen which, according to my ability and judgement, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.”

“With purity and holiness I will pass my life and practice my art.”

I have been very thankful for having had the opportunity to have known and worked with physicians who share these values – roughly one-half of the physicians whom I’ve met through the years. And the single payer supporters in PNHP with whom I continue to work? All of them, 100 percent, understand the sanctity of the healing arts. That’s what we’re all about.

Single payer pushed

By DANIEL BARLOW
Times Argus
April 2, 2009

MONTPELIER — When Ariel Zevon opened up her Barre business two years, she wanted to offer good health care to her employees. They signed up for a plan under the state’s largest health insurance company.

That lasted about a month.

“As a business, we couldn’t float it,” said Zevon, the owner of the Local Agricultural Community Exchange, know as LACE. “It was completely unattainable for our family and our employees.”

Nearly 100 Vermonters attended a Statehouse rally Wednesday morning to draw attention to an issue that has seen little discussion this year: Reforming health care. Major reforms to the industry have been pushed aside this year as lawmakers grapple with holes in the state budget.

Dr. Deb Richter of Montpelier said the session was held to draw attention to two bills — S.88 and H.100, both of which would establish a single-payer health care system in Vermont — that have not been debated in this legislative session.

“There have been no formal hearings on these bills, so we decided to hold one,” Richter said.

Russ Bennett, the owner of a design and construction company in Waitsfield, told the crowd that health insurance costs make up about 10 percent of his payroll. He wants to offer insurance to all his employees, but doing so puts him at a competitive disadvantage in bidding for work.

He said health care should not be coupled with employment.

“If you crash your car into a tree, the insurance company pays for it,” Bennett said. “But I have different policies for my eyes and teeth … as if they all weren’t connected to the same body.”

Rep. Mary Hooper, D-Montpelier, who also serves as the city’s mayor, said officials in City Hall have been grappling with health insurance cost increases. Over the last seven years, the city’s health insurance costs have increased 94 percent, she said.

The city’s payroll includes $1.2 million annually for employee health insurance, she said. And as costs went up again this year, the city cut five jobs to continue paying for the health insurance plans.

“Don’t talk to me about the potholes,” Hooper said. “We’re fixing them, but not the way we should be. The cost of health insurance is wiping everything else out. We shouldn’t have to make the choice between city services and providing health care.”

Senate President Pro Tem Peter Shumlin, D-Windham, a supporter of a single-payer health care system, told the crowd Wednesday morning that he is hopeful that the new administration of President Obama will make dramatic reforms to the health care system.

If that effort falls short — which Shumlin said would be because of the strong influence of money from reform opponents in Washington, D.C. — states such as Vermont can step in and experiment with new models, which if proven effective, could be implemented across the country.

“It’s clear that we need to move away from an employer-based health care system to one that mirrors what every other developed country in the world has,” Shumlin said.

Shumlin praised a federal bill introduced earlier this week by U.S. Sen. Bernard Sanders, I-Vt., that would establish a universal, single-payer health care system.

“This bill provides every citizen with health care coverage and services through a state-administered, single payer program,” explained Sanders’ spokesperson Will Wiquist.

Ben Graham, the owner of Plainfield’s Natural Design and Build, said he also has been unable to find affordable insurance. He worries that if the state waits for the Obama administration, it may be waiting too long.

“Sen. Shumlin says maybe in the next decade,” Graham said. “That makes me nervous. We need change now.”

Rep. Francis “Topper” McFaun, R-Barre Town, received a standing ovation from the crowd Wednesday. He teamed up with Richter last year to push a bill that would make hospital care in Vermont free. He said he was kicked off the House Health Care Committee this year for sponsoring that bill.

He said the only way to create the political atmosphere to pass a single-payer health care bill is for supporters to lobby their legislators.

“That’s the only way you’ll get this done,” McFaun said. “You’ve got to get, not in my face, but in my heart. That’s how you will change things.”

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

Health forum hears from uninsured

By Mark Binker
Greensboro News & Record
Wednesday, April 1, 2009

GREENSBORO — When she lost her job a decade ago, Kirby Heard joined the N.C. Farm Bureau so she could get health insurance. But when one of her payments arrived late, her coverage was terminated.

That, the High Point graphic designer told the Regional White House Forum on Health Care Reform on Tuesday, was when she joined the growing ranks of uninsured. Between 750 and 1,000 people attended the forum at the N.C. A&T Alumni Foundation Event Center on Benbow Road.

The event was one of five regional health reform forums that the White House says will build on a national gathering in Washington earlier this year.

Since losing her insurance, Heard, 52, said she has gotten treatment from a community care network, a group of local health providers that tries to coordinate medical care for people without insurance. Gov. Bev Perdue, who moderated the event, praised those networks as something the federal government should help expand.

“If you need a specialist, they can’t cover that,” Heard said, adding she was grateful for the care she could get. “I have a lot of achy-painy kind of things that are specialist oriented and I have learned to live with them. … I’ve been on a waiting list to see a dentist after losing a filling for eight months now.”

Also on hand Tuesday was Nancy-Ann DeParle, director of the White House Office for Health Reform. She told the audience that President Barack Obama has set two main health care goals: lowering the cost of services and making sure that everyone has some sort of health insurance coverage.

DeParle and Perdue called on people who had been pre-selected to tell their stories as well as people in the audience such as Heard who raised their hands.

Obama addressed the gathering by video.

“Through your own experience, you know what works, what doesn’t,” Obama said in the message. “I look forward to hearing your ideas.”

After the forum, DeParle said the federal government was in the “sausage-making process” of trying to craft a new national health care strategy, a task that has befuddled presidents going back more than a century.

When asked how forums such as Tuesday’s would play into that crafting, DeParle said it was important for the administration to see different ways states are helping to provide health coverage to those without.

“The personal stories are really something you take back,” she said, recalling Heard’s story as something that would stick with her. “You don’t lose that story, so it makes you understand the problem better. … On the good side, I heard more first-hand and saw more first-hand about the community care network and how that is working.”

As participants made their way to the forum, about a dozen protesters waved signs and chanted slogans in favor of a single-payer health care system, one that would be run by the federal government.

“Because the people say so, insurance companies got to go,” protester Marcia Everett, 46, yelled into a bullhorn.

“We are trying to encourage them to take a serious look at single payer,” Everett said. Advocates for that viewpoint felt they were initially excluded from the first White House forum and still say it’s an option the Obama administration should consider more closely.

“Single payer is the only way we can provide health care for everyone and save money,” said Jonathan Kotch, who heads Health Care for All N.C.

That viewpoint had sympathy inside the forum, and at least one presenter explicitly made the point. In the audience, Albertina McGirt said she wasn’t sure single-payer was the way to go but said something needed to be done.

A breast cancer survivor who describes herself as fiftyish, McGirt said she had health insurance when she got ill. But she still had to pay 20 percent of what it cost to beat back her disease.

“That 20 percent was monumental. After treatment, I was teetering,” she said. “Instead of being poor I was just ‘po.’ ”

McGirt said she hoped changes could be made to help people avoid those kind of financial trials.

“Whatever we do, we need to approach it carefully,” she said. “You must talk to those people who are in it, who have been affected by it.”

Contact Mark Binker at (919) 832-5549 or mark.binker@news-record.com